What does recovery mean for the people involved?
Summary
The concept of recovery in mental health has evolved from a clinical view focused on symptom remission to a more holistic definition that encompasses autonomy, social inclusion, and a personalized and continuous process. The Recovery movement, initiated by people who use mental health services, emphasizes active participation and empowerment in treatment. A qualitative exploratory study identified overcoming hopelessness, a safe environment, autonomy, social support, and acceptance of the diagnosis as key factors in the personal recovery process. Despite the positive influence of strong support networks and dignified treatment within the healthcare system, stigma and discrimination remain significant barriers. It is recognized that the mental health care system must foster collaboration and improve access to resources to support the integration of people in recovery into society and the workplace.
Over the years, the concept of recovery in mental health has been approached from various perspectives. From a clinical standpoint, it is understood as an improvement in symptoms and social functioning, emphasizing sustained adherence to pharmacological treatment (Bellack, 2006; Nasrallah et al., 2005) and seeking a "cure" or a return to "normalcy" (Resnick et al., 2004). However, this conception, linked to the biomedical model, tends to view service users as passive subjects within the mental health system (Slade, 2010), which represents a fundamental limitation.
The Recovery movement emerged in response to criticisms from service users of mental health services, which they perceived as hopeless, stigma-inducing, and fostering dependency (Bellack, 2006). Initiated in the late 1970s by the mental health consumer movement in the United States, it evolved into a social movement that integrates the voices and experiences of service users, their families, and professionals (Davidson, 2016). By advocating for the active participation and autonomy of service users in their treatment, this paradigm marked a shift in the approach to mental health issues (Anthony, 1993; Storm & Edwards, 2013).
From this new perspective, recovery is redefined as a personal, continuous, and non-linear process that goes beyond the remission of clinical symptoms. It implies that the individual is the protagonist, establishing relationships of mutual support and reconstructing identities through empowerment and taking control of their life (Ellison et al., 2018; Leamy et al., 2011; Slade et al., 2012; Tan et al., 2014). These findings emphasize the importance of understanding the individual experience of recovery, avoiding universal definitions and fostering an empathetic understanding of individual needs (Anthony, 1993).
Recovery is defined as a process of personal and social development, emphasizing its continuous and gradual nature across different areas of life (Anthony, 1993; Davidson, 2016). While some service users maintain a clinical view focused on "cure" based on the elimination of symptoms through psychopharmacological or psychotherapeutic treatments, others conceive of it in terms of effective functioning at a personal, family, and social level (Jose et al., 2015). Furthermore, Dell et al. (2021) identified five interrelated themes that address recovery from a broader perspective. These include:
- Overcoming hopelessness and building a positive self-image
- Creating a safe environment
- Autonomy and personal responsibility
- Social support
- Acceptance of the condition of being a diagnosed person with tools to manage psychological distress.
These topics provide a more holistic understanding of the factors that influence the recovery process.
Thus, to establish a unified vision of recovery, it is essential to consider it as a personal and individualized process that evolves over time and through multiple pathways. First-person narratives emphasize the individualization of these processes, where people are active agents of change in their lives (Gagne et al., 2007). Aspects such as self-care, participation in treatment, peer support, and the creation of a life plan influence this process (Leamy et al., 2011; Rosillo Herrero et al., 2013).
However, discrimination and stigma in the healthcare context hinder recovery. The Recovery movement advocates for collaborative and horizontal relationships between service users and professionals, characterized by respect and trust, which can facilitate the recovery process (Rosillo Herrero et al., 2013).
Fighting stigma in mental health in the healthcare sector
Ultimately, it is important to guarantee equitable access to resources and opportunities for people recovering from serious mental health problems , as well as to provide the necessary support to develop skills that allow them to fully integrate into society and the workplace (Rowe & Davidson, 2016). This requires collaboration among mental health professionals, implementing strategies that identify the strengths and skills of service users during the recovery process (Gagne et al., 2007).
A study on the meaning of recovery from a personal perspective
With the aim of analyzing the diverse subjective perspectives on recovery in mental health expressed by service users, their families, and the professionals involved in their care, and their relationship to the consulted scientific literature, we conducted an exploratory study using a qualitative approach to analyze the subjective definitions of recovery according to the experiences of service users, professionals, and family members in the field of mental health. The questionnaire technique was used, administered to these groups within the framework of the monograph on recovery in mental health published by SOM Salud mental 360º (Eiroa-Orosa and Andrés Mora, 2021). The questions were open-ended to explore the knowledge and meanings attributed to certain concepts based on personal experience.
The study involved 66 adults, including current and former users of mental health services, their families, and mental health professionals. It sought to determine how they conceptualize recovery and identify the factors that influence the recovery process. Additionally, it explored whether the mental health care system and society in general contribute to the recovery process for those facing mental health problems.
Personal perception vs. literature
Definition of recovery
Regarding the definition of recovery, two main approaches were identified: clinical recovery and personal recovery. Clinical recovery refers to the reduction of symptoms and a return to "normalcy." It focuses on biomedical parameters, seeking to reduce and control symptoms to return to a state of "normalcy" or "cure" (Bellack, 2006; Nasrallah et al., 2005; Resnick et al., 2004). Personal recovery, on the other hand, involves social inclusion, autonomy, and the development of a life plan. Individuals begin a process that starts with accepting and understanding the diagnosis, empowering themselves along the way (Anthony, 1993; Dell et al., 2021; Ellison et al., 2018; Leamy et al., 2011).
The factors that facilitate it
Regarding the factors that facilitate recovery, it was found, in line with previous literature (Dell et al., 2021; Gagne et al., 2007; Rosillo Herrero et al., 2013), that a strong support network and the quality of care received in mental health services, as well as combating stigma , exert a decisive influence on the recovery process. The positive influence of a strong support network, which includes family and friends, provides comfort, emotional stability, and motivation in the recovery process (Gagne et al., 2007). Furthermore, building therapeutic relationships based on trust and support between the service user and the professional, with a horizontal and empathetic approach, plays an essential role in the recovery process (Rosillo Herrero et al., 2013). The presence of good professionals in the mental health service, learning personal strategies, autonomy, social and work inclusion, and acceptance and awareness of mental health problems were also identified as key elements for recovery.
Promoting autonomy and learning personal strategies are crucial elements for recovery. Those who develop coping and self-regulation skills are more likely to maintain long-term stability and well-being (Davidson, 2016), enabling them to be active participants in their recovery process (Leamy et al., 2011).
Furthermore, social and labor inclusion emerges as a fundamental pillar in recovery, where having a meaningful job, a home and a solid social network contribute to a sense of identity and purpose, supported by the literature (Dell et al., 2021; Rowe and Davidson, 2016).
Regarding the healthcare system, it plays a critical role in the path to recovery, and the literature related to the recovery movement has critically examined the limitations and necessary improvements in this area. The importance of adopting a person-centered approach and fostering close collaboration between mental health professionals and service users has been highlighted. Likewise, ensuring equitable access to high-quality services that can meet individual needs and contribute to recovery has been emphasized (Anthony, 1993; Rosillo Herrero et al., 2013; Slade, 2010). Overall, participants positively valued the importance of having good professionals and a system that promotes recovery. However, negative aspects were also mentioned, such as a lack of resources and insufficient coordination among different mental health services.
Barriers to recovery
Stigma was mentioned as a significant barrier, as it can lead to social isolation and hinder access to social resources. Lack of acceptance and awareness of the problem, as well as lack of access to information about mental health issues, were highlighted as obstacles to recovery.
The stigma surrounding mental health represents a significant obstacle in the recovery process, making it crucial to combat it (Rosillo Herrero et al., 2013). Stigma can negatively affect the self-esteem and confidence of people facing mental health problems. Furthermore, social isolation is another major challenge, and the recovery movement actively works to counteract it by promoting community participation and the creation of meaningful connections through support groups and peer support—strategies that have proven effective (Anthony, 1993; Davidson, 2016).
Finally, it is important to note the main limitation of this study, which lies in the inability to generalize the results obtained from a small and not entirely representative sample. Despite the extended data collection period, the data did not cover enough perspectives to reach theoretical saturation, a condition for qualitative analysis to consider that all relevant aspects have been explored (Morse, 1995). This highlights the need for future research along the same lines, which could address this limitation by broadening the scope through population surveys or conducting multiple focus groups to obtain a greater diversity of personal narratives about recovery.
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