What is it about?
Recovery as a concept can be understood in different ways. It can be described as a model, paradigm, phenomenon, philosophy, ideology, approach, tool and/or a field of knowledge based on experience. Skeptics claim the concept is only a myth. The concept, however, is nothing new. This can be illustrated by the fact that people suffering from mental health problems for a long time have known they can get better. Findings from several longitudinal studies and research from work related to mental health issues for over 50 years show the same: people with mental health problems can get better, with or without professional help. When talking about getting better, we turn our focus away from the term “healthy”. Recovery is about living with challenges, rather than “getting rid of it” and living without. It’s about living a good life despite your struggles.
However, mental disorders, like schizophrenia, are often referred to as chronic. Longitudinal studies conducted in 2007 by Davidson and Roe show that between 45-65% of people with a schizophrenia diagnosis get better. Courteney Hardings’ study and findings from 1987 are central to recovery-related research. Harding found that between 53-68% of the people got better. Such results are also found in other studies, like in a multicenter study including 18 major patient groups. These groups were located all over the world, in both developing countries and industrialized countries, and the findings showed that about 50% of the informants experienced getting better.
Recovery’s origins are rooted in the 1960s rebellion against injustice and lack of recognition and treatment in psychiatry. The activism was about fighting for the same rights as others and good help for people with mental health/substance abuse issues. They protested against drugs and institutional treatment, which traditionally was the only treatment option at that time and age. The development of mental health services has also contributed to an increased interest for the recovery-concept, and establishing more services in local areas has been an important factor. Increased focus on human rights and user involvement in mental health care are also key elements. Recovery is closely linked to several other concepts, such as resilience, salutogenesis, empowerment, rehabilitation, health and well-being, cooperative practices and family and networking.
The fact that people with lived experience for a long time have known they can get better can illustrate something unique about recovery as a research area and the development of recovery as a concept. Recovery is about people’s experiences with mental health problems and what they think is important in order to cope with their challenges and live a good life. Therefore, an important part of recovery is working for lived experience to be recognized as a valid perspective. This is about acknowledging the individual’s own experience in personal processes and validating user knowledge in society. The “Availability Project” at KBT has this as a goal, and is currently summarizing findings from 20 User Interviews User surveys about the strengths and weaknesses in health care services. Several concepts defined by service users as strengths and key elements in health care services can be linked to recovery-oriented practices, including shared decisions, social contact and opportunities for personal development.
In American research environments, one began to focus on recovery as an approach in the 1970s and 1980s. Patricia Deegan is a pioneer who has been an activist for the recovery concept in mental health care on the basis of her own recovery process after being diagnosed with schizophrenia. She has been particularly concerned with fighting for people with disabilities’ rights and innovation related to recovery-oriented services, including electronic/online services at “Pat Deegan PhD & Associates” in Massachusetts. William A. Anthony has the same interest and has formulated one of the most cited definitions of recovery:
- Recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.
Quotations as cited are derived from Borg, Karlsson and Stenhammers’ systematic knowledge collection Recovery-Oriented Practices (2013), which has been the most comprehensive material in Norwegian in this field. In recent years, especially in British and Nordic research, one has been more concerned with rights, civic, social and contextual relationships. In February 2018, the Norwegian Directorate of Health reports in a news case based on the 2017 public health report that: “social inequalities in habits and living conditions contribute to social inequalities in health […] In the effort to reduce social health differences, it is necessary to focus attention on the causes”. They highlight inequalities and decline in economic living conditions, as well as an increase in disadvantaged children adolescents during upbringing, as worrying developmental features for the Norwegian population’s health that will require greater efforts and measures.
The second dimension is that no human being should be characterized as “so chronically ill” that they can’t live worthy, independent and meaningful lives in local communities. The definition of other people and normality in society is therefore important; who determines what is normal and abnormal, what we should achieve and what our lives should look like? The recovery philosophy is based on the fact that we are first and foremost human beings, we are all different, and what goals we have and how to get there must therefore be up to each individual. Recovery-oriented practices are based on the fact that all people have the same rights, and everyone has competence, recourses and potential to grow. This also means that people independently through a recovery process try to find out what they want in life, find opportunities and environments that lead to empowerment.
There have been formulated different definitions of the recovery concept. ImROC (Implementing Recovery through Organizational Change) in England defines recovery like this: “recovery is about creating a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing symptoms or problems”. Another known definition is the CHIME-framework, developed in 2011 by Leamy, Bird, Le Boutillier, Williams and Slade:
In 2011, Le Boutillier et al. went through 30 documents from six different countries for analysis and found the following four principles for recovery-oriented practices:
- Promoting Citizenship
- Organizational commitment
- Supporting personally defined recovery
- Working relationships
In terms of Norwegian health and welfare policy, recovery has traditionally had a modest role. This is briefly mentioned in national guidelines for treatment (including the 2012 ROP-guidelines [Guidelines for people with simultaneously mental health and substance abuse problems] and the guide “Sammen om mestring” [Together for Recovery] from 2014. However, key focus areas in mental health from the last 30 years include important principles for recovery-oriented practices. NOU 2001:22 “Fra bruker til borger” [From user to citizen] suggests different strategies to promote the opportunities for people with disabilities to participate, inclusion and equality in society. This is also found in areas such as “Opptrappingsplanen” [National Escalation Plan] from 1998 and the 2009 “Samhandlingsreformen” [Cooperation Reform]. Common to these is that they include and emphasize concepts like humanism, services in local communities, human rights, service user and patient rights, involvement, social inclusion and participation. In “Sammen om mestring” [Together for Recovery] from 2014, it is recommended that the recovery perspective should characterize the services. In this way, recovery is well rooted in political guidelines in Norway.
Borg, Karlsson and Stenhammer (2013) write that there are different approaches to the development of the recovery concept, and they argue this is based on two different sources: the mental health services, and service user experiences and lived experienced-based knowledge from grassroots movements. The first mainly focuses on results, while the other source in concerned with mobilization and dedicated to being listened to, recognized and believed to be worthy citizens. This leads to the development of three different recovery approaches that often appear in service development and mental health related research: recovery as a personal/individual process, recovery as a social process and recovery as clinical recovery.
Recovery happens where people are. The process is both individual, and social together with family, friends, colleagues and/or health professionals. In other words, in the society.
Personal recovery is about the actions, efforts and patience that one takes to get better. Such perspective to recovery-oriented practices separates from academic and research perspectives in the way that they often have basis in the biomedical perspective, and is characterized by services to be governed by demands of efficiency and measurable results.
Emphasized in personal recovery is faith in the future, the matter of hope, establishing a positive identity and self-control. It’s about having somewhere to go in everyday life that gives life meaning, to belong somewhere and be in use for something benefiting others. Working life and jobs are important areas, offering power and possibilities; to commit to something, and that others believe in you and expect something from you. Karlsson, Borg and Stenhammer (2013) write that personal recovery can consist of three different stages: to overcome being stuck, to find and take back the lost, and to be able to have good quality of life despite the limitations of problems. The first one is about accepting the struggles and current life situation. In this stage, the desire for change, finding courage and hope are important. The second stage is about taking responsibility, discovering ones possibilities, taking back authority and control, aiming to find ways to make things work in everyday life. The last stage is about well-being and being satisfied with oneself. In User Interviews User – Evaluation of Sagatun Brukerstyrt Senter in 2017 [Sagatun Peer-Driven Center] the service users of Sagatun were asked how they define recovery, and especially one of the answers clearly reflects these three stages: “Recovery will be something to get back to… a step where you were satisfied. But now, that’s not exactly what I want either. I want to get, not back to a place where I was satisfied, I want to move forward to a place where I can be satisfied with who I am now.”
Summarized, personal recovery can be described as different dimensions, entailing belief in one’s possibilities, hope, meaning, development, self-control, and accepting the difficulties (and these being just a limited part of one self). Relational recovery is one key element, which is about how interactions with others and the social context affect conditions of living and enabling the desired life. Here, experiencing affiliation and to build, maintain and repair relations are important; to love someone and having someone who loves you. In personal recovery, the main element is the person’s own efforts, but help and support from health professionals can be an important part of the process. The 6th of February 2017 at Gardermoen, the peer-driven centers were gathered to listen to Marit Borg talking about health professionals as “lobbyists”. This is about what health professionals do to enable and support service users’ meanings about and effort to well-being and dealing with difficulties. Important factors are support, guidance, empowerment, understanding, motivation and help in finding opportunities.
In recent years, there has been an increasing focus on recovery as social processes. The effect of society factors, social processes and living conditions on recovery has been emphasized in several Nordic studies. NIBR-rapporten Psykisk sykes levekår [NIBR-report Living conditions of mentally ill] from 2008 and data from Helse- og levekårsundersøkelsene i 1998, 2002 og 2005 [Surveys of health and living conditions from 1998, 2002 and 2005] show that people with mental health and substance abuse problems have poorer living conditions, health, education, income, social life and access to somatic health services. On average, this group has a life expectancy 20 years shorter than others, and are overrepresented among the homeless.
The social model accentuates in larger degree mental and physical disabilities as a civic problem, caused by lack of social inclusion and ability to facilitate. By this, a person’s disability is not necessarily to be a disability in the society, like at the workplace. Aspects as housing, education, income, social arenas, work, activities, local community, family and friends are substantial to people’s recovery process. This is stated in studies that show recovery happens in life in general, not only in treatment institutions. For example, how can one be able to work with mental health/substance abuse problems, if there is not enough money on the table to care for own children? Living conditions and health clearly interrelate, leading to a need for the society to work on these areas. Housing is one of the areas given larger focus in recent years. Opptrappingsplanen for rusfeltet 2016-2020 [National Escalation Plan for Substance Abuse 2016-2020] states that by the service users’ point of view, safe and stable housing are the most important first steps in a recovery process, and the increase of municipal housing enhances recovery, also reducing the number of inpatient admissions. In the strategy Bolig for velferd [Housing for Welfare] from 2014, national goals and priority areas for the work of social housing are enshrined. Good examples on this work and the housing services in Norway are to be found on their web page.
In 2005, Helen Glover introduced the term “recovery-nurturing environments”, which illustrates a separation between environments that nourishes development, hope and growth, and environments that create barriers and violations. In the first one, key terms are social and material conditions and fellow citizenship. Tew et al criticize the individual/personal perspective on recovery, claiming it is too easy to say the person alone is in control of his/her own life, affiliation to social areas and a positive identity formation. However, they say that social conditions and surroundings are the prerequisites for the recovery process. Tew et al also refers to publications that portray social factors as both promote and inhibit humans` development. To be able to control one’s life, one have to be in a society that allows such development. A society absent of discrimination and stigma are fundamental factors for people to reestablish positive and social identities. With a social approach to recovery, one sees that the possibilities for recovery depend on the environment around the person. This tells us that there are people that have knowledge, understanding and possibility to support the person in his/her recovery process. In 2005, Beresford presented three different models for understanding social recovery, with following key points:
- There is often a correlation between mental health problems and events in life.
- Mental health clearly interrelate with social roles, work status and class.
- Social and civic impact are key elements for people to get and continue to have mental health problems.
Community and social inclusion is an important part of social recovery. To belong and being part of something is a basic need in human, and being someone and being something for someone are of great importance in life. This can entail finding a community by work, interests and hobbies, religion and belief, games and social media. Oppfølgingsplan for arbeid og psykisk helse 2013-2016 [Follow-up Plan forWork and Mental Health 2013-2016] says that taking part in work improves mental health, economical safety, living conditions and quality of life. Therefore, facilitating to enable people with mental health or substance abuse problems to work and be included are a corporate social responsibility and important priority for public health. There are several important measures to make this possible: reduction of negative consequences for drug use, strengthening of NAV, more facilitating on the workplace, more opportunities for work training for people with disabilities, increased use of graduated sick leave rather than full sick leave, Individual Placement and Support (IPS), employer empowerment, and closer collaboration between various health and social services about prevention, early intervention and coordinated follow-up.
One measure in social recovery is community centers, a place for people with mental health and substance abuse problems to gather, participate in creative and physical activities, groups, meals and various courses to empower oneself and cope in everyday life. These places are low-threshold services regardless of referral, decisions or diagnosis. Community centers can be a recovery-nurturing environment, although it is also discussed whether they contribute to social recovery or if it becomes more of a “repository” where one does not move forward. This is largely related to own efforts and the way the centers are used. User Interviews User-Evaluation of Sagatun Brukerstyrt Senter [Sagatun Peer-Driven Center] from 2017 shows how community centers can be a successful recovery-nurturing environment, where people with mental health/substance abuse problems experience development, coping and hope from a community. Those who used Sagatun said that it helped them regain the desire to live, motivation, hope, supportive relationships, new perspectives and personal development. Being part of something, creating something together and contributing to something useful through commitment by expectations from other people was highlighted as effective. Community centers was also pointed out as a possible “intermediary place” in a stage between being in treatment and getting a job, to work with oneself and be in recovery without too much pressure from others. Other examples of community centers are Sommerstua, Heimdal and Veiskillet in Trondheim municipality, and at Vårres Brukerstyrt Senter [Vårres Peer-Driven Center] north in Trøndelag, south in Trøndelag and in Møre and Romsdal.
Clinical recovery has been developed by treatment and rehabilitation environments, and result orientation, performance goals and treatment effect are key issues. This approach differs from both personal/individual recovery and social recovery as the services often use quantitative, objective goals to evaluate whether a person is “healthy”/”healthier”. Clinical recovery is in many ways an adaption to the increasing standardization and efficiency requirements in the services. In 2009, Slade describes clinical recovery with four main features: that the process is a condition or result, that it can be observed, that it can be assessed by a professional, and that it is equal to more (it does not vary between people). The recovery process is observed and measured through operationalized findings, including absence of symptoms, functionality in various social settings (work, home affairs) and social network. Based on a traditional clinical perspective there has been little or no focus on people’s experience with mental health care, but researchers are increasingly interested in developing goals that are more relevant to individuals and, as such, reflect a multi-dimensional recovery understanding. Such an understanding can be created through the use of instruments that measure personal recovery as well as instruments that measure recovery orientation in various health and welfare services.
Tools/measures for clinical recovery:
- INSPIRE: Measurement tool to evaluate the individual’s experience with support from their health and social worker with regards to recovery.
- SURE: Assessment form in which service users with substance abuse problems can map out and evaluate their own recovery process, alone or with professionals in treatment.
In health care services
Implementation of recovery-oriented practices in health care services presupposes a change in practice in the form of new procedures and routines. This requires elevation of professional expertise on recovery in order for the service to get recovery as a basic idea and method of action in treatment. “Sammen om mestring” [Together for Recovery] (2014) states that “The recovery perspective assumes that the service provider considers the service user an expert on him/herself and conveys the belief that he or she can develop and get a better life. The relation between service user and service provider must be characterized by equality, openness, honesty and trust. The service provider must assist the service user in developing skills, networks and support, so that he or she can take responsibility for his or her own life”. The guidelines further recommend cultural change in the services focusing on language, interaction and cooperation and integration of lived experience. In 2015, Sandnes municipality developed a guide for recovery-oriented practices where they describe the following with regards to implementation:
- Work on values.
- Integrate these values in practice.
- Design practices using systematic feedback, meaning continuously checking if the server user’s needs are met and adjust the practices according to his or her wishes and goals.
On October 3, 2017, Professor Kjell A. Rørvik held a lecture on “Conversion and Implementation: The difficult implementation in mental health work” at the conference «Utvikling og bruk av kunnskap i psykisk helsearbeid» [Development and use of knowledge in mental health work]. In his lecture, Rørvik points out that mental health and substance abuse are fields that deal with very complex problems and issues in terms of professions, cultures, geography, actors and departments. Rørvik therefore says that demands for streamlining in health care services and standardization thus give tension with recovery, and may pose a greater challenge with implementation of recovery-oriented practices.
Ways, methods and arenas that focus on this:
- Peer Support Specialists – Both politics and research emphasize employment of people with lived experience as an important factor in recovery-nurturing practices. Interaction with peers and meeting others with lived experience is valuable in the way that it gives an increased sense of understanding, recognition, inspiration, faith and hope of getting better. Peer Support Specialists can work in several ways as bridge builders between service users and service providers as well as contribute to attitudinal changes in the services.
- Recoverymentor (Denmark) – Recovery mentor is an example of peer support where peer support specialists are hired in housing, in-patient treatment and FACT in Denmark. Here they work with individual conversations, course of group treatment and teaching others about recovery, and act as a link between patients, employees, relatives, the community and services. The services experience that recovery mentors help strengthen the understanding of patients and citizens, increase hope for patients and employees, increase focus on resources and opportunities, bring attention to terminology and procedures, as well as reflect on how employees think and practice.
- Erfaringsskolen [The school of Lived Experience] – A pilot project aiming to give people with experience as service users in mental health and/or drug abuse a professional basis that enable them to provide peer support. Through practice the students will experience how to utilize lived experience when meeting users/patients. The school runs over 15 weeks with teaching and practice three days a week. Funded by innovation funds from the County Governor of Oslo and Akershus.
- Medarbeider med brukererfaring (MB) [Peer Support Provider] in Bergen – This program qualifies participants to work in interdisciplinary rehabilitation in mental health and drug abuse services. The participants learn to use their lived experience as competence based on knowledge from their own recovery process. The program runs over 12 months and corresponds to a 50 % working position. The program consists of theory, practice and a project assignment.
- IMR(Illness Management and Recovery) – Treatment and approaches that take place individually and in groups, with focus on self-determination, empowerment, knowledge about own illness, motivational techniques and cognitive strategies.
- MI (Motivational Interviews) – Conversation between professionals and service users with focus on motivation, change and coping. The purpose of this method is to make the service user reflect on his or her life and to create a desire for change, as a professional avoids conducting routines, argumentation, persuasion and solutions. Key elements are acceptance, curiosity, compassion and partnership.
- Reflection cards – Tools to stimulate discussion about recovery in services, for both leaders and employees in collaboration with service users. The cards consist of statements and issues that deal with definitions of the concept, values, attitudes, user perspectives, ethics and recovery-oriented practices.
- Peer-driven measures
- Learning networks, networking and conferences
- Kommunalt Recoveryorientert Nettverk (KRON) [municipal recovery-oriented network] – Bydel Gamle Oslo, Health Council in Oslo, Bærum Municipality, Asker Municipality, Sandnes Municipality and Bergen Municipality in cooperation with NAPHA [Norwegian resource centre for community mental health] and University College in Buskerud and Vestfold.
- Kommunesektorens organisasjon (KS)’ læringsnettverk “Recovery” [The Municipal Sector Organization (KS)’ learning network].
- Regional recovery network: KBT has taken the initiative to create a recovery network for the region of Central Norway, which aims to gather actors with an interest in recovery in the field of mental health and substance abuse, with a goal to develop and exchange expertise in this area.
Training, education, courses and lectures:
- Education and training – Knowledge of recovery is included in many educations in the healthcare sector. Here are some studies in Norway that focus specifically on recovery:
- Recoveryorienterte perspektiv på psykiske lidelser og rusproblematikk [Recovery-oriented Perspectives at Mental Disorders and Substanse Abuse], University of Stavanger
- Recovery Colleges in Bergen: Courses and education to develop knowledge and skills that help people to cope in their lives despite mental health and/or substance abuse problems. The courses focus on independence and sharing of experiences.
- Courses and lectures
- KoRus [Competence center for substance abuse], Western Stavanger – Offers lectures for employees in the field of substance abuse and mental health.
- RIO [Interest Organization for Addicts] – A nationwide user organization founded in 1996. The organization offers lectures and education in topics related to service users and patients with mental health and substance abuse problems. Key topics are self-help and coping, substance abuse and injury reduction, motivation and resistance, how to meet the service user/patient etc.
- MARBORG – Offers education and guidance for healthcare services and employees in the field of substance abuse, about user involvement at a system level, user-driven measures, work and activities.
- Skolen for Recovery [The School for Recovery] (Denmark) – Free courses for service users/patients, relatives and employees in the Hospital about acquiring knowledge and skills in recovery. This concept exists in several regions. The themes are inspired by the CHIME model (connectedness, hope, identity, meaning, empowerment), and contributes to learning, sharing experiences, co-creation, empowerment, hope and new opportunities.
- The Regional Peer-driven Centers – read more below.
A critical look
Recovery as perspective and practice is also characterized by skepticism and criticism. This mainly grows out from recovery being a diffuse and abstract concept by definition and in practice. As it is largely depending on each person`s own definition of own process, it is impossible to develop general guidelines for recovery-oriented practice that are sufficiently concrete and tangible, leading to challenges for health services when it comes to operationalization and implementation. It must also be considered that recovery is a relatively new term requiring time to be incorporated. Several service providers also rejects recovery as yet another buzz-word or a new name for already existing values, and claims they already works this way. All this terms, concepts and names are also highly applicable for service users; do we have the same understanding of recovery? Do we identify with the terms we use? Concepts like dreams, values and hope for the future can be too abstract, making recovery-based approach too strange, alienated and not practical enough for the treatment to be useful.
Some of the most prominent criticism is whether recovery-oriented practice leads to disclaiming for the health services, leaving the service user alone without enough help and support. Self-control and individual understandings are emphasized in recovery-processes, possibly leading to a challenging balance for service providers between giving discharge of liability, help and support, and enabling self-control and facilities for development. Recovery also moves away from focus on diagnosis, which gives reason to be concerned about service users and relatives losing rights regarding the treatment or overshadowing rights in favor for self-responsibility. Arild Knutsen from Foreningen for human narkotikapolitikk (FHN) [Hardcore Harm Reduction Organization] was interview by Erfaringskompetanse [National Center for Experience-Based Competence in Mental Health], saying that recovery undermines those who struggle the most; being a resource and being free from substances are held forward as the only goal in recovery, leading to loss of motivation for those who are not able to start controlling their recovery process. He points out that the recovery movement earns lots of money on buzz-words, talks and books, without actually improving health services. This deduce a dilemma about the balance between meeting the service user where he/she are right now, and thinking forward in terms of dreams, goals and the future; are the service user given enough time? This balance is about the combination of recovery-based concepts and other concepts and methods, and most of all it is about timing.
The user-driven organization Recovery in the Bin has been a leading part concerning a critical look at recovery. They write:
- We are fed up with the way co-opted ‘recovery’ is being used to discipline and control those who are trying to find a place in the world, to live as they wish, trying to deal with the very real mental distress they encounter on a daily basis. We believe in human rights and social justice!
They believe that there are core principles of recovery that are worth saving and fight for, including autonomy and self-determination, but that the colonisation of recovery in health services and politics undermines those values. This is the core of the criticism of recovery; these principles cannot be found in a one size fits all technique or calibrated by an outcome measure. Therefore, many is critical to how real recovery actually becomes in clinical recovery, where measures are used as an indicator for improvement, ease of symptoms and mental health recovery.
Further on, especially in the field of research, there has been concerns about forgetting the social aspect of recovery because of the strong focus on the individ in the society and in mental health services. The social context are highly important for human health, and as mentioned earlier, some argue that we have to see mental health and substance abuse problems as a civic problems in larger degree. In practice, this can conflict with the focus on empowerment and self-control in the recovery concept. Therefore, many fear that aspects concerning relations, social interactions, working life and housing are forgot and undermined, something that can affect the treatment in a insufficient way and inhibit recovery.
Ideal Organizations, foundations and voluntary instances
- ImROC (Implementing Recovery through Organizational Change) – Strives for systems, services and cultures to develop and support recovery and wellbeing for all locally, nationally and internationally, by sharing knowledge and facilitate recovery-oriented improvements in partnerships with communities, health services and service users. Located in Nottingham.
- Scottish Recovery Network – A non-profit initiative working in Scotland and beyond to place the experience of recovery at the center of life, practice and policy. They do peer work, research, provide tools, dissemination of knowledge and strengthening recovery processes in the society through social media, video, sound and literature. Located in Glasgow.
- The Yale Program for Recovery and Community Health (PRCH) – One of the leading parts internationally when it comes to operationalisation and implementation of recovery in services and society. Conducts collaborative research, evaluation, education, training, policy development and consultation in the field of mental health and substance abuse. Located at Yale School of Medicine, Connecticut.
- South West Yorkshire Partnership Recovery Colleges – Offers recovery focused educational courses that aims to help people by learning them how to cope with and about their own recovery process, each course often by specific types of different problems. The courses are delivered by people with lived experience, alongside people with professional experience. Located in Yorkshire.
- The World Association for Psychosocial Rehabilitation (WAPR) – An international non-governmental organization mainly by mental health professionals, alongside with people with service user experiences or next of kin experiences from all around the world. The mission is dissemination of principles and practices of psychosocial rehabilitation and recovery, by worldwide conferences among other things.
- RecoveryCafè – A community of people with experience of homelessness, addiction or mental health problems providing a safe and warm place to help people to recover from the same type of problems. RecoveryCafè offers social activities, support and help to individual development and coping. Located in Seattle.
Measures and services in Norway
The regional peer-driven centers
KBT together with the other regional peer driven centres started the project “Knutepunkt for Recovery [Recovery HUBs]” with funding from the Norwegian Health Directorate. The goal of the project is to study how the centres can develop a regional recovery hub functionality in the regions across Norway, and how the centres can collaborate on being a national recovery hub in forms of a network. The hub will be a base for competence and resources about recovery, striving for:
- Acknowledgment for recovery as a personal and social process.
- Acknowledgement and use of lived experience-based knowledge.
- Real recovery for service users, good utilization of resources in health services and equal collaboration processes.
- Good quality of life, wellbeing and a worthy life situation for people with psychosocial problems.
Through actions like lectures, guidance, courses, tools, and collection and dissemination of lived experience-based knowledge, the recovery hub aims to strengthen persons and groups, prevent stigma and exclusion, and promote human rights, worthy living conditions and increased level of participation for everyone.
Each center have developed different areas of expertise. When it comes to recovery, you can read more about how KBT works with this at the bottom of this page. Here are some examples of how the other centers works with this:
- Bikuben Regional Peer-Driven Center
- Next of kin meeting point – A place for next of kin and mental health/substance abuse professionals to meet up and exchange experiences and knowledge about being a relative to someone with problems.
- Course in empowerment for different groups of people with mental health problems.
- Groups for coping.
- Vårres Regional Peer-Driven Center
- Peer conversations – Offer conversations and support from people with lived experience.
- Course for coping – Teaching tools for enabling people with health challenges and disabilities to cope with daily life, focusing on reckognizion of symptoms, goals, planning daily life, physical activity and diet, communication and solving problems.
- Community centers with different activities.
- ROM Agder
- Kjøkkenpraten [“The kitchen chat”] – A measure involving gathering around the kitchen table for exchanging mental health experiences. The goal is to contribute to hope and new knowledge regarding how to live with and cope with one`s challenges.
- Management course for “The kitchen chat” – Training in history and structure of “The kitchen chat”, management principles, evaluations, recovery, empathic communication, self-care and network for guidance.
- Sagatun Peer-Driven Center
- Recovery workshops – Involving plenary sessions, discussions and working in groups, aiming to gain knowledge about recovery as a process and practice and insight in documented conditions and experiences that promotes health and values in recovery processes.
- Verktøykassa for brukermedvirkning [“the Toolbox for user participation”] – The empowerment course offering an introduction to empowerment, communication and user participation at individual and system level. The management course offers an introduction to the same themes, aiming towards those who want to lead a group or organization working with this.
- Community center with different activities.
- Vestavind Peer-Driven Center
Examples of recovery measures in municipalities and counties
More and more municipalities are discovering recovery-oriented practice and strive for recovery as fundamental concept in their mental health and substance abuse services. Here is a selection of good examples of recovery-oriented practices in municipalities and counties:
- Rogaland and Sunnhordaland
- Asker municipality
- Also operates recoveryverksteder [recovery workshops], a collaboration project between Asker municipality and University of South-Eastern Norway. Recovery workshops are meeting points and arenas for dialogue for people with mental health and substance abuse problems, next of kin, health professionals and others of interest. This involves exchanging experiences and knowledge about recovery processes, coping, what is good help and a good life, and how health services can be more recovery-oriented.
- Bergen municipality
- Trondheim municipality
- Sandnes municipality
- Stjørdal municipality
Examples of other recovery measures in Norway
- Rockovery – A measure based on music therapy aiming to contribute to personal development, empowerment, a regular place to go, meaningful activities, good experiences and the opportunity to play own music live in front of an audience. The participants is affiliated to child welfare, substance abuse services, mental health services, correctional services or other health and social services.
- YoungRecovery at Incita – Incita is a private health thrust offering care centers for single asylum-seeking children, Wenger Gård Health Care Center in Eidsvoll and Skjeppsjøen Health Care Center in Oppland, and currently starting up units dedicated to treatment of adolescents with severe behavioral difficulties. The professional point of view and methods are strongly rooted in the recovery concept, focusing on individual resources, opportunities, coping, development and milieu therapy to create meaning in daily life.
- Hurdalsjøen Recovery Center (Incita) – A measure built on recovery-oriented methods, using mainly IMR (Illness Management and Recovery). User participation, active milieu therapy, individual customization, work training and physical activity are key agencies. They also offer methods for medication-free treatment. The center is located in Hurdal, Akershus.
- RIO-ReStart – Rehabilitation for people who have completed substance abuse treatment or atonement, desiring a drug-free and worthy life and work. RIO-ReStart includes different agencies: day measure, work training, empowerment and self-development, different courses and more. The service is located at Bragdøy island in the fjord of Kristiandsand. RIO also operates Kafe X in Tromsø and Sports against Drugs.
- Clubhouse in Norway – As of today there are 14 different Clubhouses in Norway, located in Asker, Tromsø, Bergen, Stavanger, Drammen, Hønefoss, Oslo, Rygge, Harstad, Kongsberg and Gjøvik, and under development in Trondheim. They strive for work training to be given a large focus in services for people with mental health problems. Members and employees work side by side attempting to make the clubhouses work and developed for the benefit of services users with different needs. Empowerment and regain of control are key terms in the Clubhouse model. There is no need for referral.
- Krafttak for sang [A measure for empowerment through singing] – A low-threshold service using choir as a method for recovery and participation for people with mental health problems, aiming to give happiness, self-confidence, increased level of energy, self-belief, coping and better health. This is offered in following municipalities: Bergen, Kongsberg, Vestre Toten, Alta, Klepp, Harstad, Fjaler, Målselv, Namsos, Sauherad, Steinkjer, Surnadal, Søndre Land, Vestre Slidre, Vinje, Ås, Jondal, Ullensvang and Odda, and Midsund, Nesset and Molde.
For literature in norwegian, see our norwegian resource pages.
Reports and publications
- Haukland, M., Langseth, B. & Hummelvoll, J. K. (2017). “Captain and guide on the same ship”. Report from workshop for recovery-knowledge (Sagatun-report nr. 1/2017). Hamar: Sagatun Peer-Driven Center.
Books and booklets
- Slade, M. (2009). Personal Recovery and Mental Illness. A Guide for Mental Health Professionals. Cambridge: Cambridge University Press.
- Lofthus, A.-M., Westerlund, H., Bjørgen, D., Lindstrøm, J. C., Lauveng, A., Rose, D., Ruud, T. & Heiervang, K. (2016). “Recovery concept in a Norwegian setting to be examined by the assertive community treatment model and mixed methods”. International Journal of Mental Health Nursing, 27 (1), 147-157.
- Mulvale, G., & Bartram, M. (2015). No more “Us” and “Them”: Integrating recovery and well-being into a conceptual model for mental health policy. Canadian Journal of Community Mental Health, 34 (4), 31-67.
- Glover, H. (2014). “Recovery based service delivery: are we ready to transform the words into a paradigm shift?”. Australian e-Journal for the Advancement of Mental Health, 4 (3), 179-182.
- Tew. J., Ramon, S., Slade, M., Bird, V., Melton, J. & Le Boutillier, C. (2012). “Social Factors and Recovery from Mental Health Difficulties: A Review of the Evidence”. British Journal of Social Work, 42 (3), 443-460.
- Slade, M., Adams, N., & Ohagan, M. (2012). Recovery: Past progress and future challenges. International Review of Psychiatry, 24 (1), 1-4.
- Piat, M., & Sabetti, J. (2012). Recovery in Canada: toward social equality. International Review of Psychiatry, 24 (1), 19-28.
- Provencher, H. L., & Keyes, C. L. (2011). Complete mental health recovery: Bridging mental illness with positive mental health. Journal of Public Mental Health, 10 (1), 57-69.
- Leamy, M., Bird, V., Le Boutillier, C., Williams, J. & Slade, M. (2011). “Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis”. The British Journal of Psychiatry, 199, 445-452.
- Le Boutillier, C., Leamy, M., Bird, V. J., Davidson, L., Williams, J. & Slade, M. (2011). “What does recovery mean in practice? A qualitative study of international recovery-oriented practice guidance”. Psychiatric Services, 62, 1470-1476.
- Mulvale, G., & Bartram, M. (2009). Recovery in the Canadian context: feedback on the framework for mental health strategy development. Canadian Journal of Community Mental Health, 28 (2), 7-15.
- Shepherd, G., Boardman, J. & Slade, M. (2008). Making recovery a reality. U.K., London: Sainsbury Centre for Mental Health.
- Slade, M., Amering, M., & Oades, L. (2008). Recovery: An international perspective. Epidemiologia E Psichiatria Sociale, 17 (02), 128-137.
- Davidson, L. & Roe, D. (2007). “Recovery from versus recovery in serious mental illness: One strategy for lessening confusion plaguing recovery”. Journal of Mental Health, 16 (4), 459-470.
- Beresford, P. (2005). “Social work and a social model of madness and distress: Developing a viable role for the future”. Social Work & Social Review, 12 (2), 59-73.
- Jacobson, N., & Curtis, L. (2000). Recovery as policy in mental health services: Strategies emerging from the states. Psychiatric Rehabilitation Journal, 23 (4), 333-341.
- Deegan, P. E. (1997). Recovery and empowerment for people with psychiatric disabilities. Social Work in Health Care, 25 (3), 11-24.
- Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11-23.
- Harding, C. M., Brooks, G. W., Ashikaga, T. Strauss, J. S. & Breier, A. (1987). “The Vermont Longitudinal Study of Persons With Severe Mental Illness, II: Long-Term Outcome of Subjects Who Retrospectively Met DSM-III Criteria for Schizophrenia”. American Journal of Psychiatry, 144 (6), 727-735.
Links for more information
- Erfaringskompetanse [National Center for Experience-Based Competence in Mental Health] conducted an interview with Mike Slade talking about recovery, before participating in a panel discussing recovery.
- Recovery Within Reach
For links to norwegian pages, see our norwegian resource pages.
How KBT works with this
KBT believes that good help is based on the service user’s needs and wishes, making it possible to work together in finding opportunities for personal development and ways to work with own challenges. We believe that there is resources and abilities in every person, which together with right kind of support can be used to cope in daily life and achieve a good and worthy life despite mental health or substance abuse problems. This is right at the core of the recovery concept, which is why KBT strives for more recovery-oriented practices in health services.
Our visions states that we work for better services through equal dialogue between service users and professionals. When it comes to user participation at individual level, KBT thinks that recovery is one of the areas contributing to increased user participation. It is in our interest to explore what recovery means for each person and important elements in recovery processes, to make it possible for health services to form more accurate services. In a larger perspective at civic level, recovery is also about human rights, working life and social arenas. These are areas important to KBT because we mean that aspects concerning society, working life, economy, housing, social life and environments greatly affects people’s health. We want to work for inclusion in working life, better housing, information about rights and better attitudes towards and knowledge about mental health and substance abuse problems.
Our working areas on recovery
KBT wants to contribute to this by documentation and dissemination of lived experience about recovery processes. Among other things we bring forward recovery in User Interviews User-evaluations of health services, dialogue meetings with municipalities and services, talks and presentations at conferences and in networks, and lectures and in education. We also offer courses aiming to strengthen persons and groups. Verktøykassa for brukermedvirkning [“the Toolbox for user participation”] is a course in collaboration with Sagatun Peer-Driven Center, which gives an introduction to empowerment, communication and user participation at individual and system level. KBT have also developed an empowerment course, focusing on self-control, communication, goals, motivation, conflict management and creating meaning in daily life. We offer course for peer support specialists and their employers, where recovery-oriented practice and ways for peer support specialists to promote this is emphasized. Together with the other peer-driven centers in Norway we are Recovery HUB – read more about this further up this page.
User Interviews User
Recovery has been in KBT`s interests for a long time, and we have conducted several projects and agencies highlighting recovery. User Interviews User is a way to work recovery oriented with basis in users thoughts about changes and processes in services. A recent example is User Interviews User – Evaluation of Sagatun Peer-Driven Center, where we asked the users of Sagatun about their thoughts and experiences regarding recovery, and how Sagatun contributed to their recovery process through activities and being a community center. Follow the link to read more about the project and findings.
Network for Recovery in Central Norway
In 2018 we initiated a regional network for recovery in Central Norway, which aims to gather people with interests in recovery, to exchange experiences and share knowledge. One gathering was held in November 2018 and another will be held in 2019.
Translated by: Anne R. Benschop and Christina Kildal