Recovery Model In Mental Health

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KEY TAKEAWAYS

The recovery model in mental health is a holistic approach that focuses on the long-term building of resilience to allow the patient to manage mental health symptoms independently.

It differs from the medical model for mental health in that:

It encourages independent decision-making
It provides a patient-specific end goal
It involves friends and family in treatment [1]

What Is The Recovery Model In Mental Health?

The recovery model in mental health is a framework that takes concepts present in other medical methodologies and adjusts them in the following ways:

Motivates independent decision-making for the patient about the type, frequency, and combination of treatments used (e.g. setting goals for symptom management, considering treatment options, medication management)
Actively involves friends and family in treatment
Reinforces accessing support in the community (e.g. peer support groups, supported living, counselling services)
Builds appropriate responses to triggers, coping mechanisms, strategies, and support systems to support independently dealing with mental illness (as much as symptoms allow)
End goal is specific to each patient; the ideal main goal is independence
Makes clear to patients and practitioners that maintaining mental health is a continuous process
Required specialist care dependent on local authority/NHS budget and availability of medical professionals, as opposed to constant availability for the medical model of treatment
Seeks to address shortfalls in the medical model of treatment (e.g. prioritising medication as treatment, potential for misdiagnosis, treatment of symptoms rather than prevention)
Focuses on treatment avenues that support independence rather than managing immediate symptoms of mental health disorders [2]

Differentiating The Recovery Model vs Other Models In Mental Health Care

	Recovery Model	Harm Reduction Model	Trauma-Informed Model
Follows traditionally structured therapy approach	Yes	No	Yes
Financial costs	Costs of alternative therapy approaches	Free (NHS)	Free for 8-12 weeks (NHS) and then at cost
Does the model aim to add meaning to the recovery journey?	Yes	No	Yes
Encourages taking personal responsibility for recovery	Yes	No	No
Encourages independent decision making	Yes	No	No
Medically led treatment?	No	Yes	No

	Wellness Model	Strength-Based Model	Medical Model
Independent decision-making	Yes	Yes	No
Follows traditionally structured therapy approach	No	No	Yes
Financial costs	Framework free (NHS), then at cost	Cost to patient	Free (NHS)
Does the model aim to add meaning to the recovery journey?	Yes	Yes	No
Encourages taking personal responsibility for recovery	Yes	Yes	No
Medically led treatment?	No	No	Yes

Holistic Approach

Header	Recovery Model	Medical Model
Approach of the model	Holistic approach	Physical symptoms only approach
Long-term goals for recovery	Yes	Yes
Trauma treatment	Yes	No
Personal motivation long term	Yes	No
Family member involvement	Yes	No
Financial support	Yes	Dependent on country
Achieving independence	Yes	No [3]
Long-term outcomes	32% increase in self-reported recovery [4]	36% reported more severe mental health symptoms after treatment [5]

Individualised & Person-Centered Care Path

Header	Recovery Model	Harm Reduction Model
Key strategies	Involving patients in decisions about treatment	Providing clean needles Training in overdose protection Medication-assisted treatment
Viewing life circumstances through a positive lens	No	No
Discussing negative reasons for mental illness/trauma	Yes	Yes
Follows traditionally structured therapy approach	Yes [6]	No [7]

Header	Trauma-Informed Model	Wellness Model
Key strategies	Ensuring patient is comfortable in environment and trusts therapist Patient’s feelings are validated throughout	A structured routine using self-regulation Creating healthy habits Building self-awareness of personal needs
Viewing life circumstances through a positive lens	No	Yes
Discussing negative reasons for mental illness/trauma	Yes	No
Follows traditionally structured therapy approach	Yes [8]	No [9]

Header	Strength-Based Model
Key strategies	A structured routine identifying and building on strengths Focusing on positive attributes of life and how attributes can help recovery.
Viewing life circumstances through a positive lens	Yes
Discussing negative reasons for mental illness/trauma	No
Follows traditionally structured therapy approach	No [10]

End Goal

Header	Recovery Model	Strength-Based Model	Traditional Therapy
What is the end goal of treatment?	Individual-specific- requiring ongoing treatment	Recovery from mental health crisis- being able to deal with issues in the future [11]	Emphasising positive gains by reframing events [12]

Header	Trauma-informed model	Wellness Approach	Medical Model
What is the end goal of treatment?	Resolve trauma and build resilience [13]	Develop personalised healthy habits that foster recovery [14]	Return to the original state before treatment [15]

Decision Making & Leadership

Header	Recovery Model	Harm Reduction Model	Trauma-Informed Model
Decision-making	The patient	Practitioners decide on methadone treatment - patients decide on all other forms	Shared decision making
Is recovery prescriptive?	Engaging with treatment is up to the individual [16]	Only on prescribed medication	No
How are disagreements between patients and practitioners handled?	Attempt to reach a compromise	Practitioners will only change prescriptions if it is for patient benefit [17]	Allowing patients to regain sense of control lost via trauma by making decisions [18]

Header	Wellness Model	Strength-Based Model
Decision-making	The patient	The patient
Is recovery prescriptive?	No	No
How are disagreements between patients and practitioners handled?	Patient makes decisions using self-stewardship- practitioners only advise [19]	Attempt to reach a compromise [20]

Multi-Disciplinary

Header	Recovery Model	Medical Model
Who is involved in this model?	Family, friends, doctors, mental health professionals, ADP teams and social services [21]	Doctors, psychiatrists and other relevant medical professionals - pharmacological medical input [22]
Different methodologies used	Wellness recovery action plan, recovery-oriented cognitive therapy	Physical exams, psychological testing, neuroimaging tests

Accessibility

Header	Recovery Model	Medical Model	Harm Reduction Model
Financial costs	Costs of physical activities, music/art sessions, or access to education [23]	Available for free (NHS)	Needles or methadone treatment are free to patients (NHS)
Availability of treatment	NHS provides care dependent on waiting list length (up to 18 months)	NHS provides care dependent on waiting list length (up to 18 months) [24]	Available in 48 hours (needle exchange programmes)
Demand for specialist professionals	Need for specialists to work with general doctors and social services for interconnected care	GPs prescribing treatment	Nurse prescribers or specialists- pharmacists (demand-driven)
Availability of intervention agents (medication or off-label prescribing)	Off-label prescribing used by appropriate consultants during discussions with patients	Off-label medication used at consultant’s discretion [25]	No medication or off-label prescription available

Header	Trauma-Informed Model	Wellness Model
Financial costs	8-12 weeks of NHS-funded trauma treatment, then at a cost to patient [26]	Health and wellbeing framework available free (NHS). Further wellness treatment at a cost [27]
Availability of treatment	64% of patients wait more than 4 weeks for treatment [28]	NHS provides care dependent on waiting list length (up to 18 months)
Demand for specialist professionals	Trauma-specific therapists (demand-driven)	Practitioners trained in health and wellness (demand-driven)
Availability of intervention agents (medication or off-label prescribing)	Prescribed medication of sertraline or fluoxetine - off-label use of gabapentin prescribed by consultants [29]	No medication or off-label prescription available

Giving Meaning To Life & Mental Health Healing

Header	Recovery Model	Medical Model
How does this approach add meaning to the patient’s healing process?	Future pacing and extinguishing triggers Corroborating the belief that recovery is possible Creating a future-oriented outlook that is solution-focused [1]	Considers only the physical symptoms of mental illness and not the psychological healing process [30]

Independence & Personal Responsibility

Header	Recovery Model	Medical Model
Encourages independent decision-making and personal responsibility during treatment	Yes - uses self-management procedures [31]	No
Encourages taking personal responsibility for mental health	Yes	No
Recovery dependent on professional opinion/ medication effectiveness	No- self-determined recovery [32]	Yes - clinical recovery (absence of or a reduction in mental health symptoms) [33]

Addressing Shortfalls In Other Treatment Methods

	Recovery Model	Medical Model
How treatment is prescribed	Long-term treatment goals beyond immediate symptom treatment	Treatment of presenting symptoms only
Is care personalised?	Personalised for patients' budget and symptoms	Standardised care
Independence	In control of own treatment	Treatment type/methods as determined by medical professionals
When is intervention provided?	Set up as soon as patient requires it, remaining in place after crisis	At the point of crisis [34]

Examples Of The Recovery Model In Mental Health Care

WRAP (Wellness Recovery Action Planning)

WRAP utilises principles of the recovery model by:

Having patient take personal responsibility for recovery
Preparing ahead with a personalised mental health crisis plan
Creating and utilising tools that work for each patient (e.g. identifying personal strengths, crisis and post-crisis planning)
Viewing primary care treatment as part of long-term mental health recovery, rather than the focus of recovery [35]

DREEM (Developing Recovery Enhancing Environments Measure)

The DREEM measurement tool is a 24-item questionnaire with questions on a scale (1-strongly disagree to 5- strongly agree) that measures how a recovery service utilises the recovery model.

High scores (100-120) indicate that the recovery service utilises the recovery model, whereas low scores (24-50) indicate that the recovery service does not utilise the recovery model [36].

Recovery Star

Recovery Star utilises principles of the recovery model by:

Maintaining long-term communication after treatment to measure client's sobriety
Applying a personalised recovery journey to each patient
Recording progress in all aspects of life, not just addiction [37]

Abbeycare utilises the recovery star approach as part of active aftercare plans.

Benchmarking And Measuring Progress In The Recovery Model Vs. Other Models

Header	Recovery Model	Medical Model
How model measures success in recovery	Number of days, weeks, or months of sobriety Reduced hospitalisations (measured by days or percentage of year) Reduced mental health episodes (measured by days or percentage of year) Integration into the community (measured by time spent in the community) Quality of life (measured by the WHOQOL) Resilience (measured by the Connor Davidson Resilience scale) Independence (measured by the Katz ADL) [38] [39]	No return of symptoms/ return to original state before treatment Whether abstinence has been achieved [40]
How model measures progress	Using measurements such as WHOQOL, Connor Davidson Resilience Scale, and Katz ADL, to measure progress in those who will not achieve full recovery	Considers recovery as either achieved or not achieved
Barriers to model measuring progress	Differing pre-existing recovery capital, meaning increase cannot be measured [41]	Does not allow for patients who will not achieve complete recovery as it does not consider any other form of progress

Recovery Capital In The Recovery Model Vs. Single Modality Approach

Recovery capital is the personal, social, and environmental resources the patient can use to sustain mental health recovery [42].

The table below includes two examples of patients suffering from mental health disorders.

Patient 1 is not able to access detox, but has high levels of recovery capital.

Patient 2 is able to access detox, but has low levels of recovery capital.

Factors That Alter Patient Recovery	Patient Being Treated By The Recovery Model	Patient Being Treated By The Medical Model
Is patient receiving medical detox?	No	Yes
Medical treatment provided	Can include WRAP, DREEM, or Recovery Star [43]	Can include electroconvulsive therapy, neurosurgery, or antidepressants [44]
Friends and family involved in treatment	Yes	No
Pre-existing good physical health	Yes	No
Pre-existing adaptive coping skills	Yes	No
Pre-existing spirituality	Yes	No
High self-esteem	Yes	No
Financial support	Yes	No
Inclusion of support groups (e.g., Alcoholics Anonymous, etc.)	Yes	No
Assisted into housing	Yes	No
How do the above factors influence recovery?	66.1% of those scoring on all forms of recovery capital continued progress in treatment after 1 year [45]	Lack of recovery capital accounts for 23% of reduced recovery outcomes [46]

Recovery Model In Psychiatric Issues

The recovery model in mental health caters to diagnoses of schizophrenia, bipolar disorder, borderline personality disorder, or other complex mental health disorders by:

Aiming to progress through care pathway to secondary care from psychiatric care, as complete independence from medical professionals illustrated in the recovery model may not be possible
Encouraging collaboration between patients and medical professionals, but not allowing the patient to make decisions solely
Providing secondary referrals as illustrated in the recovery model to achieve independent living, taking into account complex symptoms
Emphasis on holistic methods, while combining holistic methods with appropriate medical intervention vs holistic methods alone [47]

Recovery Model In Addiction Recovery

The recovery model is applied to addiction recovery by:

Patients take an active role in care plans, aftercare, relapse prevention plans, programme content, etc that take into account patient's trauma, religion, allergies, social phobias, etc.
Focusing on regaining independence from medical intervention, through the lens of addiction

Differences between applying the recovery model to mental health and addiction recovery, that present challenges when applying specifically to addiction, include:

The recovery model applied to addiction is solely focused on symptoms caused by addiction, whereas the mental health recovery method treats all symptoms
The recovery model applied to addiction has a smaller scope of available treatment approaches for patients than the recovery model in mental health
The recovery model applied to addiction does not include long-term medication use as part of recovery [48]

Challenges In Fully Integrating Recovery Model Into Existing Mental Health Care Systems

Ethical Considerations

Adopting a multi-disciplinary approach to care means multiple healthcare practitioners can access patient's confidential care notes, leading to data protection concerns.

Medical professionals must balance patients' self-determination of treatment with appropriate clinical care needed for treatment [49].

The Structure Of Existing Healthcare Not Supportive Of The Recovery Model

A joined-up approach to care (as outlined in the recovery model) causes difficulties when integrating processes of the recovery model:

Different care practises exist in different hospitals, community centres, or GP practices, meaning patients cannot access all forms of care in every location
NHS waiting list duration causes different services to be available at different times, meaning a joined-up approach is not possible

Managing Risks To Patients' Safety

Patients with complex psychiatric disorders (e.g. bipolar disorder, borderline personality disorder, or schizophrenia) present risks when incorporating the recovery model:

Patients with complex psychiatric disorders inadvertently trigger others, limiting their participation in group therapy, due to disruptive behaviour
The goal of full independence in mental health cannot be achieved if patient needs full-time care in a facility; living independently should not be encouraged due to safety risks

How The Recovery Model Can Influence Policy

The Reforming The Mental Health Act white paper details the following changes to the 1983 Mental Health Act that are influenced by principles in the recovery model, including:

Directives for patients to be more involved in decisions about care and treatment approaches
Involving a nominated friend/ family member in treatment decisions
A personalised care and treatment plan [50]

When The Recovery Model Doesn't Work

The Patient Does Not Believe In Mental Illness Diagnosis

Those suffering from psychosis or schizophrenia become convinced they are not suffering from a mental illness, are in denial, or are experiencing self-stigma.

This can mean patients fail to engage in making decisions or fail to become involved in treatment.

When The Patient Cannot Fully Recover

While the recovery model aims for patients to achieve full recovery in all aspects of life, in reality, patients may be:

Unable to achieve premorbid level of function
Unable to maintain employment productively
Unable to integrate into the community fully

The medical model may be more successful in these cases as patients require structured support rather than independence to achieve recovery goals.

References

[1] Jacob, K.S. “Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care.” Indian Journal of Psychological Medicine, vol. 37, no. 2, 2015, pp. 117–119. “The approach argues against just treating or managing symptoms but focusing on building resilience of people with mental illness and supporting those in emotional distress. While there is no single definition of the concept of recovery for people with mental health problems, there are guiding principles, which emphasise hope and a strong belief that it is possible for people with mental illness can regain a meaningful life, despite persistent symptoms.”
[2] Jacob, K.S. “Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care.” Indian Journal of Psychological Medicine, vol. 37, no. 2, 2015, pp. 117–119. “The approach argues against just treating or managing symptoms but focusing on building resilience of people with mental illness and supporting those in emotional distress. While there is no single definition of the concept of recovery for people with mental health problems, there are guiding principles, which emphasise hope and a strong belief that it is possible for people with mental illness can regain a meaningful life, despite persistent symptoms. Recovery is often referred to as a process, an outlook, a vision, a conceptual framework or a guiding principle.”
[3] Department of Health Victoria. "Framework for Recovery-Oriented Practice." 2011.
[4] Thomson, Lindsay, and Cheryl Rees. “Long-Term Outcomes of the Recovery Approach in a High-Security Mental Health Setting: A 20 Year Follow-up Study.” Frontiers in Psychiatry, vol. 14, 11 May 2023, p. 1111377. Accessed 18 Sept. 2023. “The Mann–Whitney U analysis of the Questionnaire about the Process of Recovery (QPR) data captured through an interview at the 20 year follow-up indicates a statistically significant difference in self-reported ratings of recovery in terms of the 22-item intra-personal scale (U = 33.5, Z = −2.14, p = 0.32, r = −0.43).”
[5] Bogaers, Rebecca, et al. “Seeking Treatment for Mental Illness and Substance Abuse: A Cross-Sectional Study on Attitudes, Beliefs, and Needs of Military Personnel with and without Mental Illness.” Journal of Psychiatric Research, vol. 147, Jan. 2022. “Table 2.”
[6] Jacob, K.S. “Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care.” Indian Journal of Psychological Medicine, vol. 37, no. 2, 2015, pp. 117–119. “Recovery is not about “getting rid” of problems but seeing beyond a person’s mental health problems, recognizing and fostering their abilities, interests and dreams. It argues against the traditional concepts of mental illness and social attitudes, which often impose limits on people experiencing mental ill health. Health professionals often have reduced expectations, while families and friends can be overly protective or pessimistic about what someone with a mental health problem will be able to do and achieve. Recovery is about looking beyond those limits to help people achieve their own goals, aspirations and dreams.”
[7] Ashton, John R., and Howard Seymour. “Public Health and the Origins of the Mersey Model of Harm Reduction.” International Journal of Drug Policy, vol. 21, no. 2, Mar. 2010, pp. 94–96. “The harm reduction model was based on a population approach to achieve the public health goal of reducing the harm to health associated with drug use. The particular concern at that time was the risk of HIV infection, but there was also the issue of the health of a group of young people who were under-served by health services. To achieve the goal, services were developed that would attract the majority of those at risk within the community, not simply the few who wished to stop using drugs, and which would enable contact with the target group to be maintained so as to bring about the necessary changes in behaviour required to maintain health and reduce risk.”
[8] Central And North West London NHS Foundation Trust. "Adult Mental Health Services Information Pack: Introduction to Trauma-Informed Approaches to mental healthcare." Dec. 2020. " This manual has been developed with permission from the Cwm Taf Morgannwg University Health Board, Psychology Therapies Team."
[9] Stoewen, Debbie L. “Dimensions of Wellness: Change Your Habits, Change Your Life.” The Canadian Veterinary Journal, vol. 58, no. 8, Aug. 2017, p. 861. “Wellness encompasses 8 mutually interdependent dimensions: physical, intellectual, emotional, social, spiritual, vocational, financial, and environmental (Table 1) (1). Attention must be given to all the dimensions, as neglect of any one over time will adversely affect the others, and ultimately one’s health, well-being, and quality of life.”
[10] SCIE. “Strengths-Based Approaches | SCIE.” Social Care Institute for Excellence (SCIE), 2022. “Strengths-based (or asset-based) approaches focus on individuals’ strengths (including personal strengths and social and community networks) and not on their deficits. Strengths-based practice is holistic and multidisciplinary and works with the individual to promote their wellbeing. It is outcomes led and not services led.”
[11] Xie, Huiting. “Strengths-Based Approach for Mental Health Recovery.” Iranian Journal of Psychiatry and Behavioral Sciences, vol. 7, no. 2, 2013, p. 5. “The strengths-based approach aligns itself with the notion of mental health recovery by focusing on person’s ability, helping them developing the confidence to embark on the journey of recovery and aiding them to progress towards mental health recovery. Attention is placed on people’s abilities rather than their shortcomings, symptoms or difficulties.”
[12] International Center For Clinical Excellence. "The Termination Checklist." Nov. 2017. "Emphasize positive gains made, assess improvements, help the client understand the changes, and saying goodbye."
[13] Sweeney, Angela, et al. “A Paradigm Shift: Relationships in Trauma-Informed Mental Health Services.” BJPsych Advances, vol. 24, no. 5, 13 Aug. 2018, pp. 319–333. “Trauma-informed practices use strengths-based approaches that are empowering and support individuals to take control of their lives and service use. Such approaches are vital because many trauma survivors will have experienced an absolute lack of power and control.”
[14] Stoewen, Debbie L. “Dimensions of Wellness: Change Your Habits, Change Your Life.” The Canadian Veterinary Journal, vol. 58, no. 8, Aug. 2017, p. 861. “Habits, in fact, are key to wellness. For better or worse, habits very much influence health, well-being, and quality of life.”
[15] Committee on National Statistics, et al. "Measures of Recovery." National Academies Press (US), 19 Sept. 2016. “Close attention to the methods used to measure recovery from substance use reveals, however, that most of the time the question that is used is simply about abstinence in a yes/no format.”
[16] IMHCN. “What Is Recovery?” International Mental Health Collaborating Network. “Recovery is often referred to as a process, outlook, vision, conceptual framework or guiding principle. The recovery process: provides a holistic view of mental illness that focuses on the person, not just their symptoms; believes recovery from severe mental illness is possible; is a journey rather than a destination; does not necessarily mean getting back to where you were before; happens in “fits and starts” and, like life, has many ups and downs; calls for optimism and commitment from all concerned; is profoundly influenced by people’s expectations and attitudes; requires a well organised system of support from family, friends or professionals; requires services to embrace new and innovative ways of working.”
[17] Davari, Majid, et al. “Factors Influencing Prescribing Decisions of Physicians: A Review.” Ethiopian Journal of Health Sciences, vol. 28, no. 6, 2018, pp. 795–804. “The identified factors showed that prescribing is not only geared for patient benefit, but also towards personal interest.”
[18] Office for Health Improvement & Disparities. “Working Definition of Trauma-Informed Practice.” GOV UK, Office for Health Improvement & Disparities, 2 Nov. 2022. “Service users are supported in shared decision-making, choice and goal setting to determine the plan of action they need to heal and move forward, by: ensuring service users and staff have a voice in the decision-making process of the organisation and its services; listening to the needs and wishes of service users and staff; explaining choices clearly and transparently acknowledging that people who have experienced or are experiencing trauma may feel a lack of safety or control over the course of their life which can cause difficulties in developing trusting relationships.”
[19] Stoewen, Debbie L. “Dimensions of Wellness: Change Your Habits, Change Your Life.” The Canadian Veterinary Journal, vol. 58, no. 8, Aug. 2017, p. 861. “Wellness necessitates good self-stewardship, for ourselves and for those we care about and who care about us.”
[20] Department of Health & Social Care. "Strengths-based approach: Practice Framework and Practice Handbook." Feb. 2019.
[21] Jacob, K.S. “Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care.” Indian Journal of Psychological Medicine, vol. 37, no. 2, 2015, pp. 117–119. “The recovery process is profoundly influenced by people’s expectations and attitudes and requires a well-organized system of support from family, friends or professionals. It also requires the mental health system, primary care, public health and social services to embrace new and innovative ways of working.”
[22] Mcleod, Saul. “Medical Model - Treating Mental Disorders.” SimplyPsychology Org, 9 Nov. 2023. “The medical model of mental illness treats mental disorders in the same way as a broken arm, i.e., there is thought to be a physical cause. This model has been adopted by psychiatrists rather than psychologists.”
[23] NHS England. “NHS England: Personal Health Budgets for Mental Health.” NHS England. “Personal health budgets for mental health can include a range of things to give people access to care, support and services that are holistic, innovative and build on their strengths. Examples include: Physical activities and equipment to help people manage voices, distract from paranoid thoughts, help with self-regulation and manage angry outbursts whilst also helping to develop friendships, build confidence and concentration ... Music/art sessions that support expression and creativity, provide distraction from symptoms, help engagement with new environments and building of relationships.”
[24] Baker, Carl, and Esme Kirk-Wade. “Mental Health Statistics: Prevalence, Services and Funding in England.” Mental Health Statistics: Prevalence, Services and Funding in England, vol. 1, no. CBP-06988, 1 Mar. 2024. “Most local mental health funding is not ring-fenced, meaning that each local NHS area determines its own mental health budget from its overall funding allocation. This means that neither the Government nor NHS England determines exactly how much funding goes to mental health services in local areas.”
[25] Baldwin, David S., and Nick Kosky. “Off-Label Prescribing in Psychiatric Practice.” Advances in Psychiatric Treatment, vol. 13, no. 6, Nov. 2007, pp. 414–422. “Many doctors believe that off-label prescribing is often necessary when attempting to treat certain patients, for example those whose symptoms have proven resistant to a range of treatment approaches. The extent of unlicensed prescribing in psychiatric practice is not fully known, but survey findings and research studies suggest that it is common across psychiatric specialties in the UK and in many other countries.”
[26] NHS UK. “Treatment - Post-Traumatic Stress Disorder.” NHS UK, 2022. “You’ll usually have 8 to 12 weekly sessions of trauma-focused CBT, although fewer may be needed. Sessions usually last for around 60 to 90 minutes.”
[27] NHS England. "Elements of Health and Wellbeing: Creating a health and wellbeing culture." Nov. 2021.
[28] Royal College of Psychiatrists. Two-Fifths of Patients Waiting for Mental Health Treatment Forced to Resort to Emergency or Crisis Services. 6 Oct. 2020. “Of those on a hidden waiting list, nearly two-thirds (64%) wait more than four weeks between their initial assessment and second appointment.”
[29] Berlin, Rachel K., et al. “Gabapentin Therapy in Psychiatric Disorders.” The Primary Care Companion for CNS Disorders, vol. 17, no. 5, 22 Oct. 2015. “Gabapentin is commonly used off-label in the treatment of psychiatric disorders with success, failure, and controversy.”
[30] Zigmond, David. "The Medical Model - its Limitations and Alternatives: How humanism may synergise biomechanism." Nov. 2014.
[31] Davidson, Laurie. “Recovery, Self Management and the Expert Patient – Changing the Culture of Mental Health from a UK Perspective.” Journal of Mental Health, vol. 14, no. 1, Feb. 2005, pp. 25–35. “Self management models derived from a recovery model and service users’ experiences may have more value than models derived from physical health.”
[32] SAMHSA. "SAMHSA's Working Definition of Recovery." SAMHSA, 2012. "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."
[33] Rethink Mental illness. “Recovery and Mental Illness.” Recovery and Mental Illness, 2022. “Some doctors and health professionals think of recovery as no longer having mental health symptoms. Or a reduction of symptoms, which means you’re able to live a meaningful life. Sometimes this is called “clinical recovery.””
[34] Mcleod, Saul. “Medical Model - Treating Mental Disorders.” SimplyPsychology Org, 9 Nov. 2023. “Supporters of the medical model consequently consider symptoms to be outward signs of the inner physical disorder and believe that if symptoms are grouped together and classified into a “syndrome,” the true cause can eventually be discovered and appropriate physical treatment administered.”
[35] Wellness Recovery Action Plan. “What Is WRAP?” Wellness Recovery Action Plan, 2023. “Discover simple, safe, and effective tools to create and maintain wellness; Develop a daily plan to stay on track with your life and wellness goals; Identify what throws you off track and develop a plan to keep moving forward; Gain support and stay in control even in a crisis.”
[36] Dinnis, Stephen, et al. "The Russell Clinic Survey: Steps towards recovery-based services - Implementing the Developing Recovery Enhancing Environment Measure DREEM." National Institute of Mental Health for England. "Figure 1."
[37] Mental Health Providers Forum. "Mental Health Recovery Star: User Guide." Mental Health Providers Forum, Sept. 2021. "The 10 areas of the recovery star."
[38] Connor, Kathryn M., and Jonathan R.T. Davidson. “Development of a New Resilience Scale: The Connor-Davidson Resilience Scale (CD-RISC).” Depression and Anxiety, vol. 18, no. 2, 2003, pp. 76–82. “The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience.”
[39] Physiopedia. "Katz ADL." Physiopedia. "Physiotherapists use the tool when assessing function and detect problems in performing ADL and formulate a plan care. The Index ranks adequacy of performance in six functions: bathing, dressing, toileting, transferring, continence, and feeding. One point means the person is independent; zero points means the person requires supervision, direction, personal assistance or total care."
[40] Committee on National Statistics et al. "Measures of Recovery. National Academies Press (US)." 19 Sept. 2016. “Close attention to the methods used to measure recovery from substance use reveals, however, that most of the time the question that is used is simply about abstinence in a yes/no format.”
[41] Committee on National Statistics et al. "Measures of Recovery. National Academies Press (US)." 19 Sept. 2016. "If someone who used to have no social contact moved toward slightly more social contact but still falls far short of what one would like to see, would that be considered recovery?"
[42] Best, David, and Emily A. Hennessy. “The Science of Recovery Capital: Where Do We Go from Here?” Addiction, vol. 117, no. 4, Dec. 2021. “In general, RC research and models address individual-level factors (oftentimes labelled “personal RC” or “human and financial RC”), inter-individual-level factors (“social RC”), and the larger environmental context (“community RC”).”
[43] Jacob, K.S. “Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care.” Indian Journal of Psychological Medicine, vol. 37, no. 2, 2015, pp. 117–119. “WRAP (Wellness Recovery Action Planning) (See Mental Health Recovery and WRAP website. It is a program to facilitate recovery; DREEM (Developing Recovery Enhancing Environments Measure). It is an outcome measure and research tool to see how “recovery-oriented” a service is and also gathers information about mental health recovery from people who use mental health services; Recovery Star. This tool allows people with mental health problems and using services to enable them to measure their own recovery progress.”
[44] Trifu, Simona, et al. “Efficacy of Electroconvulsive Therapy as a Potential First‑Choice Treatment in Treatment‑Resistant Depression (Review).” Experimental and Therapeutic Medicine, vol. 22, no. 5, 9 Sept. 2021. “Electroshock or electroconvulsive therapy (ECT) is one of the alternative treatments to medication-resistant depression.”
[45] Laudet, Alexandre B., and White, William L. "Recovery Capital as Prospective Predictor of Sustained Recovery, Life satisfaction and Stress among former poly-substance users." Substance Use Misuse, vol. 43, no. 1, 2008, pp. 27-54. "Table 2."
[46] O’Sullivan, Deirdre, et al. “Recovery Capital and Quality of Life in Stable Recovery from Addiction.” Rehabilitation Counseling Bulletin, vol. 62, no. 4, 28 Sept. 2017, pp. 209–221. “Results reveal that relapse history, refusal self-efficacy, and self-stigma significantly explained about 23% of quality of life in our sample. A discussion of recovery stages and recovery capital is included, as well as implications for rehabilitation counseling practice and research.”
[47] Warner, Richard. “Does the Scientific Evidence Support the Recovery Model?” The Psychiatrist, vol. 34, no. 1, Jan. 2010, pp. 3–5. “A growing body of research supports the concept that empowerment is an important component of the recovery process and that user-driven services and a focus on reducing internalised stigma are valuable in empowering the person with schizophrenia and improving the outcome from illness.”
[48] G.P. du Plessis. “The Integrated Recovery Model for Addiction Treatment and Recovery.” Journal of Integral Theory and Practice, vol. 5, no. 3, 1 Sept. 2010, pp. 68–85.
[49] Ørjasæter, Kristin B., and Arve Almvik. “Challenges in Adopting Recovery-Oriented Practices in Specialized Mental Health Care: “How Far Should Self-Determination Go; Should One Be Allowed to Perish?”” Journal of Psychosocial Rehabilitation and Mental Health, vol. 9, no. 9, 29 Mar. 2022. “The lack of integration is linked to physical structures not appropriate to recovery-oriented practice (Cleary et al., 2013), ethical challenges like promoting self-determination (McKenna et al., 2014) and professional responsibility for managing possible risks to patient safety.”
[50] Garratt, Katherine. "Reforming the Mental Health Act." House of Commons Library, July 2024. "Where appropriate, clinicians would be required to prepare and regularly review a personalised care and treatment plan for certain patients detained under the act."

About the author

Harriet Garfoot

Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health, and is a member of the Burney Society. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: October 30, 2025