Partnering for Recovery in Mental Health

A Practical Guide to Person-Centered Planning

Janis Tondora, Rebecca Miller, Mike Slade, Larry Davidson

• Editorial: Wiley-Blackwell
• Año: 2014
• ISBN:
  9781118388556
• Edición: 1
• Categoría: Medicine
• Categoría: Psychiatry & Mental Health

Partnering for Recovery in Mental Health is a practical guide for conducting person and family-centered recovery planning with individuals with serious mental illnesses and their families. It is derived from the authors' extensive experience in articulating and implementing recovery-oriented practice and has been tested with roughly 3, 000 providers who work in the field as well as with numerous post-graduate trainees in psychology, social work, nursing, and psychiatric rehabilitation. It has consistently received highly favorable evaluations from health care professionals as well as people in recovery from mental illness. This guide represents a new clinical approach to the planning and delivery of mental health care. It emerges from the mental health recovery movement, and has been developed in the process of the efforts to transform systems of care at the local, regional, and national levels to a recovery orientation. It will be an extremely useful tool for planning care within the context of current health care reform efforts and increasingly useful in the future, as systems of care become more person-centered. Consistent with other patient-centered care planning approaches, this book adapts this process specifically to meet the needs of persons with serious mental illnesses and their families. Partnering for Recovery in Mental Health is an invaluable guide for any person involved directly or indirectly in the provision, monitoring, evaluation, or use of community-based mental health care.

Module 1: What is mental health recovery and how does it relate to person-centered care planning?

Goal

This module introduces the key concepts in mental health recovery and recovery-oriented practice. It reviews the history and development of “person-centered” care planning and places it within the broader context of recovery-oriented efforts that are transforming the mental health system as a whole.

Learning Objectives

After completing this module, you will be better able to:

• define mental health recovery;
• describe the difference between traditional practices and recovery-oriented approaches;
• define person-centered care planning;
• understand how person-centered planning differs from past practice.

Learning Assessment

A learning assessment is included at the end of the module. If you are already familiar with mental health recovery and its implications for care planning, you can go to the end of this module to take the assessment section to test your understanding.

Recovery is about living a fulfilling and rewarding life in the context of mental health challenges. While some people recover in the sense that they no longer experience psychiatric symptoms, recovery is not necessarily about becoming symptom- or problem-free. A large part of recovery for many people is moving beyond being labeled as a “mental patient,” “client,” or even “consumer” to find new meaning, purpose, and possibility in life. For many people, recovery means [1]:

Recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

—SAMHSA National Consensus Statement on Mental Health Recovery [2]

• No longer defining oneself by the experience of mental illness.
• Being a full participant in the community with valued roles such as worker, parent, student, neighbor, friend, artist, tenant, lover, and citizen.
• Running one's own life and making one's own decisions.
• Having a rich network of personal and social support outside of the mental health system.
• Celebrating the newfound strength and skills gained from living with, and recovering from, mental illness.
• Having hope and optimism for the future.

All around the world people have been demonstrating the possibility, and reality, of mental health recovery. Their stories of lived experience are supported by a mounting evidence base that suggests that recovery is more the norm than the exception in serious mental illness. Beginning with the World Health Organization's (WHO) International Pilot Study of Schizophrenia launched in 1967, there have been a series of long-term, longitudinal studies conducted that have produced a consistent picture of broad heterogeneity in outcome for persons with serious mental illnesses. For example, with respect to schizophrenia, the WHO study documented partial to full recovery in between 45% and 65% of each sample, even when recovery was defined in a clinical fashion as a remission in symptoms, while an even larger percentage of people were able to live independently despite continued symptoms [3].

Similarly, the Vermont Longitudinal Study conducted by Courtney Harding and colleagues found recovery or significant improvement in 62%–68% of the people studied—a finding that was all the more important given that the research was carried out on individuals discharged from a state hospital who were considered to have the most severe and persistent of conditions [4]. Since then, eight more long-term studies (e.g., 22–37 years) have been completed around the world, yielding comparable—and at times, better—results [5].

Recovery is a process, a way of life, an attitude, and a way of approaching the day's challenges… The need is to meet the challenge of the disability and to re-establish a new and valued sense of integrity and purpose within and beyond the limits of the disability; the aspiration is to live, work, and love in a community in which one makes a significant contribution.

—Deegan [7]

The evidence for the prevalence of recovery and the potential for recovery-oriented care to help people live full lives has recently been gathered in two landmark texts published by the Boston University Center for Psychiatric Rehabilitation [6]. These books present a summary of over 30 years of experience that challenges the long-held view that serious mental illnesses typically follow a deteriorating course, and explore the range of interventions that have been employed to promote recovery for persons with these conditions.¹ Readers seeking a briefer overview of the empirical evidence for recovery in serious mental illness are referred to an essay on this topic by Ed Knight, Vice President of Recovery, Rehabilitation, and Mutual Support for Value Options.²

Where Did the Idea of Mental Health Recovery Come From?

The idea that people can—and do—actually recover from serious mental illnesses grew in large part from the personal experiences and stories of people who experienced recovery in their own lives. Their voices and perspectives were diverse and were from people who were receiving mental health services (“users” of services); individuals who believed they had survived despite the treatment they received (“psychiatric survivors”); and people who had once been patients receiving services, but who felt they had moved beyond that status in their lives and were now “ex-patients.” These voices provide the most powerful, and persuasive, testament to recovery, and readers who are interested in reading such stories can find them in websites such as www.SAMHSA.gov/Recoverytopractice (from the United States), www.recoverydevon.co.uk (from England) and www.scottishrecovery.net (from Scotland), to name a few.

Recovery is a process by which an individual with a disability recovers self-esteem, dreams, self worth, pride, choice, dignity, and meaning.

—Townsend & Glassner [9]

These voices and perspectives merged to form a movement that has not only survived, but has also grown and emerged as a powerful force for change in mental health policy and services around the world. Drawing on personal experiences, social justice values, civil and human rights, and a passion for changing the mental health system, users/survivors have been the driving force behind the recovery movement that promises to significantly impact both public policy an...