Date Published: February 6, 2018
Publisher: Springer US
Author(s): Donal O’Keeffe, Ann Sheridan, Aine Kelly, Roisin Doyle, Kevin Madigan, Elizabeth Lawlor, Mary Clarke.
Little is known about how recovery oriented policy and legislative changes influence service users’ perceptions of mental health care over time. Although the recovery approach is endorsed in many countries, qualitative research examining its impact on service use experiences has been lacking. This study aimed to explore this impact as well as experiences of service utilisation and suggestions for change with people diagnosed with a First Episode Psychosis between 1995 and 1999. Participants had used services during the 10 year period prior to, and 10 years post, policy and legislative shifts to the recovery approach. Semi-structured interviews were conducted with 10 participants who met criteria for ‘full functional recovery’ and 10 who did not. Data were analysed using Thematic Networks Analysis to develop Basic, Organising, and Global Themes. Over time, recovered participants perceived an improvement in service quality through the ‘humanising’ of treatment and non-recovered participants experienced their responsibility in recovery being recognised, but felt abandoned to the recovery approach. Findings suggest the importance of viewing service users as demonstrating personhood and having societal value; examining the personal meaning of psychotic experiences; and matching expectations with what services can feasibly provide. The implementation and the principal tenets of the recovery approach warrant further investigation.
The recovery approach to service delivery, the recovery model, or simply ‘Recovery’ is the cornerstone of mental health policy in many Western countries (Le Boutillier et al. 2011) and recently has extended to Asia and Africa (Ministry of Health and Family Welfare 2014; Department of Health 2013). ‘Recovery’ based services seek to integrate the input of, and achieve the outcomes prioritised by, service users and their family in order to optimise mental health treatment. These tenets of ‘Recovery’ include: (i) practitioners holding optimism for recovery for all and respecting each service user’s uniqueness, personhood, expertise, and the personal meaning of their experience; (ii) services contributing to tackling the social, political, and economic barriers to citizenship, social integration, and inclusion; (iii) psychiatric assessments interpreting perceived deficits, pathology, and symptoms within a strengths and resilience framework; (iv) systems emphasising empowerment, collaborative decision making, self-determination, choice, and risk-taking in individualised, person-centred, recovery planning; (v) health care organisations prioritising access, engagement, continuity of care, and the incorporation of user led services; and (vi) discourse among practitioners reflecting a multiplicity of biological, psychological, social, and spiritual perspectives on the aetiology of ‘mental illness’ (Commonwealth of Australia 2013; Higgins 2008; Davidson et al. 2009).
Characteristics of the sample are displayed in Table 2. Differences between both groups reflect their clinical recovery status. Thematic networks for each question are summarised in Figs. 1, 2, and 3.
Findings illuminate the real world impact of policy and legislation changes on the lives of service users. While experiences are comparable between groups, perceptions of change over time are distinct, and recommendations for improvement are both similar and discrete. People who recovered clinically described predominant satisfaction; possibly due to them meeting society’s normative definition of recovery at time of interview and recognising the role of services in achieving this outcome. However, they also felt failed by the system at times. Recovered participants wanted a value based service centred on justice, equality, respect, compassion, and empowerment. Generally speaking, they felt they received it; but like previous research, they acknowledged that the system can undermine the capacity of staff to provide it (Williams and Tufford 2012). Funding problems and legal, clinical, and risk issues may pose key challenges to recovery orientation.
The optimism, egalitarian nature, and revolutionary spirit of the recovery approach have improved the lives of service users who have been able and willing to engage with its values and principles. It has promoted social justice for, and the citizenship and human rights of, individuals who have been disenfranchised by society while challenging practitioners to question how they understand and respond to distress. However, its implementation and central tenets warrant further investigation as some service users struggle to benefit from ‘Recovery’.