Academic journal article East Asian Archives of Psychiatry

Recovery Entails Bridging the Multiple Realms of Best Practice: Towards a More Integrated Approach to Evidence-Based Clinical Treatment and Psychosocial Disability Support for Mental Health Recovery

Academic journal article East Asian Archives of Psychiatry

Recovery Entails Bridging the Multiple Realms of Best Practice: Towards a More Integrated Approach to Evidence-Based Clinical Treatment and Psychosocial Disability Support for Mental Health Recovery

Article excerpt

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Introduction

Complexity is a normal part of the mental health arena and the treatment, care and resolution of such complexity should be the "bread and butter" of all mental health service providers. In this way, we encompass the full gamut of bio- psycho-socio-cultural-environmental factors and domains in our endeavours for supporting recovery. As most mental illnesses have been found to be multifactorial in aetiology, it should be no surprise that their most effective remedies are multimodal.1 Severe mental illness, its treatment, rehabilitation, and personal efforts to recovery do not easily lend themselves to explanation by a single paradigm. An exclusively biological, psychological, social, or cultural model of care is unable to satisfactorily explain or guide intervention into the complexities of mental illness and the impact these problems have on individuals, their families, and their wider communities. While each domain can be a necessary component of care and treatment, overall, a singular and narrow approach is not sufficient to guide recovery-oriented care and practice. Many elements of a person's life can be impacted by mental illness; consequently, treatment and support require a holistic approach focused on need. For many individuals, this may involve simply supporting self-help capabilities. For many others, this will extend to a wider system of responses made up of clinical and disability support services, family and carer support, as well as government and non-governmental organisation (NGO) service provision.

Attempts at coming to grips with this inherent complexity can often lead to fracturing in our understanding and a fragmenting of our ways of working into separate compartments, which may hinder us from adopting the integrative and more holistic approach needed. We see this in the many artificial divides that emerge, including the way service-level models of care are organised, at the level of individual clinical and rehabilitation practice and even in our conceptual understanding of mental health problems. This is readily apparent in the divides that often exist between clinical treatment and the need for psychosocial rehabilitation and disability support, between hospital- and community-based service models, between the priorities of public, private and NGO sub-systems and, now even more worryingly, between the recovery approach and evidence- based practice.

Recovery Concepts and Practices

Recovery can be an elusive concept. From the lived experience of consumers and their families as well as the scientific literature, recovery emerges as a highly variable construct with differences in definition, outcome, key components, and measurement.2,3 Common themes do emerge however, with the core elements of recovery approaches emphasising the need for enabling self-determination and self-management, empowerment and supporting personal growth with the need for creating choice and opportunities for meaningful social and community participation.4 Some contemporary definitions see recovery as something that cannot be done to or for consumers by service providers. From this perspective, while it remains ultimately something consumers do, services and interventions can be made more effective and conducive for supporting the individual recovery journey and experience. That is, recovery can be supported by creating the nurturing conditions, enabling platform, and encouraging environment necessary for assisting personal efforts.

There is also growing additional scientific evidence of the effectiveness of several specific elements of the recovery approach. Warner5 highlights the evidence-supporting elements of a recovery approach including optimism about outcome, interpersonal support and empowerment through increased sense of internal locus of control, or mastery through personal choice, decision-making and low internal stigma, and the value of paid employment. …

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