No / Rhetorically contextualised against a history of poor outcomes and negative attitudes, New Labour’s mental health policy introduced recovery as a turn towards optimism, control and choice for those who provide and use mental health services. Recovery continues to occupy a key role within contemporary policy and practice. Despite such privilege recovery remains a contested concept, not least because it means different things to different people. This article reports empirical work conducted during 2010-11, and explores two interpretive repertoires (traditional and responsibilised-progressive) that mental health practitioners draw upon in their accounts of recovery. Grounded in constructionist theory, the findings suggest that practitioner accounts of recovery are diverse, and produce many different subject positions from which recovery may be experienced. Developing Webber and Joubert’s (2016) editorial comments on the challenge for Social Work, it is argued that professional Social Work must practice in a manner compatible with its own value-base and any model of recovery must be held up for scrutiny. A knowledgeable position for the practitioner is advocated, one that is capable of working multiple paradigms in order to better understand and meet service user need. / ESRC

Background: Evidence suggests that the recovery focused approach provides a new conceptual framework for modern rehabilitation practice; encouraging a movement away from traditional medical treatment, towards a more person-centred, social approach to patient care. Mental health services are increasingly focused on supporting the recovery approach to patient care, with government policies continuing to encourage local teams to develop recovery focused services. In relation to the recovery focused approach, this thesis had two aims. Firstly, to systematically analyse literature which explores the impact of recovery-oriented training on staff knowledge and attitudes toward recovery practice, and secondly, to explore nursing staff perceptions and experiences concerning moving towards and using a recovery focused approach within a low secure forensic mental health setting. Methods: Aims were addressed in two separate pieces of work. The first journal article presents a systematic review. Literature searches of six computerised databases, hand searching of selected journals, and the contacting of key authors of identified papers identified nine papers which explored the impact of recovery-oriented training programmes on increasing staff knowledge and changing attitudes towards practice. In journal article 2, interviews were conducted with eleven forensic mental health nurses in relation to service changes and analysed using Framework Analysis. Results: The systematic review found that all nine studies demonstrated significant positive changes in mental health practitioners’ self-reported recovery-based knowledge, recovery-consistent attitudes and attributions, and optimism following completion of a recovery-oriented training programme. In journal article 2, five themes were identified: managing risk; patient engagement; service developments; development of job role and ward environment. Conclusions: The systematic review demonstrated the effectiveness of recovery-oriented training programmes at facilitating positive changes in staff knowledge, attitudes and attributions towards recovery oriented practice in clinical populations. Limitations of the papers included the relatively small sample sizes, the complex nature of the populations reviewed and the high rate of demographic confounding variables identified. The results of the original study provided insight into the views and understandings of forensic mental health nursing staff, specifically, into factors which were perceived to promote and impede the recovery focused approach within a low secure forensic mental health setting. In both articles, results are discussed in relation to clinical implications, strengths and limitations, and directions for future research.

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Recovery is a new concept positing that people with schizophrenia can lead fulfilling, satisfying, and productive lives. Family carers often play a helpful but largely unacknowledged role in the support of service users with schizophrenia, and the nature of their contribution to and their role in recovery has hitherto not been investigated. This original PhD explores whether learning about the recovery approach through participation in a training intervention changes the way carers view recovery, whether they find the concept helpful, whether it modifies their behaviour, and their evaluation of the intervention. A participatory action research methodology was applied in this study, actively supported by a steering group consisting of different stakeholders. Training on the recovery approach was delivered to a group of eleven carers to explore their response to the recovery concept. The training programme was delivered by me and a carer, utilising my personal experience as a service user with the diagnosis of schizophrenia. Focus groups and individual, semi-structured follow-up interviews were applied to assess self-reported changes in attitudes and behaviours. Mainly qualitative data were collected with supplementary socio-demographic data. The analysis of the qualitative data suggests that being more ‘recovery-aware’ gives carers increased hope and optimism for their own and the service user’s future. Greater awareness of the impact of caring upon the service user’s life helps them to begin to care in such a way as to promote recovery in the service user, and gain more confidence in their own expertise-by-caring. Professionals have a key role to play in recovery, a three-cornered partnership between the carer, professionals and the service user is desirable. The carers evaluated the training programme as helpful, and particularly valued its authenticity as it was led by a service user and carer trainers. Conclusions suggest that recovery is a helpful concept for carers. It shows that learning about recovery helps them to care more effectively for the service user and for themselves. It suggests the usefulness of developing a recovery concept for carers based on reconciliation of their caring identity, their caring role and their relationships with the service user and professionals. Recovery for the service user and for the carer requires support from professionals, based on a partnership service model, a contribution to the development of recovery practice. The training programme is a useful way of conveying the hope in recovery and is strengthened by the service user perspective of recovery.

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This essay discusses some experiences of families, carers and people with experience of mental ill-health and recovery in New Zealand, focussing on ‘recovering moments’ in social exchanges, families, mental health settings and in anthropological research. It draws comparisons between phenomenological approaches in anthropology and practices promoted in recent mental health recovery philosophy, with a particular focus on the production and exchange of particular local expertise, much of which resists academic appropriation or definition. The value, currency and relevance of these ‘recovering voices’ relates to their being privileged, validated and transmitted in ethical exchanges in a range of social settings that exemplify aspects of Marcel Mauss’ discussion of the act of giving, receiving and repaying (1980:34).

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