Clients with mental health challenges and dealing with addiction often have significant barriers to accessing meaningful activity engagement in their daily lives. The process of recovery for mental health illness and addiction has historically overlapped. In 2010, the Substance Abuse and Mental Health Services Administration (SAMHSA) created an expanded definition of recovery to include people who are both suffering from addiction and mental health illnesses. The principles of recovery apply to both populations. Therefore, the content of this article pertains to both individuals recovering from mental health illness and addiction. Applicable mental health problems may include post-traumatic stress disorder, anxiety, eating disorders, schizophrenia, and more.
Like occupational therapists, behavior and addiction experts and SAMHSA recognize the importance of daily participation in meaningful, engagement activities in the recovery process. This gives occupational therapists the space to provide activity-focused interventions to these clients. Several of SAMHSA's ten principles of recovery overlap significantly with the occupational therapy domain and process.
The Ten Principles of Recovery are:
1. Driven by hope: In positive psychology, hope is the belief that individuals can attain goals. For individuals suffering from mental health disorders or addiction, the hope is to achieve sobriety or mental well-being.
2. Person-driven: An individual going through recovery is in charge of the process. While they may have a team of health professionals and loved ones, the individual is in command.
3. Multiple Pathways: Many elements contribute to the recovery process. Recovery for one person may include environmental modifications, peer support, meaningful activity engagement. The process for another person will often look different.
4. Holistic: Treatment should consider the whole person: Mind, body, and soul. Linking these three components in treatment can contribute to an individual's success in recovery.
5. Peer Support: The experience of recovery can be daunting when your support system has not been through the same challenge. Peers are an excellent resource for problem-solving, especially in times of crisis.
6. Culture: The recovery process should always respect an individual's beliefs and cultural background.
7. Trauma-informed: Successful recovery often hinges on acknowledging and processing past traumatic events. This is especially notable when trauma has led to mental health challenge or addiction.
8. Relational: Meaningful relationships provide an individual with a feeling of belonging, emotional support, and encouragement.
9. Strengths and Responsibility: It takes a village. Family and community members must support the well-being of those in recovery. Successful partnerships with key caregivers (for example, a parent, spouse, or community resource program) helps to facilitate success.
10. Respect: Dignity must be at the forefront of the recovery process. Individuals can be vulnerable during and after the recovery process. Discrimination does not have a place here.
Applying the Guiding Principles to Recovery Intervention
Occupational therapists have a toolbox well-equipped to support individuals struggling with mental health and addiction. We are experts at client-centered practice, identifying areas of strength, problem-solving, and facilitating change in the environment, person, or activity. OTs focus on eliminating barriers in order to improve client quality of life, and promote health and wellness. Many tools, specific assessments, and interventions that we already use in practice can be applied to the recovery intervention process.
Collaborate with your client to create their own goals. Not sure where to begin? Start with an occupational profile. Motivational interviewing can be an excellent tool to discover what is meaningful in their life. Practitioners can support this endeavor with assessments such as the Canadian Occupational Performance Measure (COPM). The COPM "measures performance and satisfaction in self-care, productivity, and leisure from the client's perspective." This quick client-centered assessment can be readministered at any point in the recovery process to check for progress. It can also give the client insight into what is important to them and their performance in those identified activities.
Empower your client
Educate your client on all of the principles of recovery and highlight the notion that recovery is person-driven. Empowerment is defined as an individual’s perceived ability to have control over their life. Help your client identify their strengths and motivation for recovery. The therapist can help identify the client's challenges and consider what skills they used in that scenario. This reflective practice can be a valuable learning opportunity.
Build self-advocacy skills
For an individual to drive their recovery, they must have a solid foundation of self-advocacy skills. Self-advocacy has three major parts: 1) knowing yourself, 2) knowing what you need, and 3) knowing how to get what you need. This skill can often be practiced in the midst of the therapy process- no need for roleplay! When your client is making a decision, you can work together to break down the three components. Significant benefits to being able to self-advocate include increased self-confidence, self-respect, autonomy, and an improved ability to problem-solve.
Evaluate skills and build strategies
The Empowerment Scale is an assessment tool that measures self-esteem, activism, control, anger, and power/powerlessness. The results are often an excellent starting point for developing specific strategies that will enable the individual to take control over their decisions and direction in life. This robust objective tool is used widely by mental health professionals and it can be administrated by occupational therapists.
No two recovery journeys are alike. While you'll provide education and direct the client in the process, work together to create strategies that will work specifically for the context of your client's life. Talk about the outcomes they want and refer back to their motivation. Offer choices whenever possible. Allow the client to prioritize goals based on their own values and needs. Help establish habits that fit into the context of their own routines. This often requires flexibility on the part of the therapist as your values may differ from the client’s own. Problem-solving together and in-the-moment often helps the therapist shift back to client-centered practice.
While therapy, family, and community support are essential channels in recovery, peer support is especially crucial. Peers are a valuable resource who can relate to clients, provide hope, and problem-solve situations that challenge the process. Refer your client to a specific support group. The more relevant to your client's own demographic (mental health condition, age, gender), the better the outcomes are likely to be. Depending on your client's wants and needs, you can search for a group in-person or remote (either live or an asynchronous platform).
Focus on potential challenges
What will the client do if a family emergency occurs? What if their housing is not stable? Or if a significant stressor interferes with recovery? Plan ahead. The path to recovery is not linear, and clients should be able to reflect upon challenges and consider actions they can take when something arises. Converse and roleplay through hypothetical situations. There is no 'right' or 'wrong' answer, and the process can empower and prepare the individual for potential scenarios that could jeopardize recovery.
For Further Learning
1. Dr. Tina Champagne, OTD, OTR/L, CCAP, FAOTA is a thought leader in mental health and occupational therapy. Her publications and resources are related to trauma-informed care, sensory modulation, and mental health intervention.
2. Dr. Skye Barbic, PhD, MSc, BScOT, Reg. OT(BC) has many scholarly publications that align with the role of adult mental health and occupational therapy, particularly assessment and delivery of services.
3. AOTA Practice Guideline for Adults Living with Serious Mental Illness (Susan Noyes, PhD, OTR/L, and Elizabeth Griffen Lanningan, PhD, OTR/L, FAOTA). This practice guideline is an summary of the occupational therapy literature related to adult mental health. This is an excellent resource for reviewing best practices on specific areas of occupation such as social participation, sleep, or leisure.
4. Wellness Recovery Action Plan (WRAP) is a user-friendly method of organizing the process of recovery. The structure includes a daily plan, identification of stressors, crisis plan, and more.
5. Recovery to Practice (RTP) Certificate program: This continuing education opportunity expands on SAMHSA's 10 Principles of Recovery and gives providers opportunities to demonstrate competence in best practices.
SAMHSA’s 10 Principles of Recovery are well aligned with the occupational therapy process. The recovery process is dynamic, and a variety of intervention strategies and support systems should be in place. Educate your client on the Ten Guiding Principles as a method of demonstrating the multi-faceted nature of recovery. By collaborating to create goals, empowering your client, remaining client-centered, building connections, and problem-solving, your client will be well-equipped for this journey of transformation.
Download the 10 Principles of Recovery one-page printout, a great sheet for clients in recovery to keep close by as they work through the process!