1. PRINCIPLES OF RECOVERY
Genevieve Smyth
Professional Affairs Officer
Mental Health and Learning Disabilities
The College of Occupational Therapists
Borough High Street
London SE1 1LB
College of Occupational Therapists 2008

2. College of Occupational Therapists 2008
Introduction
Current position of Recovery in mental health
Definitions
History
Ten Recovery principles
Recovery process
Relationship to Recovering Ordinary Lives and occupational therapy
Challenges and strengths
College of Occupational Therapists 2008

3. Current Position of Recovery
Fundamental guiding principle
Recovering Ordinary Lives –the strategy for occupational therapy in mental health services (COT 2006)
Other professional bodies; RCN, BPS, RCP
NIMHE Guiding Statement on Recovery (2005)
Making Recovery a Reality – Shepherd et al (2008) Sainsbury Centre for Mental Health
Vivienne Wheeler, Hilary Williams
College of Occupational Therapists 2008

4. College of Occupational Therapists 2008
Defining Recovery
“Recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and contributing life, even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness…”
(Anthony 1993)
College of Occupational Therapists 2008

5. Contested Definitions
Can you define a personal journey?
Is it a model –a clearly constructed set of theories that model or represent clinical phenomena?
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6. College of Occupational Therapists 2008
History of Recovery
Consumer/Survivor Movement of 1980s and 1990s –not professionals
Self help, empowerment, advocacy
New Zealand, USA, UK
Challenge disease-driven ideas of mental illness
Service user narratives e.g. Patricia Deegan
Recovery as a Journey of the Heart (1996)
Recovery; the Lived Experience of Rehabilitation(1998)
College of Occupational Therapists 2008

7. College of Occupational Therapists 2008
Research Evidence
Davidson and McGlashan (1997)
Long-term outcomes of people with serious mental health conditions
Research found ¼ - 2/3 of people experiencing first episode of psychosis recover to a degree where symptoms do not interfere with daily functioning
College of Occupational Therapists 2008

8. Occupational Therapy Literature
Reberio Gruhl K (2005) Reflections on…the recovery paradigm;Should occupational therapists be interested? CJOT, 72(2),
Lloyd et al (2007) The association between leisure motivation and recovery;A pilot study. AJOT, 54,
Lloyd et al (2008) Conceptualising recovery in mental health rehabilitation. BJOT, 71(8),
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9. College of Occupational Therapists 2008
Policy Context
Self management and choice in England
Securing our Future Health – Wanless 2002
Mental Health and Social exclusion 2004
Our Health, Our Care, Our Say 2006
The Next Stage Review 2008 –personal health budgets
The NHS Constitution 2008 –rights to respect and choice
Ireland –A vision for a recovery model in Irish mental health services (2005)
Scotland –Rights, Relationships and Recovery (2006)
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10. Shift in dominant paradigms and power relationships
From professional to service user
From medical to social model
Values based practice – The Ten Essential Shared Capabilities (Hope 2004)
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11. Ten Principles of Recovery (Shepherd et al 2008)
Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems
Recovery represents a movement away from pathology, illness and symptoms to health, strengths and wellness
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12. Recovery Principles cont.
Hope is central to recovery and can be enhanced by each person seeing how they can have more active control over their lives (‘agency’) and by seeing how others have found a way forward
Self-management is encouraged and facilitated. The processes of self-management are similar, but what works may be very different for each individual. No ‘one size fits all’.
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13. Recovery Principles cont.
The helping relationship between clinicians and patients moves away from being expert/patient to being ‘coaches’ or ‘partners’ on a journey of discovery. Clinicians are there to be “on tap, not on top”
People do not recover in isolation. Recovery is closely associated with social inclusion and being able to take on meaningful and satisfying social roles within local communities, rather than in segregated services
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14. Recovery Principles cont.
Recovery is about discovering - or re-discovering a sense of personal identity, separate from illness or disability
The language used and the stories and meanings that are constructed have great significance as mediators of the recovery process. These shared meanings either support a sense of hope and possibility, or invite pessimism and chronicity
College of Occupational Therapists 2008

15. Principals of Recovery cont.
The development of recovery-based services emphasises the personal qualities of staff as much as their formal qualifications. It seeks to cultivate their capacity for hope, creativity, care, compassion, realism and resilience
Family and other supporters are often crucial to recovery and they should be included as partners wherever possible. However, peer support is central for many people in their recovery
College of Occupational Therapists 2008

16. Common Recovery Factors (from www.mhrecovery.com)
Employment/Meaningful activity
Hope
Medication and treatment
Empowerment
Education/Knowledge
Support
Self Help
Spirituality
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17. Components of the process of recovery (Andresen et al 2003)
Finding and maintaining hope
- believing in oneself; having a sense of personal agency; optimistic about the future;
Re-establishment of a positive identity
- finding a new identity which incorporates illness, but retains a core, positive sense of self;
Building a meaningful life
- making sense of illness; finding a meaning in life, despite illness; engaged in life;
Taking responsibility and control
- feeling in control of illness and in control of life
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18. College of Occupational Therapists 2008
And then I lost that life; a shared narrative of four young men with schizophrenia (Gould et al 2005)
I remember when I was normal
It’s like your computer crashes
Coasting through life
Try to remake that life as best you can
Finally, I can move on with my life
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19. College of Occupational Therapists 2008
Recovering Ordinary Lives –the strategy for occupational therapy in mental health services (COT 2006)
“Occupational therapists will value recovery and will work within a socially inclusive framework to achieve goals that make a real difference to peoples’ lives. They will encourage people with mental health problems to make decisions and responsibilities for their lives by providing the necessary support.”
College of Occupational Therapists 2008

20. Recovering Ordinary Lives –guiding principles
Interventions assist the client to achieve greater autonomy of thought, will and action
Interventions support the client in developing or maintaining a satisfying personal and social identity
Interventions move the client in the direction of fuller participation in society through performance of occupations that are appropriate to her or his age, social and cultural background, interests and aspirations.
College of Occupational Therapists 2008

21. Recovering Ordinary Lives –key messages
For practitioners – Using occupational language explain the meaning of occupation and its relationship to recovery and wellbeing to service users, carers, colleagues and commissioners.
For managers - Provide information within your organisation on the importance of occupation to recovery and wellbeing
Our profession need to be able to articulate the links between occupation and building a meaningful, satisfying life
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22. Challenges (from www.mentalhealthnursingstaff.com)
Vague and subjective
Lack of research evidence base
‘We’ve been doing this for years’
‘Language reconstructive operatives’ – giving old things new names
Tension between standardisation and individual process
Lack of BME involvement
Linked to discharge
Backlash from the medical model (Craddock et al 2008) attacking “psychosocial support with extremely limited therapeutic ambition”.
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23. Advantages of Recovery
Shifting power balances
Focuses on people not services
Emphasises strengths rather than weaknesses
Cost effective?
Wellness Recovery Action Plans (Mary Ellen Copeland)
Emphasis on hope – alerting healthcare professionals to institutional responses
Positive risk taking
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24. College of Occupational Therapists 2008
Summary
Contexts and definitions of Recovery
How it links to occupational therapy and Recovering Ordinary Lives
Challenges and strengths
College of Occupational Therapists 2008

25. College of Occupational Therapists 2008
References
Andresen R, Oades L, Caputi (2003) The experience of recovery from schizophrenia; towards an empirically validated stage model. Australian and New Zealand Journal of Psychiatry, 37,
Anthony W A (1993) Recovery from mental illness; the guiding vision of the mental health service system in the 1900s. Psychosocial Rehabilitation Journal, 16,
Craddock N. et al (2008) A wake up call for British psychiatry. The British Journal of Psychiatry, 193, 6-9.
College of Occupational Therapists (2006) Recovering ordinary lives the strategy for occupational therapy in mental health services 2007 – London: COT.
Davidson L, McGlashan TH (1997) The varied outcomes of schizophrenia. Psychiatric Services, 57, 642 – 645.
College of Occupational Therapists 2008

26. College of Occupational Therapists 2008
References
Deegan P (1996) Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 19 (3),
Deegan P (1998) Recovery; the lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 11,
Hope R (2004) The 10 essential shared capabilities: a framework for the whole of the mental health workforce. London: DH.
Gould A, DeSouza S, Rebeiro-Gruhl KL (2005) And then I lost that life: a shared narrative of four young men with schizophrenia. British Journal of Occupational Therapy, 68 (10),
National Institute for Mental Health in England (2005) NIMHE Guiding statement on recovery. Available at
Shepherd G, Boardman J, Slade M (2008) Making recovery a reality. London: Sainsbury Centre for Mental Health.
College of Occupational Therapists 2008