Recovery: an international perspective

Aims - To review developments in recovery-focussed mental health services internationally. Methods - Two forms of 'recovery' which have been used in the literature are considered, and international examples of recovery-focussed initiatives reviews. A 'litmus test' for a recovery-focussed service is proposed. Results - 'Clinical recovery' has emerged from professional literature, focuses on sustained remission and restoration of functioning, is invariant across individuals, and has been used to establish rates of recovery. 'Personal recovery' has emerged from consumer narratives, focuses on living a satisfying, hopeful and contributing life even with limitations caused by the illness, varies across individuals, and the empirical evidence base relates to stages of change more than overall prevalence rates. Clinical and personal recovery are different. Two innovative, generalisable and empirically investigated examples are given of implementing a focus on personal recovery: the Collaborative Recovery Model in Australia, and Trialogues in German-speaking Europe. The role of medication is an indicator: services in which all service users are prescribed medication, in which the term 'compliance' is used, in which the reasoning bias is present of attributing improvement to medication and deterioration to the person, and in which contact with and discussion about the service user revolves around medication issues, are not personal recovery-focussed services. Conclusions - The term 'Recovery' has been used in different ways, so conceptual clarity is important. Developing a focus on personal recovery is more than a cosmetic change - it will entail fundamental shifts in the values of mental health services.