Implications for the Design of Mental Health Systems Recovery as a concept is by no means fully understood.
Much research, both qualitative and quantitative, still needs to be done. Paramount to the recovery concept are the attempts to understand the experience of recovery from mental illness from those who are experiencing it themselves. Qualitative research would seem particularly important in this regard.
However, it is not too early for system planners to begin to incorporate what we currently think we know about recovery.
For example, most first-person accounts of recovery from catastrophe (including mental illness) recount the critical nature of personal support (recovery assumption #2). The questions of system planners are: Should personal support be provided by the mental health system? And if so, how can this personal support be provided? Should intensive case managers fill this role? What about self-help organizations? Recovery…the Guiding Vision in the 1990s 533 Should they be expanded and asked to perform even more of this function?
If personal support is characterized as support that is trusting and empathic, do human resource development staff members need to train helpers in the interpersonal skills necessary to facilitate this personal relationship? Quality assurance personnel would need to understand the time it takes to develop such a relationship and figure out ways to assess and document this process.
Recovery, as we currently understand it, involves the development of new meaning and purposes in one’s life as one grows beyond the catastrophic effects of mental illness. Does the mental health system help in the search for this new meaning? Does it actively seek to provide opportunities that might trigger the development of new life purposes? Is this the type of service professionals and survivors talk about when the value of “supportive psychotherapy” is mentioned? Is there the support of therapists trained to help persons with mental illness control their lives once again—even without fully controlling their mental illness?
There are a number of possible stimulants to recovery. These may include other consumers who are recovering effectively.
Books, films, and groups may cause serendipitous insights to occur about possible life options. Visiting new places and talking to various people are other ways in which the recovery process might be triggered. Critical to recovery is regaining the belief that there are options from which one can choose—a belief perhaps even more important to recovery than the particular option one initially chooses.
Recovery-oriented mental health systems must structure their settings so that recovery “triggers” are present. Boring day treatment programs and inactive inpatient programs are characterized by a dearth of recovery stimulants. The mental health system must help sow and nurture the seeds of recov- 534 CHANGING TOWARD THE FUTURE ery through creative programming. There is an important caveat to this notion of recovery triggers. At times the information provided through people, places, things, and activities can be overwhelming. Different amounts of information are useful at different times in one’s recovery. At times denial is needed when a recovering person perceives the information as too overwhelming. At particular points in one’s recovery, denial of information prevents the person from becoming overwhelmed. Information can be perceived as a bomb or a blanket—harsh and hostile or warm and welcome. Helpers in the mental health system must allow for this variation in the time frame of information they are providing—and not routinely and simply characterize denial as non-functional.
Similarly, the range of emotions one experiences as one recovers cannot simply be diagnosed as abnormal or pathological.
All recovering people, whether mentally ill or not, experience strong emotions and a wide range of emotions.
Such emotions include depression, guilt, isolation, suspiciousness, and anger. For many persons who are recovering from catastrophes other than mental illness, these intense emotions are seen as a normal part of the recovery process. For persons recovering from mental illness, these emotions are too quickly and routinely considered a part of the illness rather than a part of the recovery. The mental health system must allow these emotions to be experienced in a nonstigmatizing and understanding environment. Helpers must have a better understanding of the recovery concept in order for this recovery- facilitating environment to occur.
Much research, both qualitative and quantitative, still needs to be done. Paramount to the recovery concept are the attempts to understand the experience of recovery from mental illness from those who are experiencing it themselves. Qualitative research would seem particularly important in this regard.
However, it is not too early for system planners to begin to incorporate what we currently think we know about recovery.
For example, most first-person accounts of recovery from catastrophe (including mental illness) recount the critical nature of personal support (recovery assumption #2). The questions of system planners are: Should personal support be provided by the mental health system? And if so, how can this personal support be provided? Should intensive case managers fill this role? What about self-help organizations? Recovery…the Guiding Vision in the 1990s 533 Should they be expanded and asked to perform even more of this function?
If personal support is characterized as support that is trusting and empathic, do human resource development staff members need to train helpers in the interpersonal skills necessary to facilitate this personal relationship? Quality assurance personnel would need to understand the time it takes to develop such a relationship and figure out ways to assess and document this process.
Recovery, as we currently understand it, involves the development of new meaning and purposes in one’s life as one grows beyond the catastrophic effects of mental illness. Does the mental health system help in the search for this new meaning? Does it actively seek to provide opportunities that might trigger the development of new life purposes? Is this the type of service professionals and survivors talk about when the value of “supportive psychotherapy” is mentioned? Is there the support of therapists trained to help persons with mental illness control their lives once again—even without fully controlling their mental illness?
There are a number of possible stimulants to recovery. These may include other consumers who are recovering effectively.
Books, films, and groups may cause serendipitous insights to occur about possible life options. Visiting new places and talking to various people are other ways in which the recovery process might be triggered. Critical to recovery is regaining the belief that there are options from which one can choose—a belief perhaps even more important to recovery than the particular option one initially chooses.
Recovery-oriented mental health systems must structure their settings so that recovery “triggers” are present. Boring day treatment programs and inactive inpatient programs are characterized by a dearth of recovery stimulants. The mental health system must help sow and nurture the seeds of recov- 534 CHANGING TOWARD THE FUTURE ery through creative programming. There is an important caveat to this notion of recovery triggers. At times the information provided through people, places, things, and activities can be overwhelming. Different amounts of information are useful at different times in one’s recovery. At times denial is needed when a recovering person perceives the information as too overwhelming. At particular points in one’s recovery, denial of information prevents the person from becoming overwhelmed. Information can be perceived as a bomb or a blanket—harsh and hostile or warm and welcome. Helpers in the mental health system must allow for this variation in the time frame of information they are providing—and not routinely and simply characterize denial as non-functional.
Similarly, the range of emotions one experiences as one recovers cannot simply be diagnosed as abnormal or pathological.
All recovering people, whether mentally ill or not, experience strong emotions and a wide range of emotions.
Such emotions include depression, guilt, isolation, suspiciousness, and anger. For many persons who are recovering from catastrophes other than mental illness, these intense emotions are seen as a normal part of the recovery process. For persons recovering from mental illness, these emotions are too quickly and routinely considered a part of the illness rather than a part of the recovery. The mental health system must allow these emotions to be experienced in a nonstigmatizing and understanding environment. Helpers must have a better understanding of the recovery concept in order for this recovery- facilitating environment to occur.
