Reprinted from the "Recovery" issue of Visions Journal, 2013, 9 (1), pp. 7-9
I want to tell you about Corina.* First, Corina was a client of mine while I was an occupational therapist at a community mental health clinic. She had been referred for rehabilitation following a lengthy hospitalization, with the goal of developing a meaningful daily life.
We started with goals related to physical fitness and overall wellness. As we achieved these initial goals, the process of rehabilitation opened up more possibilities for change.
Over time, Corina developed many new roles, including becoming a peer support worker, developing skills to start a small business, and ultimately becoming a peer support teacher and facilitator of peer-delivered groups.
Corina continued to have ups and downs, but with each period following stabilization, she was able to return more quickly to her valued roles and identities. And my role and relationship to Corina changed as her situation and recovery changed. During these times, she could be accurately labelled a patient or a client. However, she could also be labelled as a coworker, since I had hired her as a peer group facilitator; a mother, since she had reconnected with her children; a leader in her community, as she had joined an advocacy group fighting for people living in poverty; and most importantly, to me, an inspiration and role model for recovery.
Despite severe symptoms, with the right support and opportunities, Corina has demonstrated an ability to live a meaningful life and be an active citizen in her community. She is not an isolated example of what is possible in a recovery-oriented system. I regularly witness people with incredible stories of trauma, victimization and severe mental health symptoms who live beyond their illness. They lead purposeful lives, demonstrating resilience, recovery and humanity.
As we know, mental illnesses can be devastating to the individuals affected and also to their families. These illnesses create serious barriers to quality of life. One way people with mental illness and their family recover is by reclaiming, regaining and recovering the roles in their lives that lead to social inclusion, meaningful engagement in life and participation in their communities.
What gets in the way of recovery?
“Whether you think you can, or you think you can’t—you’re right.” – Henry Ford
For me as a clinician, this quote demonstrates a central goal of my paid health care work with people with disabilities: instilling hope and a belief that positive change is possible. I have found that the severity of a mental illness does not seem to predict a person’s ability to make friends, build connections and create a life they are proud of. Hope, belief and an opportunity can have a profound effect on recovery.
I am not suggesting that the ability and possibility for change resides solely within individuals or within their perspective. Nevertheless, the matter of the individual’s belief in the possibility for a better life is a central factor in the relationship between health care workers and their clients. As a health care worker, understanding the strengths and limitations of one’s role in the recovery journey is essential to understanding the concept of recovery. Health care cannot be relied on to provide family and community, and family and community can not be relied on to provide health care.
In the health field, clinical effectiveness is typically defined in terms of “correctness of diagnosis and appropriateness and efficacy of treatment and care provided.”1 I believe this kind of clinical effectiveness definition is common in our mental health system, but is not necessarily evidence of a “recovery” orientation. For me, a recovery orientation means not only living with an illness, but beyond the illness, extending the boundaries of “client-hood.” Having valued roles in one’s neighbourhood and natural community are examples of living beyond client-hood.
So what is recovery?
The term recovery means many things to many people. It is individually defined. One common thread among the people I’ve worked with, though, is the need to be valued and the desire to participate in our world with one’s unique assets.
To understand the concept of recovery for people with mental illness at this time in our society, I believe we can learn from the human and civil rights movement of African Americans in the United States in the 1960s. There were comparable issues with gaining basic human rights, a lack of power and voice, learned helplessness, and frequent misrepresentation in the media. The media often tended to place responsibility for change predominantly on the individual.
John McKnight writes, “Revolutions begin when people who are defined as problems achieve the power to redefine the problem.”2 The quote highlights the need for a change of perspective as a society given that the problem of mental illness is also predominantly situated on the individuals with the illness. This idea is also a key aspect of fostering peer leadership and stewardship (i.e., the responsible management of something entrusted to one’s care) as it relates to mental health recovery. For instance, peer leadership and stewardship may include opportunities for people with mental health issues to participate in mental health system reviews and health care improvement committees. It might also include focusing on positive examples of recovery from mental illness in the media.
Did you know?Occupational therapists are concerned with helping people to engage in their daily lives, on their own terms, in their own communities. Within the mental health system, the role of occupational therapy (OT) could include:
Therapists and clients both need to explore how success is defined. In a recovery-oriented system—in contrast to a clinical effectiveness system—a ‘successful’ story will include social inclusion in the local community, friendships within and outside of the mental health system, and purpose in life. In this system, rather than a few select leaders, what will emerge is a collective of citizens who are willing to share and lead via the wisdom in their wounds.
In my experience, a great deal of recovery is “kindled” in the community, person to person. As a health care worker, I have a role with my clients—to teach, to enable possibilities, to inspire and to instill hope. Ultimately, however, this work needs to tie into my client’s goals for valued roles in society and a meaningful life with friends and family. I hope that when my work ends at 5pm, my clients will have the skills and resource links to connect and be anchored in their community.
I believe I also have a role outside of my job, as a citizen in a society that misrepresents and misunderstands mental illness. I have often said that I do far more for my clients when I elaborate on mental health recovery outside of work—at dinner parties, the gym or just out-and-about in my community, for example—than I do when I’m working within health care. I seize occasions to let people know about health care effectiveness and how change is needed in society for this effectiveness to translate into changed lives. I believe that accepting a personal responsibility to advocate in this way is what provides the fuel, or kindling, that can support the flame of healing in the community to grow.
About the author
Stephen is the Occupational Therapy Practice Coordinator for Mental Health and Addictions in Vancouver Coastal Health. He is also an instructor in the post-degree diploma program in Psychosocial Rehabilitation at Douglas College
- Salvatori, P., Simonavicius, N., Moore, J., et al. (2008). Meeting the challenge of assessing clinical competence of occupational therapists within a program management environment. Canadian Journal of Occupational Therapy, 75(1), 51-60.
- McKnight, J. (1995). The careless society: Community and its counterfeits. New York: Basic Press.