Conceptualising Recovery in Mental Health Rehabilitation

In mental health, the term ‘recovery’ is commonly used to refer to the lived experience of the person coming to terms with, and overcoming the challenges associated with, having a mental illness (Shepherd et al 2008). The term ‘recovery’ has evolved as having a special meaning for mental health service users (Andresen et al 2003) and consistently refers to their personal experiences and expectations for recovery (Slade et al 2008). On the other hand, mental health service providers often refer to a ‘recovery’ framework in order to promote their service (Meehan et al 2008). However, practitioners lean towards a different meaning-in-use, which is better described as ‘clinical recovery’ and is measured routinely in terms of symptom profiles, health service utilisation, health outcomes and global assessments of functioning. These very different meanings-in-use of the same term have the potential to cause considerable confusion to readers of the mental health literature. Researchers have recently identified an urgent need to clarify the recovery concept so that a common meaning can be established and the construct can be defined operationally (Meehan et al 2008, Slade et al 2008). This paper aims to delineate a construct of recovery that can be applied operationally and consistently in mental health. The criteria were twofold: 1. The dimensions need to have a parsimonious and near mutually exclusive internal structure 2. All stakeholder perspectives and interests, including those of the wider community, need to be accommodated. With these criteria in mind, the literature was revisited to identify possible domains. It was subsequently identified that the recovery literature can be reclassified into components that accommodate the views of service users, practitioners, rehabilitation providers, family and carers, and the wider community. The recovery dimensions identified were clinical recovery, personal recovery, social recovery and functional recovery. Recovery as a concept has gained increased attention in the field of mental health. There is an expectation that service providers use a recovery framework in their work. This raises the question of what recovery means, and how it is conceptualised and operationalised. It is proposed that service providers approach the application of recovery principles by considering systematically individual recovery goals in multiple domains, encompassing clinical recovery, personal recovery, social recovery and functional recovery. This approach enables practitioners to focus on service users’ personal recovery goals while considering parallel goals in the clinical, social, and role-functioning domains. Practitioners can reconceptualise recovery as involving more than symptom remission, and interventions can be tailored to aspects of recovery of importance to service users. In order to accomplish this shift, practitioners will require effective assessments, access to optimal treatment and care, and the capacity to conduct recovery planning in collaboration with service users and their families and carers. Mental health managers can help by fostering an organisational culture of service provision that supports a broader focus than that on clinical recovery alone, extending to client-centred recovery planning in multiple recovery domains.