“I don’t believe I’m going to recover from anything.” Understanding recovery amongst people with severe mental illness attending community health services in Spain

Abstract

Purpose

The concept of recovery has become the backbone of mental health services and professional practices. However, research aimed at analysing the conceptualisation of recovery of people diagnosed with severe mental illness (SMI) has an obvious Anglo-Saxon bias. Our objective was to analyse what a sample of 51 users of mental health services diagnosed with SMI in Spain understand by recovery.

Method

The participants were interviewed in depth about their concept of recovery, and their responses were thematically analysed by three observers.

Results

Four categories of definitions of the concept of recovery were found in the analysis: Socio-Behavioural, Biomedical, Resistance, and Wellbeing-Growth. Inter-rater reliability scores ranged from 0.7 to 0.84 according to Krippendorff’s alpha. While the Biomedical category essentially corresponded to the idea of clinical recovery, the Wellbeing-Growth category reproduced the concept of personal recovery (PR) that is dominant in the literature. The most frequent categories were Socio-Behavioural and Biomedical. Assimilation of the PR concept by participants was quite limited. The markedly relational character of the most frequent categories challenges the individualistic core of the classic definition of PR.

Conclusions

We advocate the need to make alternative recovery concepts and narratives visible to the mental health services’ users and practitioners.

IMPLICATIONS FOR REHABILITATION

• The concept of personal recovery is not common amongst mental health services’ users as recovery is mainly understood in social and biomedical terms.

• Different conceptualizations of recovery can coexist in participants.

• Mental health services should consider alternative narratives to personal recovery.

• Mental health services should provide resources for creating community and sense of belonging as first strategies for promoting recovery.

Keywords:

• Mental health recovery
• community health services
• severe mental illness
• schizophrenia
• bipolar disorder
• culture

Acknowledgements

Special thanks to the professionals and users of CSM "Centro de Salud Mental Comunitaria-Guadalquivir" and SOAE "Servicio de Orientación y al Empleo-FAISEM" for their collaboration.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was carried out within the framework of the research project funded by the Spanish Government, Ministry of Science and Innovation, State Research Agency and European Regional Development Fund-ERDF, entitled “Challenges of the self: Identity reconstruction in situations of inequality and social exclusion” (Reference: PSI2016–80112–P).