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Kartalova-O'Doherty, Yulia (2010) Reconnecting with life: recovering from mental health problems. Drugnet Ireland , Issue 35, Autumn 2010 , pp. 13-14.

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A Vision for Change, the blueprint for Irish mental health policy,1 recommends that the mental health services adopt a recovery perspective. Itbroadly defines the principle of recovery as the belief that people with mental illness can recover their self-esteem and regain control of their lives despite their illness. However, at present there is no clearly laid-out theory of recovery to guide daily clinical practice.2 

In February 2010 the Health Research Board (HRB) published the research report Reconnecting with life: personal experiences of recovering from mental health problems in Ireland.3 Dr Tony Bates, the founding director of Headstrong,4 referred to this publication as ‘the most important report to have been published since Vision, because it brings clarity to an issue that has been poorly understood. Without a shared understanding and belief in recovery, our services will remain stagnant, regardless of how many new resources are provided’.5
 
The aim of the HRB study was to develop a coherent theory of recovery from mental health problems from the point of view of those recovering. This was the first classic grounded theory (GT) study of recovery in Ireland carried out from a service-user perspective. Classic GT seeks to identify the main concern of the population under study.6 Understanding the main concern helps service providers to readjust their practices to better meet the needs of service users. The study was based on individual interviews with 32 self-nominated volunteers who had experienced mental health problems more than once over a period of two years or more, and who now considered that their mental health had improved.
 
An analysis of the interviews identified participants’ main concern as striving to reconnect with life. The dynamic and non-linear process of reconnecting with life had three interactive dimensions: 1) reconnecting with self, i.e. accepting oneself as a worthy individual capable of positive change; 2) reconnecting self with others, i.e. experiencing empathic, accepting, and validating interaction with others; and 3) reconnecting with self, others and time, i.e. getting a glimpse of a positive future, coming to terms with the past, and planning and executing one’s present. The process involved exploring, acknowledging and developing personal strengths and capabilities through trial and error.
 
As the study findings show, some isolated elements of recovery-oriented care already exist in Irish mental health services, at least in community mental health services. Participants complimented individual psychiatrists, nurses, psychotherapists and other professionals for their understanding, empathy, sense of humour, encouragement and listening skills which facilitated their reconnection with self, others and time. Educational and occupational activities provided by day centres were also reported by participants as facilitating their reconnection with life. Such qualities and activities need to be supported and enhanced, and used as positive examples of recovery-oriented care.
 
This study also provided qualitative evidence that depersonalised, paternalistic and pessimistic attitudes and behaviours, which can slow down reconnection with life, generally prevail over a person-centred, empathic and accepting approach within the Irish mental health services. Recovery-oriented mental health care requires a paradigm shift towards refocusing on the life goals of those recovering, and the vital importance of service users' input into the planning and delivery of care. Service users should be encouraged to talk at length, narrate their story, voice their concerns and aspirations, and participate in a dialogue with service providers.
 
It is hoped that the study will encourage creative innovation in mental health practice and research, and will not only improve the quality of care, but also contribute to the morale and job satisfaction of service providers. The underlying processes and tasks of mental health recovery identified in this study are highly relevant and applicable to any clinical or community context. Service users’ preferred individual strategies for reconnecting with life can be effectively combined with therapies and supports available in the services and in the wider community to match specific tasks of reconnecting with self, others and time.In addition, this study informs the Irish public about the possibility of recovery, and the important role of community in reconnection with one’s life and thus can aid mental health promotion campaigns.
 
Viewing recovery as a process of gradual reconnection with life embraces and synthesises diverse concepts and theories of recovery and rehabilitation in a coherent theory of mental health recovery.7 The theory thus generated is congruent with the WHO definition of mental health as ‘a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’.8 The generated theory, with its concepts of self-acceptance, meaningful connection with others, and reconnection with time as it changes can be relevant to other health areas, such as recovery from addiction or physical illness.9 The relevance and applicability of the generated theory to other areas of health and well-being can be further addressed by reviews of previous findings, or further research carried out from the perspectives of users of various health services.
 
Familiarisation with this study is recommended for mental health professionals and educators, service users, carers, researchers, policymakers and the general public.
 
1. Department of Health and Children (2006) A vision for change: report of the Expert Group on Mental Health Policy. Dublin: Stationery Office.
2. Care Services Improvement Partnership, Royal College of Psychiatrists, and Social Care Institute for Excellence (2007) A common purpose: recovery in future mental health services. Joint position paper 08. London: Social Care Institute for Excellence. pp. 3–5. Available at  www.scie.org.uk/publications/positionpapers/pp08.pdf
3. Kartalova-O’Doherty Y and Tedstone Doherty D (2010) Reconnecting with life: personal experiences of recovering from mental health problems in Ireland. HRBResearch Series 8. Dublin: Health Research Board. Available at www.hrb.ie/publications/hrb-publication/publications//508
4. The National Centre for Youth Mental Health. www.headstrong.ie
6. Glaser B (2001) The grounded theory perspective: conceptualisation contrasted with description. Mill Valley, CA: The Sociology Press.
7. See, e.g., Onken S, Craig C, Ridgway P, Ralph R and Cook J (2007) An analysis of the definitions and elements of recovery: a review of the literature. Psychiatric Rehabilitation Journal, 30(1): 9–22.
8. World Health Organization (2007) Mental health: strengthening mental health promotion.Fact sheet No 220. Retrieved 6 August 2010 from www.who.int/mediacentre/factsheets/fs220/en
9. Kartalova-O'Doherty Y (2010) Reconnecting with life: reconnecting with self, others and time. A grounded theory study of recovering from mental health problems in an Irish context. PhD thesis. Dublin City University. Available at http://doras.dcu.ie/15081
Item Type:Article
Issue Title:Issue 35, Autumn 2010
Date:2010
Page Range:pp. 13-14
Publisher:Health Research Board
Volume:Issue 35, Autumn 2010
EndNote:View
Accession Number:HRB (Available)
Related URLs:
Subjects:G Health and disease > State of health > Mental health
J Health care, prevention and rehabilitation > Care by type of problem > Mental health care
VA Geographic area > Europe > Ireland

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