The recovery model advocates a creative approach to providing quality mental health care by combining holistic treatment with a personal touch. Ever since its debut in medical circles, a couple of decades ago, the recovery model has quickly established its credentials as a dependable system of providing mental health and de-addiction services.
The recovery model operates on two fundamental assumptions:
A person suffering from a mental health condition can recover from it
Patient-directed treatments lead to the most effective recoveries
Substance Abuse and Mental Health Services Administration (SAMHSA) has developed a working definition of recovery from mental disorders or substance use disorders. Recovery, according to SAMHSA, can be defined as,
“A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”1
Believing in oneself and the reality of a better future through recovery are the only motivation that can spur a person to face the challenges within and outside. If hope comes from within the person, family and friends can pitch in to support the recovery process. It is self-determination and self-direction that come to the fore and pave the way to recovery as each person charts the path to the goals they set. People tend to utilize their personal freedom in the best possible way by making informed decisions on the options available during their journey to a new life.
Every person is an individual with unique requirements, specific strengths, preferences, and goals. Factors such as cultural and social background also influence a person’s responses to trauma and, consequently, the path or paths they choose to achieve recovery. In a nutshell, recovery is possible through any of the several capacities that a person possesses. These strengths include the patient’s internal value systems, physical and emotional resources.
Recovery can be achieved in several ways as it is a non-linear process that is never-ending, and comes with the possibility of suffering setbacks. Routes to recovery include taking the help of professional treatment clinics, using prescription medications under supervision, falling back upon a support system of family and friends, peer support groups, and faith-based approaches. It’s essential and useful to remember that occasional setbacks are part of the recovery process, and therefore people have to prepare for such eventualities and continue to move towards recovery.
Recovery is not a standalone process but one that covers an individual’s entire lifestyle. The process of recovery involves the person’s body, mind, and surroundings – both immediate and distant. For effective recovery to take place, it’s necessary to address the different aspects of the patient’s life, such as personal habits, family issues, housing, education, employment, healthcare, faith, social networks, community participation, and so on. In essence, a comprehensive and holistic approach to recovery is essential.
Usually, it is some undesirable experience or trauma that leads to mental health issues, substance or alcohol abuse problems. The trauma could stem from instances of physical or sexual abuse, mishaps, domestic violence, personal loss, war, and any other such incidents or developments. That’s why recovery services must be rooted around trauma resolution to ensure physical as well as emotional safety. Apart from fostering and trust, this approach also empowers the person with the ability to choose and collaborate.
Looking beyond clinical support alone, a person’s recovery path thrives on the support network obtained through mutual aid groups. Such groups are invaluable because they are a great way of sharing experiential knowledge, skills, and social learning, which have a crucial role in the overall recovery process. Peers support and spur each other, along with filling one other with a mutual sense of togetherness, synergetic relationships, and community. The underlying principle is that by helping others and the community, one is ultimately helping oneself. Peer support groups offer valuable resources for people to dip into on their journey to recovery and a complete life.
People with the belief in the person’s innate strengths and intentions to recover, play a large role in the process of recovery. Such people are pillars of strength and provide the support, encouragement, and hope, so essential for the patient to face the challenges thrown up by the recovery process. Relationships and social networks include those of family and community members, peers, faith groups, and others who help strategize and provide much-needed resources. These relationships help people disengage from unhealthy habits and unworthy life roles to don new roles. The new roles could be that of partner, friend, employee, caregiver, or student, which develops a stronger sense of self-esteem, belonging, social inclusion, and community participation.
Culture and cultural backgrounds, such as values, beliefs, and traditions, substantially determine the course of the person’s journey and help in outlining his recovery pathway. Therefore, services that are culture-based, sensitive, appropriate, and competent, apart from being personalized, are ideal for addressing the unique and specific requirements of each individual.
In recovery, it is the strengths and resources of individuals, their families, and respective communities that form the basis for positive transformation. While individuals must be encouraged to express themselves, their families are responsible for extending support in recovery. Similarly, communities also need to bear responsibility for protecting the patient from discrimination by providing opportunities and resources. Ultimately it is the person in recovery who should come forward to team up with peers to talk about their expectations, fears, and aspirations.
It takes immense courage to acknowledge that one has a problem. But acceptance of the problem is the first step to recovery. Respecting such persons can be invaluable in building up the inner reserves of strength and self-respect so necessary for embarking on the journey of recovery.
The first stage in the recovery model, where the person faces the fact that an addiction or abuse problem exists, and help is required to address it.
In this stage, the person begins to actively study the problem, through observation and peer consultation.
During the third stage of the recovery model, the addict starts actively considering treatment options. People in this stage of recovery do not shy away from the prospects of opting for drug rehab and counseling as potential solutions for achieving permanent freedom from addiction.
The addict begins to understand the problem and the impact it is having on his or her life, on family and the community.
The fifth and final stage symbolizes the addict’s ultimate objective. Usually, recovery is a lifetime goal that call for personal commitment and requires regular reinforcement.
SAMHSA has been accused of creating a politically correct definition of recovery by which it is deemed that every person can be cured.
“Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.”
Some allege that SAMHSA’s definition of “RECOVERY” discourages people with serious mental illness by telling them they should be cured of the condition. When a person takes a step back, they wonder what is wrong with them. However, SAMHSA also states,
“Complete symptom remission is neither a prerequisite of recovery nor a necessary outcome of the process.”
It’s also alleged that SAMHSA’s definition misallocates treatment funds by providing people with skill training before their mental illnesses are controlled.
Detractors of SAMHSA claim that the dictionary defines recovery in 15 words as a “return to health: the return to normal health of somebody who has been ill or injured.” Under that definition, most people with serious mental illness do not recover. They remain symptomatic even with treatment. The detractors believe the medical model should be used in place of the recovery model.2
While the medical model has a long history spread over hundreds of years, the recovery model has comparatively recent origins. Unlike the medical model of treatment, which is based on evidence and science, the recovery model advocates tenets such as hope, self-esteem, empowerment, peer support, and self-management. Rather than be pitted as rivals, the two forms of treatment are viewed by most as complementary to each other in treating mental health issues and addiction issues.
Although recovery could imply different things to each individual, some of its components can be seen in many models of treatment. The recovery model owes its genesis to work done on rehabilitating the substance-abuse community. The Substance Abuse and Mental Health Services Administration (SAMSHA) engaged in a process with many stakeholders to come up with its definition of recovery from mental illness and substance use disorders.
Using the Recovery Support Strategic Initiative, SAMHSA has deduced four major aspects that come into focus when a person with addiction issues aims for recovery:
Health: The first pillar of recovery is aiming for health by defeating or controlling one’s disease or the symptoms. So, anyone suffering from alcohol or drug dependence issues should aim for emotional and physical recovery by taking informed and intelligent decisions.
Home: It is the second pillar of the recovery model and calls for a home to be a safe place that offers stability to the affected person.
Purpose: Every objective has a purpose, and in the recovery model, it can mean getting involved in seemingly simple things. Things that most people take for granted, such as going to school or work, volunteering for community causes, participating in creative activities, are all purposes that can make a difference to people wanting to recover from addiction or mental health issues. It all boils down to enjoying the freedom to do, earn, and express oneself as a vibrant member of the family and wider community.
Community: Community is the fourth and final pillar of the recovery model. To sustain oneself through the arduous journey of recovery, one needs companionship and peer support. One’s local community and even the wider community are the best places to seek relationships and support networks that offer support, love and hope to keep a person on the track to success.
The recovery model caters to the goals that people have and tries to point them to the best path available. It stresses aiming for a fulfilling life. By involving the many commonalities that people share, the recovery model harnesses shared concerns. Apart from using the individual’s experience as a fountainhead of expertise, it generates positive expectations in people in the recovery process.
The main weakness of the recovery model is the subjective nature of recovery and lack of tools to measure progress. Although some measures of progress have been found, a consensus is yet to emerge on using them practically. Another of the model’s weaknesses is the possibility that people suffering psychosis may not consider themselves as ill, and as a result, do not respond to treatment.
The ‘social model’ approach to recovery was developed in California. The concept evolved when it emerged that although peer support is recognized as being integral to many treatment methodologies in treating alcohol and drug problems, very little information is available on its utilization. The social model gives useful information on providing peer support for facilitating recovery amid residential settings. The most popular methods used in this model include the 12-step and other mutual self-help group approaches aimed at establishing an environment conducive for the recovery of the participants. The groups usually encourage members to participate in decision-making exercises, relate their personal experiences, and rely on each other during the recovery path and beyond too. The model believes that interaction between the individual and their surrounding environment is key to a successful recovery.
The medical model depends upon the scientific tenets of biological diagnosis and meticulous research. Medical diagnosis revolves around pathology or identifying the problem so that solutions can be developed. The medical model works exclusively on the scientific evidence provided by a pathological process, or medical interventions that give similar results across other studies.
The medical model places its faith solely in scientific fact and objective facts. The model has had success in handling infectious diseases and conditions such as cancer and, to some extent, even HIV and AIDS.
While the medical model of treatment is very successful in treatment of physiological health problems, it’s a different story in handling psychiatric and addiction health issues. By being obsessed with the pathology of a patient, the medical model often tends to ignore the inherent emotional and mental strengths that a person possesses. Also, psychiatry involves the largely uncharted physiology of the human brain, making it impossible for the conventional medical model of treatment to show results that the recovery model achieves.
As opposed to the medical model, which limits itself to ‘hard facts’ based on pathology and diagnostics, the nursing model gives importance to providing for the mental, emotional, and physical needs of the patient. A cyclical nursing process that provides elaborate guidance for every step in the caring process, the Nursing model outcomes can be broadly described as long-term effects that are brought about by providing immediate care. In essence, the nursing model considers the patient as a whole and doesn’t focus merely on the disease or condition that needs treatment. Using the model, nurses can systematically assess, plan, deliver, and evaluate the care given to patients.
The Veterans’ Association (VA) subscribes to some basic principles that form the basis of all their mental health care initiatives. These fundamentals include:
he VA believes in adopting a recovery-oriented approach to mental health care as it leads to the empowerment of the Veteran. In this way, the Veterans can stay in charge of their treatment and lead a complete and meaningful life.
VA health care providers endeavor to provide safe and effective treatment for the body in its entirety. This translates into Veterans availing their mental health care services at the primary care providers in the beginning and moving on to specialized facilities if the situation warrants. Many VAs also use the services of chaplains assigned to help with the spiritual or religious wellbeing of veterans.
Primary Care clinics make use of Patient Aligned Care Teams (PACTs) for providing healthcare to the Veterans. As a medical team that includes mental health experts too, the PACTs coordinate services between various health service providers.
A Mental Health Treatment Coordinator (MHTC) is assigned for Veterans receiving specialty mental health care. The MHTC ensures continuity throughout each Veteran’s transition during mental health treatment. The assigned MHTC remains the Veteran’s mental health point of contact for the Veteran.