The Importance of Social Recovery in Mental Healthcare

Recovery is a term frequently used by people with mental health issues to describe their efforts to live meaningful and satisfying lives. Colorado Recovery approaches mental healthcare based on a path of self-reliance through developed practiced skills. This non-institutionalized social recovery offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation.

Shulamit Ramon is mental health research lead at the University of Hertfordshire in Britain. In a 2018 article for the International Journal of Environmental Research and Public Health, Professor Ramon looked at the place of social recovery in mental health and social care services, alongside personal recovery.

“As distinct from personal recovery, yet inter-related to it, social recovery includes the components of interdependence with others, connectedness, recovery capital, and social capital, as well as the impact of collective culture and the structural elements of our socio-economic-political system,” wrote Ramon. “To add to the complexity, the impact of each element on one’s identity, in interaction with how one is seen by others, needs to be taken into account.”

Ramon points out that social recovery was initially defined by the late Colorado Recovery founder Richard Warner in Recovery from Schizophrenia as economic and residential independence with low social disruption but has since been expanded to refer to people’s ability to lead meaningful and contributing lives as active citizens.

People with mental health disorders are no longer just the recipients of treatment but are encouraged to participate in joint decision-making. “Existing research demonstrates that most people experiencing mental illness are able to make decisions and have the mental capacity to do so most of the time, including many of those who are in an acute admission ward,” wrote Professor Ramon. “This is hardly surprising to those of us coming from the recovery perspective, given that the intellectual and social capacities of many members of this group have been demonstrated by the strengths approach, the valued contribution of peer support workers, and the impressive contribution of service users [patients] who have championed recovery.”

Social recovery is a “co-production” of therapists and patients who “have not only strengths to share in a joint project, but that co-production can enhance the power they have within such an undertaking and with it their social standing and identity, as well as enriching any given project.”

This kind of empowerment is central to the Warner Model utilized at Colorado Recovery. It includes a residential treatment program, a transitional program, and an intensive outpatient program, and a “clubhouse” community mental health service model. “Treatment should include social rehabilitation,” wrote Dr. Warner in The Environment of Schizophrenia. “People with schizophrenia usually need help to improve their functioning in the community. This can include training in basic living skills; assistance with a host of day-to-day tasks; and job training, job placement, and work support.” The treatment team at Colorado Recovery recognizes that their clients share with them a need for a sense of community, meaning in life, and self-respect.

Professor Ramon also listed active citizenship and employment as important aspects of social recovery. “The emerging focus on co-production and active citizenship to overcome social exclusion and to foster social inclusion of people experiencing mental ill health is encouraging, and hopefully will also enhance the implementation of shared decision making at all levels. The message of social recovery lies in the need to include the social context in understanding, analyzing, and responding to people’s mental health difficulties. This author, for one, shares Warner’s optimism while being aware of the obstacles to achieving social recovery for all who need it.”

At Colorado Recovery it is our mission to help adults with serious mental health issues stabilize their illness, minimize symptoms, improve functioning and enhance each person’s social inclusion, quality of life, and sense of meaning in life.

If you have questions about our recovery model or our services to treat schizophrenia, bipolar disorder, and similar mental illnesses, call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

The Recovery Model of Mental Healthcare

The recovery model is a holistic, patient-centered approach to mental healthcare. This model has gained momentum in recent years and is based on the simple premise that it is possible to recover from a mental health condition.

That may not sound too surprising two decades into the 21st century but not that long ago, schizophrenia, bipolar disorder, and similar severe mental health conditions were considered chronic and beyond the reach of any meaningful recovery.

“As the name of the model implies, its hallmark principle is the belief that people can recover from mental illness to lead full, satisfying lives,” wrote Sarah Lyon in 2020 on Verywellmind.com. “Until the mid-seventies, many practitioners believed that patients with mental health conditions were doomed to live with their illness forever and would not be able to contribute to society.”

In the 1980s, the late Colorado Recovery founder Richard Warner used empirical evidence to strongly challenge the then-prevailing view of schizophrenia, which suggested that psychosis was strongly characterized by poor clinical and social outcomes. Since then, epidemiological, sociological, psychological, and biological research has made many aspects of that outdated model unsustainable.

“A central tenet of the recovery model is that empowerment of the user is important in achieving a good outcome in serious mental illness,” wrote Dr. Warner in 2010. “To understand why this may be so, it is important to appreciate that people with mental illness may feel disempowered, not only as a result of involuntary confinement or paternalistic treatment but also by their own acceptance of the stereotype of a person with mental illness. People who accept that they have mental illness may feel driven to conform to an image of incapacity and worthlessness, becoming more socially withdrawn and adopting a disabled role. As a result, their symptoms may persist and they may become dependent on treatment providers and others.” 

The recovery model counteracts those feelings of disempowerment and worthlessness. Its key tenets—”optimism about recovery from schizophrenia, the importance of access to employment, and the value of empowerment of user/consumers in the recovery process—are supported by scientific research,” wrote Warner in 2009. “Attempts to reduce the internalized stigma of mental illness should enhance the recovery process.”

Dr. Warner distinguished between “complete recovery” and “social recovery.” He defined the former as loss of psychiatric symptoms and return to a pre-illness level of functioning, whereas he defined social recovery in functional terms; economic and residential independence with low social disruption, an important component of which is employment. His findings were recently confirmed by British research

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery from mental disorders as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” SAMHSA emphasizes four aspects of recovery:

 

  • Health: Overcoming or managing one’s disease(s) or symptoms and making informed, healthy choices that support physical and emotional wellbeing. 
  • Home: A stable and safe place to live.
  • Purpose: Meaningful daily activities, such as a job, school, volunteerism, family caretaking, creative endeavors, etc., and the resources to participate in society. 
  • Community: Relationships and social networks that provide support, friendship, love, and hope.

All four are important pillars of the Warner model utilized at Colorado Recovery. Our psychiatrists evaluate clients with bipolar, schizophrenia, and other serious mental illness as often as necessary to prescribe an effective medication regimen—a regimen that may vary from day to day depending on the current state of their disorder. Finding stable and safe housing for clients is another important aspect of the Warner treatment model. Transitional living is available to qualifying clients at an enhanced outpatient level of care.

At Colorado Recovery, treatment professionals empower their patients by giving them roads to be productive, to help them perceive a positive meaning in life and a sense of belonging that can significantly improve treatment outcomes. We offer a variety of vocational services to help clients with their short-term and long-term career goals, including job-seeking skills, career exploration, and resume creation.

“The recovery model stresses the importance of connectedness and social supports,” wrote Lyon. “When people have supportive relationships that offer unconditional love, they are better able to cope with the symptoms of their illness and work toward recovery.”

At Colorado Recovery it is our mission to help adults with serious mental health issues stabilize their illness, minimize symptoms, improve functioning and enhance each person’s social inclusion, quality of life, and sense of meaning in life.

If you have questions about our recovery model or our services to treat schizophrenia, bipolar disorder, and similar mental illnesses, call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

How Transitional Living Paves the Road to Independence

 

For people with a mental health condition, the basic necessity of a stable home can be hard to come by. “The lack of safe and affordable housing is one of the most powerful barriers to recovery,” according to the National Alliance on Mental Illness. “When this basic need isn’t met, people cycle in and out of homelessness, jails, shelters, and hospitals. Having a safe, appropriate place to live can provide stability to allow you to achieve your goals.”

Finding stable and safe housing for clients is an important aspect of the treatment model pioneered by the late Colorado Recovery founder Richard Warner. “We offer a Transitional Living Program to our patients with schizophrenia, bipolar disorder, and schizoaffective disorder,” says Ginger Robitaille, Director of Operations at Colorado Recovery.

The program includes:

  • Room and funds to buy groceries to prepare meals
  • A safe and healthy living environment
  • Oversight by live-in therapeutic housemates
  • Shopping, cooking, and dining as a group
  • Learning how to manage an independent household
  • Weekly house meetings
  • Life skills coaching
  • Individual therapy sessions
  • Vocational counseling
  • Recreational, therapeutic and psychoeducational groups
  • Fully furnished townhomes

The program has been offered to clients progressing from residential care or intensive outpatient treatment but Colorado Recovery is now also admitting directly into transitional living clients who are ready to begin this phase of their recovery.

Key to direct admission is a careful assessment of the new client by the outpatient team that typically takes several days. “It is important to make sure that clients are ready for a transitional-living environment in an unlocked, co-ed facility,” says Robitaille. “It’s also important to remember that transitional living at Colorado Recovery means sober living.”

“Unfortunately, we cannot admit patients into this program who are still struggling with a full-force addiction,” says June Bianchi, Transitional Living Program Manager for Colorado Recovery. “Patients should be stable in their recovery, have a good idea what medications work for them, and should able to rely on their support system.” If clients do have substance use issues, the Colorado Recovery team will help address them and help engage that support system to avoid jeopardizing their recovery.

Transitional-living clients benefit from an enhanced outpatient level of care. “They will be seeing a Colorado Recovery therapist and a Colorado Recovery psychiatrist,” says Bianchi. “The outpatient nurses help out with the medication schedules. That really helps keeping patients stable. It’s a pretty intensive level of care, comparable to an intensive outpatient program.”

Six Stages to Success

Colorado Recovery utilizes six stages in its transitional living process. The first is orientation, a time to adjust to the program. “Clients identify their strengths and areas they want to work on,” explains Robitaille. “They are getting comfortable with independent transportation, time management, food shopping, preparing meals, and other life skills.”

In the community stage, clients get to engage with their transitional living peers and the wider community. They begin to help with meetings and meals for the transitional living program and start exploring activities and groups outside the program. “They are spending quite a bit of time with life skills coaches and vocational trainers,” says Robitaille.

In the third stage, it’s time to focus on goals. After working toward employment, volunteering, or continuing education, it’s now time to focus on some short and long-term goals. Clients get to check in with their treatment team to discuss the best options for moving forward. They can also rely on Colorado Recovery’s local community partners to help make those goals a reality.

The fourth stage is all about maintaining a routine surrounding all of the healthy habits clients are learning. This helps increase structure and stability.

The fifth stage allows clients time to reflect on how far they have come and where they are headed as they prepare to leave the transitional living program. In the final stage, clients work through logistical preparation while they enjoy lots of access to support. They work on packing, making purchases, and organizing their new home. They are now well prepared for success!

“Our mission is to help people become more independent,” says Bianchi.

If you have questions about our transitional-living program or our other services to treat schizophrenia, bipolar disorder, and similar mental illnesses, call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

The Difference Between Unipolar and Bipolar Depression

Bipolar disorder and major depression share some similarities. They are sometimes confused because both can include depressive episodes, but there are some key differences. 

The main difference between the two is that depression is unipolar, meaning that there are no periods of abnormally elevated mood, while bipolar disorder includes symptoms of mania.

In a recent article for PsychCentral, Sonya Matejko explored the distinction between the two conditions. “To put it simply, unipolar depression is another name for major depressive disorder (MDD), also known as clinical depression,” she wrote. “This mood disorder is characterized by a persistent feeling of sadness or a lack of interest in things that you used to enjoy.”

According to the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) used by psychiatrists to diagnose mental health conditions patients must experience the following to receive an MDD (unipolar depression) diagnosis:

  • symptoms for two weeks or longer
  • episodes of depression or significant loss of interest, or both
  • a change in the way you previously functioned

Diagnostic criteria include experiencing five or more of the following symptoms in a two-week period:

  • feeling sad or irritable
  • trouble falling asleep
  • feeling worthless or guilty
  • intense feelings of restlessness
  • change in appetite or sudden weight loss
  • lack of energy or unusual sense of tiredness
  • loss of interest in activities you once enjoyed
  • difficulty with decision making or concentrating
  • having thoughts about self-harming

In unipolar depression, there is one prolonged mood episode—a major depressive episode, i.e. a period characterized by symptoms of major depressive disorder. “This is in comparison with other mental health conditions, like bipolar disorder, which may lead you to experience changes in your mood, from depression to mania, an elevated mood state,” wrote Matejko. 

Bipolar depression, on the other hand, is a term used to describe depression within bipolar disorder. It’s not so much a condition by itself but rather a symptom of depression for someone living with bipolar disorder.

According to the American Psychiatric Association, “people with bipolar disorder experience intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes. These mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood). People with bipolar disorder generally have periods of neutral mood as well.”

The National Institute of Mental Health lists three types of bipolar disorder

Bipolar I disorder is defined by manic episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospitalization. Usually, depressive episodes occur as well, typically lasting at least two weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible.

Bipolar II disorder is defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of bipolar I disorder.

Cyclothymic disorder (also called cyclothymia) is defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least two years in adults. However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

It is primarily the alternation between mood episodes that differentiates bipolar depression from unipolar or clinical depression. The most significant difference is that the latter does not include episodes of mania as a major symptom.

Colorado Recovery provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.