Recovery From Severe Mental Illness
Approaches to Recovery
The medical model
The medical model is the traditional approach to recovery from severe mental illness. It considers recovery to be a reduction in symptoms, a reduced need for medication and a reduced need for medical and social care services. In this approach recovery requires a 'cure' for the illness and tends to consider people with mental illness as passive recipients of treatment and services.
The recovery model
In recent years there has been increased recognition that recovery can refer to a person's improved capacity to lead a fulfilled life that is not dominated by illness and treatment. This is known as the 'recovery approach' or 'psychosocial rehabilitation'.
In contrast to the medical approach, the recovery approach does not require people to experience reduced symptoms and reduced need for medical and social care; it is about experiencing improved quality of life and higher levels of functioning despite the illness.
Recovery in this sense does not mean the illness has gone in to complete remission. It means that over time, through what for many is a long and difficult process, individuals come to terms with their illness, learn first to accept it and then move beyond it. They learn to believe in themselves as individuals, learn their strengths as well as their limitations and come to realise that they have the capacity to find purpose and enjoyment in their lives despite their illness. The recovery approachfocuses upon the potential for growth within the individual. That potential can then be developed by integrating medical, psychological and social interventions. The recovery model sees individuals with mental illness as active participants in the recovery process.
Can People With Severe Mental Illness Recover?
Over time, most people with schizophrenia will make at least a partial medical recovery. Within ten years of the onset of illness
- Approximately 25 % will be in complete remission
- 25 % will experience substantially fewer symptoms
- 25 % will have slightly reduced symptoms
- 15 % will still experience the same level of symptoms
- 10 % will be dead, often as a result of suicide or accident
Medical outcomes are better over longer periods of time. Many people will need to take medication for a long time in order to control symptoms and prevent relapse. As people get older their symptoms may change and/or become less severe. Changes in symptoms may lead to different medications being prescribed and this may assist medical recovery.
A number of factors can be used to predict medical recovery but these are only indicators. Factors, which suggest that a good recovery is likely, include:
- Good adjustment prior to the start of the illness
- A family with no history of schizophrenia
- Developing the illness at an older age
- Sudden onset of the illness
- Onset of the illness following a major life event
Progress and recovery can be helped significantly by positive attitudes and constructive support from family, friends and professionals. Providing training and support to enable people with mental illness to regain social skills and life skills, to engage in work or education will all assist in recovery. Some people with a diagnosis of mental illness will continue to experience symptoms, much of the time or periodically. If, through support and training, they can learn to live fulfilled lives, despite their illness, then they can be thought of as recovered.
Recovery, in the sense of leading a fulfilled life, despite an illness, requires a belief by both the person with the illness and those around them that the ill person will recover. It requires a commitment to recovery and a recovery strategy, as well as resources to enable recovery and opportunities to share personal growth with others also seeking to recover. Finding a sense of meaning and purpose even in suffering is often thought of as a useful step. For some individuals the illness itself and the adversity associated with it may stimulate personal growth. For others the journey to recovery will feel hard. How far and how quickly each individual recovers will vary widely and it is important to recognise and value every step no matter how small.
Self-management is an important part of the recovery approach. It is about taking control of your own life. It is something we all do in coping with life's difficulties and choosing how we want to live our lives. Self-management can be broken down into four parts: support; stimulation; medication and planning.
It is important that you get the right support. Family and friends may try to overprotect you, leading to feelings of being stifled and frustrated. Alternatively friends and family may become distant and angry, increasing your feelings of isolation. Talking to people about what support you want will help everyone to meet your needs in the best way for you.
It is important that you find the right balance between doing too little, so that your life becomes a vacuum and doing too much, so that you are under stress and more vulnerable to your symptoms. There may be some activities that are too stressful for you but there may be new activities that you can try and enjoy. Try to learn to recognise situations that are difficult for you and try to find ways of coping with these situations, perhaps with the help of other people.
Talk to your psychiatrist or doctor about your medication to ensure that you are receiving the right treatment for you, that side effects have bee eliminated as far as possible and to explore whether you are on the optimum dose. What medication works for one may not work for another and it's likely to take time to find the best one for you.
Plan in advance what you want to happen if you experience future acute episodes of your symptoms. Make sure that people know what you want to happen and what they need to do. Consider making an 'advance statement' explaining how you want matters to be dealt with, so that it can be held in your medical records and also by a relative or friend you trust.
About the Author:
Rethink is the largest severe mental illness charity in the UK. We are dedicated to improving the lives of everyone affected by severe mental illness, whether they have a condition themselves, care for others who do, or are professionals or volunteers working in the mental health field. URL: www.rethink.org
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