Recovery model

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The recovery model is a concept that comes into play in the case of mental disorders and addictions and emphasizes and supports the recovery potential of those affected. The term recovery comes from the English-speaking world and in the context used here can be translated as “recovery”, whereby this translation assumes that the episode of mental problems was an illness and that the person affected was in a state before the illness of Health have found. The translation “restoration” or “restoration” for recovery is, however, more neutral in this regard, since here only reference is made to the extent to which the old living conditions are restored.

First of all, the question arises why “restoration” or “restoration” was raised to a technical term at all; after all, with all therapies there is the basic claim or the basic goal of allowing the patient to recover, i.e. to put them in a state in which the person was before they fell ill. In this context it is therefore important to understand the term as a description of the resource-oriented cooperation between the sick person and all institutions that are involved in the therapy. In this model, restoration can be seen as a personal process that requires hope, a secure base, supportive interpersonal relationships, self-determination ( empowerment ), social integration and problem-solving skills, and which conveys a meaning in life .

history

The concept of recovery was originally used in therapy for drug addicts. However, it spread to the psychiatric field as a non-institutional concept through individuals living in shared apartments . Because of the existing deficits in the integration of the mentally ill and because of studies that show that many sufferers can achieve integration into their environment, recovery received a rapid boost. The recovery model has already become the guiding principle for state health policy in psychiatric care in some countries. While there are a variety of obstacles and conflicts of interest, in many cases practical steps are taken to incorporate existing services into the recovery model. A number of testable standards have been developed that can be used to assess the recovery process. There are some differences between professional recovery models and those that are established in primary networks ( family , friends , neighborhood ).

In medicine and especially in the psychiatric recovery has been long used to a certain disease experience to describe or illness episode. The broader concept of recovery as a general philosophy and model first gained wide attention in the recovery of drug addicts, e.g. B. in the application of the twelve-step program .

The use of the recovery concept in psychiatric disorders is relatively new. It is generally accepted that the main driver for the development of the concept during the late 1980s and early 1990s came from the US consumer protection movement - a grassroots movement . The concept entered the American literature in the early 1990s, beginning with the literature on rehabilitation , before recently spreading in this way to New Zealand and almost all of the first world countries . Similar developments took place around the same time in Italy , the Netherlands and the UK , but the term recovery was not used here. These developments were encouraged by the results of a number of long-term studies with patients with common psychiatric conditions. People from almost all parts of the world were involved in the studies. The WHO country studies from the 1970s and 1990s were also used, which showed unexpectedly high rates of complete (20 to 25%) and social recovery (40 to 45%). The cumulative effect of personal stories or the factual evidence of the recovery have also given the impetus for the development of recovery concepts and political action strategies. A key question was how the users of services can assert their ownership and the authenticity of the recovery concept within a diverse range of professional concepts and services.

Increasingly, the recovery model is becoming a topic of psychiatric nursing research and a key concept in the consumer protection movement. It is often defined differently by consumers and professional service providers. Technical guidelines and clinical strategies have been developed to introduce recovery principles, but important questions remain.

Concepts of recovery

There are many variations within the recovery model. From the psychiatric clinic's point of view, recovery should focus on the improvement of symptoms , function, and overall the role of treatments; Affected models, on the other hand, tend more towards network-supported help, empowerment and personal experience in the real world. Recovery can be seen as a social model of disability rather than a medical model of disability, and there can therefore be differences in the acceptance of gradual diagnoses in the form of labels or in relation to treatments. In psychiatric rehabilitation, the recovery concept can be used to regulate the main symptoms, reduce psychosocial disability and improve personal performance.

A US health agency publication on mental health recovery that includes some consumerist positions outlines 10 fundamental parts of recovery that define it as a journey of healing and transformation that a person with mental health problems takes able to lead a meaningful life in a community of their choice in an effort to reach their full potential. Various conferences were held to highlight the importance of recovery from the perspective of the patient and of psychiatry.

From the perspective of psychiatric rehabilitation, a number of qualities of recovery have been named: Recovery can take place without professional intervention; Recovery requires people who believe in and stand by the person being supported; a vision of recovery is not a theory about the causes of psychiatric complaints; Recovery can succeed even if symptoms recur; Recovery changes the frequency and duration of symptoms; Recovery after the effects of psychiatric conditions is often far more difficult than after the symptoms; Recovery is not linear; Recovery takes place as a series of small steps; Recovery does not mean that the person was never truly mentally disabled; Recovery is focused on health, not disease; Recovery should be geared towards the interests of those affected.

For many, recovery has political as well as personal implications - where one is, finding a purpose in life, overcoming stigmatization (including the diagnostic labels in some cases ), leading a self-determined life and reclaiming one's place in society and the self to prove. Recovery can thus be seen as a manifestation of empowerment. An empowerment model of recovery can emphasize that conditions are not necessarily permanent, that other people have recovered, and that models can be compared and experiences can be shared. Symptoms can be understood as expressions of distress related to feelings and other people. Such a model by the US National Empowerment Center highlights ten such principles of recovery and places them in a cognitive-behavioral context.

Some interests have been raised about recovery, including the claim that recovery is an old concept that is adding new burdens to the already numerous service providers that exist, that recovery must include healing, that recovery benefits few people, that recovery is the same It was an irresponsible scam that recovery only arises after and as a result of active treatment, that recovery-oriented care can only be introduced by adding new resources , that recovery-oriented care is neither reimbursable nor evidence-based, that recovery-oriented care is more professional Devaluing services, and that recovery-oriented care is increasingly exposing commercial providers to financial risks. There has also been tension between advocates of some recovery models and advocates of certain models of evidence-based practice that emerged in the transformation of US health services as recommended by the New Freedom Commission .

Efforts have been made in the USA since around 1999 to make it possible to evaluate institutions for those affected. For this purpose, a research and treatment concept was developed by a recovery advisory group, which should be brought closer to those affected, clinicians, payers and health policymakers. The concept is based on six phases through which individual affected persons go on the path to well-being: fear , awareness , realization , action plan, determination that one is well, and well-being / recovery. Not all phases are passed through by each individual person; there are phase jumps as well as weakenings and reinforcements.

The concept was further developed in the following years and differentiated in particular into internal and external influencing factors. In addition, various instruments have been developed to measure the recovery process: Recovery Assessment Scale (RAS, Giffort et al. 1995), Recovery Process Inventory (RPI, Jerrell et al. 2006), Recovery Attitudes Questionnaire (RAQ, Borkin et al. 2000) and Recovery Style Questionnaire (RSQ, Drayton et al. 1998, German: Sibitz et al. 2006).

Elements of recovery

It should be emphasized that every individual journey to recovery is a deep personal process that also affects the community of the person concerned and society. Some elements of recovery have been suggested as core elements:

hope

Gaining hope and maintaining hope are described as keys to recovery. The goal is to generate not just optimism, but an ongoing belief in yourself and a willingness to endure uncertainty and obstacles. Hope can begin at a certain pivot point or gradually emerge as a small, fragile feeling and it can alternate with despair. In addition, the confidence in oneself and others as well as the ability to endure disappointments, mistakes and hurts should be strengthened.

Solid foundation

Adequate housing, an adequate income, freedom from violence and adequate access to health services are seen as further foundations of recovery.

Supportive relationships

A general aspect of recovery is the presence of other people who believe that the person in need has the potential to achieve recovery and is ready to do so. While professional services can offer a limited type of relationship and make a promise of care, relationships with friends, family and community are broader and long-term. Others who have encountered similar difficulties in their recovery process may be of particular concern. Those who share the same values ​​and beliefs (not necessarily in the area of ​​sanity) can also be particularly important. It is believed that one-sided relationships based on dependency can be derogatory and that mutual relationships and mutual support networks are more valuable for self-esteem and recovery.

Empowerment and participation

Empowerment and self-determination as well as the possibility of control are also important for recovery. This can develop trust in one's own determination and the acceptance of offers of help. Integration into social contexts can require support and it requires combating stigmatization and prejudice regarding mental distress, mental disorders and deviations. It may also be necessary to regain unpracticed social or professional skills.

Coping Strategies

Developing personal coping strategies (including self-management and self-help) is another important element. This can include the use of medication or psychotherapy if the person concerned has been fully informed and heard about the effects, including adverse effects. He must also be informed about which methods are suitable for the life of the person affected and their recovery path. By developing the ability to cope with problems and to manage individual traits and problem situations (which may or may not be seen as symptoms of mental disorders), an affected person becomes their own expert and is able to identify key points for stress and possible crises and to understand and cope with them in a personal way. See also: Psychoeducation .

Coping with Loss

The ability to move on can mean coping with feelings of loss, which can include hopelessness and anger. In a healthy individual, this can be referred to as a process of grief or grief . It requires accepting past sufferings and missed opportunities or time .

meaning

The development of a direction and a sense and a total order is important to support the recovery process. This can include developing a social or professional role. It can also be refreshing, finding or developing a guiding philosophy , religion , politics or culture (see finding meaning , especially Sect. 4.4).

National health policies

USA and Canada

Some states in the United States, such as B. Wisconsin and Ohio are redesigning their mental health systems with an emphasis on values such as hope, healing, empowerment, social participation , human rights and recovery-oriented services. The US Department of Health and Human Sciences reports that it is developing government initiatives to empower those affected to achieve recovery. For this purpose, special committees are set up that are responsible for initiating national pro-recovery and anti-stigma campaigns. They develop recovery guidelines and ensure that they are implemented, they train those affected in the handling of evaluations of the mental and mental health system and also help in setting up services in support networks at the same level. The heads of the mental services and the planners of the services also provide support in the implementation of government recovery concepts.

In Canada , some subdivisions of the Canadian Mental Health Association , such as B. the Ontario Region, recovery has been adopted as the guiding principle for reforming and developing the mental health system.

New Zealand and Australia

Since 1988, all mental health services in New Zealand have been required by the government to follow a recovery policy. The specialist staff is expected to have skills in the recovery model. Australia's Mental Health Plan 2003 - 2008 states that service providers should introduce a recovery orientation, but there are considerable differences between the Australian states and territories in terms of knowledge, commitment and implementation.

Great Britain and Ireland

The National Institute for Mental Health in England (NIMHE) has introduced recovery as a guiding principle for all mental health service institutions. The use of time and manpower has been reorganized by the National Health Service and has been given a completely new role by recovery. The Scottish administration has sponsored and financially supported the introduction of recovery. Recovery has become one of the four pillars of the mental health system. The Scottish Recovery Network was also established to support government initiatives. The 2006 Scottish Nursing Report recommends recovery as the preferred model in nursing and intervention of the mentally ill.

The Mental Health Commission of Ireland reports that their guidelines put service users first as humans, highlighting the individual's personal journey towards recovery.

literature

  • Michaela Amering, Margit Schmolke: Recovery. The end of incurability . Psychiatrie-Verlag, Bonn 2007, ISBN 978-3-88414-421-3 .
  • Andreas Knuf: Empowerment and Recovery. Psychiatrie-Verlag, Cologne 2016.
  • Peter N. Watkins: Recovery - being able to recover. A manual for mental health practitioners . Huber, Bern 2009, ISBN 978-3-456-84723-8 .
  • Wilma Boevink: Recovery Stories . The joint development of empirical knowledge in psychiatry . Trimbos-Instituut, Utrecht 2007.
  • Markus Wiencke: Cultures of Health. Meaningful life in dealing with mental illness. An Anthropology of Health Promotion . transcript Verlag, Bielefeld 2011, ISBN 978-3-8376-1690-3 .

Web links

Pages in German

Pages in English