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Psychiatric-Mental Health Nursing

1.4 Mental Health Recovery and Wellness

Psychiatric-Mental Health Nursing1.4 Mental Health Recovery and Wellness

Learning Objectives

By the end of this section, you will be able to:

  • Discuss principles central to the recovery model
  • Identify stages of psychiatric-mental health recovery
  • List strategies for psychiatric-mental health wellness

Recovery in mental health is a nonlinear process. According to Mental Health America’s 2023 survey, over half of the people in the United States who have mental health disorders, and a staggering 93.5 percent of people with substance use problems, do not get treatment (para 2). People can get better, but they need to understand what resources are available. Health-care providers can educate the individual, families, and communities about the steps of recovery. The goal is to instill hope that with support, the client can maintain wellness throughout their lifetime. Hope is the basis of recovery (SAMHSA, 2023).

Principles of the Recovery Model

Mental illness is treatable. Research reveals that people with mental illness can get better, and many recover completely (Centers for Disease Control and Prevention, 2021a). The majority of individuals with mental illness continue to function in their daily lives. The term recovery refers to a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential (Center for Substance Abuse Treatment, 2014). Dimensions that support a life in recovery include the following:

  • Health: Overcoming or managing one’s disease(s), as well as living in a physically and emotionally healthy way
  • Home: Having a stable and safe place to live
  • Purpose: Participating in meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society
  • Community: Enjoying relationships and social networks that provide support, friendship, love, and hope

There are ten principles of recovery and five stages of recovery. According to the American Psychological Association (2012), the ten principles of recovery are:

  1. Self-direction: The journey to recovery is determined by the person recovering.
  2. Individualized and person-centered: The chosen road to recovery should be tailored and customized to the client in terms of ability, background, inclinations, and assets.
  3. Empowerment: Clients participate in the decision-making process.
  4. Holistic: Recovery involves the entire person, including mind, body, spirit, and community.
  5. Nonlinear: Recovery is not linear and may entail setbacks. It involves continuing to grow and learning from the setbacks.
  6. Strengths-based: Recovery takes what clients are already good at and enhances it.
  7. Peer support: Support from others enriches recovery.
  8. Respect: Recovery requires acceptance by clients’ communities, families, peers, and health-care providers.
  9. Responsibility: Clients must take ownership of their own recovery path.
  10. Hope: The drive to recover stems from hope of getting better and knowing that it is possible (p. 5).

Additionally, participation in mutual aid groups can be one pathway to recovery. Such groups include twelve-step programs, like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or Gamblers Anonymous (GA), that provide support for addictions and compulsions. The twelve steps are guidelines for persons to acknowledge and surrender their addiction, and to draw strength from a higher power, as they personally conceptualize that to be.


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.

Cultural Context

Cultural Views of Drug Use in China

Managed by the courts, compulsory detoxification centers in China have been criticized for human rights violations. However, community-based treatment and voluntary treatment with medical management also exist in the country. Yang and Giummarra (2021) propose evidence-based treatment while acknowledging the Chinese population size, history, and culture.

Criminalization of drug use in China may be preventing incorporation of drug treatment into the health-care system (Yang & Giummarra, 2021).


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.

Clinical Judgment Measurement Model

Generate Solutions: Advocating for Clients

After completing a client assessment and determining a nursing diagnosis, the nurse must then generate solutions. These must be individualized interventions to address the problems the client is currently facing. The client must be involved in the decision-making process as much as possible in order to have the best chance at achieving the projected outcomes. For example, telling a client that they need to eat healthier foods and then removing certain foods that are culturally relevant to that client will likely not be a maintainable intervention. To make this intervention individualized, it might include advocating for their dietary needs, especially if the intervention is occurring in a facility treatment setting.

Five Stages of the Psychiatric-Mental Health Recovery Model

The five stages of recovery include starting treatment, mental illness education, making a change, finding new meaning, and sticking with recovery (Georgetown Behavioral Hospital, 2023) (Figure 1.7). While each stage builds on the prior one, it is important to remember that recovery itself is a nonlinear process. In the first stage, the person realizes that they need help. During the second stage, the person starts gaining education about their illness and coping skills that can be used during the recovery process. The third stage, making a change, refers to the changes that a person needs to make in their lifestyle, friends, and environment in which they live in order to be able to recover and maintain recovery. The fourth stage encourages trying new positive experiences, making new supports, and finding joy in life. The final stage is planning what recovery is going to look like throughout life: treatment, therapy, and medication are examples. Each of these stages helps the person learn about “self-care, determination, and persistence” (para 10).

A five-panel graphic showing the Five Stages of Recovery. From left to right the graphic reads as follows. 1-Starting Treatment: Deciding to start treatment is the most important step of recovery. This is where the healing starts and a professional mental health center is a great place to start. 2-Mental Illness Education: Understanding your mental health condition(s) is the foundation of recovery. In this stage of recovery you'll learn common symptoms and coping skills for any mental illnesses you're facing. 3-Making a Change: Making changes after treatment can make all the differences in your recovery. By learning to prioritize healthy relationships and develop a support system, you'll give yourself the best chance of long-term recovery. 4-Find New Meaning: Finding new hobbies, activities, responsibilities, and other rewarding factors in life can help you to find joy in the little things once again. 5-Sticking with Recovery: Recovery requires commitment. When you decide to keep working on your recovery every day, you achieve the last stage of mental health recovery!
Figure 1.7 In this model, the five stages of recovery have a starting point and a future achievement goal. Stage five is the most difficult and may require starting again at stage one. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)


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).


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.


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 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 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).


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.

Strategies for Psychiatric-Mental Health Wellness

Adopting healthier life choices is the most important factor in recovery and working toward/maintaining psychiatric-mental health wellness. Prakash et al. (2020) suggest that the difference in mental illness and mental wellness is that in illness the focus is on management of the illness while wellness focuses on all the aspects in life that can help people live and participate in the world around them. Some wellness strategies include getting good sleep; eating a diet that includes a balance of fruits, vegetables, lean meats, fish, and whole grains; limiting caffeine use; exercising three to five days per week for forty-five minutes; and maintaining connections to others.

Psychosocial Considerations

What Is Psychosocial Rehabilitation?

Psychosocial rehabilitation helps individuals develop the skills to live happily with the smallest amount of professional intervention manageable. Psychosocial rehabilitation uses two strategies: coping skills to empower the client to more successfully handle stressful situations and resource development to reduce future stressors. Treatments and resources vary case to case but may include medication management, psychological support, family counseling, vocational and independent living training, housing, job coaching, educational assistance, and social support.

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.


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