Myth: People Living with Mental Illness Never Really Recover

by admin admin | Dec 03, 2012
Mental illness is often framed as a disease just like any other, creating confusion about what it means to recover from these types of diseases. A growing body of research is showing that, without necessarily being cured of all of their symptoms, people living with mental illness can recover a meaningful and satisfying life.
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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[1]. 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[1]. However, assuming recovery can only mean cure ignores the growing body of research[2] showing a person can recover a meaningful and satisfying life without necessarily being cured of the symptoms of mental illness[3].

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”[4]. Historically patients were commonly told that their illness would persist or even worsen over time[5]. However, research is starting to show that instilling hope and adopting an orientation toward recovery is essential for improving individual outcomes[6], [7], reducing symptoms[8] and making better use of healthcare resources[9].

BY THE NUMBERS

Researchers have estimated that mental illness affected over 6.7 million people in Canada in 2011[10]. As a class of conditions, mental illness is responsible for a significant amount of health system utilization, reduced productivity, and human suffering[11]. 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[10]. 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[12]. A new philosophy of mental health recovery formed[13], which stressed that it is possible to live a meaningful and productive life despite clinical diagnosis[3]. 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[3], [12], [14]. Regaining self-esteem, empowerment and personal control are also emphasized, as these can be threatened by a diagnosis of mental illness[12].

A model of recovery in mental illness[1] 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[2]. 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[15].

RECOVERY IN PRACTICE

In addition to positive mental health outcomes for participants[6], [16], evidence indicates that peer-support can reduce the length of hospital stays and readmissions[9]. 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[17]. It has led to increased hopefulness, enhanced quality of life and symptom reduction[8], [18]. 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[19]. Community supports are also important for achieving recovery goals, including access to affordable housing, education, and work[4]. 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[4].

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[13]. 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[13].

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[20]. 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[21]. Both of these projects have been valuable in encouraging improved client and staff attitudes about recovery.

CONCLUSION

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[1]. 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

REFERENCES

1. Davidson, L. & D. Roe. (2007). Recovery from versus recovery in serious mental illness: One strategy for lessening confusion plaguing recovery. Journal of Mental Health, 16(4), 459-470.
2. Warner, R. (2010). Does the scientific evidence support the recovery model? The Psychiatrist, 34(1), 3–5.
3. Mental Health Commission of Canada. (2009). Toward recovery and well-being: A framework for a mental health strategy for Canada. Retrieved from http://www.mentalhealthcommission.ca/
4. Mental Health Commission of Canada. (2012). Changing Directions, Changing Lives: The Mental Health Strategy for Canada. Retrieved from http://strategy.mentalhealthcommission.ca/pdf/strategy-images-en.pdf
5. Canadian Mental Health Association Ontario (2012). About Mental Health: Recovery. Retrieved from http://www.ontario.cmha.ca/
6. Resnick, S. & Rosenheck, R. (2008). Integrating peer-provided services: A quasi-experimental study of recovery orientation, confidence, and empowerment. Psychiatric Services, 59, 1307-1314.
7. Barbic, S., Krupa, T., & Armstrong, I. (2009). A randomized controlled trial of the effectiveness of a modified recovery workbook program: Preliminary findings. Psychiatric Services, 60(4), 491-497.
8. Cook, J., Copeland, E., Jonikas, A., Hamilton, M., Razzano, A., Grey, D., Floyd, C., Hudson, W., Macfarlane, T., Carter, M., & Boyd, S. (2012). Results of a randomized controlled trial of mental illness self-management using Wellness Recovery Action Planning. Schizophrenia Bulletin, 38(4), 881-891.
9. Sledge, W., Lawless, M., Sells, D., Wieland, M., O’Connell, M., & Davidson, L. (2011). Effectiveness of peer support in reducing readmissions of persons with multiple psychiatric hospitalizations. Psychiatric Services, 62(5), 541-544.
10. Smetanin, P., Stiff, D., Briante, C., Adair, C., Ahmad, S. & Khan, M. (2012). The life and economic impact of major mental illnesses in Canada: 2011 to 2041. Ottawa, Canada: Mental Health Commission of Canada.
11. Lim, K., Jacobs, P., Ohinmaa, A., Schopflocher, D., & Dewa, C. (2008). A new population-based measure of the economic burden of mental illness in Canada. Chronic Diseases in Canada, 28(3), 92-98.
12. Anthony, W.A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16, 11-23.
13. Shepherd, G., Boardman, J., & Slade, M. (2008). Making recovery a reality. London, UK: Sainsbury Centre for Mental Health.
14. Mulvale, G. & Bartram, M. (2009). Recovery in the Canadian context: Feedback on the framework for mental health strategy development. Canadian Journal of Community Mental Health, 28(2), 7-15.
15. Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. British Journal of Psychiatry, (199), 445-452.
16. Fukui, S., Davidson, L., Holter, M., & Rapp, C. (2010). Pathways to Recovery (PTR): Impact of peer-led group participation on mental health recovery outcomes. Psychiatric Rehabilitation Journal, 34(1), 42-48.
17. Higgins, A., Callaghan, P., deVries, J., Keogh, B., Morrissey, J., Nash, M., Ryan, D., Gijbels, H., & Carter, T. (2012). Evaluation of mental health recovery and Wellness Recovery Action Planning education in Ireland: A mixed methods pre-post evaluation. Journal of Advanced Nursing.
18. Starnino, V., Mariscal, S., Holter, M., Davidson, L., Cook, K. Fukui, S., & Rapp, C. (2010). Outcomes of an illness self-management group using Wellness Recovery Action Planning. Psychiatric Rehabilitation Journal, 34(1), 57-60.
19. Cook, J., Russell, C., Grey, D., & Jonikas, J. (2008). Economic grand rounds: A self-directed care model for mental health recovery. Psychiatry Services, 59(6), 600-602.
20. Kidd, S.A., & Mihalakakos, G. (2012). Bringing Narratives onto Inpatient Units: A Method for Enhancing Care. Psychosocial Rehabilitation Canada Annual Conference, Vancouver, BC.
21. Brink, J., Livingston, J., Calderwood, C., Hediger, M., Kinvig, D., Robinson, N., Sharifi, N., Nijdam-Jones, A., & Lapsley, S. (2011). The Patient Engagement Project at the BC Forensic Psychiatric Hospital. BC Mental Health & Addiction Services and the Canadian Health Services Research Foundation

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