Comparing Personal and Clinical Recovery
Personal and Clinical Recovery
Explore the differences between clinical and personal recovery via the depiction of the lived experience in O’Hagan, Mary (2014): Madness Made Me New Zealand: Open Box Press
What are Recovery principles? How are these different from Clinical Recovery? Give examples from the Stories of Janet Version one and two. (pp221-228).
Comparing Personal and Clinical Recovery
Personal and Clinical Recovery
Mental health is quite different from physical health. In physical health, physicians focus on eliminating the symptoms of the problem. Recovery is measured by the lack of recurrence of the symptoms. Mental health recovery, however, focuses on helping individuals to stay in control of their lives even though they may continue to experience mental health problems. There are two different approaches to mental health recovery and clinical and personal recovery. This essay discusses the differences that exist between personal recovery and clinical recovery.
Clinical recovery was developed as a result of the expertise of professionals in mental health. The principle of clinical mental health recovery, just like in physical health recovery, is eliminating the symptoms, restoring one’s social functioning and becoming normal again (Deegan et al., 2017). The aim is to return the patient to the former state of health. The patient is hospitalized and medications are used in reducing symptomatology. However, this approach does not focus on the person or his/her preferences (Wyder et al., 2017). Intervention measures are defined by the health institution, including the rules and recovery paths. For instance, patients have to take medication whether they feel better from using those drugs or they feel worse (Perlman et al., 2017). For example, from the first story of Janet, she was roughly picked off the streets when she wore a showing dress and started blessing people as an angel. She was then injected with drugs that made her feel numb and drowsy. Even when she later complained that she did not like the drugs, the doctors insisted that she needed them to survive (O’Hagan, 2014).
In clinical recovery, the mental condition is not attributed to any root cause. Physical tests are carried out and evidence for the existence of the conditions are sought by experienced professionals. They do not open up to listen to the patient’s side of the story (Oates, Drey, & Jones, 2017). For example, when Janet tried to explain to the doctor that she had been sexually abused by her uncle, which could have contributed to her condition, the doctor just replied that there was no evidence of sexual harassment (O’Hagan, 2014). Instead of opening up to the patient and listening to their accounts of the problem, clinical care focuses on previously defined principles to achieve the patient’s recovery (Lim, Remington, & Lee, 2017).
In most clinical recovery institutions, the mentally ill patients are the ones blamed for their conditions (Isaacs, Sutton, Dilziel, & Maybery, 2017). When Janet’s friend, Emma, found her after attempting to kill herself by taking a big overdose and rushed her to hospital, the doctor was quick to state that it was a “…silly thing to do” (O’Hagan, 2014). Blaming the patient, however, only worsens the condition by making the patient feel rejected and stigmatized (Frost et al., 2017). It is for the sake of the blame that Janet was arrested from the streets, tied up and taken to a psychiatric ward, where she was locked up and injected with drugs she did not want. When a person with a mental problem ends up acting out their madness on the streets and are treated roughly, they start to feel they are not wanted by their own society. As a result, they often give up hope, which is the central requirement for a proper recovery (Grealish et al., 2016).
The concerns of the patients are often treated at the result of their psychosis. Whenever they express that they feel like killing themselves, or that they wish to go home or see their relatives, they are often told to relax and the feeling would go away with time. The issue is, telling a mentally ill person to relax is just like telling a penguin to fly. Janet was told to make herself a cup of coffee when she called the crisis team and reported that she wanted to kill herself. Her case was not even treated with any amount of emergency, and when she had overdosed herself, Emma was only told to call the ambulance. The doctor required that she stayed overnight but she was not seen by the doctor till when Emma returned the next day. The reluctance alone could have killed Janet, and made her feel there was no help for her situation. Many of the mentally ill patients who receive clinical recovery procedures end up in similar situations as Janet’s case quite often because of the reluctance and procedural approaches followed (O’Hagan, 2014).
This is a recovery that is coined from the lived, subjective experiences that people have had with mental illness and recovery. It takes into account the challenges at recovery and the notion of the instance of a permanent mental illness. The desired outcomes include hope, empowerment, choice, healing, goals defined by self and control of symptoms (Enticott et al., 2016). Other objectives include changing the attitudes, feelings, values, skills, goals and roles of the person. As a result of personal recovery, one may live a hopeful, satisfying and contributing life with or without the limitations that have been introduced by the illness. The recovered person develops a new purpose and meaning to his or her life as he or she overcomes the drastic effects of mental illness (Mental Health Foundation, 2017).
In personal recovery, there is no single procedure or defined way of handling the mental illness problems. The professionals only focus on supporting recovery instead of driving it. Despite the serious mental problem, the patient is given a hope that they can regain a meaningful life. Personal recovery respects the uniqueness of the person. It accepts the fact that cure may not necessarily be the entire focus of recovery, but it is focused on providing opportunities for choices so that the patient can live a meaningful life that is both satisfying and purposeful. The individual also needs to be kept aware that he/she is a valued member of the community despite the illness (Biringer, Davidson, Sundfor, Ruud, & Borg, 2016).
The providers of personal recovery also accept that the outcomes of recovery are personal and each individual has unique outcomes. It is not an exclusive focus on health like clinical recovery, but goes as far as including an emphasis on the quality of life and social inclusion. Individuals are empowered to recognize that they are in control of the care given to them (American Psychological Association (APA), 2012). In Janet’s second story, Emma helped Janet to visit rockup.com, a place that depressed and people feeling suicidal could visit for help, the personal care began on the onset. The local Rock Up wished to call her, but she was the one to choose whether they could phone her or not. She was not even the one to make the call. Being given the power to make the choices is effective in making the patients feel they are in control (Yam et al., 2016).
The patients should be given the opportunities to make choices about the lives they want to lead. The choices are only guided so that they are creatively explored and are meaningful. Individuals are helped to build on the strengths they have and be as responsible for their lives as they can. For example, when Janet felt she could not bear the pressure of school anymore and went out blessing people, she was not discouraged from doing that, but was encouraged to take some rest. When she wanted to continue the next day, she was allowed to go ahead but was accompanied by someone to ensure she did not get lost or run into any risk (O’Hagan, 2014). This is unlike clinical recovery that involves locking up anyone who has a mental breakdown.
Personal recovery also respects the rights and attitudes of the patient. The care providers listen to the patient and learn from the communication from the patient and their caregivers (Mak, et al., 2017). The information is used to learn about what is important to the individual. Janet got the opportunity to share with the peer support worker about the sexual abuse she had undergone when she was young. The information was used to refer her to the right therapy. When she complained that the drugs for the psychosis were not favourable to her, the clinical worker reduced the dosage and emphasized that she attend the organized therapy (O’Hagan, 2014). These are privileges Janet could not get in the clinical recovery option in the first story.
The patient’s legal, human and citizenship rights are also protected and promoted. In many institutions, the mentally ill patients are often locked up in psychiatric wards or staffed residences where they are denied so many comforts of life and rights (Jahn, DeVylder, Drapalski, Medoff, & Dixon, 2016). Most of them, just like Janet in the first story, are not allowed to even see their relatives or go home. They are required to attend organized social events even if they have no interest in them and have to live by rules that have been set by an institution. Personal recovery ensures that all patients continue to enjoy their legal, citizenship and human rights even when they are in residences where their recovery progress is monitored (McKenna, Oakes, Fourniotis, Toomey, & Furness, 2016).
The places where the care is provided are also designed in ways that they do not shout of the mental illness they are designed to cater for. When patients visit, they feel that they are still in the confines of their usual communities. They can go ahead and socialize with one another, share experiences and make new friends. The diversity at Rock Up was quite welcoming, unlike the monotony of psychiatric hospitals. Janet already felt a hope that she could be helped by the way she was treated from the word go. To further give Janet hope, she the first person she met was a peer support worker, who had gone through a similar experience as her and overcame (McKenna, Oakes, Fourniotis, Toomey, & Furness, 2016).
All the patients are treated with dignity and respect. The care providers are courteous, honest and respectful at all times. They are sensitive to and respect each individual and challenge any instances of discrimination and stigma in their services or within the community at large. Personal care is based on partnership and communication. The care is provided in partnering with the patient. The professionals also provide environments that promote communication from the patients. When patients communicate their values and preferences, these are worked with to provide them with the care they want, not care that has been predefined as in clinical recovery (Jahn, DeVylder, Drapalski, Medoff, & Dixon, 2016).
health care institutions that deal with mental illness have been focusing on
providing clinical recovery, which emphasizes returning the patient to his/her
former health condition. However, this kind of care has made many patients
hopeless and degraded. Personal recovery, in which the patient is given care
that is unique to his or her own values, experiences and preferences, has
proven to be more effective. Giving the patient a hope that they can recover
from their mental illness and allowing them to choose the kind of life they
want to live has helped many patients to live purposeful and meaningful lives
despite their mental problems. Personal recovery can be even more effective if
provided together with clinical recovery.
American Psychological Association (APA). (2012). Recovery principles. Available at http://www.apa.org/monitor/2012/01/recovery-principles.aspx
Mental Health Foundation. (2017). Recovery. Available at https://www.mentalhealth.org.uk/a-to-z/r/recovery
Deegan, Carpenter-Song, Drake, Naslund, Luciano, & Hutchison. (2017). Enhancing Clients’ Communication Regarding Goals for Using Psychiatric Medication. Psychiatr Serv.
Wyder, Ehrlich, Crompton, McArthur, Delaforce, Dziopa, Ramon, & Powell. (2017). Nurses experience of delivering care in acute inpatient mental health settings: A narrative synthesis of the literature. Int J Ment Health Nurs.
Perlman, Taylor, Moxham, Patterson, Brighton, Heffernan, & Sumskis. (2017). Innovative Mental Health Clinical Placement: Developing Nurses’ Relationship Skills. J Psychosoc Nurs Ment Health Serv, 55(2): 36-43.
Oates, Drey, & Jones. (2017). ‘Your experiences were your tools’. How personal experience of mental health problems informs mental health nursing practice. J Psychiatr Ment Health Nurs.
Lim, Remington, & Lee. (2017). Personal Recovery in Serious Mental Illness: Making Sense of the Concept. Ann Acad Med Singapore, 46(1): 29-31.
Isaacs, Sutton, Dilziel, & Maybery. (2017). Outcomes of a care coordinated service model for persons with severe and persistent mental illness: A qualitative study. Int J Soc Psychiatry, 63(1): 40-47.
Frost, Tirupati, Johnston, Turrell, Lewin, Sly, & Conrad. (2017). An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges. BMC Psychiatry, 17(1): 22.
Grealish, Tai, Hunter, Emsley, Murrells, & Morrison. (2016). Does empowerment mediate the effects of psychological factors on mental health, well-being, and recovery in young people? Psychol Psychother.
Enticott, Shawyer, Brophy, Russel, Fossey, Inder, Mazza, Vasi, Weller, Wilson-Evered, Edan, & Meadows. (2016). The PULSAR primary care protocol: a stepped-wedge cluster randomized controlled trial to test a training intervention for general practitioners in recovery-oriented practice to optimize personal recovery in adult patients. BMC Psychiatry, 16(1): 451.
Biringer, Davidson, Sundfor, Ruud, & Borg. (2016). Experiences of support in working toward personal recovery goals: a collaborative qualitative study. BMC Psychiatry, 16(1): 426.
Yam, Lo, Chiu, Lau, Lau, Wu, & Wan. (2016). A pilot training program for people in recovery of mental illness as vocational peer support workers in Hong Kong – Job Buddies Training Program (JBTP): A preliminary finding. Asian J Psychiatr.
Mak, Chan, Wong, Lau, Tang, Tang, Chiang, Cheng, Chan, Cheung, Woo, & Lee. (2017). A Cross-Diagnostic Investigation of the Differential Impact of Discrimination on Clinical and Personal Recovery. Psychiatr Serv, 68(2):159-166.
Jahn, DeVylder, Drapalski, Medoff, & Dixon. (2016). Personal Recovery as a Protective Factor Against Suicide Ideation in Individuals With Schizophrenia. J Nerv Ment Dis, 204(11): 827-831.
McKenna, Oakes, Fourniotis, Toomey, & Furness. (2016). Recovery-Oriented Mental Health Practice in a Community Care Unit: An Exploratory Study. J Forensic Nurs, 12(4): 167-175.
O’Hagan, M. (2014). Madness Made Me. Open Box Press. New Zealand.