Social work theory · Volume E: Strengths, Agency & Meaning
Recovery-oriented approaches
Recovery-oriented approaches are ways of designing and delivering mental health services that support people to live a satisfying, hopeful and contributing life, as defined by the person, with or without ongoing symptoms.
Type: practice and service framework grounded in lived experience, with a conceptual model of personal recovery (CHIME) and national policy frameworks.
1. What it is
Recovery-oriented approaches are ways of designing and delivering mental health services that support people to live a satisfying, hopeful and contributing life, as defined by the person, with or without ongoing symptoms (Anthony, 1993; Slade, 2009). They emerged from the accounts of people with lived experience of mental illness and from consumer movements. They are now embedded in Australian mental health policy (Australian Health Ministers’ Advisory Council [AHMAC], 2013). Recovery-oriented practice emphasises self-determination, hope, meaning, social inclusion and partnership. It connects closely with the strengths perspective (E1), hope theory (E5) and empowerment theory (E2), and the strengths model of case management was explicitly developed as a recovery-oriented approach (Rapp & Goscha, 2012).
Personal recovery. Personal recovery refers to the individual’s own process of building a meaningful life and a positive identity, whether or not symptoms continue. It is defined by the person and is often described as a journey with no fixed endpoint (Slade, 2009). Deegan (1988), writing from lived experience, described recovery as a process of accepting and overcoming the challenge of disability and re-establishing a sense of self and purpose.
Clinical recovery. Clinical recovery refers to the reduction or remission of symptoms and the restoration of functioning, as defined and measured by clinicians. It is the traditional outcome of psychiatric treatment. Slade (2009) argued that services had focused on clinical recovery and needed to give equal or greater priority to personal recovery. Davidson and Roe (2007) made a related distinction between recovery from mental illness (symptom remission) and recovery in mental illness (living well while managing an ongoing condition).
Anthony (1993). William Anthony described recovery as a deeply personal and unique process of changing one’s attitudes, values, feelings, goals, skills and roles, leading to a satisfying, hopeful and contributing life even with the limitations caused by illness. He argued that recovery should be the guiding vision of mental health systems in the 1990s. Anthony (1993) noted that recovery can occur without professional help, is supported by people who believe in the person, does not depend on theories about the causes of illness, and involves recovering from the consequences of illness, such as stigma and loss of roles, as well as the illness itself.
CHIME (Leamy et al., 2011). Leamy et al. (2011) conducted a systematic review and narrative synthesis of 97 papers on personal recovery. They identified five recovery processes, summarised by the acronym CHIME: Connectedness (support from others, relationships, being part of the community); Hope and optimism about the future; Identity (rebuilding a positive sense of self and overcoming stigma); Meaning in life (meaningful roles, goals and spirituality); and Empowerment (personal responsibility, control over life and a focus on strengths). CHIME is now widely used to design, evaluate and teach recovery-oriented practice.
Australia’s national framework (2013). A National Framework for Recovery-Oriented Mental Health Services was endorsed by Australian health ministers in 2013 (AHMAC, 2013). It defines personal recovery and sets out practice domains and capabilities for the workforce and services: promoting a culture and language of hope and optimism; person first and holistic; supporting personal recovery; organisational commitment and workforce development; and action on social inclusion and the social determinants of health, mental health and wellbeing. The framework also addresses recovery for Aboriginal and Torres Strait Islander peoples, recognising social and emotional wellbeing as a collective and culturally grounded concept.
Peer work. Peer workers are people employed to use their own lived experience of mental ill-health and recovery to support others. Peer support is based on mutuality, shared experience and hope (Mead et al., 2001). A review of the literature found that peer workers can promote hope, empowerment and social inclusion, although the evidence base was still developing (Repper & Carter, 2011). Lived experience workforces, including consumer and carer peer workers, are a growing part of Australian mental health services.
2. Historical development
| Period | Development |
|---|---|
| 1970s | Deinstitutionalisation; consumer/survivor movements challenge psychiatric authority |
| 1988 | Deegan’s “Recovery: The lived experience of rehabilitation” |
| 1993 | Anthony describes recovery as the guiding vision of mental health services |
| 1990s–2000s | Recovery adopted in policy in the United States, New Zealand, the United Kingdom and Australia |
| 2009 | Slade’s Personal Recovery and Mental Illness distinguishes personal and clinical recovery |
| 2011 | Leamy et al. publish the CHIME framework |
| 2013 | Australia’s National Framework for Recovery-Oriented Mental Health Services |
| 2014 | Slade et al. examine the “uses and abuses” of recovery in mental health systems |
| 2021 | Royal Commission into Victoria’s Mental Health System calls for greater lived experience leadership |
The recovery movement grew from the experiences of people with serious mental illness who rejected the prognosis of chronic decline associated with institutional psychiatry. Long-term follow-up studies showed that many people diagnosed with schizophrenia improved substantially over time (Anthony, 1993). First-person accounts, such as Deegan’s (1988), described recovery as a personal process of reclaiming identity and purpose. Psychiatric rehabilitation research at Boston University, led by Anthony, provided an academic base for these ideas.
Recovery became an independent approach because it offered a vision of mental health services defined by the goals of people who use them. During the 1990s and 2000s it was adopted in national mental health policies. In Australia, the National Mental Health Plans and the 2013 national framework made recovery orientation an expected feature of public and community mental health services (AHMAC, 2013). Social work, with its emphasis on self-determination, social inclusion and the person in environment, has been closely involved in recovery-oriented practice in mental health settings (Slade et al., 2014).
3. Practical guidance
Recovery-oriented practice asks workers to support personal recovery as the person defines it.
- Start with the person’s goals. Ask what a good life would look like for the person, and plan around those goals as well as clinical needs (Slade, 2009).
- Use CHIME as a guide. Check whether plans address connectedness, hope, identity, meaning and empowerment (Leamy et al., 2011).
- Communicate hope. Use language that conveys belief in recovery and avoid statements that limit expectations (AHMAC, 2013).
- Share decision-making. Involve the person in decisions about treatment and support, including through advance statements where available.
- Work with peer workers. Value lived experience expertise and refer to peer support where appropriate (Repper & Carter, 2011).
- Address social inclusion. Support access to housing, education, employment and community participation. In Australia, this may involve linking people to NDIS psychosocial supports where eligible.
- Respect cultural understandings. With Aboriginal and Torres Strait Islander people, work within social and emotional wellbeing frameworks that include connection to Country, culture, kin and spirit.
4. Critical evaluation
Strengths. Recovery-oriented approaches centre the voices of people with lived experience and restore hope to mental health practice. CHIME provides an evidence-based conceptual framework, and recovery orientation is supported by national policy in Australia and other countries (AHMAC, 2013; Leamy et al., 2011). The approach is consistent with social work values, and it has expanded the role of peer workers and lived experience leadership.
Limitations. Slade et al. (2014) identified several misuses of recovery, including using it to justify withdrawing services, relabelling existing practice without change, and expecting people to “recover” on a set timetable. Critics from consumer and survivor movements argue that recovery has been co-opted by services and governments and can be used to place responsibility for wellbeing on individuals while neglecting poverty and discrimination (Harper & Speed, 2012). Personal recovery is difficult to measure, and its individual focus may not fit collectivist cultures. Tensions remain between recovery orientation and involuntary treatment.
Overall importance. Recovery-oriented approaches have reshaped mental health policy and practice in Australia and internationally. They give social workers a framework for supporting self-defined goals, hope and inclusion, and they recognise lived experience as expertise. Their value depends on genuine shifts in power and resources that accompany changes in language.
5. References
- 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. https://doi.org/10.1037/h0095655
- Australian Health Ministers’ Advisory Council. (2013). A national framework for recovery-oriented mental health services: Policy and theory. Commonwealth of Australia.
- 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. https://doi.org/10.1080/09638230701482394
- Deegan, P. E. (1988). Recovery: The lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 11(4), 11–19. https://doi.org/10.1037/h0099565
- Harper, D., & Speed, E. (2012). Uncovering recovery: The resistible rise of recovery and resilience. Studies in Social Justice, 6(1), 9–25.
- 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. British Journal of Psychiatry, 199(6), 445–452. https://doi.org/10.1192/bjp.bp.110.083733
- Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: A theoretical perspective. Psychiatric Rehabilitation Journal, 25(2), 134–141.
- Rapp, C. A., & Goscha, R. J. (2012). The strengths model: A recovery-oriented approach to mental health services (3rd ed.). Oxford University Press.
- Repper, J., & Carter, T. (2011). A review of the literature on peer support in mental health services. Journal of Mental Health, 20(4), 392–411. https://doi.org/10.3109/09638237.2011.583947
- Slade, M. (2009). Personal recovery and mental illness: A guide for mental health professionals. Cambridge University Press.
- Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., Perkins, R., Shepherd, G., Tse, S., & Whitley, R. (2014). Uses and abuses of recovery: Implementing recovery-oriented practices in mental health systems. World Psychiatry, 13(1), 12–20. https://doi.org/10.1002/wps.20084
- State of Victoria. (2021). Royal Commission into Victoria’s Mental Health System: Final report. State of Victoria.