By Larry Davidson, Ph.D., and Katherine Ponte, B.A., J.D., MBA, CPRP
When managing serious mental illness (SMI), the recovery journey can be long and challenging. It often requires creative and prolonged efforts to build and maintain a full life, but many people do reach recovery. In fact, up to 65% of people living with SMI experience partial to full recovery over time.
The term “recovery” refers to the process of learning how to minimize the symptoms associated with SMI. Note that recovery does not mean symptoms stop entirely or that deficits disappear. Ultimately, recovery is not synonymous with “cured.” Rather, it means reaching a place where you are able to pursue a safe, dignified and meaningful life.
The cornerstones of recovery are self-determination, treatment, engagement with family and friends, work and hope. Loved ones play a critical role in a person’s recovery, especially when well-intentioned caregivers listen to and respect their loved one’s goals. Additionally, the guidance of competent, experienced and compassionate mental health practitioners can also be invaluable.
While recovery may look different for different people, there are several basic strategies that can serve anyone looking to manage their illness. These basics may help you reach recovery more quickly and easily.
Recovery is rarely achieved in the absence of hope. Its power cannot be overestimated. You must always try to maintain hope despite the challenges (including loss, stigma, discrimination) you face. Hope doesn’t have to come solely from internal strength; it can come from caregivers, friends, peers, people outside of a mental health context, and even animals or faith. Feeling supported, accepted and loved as a person of value and worth can foster and nurture hope.
Recovery has to be pursued; it does not simply occur in response to medication or other treatments. That is why it is so important to make your own decisions and actively use treatment, services, supports or other resources. For example, preparing a Psychiatric Advance Directive, which states your treatment preferences in the event of a mental health crisis, can allow you to retain control over care even if you become impaired. As with any illness, you may have to self-advocate to ensure everyone in your care team respects your right to have a say in your care.
Do not give up on your dreams. Identifying your life pursuits, such as living, working, learning and participating fully in the community, is an important recovery goal. After establishing these objectives, you can work with your providers and caregivers to make those goals a part of your care plan.
You should not delay the pursuit of recovery in the hopes that your symptoms will go away on their own. Progress typically occurs through a series of small steps, which may involve considerable effort, patience and persistence over time. These accomplishments become possible and noticeable if you set and achieve realistic and short-term, if not immediate, personal goals. Small, incremental steps can build on each other, positioning you to address more ambitious goals further down the line. Celebrating achievements, no matter how seemingly mundane, is an important part of the recovery process.
Finding the Right Care
Finding caring, trusting, supportive relationships with a practitioner is critical for recovery. Practitioners should encourage and support your hopes, interests, assets, talents, energies, efforts and goals. To achieve these, you should discuss calculated risk-taking with your practitioner. A calculated risk is a carefully considered decision that could be beneficial but includes some degree of risk. For example, making the decision to change your treatment plan or medication regimen.
Care should be person-centered and you should hold an active role in your care. Accordingly, practitioners should engage your participation using a strengths-based approach. This approach, known as shared decision-making, is evidence-based and has been shown to improve outcomes.
Care should also be grounded in your “life-context,” which acknowledges, builds on and appreciates your unique history, experiences, situations, developmental trajectory and aspirations. Care plans should be based on individualized, culturally sensitive, holistic and multidisciplinary considerations and developed in collaboration with you and your supporters each step of the way. Your care should focus on helping you live the life you want and choose.
Gathering Information on Community Factors
Practitioners should have adequate knowledge of community factors that may impact care, including opportunities, resources and potential barriers. These may relate to access to employment opportunities as well as employment disincentives that are built into programs for access to affordable housing and medical care. If practitioners cannot offer you guidance on these subjects, they should at least be able to share resources and provide referrals to people who can.
Coping with Stigma
Stigma is widespread, even among friends and family and within the mental health care system, including from practitioners themselves. The detrimental impact of stigma can be greater than that of the illness itself. Thus, you may need to develop coping strategies to manage stigma, particularly if you are experiencing self-stigma.
You might consider discussing how you are impacted by insensitive statements with those who use them. You could also consider limiting interaction, if possible, with people who may continue to stigmatize you. Talking to peers can also be helpful to process the way stigma affects you.
Engaging with Peer Support
Peer support can be invaluable. People living with a similar condition can help you normalize SMI, address loneliness and isolation, and offer acceptance and support. They also can provide insights based on their own struggles and achievements, and they can help take away some of the uncertainty of living with SMI by helping you understand what to expect. They can offer hope as a mentor who is a living example of the reality of recovery.
The recovery journey is never easy, but it is always worth it. When a person with SMI reaches recovery, they often regain their self-love, self-worth and self-esteem. Recovery can then free a person from stigma, shame and embarrassment. Perhaps most importantly, it can stop them from defining themselves merely by their illness.
Some people with SMI have to recognize that the greatest barrier to reaching recovery may be their own mindset. People who refuse to take back control of their lives (including their care) and refuse to take responsibility for their illness will find it more difficult to reach recovery. It is a great tragedy that so many never reach recovery because it is possible for so many more.
Ultimately, we all need more visible and promoted examples of everyday people living in recovery. The promise of eliminating stigma does offer hope, but recovery offers so much more.
Note: An extremely helpful recovery resource is: A Practical Guide to Recovery-Oriented Practice: Tools for Transforming Mental Health Care.
Larry Davidson, Ph.D., is a Professor of Psychiatry and Director of the Program for Recovery and Community Health at Yale University’s School of Medicine. He is the author and co-author of more than 450 publications on the processes of recovery and the development of innovative policies and programs to promote the recovery and community inclusion of individuals with serious mental illnesses and addictions.
Katherine Ponte, B.A., J.D., MBA, CPRP, is a mental health advocate, writer, entrepreneur and lawyer. She has been living with severe bipolar I disorder with psychosis and extended periods of suicidal depression for 20 years and is now happily in recovery. Katherine is the Founder of ForLikeMinds, an online mental illness peer support community. She is a Faculty Member of the Program for Recovery and Community Health in the Department of Psychiatry at Yale University’s School of Medicine. Katherine is also the Founder of BipolarThriving, which provides bipolar recovery coaching, and the Creator of Psych Ward Greeting Cards, which visits and distributes greeting cards to patients in psychiatric units. She is a member of the Board of NAMI New York City and Fountain House. Katherine is the author of ForLikeMinds: Mental Illness Recovery Insights.
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