Recovery in forensic services: facing the challenge

The recovery approach has been steadily gain­ ing prominence as a guiding principle for mental health services (Department of Health 2001), with rehabilitation services in particular in the process of redefining themselves according to a recovery ethos (Shepherd 2008). This has entailed a funda­ mental shift in values for mental health services, from a predominant clinical recovery ethos (i.e. symptom reduction) to one primarily aimed at fostering personal recovery. There is no universal definition of ‘personal recovery’, although Andresen et al (2003) give the four key processes in recovery as: finding hope, re­establishing one’s identity, finding meaning in life, and taking responsibility and control. Recovery models such as Andresen et al ’s five­stage model of moratorium, awareness, preparation, rebuilding and growth (Andresen 2003) have much in common with the Recovery Star’s five stages of ‘stuckness’, accepting help, believing, learning and self­reliance (MacKeith 2010). In contrast to traditional rehabilitation and medical models, the focus is shifted from pathology, illness and symptoms to health, strengths and wellness. Recovery is also closely associated with social inclusion and being able to take on meaningful and satisfying social roles in society. There is some evidence that a recovery­ oriented approach is associated with better mental health and social outcomes for patients in general mental health services (Warner 2010). However, there is less evidence on the applicability of personal recovery within specialist mental health settings such as forensic rehabilitation.