Understanding the whole person
The Revolving Doors Agency has just (26 November 2015) published the first in a series of literature reviews on severe and multiple disadvantage.
Entitled: Understanding the whole person, it asks the key question:
What are the common concepts for recovery and desistance across the fields of mental health, substance misuse, and criminology?
Written by Lucy Terry (@LucyACTerry)and Vicki Cardwell (@vickihcardwell), and funded by the Lankelly Chase Foundation, the report examines existing research in several different disciplines and concludes that people facing complex needs and disadvantaged lives will see many common steps across their recovery journeys.
The authors reviewed 53 studies across the mental health recovery, desistance from crime and substance misuse recovery sectors. They found three common themes:
- Recovery journeys are difficult and relapse or setbacks are common. But many people can and do overcome deeply entrenched problems
- Finding meaningful opportunities and roles helps to build a positive self-image
- Supportive friends and family play a key role in sustaining these journeys, while discriminatory attitudes and labels can hold people back.
These findings are explored in more detail below.
A long and difficult process
The literature is clear across all three domains that recovery from/in mental illness, recovery from substance misuse and desistance from crime are processes that take considerable time and effort. The journeys involve deciding to change (whether gradually or suddenly), and then consistently maintaining that decision in the face of stigma, anxiety and fear, barriers to opportunities and social exclusion. Maintaining a process of change is different from and harder than deciding to change. Lapses and setbacks are part of most journeys, which are non-linear, even if the overall trajectory is upwards.
Maintaining the process of desistance or recovery is dependent on things like personal skills and capabilities, support networks, self-confidence and location. For example, recovery from drug misuse may require building up a new community of supportive friends, and moving away from contacts who encourage using.
The literature across all three domains depicts these processes as highly subjective. It is about the ‘lived realities’ of people’s lives, not a prescribed service intervention or a combination of factors that automatically propel someone forward. Recovery and desistance happen largely outside formal treatment settings and support services. Professional roles are to support and facilitate these journeys, with some researchers arguing that the main responsibility of professionals is simply to not “get in the way” of recovery.
One of the most fundamental aspects of successful journeys of recovery and desistance is a strong, coherent and positive personal identity. People must be able to imagine themselves beyond the identities of addict, offender, or mental health patient. This new identity must also be reaffirmed by others. Without this robust sense of a ‘good’ self, which is meaningful to the individual, it is hard to believe in the possibility of change.
In addiction recovery and desistance in particular, a feeling of shame or dislike around what one has ‘become’ is fairly common, but must be accompanied by a sense of a positive future for oneself.
Meaning in life
Identity is strongly tied to meaningful roles in life, which validate new positive identities, making people feel part of the ‘mainstream’ and giving self-worth. People’s roles reinforce their identities, defining themselves by their occupation, their role in the community, their relationship to others: mother, friend, carer, expert by experience, counsellor. Longitudinal data shows a strong association between higher life quality and engagement in meaningful activity. But (re)assuming these roles is not always easy; for example it is hard to reassert parental authority following residential care or prison.
The literature across all three domains shows that developing a meaningful identity cannot be separated from social capital. Social networks provide emotional support, empathy, inspiration, encouragement, opportunities, roles, practical help, a chance to give help as well as receive, and motivation to change. The research finds that supportive social networks are a strong predictor of quality recovery from substance misuse.
However, there are also some differences in recovery journeys from these different problems (although, it is important to remember that many people face two or all three of these problems – and often homelessness as well).
The mental health recovery model is not primarily about recovery from mental illness symptoms, since many people will need to learn to cope with these symptoms throughout their lives.
In the mental health literature, services and systems are often portrayed as the biggest barriers to recovery, in undermining choice, personhood, hope, and self-control. Some problems are actually caused by doctors and the mental health treatment system and the continuing (if slowly lessening) stigmas and stereotypes which abound in mainstream society.
The paper is part of an ambitious project aiming to break down academic boundaries and promote collaboration between researchers, leading to greater insight into the experiences of people facing multiple needs.
Vicki Helyar-Cardwell, one of the authors and the Director of Research and Development at Revolving Doors, said:
People facing multiple and complex needs have a steep hill to climb in search of a better life. People need to believe in their own potential, and have the support of others. The review should also encourage us to be optimistic as it shows that change is possible, even if it is hard to get there.