Recovery in Mental Health: Reshaping Scientific and Clinical Responsibilities

The demand that all mental health programs assume a recovery orientation, and the call for deep transformation of the service system culture toward that end, have been the targets of social policy for a decade in the United States, with some progress made in that direction in many state and local systems. The emerging recovery paradigm has begun to make inroads worldwide and has been taken up as a guiding principle in the United Kingdom, Ireland, Canada, New Zealand, and Australia. Psychiatrist Michaela Amering and researcher and psychotherapist Margit Schmolke wrote an introduction to mental health recovery concepts and research in 2007 for the German-speaking world. That volume, updated and translated into English by American psychiatrist Peter Stastny, has been released as a World Psychiatric Association publication, Recovery in Mental Health.

Prepared for policy makers, clinicians, and researchers, this volume is written in descriptive down-to-earth prose, with a narrative style that makes it accessible and likely also of interest to people in recovery, their families, clinical educators, and students of the mental health professions. Amering and Schmolke successfully summarize a great deal of information about recovery concepts, programs, and research. They focus largely on U.S. sources but also include selected information about work being done in other areas of the world. They highlight the lived experience of recovery through the life and work of seven individuals—Ron Coleman of the United Kingdom; Dan Fischer, Laurie Ahern, Pat Deegan, and May Ellen Copeland of the United States; Wilma Boevink of the Netherlands; and Helen Glover of Australia, who prepared the foreword. The volume situates recovery concepts within the overall history of diagnosis and prognosis in the mental health field. It emphasizes the decline of the chronicity paradigm and the increasing acceptance of heterogeneity of the course of serious mental disorders along with growing interest in resilience, positive psychology and hope, and the rising influence of the mental health service user movement across the world.

Limited information on long-term outcome research is provided along with description of selected survey instruments that attempt to capture important dimensions of recovery, quality of life, and evidence-based practice. These segments are balanced with attention to the complexity of subjective experience and qualitative research that contribute to our understanding of processes of recovery. User-led research in the United Kingdom and United States are highlighted.

In terms of change in clinical practice, the authors call for a person-centered psychiatry that is open to collaborative partnership and subjective experience. They provide brief descriptions of the principles and practices of several recovery-oriented services, as well as longer descriptions of peer-developed models such as Personal Assistance for Community Existence (PACE), personal medicine, intentional peer support, Wellness Recovery Action Planning (WRAP), and others.

The authors do not attempt synthesis or deep analysis, nor does the volume really deliver on the implied promise of explicitly spelling out the responsibilities of clinicians and researchers. They do provide an excellent introduction to the field and ultimately invite readers to collaborate in reconstructing the practice of mental health services to reduce stigma, coercion, and the focus on compliance in favor of open dialogue, psychosocial practice, shared decision making, personally tailored recovery planning, active coping and self-management, social inclusion and empowerment, health promotion, self-help, meaning making, and quality of life—concepts that more fully adopt the emerging recovery paradigm.