31 - Rehabilitation and recovery in the 21st century

Summary

Introduction

This book has provided a detailed description of current practice, policy, services and research in the field of mental health rehabilitation. In this concluding chapter, we attempt to draw out the main themes that are most likely to influence practice in the future and highlight areas where rehabilitation clinicians need to remain alert to the conscious and unconscious biases and drivers that can influence disinvestment in specialist services for people with complex mental health needs.

Rehabilitation and recovery – making the distinction

In Chapter 2, ‘What is psychiatric rehabilitation?’, mental health rehabilitation was defined as requiring a whole system of services that aim to promote an individual's recovery and social inclusion. The two concepts, rehabilitation and recovery, are often referred to together, since they both emphasise the goal of maximising autonomy and independence. Rehabilitation practitioners were early adopters and champions of recovery-oriented services in the UK, perhaps because of a synergy of values (described in more detail in Chapter 3, ‘Rehabilitation as a values-led practice’). Both rehabilitation and recovery emphasise collaborative practice and therapeutic optimism, among other things. However, the principles of recovery apply across all mental health services, not just rehabilitation services. While their adoption by generic mental health services is to be welcomed, this can also present something of a threat to rehabilitation services. When services are renamed ‘recovery’ services, the importance of providing specialist services for people with complex mental health needs can be lost. As we have seen in Chapter 30, ‘Psychiatric rehabilitation: future directions in policy and practice’, historically, policy-makers, commissioners and service planners seem recurrently to marginalise people with the most severe mental health problems. The conflation of recovery and rehabilitation can feed into this process, either unwittingly or through the mistaken belief that the latest trend in mental health practice can magically transform outcomes for everyone, negating the need for longer-term, more expensive services. In addition, protagonists of the recovery approach can sometimes present the false and unrealistic polarisation of recovery as a positive ‘social model’ and psychiatry as a negative ‘medical model’.