title: An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges.
abstract: Over past decades, improvements in longer-term clinical and personal outcomes for individuals experiencing serious mental illness (SMI) have been moderate, although recovery has clearly been shown to be possible. Recovery experiences are inherently personal, and recovery can be complex and non-linear; however, there are a broad range of potential recovery contexts and contributors, both non-professional and professional. Ongoing refinement of recovery-oriented models for mental health (MH) services needs to be fostered.
  
  
  
  This descriptive paper outlines a service-wide Integrated Recovery-oriented Model (IRM) for MH services, designed to enhance personally valued health, wellbeing and social inclusion outcomes by increasing access to evidenced-based psychosocial interventions (EBIs) within a service context that supports recovery as both a process and an outcome. Evolution of the IRM is characterised as a series of five broad challenges, which draw together: relevant recovery perspectives; overall service delivery frameworks; psychiatric and psychosocial rehabilitation approaches and literature; our own clinical and service delivery experience; and implementation, evaluation and review strategies. The model revolves around the person's changing recovery needs, focusing on underlying processes and the service frameworks to support and reinforce hope as a primary catalyst for symptomatic and functional recovery. Within the IRM, clinical rehabilitation (CR) practices, processes and partnerships facilitate access to psychosocial EBIs to promote hope, recovery, self-agency and social inclusion. Core IRM components are detailed (remediation of functioning; collaborative restoration of skills and competencies; and active community reconnection), together with associated phases, processes, evaluation strategies, and an illustrative IRM scenario. The achievement of these goals requires ongoing collaboration with community organisations.
  
  
  
  Improved outcomes are achievable for people with a SMI. It is anticipated that the IRM will afford MH services an opportunity to validate hope, as a critical element for people with SMI in assuming responsibility and developing skills in self-agency and advocacy. Strengthening recovery-oriented practices and policies within MH services needs to occur in tandem with wide-ranging service evaluation strategies.
authors.affiliation: School of Psychology, Faculty of Science and Technology, University of Newcastle, Callaghan, NSW, 2308, Australia.|Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW, 2308, Australia.
authors.forename: Barry G
authors.initials: BG
authors.lastname: Frost
authors.affiliation: Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.|School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Tirupati
authors.affiliation: Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Johnston
authors.affiliation: Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.
authors.forename: Megan
authors.initials: M
authors.lastname: Turrell
authors.affiliation: Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW, 2308, Australia. Terry.Lewin@hnehealth.nsw.gov.au.|Hunter New England Mental Health, Newcastle, NSW, 2300, Australia. Terry.Lewin@hnehealth.nsw.gov.au.|School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia. Terry.Lewin@hnehealth.nsw.gov.au.
authors.forename: Terry J
authors.initials: TJ
authors.lastname: Lewin
authors.affiliation: Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW, 2308, Australia.|Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.|School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
authors.forename: Ketrina A
authors.initials: KA
authors.lastname: Sly
authors.affiliation: Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW, 2308, Australia.|Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.|School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
authors.forename: Agatha M
authors.initials: AM
authors.lastname: Conrad
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000379:methods* / Q000639:trends; D065026:Hope; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation*; D008605:Mental Health Services / Q000639:trends; D008960:Models, Psychological; D012111:Residence Characteristics
keywords: Evidence-based psychosocial interventions; Hope; Mental health services; Models; Recovery; Recovery-oriented; Rehabilitation; Serious mental illness