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Recovery from serious mental illness is not only possible, but for many people living with mental illness today, probable. The notion of recovery involves a variety of perspectives. Recovery is a holistic process that includes traditional elements of physical health, and aspects of recovery extend beyond medication. Recovery from serious mental illness also includes the idea of attaining and maintaining physical health as another cornerstone of wellness. People in recovery make important contributions to their communities. Hope for recovery should be reflected in all treatments, services, and supports.
The recovery journey is unique for each individual. There are several definitions of recovery; some grounded in medical and clinical values, some grounded in context of community and successful living. One of the most important principles of recovery is this: recovery is a process, not an event. The uniqueness and individual nature of recovery must be honored.
For NAMI, recovery is a foundational principle. While serious mental illness impacts individuals in many challenging ways, the concept that all individuals can move towards wellness is paramount. A strengths-based approach is a cornerstone for NAMI initiatives, activities, and efforts. Many, many NAMI members living with mental illness have benefited from the various opportunities within the organization. NAMI has become a vehicle for recovery, and a pathway towards wellness.
Specific NAMI initiatives developed to help the process of recovery are:
The Peer-to-Peer Recovery Education Course: a 9-week, experiential, illness management and wellness educational course taught by people in recovery, for people living with mental illness.
In Our Own Voice: a public awareness project built around a one-hour presentation by a person living with mental illness. An 11-minute video frames the presentation around dark days, acceptance, treatment and medications, and hopes and dreams.
NAMI-C.A.R.E. (Consumers Advocating Recovery through Empowerment): a mutual self-help support group model.
Hearts and Minds: Learn about healthy, accessible and affordable lifestyle changes designed to reduce cardiac risk among people with mental illness.
The Provider Education Course: a 10-week initiative developed to raise awareness with mental health providers of the perspective of the impact mental illness has on the family and the individual. A team of persons living with mental illness, family members of a person living with mental illness, and a consumer- or family member-provider teaches the course.
National Consumer Council: the only nationally convened representative body of persons living with mental illness. The Council serves in an advisory capacity to the NAMI National Board of Directors, and includes subcommittees on the issues of Restraint and Seclusion; Ethics; and Education, Mentoring, and Outreach.
State level Consumer Councils: similar in structure and purpose to the National Consumer Council; but established as advisory bodies to some state NAMI Boards of Directors.
Leadership development opportunities are emerging as an important mechanism to help in the recovery process. The Consumer Councils are one important opportunity supported by NAMI. Experiential knowledge is a common theme in both leadership and recovery, and NAMI provides those experiences.
In summary, NAMI is dedicated to improving the lives of all those affected by mental illnesses. Whether by providing support, education, advocacy, or leadership experiences, all levels of NAMI are working every day to help. Recovery is possible, and people no longer need be defined by their illness, but rather by the goals, hopes, and dreams so vital to each of us.
The Substance Abuse and Mental Health Services (SAMHSA) recognizes there are many different pathways to recovery and each individual determines his or her own way. SAMHSA engaged in a dialogue with consumers, persons in recovery, family members, advocates, policy-makers, administrators, providers, and others to develop the following definition and guiding principles for recovery. The urgency of health reform compels SAMHSA to define recovery and to promote the availability, quality, and financing of vital services and supports that facilitate recovery for individuals. In addition, the integration mandate in title II of the Americans with Disabilities Act and the Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581 (1999) provide legal requirements that are consistent with SAMHSA’s mission to promote a high-quality and satisfying life in the community for all Americans.
Recovery from Mental Disorders and Substance Use Disorders: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
Through the Recovery Support Strategic Initiative, SAMHSA has delineated four major dimensions that support a life in recovery:
Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. Hope is internalized and can be fostered by peers, families, providers, allies, and others. Hope is the catalyst of the recovery process.
Recovery is person-driven: Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals. Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives.
Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds — including trauma experiences — that affect and determine their pathway(s) to recovery. Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual. Recovery pathways are highly personalized. They may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches. Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks. Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families. Abstinence is the safest approach for those with substance use disorders. Use of tobacco and non-prescribed or illicit drugs is not safe for anyone. In some cases, recovery pathways can be enabled by creating a supportive environment. This is especially true for children, who may not have the legal or developmental capacity to set their own course.
Recovery is holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. This includes addressing: self-care practices, family, housing, employment, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care, complementary and alternative services, faith, spirituality, creativity, social networks, transportation, and community participation. The array of services and supports available should be integrated and coordinated.
Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery. Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community. Through helping others and giving back to the community, one helps one’s self. Peer-operated supports and services provide important resources to assist people along their journeys of recovery and wellness. Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths. While peers and allies play an important role for many in recovery, their role for children and youth may be slightly different. Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.
Recovery is supported through relationship and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change. Family members, peers, providers, faith groups, community members, and other allies form vital support networks. Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend, student, employee) that lead to a greater sense of belonging, personhood, empowerment, autonomy, social inclusion, and community participation.
Recovery is culturally-based and influenced: Culture and cultural background in all of its diverse representations — including values, traditions, and beliefs are keys in determining a person’s journey and unique pathway to recovery. Services should be culturally grounded, attuned, sensitive, congruent, and competent, as well as personalized to meet each individual’s unique needs.
Recovery is supported by addressing trauma: The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues. Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.
Recovery involves individual, family, and community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery. In addition, individuals have a personal responsibility for their own self-care and journeys of recovery. Individuals should be supported in speaking for themselves. Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery. Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery. Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires, and aspirations.
Recovery is based on respect: Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery. There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important.
SAMHSA has developed this working definition of recovery to help policy makers, providers, funders, peers/consumers, and others design, measure, and reimburse for integrated and holistic services and supports to more effectively meet the individualized needs of those served.
Many advances have been made to promote recovery concepts and practices. There are a variety of effective models and practices that States, communities, providers, and others can use to promote recovery. However, much work remains to ensure that recovery-oriented behavioral health services and systems are adopted and implemented in every state and community. Drawing on research, practice, and personal experience of recovering individuals, within the context of health reform, SAMHSA will lead efforts to advance the understanding of recovery and ensure that vital recovery supports and services are available and accessible to all who need and want them.
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