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Recovery in Mental Health: Reshaping scientific and clinical responsibilities

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Recovery in Mental Health: Reshaping scientific and clinical responsibilities

Michaela Amering, Margit Schmolke

ISBN: 978-0-470-74316-4 February 2009 280 Pages

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Description

Winner of Medical Journalists’ Association Specialist Readership Award 2010

Recovery is widely endorsed as a guiding principle of mental health policy. Recovery brings new rules for services, e.g. user involvement and person-centred care, as well as new tools for clinical collaborations, e.g. shared decision making and psychiatric advance directives. These developments are complemented by new proposals regarding more ethically consistent anti-discrimination and involuntary treatment legislation, as well as participatory approaches to evidence-based medicine and policy.

Recovery is more than a bottom up movement turned into top down mental health policy in English-speaking countries. Recovery integrates concepts that have evolved internationally over a long time. It brings together major stakeholders and different professional groups in mental health, who share the aspiration to overcome current conceptual reductionism and prognostic negativism in psychiatry.

Recovery is the consequence of the achievements of the user movement. Most conceptual considerations and decisions have evolved from collaborations between people with and without a lived experience of mental health problems and the psychiatric service system.  Many of the most influential publications have been written by users and ex-users of services and work-groups that have brought together individuals with and without personal experiences as psychiatric patients.

In a fresh and comprehensive look, this book covers definitions, concepts and developments as well as consequences for scientific and clinical responsibilities. Information on relevant history, state of the art and transformational efforts in mental health care is complemented by exemplary stories of people who created through their lives and work an evidence base and direction for Recovery.

This book was originally published in German.  The translation has been fully revised, references have been amended to include the English-language literature and new material has been added to reflect recent developments. It features a Foreword by Helen Glover who relates how there is more to recovery than the absence or presence of symptoms and how health care professionals should embrace the growing evidence that people can reclaim their lives and often thrive beyond the experience of a mental illness.

Comments on German edition:

"It is fully packed with useful information for practitioners, is written in jargon free language and has a good reading pace."
Theodor Itten, St. Gallen, Switzerland and Hamburg, Germany

"This book is amazingly positive. It not only talks about hope, it creates hope. Its therapeutic effects reach professional mental health workers, service users, and carers alike. Fleet-footed and easily understandable, at times it reads like a suspense novel."
Andreas Knuf, pro mente sana, Switzerland

'"This is the future of psychiatry"' cheered a usually service-oriented manager after reading the book. We might not live to see it.'
Ilse Eichenbrenner, Soziale Psychiatrie, Germany

Foreword xi

1 Introduction 1

2 Recovery – Developments and Significance 5

3 Recovery – Basics and Concepts 9

Definition 9

Political Strategies 15

Collaboration with Users of Psychiatric Services 21

Resilience–a Dynamic Recovery-Factor 25

Recovery, Prevention and Health Promotion 40

Recovery and Quality of Life 52

Recovery and Empowerment 54

Recovery and Evidence-Based Medicine 56

Recovery and Remission 57

4 Personal Experience as Evidence and as a Basis for Model Development 61

‘Recovery – an Alien Concept’ - Ron Coleman/UK 61

‘Empowerment Model of Recovery’ – Dan Fisher and Laurie Ahern/USA 65

‘Conspiracy of Hope’ – Pat Deegan/USA 71

‘Holders of Hope’ – Helen Glover/Australia 78

‘Wellness Recovery Action Plan (WRAP)’ – Mary Ellen Copeland/USA 83

‘Two Sides of Recovery’ – Wilma Boevink/The Netherlands 89

‘No Empowerment Without Recovery’ – Christian Horvath/Austria 95

5 Recovery – Why Not? 99

The Slow Demise of Incurability 99

Incurability 99

Chronicity 100

Other misunderstandings 102

Is the glass half-full or half-empty? 103

A Diagnosis or a Verdict – The Example of Schizophrenia 103

Heterogeneity of Course Over Time 104

Prognosis – ‘From demoralizing pessimism to rational optimism’ 108

Diagnosis – ‘A century is enough’ 111

Scientific and Clinical responsibility 112

Classic Dimensions of Madness 117

Insight 117

Compliance 120

Capacity 122

Coercion 122

Psychiatric Treatment and Services 126

State of the Art 126

Shortcomings 129

Recent Developments 131

Stigma and Discrimination 134

Attitude Research 136

Iatrogenic Stigma 138

Stigma – Experiences and Expectations 140

Internalized Stigma and Stigma Resistance 141

Social Inclusion 145

The Hearing Voices Movement 148

6 Recovery – Implications for Scientific Responsibilities 153

New Directions 153

The Increasingly Active Role of UK Users in Clinical Research 156

Assessing Recovery 163

Ruth Ralph and the Recovery Advisory Group 163

Examples of Published Recovery Instruments 165

Recovery as a Process 168

Turning points – Living with Contradictions 168

Findings from four Countries 175

Identity and Recovery in PersonalAaccounts of Mental Illness 179

Recovery as lived in Everyday Practice 182

Qualitative Research as one Royal Road 187

7 Recovery – Implications for Clinical Responsibilities 189

Sharing 190

Alternatives 193

Recovery-Factors in Therapeutic Relationships and Psychiatric Services 195

Recovery-oriented Professionals 195

Recovery Self Assessment (RSA) 201

Measuring Recovery-Orientation in a Hospital Setting 202

Recovery Knowledge Inventory (RKI) 204

Developing Recovery Enhancing Environments Measure (DREEM) 206

Initiatives of the World Psychiatric Association 206

Psychiatry for the Person 206

A Person-centred Integrative Diagnosis 208

Recovery and Psychopharmacology 209

New goals and New Roles for Psychopharmacologists 209

Pat Deegan’s concept of ‘Personal Medicine’ 213

A Programme to support Shared Decision-Making 219

System Transformation 220

Recovery-Oriented Services 221

Recovery-Oriented Mental Health Programmes 222

A Recovery-Process Model 225

Practice guidelines for Recovery-Oriented Behavioral Health Care 228

Peer support and Consumer-Driven Transformation 230

8 The Significance of Discovering Recovery for the Authors 235

References 239

Index 260

“Recovery is probably the most important new direction for mental health.  It represents the convergence of a number of ideas – empowerment, self-management, disability rights, social inclusion and rehabilitation – under a single heading that signals a new direction in services.   …  For those with an interest and some knowledge of recovery, the book provides a treasure trove of bite-size chunks of knowledge and theory.” (The British Journal of Psychiatry, 2010)