Learning Objectives
By the end of this section, you will be able to:
- Define the recovery model in psychiatric nursing
- Outline the history of recovery in psychiatric nursing
- Explain the role of the psychiatric nurse in promoting recovery
Recovery is the emergence from a stressful state, incorporating self-care ability, and attempting to reach one’s full potential. As a model of care, recovery has been applied to mental health and addictions treatment, wherein the client defines wellness, and a supportive team fosters resilience. Recovery encompasses social change and utilizes person-centered mental health care.
Defining Recovery and the Recovery Model in Psychiatric Nursing
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery from mental illness and substance use disorders as change that improves health and wellness, empowers a self-directed life, and enhances full potential of the individual. Health is defined by SAMHSA as “overcoming or managing one’s disease(s) or symptoms” and “for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing” (SAMHSA, 2012, para 4) Nurses should take note that the SAMHSA definition does not limit the meaning of health to cure, but extends it to the ability to function and make choices in life.
The Recovery Model—Mental Health
In mental health care, a recovery focus views the person beyond the limitations of the disease process. Elimination of the disease is not the specific goal—rather, the goal might be the person’s potential for resilience, even if symptoms continue. Incorporating hope and optimism and the willingness to take responsibility for self, the recovery model emphasizes ability and personal control of one’s health and well-being, functioning at higher levels, and achieving a meaningful life even without complete cure.
The Recovery Model—Addictions
In addictions treatment, various methods support recovery. The recovering person assumes ownership in the process. Some will achieve sobriety, stability, or freedom from dependency through abstinence, while others may utilize behavioral change or harm reduction strategies. Peer counselors and twelve-step sponsors, along with professional therapists, collaborate with the recovering person. Communities, such as Alcoholics Anonymous or Recovering Couples Anonymous, provide mutual support and fellowship within the social network.
Historical Overview of Recovery in Psychiatric Nursing
The recovery model was officially defined by experts working in mental health and substance use. These experts set out to define a working definition of recovery and to clarify the concepts of recovery.
Some believe that the recovery model started in the 1960s with the deinstitutionalization of psychiatric clients from state institutions. There was a belief that those living with mental illness would improve in a community setting as compared with an institution. In 1993, Dr. William Anthony published a paper discussing recovery from mental illness and described recovery as a “process of changing one’s attitudes, values, feelings, goals, and skills in order to live a satisfying life within the limitations caused by an illness” (p. 11). In February 2001, President George W. Bush announced his New Freedom Initiative, which ensured that people with disabilities had access to educational and employment opportunities (President’s New Freedom Commission on Mental Health, 2001). The commission recommended transforming mental health to focus on recovery-oriented approaches utilizing evidence-based practices. The commission focused on reducing the stigma against mental health.
Since that time, organizations including SAMHSA and the National Alliance on Mental Illness (NAMI) have endorsed the recovery model as an effective strategy to help clients become partners in their care. SAMHSA reports the foundation of recovery as being built on persons’ strengths, talents, coping abilities, resources, and inherent values. They also report recovery should be holistic, address the whole person as well as their community, and be supported by peers, friends, and family members.
Asylums and Mental Illness
According to the National Institute of Health, early Americans cared for mentally ill family members at home, but in severe cases they would be detained in “almshouses or jails.” As the population grew, community institutions arose to house those who were mentally ill. In 1752, the Quakers in Pennsylvania opened Pennsylvania Hospital, which had rooms in the basement to house mentally ill clients. In the nineteenth century, new ideas for treatment of the mentally ill brought the advent of the asylum, which is an institution offering shelter. The focus of treatment was on recovery and cure. The asylums were meant to provide a quiet, peaceful environment for promotion of health and recovery. The Friends Asylum, built in 1814, was the first asylum built to promote a program of moral treatment and was meant for those who could afford to pay for the care provided. In the 1930s, the economic crisis in America cut funding for any state appropriations to the asylums.
Peer Support and Health-Care Consumers
The concept of peer support, ironically the sharing of experiences and personal stories among survivors of harsh treatments for psychiatric disorders, likely began in France in the eighteenth century. Public awareness emerged over the next 200 years as more individuals and families made their experiences known. This awareness promoted the concept of an individual or family as a consumer of health care, meaning those who purchase a service, and peer support as beneficial in mental health care (Colorado Mental Wellness Network, 2023).
Link to Learning
The National Alliance on Mental Illness has created a free, eight-session educational program called NAMI Peer-to-Peer intended to help adults with a mental health diagnosis to help themselves in their recovery.
The Civil Rights Movement and Deinstitutionalization
The civil rights movement of the 1960s focused on human rights and equality among social groups. At the time, much mental health care entailed simple confinement and using harsh measures to manage extreme behaviors. Political and social pressure came from the public wanting change, along with financial demands to reduce the cost of incarceration-type mental health care.
Dr. Richard Lamb published in 1998 on the subject of deinstitutionalization, which was the policy, process, and movement that released thousands of mentally ill persons from state institutions back into the communities. Lamb and Bachrach (2001) discussed the lack of support within individual communities, which resulted in many persons released from psychiatric institutions being simply displaced. Many years later, lessons revealed the need for services planning and continuity of care, as these were lacking in the beginning (Lamb & Bachrach, 2001).
Consumer Movement and Current Trends
Consumer rights were formalized in 1962. The term consumer was developed to create a positive term for people who were utilizing mental health care and resources. Consumer activists began to collaborate with mental health-care policymakers about improving mental health treatment. As the philosophies of consumer rights and the shared stories of peer supporters came together, a recovery orientation in mental health care emerged (Moran, 2018).
The Role of the Psychiatric Nurse in Promoting Recovery
Because recovery in mental health care includes the person’s self-care ability, nurses are essential as coaches, educators, and advocates. Nurses must distinguish between simple remedy to empowerment of the person, which becomes power sharing within the domain of recovery. The client’s definition of success is the guiding principle.
APNA Recovery Components
The American Psychiatric Nurses Association Recovery Council envisions PMH nursing practice as incorporating a recovery orientation. The therapeutic relationship as basis of care places the PMH nurse in position to foster wellness through the shared belief in recovery as a possibility. The use of person-first language, which means speaking of the person without focus on the diagnosis, is one of the components. Role modeling this way of expression can be a powerful motivator for others. Some phrases in our language can reinforce harmful stereotypes. Try substituting these words to promote a recovery orientation. For example:
- Instead of: “Robin is crazy.”
Say: “Robin lives with a mental health challenge.” - Instead of: “He’s schizophrenic.”
Say: “He’s living with schizophrenia.” - Instead of: “She’s manic-depressive.”
Say: “She lives with bipolar disorder.” - Instead of: “Their father committed suicide.”
Say: “Their father died by suicide/was lost to suicide.” - Instead of: “Denny’s an old junkie.”
Say: “Denny has been in recovery for ten years.” - Instead of: “Mari is an ex-addict.”
Say: “Mari is in recovery.”
Practicing with a recovery orientation means the nurse speaks and acts with a focus on the client’s strengths and abilities and the possibility of self-care. Reflection is essential for the nurse, as is peer feedback, in order to increase personal awareness.
Nurses may inadvertently discourage those in their care by emphasizing limitations. Nurses should strive to strengthen their own communication skills by asking clients what may be helpful to learn before developing a teaching plan, or acknowledging the client’s frustration before offering a solution. As in all therapeutic communication, the nurse’s nonverbal expressions must be congruent with the verbal message. For instance, if the nurse is physically preparing to leave the interaction and chooses that moment to ask the client if they have any more questions, the message is unclear.
Link to Learning
Watch this video to learn about the national observance of recovery that began in 1989 to raise national consciousness regarding mental health and addictions recovery.
National Initiatives
Originally an initiative by SAMHSA to increase public awareness about mental health and substance use, President Biden issued a proclamation endorsing the recognition of National Recovery Month in September 2023. This reinforces the government’s dedication to prevention, support, and recovery for those living with mental health or substance use challenges. The document further calls for health insurance coverage parity for these conditions.