10 Principles of Recovery-Oriented, Community-Based Care

I’ve been looking at the seminal book A Practical Guide to Recovery-Oriented Practice by Larry Davidson and colleagues over the weekend. This must-read book contains ‘Tools for Transforming Mental Health Care’.

I’d just like to refer to a few quotes in the first of the ten principles, asking you to think about addiction treatment when I refer to mental health care. What is said in this book is of course relevant to our current treatment system.

Principle 1: Care is Oriented to Promoting Recovery

“Promoting recovery is not synonymous with reducing symptoms, increasing insight or medication adherence, ameliorating deficits, enhancing community tenure, or preventing hospitalizations, all of which have been seen as aims of mental health care in the past.”

The authors then point out that in the USA, since the 1999 Surgeon General’s Report on Mental Health, the field has been encouraged to accept that ‘all services for those with a mental disorder should be consumer-oriented and focused on promoting recovery’ ‘DHHS, 1999, pp. 455).

Yes, the mental health field in the States is well ahead of the addiction field in the UK.

“That is, all mental health care should be driven by the client’s own goals, grounded in an appreciation of the possibility and the nature of recovery, and oriented to facilitating each person’s efforts toward recovery in whichever form it takes at the time.”

The book authors point out that these statements contrast starkly with much of the past 150 years mental health policy and practice, an “era based on a maintenance and stabilization framework at best, or in a belief in the progressive deterioration of persons with serious mental illness at worst.”

Ring any bells about addiction treatment in the UK?

The authors go on to talk about one implication of this shift in focus – people need to be offered hope for a renewed sense of self and purpose in their lives. (I’ll talk about hope in my next blog in this series)

They go on to say:

“… being in recovery involves a process of overcoming some of the consequences of illness; gaining an enhanced sense of identity, empowerment, and meaning and purpose in life; and developing valued social roles, citizenship, and community connections in spite of having symptoms, deficits or continue disability.”

“A recovery vision requires that care be based explicitly on a belief in people’s potential to manage and improve their lives over time.” [Note the emphasis on the person – they actually do the work, not the practitioner].

“Recovery-oriented care thus includes practices that help people gain connections with and autonomy in relation to others [this stresses importance of social inclusion – DC], aid in skill development as well as symptom management and treatment [importance of life skills training, relapse prevention techniques – DC], focus on abilities and strengths rather than deficits [right from first assessment – DC], and are guided by the person in recovery.”

In contrast to what is stressed here, so many people who have been in treatment in the UK (generally on methadone maintenance programmes) have told me that treatment agency workers have focused on their deficits rather than strengths, told them they are likely to relapse (generally with no advice), and have told them they must listen to the worker.

Davidson and co-authors go on to say: “It includes asking clients about their hopes, dreams, interests, talents and skills and, perhaps most important, asking “How can I help?”“

The practitioner needs to ask: “Does this person gain power, purpose, competence, or connections to people as a result of this interaction?” and

“Does this interaction interfere with this person’s acquisition of power, purpose, skills, or connections to others?”

All practitioners working in this field need to think about these questions.