What are the implications of a recovery model for mental health services and for service users/survivors?
In discussing the implications of a recovery model on service users/survivors and mental health services, it is essential to define recovery. In illustrating the controversial nature of this concept it is pragmatic to discuss service users and workers in mental health because implications of the recovery model affect both, but in different ways. It is important to realize there is a division in the focus of each group; service users generally want independence from services while health care providers focus on methods and models (Bonney & Stickley, 2008). In working together both groups can improve the provision of recovery services.
Traditionally, rehabilitation is provided within hospitals and is medically based and determined by professionals (Unit 21, pg 67). Alternatively, ‘recovery‘ defined in service user literature is the powerful idea that people can return to a full life following experiences of mental distress (Unit 21, pg 59; Mental Health Foundation, 2009). Anthony (1993, cited in Unit 21, pg 62) notes that recovery enables people to understand their problems and allows them to cope with setbacks. This implies hope and being believed in by others so is a social model. Jan Wallcraft notes most mental health literature neglects the idea of recovery (Audio 4). Additionally, John Hopton (Audio 4) believes it is important recovery is defined by the person experiencing distress rather than professionals. The role of professionals within recovery based services is an issue necessitating redefinition of roles (Unit 21, pg 67).
Although the recovery model outlined is positive, the concept is not without detractors. Recovery implies getting over 'illness', but it doesn’t necessarily imply illness; rather it entails a process in line with recuperating from physical exercise. Nonetheless, according to the illness viewpoint, mental distress is seemingly restricted to a medical model and an implied medical 'cure' – medication. This predominant model accounts for the inadequate help for those wanting to reduce or stop taking medication. Additionally, much mental health policy and practice encourages people to continue taking drugs (Unit 21, pg 70).
Furthermore, some believe the medical model doesn't anticipate recovery. Coleman (cited in Unit 21, pg 61) believes this is because of a lack of recognition that individuals can return to the life they had prior to illness. Accordingly, the focus is on compliance, risk avoidance and dependency with a resulting negative impact on service users. Lindow (Reading 32) believes the ‘illness’ framework promotes pessimism and that its paternalism loses sight of service users as self-determining adults. In this context, incorporation of recovery implies a change in approach. For example, to foster independence, staff could reduce interventions, doing only what is essential (Bonney & Stickley, 2008). This would be challenging as workers need to protect an individual’s right to independence while recognizing that the public also needs protection sometimes.
One implication of the recovery model is that it could lead to the neglection of those believed less likely to recover and feelings of failure in people who don't recover (Unit 21, pg 76). John Hopton (Audio 4) notes this may increase mental distress. These are potential risks; additionally Frese et al. (2001, cited in Unit 21, pg. 67) argue that those with severe mental distress are unlikely to benefit from recovery as they don’t have capacity to understand they are ‘ill’.
Frese et al. say those who can understand recovery may benefit from responsibility. Those not so well want better treatments and some control. Although service users should have input, Frese et al. note enthusiasm for recovery should not consequently deny treatment to those who need it. Their implication is that not all can benefit from recovery....
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