Recovery is something you do yourself
The dignity of risk is an important concept. It puts the emphasis on personal choice and self-determination, two concepts that are central to recovery. Qualitative research shows that the thinking of the recovery movement comes together in the now widely supported CHIME framework (Leamy et al. 2011).
What is recovery?
Recovery is a way of living a satisfying, hopeful life, with a meaningful contribution to the community, despite the limitations of a mental susceptibility (after Anthony 1993).
CHIME
CHIME is the acronym of the elements Connectedness, Hope and optimism, Identity, Meaning in life and Empowerment.
| Concept | Description | Elements |
| Connectedness | Having good relationships and being connected to other people in a positive way. | Peer support and support groups; support from others; community. |
| Hope and optimism | Having hope and optimism that recovery is possible, and having relationships that support this. | Motivation to change; positive thinking and valuing success; having dreams and aspirations. |
| Identity | Regaining a positive sense of self-worth and identity, and overcoming stigma. | Dimensions of identity; rebuilding or redefining a positive sense of identity; overcoming stigma. |
| Meaning | Living a meaningful and purposeful life, as defined by the person (not by others). | Meaning in the experience of mental ‘illness’; spirituality; a meaningful life and social goals. |
| Empowerment | Having control over your life, focusing on strengths and taking personal responsibility. | Personal responsibility; control over life; focusing on strengths. |
The CHIME framework is still being developed
The framework still has to be adapted further to differing social and cultural circumstances and to the characteristics of different populations. The elements ‘difficulties’ and ‘trauma‘ should also be included, and ‘having choices’, ‘taking risks’ and ‘dealing with challenges’ should get a place in the concept of personal recovery as well.
Recovery-oriented work is not yet the norm
- Mental health care can hinder recovery through negative side effects, including medication, the use of stigmatising diagnoses and implicit biological messages (such as the term ‘brain disease’) that strengthen stigma (van Weeghel et al. 2019).
- Spirituality, being in charge yourself and social support, on the other hand, promote recovery, but the question is how far mental health care promotes them (van Weeghel et al. 2019).
- Research in the United Kingdom and the United States shows that recovery-oriented work is not the norm in mental health care (Ostrow and Adams 2012; Schizophrenia Commission 2012).
- Dutch reports suggest that it is no different in the Netherlands (Van Sambeek et al. 2011), although there certainly are places and organisations where recovery-oriented work seems to succeed (Boevink 2012).
Interventions that promote recovery
Most recovery-promoting interventions with good scientific credentials are not offered routinely in mental health care. Examples are:
- Peer support
- Open dialogue
- Advance directives
- Wellness recovery action planning (WRAP)
- Illness management and recovery
- REFOCUS
- The strengths model
- Recovery colleges
- Individual placement and support (IPS)
- Supported housing
- Mental health trialogues
Research confirms that the institutional readiness of mental health organisations is decisive for the successful introduction of recovery-oriented work (Leamy et al. 2014).
Promoting hope, empowerment and personal recovery
Boevink showed that recovery-oriented interventions by experts by experience, organised in parallel to mental health care, promote hope, empowerment and personal recovery (Boevink 2017).
This may be the reason that recovery colleges, which use a learning model for dealing with mental distress that is grounded in knowledge from experience and which mostly operate outside mental health care, seem to be successful.
Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare.
Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.
Want to read more?
Blogs by Jim van Os can be read here
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