A critical view on Recovery

Recovery - a diffuse concept for many

Recovery as perspective and practice is also characterized by skepticism and criticism. This mainly grows out from recovery being a diffuse and abstract concept by definition and in practice. As it is largely depending on each person`s own definition of own process, it is impossible to develop general guidelines for recovery oriented practice that are sufficiently concrete and tangible, leading to challenges for health services when it comes to operationalization and implementation.

Just a buzz-word?

It must also be considered that recovery is a relatively new term requiring time to be incorporated. Several service providers also rejects recovery as yet another buzz-word or a new name for already existing values, and claims they already works this way. All this terms, concepts and names are also highly applicable for service users; do we have the same understanding of recovery? Do we identify with the terms we use? Concepts like dreams, values and hope for the future can be too abstract, making recovery-based approach too strange, alienated and not practical enough for the treatment to be useful.

 

Responsibility and focus on diagnosis

Some of the most prominent criticism is whether recovery oriented practice leads to disclaiming for the health services, leaving the service user alone without enough help and support. Self-control and individual understandings are emphasized in recovery-processes, possibly leading to a challenging balance for service providers between giving discharge of liability, help and support, and enabling self-control and facilities for development.

Recovery also moves away from focus on diagnosis, which gives reason to be concerned about service users and relatives losing rights regarding the treatment or overshadowing rights in favor for self-responsibility. Arild Knutsen from Foreningen for human narkotikapolitikk (FHN) [Hardcore Harm Reduction Organization] was interview by Erfaringskompetanse [National Center for Experience-Based Competence in Mental Health], saying that recovery undermines those who struggle the most; being a resource and being free from substances are held forward as the only goal in recovery, leading to loss of motivation for those who are not able to start controlling their recovery process.

He points out that the recovery movement earns lots of money on buzz-words, talks and books, without actually improving health services. This deduce a dilemma about the balance between meeting the service user where he/she are right now, and thinking forward in terms of dreams, goals and the future; are the service user given enough time? This balance is about the combination of recovery-based concepts and other concepts and methods, and most of all it is about timing.

Human rights and social justice

The user-driven organization Recovery in the Bin has been a leading part concerning a critical look at recovery. They write:

We are fed up with the way co-opted ‘recovery’ is being used to discipline and control those who are trying to find a place in the world, to live as they wish, trying to deal with the very real mental distress they encounter on a daily basis. We believe in human rights and social justice!

They believe that there are core principles of recovery that are worth saving and fight for, including autonomy and self-determination, but that the colonisation of recovery in health services and politics undermines those values. This is the core of the criticism of recovery; these principles cannot be found in a one size fits all technique or calibrated by an outcome measure. Therefore, many is critical to how real recovery actually becomes in clinical recovery, where measures are used as an indicator for improvement, ease of symptoms and mental health recovery.

 

The social aspect

Further on, especially in the field of research, there has been concerns about forgetting the social aspect of recovery because of the strong focus on the individ in the society and in mental health services. The social context are highly important for human health, and as mentioned earlier, some argue that we have to see mental health and substance abuse problems as a civic problems in larger degree. In practice, this can conflict with the focus on empowerment and self-control in the recovery concept. Therefore, many fear that aspects concerning relations, social interactions, working life and housing are forgot and undermined, something that can affect the treatment in a insufficient way and inhibit recovery.

 

Ideal Organizations, foundations and voluntary instances

• ImROC (Implementing Recovery through Organizational Change) – Strives for systems, services and cultures to develop and support recovery and wellbeing for all locally, nationally and internationally, by sharing knowledge and facilitate recovery-oriented improvements in partnerships with communities, health services and service users. Located in Nottingham.
• Scottish Recovery Network – A non-profit initiative working in Scotland and beyond to place the experience of recovery at the center of life, practice and policy. They do peer work, research, provide tools, dissemination of knowledge and strengthening recovery processes in the society through social media, video, sound and literature. Located in Glasgow.
• The Yale Program for Recovery and Community Health (PRCH) – One of the leading parts internationally when it comes to operationalisation and implementation of recovery in services and society. Conducts collaborative research, evaluation, education, training, policy development and consultation in the field of mental health and substance abuse. Located at Yale School of Medicine, Connecticut.
• South West Yorkshire Partnership Recovery Colleges – Offers recovery focused educational courses that aims to help people by learning them how to cope with and about their own recovery process, each course often by specific types of different problems. The courses are delivered by people with lived experience, alongside people with professional experience. Located in Yorkshire.
• The World Association for Psychosocial Rehabilitation (WAPR) – An international non-governmental organization mainly by mental health professionals, alongside with people with service user experiences or next of kin experiences from all around the world. The mission is dissemination of principles and practices of psychosocial rehabilitation and recovery, by worldwide conferences among other things.
• RecoveryCafè – A community of people with experience of homelessness, addiction or mental health problems providing a safe and warm place to help people to recover from the same type of problems. RecoveryCafè offers social activities, support and help to individual development and coping. Located in Seattle.