Objective: baby sit and object for 3 months photographing it every week. Find a story for it to tell and make it into a booklet. Was great fun. Special thanks to Heather Burns for photography.

1. Mental Disorder
Aranged by Nathan Cowles
Photographed by Heather Burns

2. The Model
What Is Recovery?
A Conceptual Model
and Explication
Written by Nora Jacobson, Ph.D.
1
Dianne Greenley, M.S.W., J.D.
Psychiatric Services 2001
I n our model, the word recovery
refers both to internal conditions—
the attitudes, experiences, and pro-
cesses of change of individuals who are
recovering—and external conditions—
the circumstances, events, policies, and
practices that may facilitate recovery.
Together, internal and external condi-
tions produce the process called recov-
ery. These conditions have a reciprocal
effect, and the process of recovery,
once realized, can itself become a
factor that further transforms both
Special thanks to my dear friend Heather Burns for the photography, who without this would not have been possible. internal and external conditions.

3. Hope
T he hope that leads to recovery is,
at its most basic level, the indi-
vidual’s belief that recovery is pos-
psychiatry, psychology, social work, and
science cannot account for this phe-
nomenon of hope. But those of us who
Focusing on
strengths rather
than on weaknesses
sible. The attitudinal components of have recovered know that this grace is or the possibility
hope are recognizing and accepting real. We lived it. It is our shared secret”. of failure, looking
that there is a problem, committing to The source of this grace is differ- forward rather
change, focusing on strengths rather ent for each individual. For one it will be than ruminating
than on weaknesses or the possibility the entity he or she knows as God. For on the past
of failure, looking forward rather than another, it might be a spiritual connec-
ruminating on the past, celebrating tion with nature. Individuals not drawn
small steps rather than expecting seis- to spirituality may find their grace in
mic shifts in a short time, reordering other sources, such as making art or
priorities, and cultivating optimism. contemplating philosophical issues.
Gaining hope has about it something Hope sustains, even during periods of
of the transcendent. “A tiny, fragile relapse. It creates its own possibilities.
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spark of hope appeared and prom- Hope is a frame of mind that
ised that there could be something colors every perception. By expand-
more than all of this darkness.… This ing the realm of the possible, hope lays
is the mystery. This is the grace.… the groundwork for healing to begin.
All of the polemic and technology of
In its simplest sense, empow- of meaningful choices. The second is
erment may be understood as a cor- courage—a willingness to take risks,
rective for the lack of control, sense to speak in one’s own voice, and to
of helplessness, and dependency that step outside of safe routines. The
many consumers develop after long- third is responsibility, a concept that
term interactions with the mental speaks to the consumer’s obligations.
health system. A sense of empow-
erment emerges from inside one’s In the recovery model, the
self—although it may be facilitated by aim is to have consumers assume
external conditions—and it has three more and more responsibility for
components. The first is autonomy, themselves. Their particular respon-
or the ability to act as an indepen- sibilities include developing goals,
dent agent. The tools needed to act working with providers and others—
autonomously include knowledge, for example, family and friends—to
self-confidence, and the availability make plans for reaching these goals.

4. Healing
C onsumers and professionals who
accept the dictionary definition
of recovery—to regain normal health,
The second healing process
is control—that is, finding ways to
relieve the symptoms of the illness or
The external
conditions that
define recovery
poise, or status—may resist the very reduce the social and psychological are human rights,
possibility of recovery because they effects of stress. For some consum- “a positive culture
see it as an unrealistic expectation. ers, medication is a successful strategy of healing,” and
However, it is important to remember for effecting control. Another strat- recovery oriented
that recovery is not synonymous with egy is learning to reduce the occur- services.
cure. Recovery is distinguished both rence and severity of symptoms and
by its endpoint—which is not neces- the effects of stress through self-care
sarily a return to “normal” health and practices, such as adopting a wellness
functioning—and by its emphasis on lifestyle or using symptom moni-
the individual’s active participation toring and response techniques.
in self-help activities. The concept
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of recovery is better captured by the The word “control” has a
notion of healing, a process that has double meaning. In one sense it refers
two main components: defining a to the outcome of managing symp-
self apart from illness, and control. toms or stress. The second meaning,
however, refers to the locus of con-
As Estroff has noted, people trol, or who has control. In recovery
who have psychiatric disabilities often it is the consumer who has taken
find that they lose their “selves” inside control, who has become an active
mental illness. Recovery is in part agent in his or her own life. Control
the process of “recovering” the self is an important factor in the next
by reconceptualizing illness as only a internal condition, empowerment.
part of the self, not as a definition of
the whole. As consumers reconnect
with their selves, they begin to expe-
rience a sense of self-esteem and self-
respect that allows them to confront
and overcome the stigma against
persons with mental illness that they
may have internalized, thus allow-
ing further connection with the self.

5. Connection
An analysis of
T o find roles to play in the world.
These roles may involve activi-
ties, relationship status, or occupa-
services provided. It is important to
recognize, however, that these three
conditions are simply different foci
numerous accounts
by consumers
who describe
tion. Many consumers report that the viewed through the same lens. That themselves as
most powerful form of connection is, implementation of the principles “being in recovery”
is helping others who are also living of human rights in an organization suggests that the
with mental illness. For some consum- results in a positive culture of healing, key conditions in
ers, this means becoming a mental and recovery-oriented services are ser- thips proccess are
health provider or advocate; for others, vices that emerge from such a culture. hope, empowerment,
it means bearing witness, or telling healing, and
their own stories in public arenas. connection
In all of these capacities, consumers
increase the general understanding
of what it is like to live with a men-
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tal illness. They find ways to validate
and reconcile their own experiences,
and by standing as living exemplars
of the possibility of recovery, they
serve as role models for others.
In yet another sense, connec-
tion is the bridge between internal
and external conditions, allowing
reciprocal action between the two.
The external conditions that
define recovery are human rights, “a
positive culture of healing”, and recov-
ery-oriented services. On the surface,
these three conditions seem quite dif-
ferent. Human rights denotes a broad,
societal condition; a positive culture of
healing refers to the cultural milieu in
which services are offered; and recov-
ery-oriented services are the actual

6. Healing Culture
In its broadest sense, a human
rights agenda lays out a vision of a F isher has written of the need to
“build a coherent social faith and
order” as a way to promote recov-
matter what his or her current status.
This belief must lead them to focus
society in which power and resources on the person, not the illness, and
are distributed equitably. When ery. He described this new order as
on his or her strengths and goals.
applied to mental illness, human “a positive culture of healing… a
A key component of a posi-
rights emphasizes reducing and then culture of inclusion, caring, coopera-
tive culture of healing is the develop-
eliminating stigma and discrimina- tion, dreaming, humility, empower-
ment of collaborative relationships
tion against persons with psychiatric ment, hope, humor, dignity, respect,
between consumers and providers.
disabilities; promoting and protecting trust, and love.” When applied to the
In contrast to a hierarchical model of
the rights of persons in the service culture of a human services organiza-
service provision, the collaborative
system; providing equal opportunities tion, this vision of a positive culture of
model allows consumers and provid-
for consumers in education, employ- healing begins with an environment
ers to work together to plan, negoti-
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ment, and housing; and ensuring that characterized by tolerance, listen-
ate, and make decisions about the
consumers have access to needed ing, empathy, compassion, respect,
services and activities the consumer
resources, including those necessary safety, trust, diversity, and cultural
will use to support his or her recov-
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for sustaining life (adequate food competence. A healing culture is
ery. Collaboration implies that the
and shelter) as well as the social and oriented toward human rights for all
consumer is an active participant, that
health services that can aid recovery individuals and groups. Consumers’
he or she is presented with a range
(physical, dental, and mental health rights are incorporated into all deci-
of options and given the opportunity
services; job training; supported hous- sions, and informed consent is part
to choose from among them, and
ing; and employment programs). of the bedrock of daily practice.
that providers allow the consumer to
take some risks with these choices.
This human rights agenda In a positive culture of heal-
Consumers have the opportunity to
allows for different perspectives and ing, professionals as well as consum-
make choices other than those the
different types of activism. It can be ers are empowered and engaged. For
provider might have made for them.
used to advocate for the reduction providers, empowerment means first
and ultimately the elimination of believing that they can make a differ-
Finally, a true collaborative
involuntary commitment and other ence and then making a commitment
relationship is one in which both
forced treatment, which many view as to changing the way they concep-
consumer and provider come to see
violations of human rights, or it can tualize the course of mental illness
each other as human beings. For
be used to campaign for parity legisla- and the way they practice. Providers
providers, this means learning to see
tion and universal health coverage. must embrace the belief that every
beyond the diagnostic—or racial,
consumer can achieve hope, healing,
ethnic, and socioeconomic—catego-
empowerment, and connection, no

7. Recovery Services
T he Boston University Center for
Psychiatric Rehabilitation has
developed a model for designing
Examples include
advocacy, peer
support programs,
recovery-oriented services. The model hospitalization
delineates four major consequences alternatives, hotlines
of severe mental illness—impair- or “warm lines,”
ment, dysfunction, disability, and and programming
disadvantage. Recovery-oriented that provides
services address the range of these opportunities for
features and include services directed role modeling
at symptom relief, crisis interven- and mentoring.
tion, case management, rehabilita-
tion, enrichment, rights protection,
basic support, and self-help.
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A second model, developed
by the Ohio Department of Mental
Health, describes the best practices
to be implemented by consumers,
clinicians, and community supports and family involvement, challenging sions about medication are worked size their diverse but complementary
at four different stages of the mental stigma and discrimination, reflective out in a partnership between the strengths. Examples include recovery
health recovery process. The practices practice and continuous improvement, provider and the consumer, rather education and training, clubhouse
encompass clinical care, peer and fam- cultural sensitivity and safety, and than being dictated by the provider. organizations, crisis planning, the
ily support, work, power and control, spirituality and personal meaning. Consumer-run services are development of recovery and treat-
stigma, community involvement, Each of these models inte- planned, implemented, and provided ment plans, community integration,
access to resources, and education. A grates services provided by profes- by consumers for consumers. Exam- and consumer rights education.
third model offers practice guidance sionals, services provided by con- ples include advocacy, peer support Although many of these
within “a framework for designing, sumers, and services provided in programs, hospitalization alternatives, services may sound similar to services
implementing, and evaluating behav- collaboration. Services provided by hotlines or “warm lines,” and pro- currently being offered in many mental
ior healthcare services that facilitate professionals include medication, gramming that provides opportunities health systems, it is important to
individual recovery and personal out- psychiatric rehabilitation, and tradi- for role modeling and mentoring. recognize that no service is recovery-
comes.” Using the overarching meta- tional support services such as therapy Collaborative services are oriented unless it incorporates the
phor of “a healing culture,” this model and case management. The recovery provided by and for both consum- attitude that recovery is possible and
addresses such issues as language, orientation in these services lies in ers and professionals as well as family has the goal of promoting hope, heal-
dignity and respect, empowerment the attitudes of the professionals who members, friends, and members of ing, empowerment, and connection.
and personal responsibility, consumer provide them. For example, deci- the larger community and empha-

8. About the Authors
The hope that leads
to recovery is, at its
most basic level,
the individual’s
belief that recovery
Dr. Jacobson’s work on is possible.
HOUSEING STRATGIES USED Number of Percent of
the conceptual model and on this programs programs
paper was supported by the Wis-
consin Coalition for Advocacy.
Permanent housing strategies
Dr. Jacobson is an associate Develops dedicated 33 77%
scientist with the University of Wis- Actively recruit landlords 18 42%
consin School of Nursing in Madison,
has dedicated section vouchers 17 40%
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K6/316 Clinical Science Center, 600
Highland Avenue, Madison, Wisconsin Operates perminent 6 14%
suppotive housing
53792 (e-mail, najacobson@facstaff.
wisc.edu). Ms. Greenley is a supervis- Temporary and transition assistance
ing attorney at the Wisconsin Coali- Uses resources for short term 43 100%
tion for Advocacy and co-principal
investigator with the women and men- Uses resources for ongoing rental 37 86%
tal health study site at the University
of Wisconsin School of Social Work. Offers transitial options 30 70%
Uses motels 21 49%
Housing search and retention assistance
Provides housing advocates 42 98%
Offers land lords support 43 100%
Offers ongoing support 43 100%
Helps consumers apply for housing 38 88%
Partnerships
Perminent suportive housing 19 44%
Public housing authority 13 30%

9. Mental Disorder
& Recovery