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| Developing a Consumer-oriented Model of Recovery |
Developing a Consumer-oriented Model of Recovery
While mental health policies are embracing consumers’ demand for recoveryoriented services, there is at the same time a widespread push for the use of only evidence-based best practices. Both in the development of new programmes and treatment, and in the evaluation of services, the demand is that outcomes be measurable and measured. The challenge is to identify measurable outcomes while at the same time ensuring that those outcomesmatch consumers’ personal experience of recovery. In Chapter 1 we explored the traditional meanings of the term recovery, and recognized that consumers are not talking of recovery as defined in the pathology model of mental illness. Therefore, measures based onthe medical model oftendonot resonatewithconsumers.Consumersdonotalwaysgaugetheirmentalhealth interms of non-use of medications or hours of paid employment. Even within the research community, the conventional methods of outcome measurement have been questioned for some time. Harding (1994) who, with colleagues, conducted the seminal ‘Vermont’ study, cast doubt on whether the comprehensive protocol they had used comprised valid measures of recovery. Measures used in that study included: no signs or symptoms of psychiatric disorder; no psychotropic medications; working or ageretired after a work history; mutually satisfying relationships; no behavioural indicators of being a former psychiatric patient and full integration into the community (Harding et al., 1987b). As we suggested in Chapter 1, these standards are higherthanwouldbeapplied tomanypeoplewhohavenotsufferedanytype of serious illness or disability. Harding (1994) pointed out that while there were people in the Vermont cohort who clearly fit these criteria, and others who clearly did not, there were also people who fell into a ‘grey area’. First, over one-third of the cohort still had symptoms and mild impairment, but had learned to manage their symptoms; they were working, had satisfying relationships and a satisfying life. These individuals were described as ‘significantly improved’ in the study. Then there was a group who were sociable, had relationships and interests, and were happy, but did not work.
Yet another group worked and were independent, but were self-described ‘loners’ (Harding, 1994). These latter two ‘non-recovered’ groups illustrate the value judgements that are often applied to outcome measurement in the field of mental health.
Unquestionably,peoplewithnohistory ofmentalillness,butwhofitintothesegroups, would not be considered mentally ill based on their lifestyles.
In addition to measuring clinical outcomes, measurement tools are required for research into the process of recovery itself. While investigations have been conducted into the course of recovery, the intrapersonal and environmental factors that help recovery and to overcome barriers to recovery, there is, as yet, no widely accepted measure of recovery based on a theoretical model. We need to conceptualize recovery as consumers see it, to ensure that the working definition of recovery used by researchers incorporates the processes, views and aspired outcomes of consumers. To this end, we have explored what recovery means to those who have experienced mental illness and have struggled with their own recovery.
While mental health policies are embracing consumers’ demand for recoveryoriented services, there is at the same time a widespread push for the use of only evidence-based best practices. Both in the development of new programmes and treatment, and in the evaluation of services, the demand is that outcomes be measurable and measured. The challenge is to identify measurable outcomes while at the same time ensuring that those outcomesmatch consumers’ personal experience of recovery. In Chapter 1 we explored the traditional meanings of the term recovery, and recognized that consumers are not talking of recovery as defined in the pathology model of mental illness. Therefore, measures based onthe medical model oftendonot resonatewithconsumers.Consumersdonotalwaysgaugetheirmentalhealth interms of non-use of medications or hours of paid employment. Even within the research community, the conventional methods of outcome measurement have been questioned for some time. Harding (1994) who, with colleagues, conducted the seminal ‘Vermont’ study, cast doubt on whether the comprehensive protocol they had used comprised valid measures of recovery. Measures used in that study included: no signs or symptoms of psychiatric disorder; no psychotropic medications; working or ageretired after a work history; mutually satisfying relationships; no behavioural indicators of being a former psychiatric patient and full integration into the community (Harding et al., 1987b). As we suggested in Chapter 1, these standards are higherthanwouldbeapplied tomanypeoplewhohavenotsufferedanytype of serious illness or disability. Harding (1994) pointed out that while there were people in the Vermont cohort who clearly fit these criteria, and others who clearly did not, there were also people who fell into a ‘grey area’. First, over one-third of the cohort still had symptoms and mild impairment, but had learned to manage their symptoms; they were working, had satisfying relationships and a satisfying life. These individuals were described as ‘significantly improved’ in the study. Then there was a group who were sociable, had relationships and interests, and were happy, but did not work.
Yet another group worked and were independent, but were self-described ‘loners’ (Harding, 1994). These latter two ‘non-recovered’ groups illustrate the value judgements that are often applied to outcome measurement in the field of mental health.
Unquestionably,peoplewithnohistory ofmentalillness,butwhofitintothesegroups, would not be considered mentally ill based on their lifestyles.
In addition to measuring clinical outcomes, measurement tools are required for research into the process of recovery itself. While investigations have been conducted into the course of recovery, the intrapersonal and environmental factors that help recovery and to overcome barriers to recovery, there is, as yet, no widely accepted measure of recovery based on a theoretical model. We need to conceptualize recovery as consumers see it, to ensure that the working definition of recovery used by researchers incorporates the processes, views and aspired outcomes of consumers. To this end, we have explored what recovery means to those who have experienced mental illness and have struggled with their own recovery.
