Individual recovery or collective recovery? Do we really consider both in current Irish mental health policy and provision?

We are now over 2 years since the publication of ‘Sharing the Vision: A Mental Health Policy for Everyone’ (Department of Health 2020). Similar to the previous national mental health policy, ‘A Vision for Change’ (Department of Health 2006), the idea of personal recovery continues to be reflected as the cornerstone of service provision and policy in Ireland. Anthony (1993) is commonly referenced in the literature (Norton and Swords 2020; Swords and Houston 2020) in terms of defining what personal recovery is:

“It is a way of living a satisfying, hopeful and contributing life, even with limitations caused by illness”.

(Anthony 1993, p. 15)

Taking the above definition, recovery is a personal journey through life, one which should take individuals beyond mental health services and into society (Norton and Swords 2020). However, when we reflect on our national mental health policies, do they really consider personal recovery as not only the responsibility of the individual and frontline professionals, but also the collective responsibility of social institutions and society? Firstly, if we look at individual responsibilities associated with recovery. For each person, personal recovery is their journey, one which they should be encouraged to steer in the direction which they believe will reflect a life of satisfaction, hope and fulfilment (Anthony 1993; Norton and Swords 2020; Swords and Houston 2020).

In an Irish context, the response of policy and provision has been to develop services which reflect the experiences of personal recovery. This has been seen in recent frameworks, including the ‘National Framework of Recovery in Mental health’ in 2017, with an updated version due to be published by the end of 2023. Within these frameworks, there are key criteria for what can be defined as a ‘recovery-orientated service’. In the 2017 document, there were four principles in which a service must attain to be recovery-orientated:

• Centrality of the service user’s lived experience.

• The co-production of recovery promoting services, between all stakeholders.

• An organisational commitment to the development of recovery-orientated mental health services.

• Supporting recovery-orientated learning and recovery-orientated practice across all stakeholder groups.

(Health Service Executive 2017)

Reflecting on the above principles, the focus here remains on individuals, either providers or receivers of mental health care in Ireland. It focuses specifically on the development of mental health services towards a recovery-orientated philosophy. However, for life satisfaction, hope and fulfilment to be fully realised for individuals living with mental ill health (Anthony 1993), collective responsibility must be considered and included in implementing and improving the outcomes for those on their recovery journey.

Societal responsibility must be considered and inform policy surrounding service delivery and development on recovery-orientated services. In other words, when policy is written on mental health in Ireland, in this case, ‘Sharing the Vision’, do we see individual and collective responsibility considered and promoted in these documents? Also, if we do see it in policy, does it translate into the reality of the experiences of people using and providing mental health services? Research has highlighted the influence of neoliberalism on policy discourse and service delivery internationally (McWade 2016) and in Ireland (Swords 2021), leading to a focus on individualism. Consequently, there is an overwhelming pressure on service users to succeed in their journey of recovery in their everyday situations and relationships (Swords 2021).

Furthermore, the influence of neoliberal discourse has contributed to service providers, especially frontline professionals being tasked with unrealistic caseloads, time-limited approaches, and a pressure to be efficient and measurable in their everyday assessments (Swords 2021). Undeniably, not only do service users and families deserve better, but also frontline practitioners should be provided with the time, resources, and opportunities to build genuine, trustworthy, and empowering experiences for people seeking to move beyond services and lead a life of recovery beyond their diagnosis.

‘Sharing the Vision’ is a policy document which states it is a ‘mental health policy for everyone’ (Department of Health 2020). If it is a mental health policy for everyone, then each person in Irish society is responsible for supporting people to experience hope throughout their recovery journey. For individuals to have opportunities to contribute to society in their lives, leading to satisfaction and fulfilment, then society needs to facilitate this. More importantly, collective responsibility within society comes in the decision-making and role of government in making policy translate to practice.

‘Sharing the Vision’ states that a “whole-of-government-approach” is necessary for a successful mental health policy in Ireland (Department of Health 2020, p.20). Our argument in this letter has asked for a shift in thinking and priority towards the collective, rather than just the individual responsibility of personal recovery. Frustratingly, recovery-orientated services continue to place responsibility on individuals, both users and providers of services. However, in order to achieve the outcomes of personal recovery in line with the experiences of Anthony (1993), then there is a need to consider how recovery is achieved in society, beyond what mental health acute and community services can offer.

It is not enough to just state, that a “whole-of-government-approach” needs to be taken to mental health policy provision within Ireland (Department of Health 2020, p.20). It is positive to see an implementation plan introduced for ‘Sharing the Vision’ in 2022 (Health Service Executive, 2022). However, it remains a challenge to understand how a “whole-of-government-approach” is being translated into practice from this implementation document (Department of Health 2020, p.20). Essentially, there still needs to be clear guidelines on how such an approach can be a collective, rather than an individual experience. Otherwise, the users of services will continue to face barriers to achieving hope, satisfaction and fulfilment on their recovery journeys within an Irish context.