Although a mental health nurse by trade, I’ve worked in community drug and alcohol services for a number of years. Not so many years though. I guess you could say I’ve only been a part of addiction services in the ‘recovery era’ – the days where client retention was the goal, and methadone maintenance and harm reduction was the only party in town, seem like a distant memory from where I’m sitting. And while substitute prescribing and harm reduction are still useful and potentially lifesaving tools, it is the tools of recovery that are now utilised by services.
Recovery Equals Hope
While there’s ongoing debate about exactly what recovery means, as an outsider looking in (I’m not in recovery myself), at its most visceral, ‘recovery’ equals hope; hope that things can change, and change for the better. Indeed, one of the benefits of mutual aid is the chance to see, through positive role models, that change is possible (perhaps in contrast to the same old faces clients see in waiting rooms up and down the country).
Coming from the field of mental health, the prominence of recovery in drug and alcohol services made for a refreshing change. It wasn’t that long ago that I was a student nurse, and while there was the occasional lecture that nodded its head towards the possibility of recovery, working in the field I never got the impression that the message had seeped through to those working in difficult conditions at the coal face. Of course, things aren’t black and white, and I understand that there have been great strives to improve many aspects of patient care. Nevertheless, having spoken to a psychiatrist with recent experience of working within mental health services, it appears that there’s still work to be done.
Addiction and mental health disorders regularly co-occur; one often precipitating the other. Having worked within both fields, I’ve often thought of the parallels between the two.
Both appear to suffer at the hands of a negative media portrayal, with scaremongering, stereotyping, and labelling, helping to promote stigma and an ‘us and them’ attitude in the wider public. Rare is it to find a positive news story about mental health or addiction.
Perhaps the most intriguing similarity exists in the use of medication. Through the 1990s, the ‘chemical imbalance’ theory of depression (in part propagated by the pharmaceutical industry) was ubiquitous. With hindsight, most agree that the theory was a gross oversimplification to explain a complex and multifactorial disorder, but the implication at the time was that medication was the only answer and possibly needed to be taken for life. While for some with depression it may have been the answer, for others it may have closed the door to alternative treatments and a chance of recovery without the need for long-term medication. The parallel between this and the implementation of methadone maintenance is stark.
Where Are They?
In relation to schizophrenia, psychiatrists often talk about a ‘rule of thirds’: a third of patients will remain chronically unwell despite treatment; a third will respond somewhat to treatment, and a third will make a full recovery. Of course these figures are only a rule of thumb, but given that schizophrenia will affect around 1 in 100 people, it leaves the possibility that around 200 000 people in the UK have recovered from the disorder. Add in the many who have recovered from conditions like anxiety, depression, and PTSD, and you can see there might be a very large, untapped resource out there.
Through the spectrum of addiction services – from harm reduction to recovery – there exists a significant portion of the workforce who have experienced one form of dependence or another; many climbing through the ranks into positions of senior management. Given the oft-quoted statistic that one in four will experience some kind of mental health problem, it is more than conceivable that a significant percentage of mental health practitioners have experienced mental illness themselves…and presumably recovered. And yet, many remain hidden. Is this a reflection of the stigma associated with mental illness, or perhaps a culture where is self-disclosure is discouraged?
So What’s Happening?
From a UK perspective Dr. Phil Barker, a nursing theorist, has long advocated for a recovery model within mental health services. Indeed, Barker tips his hat to AA who he sees as the father of the mental health recovery movement. His concept of the ‘inevitability of change’ is a message of hope and a central pillar of his ‘Tidal Model’ of nursing (Barker, 2000). The model was developed in the mid-1990s and, although it has featured in mental health nurse training for a number of years, I’m not sure it’s seen widespread implementation. That being said, mental health services have developed the role of so-called S.T.R. (Support, Time and Recovery) workers with the idea that they “will provide support, give time to the service user, and thus promote their recovery” (NHS Careers [no date]). The fact that recovery is even mentioned is a huge step in the right direction.
In the U.S. and Canada, the recovery/consumer movement is apparently far more prominent, with radio programs and Mad Pride marches (although there’s definitely an anti-psychiatry flavour to some of their messages). In 2002, it was estimated that there were 7467 mental health mutual support groups and self-help organisations in the United States (Goldstrom et al., 2006). Perhaps this is a reflection of healthcare provision (or lack of) in America.
Back in the UK, organisations such as MIND and the Depression Alliance, and online communities, do a fantastic job of promoting the possibility of mental health recovery through peer support, but are statutory services doing enough to link service users to these potentially life changing resources?
Within the treatment of addiction, it should never be a case of either harm reduction (including O.R.T.) or recovery. The two can co-exist. Similarly, within mental health treatment, the implementation of a recovery orientated treatment system would not necessarily substitute the need for medication or other traditional interventions (I’m not advocating an anti-psychiatry viewpoint). We might not see a drastic improvement in the remission rates of mental disorders, but we may see improved treatment outcomes, increased social functioning, and reduced stigma.
The recovery movement has brought about drastic changes to the provision of addiction services within the UK. Although there’s still a long way to go, most would agree that things are moving in the right direction. But if the message of recovery is one of hope; that change is possible, then why should we restrict the message to the field of addiction?
[Paul Molyneux is a nurse working in a alcohol and drug service in the North West of England]
Barker, P. (2000). The Ten Commitments. Available: http://www.tidal-model.com/Ten%20Commitments.htm. Last accessed 7th Sep 2014.
Goldstrom, I., Campbell, J., Rogers, J., Lambert, D., Blacklow, B., Henderson, M., Manderscheid, R. (2006). National Estimates for Mental Health Mutual Support Groups, Self-Help Organizations, and Consumer-Operated Services. Administration and Policy in Mental Health and Mental Health Services Research. 33, 92-103.
NHS Careers. (No date) Support, time and recovery worker. Available: http://www.nhscareers.nhs.uk/explore-by-career/wider-healthcare-team/careers-in-the-wider-healthcare-team/clinical-support-staff/support,-time-and-recovery-worker/. Last accessed 7th Sep 2014.