Recovery As a Journey, Not a Destination by Melissa Neathery Istock/Vwpix

Home , Recovery model

ABSTRACT: Recovery in mental illness is a person-oriented process that involves self-determination/choice, and growth potential. This article discusses eight components of recovery-oriented treatment, and how nurses in any setting can facilitate recovery and encourage the healthy role of spirituality in clients’ lives during the recovery process. Biblical references relating to each component of the recovery-oriented process are offered. KEY WORDS: faith community nursing, holistic care, nursing process, recovery-oriented care, self-management, spirituality, therapeutic alliance

1.5 contact hours Treatment and Spiritual Care in Mental Health Recovery As a Journey, Not a Destination By Melissa Neathery iStock/vwPix

86 JCN/Volume 35, Number 2 journalofchristiannursing.com

Copyright © 2018 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. he term recovery has vari- treatment in community settings was COMPONENTS OF RECOVERY ous meanings and con- ill-equipped and poorly funded (Test In response to the confusion about notations. When a football & Stein, 1978). The enactment of the what was meant by recovery, Jacobson team fumbles but then has a Americans with Disabilities Act in and Greenley (2001) presented a recovery, the team has regained 1990 (U.S. Department of Justice, conceptual model of recovery that possessionT and is now in control of the n.d.), the Surgeon General’s Report considered internal conditions football. A surgical patient’s transfer to in 1999 (U.S. Department of Health (attitudes, experiences, processes) the recovery area implies the process of and Human Services [DHHS]), and external conditions (policies, waking up from anesthesia and begin- and the President’s New Freedom treatment practices, circumstances) ning the return to a pre-illness state of Commission on Mental Health in experienced by those recovering. To be health. 2002 (Mental Health Commission) considered recovery-oriented, programs must contain four dimensions: 1) person-oriented, 2) person involve- Recovery-oriented nursing care is not a list of ment, 3) self-determination/choice, and 4) growth potential (Farkas, Gagne, additional activities tacked on to a treatment plan. Anthony, & Chamberlin, 2005). Davidson, O’Connell, Tondora, Are these examples relevant to advanced the concept of recovery and Lawless, and Evans (2005) conducted a recovery in mental illness? Is recovery identified the need for effective and concept analysis and identified nine from alcohol addiction, depression, or evidence-based mental healthcare. critical aspects of recovery: renewing schizophrenia a state of being symptom- By 2000, mental health treatment hope and commitment; redefining self; free? Does recovery mean that a person shifted from a medical model to a recovery incorporating illness; involvement in has complete control of the illness? model of care. The medical model meaningful activities; overcoming This article examines the concept of considers recovery as regaining a stigma; assuming control; becoming recovery in mental illness, explores previous level of functioning and empowered; managing symptoms; and components of recovery, and includes alleviation of symptoms in response to being supported by others. ways biblically focused spiritual care treatments aimed at a cure. In contrast, To provide health-promoting and can enhance recovery. the recovery model defines recovery as evidence-based care, nurses must adopt “a process of change through which a recovery-oriented view that pro- THE RECOVERY MOVEMENT individuals improve their health and motes and nurtures recovery. From a During the first half of the 20th wellness, live self-directed lives, and strive Christian perspective, that view focuses century, mental illness was considered to reach their full potential” (Substance on God as the ultimate source of a deteriorating condition that often Abuse and Mental Health Services identity, strength, and purpose. The required lifelong institutionalization Administration [SAMHSA], 2012). recovery-oriented perspective entails (Drake & Whitley, 2014). With the New terminology is preferred in the following components. discovery of psychotropic medications the recovery model. Instead of a Renewing Hope and Commitment: and U.S. President John F. Kennedy’s person recovering from mental illness, Having a sense of hope in the 1963 Community Mental Health Act we say a person is in recovery. The prospect of living a purposeful and promoting deinstitutionalization term recovery is “often referred to as a meaningful life is essential in recovery. (National Council for Behavioral process, an outlook, a vision, a Some purport that hope is the core Health, 2017), many people with conceptual framework, or a guiding component that allows belief that mental illness were released from principle” (Jacob, 2015, p. 117). The other recovery aspects are possible. institutions into what was named Surgeon General’s report (DHHS, Without hope, the recovery process “community treatment” (Test & Stein, 2016) refers to recovery in substance will not be instigated or maintained 1978, p. 351). However, at the time, abuse as broader than abstinence or (Park & Chen, 2016). For those in remission, to include changes in recovery, hope correlates with fewer “behaviors, outlook, and identity” psychiatric symptoms, and conversely, Melissa Neathery, MSN, RN, is a clini- (p. 5-3). Recovery is a holistic hopelessness is associated with cal assistant professor at Baylor University School of Nursing, Dallas, Texas. She has approach; it is a journey, not a increased symptom severity (Waynor, taught psychiatric nursing in didactic and destination. Terms used synonymous- Gao, Dolce, Haytas, & Reilly, 2012). clinical settings for 15 years, with an interest in promoting spiritual care. ly in mental health rehabilitation Although hope is critical for recovery, The author declares no conflict of interest. literature focusing on the emerging sources of hope are specific to each Accepted by peer-review 2/13/17. concept of the recovery model are: person. Threats of hopelessness also are Copyright © 2018 InterVarsity Christian Fellowship/ recovery-oriented practice, recovery to unique, as described by mental health USA. practice, patient-oriented care, and consumer Peter Amsel (2012): “Hope DOI:10.1097/CNJ.0000000000000475 consumer-based approach. can be lost over virtually anything, no journalofchristiannursing.com JCN/April-June 2018 87

Copyright © 2018 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. iStock/Wichai_T Having a sense of hope in the prospect of living a purposeful and meaningful life is essential to recovery. process of adopting and internalizing negative assumptions about oneself. Unfortunately, societal stigmatization matter how seemingly insignificant; Incorporating Illness: Although of mental illnesses affects people had I allowed myself to enter that mental illness should not define worldwide (Seeman, Tang, Brown, & stream of hopelessness, I may well someone, it cannot be denied either. Ing, 2016). Stigmatization interferes have lost my battle with this illness Recognizing and accepting that one with care-seeking behaviors (Corrigan, altogether” (p. 85). has a mental illness enables the person Druss, & Perlick, 2014), promotes Redefining Self: Identity can be to seek treatment, to cope, and to discrimination (Rüsch, Angermeyer, defined as “persistent characteristics pursue a meaningful and fulfilling life, & Corrigan, 2005), and decreases that makes us unique and by which we despite the need to adjust for limita- adherence to treatment (Kamaradova et are connected to the rest of the world” tions. A systematic review of coping al., 2016). Therefore, recovery requires (Slade, 2009, p. 82). After experiencing strategies in mental illness found that that a person not internalize stigmatiz- symptoms and receiving a mental acceptance of mental illness is associ- ing beliefs, but promote accurate illness diagnosis, people in recovery ated with more efficacious coping depictions of mental illness and support must not define themselves solely by a (Phillips, Francey, Edwards, & McMur- policies that eliminate discrimination. diagnosis. A healthy self-concept is ray, 2009). A patient describes her Assuming Control and Becoming based on many characteristics, abilities, experience (Salsman, 2012): “In the Empowered: Assuming responsibility traits, and behaviors of a person. beginning, denial became my defense. for the recovery process is crucial Davidson and Strauss (1992) identified I was angry and resentful.” But then for developing a healthy sense of self four steps of redefining a healthy sense she continued, “I made an effort to and health-promoting behaviors. As of self in recovery as: 1) discovering the open my eyes, to become aware of opposed to previous views that it was possibility that an identity exists apart myself. I made a decision to stop psychiatry’s job to fix people with from a diagnosis; 2) validating one’s wallowing in self-pity and to become mental illness, the locus of control is on strengths and limitations; 3) putting responsible for the course my life the individual. Instead of feeling aspects of one’s identity into action; would take” (p. 9). helpless to the influences of mental and 4) using the enhanced sense of self Involvement in Meaningful Activities: illness, empowerment enables people to address other aspects of recovery. A Recovery is enhanced by pursuing goals to fight stigma, demand rights, promote man in recovery describes his experi- and roles that have significant meaning. awareness, and obtain effective available ence: Feeling fulfilled in family roles (sibling, treatment and resources. Through her child, spouse, parent) or societal roles recovery process that propelled the They say that recovery is (employee, church member, friend, recovery-oriented model, Deegan knowing oneself under new hobby participant) promotes recovery. (1997) describes empowerment as, circumstances, redefining one’s Recovery approaches enhance con- role, and reevaluating oneself to structive use of leisure and activities that Founded on values that in- develop a new sense of respect a person finds meaningful and enjoy- clude a profound reverence for for oneself. After living in dark- able, thus emphasizing the importance the subjectivity of other human ness for many years and having of “making life better rather than beings, a belief that one can act to died to my old self, thinking that making life less bad” (Iwasaki, Coyle, change his situation, an under- my life was over and futile, a Shank, Messina, & Porter, 2013, p. 54). standing that power is not finite new birth emerged from within Overcoming Stigma: Stigma comes but can be shared and created, me that has made my life more from the negative stereotypes and and the willingness to love and be meaningful and purposeful than assumptions about people who have transformed by the love of those before. (Scotti, 2012, p. 14) mental illness. Self-stigma refers to the we serve. (p. 15)

88 JCN/Volume 35, Number 2 journalofchristiannursing.com

Copyright © 2018 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. Managing Symptoms: Some people nurses address self-concept, decision- Choice, option, informa- experience complete alleviation of making, resource attainment, social tion, role models, being heard, mental illness symptoms, whereas many support, advocacy, and self-care developing and exercising a voice, experience lifetime recurrences. activities, while conveying empathy, opportunities for bettering one’s Sometimes symptoms are more dignity, and respect for each person’s life—these are the features of controlled and less severe than at other lived experience. a human interactive environ- times. Symptom management may In conjunction with the SAMHSA, ment that supports the transition include medication, counseling, stress the American Psychiatric Nurses from not caring to caring, from management, and lifestyle changes. Association (2017) provides interpro- surviving to becoming an active Decades ago, the term treatment fessional education to enhance participant in one’s recovery compliance described a patient’s response recovery-oriented practice. Interven- process. (p. 92) to treatment. Because of the connota- tions specified in the Psychiatric tion of coercion, treatment adherence or Mental Health Standards of Practice Interestingly, recovery-oriented management is now used. This shift in address the needs of those in mental care also benefits nurses. For example, focus acknowledges that a person has illness recovery (American Nurses Kraus and Stein (2013) found that choices and autonomy in how to Association, 2014). Recovery-oriented case managers who worked for incorporate therapeutics into one’s life nursing care is not a list of additional facilities with perceived higher and recognizes that someone with activities tacked on to a treatment plan. levels of patient-focused services mental illness is an active participant in Instead, care reflects a mindset, attitude, reported less burnout and higher job his or her care (Vuckovich, 2010). and motivation integrated into all satisfaction. Being Supported by Others: Instead aspects of the nursing process. Table 1 of being alienated, a person with a offers questions to help you assess if SPIRITUALITY IN RECOVERY mental illness needs connection to you have a recovery-oriented mindset. Many mental health service consum- and support by others. Positive Nurses have the power to create a ers and mental health professionals view relationships enhance recovery by milieu that enhances recovery and spirituality as an integral aspect of providing role modeling, resources, provides the care needed to recover, as well-being for recovery, and life in encouragement, information, and Deegan (1996) points out: general. Spirituality sometimes includes understanding. Research exploring subjective and objective reports of Table 1. Self-Assessment: Do You Have a Recovery- social support by people with mental illness indicates a significant associa- Oriented Mindset? tion with recovery (Corrigan & 3 Do you believe that people with mental illness can get better? Phelan, 2004) and coping (Davis & When you see a person in a symptomatic state of mental illness, do you imagine him/ Brekke, 2014). Sometimes called peer 3 her being in recovery in the future? specialists or consumer-providers, individuals with experiences of living Do you focus on the person and not the disease? For example, refer to someone as a 3 “person with schizophrenia” rather than “a schizophrenic.” successfully with mental illness, who support others with similar issues, is a 3 Do you remind people that they are the expert on their experience? growing modality in recovery. 3 Do you encourage people to consider various options when deciding on treatments? Professional peer providers obtain 3 Do you encourage people to ask questions about their diagnoses and recommendations? training and certification in helping Do you listen to people’s stories and view each one as a unique experience? others by promoting hope, advocacy, 3 resources, socialization skills, and 3 Do you assess each patient’s source of hope, meaning, and support? sharing their lived experience to Do you acknowledge and reinforce each patient’s positive qualities and abilities? engage others in treatment (Salzer, 3 Schwenk, & Brusilovskiy, 2010). Do you professionally confront others who use derogatory language about people with 3 mental illness or who perpetuate stigma? NURSING FACILITATION 3 Do you advocate for the rights of people with mental illness? Regardless of the setting, nurses are Do you encourage clients to imagine themselves in 6 months and describe how they posed to promote and nurture recovery 3 would like to be? from mental illnesses and substance abuse. It is important to remember that Do you write treatment goals with the client and use empowering language? For 3 example, “Patient will identify 5 realistic methods of managing symptoms” instead of recovery is what clients do; facilitating “Patient will be compliant with treatment.” recovery is what nurses and other mental health professionals do. Through the Do your treatment plan interventions use verbs, such as “promote,” ”enhance,” “en- 3 courage,” “assist,” “teach,” “offer,” and “reinforce”? therapeutic nurse/patient relationship, journalofchristiannursing.com JCN/April-June 2018 89

Copyright © 2018 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. religiousness. In general, religion is viewed they search for relationship with him. surrender, regeneration, and belief are as a system of beliefs, doctrine, or worship Dr. Daniel Fisher, a psychiatrist with a entwined throughout the recovery that is shared by a group of followers. previous diagnosis of schizophrenia, process (Fallot, 2001). Table 2 offers Spirituality tends to be a broader concept who has advocated extensively for the biblical references that support that encompasses personal transcendence recovery model, says: recovery-oriented care. Faith com- and meaning. However, spirituality and munity nurses will find these refer- religion both refer to: [Recovery] is essentially a spiri- ences especially helpful in their tual revaluing of oneself, a gradu- spiritual care of clients. The feelings, thoughts, experi- ally developed respect for one’s ences, and behaviors that arise own worth as a human being. INCORPORATING from a search for the sacred. The Often when people are healing SPIRITUALITY INTO CARE term search [emphasis added] from an episode of mental disor- Nurses can address spirituality in refers to attempts to identify, der, their hopeful beliefs about the recovery throughout all steps of the articulate, maintain, or transform. future are intertwined with their nursing process. Begin by examining The term sacred [emphasis added] spiritual lives, including praying, your beliefs about mental illness, refers to a divine being, divine reading sacred texts, attending substance abuse, recovery, and spiritual object, Ultimate Reality, or Ul- devotional services, and following care. As with any form of care, timate Truth, as perceived by the a spiritual practice. (2013) spiritual care should be offered individual. (Hill et al., 2000, p. 66) ethically, effectively, and within the Faith and religious beliefs can nurse’s scope of practice and expertise. Based on this conceptualization, be sources of hope, meaning, self- Assess a person’s spiritual beliefs spirituality/religiousness is not deemed concept, empowerment, support, and how those beliefs influence the good or bad. The feelings, thoughts, and motivation to take responsibility client’s understanding of recovery. experiences, and behaviors that result for treatment. Spiritual experiences Motivational interviewing, a clinical from the search for the sacred can be influence sense of self, philosophy approach that helps people make acceptance, hope, fulfillment, and of life, growth after episode of acute positive behavioral changes (SAM- strength; or guilt, self-blame, abandon- symptoms, and peacefulness for HSA, n.d.), and formalized spiritual ment, and isolation. Mental health people in recovery from severe assessment (Timmins & Caldeira, service consumers and providers mental illness (Ho et al., 2016). The 2017), can help identify beliefs that together can identify the role of innate desire to feel connected, should be encouraged and strength- spirituality/religiousness in the promo- inspired, and strengthened by a power ened or recovery barriers that should tion or hindrance of a client’s recovery. greater than ourselves is core to the be explored. Spiritual assessment Many people with health-promot- recovery narratives of many (Slade, guidelines identified by Gomi, ing spirituality believe that recovery is 2009). In fact, themes such as hope, Starnino, and Canda (2014) include rooted in a connection to God, and reconciliation, faith, grace, fellowship, developing a therapeutic alliance, identifying a client’s readiness to Table 2: Biblical References That Support and Encourage discuss spirituality, focusing on past and present spiritual strengths, Recovery-Oriented Care considering the client’s cultural Renewing Hope and Psalm 33:22, 42:11, 62:5, 130:5; Proverbs 13:12; Jeremiah context, and “letting the client direct Commitment 29:11; Romans 8:25, 15:13; Hebrews 10:23 whether and how spirituality can be 1 Samuel 16:7; Jeremiah 29:11, 30:17; Ephesians 2:10; used in an assessment to develop Redefining Self Hebrews 11:1; 1 John 3:1-3 treatment plans” (p. 452). Incorporating Illness Psalm 25:5; Proverbs 3:7-8; Romans 5:3-4; 2 Corinthians 5:17 Core tenets of recovery-oriented treatment planning are promotion of Involvement in Meaningful Psalm 90:17; Proverbs 16:3; Matthew 5:16; Ephesians 2:10, Activities 6:7; Hebrews 6:10; 1 Peter 4:10 client autonomy, empowerment, and decision-making (Slade et al., 2014). Overcoming Stigma Genesis 1:27; Psalm 9:18, 25:3, 119:114; 1 Timothy 5:5 The client is viewed as a member of Exodus 15:2; 1 Chronicles 16:11; Psalm 31:24; Isaiah 40:31; Assuming Control and the treatment team and collaborates in Romans 5:4, 12:1, 15:13; 1 Corinthians 6:19-20; Philippians Becoming Empowered development of the treatment plan. 4:13 Recovery-oriented programming uses 2 Chronicles 15:7; Psalm 119:66; 1 Corinthians 9:27; 3 John Managing Symptoms strength-based and self-management 1:2 approaches (Kidd, Kenny, & McKinstry, Psalm 133:1; Proverbs 12:26; Ecclesiastes 4:9-10; John 2015). Spirituality should be included Being Supported by Others 15:12; Romans 15:1; Galatians 6:2; Philippians 2:4; in the treatment plan, based on the 1 Thessalonians 5:11 client’s direction. Goals focused on

90 JCN/Volume 35, Number 2 journalofchristiannursing.com

Copyright © 2018 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. Recovery is what clients do, and facilitating recovery is what nurses and other mental health professionals do. iStock/SanderStock

employing spiritual strengths and addressing spiritual deficits can Sidebar: Implementing promote overall recovery. Spiritual resources, such as church Components of Recovery attendance, spiritual readings, prayer, worship, service, and interaction with a religious leader, can be part of a client’s ay, a 29-year-old male, visits a church-based treatment plan. Rmental health support group led by Jana, a faith community nurse. Hot meals are offered at each Interventions based on accurate assessment and planning can meeting. Seeing Ray is unwilling to interact with encourage the healthy role of spirituality in clients’ lives. Nurses group members, Jana catches him after the meeting can direct spiritually seeking clients to consider beliefs that to introduce herself. He doesn’t say much but states encourage and guide recovery, as well as nurture the faith of he recently relocated to the community. She affirms those who have a spiritual/religious grounding. his positive action in attending the meeting and Promotion of the client’s spiritual recovery journey can occur invites him to return. in many ways: At subsequent meetings, Ray avoids group • Encourage clients to develop a healthy, God-based view interaction and barks “no” when Jana mentions of self; establishing care with a behavioral healthcare pro- • Treat clients in ways that convey dignity, value, and respect; vider. Noting his blunted affect, facial grimacing, mumbling speech, and pervasive social avoidance, • Encourage participation in meaningful spiritual activities, Jana asks privately, “Ray, are you struggling with such as prayer, reading Scripture, worship, and attending mental health issues?” Ray mumbles, “I don’t want services; people to know me; they won’t like me.” • Listen to the client’s personal journey through discussion Having identified his need for healthcare, Jana and encouraging further exploration through writing, art, or offers to accompany Ray to a community clinic. He photovoice (expression of experience through multimedia); shows her a recent prescription for chlorpromazine • Acknowledge the value and uniqueness of the client’s from a local clinic for the uninsured. Jana asks Ray experience; what he understands about the medication and if • Encourage clients to focus on helping others and provide he is taking it as prescribed. opportunities to do so; As trust is built with Ray, Jana ascertains the • Suggest and help clients accept divine strength to manage absence of social supports. She encourages him to treatment; volunteer at the local food bank and introduces him to the manager. At each encounter, Jana offers to Pray with clients who request prayer, for divine interven- • pray for Ray; she and other group members invite tions, such as wisdom, insight, grace, forgiveness, and him to Sunday services and social gatherings; he is physical and emotional strength; unresponsive. • Provide information for supportive community resources that Seven months after his first support group visit, are congruent with the client’s spiritual and recovery needs; Ray makes eye contact more often and sometimes • Help reframe negative thoughts to biblically aligned thoughts; responds to members’ conversation. He consistently • Encourage clients to accept love and support from family, interacts with Jana after meetings and volunteers at peers, providers, support groups, and religious community; the food bank a few times each month. • Explain that relapse is not an indication of failure but is often Reflect: a part of the overall recovery process and an opportunity to • How did Jana acknowledge Ray’s journey in recovery? grow spiritually and emotionally; • Which components of recovery has Jana successfully • Connect client to a peer provider (a person trained to share addressed? his or her lived experience of recovery to promote recovery • Has she made missteps in her interactions with Ray? If and resilience in others). so, what could she have done differently? • What steps toward overcoming stigma would you offer Faith can be a source of hope, understanding, and strength Ray? in recovery, as described in this first-person account of a • How could a peer specialist benefit Ray in his recovery? client in recovery: —JCN

journalofchristiannursing.com JCN/April-June 2018 91

Copyright © 2018 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. Mental health consumers identify facilitate recovery from severe mental illness. Journal of positive outcomes of treatment partner- Psychosocial Nursing and Mental Health Services, 46(7), 24. Web Resources doi:10.3928/02793695-20080701-01 ships if providers promote the accep- Baird, C. (2012). Recovery-oriented system of care. • American Psychiatric Nurses tance of mental illness, management of Association—http://www.apna. Journal of Addictions Nursing, 23(2), 146–147. doi:10.3109 org/i4a/pages/index.cfm?page symptoms, improvement in self-esteem, /10884602.2012.669125 id=4100 and development of positive meanings Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participat- • American Psychological Association and life goals (Anthony, 2008). Nurses ing in mental health care. Psychological Science in the Public —http://www.apa.org/monitor/ can incorporate spiritual outcomes into Interest, 15(2), 37–70. doi:10.1177/1529100614531398 2014/09/recovery.aspx these areas of partnership. The sidebar, Corrigan, P. W., & Phelan, S. M. (2004). Social support • Department of Veterans Affairs— Implementing Components of Recov- and recovery in people with serious mental illnesses. http://www.mentalhealth.va.gov/ Community Mental Health Journal, 40(6), 513–523. ery, explores applying the recovery- doi:10.1007/s10597-004-6125-5 mentalhealthrecovery.asp oriented model by a faith community Davidson, L., O’Connell, M. J., Tondora, J., Lawless, • National Alliance on Mental Illness nurse in a support group setting. M., & Evans, A. C. (2005). Recovery in serious mental —http://www.nami.org/Learn- illness: A new wine or just a new bottle? Profes- More/Mental-Health-Conditions sional Psychology: Research and Practice, 36(5), 480–487. • SAMHSA—http://www.samhsa. CONCLUSION doi:10.1037/0735-7028.36.5.480 gov/recovery The perspective that mental health Davidson, L., & Strauss, J. S. (1992). Sense of self and/or substance abuse treatment in recovery from severe mental illness. The Brit- • U.S. DHHS—www.mentalhealth. ish Journal of Medical Psychology, 65(Pt 2), 131–145. gov/basics/recovery/index.html consists of professionals telling passive doi:10.1111/j.2044-8341.1992.tb01693.x patients what to do is a paradigm of Davis, L., & Brekke, J. (2014). Social support and func- the past. Recovery-oriented care is a tional outcome in severe mental illness: The mediating role of proactive coping. Psychiatry Research, 215(1), It was times like these I real- collaborative partnership that views the 39–45. doi:10.1016/j.psychres.2013.09.010 ized God was with me and had person with a mental illness holistically. Deegan, P. (1996). Recovery as a journey of the been with me all along. He Core components of recovery are well heart. Psychiatric Rehabilitation Journal, 19(3), 91–97. didn’t actually give me what I’d aligned with one’s spiritual life themes. doi:10.1037/h0101301 Deegan, P. E. (1997). Recovery and empowerment for asked for (a life free of anxiety Nurses must remember: people with psychiatric disabilities. Social Work in Health and sadness), but he put it within Care, 25(3), 11–24. doi:10.1300/J010v25n03_02 my reach. Looking back, I see There are many pathways to Drake, R. E., & Whitley, R. (2014). Recovery he had done this all along, but recovery. It is self-directed and and severe mental illness: Description and analysis. Canadian Journal of Psychiatry, 59(5), 236–242. he required me to work for it so empowering, with a personal rec- doi:10.1177/070674371405900502 I could be a better and stronger ognition of the need to change Fallot, R. D. (2001). Spirituality and religion in person. (Grazia, 2012, p. 133) and transform. There is a holistic psychiatric rehabilitation and recovery from mental illness. International Review of Psychiatry, 13(2), 110–116. healing process, with a gradual re- doi:10.1080/09540260120037344 Evaluating treatment success cannot turn to mind, body, and spiritual Farkas, M., Gagne, C., Anthony, W., & Chamberlin, J. be solely based on reduced symptom- balance, based on the individual’s (2005). Implementing recovery oriented evidence based atology, fewer hospitalizations, or personal cultural beliefs and tradi- programs: Identifying the critical dimensions. Commu- nity Mental Health Journal, 41(2), 141–158. doi:10.1007/ decreased relapses. Helping a client tions. (Baird, 2012, p. 147) s10597-005-2649-6 determine if a treatment goal was Fisher, D. (2013). Believing you can recover is vital to recovery unrealistic can help establish if plan Nurses can and should help people from mental illness. Retrieved from http://www.power2u. modification is needed. Through ongo- in recovery promote healthy spiritual org/articles/recovery/believing.html Gomi, S., Starnino, V. R., & Canda, E. R. (2014). Spiri- ing collaboration, nurses can help the and religious beliefs and practices. In so tual assessment in mental health recovery. Community client explore how his/her spirituality doing, we may help those on the Mental Health Journal, 50(4), 447–453. doi:10.1007/ is or is not benefiting recovery. journey of recovery discover God’s s10597-013-9653-z Sometimes an intervention must be path that leads to understanding (Psalm Grazia, D. (2012). On the outside looking in. In C. W. Lecroy & J. Holschuh (Eds.), First person accounts of mental changed to better suit the client’s needs. 119:32) and life (Psalm 16:11). illness and recovery (pp. 122–133). Hoboken, NJ: Wiley Press. For example, to increase socialization, Hill, P. C., Pargament, K. I., Hood, R. W., McCullough, feelings of connectedness, and opportu- M. E., Swyers, J. P., Larson, D. B., & Zinnbauer, B. American Nurses Association. (2014). Psychiatric-mental J. (2000). Conceptualizing religion and spiritual- nities for service, a client may set a goal health nursing: Scope and standards of practice. Silver Spring, ity: Points of commonality, points of departure. to participate in a faith community. If MD: Author. Journal for the Theory of Social Behavior, 30(1), 50–77. an initial visit was not positive, the American Psychiatric Nurses Association. (2017). doi:10.1111/1468-5914.00119 nurse and client can explore specific APNA recovery to practice. Retrieved from https://www. Ho, R. T., Chan, C. K., Lo, P. H., Wong, P. H., Chan, C. apna.org/i4a/pages/index.cfm?pageID=4100 L., Leung, P. P., & Chen, E. Y. (2016). Understandings faith community characteristics the Amsel, P. (2012). Living with the dragons: The long road of spirituality and its role in illness recovery in persons client is seeking. Provide realistic to self-management of bipolar II. In C. W. LeCroy & J. with schizophrenia and mental-health professionals: A expectations by explaining that it may Holschuh (Eds.), First person accounts of mental illness and qualitative study. BMC Psychiatry, 16, 86. doi:10.1186/ recovery (pp. 76–90). Hoboken, NJ: Wiley Press. s12888-016-0796-7 require visits to several faith communi- Anthony, K. H. (2008). Helping partnerships that Iwasaki, Y., Coyle, C., Shank, J., Messina, E., & Porter, H. ties before a client finds a good fit. (2013). Leisure-generated meanings and active living for

92 JCN/Volume 35, Number 2 journalofchristiannursing.com

Copyright © 2018 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. persons with mental illness. Rehabilitation Counseling Bul- Phillips, L. J., Francey, S. M., Edwards, J., & McMurray, https://www.integration.samhsa.gov/clinical-practice/ letin, 57(1), 46–56. doi:10.1177/0034355213486359 N. (2009). Strategies used by psychotic individuals to motivational-interviewing Jacob, K. S. (2015). Recovery model of mental ill- cope with life stress and symptoms of illness: A system- Substance Abuse and Mental Health Services Adminis- ness: A complementary approach to psychiatric care. atic review. Anxiety, Stress & Coping, 22(4), 371–410. tration. (2012). SAMHSA’s working definition of recovery: Indian Journal of Psychological Medicine, 37(2), 117–119. doi:10.1080/10615800902811065 10 guiding principles of recovery. Publication ID: PEP12- doi:10.4103/0253-7176.155605 Rüsch, N., Angermeyer, M. C., & Corrigan, P. W. (2005). RECDEF. Rockville, MD: SAMHSA. Retrieved from Jacobson, N., & Greenley, D. (2001). What is recovery? Mental illness stigma: Concepts, consequences, and http://content.samhsa.gov/ext/item?uri=/samhsa/ A conceptual model and explication. Psychiatric Services, initiatives to reduce stigma. European Psychiatry, 20(8), content/item/10007447/10007447.pdf 52(4), 482–485. doi:10.1176/appi.ps.52.4.482 529–539. doi:10.1016/j.eurpsy.2005.04.004 Test, M. A., & Stein, L. I. (1978). Community treat- Kamaradova, D., Latalova, K., Prasko, J., Kubinek, R., Vr- Salsman, S. A. (2012). The best medicine. In C. W. ment of the chronic patient: Research overview. bova, K., Mainerova, B., …, Tichackova, A. (2016). Con- LeCroy & J. Holschuh (Eds.), First person accounts of Schizophrenia Bulletin, 4(3), 350–364. doi:10.1093/ nection between self-stigma, adherence to treatment, mental illness and recovery (pp. 6–9). Hoboken, NJ: schbul/4.3.350 and discontinuation of medication. Patient Preference and Wiley Press. Timmins, F., & Caldeira, S. (2017). Assessing the spiritual Adherence, 10, 1289–1298. doi:10.2147/PPA.S99136 Salzer, M. S., Schwenk, E., & Brusilovskiy, E. (2010). needs of patients. Nursing Standard, 31(29), 47–53. Kidd, S., Kenny, A., & McKinstry, C. (2015). Exploring Certified peer specialist roles and activities: Results from doi:10.7748/ns.2017.e10312 the meaning of recovery-oriented care: An action-re- a national survey. Psychiatric Services, 61(5), 520–523. U.S. Department of Health and Human Services. (1999). search study. International Journal of Mental Health Nursing, doi:10.1176/ps.2010.61.5.520 Mental health: A report of the Surgeon General. Rockville, 24(1), 38–48. doi:10.1111/inm.12095 Scotti, P. (2012). Recovery as discovery. In C. W. LeCroy MD: Author. Kraus, S. W., & Stein, C. H. (2013). Recovery-oriented & J. Holschuh (Eds.), First person accounts of mental illness U.S. Department of Health and Human Services. services for individuals with mental illness and case manag- and recovery (pp. 9–13). Hoboken, NJ: Wiley Press. (2016). Facing addiction in America: The Surgeon General’s ers’ experience of professional burnout. Community Mental Seeman, N., Tang, S., Brown, A. D., & Ing, A. (2016). report on alcohol, drugs, and health. Retrieved from Health Journal, 49(1), 7–13. doi:10.1007/s10597-012-9505-2 World survey of mental illness stigma. Journal of Affective https://addiction.surgeongeneral.gov/surgeon-generals- Mental Health Commission. (2002). President’s New Disorders, 190, 115–121. doi:10.1016/j.jad.2015.10.011 report.pdf Freedom Commission on Mental Health. Retrieved from Slade, M. (2009). Personal recovery and mental illness: A U.S. Department of Justice. (n.d.). Introduction to the http://govinfo.library.unt.edu/mentalhealthcommis- guide for mental health professionals. New York, NY: Cam- ADA. Retrieved from https://www.ada.gov/ada_intro. sion/index.htm bridge University Press. htm National Council for Behavioral Health. (2017). Com- Slade, M., Amering, M., Farkas, M., Hamilton, B., Vuckovich, P. K. (2010). Compliance versus adherence munity Mental Health Act. Retrieved from https://www. O’Hagan, M., Panther, G., …, Whitley, R. (2014). Uses in serious and persistent mental illness. Nursing Ethics, thenationalcouncil.org/about/national-mental-health- and abuses of recovery: Implementing recovery-oriented 17(1), 77–85. doi:10.1177/0969733009352047 association/overview/community-mental-health-act/ practices in mental health systems. World Psychiatry, Waynor, W. R., Gao, N., Dolce, J. N., Haytas, L. A., Park, J., & Chen, R. K. (2016). Positive psychology and 13(1), 12–20. doi:10.1002/wps.20084 & Reilly, A. (2012). The relationship between hope hope as means to recovery from mental illness. Journal of Substance Abuse and Mental Health Services Adminis- and symptoms. Psychiatric Rehabilitation Journal, 35(4), Applied Rehabilitation Counseling, 47(2), 34–42. tration. (n.d.). Motivational interviewing. Retrieved from 345–348. doi:10.2975/35.4.2012.345.348

Instructions for Taking the CE Test Online

• Read the article. The test for this CE activity can be taken Provider Accreditation: online at www.NursingCenter.com/CE/CNJ. Find the Lippincott Professional Development will award 1.5 contact test under the article title. Tests can no longer be mailed hours for this continuing nursing education activity. or faxed. You will need to create a username and password and log in to your free personal CE Planner Lippincott Professional Development is accredited account before taking online tests. Your planner will keep as a provider of continuing nursing education by the track of all your Lippincott Professional Development American Nurses Credentialing Center’s Commission online CE activities for you. on Accreditation. • There is only one correct answer for each question. A pass- This activity is also provider-approved by the California ing score for this test is 17 correct answers. If you pass, you Board of Registered Nursing, Provider Number CEP can print your certificate of earned contact hours and access 11749 for 1.5 contact hours. Lippincott Professional the answer key. If you fail, you have the option of taking the Development is also an approved provider of continuing test again at no additional cost. nursing education by the District of Columbia, Georgia, and Florida, CE Broker #50-1223. • This CE test also is available for viewing at www.journalofchristiannursing.com in the table of Payment and Discounts: contents for this issue under • The registration fee for this test is $17.95 for nonmembers, • Visit www.nursingcenter.com for other CE activities and $12.95 for NCF members. your personalized CE planner tool. • For questions, contact Lippincott Professional For additional continuing education articles on the Development: 1-800-787-8985. topic of mental health, go to NursingCenter.com/CE. Registration Deadline: June 4, 2021 Disclosure Statement: The authors and planners have disclosed that they have no financial relationships related to this article.

journalofchristiannursing.com JCN/April-June 2018 93