Mental health accounts for around 23% of the ‘disease burden’ in the UK – more than heart disease or cancer – but only around 10% of the health budget. In her new book, Emma Drew FRSA explains why the holistic, person-centred approach developed by the RSA’s Whole Person Recovery programme can radically improve the chances of lasting recovery.
People with severe mental health problems have a reduced life expectancy of 15-20 years, and often experience chronic physical health problems and frequent use of NHS services. For many people, substance misuse is a symptom not a cause of mental ill-health. Taking into account both illegal and legal substances such as prescription drugs, alcohol and tobacco, about 1 in 4 people in the UK experience some form of addiction in their lifetime
For each of these people, it is estimated that a further 9 people are adversely affected. Perhaps as many as 75% recover without formal professional support, but many of the rest end up in prolonged and challenging engagement with public services such as the NHS, the police, social services and the criminal justice system. Problems associated with addiction may be replicated in families across generations, so it is easy to see how the patterns of substance misuse in society are complex, embedded and overlapping. As are the causes, and the consequences.
At the time I was researching The Whole Person Recovery Handbook, it was reported that the success rate for NHS treatment programmes for addiction (that is, people who reported being free of substance misuse one year after exiting treatment) was 16%, so worse than most cancer treatments.* The RSA was among a number of leading organisations calling for a deep and searching investigation into how this could be changed, and consequently launched the Whole Person Recovery Project in 2010.
The project developed its pioneering research into drugs, addiction and recovery on the back of a simple but essential assumption: successful recovery requires an equal partnership between ‘experts by profession’ – doctors, therapists, drugs workers, nurses, pharmacists – and ‘experts by experience’ – people with lived experience of addiction and its social, psychological and practical effects, and of other mental health difficulties. These people are, by definition, the experts on their own lives. This assumption has pretty radical implications for the simple reason that it moves power away from professionals and into the hands of people who may traditionally be seen in some quarters, as difficult, destructive and untrustworthy.
In other words, if you are a person affected by reliance on addictive behaviour, you are nonetheless a decision-maker about your own life, and as with any other health problem, should have the support of a team of experts. You may feel vulnerable – that is fine. It should not deprive you of your dignity or the agency or responsibility without which recovery is well-nigh impossible. The recovery journey is designed around you, by you, with support. You go at whatever pace and in whatever direction works for you. Relapse is possible, but it is not the end of the world. You can learn each time and carry on, if you feel able. You may wish for certain types of treatment as part of what happens, but Whole Person Recovery is not ‘treatment’. It is much bigger than that.
The notion of ‘treatment’ assumes something is done by one person (the ‘expert’) to another person (the ‘patient’). Recovery looks more widely at the person in context. It recognises that without a sufferer assuming responsibility and control, recovery is less likely, but it also recognises the painful vulnerability that may lie underneath addiction, and the resistant coping mechanisms developed as a result, that may themselves contribute to the problems a person is experiencing. It recognises that relapse is a possibility and does not operate from a judgmental point of view. It understands that people can learn from mistakes, and that no-one is perfect. The expert by experience and the experts by profession are equal partners in the recovery project. Recovery sees that what may propel someone forward to a more balanced life and social functionality, is hope
As the contrite plagiarist and recovering addict Johann Hari has observed, the opposite of addiction is not sobriety, but human connection.
I interviewed a number of people for the book, and was in awe at the great courage and capacity for humility that it takes to make a success of recovery. The problems associated with addiction can be huge, unmanageable and destructive, and the stigma immense, as I discovered with my late partner and describe briefly in the book, but what can be learned from those who emerge out of the other side into the light has the power to change the world.
The Whole Person Recovery Handbook is available to buy from 20 August 2015.
*Research from Drugscope, the British Crime Survey and Addiction Myths by Stanton Peele (2014).
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I look forward to reading this. It sounds exactly where we need to go. I worry that our workforce, long focused on statistical outcome driven "success" may be the last great barrier on this journey unless we can free them to be professionals and allow them to connect rather than transact everyday. This will be a powerful tool to help shape policy and I hope to change culture.We can the create space for professional practice along these lines, helping it flourish rather than as the fluffy bit you do after paper work and stats. We are moving though and that's really exciting.