Mental Health, Recovery, and the Community

Abstract

The prevalence of mental health problems is high and causes profound health, social, cultural, and economic problems worldwide [1, 2]. Most psychiatric disorders are characterized by a chronic and complex nature and recurring episodes of acute symptoms. For decades, the treatment of mental health problems was primarily situated in residential services. Criticism of the so-called “total institutions” led to the downsizing or even the total close of institutions in favor of community mental health care [3]. Still, the number of psychiatric beds and hospitalizations remains high in several countries. Moreover, the treatment of mental health problems has traditionally been guided by a cure-oriented approach followed by rehabilitation efforts to reinsert individuals in society after substantial periods of hospitalization. In reaction against what is perceived to be an overly narrow biomedical model, the recovery movement emphasizes the importance of a client-centred approach, based on individuals' perceived needs and goal-directed practices that reflect clients' valued activities [4]. Instead of rehabilitation, in which clients' role in regaining control over their life is often neglected, recovery focuses on the question how individuals can have more active control over their lives (agency). Recovery has been defined as “a deeply personal, unique process of changing one's attitudes, values, feelings, goals, skills, and roles. It is a way of living a satisfying, hopeful, and contributing life, even with any limitations caused by illness” [5, 6]. It is characterised by a search for the person's strengths and capacities, satisfying and meaningful social roles, and mobilizing formal and informal support systems. Recovery has begun to have an influence in thinking more broadly about mental health care and how social inclusion can be promoted [4]. Research on recovery among various mental health populations and on effective strategies and interventions to promote recovery is still in its infancy [6]. Empowerment, hope, responsibility, peer support, advocacy, and quality of life have become predominant concepts in the recovery debate but remain poorly understood from a consumer's perspective. Treatment providers and key workers need to rethink their role as supporters of service users' personal recovery and require the skills and competences necessary for doing so. On the other hand, service users are considered to be the primary agents of their recovery process and need to employ personal and community resources for living a satisfying life. In this special issue, we present 11 original papers on the emerging topic of recovery from mental health problems and the role of community services and support. The contributions concern diverse mental health populations, including people with psychosis or schizophrenia, substance use disorders, offenders with mental disorders, and young adults with posttraumatic stress disorders. We focus on formal as well as informal systems for supporting recovery. Empirical data for this special issue were collected using quantitative as well as qualitative research methods and involve diverse stakeholders, including service users themselves. The papers represent contributions from various continents, illustrating the topicality and international relevance of recovery in the field of mental health care. Three areas of recovery research can be distinguished in this special issue. The first area addresses the conceptualization of recovery and how professionals, relatives, and society at large can be educated regarding the process of recovery from mental health problems. The second area of papers explores the lived experiences of individuals with mental health difficulties and the personal and community resources they employ to enhance their recovery process. The last area focuses on formal and informal support systems that may stimulate recovery among diverse mental health populations.