Dave's Progress. Chapter 100: The Road to Recovery.

Yesterday, together with another member of the Pathways Group, I was invited to sit in on the meeting of a steering group brought together to discuss the treatment of psychosis in our local area. The group brought together everyone from a consultant psychiatrist to an outreach worker to a representative from the North Staffs Users Group (an organisation run by service users, i.e patients, which aims to improve mental health services and get the voice of service users heard).
As preparation for the meeting, we were sent a document about making mental health services "recovery" oriented. The document, written by a group of psychiatrists from South London and Maudsley and South West London and St.George's NHS trusts, I felt, contained many good ideas about essentially changing mental health services from a strictly clinical practice defined by symptoms, treatment and cure, to a more recovery based one, being about the "social recovery" as well as the clinical recovery of the service user and building a life beyond illness without necessarily achieving the elimination of all the symptoms of illness.
The concept of recovery, then, was much discussed within the document and it was suggested that there were three core ideas pertaining to the process: Hope- for this is essential in sustaining motivation and supporting expectations of an individually fulfilled life. Agency- which refers to people gaining a sense of control, having jurisdiction over their own problems, the services they use and their lives. It is concerned with self-management, self-determination, choice and responsibility. Opportunity- which links recovery to social inclusion and people's participation in wider society.
The change to a recovery oriented practice, then, would have many implications and would represent something of a paradigm shift in mental health practice. In terms of hope, there is now evidence to suggest that recovery from the most severe of illnesses, including schizophrenia, is not only possible, but statistically becoming more probable. Old models which traditionally saw schizophrenia as having quite a poor prognosis now seem to be a little outdated and I think it is essential that a message of hope is given to a patient right from the outset of treatment, for without the promise of becoming well and achieving, there seems to be little motivation for the service user to even try. In terms of agency, this would perhaps mean a radical shift in the existing power structures involved in mental health practice, with service users being placed on a more equal footing with their carers and even, when well enough, becoming involved in paid positions within mental health services as "peer professionals" who could encourage and help others in their own journeys through the recovery process. Lastly, in terms of opportunity, this would mean mental health professionals perhaps becoming involved in helping people achieve a life beyond mental health services by, for example, aiding them in gaining some form of employment or just engaging them in some form of meaningful activity. This may also have implications in terms of stigma and discrimination, a major barrier to opportunity, as service users would, perhaps, be able to rely on psychiatrists and others of professional capacity to join the fight against stigma.
At the meeting I attended it was discussed how professionals could measure the outcomes of their interventions, and which tools would be appropriate in measuring how well or how badly mental health services were performing in providing such new approaches. If I'm honest, I was a little overcome with all the professional jargon that was used in the meeting, and one wondered whether our presence there was simply tokenistic. I also expected there to be more discussion of how recovery principles were going to be put into practice, and I think only one person, the outreach worker, mentioned something about getting users more involved in choices about their treatment. However, the very fact that we were at the meeting and the fact that many recovery principles seem to be already in operation at the Pathways Group is heartening. There was even a tacit promise made that some of us could, in the near future, take on the role of a paid "peer professional".
All in all, then, the future of mental health treatment looks promising. We are no longer, it seems, and in the words of the great Talking Heads song, on a "road to nowhere". We are, most reassuringly, finally on the road to recovery.