What does recovery really mean in mental health today?
ToggleThe concept of recovery is central to how we deliver mental health services across the world, including Ireland. But the meaning of recovery in this context is very different to how we interpret it more broadly within society.
If you were to break your leg, for example, the recovery process would have a start and end point, with the prognosis often being that your leg would fully heal, and the recovery process would be complete. There may be visible scars when the leg break was fully healed, but you would otherwise be able to move on with your life, forgetting about this challenging period.
Doctors and psychiatrists also view mental health recovery as an illness, one which should have a beginning and end point, especially with the right treatment, which is usually medication. Up until the late 20th century, recovery in mental health was seen as a biological illness, like other areas of medicine.
However, people using services in the 1980s began to speak out about the poor outcomes associated with medication and the need for their recovery to be viewed beyond the medical model of treatment. They spoke about their recovery journeys involving moving beyond what services had taken away from them in terms of their identity. For many, recovery needed to move to support the entire individual and, more importantly, the psychological and social effects of having a mental health diagnosis. This is often referred to as a holistic approach to service delivery.
Advocates for these changes, predominantly individuals and their families using services, became part of the ‘mental health survivor movement'. It led to significant changes in how mental health recovery was defined and understood. In policy and practice, mental health recovery should now be the cornerstone in 21st century Ireland.
Recovery was defined as a personalised journey, one which involved individuals and their families being supported by services to reclaim or build a new identity beyond their mental health challenges, diagnosis or illness. Put more simply, recovery should be about ‘somewhere to live, someone to love and something to do’.
Interestingly, this involves providing opportunities for individuals and their families to create new identities in their lives. If you reflect on your life, we all step into different identities in our everyday lives. Some examples include our identity as a friend, a partner, a student, a parent, a patient, an employee and/or a tenant. However, opportunities to step into and experience these identities can be influenced or determined by our circumstances and the opportunities that become available to us during our lifetime.
For individuals experiencing mental health challenges in their lives (especially following a diagnosis), recovery is not a straight line from start to end. Rather it is a journey through life that comprises of many peaks and troughs.
The most significant challenge for individuals and families using services regarding recovery is the transition back into society and participating in what society deems 'normal' activities of everyday life. A person living with their mental health challenges is often reminded of this in encounters with society. They are reminded of their identity as someone with a mental illness when stepping into different roles in life including being a friend, a partner, a student, a parent, an employee and/or a tenant.
A significant reason for this is the continued emphasis placed on recovery in mental health as a medical issue, one which is solved by medication and returning to ‘normal functioning’ like other areas of medicine. This has been influenced by many factors, one being the significant level of pharmaceutical funding for medications to ‘treat’ mental illness. We are not claiming that medication does not have a place, especially in times of acute unwellness, but it is not the only place that we should be focusing on.
Recovery in mental health is about seeing the entire person, their multiple identities and supporting each of these roles to grow and flourish beyond their current experiences of being seen and reminded that they have an illness and a diagnosis. For individuals to flourish and move beyond their mental health diagnosis, government and social institutions need to provide the adequate supports necessary in society for them to be seen as a whole person, including their creativity, skills, qualities, and their unique personality. This would involve significant funding in housing, employment supports and social services (including support workers) for individuals to participate as active citizens in everyday life. It also requires our society to be educated on the difference between the recovery journeys of physical and mental illness.
When we think of mental health recovery, are our government, services and society providing opportunities for people to have somewhere to live, someone to love and something to do? The World Health Organization has stated that long-standing mental health challenges should be viewed as a psychosocial disability and not a mental illness. The focus should not be on the person, but instead on the barriers they face in society. It's clear we still have a significant way to go for recovery in mental health to be both fully understood and made a reality for individuals and their families in Irish society.
This piece originally appeared on RTÉ Brainstorm