Myth busted December 2012
Mental illness is often framed as a disease just like any other.
Unfortunately, this often creates confusion between cure and
recovery in mental illness. A common understanding of
recovery emphasizes the elimination or reduction of
symptoms, which is indeed what happens for many people:
research shows that anywhere from 25% to 65% of people
with a serious mental illness make a full “clinical” recovery.
However, assuming recovery can only mean cure ignores the
growing body of research showing a person can recover a
meaningful and satisfying life without necessarily being
cured of the symptoms of mental illness.
In the mental health context, ‘recovery’ refers to living a
“satisfying, hopeful and contributing life, even when there
are ongoing limitations caused by mental health problems
and illnesses”. Historically patients were commonly told that
their illness would persist or even worsen over time.
However, research is starting to show that instilling hope and
adopting an orientation toward recovery is essential for
improving individual outcomes, , reducing symptoms and
making better use of healthcare resources.
BY THE NUMBERS
Researchers have estimated that mental illness affected
over 6.7 million people in Canada in 2011. As a class of
conditions, mental illness is responsible for a significant
amount of health system utilization, reduced productivity,
and human suffering. It has been estimated that a whopping
$42.3 billion was spent directly on services for those living
with mental illness in Canada in 2011. The widespread
impacts of mental illness make it clear that an effective
approach to promoting recovery could yield substantial
personal, social and economic benefits.
MOVING TOWARD RECOVERY
Recognizing that a “cure” orientation to treatment can
overemphasize the biological elements of mental illness, a
consumer movement that emerged in the eighties and nineties
sought to demonstrate the value of self-help, empowerment
and advocacy. A new philosophy of mental health recovery
formed, which stressed that it is possible to live a meaningful
and productive life despite clinical diagnosis. Commonly
dubbed “personal recovery”, this approach emphasizes people’s
ability to adapt their outlook, skills and goals so that they
can lead a satisfying and fulfilling life, even with the
limitations that may be imposed by illness, , . Regaining
self-esteem, empowerment and personal control are also
emphasized, as these can be threatened by a diagnosis of
A model of recovery in mental illness which focuses on
both clinical and personal recovery is important for
consumers of services and for the professionals who
provide those services. While encouraging
empowerment, interpersonal support and changes in
attitudes, it also emphasizes the importance of creating
positive, recovery-oriented services and treatments. This
approach has led to the development of many supports
and services, such as peer-support and self-help, and to
changes in clinician-patient relationships. It also
promotes broader societal change through eliminating
stigma and exclusion within the community.
RECOVERY IN PRACTICE
In addition to positive mental health outcomes for
participants, , evidence indicates that peer-support can
reduce the length of hospital stays and readmissions.
One example of a successful peer-led initiative in the
United States is called WRAP (Wellness Recovery Action
Planning). WRAP has been used to educate people living
with mental illness, and has improved attitudes toward
the possibility of recovery. It has led to increased
hopefulness, enhanced quality of life and symptom
reduction, . Self-help has delivered impressive results
as well. Research shows that by allowing individuals to
take control of their own recovery plan, they enjoy more
days in the community, exhibit better functioning, and
are more likely to reach their recovery goals, such as
living independently or finding employment.
Community supports are also important for achieving
recovery goals, including access to affordable housing,
education, and work. The At Home/Chez Soi Initiative
of the Mental Health Commission of Canada is just one
example of a project exploring the positive mental health
outcomes associated with meeting people’s basic needs
and supporting their recovery.
Clinicians and other service-providers have an essential role to play in the process of personal recovery. While practitioners have often assumed the role of authority figures, the recovery model encourages clinicians to become “partners” to individuals on the road to recovery. The expertise and support clinicians offer makes them invaluable for providing individuals with the information and resources they need to manage their conditions and live full lives.
Strategies for improving clinician attitudes and practices regarding recovery are being developed across Canada, including at the Centre for Addiction and Mental Health (CAMH) and the BC Forensic Psychiatric Hospital (FPH) in Canada.* CAMH has started a speaker series in which clients of CAMH with schizophrenia (past and present) share stories with staff about their recovery process inside and outside of the clinical setting. The BC FPH project has encouraged improved client-engagement and participation in the design, delivery and evaluation of services at BC FPH through peer-support programs, client-engagement in decision-making and peer-to-peer research teams. Both of these projects have been valuable in encouraging improved client and staff attitudes about recovery.
At its worst, living with a mental illness can be devastating, particularly if healthcare delivery systems reinforce the myth that there is no hope for improvement. But a growing body of evidence is showing that recovery of a meaningful life despite the limitations imposed by illness is possible and likely. People with lived experience have known for some time that, with hope, empowerment and support from others, recovery is possible. Promoting a mental health system that views both personal and clinical recovery as the objective can reduce healthcare costs, enhance quality of life, promote social inclusion, and help those living with mental illness lead full and productive lives.
*These projects are being supported by CFHI. More information is available at: http://www.cfhi-fcass.ca/WhatWeDo/Collaborations/PatientEngagement.aspx
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Production of this Mythbuster has been made possible through a financial contribution from the Mental Health Commission of Canada. Mythbusters articles are published by the Canadian Foundation for Healthcare Improvement only after review by experts on the topic. CFHI is an independent, not-for-profit corporation funded through an agreement with the Government of Canada. Interests and views expressed by those who distribute this document may not reflect those of CFHI. © 2012