Recovery Attitudes and Recovery Practices Have an Impact on Psychosocial Outreach Interventions in Community Mental Health Care.

Emmanuelle Khoury

doi:10.3389/fpsyt.2019.00560

Abstract

The most recent mental health policies implemented in the province of Québec, Canada, have emphasized recovery-oriented mental health practice. Part of this impetus has resulted in significant importance placed on the development of community mental health models in the public health system. The forms of community mental health programs have evolved considerably over time in Québec but are largely inspired by the evidence-based model of Assertive Community Treatment (ACT). However, if mental health policies and programs in Québec are now emphasizing the role of community mental health, it is also clear that actors on the field are implementing the evolving practice paradigms that dominate our mental health policies, such as recovery, participation, citizenship, in a variable way (1, 2). This article presents an ethnographic inspired research study conducted in 2014 and aims to contribute to the understanding of how recovery-oriented mental health policies are understood and implemented in an ACT team in downtown Montréal, Québec. With the aim of developing integrated knowledge on the issue of recovery in mental health and the conditions it presupposes, this research draws on field experiences from various actors, including service users with severe mental health problems, typically with concomitant disorders and complicated by substance use and/or living in a situation of homelessness. Using a critical constructivist approach, the research sought to a) explore how participants (stakeholders, users, and psychiatrists) achieve their social order; b) understand the meaning of recovery in mental health for participants and the actions associated with recovery as a process or as a practice; c) apprehend the potential of community interventions to connect the individual to the collective. The results indicate that the (over)use of medicolegal tools and the unchanging conception of “madness” represent obstacles to the sustained development of interventions centered on the person, his living conditions, and his recovery. Nevertheless, many interactions between service providers and service users indicate the potential for emerging recovery-oriented practice interventions, particularly when those interactions are based on positive and egalitarian conceptions between service providers and service users that led to the development of spaces for the co-construction innovative practice approaches.

Highlights

The concept of mental health recovery is the dominant organizing principle for public mental health services in many countries [1]
My findings related to the subjective participant meanings and accomplishment of recovery-oriented mental health care that are embedded in this dynamic active state
These three elements, flexibility in practice, complexity of practice, and relationships in practice, are located at the intersection of difficult practice moments, which I refer to as “practice tensions.”. These three elements sum up the particular nature of the culture of intervention of an urban Assertive Community Treatment (ACT) team with a population experiencing complex mental health problems and social problems as well as the meanings and actions involved in recovery-oriented attitudes and practices

Summary

Introduction

The concept of mental health recovery is the dominant organizing principle for public mental health services in many countries [1]. This has resulted in important changes in the strategic direction and in the practice guidelines of mental health delivery systems. The literature has supported the idea that, an individual will go through the process of recovery, professional intervention can facilitate this process [3,4,5,6] This requires certain critical values focused on egalitarian and relational attitudes [6], hope, implication, and relationships [7] that are supported by both training and organizational structures [1]. There are documented difficulties in implementing a recovery-oriented practice approach [1, 8,9,10,11] that has led to misapplications, misunderstandings, and critiques [12, 13]

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Discussion

Conclusion