Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 2
Overview of Recovery
Impact of the Recovery Concept
The impact of the recovery concept is felt most by consumers
and families. Consumers and families are energized by the message of hope and
self-determination. Having more active roles in treatment, research, social and
vocational functioning, and personal growth strikes a responsive cord.
Consumers’ harboring more optimistic attitudes and expectations may improve the
course of their illness, based on related research from the field of
psychosocial and vocational rehabilitation (see Chapter 4). Yet direct empirical
support for the salutary, long-term effect of positive expectations, on both
consumers and families, is still in its infancy (Lefley, 1997).
The recovery concept likewise is having a bearing on mental health research and
services. Researchers are beginning to study consumer attitudes and behavior to
attempt to identify the elements contributing to recovery. Though still at an
early stage, research is being driven by consumer perspectives on recovery.
Consumers assert that the recovery process is governed by internal factors
(their psychological perceptions and expectations), external factors (social
supports), and the ability to self-manage care, all of which interact to give
them mastery over their lives. The first systematic efforts to define consumer
perceptions of recovery was conducted by consumers. The Well-Being Project,
sponsored by the California Department of Mental Health, was a landmark effort
in which mental health consumers conducted a multifaceted study to define and
explore factors promoting or deterring the well-being of persons diagnosed with
serious mental illness (Campbell & Schraiber, 1989). Using quantitative survey
research, focus groups, and oral histories, Campbell (1993) arrived at a
definition of recovery that incorporates “good health, good food, and a decent
place to live, all supported by an adequate income that is earned through
meaningful work. We need adequate resources and a satisfying social life to meet
our desires for comfort and intimacy. Well-being is enriched by creativity, a
satisfying spiritual and sexual life, and a sense of happiness” (p. 28).
Through semistructured interviews with consumers about recovery, a subsequent
study identified the most common factors associated with their success in
dealing with a mental illness. They included medication, community support/case
management, self-will/self-monitoring, vocational activity (including school),
and spirituality (Sullivan, 1994). Other researchers, also using semistructured
interviews, suggested that the rediscovery and reconstruction of a sense of self
were important to recovery (Davidson & Strauss, 1992).
These early forays by researchers set the stage for consumer-driven research
efforts to identify some of the aspects of recovery. A group of consumers with
consultant researchers developed the Empowerment Scale (Rogers et al., 1997).
After testing a 28-item scale on members of six self-help programs in six
states, factor analysis revealed the underlying dimensions of empowerment to be
(1) self-efficacy–self-esteem; (2) power-powerlessness ; (3) community activism;
(4) righteous anger; and (5) optimism–control over the future. Other
instruments, found to have consistency and construct validity, are the Personal
Empowerment Scale, the Organizational Empowerment Scale, and the
Extra-Organizational Empowerment Scale (Segal et al., 1995).
Mental health services continue to be refined and shaped by the consumer and
recovery emphasis. The most tangible changes in services come from assertive
community treatment and psychosocial and vocational rehabilitation, which
emphasize an array of approaches to maximize functioning and promote recovery.
Consumer interest in self-help and recovery has stimulated the proliferation of
interventions for what has been called “illness management” or “self-managed
care” for relapse prevention of psychotic symptoms. Illness management training
programs now teach individuals to identify early warning signs of relapse and to
develop strategies for their prevention. All of these transformations in service
delivery and research affirming their benefits are discussed at length in
Chapter 4.
Champions of recovery assert that its greatest impact will be on mental health
providers and the future design of the service system. They envision services
being structured to be recovery-oriented to ensure that recovery takes place.
They envision mental health professionals believing in and supporting consumers
in their quest to recover. In a groundbreaking article, William A. Anthony
described recovery as a guiding vision that “pulls the field of services into
the future. A vision is not reflective of what we are currently achieving, but
of what we hope for and dream of achieving. Visionary thinking does not raise
unrealistic expectations. A vision begets not false promises but a passion for
what we are doing.”
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