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Related Topics
Personal Recovery and Mental IllnessReview - Personal Recovery and Mental Illness
A Guide for Mental Health Professionals
by Mike Slade
Cambridge University Press, 2009
Review by Tony O'Brien RN, MPhil
Apr 27th 2010 (Volume 14, Issue 17)

How do you take a concept developed by consumers of mental health services and translate into something with utility for mental health professionals? This is no easy task, and author Mike Slade is well aware that for every assertion of consumer rights, for every criticism of mental health services, for every critique of the biomedical model of mental illness there is a response that attempts to maintain business as usual. Throughout this book Slade outlines the contemporary concept of 'recovery' and anticipates those responses. Personal Recovery and Mental Illness is a dialogue between different philosophies, different models, different value systems, and different ways of thinking about what traditional mental health services call mental illness.

The book is divided into four sections, with a total of 25 chapters, all quite brief, and each discussing a different aspect of recovery. It begins with an introductory section in which the critique of the traditional model is outlined and the concept of recovery is presented as an alternative. The conclusion of this section is that clinical and personal recovery are quite different, and so recovery, in the sense Slade is using the term, is not to be equated with a medical notion of cure; nor is it something professionals can provide, like a treatment program or a new drug. Recovery is personal to each person with mental illness, and the job of the professional is to offer what expertise they have while working with people on their self-defined goals.

Section Two contains six chapters, each with a different rationale as to why personal recovery should assume primacy as the preferred model of mental health care. Topics covered are epistemology, ethics, effectiveness, empowerment and policy. Thus all the traditional, and some of the newer streams of thought in mental health care are examined, in each case constructing a rationale for personal recovery. Slade is quite comfortable including aspects of traditional mental health care along with the new concept of recovery. Medication, hospital admission, even treatment without consent may be necessary for some people at some time. More importantly, personal recovery is about choice, and individuals may choose medication or hospital admission. But Slade asserts that choice should be informed, and there should be real alternatives, so that 'choice' does not become resigned acceptance from a very limited range of options. The final chapter in this section outlines how different countries have attempted to develop mental health policies informed by recovery principles.

The longest section, Section Three covers recovery-focused mental health services. Each of the 14 chapters explores application of recovery to various aspects of clinical care. In every case recovery provides an alternative that supports personal responsibility, respect for consumers' experience, and practice-based alternatives to traditional mental health care. Assessment is about validating personal meaning, rather than eliciting a list of professional-defined problems, crisis care is about maintaining hope rather than substituting professional decision making for personal responsibility, professional relationships are not about detachment and defensive boundaries, but offering professional expertise as a resource, and being open to whether and how consumers wish to use that resource. The book closes with a future-focused section in which concerns of consumers and clinicians are considered separately and a program is outlined to transform mental health services into services that support individuals in managing their own recovery.

The subtitle of the book A guide for Mental Health Professionals is perhaps the best indicator of its overall style. It is an exhaustive exploration of recovery that professionals could use in everyday practice. It is a platform from which to develop clinical services that truly focus on the needs of consumers rather than imposing solutions for professionally defined problems. On every page there is one more program or one more example of research or a practice model based on recovery. These are supported by over 600 references, so there is no shortage of opportunities to apply recovery concepts in clinical care. A criticism of the book might be that all this restatement becomes a little repetitive, and there is a good deal of overlap between the various tables and lists describing the examples used. But there can be no doubting that recovery is a fertile concept that has spawned a wide range of services and practices.

Slade is attentive to the perception of the notion of recovery among mental health professionals, in particular to the idea that professionals are generally motivated to do their best for consumers, even if their conceptual models, in Slade's view, lead them into error. Neither does Personal Recovery and Mental Illness shy away from individuals' responsibility for their own mental health. Recovery is not simply a matter of asserting rights and waiting for them to be satisfied. This aspect of recovery is one of the less recognized aspects of Szasz's views on madness, although Slade's overall program is quite different to Szasz's.

Personal Recovery and Mental Illness is recommended reading for all mental health professionals. They may not agree with everything in it, but they will find much to reflect on. Even in countries where there is government policy commitment to recovery, services and clinicians struggle to realize the ideals of recovery in practice. Slade provides many examples of where change can take place, whether driven by an individual clinician striving to give new meaning to engagement in care, or to managers attempting change at service level.

 

© 2010 Tony O'Brien

 

Tony O'Brien RN, MPhil, Senior Lecturer, Mental Health Nursing, University of Auckland, a.obrien@auckland.ac.nz


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