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Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Illness Management and Recovery Workbook

Handout 1:
Recovery Strategies

“Always remember that you are a person first and foremost. A mental health label does not define you. You are not ‘depression’ or ‘schizophrenia’ or ‘bipolar.’ You are a person. A person with cancer does not call himself or herself ‘cancer,’ so why should you limit yourself to a label?”

David Kime: artist, writer, floral designer, in recovery for bipolar disorder since age 15.

Introduction

This handout is about the topic of recovery from mental illness. It includes a discussion of how different people define recovery and encourages each person to develop his or her own definition of recovery. Pursuing goals is an important part of the recovery process. Working on this handout can help you set recovery goals and choose strategies to pursue these goals.

What is “recovery”?

People define recovery from mental illness in their own individual ways. Some people think of it as a process, while others think of it as a goal or an end result.

Here are some examples of how different people describe recovery from their own point of view:

• “Recovery from mental illness is not like recovery from the flu. It’s recovering your life and your identity.”
• “Recovery for me is having good relationships and feeling connected. It’s being able to enjoy my life.”
• “I don’t dwell on the past. I’m focusing on my future.”
• “Being more independent is an important part of my recovery process.”
• “Not having symptoms any more is my definition of recovery.”
• “Recovery for me is a series of steps. Sometimes the steps are small, like fixing lunch, taking a walk, following my daily routine. Small steps add up.”
• “Having a mental illness is part of my life, but not the center of my life.”
• “Recovery is about having confidence and self-esteem. I have something positive to offer the world.”

People define recovery in their own personal ways.

Question: What does recovery mean to you?

What helps people in the process of recovery?

People use a variety of different strategies to help themselves in the recovery process, such as the following:

Becoming involved in self-help programs

“I belong to a support group which is part of a self- help program. Everyone in the group has experienced psychiatric symptoms. I feel very comfortable there. The other people understand what I am going through. They also have good ideas for solving certain problems.”

(Contact information for a variety of self help programs and resources is provided in the Appendix to this handout).

Staying active

“I find that the more I do to stay active during the day, the better things go. I make a list each day of what I want to do. I try to list fun things as well as work things. Just being active makes me feel more confident.”

Developing a support system

“It helps me to have friends and family I can do things with and talk things over with. Sometimes I have to work on these relationships and make sure I stay in touch. It’s better for me not to rely on just one person.”

Maintaining physical health

“When I’ve been eating junk food or not getting any exercise, it makes me feel sluggish, both physically and mentally. So I try to eat things that have decent nutrition and I try to get at least a little exercise every day. It makes a lot of difference.”

Being aware of the environment and how it affects you

“I concentrate much better when I’m in a quiet environment. When things start to get noisy I get distracted and sometimes I get irritable. When I can, I seek out quieter places and situations with fewer people involved. It also upsets me to be around critical people. I avoid that kind of person when I can.”

Making time for leisure and recreation

“I can’t just work all the time. I need time for pleasure, too. My wife and I like to rent a video every Friday. We take turns picking out what we will watch.”

Creativity
“I like to write poetry. It helps me to express my emotions and put my experiences into words. And sometimes I read other people’s poems. It’s very satisfying.”
Spirituality
“Being in touch with my spirituality is essential to me. I belong to a church, but I also find spirituality in meditation and in nature.”
Following through with treatment choices
“I have chosen treatment that includes a self-help group, a part-time job, and taking medication. I like to be pro-active. Following through with those things makes me feel strong, like I can handle my daily challenges.”
“I’m in a peer support program, and I see a therapist once a week who helps me figure out how to deal with some of the problems in my life. Both things have been important to my recovery.”

Questions:

Which of the strategies for recovery have you used?

Which of the strategies would you like to develop further or try out?

You can use the following chart to record your answers to these questions.

Strategies for Recovery

What’s important to you? What goals would you like to pursue?

Most people in the process of recovery report that it is important to establish and pursue goals, whether the goals are small or large. However, experiencing psychiatric symptoms can take up a great deal of your time and energy. Sometimes this can make it difficult to participate in activities or even to figure out what you would like to do.

It may be helpful to take some time to review what’s important to you as an individual, what you want to accomplish and what you want your life to be like. The following questions may be helpful:

• What kind of friendships would you like to have?
• What would you like to do with your spare time?
• What kind of hobbies or sports or activities would you like to participate in?
• What kind of work (paid or volunteer) would you like to be doing?
• Are there any classes you would like to take?
• What kind of close relationship would you like to have?
• What kind of living situation would you like to have?
• Would you like to change your financial situation?
• How would you like to express your creativity?
• What kind of relationships would you like with your family?
• What kind of spiritual community would you like to belong to?

It may also be helpful to think about the following questions:

• Which areas of life do I feel most satisfied with?
• Which areas of life do I feel least satisfied with?
• What would I like to change?

The following chart may help you answer these questions:

Satisfaction with Areas of My life

You might find it helpful to set goals for yourself in one or two areas of your life that you are not satisfied with. For example, if you are not satisfied with having enough enjoyable activities, it might be a good idea to set a goal of identifying some activities and scheduling time to try them out.

Question: What two areas of your life are you not satisfied with and would like to improve?

What goals would you like to set for yourself in these areas? You can use the following chart to record your goals. You can also refer back to the chart to record how you follow up on these goals.

Goals Set in the Illness Management and Recovery Program

What are some strategies for achieving your goals?

Setting goals

People who are most effective at getting what they want usually set clear goals for themselves and plan step-by-step what they are going to do.

The following suggestions may be helpful:

• Break down large goals into smaller, more manageable ones.
• Start with short-term goals that are relatively modest and that are likely to be achieved.
• Focus on one goal at a time.
• Get support in working on goals; other people’s ideas and participation can make a big difference.
• Don’t be discouraged if it takes longer than you think to accomplish a goal; this is very common.
• If you first attempt to achieve a goal doesn’t work, don’t lose heart and give up. Keep trying other strategies until you find something that works. As the saying goes, “If at first you don’t succeed, try, try again!”

Planning steps for achieving goals

You may find it helpful to follow a step-by-step method, such as the following, for achieving goals. This method can also be used to solve problems, as described in the handout “Coping with Problems and Symptoms.”

1. Define the goal you would like to accomplish. Be as specific as possible.
2. List at least 3 possible ways to achieve the goal.
3. For each possibility, briefly evaluate its advantages (the pros) and disadvantages (the cons) for achieving your goal.
4. Choose the best way to achieve your goal. Be as practical as possible.
5. Plan the steps for carrying out your decision. Think about: Who will be involved? What step will each person do? What is the time frame? What resources are needed? What problems might come up and how could they be overcome?
6. Set a date for evaluating how well your plan is working. First focus on the positive: What has been accomplished? What went well? Then look at whether your goal has been achieved. If it hasn’t been achieved, decide whether to revise your plan or try another one.

Questions:

What is an example of a goal that you have set in the past?

Have you used a step-by-step plan for achieving a goal before?

What goals would you like to focus on?

Choose one or two goals that you would like to achieve. Start with goals that are relatively small and have a strong chance of being successful. Use the following planning sheets to record your plans.

Step-By-Step Problem-Solving and Goal Achievement

1. Define the problem or goal as specifically and simply as possible.

2. List 3 possible ways to solve the problem or achieve the goal.
a.
b.
c.

3. For each possibility, list one advantage and one disadvantage.

Advantages/pros:
a.
b.
c.

Disadvantages/cons:
a.
b.

4. Choose the best way to solve the problem or achieve the goal. Which way has the best chance of succeeding?

5. Plan the steps for carrying out the solution. Who will be involved? What step will each person do? What is the time frame? What resources are needed? What problems might come up? How could they be overcome?
a.
b.
c.
d.
e.
f.

6. Set a date for follow up:_________.
Give yourself credit for what you have done. Decide whether the problem has been solved or whether the goal has been achieved. If not, decide whether to revise the plan or try another one.

Step-By-Step Problem-Solving and Goal Achievement

1. Define the problem or goal as specifically and simply as possible.

2. List 3 possible ways to solve the problem or achieve the goal.
a.
b.
c.

3. For each possibility, list one advantage and one disadvantage.

Advantages/pros:
a.
b.
c.

Disadvantages/cons:
a.
b.

4. Choose the best way to solve the problem or achieve the goal. Which way has the best chance of succeeding?

5. Plan the steps for carrying out the solution. Who will be involved? What step will each person do? What is the time frame? What resources are needed? What problems might come up? How could they be overcome?
a.
b.
c.
d.
e.
f.

6. Set a date for follow up:_________.
Give yourself credit for what you have done. Decide whether the problem has been solved or whether the goal has been achieved. If not, decide whether to revise the plan or try another one.

What reminders, guidelines or suggestions to yourself will help you most in pursuing our recovery goals?

James’s recovery goals center on working and being a good husband and father. He uses the following reminders for himself:

• Make time for yourself.
• Reward yourself for things you do.
• Look good for yourself.
• Keep up with your appointments.
• Tell people what’s really on your mind.
• Try to listen to your doctor and nurse.
• Think positively. Have hope.
• Get outside those four walls—take a walk, see a movie, go listen to music in the park.
• Make time for romance.
• Learn what makes you feel good, what you enjoy doing.
• Be willing to apologize sometimes; it takes a real man or a real woman to apologize.
• You don’t have to get in arguments with people who say things you don’t like. It only builds up your adrenaline, and then you feel worse.
• Say a prayer. “Let me be positive today. Don’t let me focus on the negative.

In David’s recovery, he has focused on goals related to creative expression, living independently and having strong relationships with family and friends. He said that the following guidelines have helped him pursue his goals:

• Express yourself in art. Do it for your own enjoyment.
• Express yourself in writing. Keep a journal. Write a poem, a story, an article, or even a comic.
• Find a job that suits you and is not too stressful.
• Stay busy. Try to schedule things with other people.
• Persist until you find a medication that’s right for you.
• Don’t let other people’s opinions about mental illness get you down.
• Meet other people who have experienced psychiatric symptoms.
• Help other people in their recovery. You’ll both feel the benefits.
• Keep up family traditions as much as possible and stay in touch with family members.

Sarah said that her recovery goals center on improving her relationships with the important people in her life (her husband, best friend, and mother) and maintaining her good social standing in the community. She said that finding out who she is and what she likes has been her salvation. For Sarah, a daily checklist has been important in pursuing her recovery goals. She suggests asking yourself the following questions every morning:

• How is your medication situation?
• How is your wardrobe?
• Did you eat a healthy breakfast?
• What is your structure for the day?
• How is your money situation?
• Who do you trust, who can you talk to?
• Are you getting good sleep?

What reminders, guidelines, or suggestions to yourself will help you most in pursuing your recovery goals?

1.

2.

3.

4.

5.

Summary of the main points about recovery strategies

• People define recovery in their own personal ways.
• Strategies for recovery include:
• Self help programs
• Staying active
• Developing a support system
• Maintaining physical health
• Being aware of the environment and how it affects you
• Making time for leisure and recreation
• Expressing creativity
• Seeking out spirituality
• Following through with treatment choices
• Identifying what you would like to improve in your life will help you set goals.
• Make a step-by-step plan to help you achieve your goals.
• Each person finds his or her own pathway to recovery.

Appendix: Contact Information for Information about Self-Help Organizations

Consumer Organization and Networking Technical Assistance Center (CONTAC)
800-598-8847.
website: contac.org
CONTAC provides technical assistance to adults with psychiatric disability throughout the U.S.

International Association of Psychosocial Rehabilitation Services (IAPSRS)
410-730-7190
website: iapsrs.org
IAPSRS is a nonprofit organization committed to promoting, supporting and strengthening community-based psychosocial rehabilitation services and
resources. It also publishes a journal, newsletters, and a resource catalogue.

Mental Illness Education Project (MIEP)
800-343-5540
website: miepvideos.org
The Mental Illness Education Project seeks to improve understanding of mental illness through the production of video-based programs for use by people with psychiatric conditions, their families, mental health practitioners, administrators, and educators, as well as the general public.

Mental Health Recovery
802-254-2092
website: mentalhealthrecovery.com
Mary Ellen Copeland has developed a number of publications and programs for helping people in the recovery process, including the Wellness Recovery Action Plan (WRAP). Her web site offers a free newsletter and articles and a list of publications and workshops that can be purchased.

National Alliance for the Mentally Ill (NAMI)
800-950-NAMI (helpline)
website: www.nami.org
NAMI is a support and advocacy organization of consumers, families and friends of people with mental illness. It provides educational about severe brain disorders, supports increased funding for research and advocates for adequate health insurance, housing, rehabilitation and jobs for people with psychiatric disabilities. Each state has a chapter and many communities have their own chapters. They offer a consumer-led educational program called “Peer-to-Peer.”

National Depressive and Manic-Depressive Association (NDMA)
website: www.ndmda.org
NDMA is a membership organization that provides direct support services to people with psychiatric symptoms and their families, legislation and public policy advocacy, litigation to prevent discrimination, public education, and technical assistance to local affiliates.

National Empowerment Center (NEC)
website: www.power2u.org
NEC is an award-winning provider of mental health information, programs and materials, with a focus on recovery. It can refer you to a local support group or help you to set up a new group. Newsletter and audio-visual materials are also available.

National Institute for Mental Health (NIMH)
website: www.nimh.nih.gov
NIMH is engaged in research for better understanding, more effective treatment and eventually prevention of mental disorders. Its website provides educational materials and an excellent list of free publications on psychiatric disorders, including a comprehensive listing of resources for help.

National Mental Health Association (NMHA)
website: www.nmha.org
The NMHA provides information and referral services for people in the process of recovery.

National Mental Health Consumers’ Self-help Clearinghouse
website: www.mhselfhelp.org
This organization provides information about psychiatric disorders, technical support for existing or newly starting self-help groups, and a free quarterly newsletter for consumers. They sponsor an annual conference. Spanish language services are available.

Resource Center to Address Discrimination and Stigma
1-800-540-0320
website: www.adscenter.org
This SAMHSA-funded center provides resources and information to help people implement and operate programs and campaigns to reduce the stigma of mental illness.

SAMHSA Center for Mental Health Services
800-789-CMHS
website: www.samhsa.gov/cmhs
The Substance Abuse and Mental Health Services Agency (SAMHSA) provides a large variety of free (or very inexpensive) publications and videotapes about mental illness and effective treatment.

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