The recovery model, a person-centered approach to treatment of an individual with mental illness, stems from the psychosocial rehabilitation model, at least in part, as per Marvin Elias, Clubhouse director at Chestnut Place in Philadelphia.
Recovery is about a person asserting the maximum control over his/her treatment. It is a way of living a satisfying, hopeful life despite symptoms of illness. 1
The recovery model is extensively discussed in the literature and considered an integral part of community-based mental health treatment. Its use is specifically seen in Clubhouses, as I witnessed during a recent visit. I spoke with the director and a member of very good standing, who told me her story:
"Recovery is a lifelong journey. It is a lot of different things to a lot of different people. I have PTSD, used drugs and alcohol-my life was a mess. I got my life back with the Clubhouse. Recovery is being independent, free, being able to go into your records. We can participate in whatever we want."
This member's recovery process has led her to hold a position on the advisory board of the Clubhouse and the Pennsylvania Board of Mental Health. She is a founding member of the Pennsylvania Clubhouse Coalition and has written grants to expand Clubhouse services. She fits the textbook definition of someone who truly has developed new meaning and purpose in her life as she has risen above the catastrophic effects of her illness. She has blossomed with the choices/opportunities that she has found so readily at Chestnut Place.
At the Clubhouse, members are expected to voice their opinions in all aspects of the operation, whether through working in the various units such as clerical, food service, education (to name a few), participating in transitional employment, or engaging in available leisure activities. Such assumption of control and active engagement in daily life is a vital part of the recovery process.
Elias noted key aspects of the recovery model as applicable to the Clubhouse approach:
It allows a chance for members to make a choice to take initiative.
An environment that fosters making choices is at the central core of the model, and is conducive to the exploration of many opportunities.
It is vital to acknowledge that everyone's values, perceptions, wants, needs and expectations may be different. Individual assessment and planning is key; it is important to recognize everyone has abilities that may be unique.
When asked if there are any downsides to the Recovery Model, Elias responded, "It has the potential to become an 'ism.' It would be a mistake to attribute everything to the environment and disregard the role of genetics/biology in the recovery of individuals."
The recovery model is viewed as less applicable in an inpatient setting yet still integral in the treatment of many individuals. The medical model takes precedence in acute psychiatry due to the short lengths of stay, the severity of symptomatology, and frequent lack of insight on the part of patients admitted in highly acute states.
So how do we reconcile use of the evidence-based medical model with the recovery model? Specifically, how do we effectively treat acutely ill individuals in an inpatient setting when perhaps they are minimally able to make decisions or exercise good judgment regarding treatment?
Some, like Frederick Frese, a consumer and psychologist, would say the two models are compatible. That is, there is a continuum of recovery that would support the gradual regaining of control over one's life as the person becomes responsive to external interventions. The inpatient treatment team should respond with allowing the client increasing opportunities to make decisions and encourage internal locus of control.2
As occupational therapists, how can we facilitate such use of the recovery model in an inpatient setting? Initially, one can grade activities to provide just the right amount of simple decision making in structured activities, particularly craft/task groups and cooking groups. The therapist may then seek out opportunities for patients to have increased autonomy, such as encouraging patient choice of contributions to be made in prevocational groups or creative community projects such as poster making, unit decorating, or newsletter production.
Further chances for the patient to assert control over his/her treatment could occur in the guided assumption of community leadership roles. As president or vice president of the community the individual can suggest areas for improvement/change, respond to peer concerns, and help set a positive tone in the milieu.
These are just a few examples of how an OT can apply the recovery model to daily interventions in order to help individuals begin the long journey into recovery.
1, 2: Frese (FJ) et al. (2001). Psychiatric Services. Vol. 52(11). 1462-68.
Teresa Hanssens, MS, OTR/L, has practiced in the area of mental health for over 15 years. She is currently employed full time at the Hospital of the University of Pennsylvania. Teresa has experience in both inpatient and community-based settings, and developed the first OT program in one of Philadelphia's largest community mental health center's partial programs. Teresa has been interested in further exploring the psychosocial aspects of occupational therapy in the acute care setting. She has served as adjunct faculty at several Philadelphia OT programs, and enjoys her role as guest lecturer on mental health issues. Readers may contact her @ 215-662-2814 or Thanssens@msn.com.