A national framework for recovery-oriented mental health services: policy and theory

Conceptual models of recovery processes

Page last updated: 2013

In recent years, mental health services and programs throughout Australia have adopted different models for helping staff to understand personal recovery processes and how they might enable and support personal recovery. While this new national framework is not seeking to standardise the use of particular models, the following models are highlighted as useful examples.

Andresen, Oades and Caputi (2003, 2006 and 2011)

By studying personal accounts of recovery, this Australian team of researchers developed a conceptual model of recovery processes to guide research and training and to inform clinical practices. The team identified four processes involved with personal recovery.
  • Finding and maintaining hope—believing in oneself; having a sense of personal agency; optimistic about the future
  • Re-establishing a positive identity—incorporates mental health issues or mental illness but retains a positive sense of self
  • Building a meaningful life—making sense of illness or emotional distress; finding a meaning in life beyond illness; engaged in life
  • Taking responsibility and control—feeling in control of illness and distress and in control of life.

Glover (2012)

Glover’s model reflects the efforts that people undertake in their personal recovery journeys through a set of five processes.
  • From passive to active sense of self—moving from the passive space of being a recipient of services to reclaiming one’s strengths, attributes and abilities to restore recovery
  • From hopelessness and despair to hope—moving from a space of hopelessness and despair to one of hope
  • From others’ control to personal control and responsibility—moving from others taking responsibility for recovery to the person taking, holding and retaining responsibility
  • From alienation to discovery—‘finding meaning and purpose in the journey, doing more of what works and less of what does not work; learning from past experiences and incorporating that lesson into the present; acknowledging that journeys always have something to teach us and contribute to our sense of discovery’
  • From disconnectedness to connectedness—moving from an identity of illness or disability to an appreciation of personal roles and responsibilities and to ‘participating in life as a full citizen and not through the powerlessness of illness’.
As with the model developed by Andresen, Oades and Caputi, this personal recovery effort model emphasises personal responsibility and personal control.

This is a challenging concept for workers in helping and caring professions. Their impulse is to ‘do for another’ who is experiencing distress, pain, illness or disability. However, constantly ‘doing for another’ can contribute to a state of impotence and inability. A recovery approach encourages people to take an active role and reclaim responsibility for the direction of their life (Glover 2012). Top of page

Le Boutillier, Leamy, Bird, Davidson, Williams and Slade (2011)

This study analysed 30 international documents to identify the key characteristics of recovery-oriented practice guidance. The researchers developed an overarching conceptual framework to aid the translation of recovery guidance into practice. The five practice domains and 17 competencies of recovery-oriented practice developed for Australia’s national framework are consistent with the themes and categories of recovery identified by these researchers.

In terms of people’s recovery processes, this research team identified similar but differently worded processes to those proposed by Andresen, Oades and Caputi and by Glover.

The interconnectedness of personal recovery and clinical recovery

A growing number of commentators (including researchers with personal experience of mental illness), while acknowledging the difference between clinical recovery and personal recovery, argue that the two types of recovery are complementary and support one another (Glover 2012; Slade 2009a).

A recent study conducted by researchers with lived experience explored the views of people with psychosis about the relationship between clinical recovery and personal recovery. The research team reports:

All participants highlighted symptom change as an indicator of their recovery, and change in symptoms was often accompanied by alleviation of distress and personal change.
Improvements in psychotic symptoms may be important to recovery, but only in conjunction with a range of other factors. Furthermore, the findings in relation to the need for change within symptoms may indicate that although full symptom alleviation or removal may be important for some service users, for others, changes in the nature of the symptoms may be just as important. For example, recovery may mean the continued presence of symptoms but without their negative impact (Wood et al. 2010, pp. 468–469).
There is general agreement in the research that while recovery is much broader than symptom improvement, alleviation of distress associated with symptoms and assistance to manage the illness make an important contribution (Slade 2009a). There is also agreement that an increased sense of wellbeing regardless of continuing symptoms can contribute to a reduction in those symptoms or in their severity (Davidson et al. 2006). Increasingly the importance of physical health, activity, fitness, exercise, healthy diets and healthy lifestyles are being emphasised. Physical fitness through increased activity and exercise contribute to recovery by increasing stress tolerance, promoting resiliency and strengthening a person’s sense of wellbeing and self-mastery.

The major implication for practice and service delivery arising from the complementary nature of clinical recovery and personal recovery is the need for practitioners and services to offer their assistance and expertise through the medium of a collaborative working alliance with each person and where appropriate, their family (Oades et al. 2005). Another principle is the mutual sharing of lived and trained expertise in crafting a service plan.

Key practice tasks emerging from the interconnectedness of clinical and personal recovery include: fostering personal responsibility, promoting shared decision making, supporting the development of motivation, self-management and self-empowerment, and being responsive to families.