What are the implications of personal recovery for older people's mental health services?

Background/Objectives: The concept of personal recovery has been based on the experiences of adults of working age with a lived experience of mental illness. The impact of the recovery philosophy upon mental health services for working age adults has been substantial, and is likely to continue. Similar developments have not yet taken place in older people's mental health services. Additionally it is not yet evident whether the philosophy of personal recovery holds relevance for older people with mental health problems. Research in this area is under-developed. It is probable that the mental health policy direction will mean that older people's mental health services will need to respond to the recovery agenda, but in doing so they will need to be clear which components of recovery are valued by older people. This research seeks to develop an understanding of the applicability of personal recovery for users of older people's mental health services. The objectives of the research are: (1) to identify the components of personal recovery which are meaningful to older people with mental health problems. (2) to identify how the concept of personal recovery is applicable to older people with dementia; and (3) to understand the implications for delivering recovery-oriented practice within older people's mental health services.

Methods: 40 qualitative interviews have been carried out with 29 users of older peoples’ mental health services and 11 care-givers. These interviews have been analysed using grounded theory techniques. The preliminary findings from the qualitative interviews have been fed back to two focus groups of service users, carers and clinicians in order to develop a model for recovery-oriented practice for older people's mental health services.

Results: There would appear to be overlaps with some of the components of recovery experienced by working age adults, namely hope, agency and self management. However, the experience of recovery for users of older people's mental health services differs in that it appears to be primarily concerned with maintaining or regaining a sense of pre-illness identity. Key issues appear to relate to the continuity and adaptation of existing social supports, valued social roles and meaningful activities, as well as pre-existing coping styles and co-existing physical illnesses. For people with dementia, the subjective experience of recovery changes over time, and spousal carers in particular are seen as having a pivotal role in facilitating or hindering the opportunities for recovery to take place.

Discussion/Conclusions: Personal recovery does have resonance for older people, but there are key differences from the experience of recovery of working age adults with a lived experience. The process of personal recovery for people with dementia would appear to be different. There are substantial practice implications arising from these findings for older people's mental health services.

Funding: South London & Maudsley Charitable Trustees (grant no. App 433), and Guy's & St. Thomas’ Charity (grant no. G081011).

Keywords: Recovery-oriented interventions, personal recovery, older people.