Five Common Factors That Foster Recovery From Mental Illness
New research shows that recovery is much more than symptom remission.
Posted May 7, 2018
For many decades, recovery from mental illness was equated with symptom remission. As such, clinical services traditionally focused much energy on the management, control and reduction of mental illness symptoms.
However, this narrow view of recovery has recently been challenged by a coalition of mental health advocates; including clinicians, researchers and mental health service users. Building on evidence from new research, the narrow definition of recovery has been expanded and renewed.
What is the Renewed Definition of Recovery?
One of the most widely-used definitions comes from the Substance Abuse and Mental Health Services Administration, which states that “mental health 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.”
In other words, mental health recovery is much more than symptom remission, and involves transformation in other domains which have been neglected by traditional psychiatric services.
What are these other domains, and what can be done to advance recovery progress therein?
My colleague Dr Robert E. Drake and myself have conducted much research on recovery with a variety of populations. This led us to propose five dimensions of recovery, which are by no means exhaustive, but can be used by clinicians or people with mental illness to help enact and implement a recovery action plan. These are described in detail below.
Clinical recovery refers to the traditional notion of recovery as symptom remission. This involves the use of clinical interventions to reduce symptoms so that they do not engulf and disable people with mental illness. Common interventions include psychotropic medication, talking therapies and behavioral interventions.
These clinical interventions can provide a solid foundation for the other aspects of recovery outlined below. But mental health advocates agree that these interventions are not enough to fully advance the holistic aspects of recovery emerging from the renewed definition.
People with mental illness frequently report feeling an existential void in their lives; indeed many people with depression call it a ‘deep black hole’. This can manifest itself in an absence of hope, meaning and purpose. Thus, existential recovery refers to progress that moves to fill this void.
This frequently includes religious or spiritual activity, which has helped many people advance in recovery, as well as secular equivalents such as finding new hope, purpose and meaning. Many people find purpose and meaning through meaningful employment and social relationships, areas of such importance that they are dealt with in separate dimensions below.
Functional recovery refers to participation in everyday and valued social roles which are often taken for granted by people who have not experienced mental illness. For example, there are high rates of unemployment, underemployment, college drop-out and homelessness among people with mental illness; social inequalities which can be as painful as the illness symptoms themselves.
As such, functional recovery means taking action to make progress in areas such as employment, education and housing, depending on individual goals. Vocational rehabilitation and occupational therapy can help people advance in their functional recovery.
People with mental illness have higher rates of physical health issues such as obesity and diabetes. Many people with mental illness also struggle with poor diet, lack of exercise and smoking. As such, physical recovery refers to positive improvements in physical health.
This can involve adoption of a healthier diet, increased exercise, and reductions in use of substances such as cigarettes and alcohol. Such improvements in physical health frequently have a knock-on effect on mental health: a win-win situation for body and mind. Physical recovery can be self-initiated, or assisted by physical therapists and nutritionists.
Stigma and stereotypes can lead to social exclusion for people with mental illness. This can result in piercing isolation and crushing loneliness. As such, social recovery involves taking action to better participate in the social arena, for example by expanding social networks and engaging in rewarding social activity. As always, this must be tailored to individual goals.
This can involve connecting/ reconnecting with family and old friends. It can also involve new activity in the social domain, such as joining sports clubs or other community organizations. Clinical psychologists and social workers can help people enter and thrive in the social domain.
These five domains are discussed in much more detail in the video below.
A recovery-oriented mental health system must include a wide variety of options, ensuring choice within the system so that patients can determine their own recovery priorities. Indeed clinicians from a variety of backgrounds have a vital role to play in making recovery a reality, working with patients to establish recovery priorities, develop an action-plan and spur activity.
The renewed definition of recovery brings hope and opportunity for all people with mental illness. In the inimitable words of leading recovery advocate Dr Pat Deegan “the goal of the recovery process…is to become the unique, awesome, never to be repeated human being that we are called to be’.
Ain’t that the truth.