Old age psychiatry and the recovery model

We fail to see what all the fuss over the ‘recovery model’ is about. Nor can we appreciate why it has been so powerful in ‘influencing mental health service development around the world’. ¹ Working with older people, especially those with dementia but also those with functional disorders, recovery has been the style of our work long before it became a jargon term.

Our day assessment unit aims to give both the patient and their relatives as much autonomy as possible despite progressive mental disability. Enhancing well-being and giving meaning to people's lives, empowering patients and carers to make decisions collaboratively, and enabling activities salient to the patient and carer have been integral to our work for years. We run in-house educational courses and support groups for carers. Some carers' courses have continued as informal groups who meet and support each other even after the relative they were caring for has died. An upmarket chain coffee emporium offers free drinks for one peer support group organised by a patient with a history of bipolar affective disorder that meets in their café; perhaps some would say this is unwarranted charity: the group does not think so. A ‘drop-in’ at a local church hall is popular. Carers contribute to our educational programme for staff.

To us, the recovery model represents standard high-quality old age psychiatric practice. Often we can see the quality of life of patients and their relatives improve, despite progressive illness and disability, as understanding and coping mechanisms increase. Scientific evidence is not always necessary, especially when it is measured in economic rather than person-centred terms. The recovery model is a humane, self-esteem, self-respect approach, perhaps one which all psychiatry can learn from older people's services. We will not become complacent in our practices even if services for younger people are catching up with us.