History of Recovery Approaches
To understand the unique role that peer support can play in promoting and supporting mental health recovery, we first need to understand the wider context that encouraged its growth. The development of what is sometimes described as a ‘recovery approach’ and the new learning it brought to the experience of personal recovery was instrumental in the creation of new peer worker roles around the world.
Before we look at historical influences we should consider two core elements of the recovery approach.
The first is that it is based on a fundamental belief that everyone has the potential for recovery — no matter how long-term or serious their mental health problem.
Secondly the approach is based on learning directly from people who are in recovery, or who have recovered from mental health problems. This learning is then applied in the way that mental health supports are developed. This also means that people should be able to play an active part in managing their mental health and recovery in directing the support they receive.
This may sound like an obvious thing to do, but in reality it can lead to significant changes in our approach to providing support and treatment. This can be a challenge mental health services, service users and their informal supporters alike. The recovery approach and the drive to adopt recovery-focused systems of support have become a driving force in mental health policy and practice internationally.
Firstly it is important to keep in mind that people have always recovered from mental health problems. What has changed is the emphasis on recovery as a way of improving services and experiences. A number of factors have contributed to the development of the recovery approach. These originated in the United States and then spread more widely. They include:
• Long term outcome research• Activism and the rights based approach
• Sharing experiences and recovery narratives
• Social perspectives in mental health
Long-term outcome studies involve tracking people over time to review their mental health. This involves repeating the same outcomes measures, sometimes over many years. The majority of these studies have focused on people with a diagnosis of schizophrenia. They have been important to the development of the recovery approach because their findings, while variable, have consistently identified significant numbers of people recovering.
This provides a more encouraging picture of the course of schizophrenia than the traditional view first described by eminent psychiatrist, Emil Kraepelin (1856–1926). He described a continued deterioration with little hope of recovery.
In the second half of the last century, there was a move to close large psychiatric institutions and to focus more on supporting people with mental health problems in the community. This led policy makers and academics to more closely consider the extent to which people, who may have traditionally spent the majority of their lives in hospital, could in fact enjoy a degree of recovery in community settings.
A series of long-term outcome studies were developed around the world to assess people’s progress over time. While measures and outcomes varied between studies, the research identified that many people were going on to enjoy full and complete recoveries in community settings — something almost unimaginable before the closure of large psychiatric institutions.
Perhaps the most widely cited study is the Vermont Longitudinal Study of Persons with Severe Mental Illness conducted between the mid-1950s and early-1980s (Harding et al 1987). The findings of this study revealed that two-thirds of the 262 previously long-stay patients had either improved considerably, or had recovered 25 years after their first assessment, having undergone a rehabilitation and community aftercare programme.
These findings challenged the assumption that people who suffer repeated episodes of illness can only ever regain marginal levels of functioning. Sixty-eight per cent of the study’s sample was rated as functioning above a level of ‘mild impairment’ and fifty-five per cent received a rating of ‘slight or no impairment’.
A Scottish Recovery Network discussion paper is available for further reading on this subject. Evidence of Recovery: The ‘Ups’ and ‘Downs’ of Longitudinal Outcome Studies highlights a number of key points including:
- The phenomenon of ‘late recovery’ in schizophrenia
- World Health Organisation research suggesting better outcomes in some developing countries when compared to developed countries
- A review study suggesting no apparent improvement in recovery rates over the 20th century despite the introduction of new treatments and approaches
- the limitations of outcome studies and the extent to which measures used fit the unique and personal nature of recovery