Recovery Oriented Approach Teaching activities and resources

The concept of “recovery” in mental health refers to living a satisfying, hopeful, and contributing life, even when mental health problems and mental illnesses cause ongoing limitations. Recovery — a process in which people living with mental health issues and mental illnesses are actively engaged in their own journey of well-being — is possible for everyone. Recovery journeys build on individual, family, cultural, and community strengths and can be supported by many types of services, supports, and treatments. Recovery includes a process of refining oneself, learning to accept one’s vulnerabilities, overcoming stigma, discrimination, looking beyond what is lacking in one’s life, regaining responsibility, control and hope in one’s life and becoming involved in meaningful social activities and community citizenship (Snow, 2010). The process for recovery requires genuine interest, and open and transparent therapeutic relationships where the client and health-care provider work in partnership to establish mutual goals (Snow, 2010). Specifically, a recovery model for mental health expands on clinical dialogues to include valued life goals, facilitates hope through education about realistic possibilities and probability of recovering to the point of having a good quality of life, is holistic and treats the person as a person, is sensitive to labeling and stigma and understands the importance of theraputic relations.

Implementing recovery-oriented practices that will enhance health outcomes and quality of life for people with lived experience and their families is at the heart of the Mental Health Commission of Canada’s Mental Health Strategy for Canada, and stands on two pillars:

1. Recovery approaches recognize that each person is unique and has a right to determine their recovery journey. Using a recovery-orientated approach, clients take an active role in determining their own treatment paths (Cirpili & Shoemaker, 2014; Mental Health Commission of Canada, 2015).
2. Recovery approaches provide recognition that individuals live in complex societies where there are many intersecting factors (biological, psychological, social, economic, cultural, and spiritual) which have an impact on health and well-being.

The nurses' role in recovery

Future nurses must understand how the recovery perspective guides nurses’ engagement with clients along the spectrum of care. Nurses can support recovery with the client by understanding the recovery perspective’s overarching guiding principles of dignity, hope, resilience, relationships, creating meaning of one’s life, and self-efficacy in each person’s unique and evolving journey (Deegan, 1988; Forchuk, 2003; Jacobson, 2012; Jacobson & Curtis, 2000). Nurses can also provide support by:

• Understanding recovery is personal and unique to each individual.
• Understanding each individual has a right to their own path and journey towards wellness.
• Honouring diversity.
• Being culturally responsive and safe.
• Facilitating interconnections between community and health-related resources for their care.
• Fostering and building positive environments that address clients’ true needs and fostering a culture and language of hope (Cirpili & Shoemaker, 2014 & Mental Health Commission of Canada, 2015).

Moreover, the perspective acknowledges that recovery is:

• A long-term process of internal change, and that these internal changes are processed through various stages (Substance Abuse and Mental Health Service Administration [SAMHSA], 2005).
• An ongoing process of refining oneself and learning to accept one’s vulnerabilities, overcoming stigma and discrimination, regaining hope, control, and responsibility in one’s life.
• Involves becoming engaged in meaningful social activities and community citizenship (Snow, 2010).

There is a concern expressed by mental health stakeholders that principles associated with the recovery approach, such as autonomy and peer accountability, will be used to limit or avoid providing services (MHCC, 2015), or, that by being assimilated into mainstream, there is a potential to turn recovery into a task which professionals ‘do’ or ‘facilitate’, rather than recovery being a process (Barker & Buchanan-Barker, 2005, p 238-239). In order to combat these obstacles to recovery, it’s important for nurses to develop and promote individualized care planning.

The Philip Barker’s Tidal Model, which emphasizes empowering interactions rooted in the lived experience of the client (Pagé, 2010), can be used to guide such strategies. Rather than conducting an assessment, the interaction is a nurse-client collaboration, where the nurses seek to understand who clients are by listening to their stories and perspectives (Barker, 2005). There are 10 commitments of the model and they include: value the voice; respect the language; develop genuine curiosity; become the apprentice; reveal personal wisdom; be transparent; use the available toolkit; craft the step beyond; give the gift of time; and, know that change is constant. Indeed, at the core of this model is change, so the nurse needs to be responding and adapting the focus to the changing needs of the client across the continuum of care (Pagé, 2010).

For more information, see Resources in this section.