Recovery from emotional distress, mental health and substance use challenges is driving national and international system transformation, but is often misinterpreted and misunderstood. At PRN, we strive to share knowledge about recovery by providing up to date information, personal stories, research, tools, resources, practices and models.
The word Recovery is one that is debated among peers and professionals. Opponents of the word Recovery feel like it misleads people to believe that Recovery happens when a person is cured or able to function as if they never had a mental illness. Neither of these descriptions, however, is accurate. Some people think that more appropriate terms for the process of self-acceptance, self understanding, and strength that a person goes through in Recovery are transformation, survival, healing and overcoming.
Recovery is a concept that arose from the consumer mental health movement, beginning sporadically in the 1940’s and nationally in the 1980’s when ex-patients organized and talked about their frustration with a mental health system that taught them that, due to their mental health diagnoses, the best they could hope for is the stabilization of their symptoms and maintenance of their functioning; that is, if they were compliant with their treatment and medications.
For decades, this traditional perspective has relegated people to a life of appointments, pills, paternalism, low expectations and dependency. It was their experience of oppression and helplessness that motivated people to be courageous enough to tell their stories and share their recovery from mental illness despite the treatments they endured.
As ex-patients/consumers/survivors began talking, some mental health professionals, researchers and policy makers began listening and became convinced that Recovery was possible. People with lived experience of mental health challenges began emerging as “experts,” becoming consultants, working with state, local and national governments to transform the mental health system, getting involved in policy making, program evaluations and service provisions. In further support of the notion of Recovery, some ex-patients/consumers/survivors pursued their education, became therapists as well as psychiatrists and gave a more “credentialed” professional and personal voice to Recovery.
The term Recovery soon began to be nationally adopted as the description of the successful interventions that seemed to “work” for people with mental illness. Theoretical and practical models of Recovery were developed and research on Recovery began. With this, the Recovery Movement was launched!
Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them.
Recovery is person-driven: Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s).
Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds including trauma experiences that affect and determine their pathway(s) to recovery. Abstinence is the safest approach for those with substance use disorders.
Recovery is holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. The array of services and supports available should be integrated and coordinated.
Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery
Recovery is supported through relationship and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change.
Recovery is culturally-based and influenced: Culture and cultural background in all of its diverse representations including values, traditions, and beliefs are keys in determining a person’s journey and unique pathway to recovery.
Recovery is supported by addressing trauma: Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.
Recovery involves individual, family, and community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery.
Recovery is based on respect: Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery.
According to SAMHSA’s concept of a trauma-informed approach, “A program, organization, or system that is trauma-informed:
- Realizes the widespread impact of trauma and understands potential paths for recovery;
- Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
- Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and
- Seeks to actively resist re-traumatization.”
A trauma-informed approach can be implemented in any type of service setting or organization and is distinct from trauma-specific interventions or treatments that are designed specifically to address the consequences of trauma and to facilitate healing.
SAMHSA’S SIX KEY PRINCIPLES OF A TRAUMA-INFORMED APPROACH
A trauma-informed approach reflects adherence to six key principles rather than a prescribed set of practices or procedures. These principles may be generalizable across multiple types of settings, although terminology and application may be setting- or sector-specific:
- Trustworthiness and Transparency
- Peer support
- Collaboration and mutuality
- Empowerment, voice and choice
- Cultural, Historical, and Gender Issues
From SAMHSA’s perspective, it is critical to promote the linkage to recovery and resilience for those individuals and families impacted by trauma. Consistent with SAMHSA’s definition of recovery, services and supports that are trauma-informed build on the best evidence available and consumer and family engagement, empowerment, and collaboration.
Trauma-specific intervention programs generally recognize the following:
- The survivor’s need to be respected, informed, connected, and hopeful regarding their own recovery
- The interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety
- The need to work in a collaborative way with survivors, family and friends of the survivor, and other human services agencies in a manner that will empower survivors and consumers
Known Trauma-Specific Interventions
Following are some well-known trauma-specific interventions based on psychosocial educational empowerment principles that have been used extensively in public system settings. Note that these interventions are listed for informational and educational purposes only. NCTIC does not endorse any specific intervention.
- Addiction and Trauma Recovery Integration Model (ATRIUM)
- Essence of Being Real
- Risking Connection®
- Sanctuary Model®
- Seeking Safety
- Trauma, Addiction, Mental Health, and Recovery (TAMAR)
- Trauma Affect Regulation: Guide for Education and Therapy (TARGET)
- Trauma Recovery and Empowerment Model (TREM and M-TREM)
Information on Trauma-Informed practices came directly from SAMHSA and NCTIC
Psychiatric rehabilitation (sometimes referred to as PsyR) is a professional discipline that fosters recovery, full community connectedness, and improved personal quality of life for people that have been diagnosed with any mental health condition may cause significant barriers to living a life in which s/he finds personally meaningful. PsyR services are collaborative, person-directed (rather than person-centered) and individualized and are an essential element of a recovery-oriented service array as they are evidence-based and are guided by the values and principles of recovery. The focus in PsyR is NOT on symptom management, treatment or stabilization, rather on fostering skills and access resources, based on the person’s valued social roles and identified needs, to be successful and satisfied in their home, work, educational, and social communities of their choosing.
SKILLS + SUPPORTS= SUCCESS AND SATISFACTION
KEY PRINCIPLES OF PSYCHIATRIC REHABILITATION
Through the 12 Core Principles and Values, PRA (Psychiatric Rehabilitation Association) further describes the key elements of psychiatric rehabilitation practice. All psychiatric rehabilitation service providers should be guided by PRA’s Code of Ethics and Multicultural Principles. All people receiving services should request that all services they receive reflect USPRA’s Core Principles and Values, Multicultural Principle and definition of psychiatric rehabilitation.
Principle 1: Psychiatric rehabilitation practitioners convey hope and respect, and believe that all individuals have the capacity for learning and growth.
Principle 2: Psychiatric rehabilitation practitioners recognize that culture is central to recovery, and strive to ensure that all services are culturally relevant to individuals receiving services.
Principle 3: Psychiatric rehabilitation practitioners engage in the processes of informed and shared decision‐making and facilitate partnerships with other persons identified by the individual receiving services.
Principle 4: Psychiatric rehabilitation practices build on the strengths and capabilities of individuals.
Principle 5: Psychiatric rehabilitation practices are person‐centered; they are designed to address the unique needs of individuals, consistent with their values, hopes and aspirations.
Principle 6: Psychiatric rehabilitation practices support full integration of people in recovery into their communities where they can exercise their rights of citizenship, as well as to accept the responsibilities and explore the opportunities that come with being a member of a community and a larger society.
Principle 7: Psychiatric rehabilitation practices promote self‐determination and empowerment. All individuals have the right to make their own decisions, including decisions about the types of services and supports they receive.
Principle 8: Psychiatric rehabilitation practices facilitate the development of personal support networks by utilizing natural supports within communities, peer support initiatives, and self‐ and mutual‐help groups.
Principle 9: Psychiatric rehabilitation practices strive to help individuals improve the quality of all aspects of their lives; including social, occupational, educational, residential, intellectual, spiritual and financial.
Principle 10: Psychiatric rehabilitation practices promote health and wellness, encouraging individuals to develop and use individualized wellness plans.
Principle 11: Psychiatric rehabilitation services emphasize evidence‐based, promising, and emerging best practices that produce outcomes congruent with personal recovery. Programs include structured program evaluation and quality improvement mechanisms that actively involve persons receiving services.
Principle 12: Psychiatric rehabilitation services must be readily accessible to all individuals whenever they need them. These services also should be well coordinated and integrated with other psychiatric, medical, and holistic treatments and practices.
The language we use can foster or diminish recovery! Psychiatric Rehabilitation has a strong position of the role of language in recovery.
What is a Certified Psychiatric Rehabilitation Practitioner (CPRP)? Click here to learn more.