1.4 Mental Health Recovery and Wellness

Hope

Hope is the foundation of the recovery process. Hope in this context is the belief that one can overcome their challenges (SAMHSA, 2023). The nurse helps clients increase their sense of hope by looking beyond the current stressful situation and toward a healthier future. The nurse helps the client identify their “strengths, talents, coping abilities, resources and inherent values” (para 3). Hope is “the catalyst for change” (Laranjeira & Querido, 2022, p. 2). By using a recovery-oriented approach, nurses create a feeling of hope even when the client feels hopeless (Dallum et al., 2015).

Self-Determination, Self-Management, and Empowerment

Recovery is centered around the client developing their own autonomy in making choices about treatment and resources used to achieve their self-directed goal (SAMHSA, 2012). Empowerment begins from the moment a person makes the decision to get treatment. With self-determination, a support system, and learning what feels right in terms of treatment options, a person’s sense of empowerment grows. The adage “knowledge is power” is true in recovery. It is here that psychosocial rehabilitation comes into play; it helps individuals develop the social, emotional, and intellectual skills needed to live happily with the smallest amount of professional assistance manageable.

Advocacy

Advocacy comes in two forms: for the client and for education. A nurse can advocate for the client’s needs when they are in too acute a condition to be able to make decisions for themselves. As the client begins to feel better, the nurse steps back and begins to let the client advocate for themselves. One of the foundations of recovery-oriented care is creating safe spaces for healing (Solomon, Sutton, & McKenna, 2021). The high numbers of people with mental health and substance use problems who do not seek treatment attest to the fact that education is important. Nurses can advocate for education in communities about the resources available to fight against substance misuse.

Acceptance

Learning to accept oneself is an important part of recovery. It helps people let go of the past and move forward (Linney, 2022). Accepting that they have an illness helps people face mistakes made in the past and adopt a mindset toward future problem-solving. Part of the process is understanding that recovery will have some rocky spots, but with support people in place and the use of positive coping skills, it is possible to get through those tough times.

Nurses and other health-care personnel must also practice acceptance of the clients for whom they are caring. Realizing that the client is a human who comes with a history, individual needs, strengths, and values will improve the nurse-client relationship (Solomon, Sutton, & McKenna, 2021).

Insight

As the individual and family become more educated about mental illness and substance misuse (psychoeducation), they begin to gain insight into how their lives are affected by it. Being taught that there are peer support resources available in the community can be invaluable in making the individual feel less alone. Peer support services (see 6.3 Peer Support) provide the individual with a sense of belonging and acceptance (Dell, Long, & Mancini, 2021). Listening to the experiences of the peer support people can help individuals build insight into their own illness and recovery. Family education helps family members to be more understanding, supportive, and can increase the family bond.

Action

One nursing intervention to help individuals take action is to get them involved in illness self-management (ISM). Such programs are meant to help the individual design their recovery in a way that works best for them in their daily lives. Wellness Recovery Action Plan (WRAP) is one of the most often suggested ISMs due to the way it “enhances recovery, self-advocacy, and hope” (Petros, & Solomon, 2021, p. 631). WRAP is led by a trained peer support person and usually consists of a small group that meets over eight to twelve sessions. Instilling hope is the basis for this ISM. Over the course of the program, participants learn how to enhance or maintain their wellness through self-reflecting, being proactive, recognizing triggers, and setting up plans for crisis intervention (Petros & Solomon, 2021).

Self-Esteem

Self-esteem has three parts: (1) the positive and negative thoughts people have about themselves, (2) how people rate their self-worth, and (3) evaluating their own abilities and personal characteristics (Hasani, Aung, & Mirghafourvand, 2021). Low self-esteem is associated with higher rates of depressive symptoms. On the other hand, if a person has a high level of self-esteem, they are more likely to be able to manage stressful events successfully.

The inclusion of self-esteem in Maslow’s hierarchy of needs supports the importance of fulfilling this need in one’s life (Family Addiction Specialist, n.d.). The recovery process helps individuals increase their self-esteem as they begin to rebuild relationships, jobs, and their health.

Healing

Healing is not immediate. It takes time, patience, and education. The medical model for mental health focuses on biology while recovery-oriented mental health focuses on holistic healing (Chisholm & Petrakas, 2021). Medication management can be a viable part of the healing process for people with severe mental illness (SMI) as it can decrease symptoms and help them feel better (Jessell & Stanhope, 2022). Collaboration between the client and the prescriber ensures the client’s autonomy in discussing medication options, side effects, and contributions toward the person’s healing. Healing is not a cure, but is a chance to live a better life than they did before they recognized their illness and entered into recovery. The recovery process involves the client and their families. The hope is that with education about the illness, family members, too, can heal, thus improving perceptions they may have developed about the illness and their loved one (Galimidi, & Shamai, 2022).

Meaning

Finding meaning in life provides individuals protection from stressful situations by helping them to effectively cope and move beyond that challenge (Prakash et al., 2020). Going through the lows of addiction or severe mental illness is sometimes the catalyst for making a positive change (Family Addiction Specialist, n.d.). It is often at the lowest point that an individual finds their purpose to move forward. The individual finds meaning from realizing that they need to make positive changes in their lives.

Focus on the Positive

Focusing on the positive, despite what may seem like insurmountable obstacles, changes one’s perspective. The mindset of always looking at the negative aspects of life can only have a poor effect on one’s mental health and hope for recovery. Encouraging a focus on the positive is one of the interventions that nurses can offer to individuals or as a part of therapeutic group work.

Practice Gratitude

Practicing gratitude is embraced by twelve-step programs and recovery specialists and can be an intervention implemented by psychiatric nurses. Encouraging clients to keep a gratitude journal allows them to sit down at the end of the day and reflect on the things for which they are grateful that day. This changes the focus to positive events, no matter how insignificant they may seem and helps the client realize that even when everything seems dismal, there are things to be thankful for in life.

Connect with Others

Learning to have healthy relationships means understanding that sometimes relationships require boundaries in order to stay healthy. When a person is actively using substances or in the midst of severe mental illness, they often make bad choices about the people with whom they connect socially. These connections can negatively affect their mental health. Healthy relationships offer support by increasing one’s sense of well-being (Family Addiction Specialist, 2023). Though it may be a difficult decision to cut ties with people and places, it is a necessary part of staying healthy in recovery. As individuals work on their recovery, they begin to learn that in order to become a healthier version of themselves, they need to find and make new friends.

Maintain Physical Health

Physical health and mental health are often connected. Many people have co-occurring diagnoses. For instance, diabetes and depression often co-occur. Teaching clients the importance of maintaining their physical health is just as important as watching for signs and symptoms of mental illness. Again, a holistic approach to the client’s health means that mind, body, and spirit are all connected. There are certain things nurses can teach their clients about maintaining better physical health. These include smoking cessation, recovery from substance misuse, improving their diet and exercise routines, and getting plenty of sleep.

In Kesavayuth, Shangkhum, and Zikos (2022), several studies showed connections between health and certain health factors. One study from Nova Scotia reported a connection between having depression and developing coronary artery disease. This connection is further supported by research showing that people with higher levels of physical health are also more likely to have better mental health.