Providers' Hope-Inspiring Competence as a Factor Optimizing Psychiatric Rehabilitation Outcomes

Abstract

Advances in both modern psychopharmacology and psychiatric rehabilitation technology and the intensified activism of consumers of mental health services have increased optimism regarding the treatment and outcomes of people who have experienced the disabling effects of a serious mental illness. This encouraging perspective has provided the opportunity to further conceptualize and operationalize the phenomenon of recovery of people with psychiatric disabilities. This article conceptualizes the critical importance of hope in the recovery process. More specifically, it examines the role of hopefulness of mental health and rehabilitation practitioners as an essential factor in promoting recovery. The Recovery Paradigm Recovery from severe and persistent mental illness is the guiding principle for both psychiatric rehabilitation services delivery and outcome evaluation. In the 1990s, the notion of recovery has been also transformed into the vital core of mental health consumers' self-help movement. While currently a consensus about the nature of recovery from serious mental illness is still missing (Blanch, Fisher, Tucker, Walsh, & Chassman, 1993; Ralph, 1998), a rapidly growing number of consumers and practitioners are embracing the belief that people with psychiatric disabilities can recover and lead meaningful lives. Recovery is permeating the services delivery practice and research and the consumers' self-help movement and is becoming a leading paradigm in the understanding and the treatment of severe and persistent mental illness. Anthony's (1993) prediction that recovery would be the guiding vision of the mental health system in the 1990s has become a reality in the eve of the new millennium. The recovery paradigm integrates the strengths perspective (Saleebey, 1997) and the empowerment perspective (Lee, 1994), both of which lately have been gaining popularity in the field of human services. These perspectives are quite different from the deficit approach which has prevailed in the mental health field for decades. From a recovery perspective, the development of client's skills for engaging in meaningful activities and for rebuilding a deeply wounded self becomes the treatment priority rather than symptom management and relapse prevention. Thus, the focus of service delivery changes from treating the disorder to treating the whole person. The development of the person's strengths becomes the road to overcoming the limitations of the illness and to recovery. Initially, the concept of recovery emerged in the writings of people who have experienced a serious mental illness and who were able to master its negative impact to a significant point and build more satisfying lives for themselves (Deegan, 1988; Leete, 1989; Lovejoy, 1982; Unzicker, 1989). Based on consumers' personal accounts, Anthony (1993) conceptualized recovery from mental illness as a deeply personal, unique process of changing one's attitudes, values, feelings, goals, skills, and roles. Recovery means that the person is able to live a satisfying and meaningful life even with the limitations caused by the illness. Recovery is conceptualized as a process of improving people's impairment, dysfunction, disability and disadvantage during which the person develops new meaning and purpose in life and grows beyond the catastrophic effects of the mental illness (Anthony, 1993). Recovery from psychiatric disability is understood as a significant improvement in the person's functioning and not as a complete cure from the illness (Anthony, 1993; Deegan, 1996), although the notion of recovery does not exclude the potential for a full recovery from a disabling mental illness (Fisher, 1998). The recovery perspective in understanding and treating psychiatric disabilities is grounded in mental health consumers' personal accounts and in recent empirical findings. Harding and Zahniser (1994) found that existing empirical data challenge pessimistic beliefs about the prognosis of severe and persistent mental illness. …