The International Journal of Psychosocial Rehabilitation
Recovery and Lifelong Learning: Interrelated Processes

   
Christopher A. Griffiths (BSc).
 EMILIA Project Researcher, Department of Mental Health

 
Dr Peter Ryan (DProf, MSc).
Professor of Mental Health, Department of Mental Health



 
Citation:
Griffiths CA & Ryan P.  (2008). Recovery and Lifelong Learning:  Interrelated Processes
.
  International Journal of Psychosocial Rehabilitation. Vol 13(1). 51-56



 
Correspondence address: Christopher A. Griffiths, Department of Mental Health, Middlesex University, F Block, Archway Campus, London, N19 5NF
Email: c.griffiths@mdx.ac.uk
 
 
 

Abstract
The purpose of this paper is to explore the links between the process of recovery and the process of lifelong learning, see how they are interrelated and to see what mental health services can learn from any emergent connections to bring benefits to those who experience mental disorder.
  A review of literature on recovery and lifelong learning was conducted to determine similarities in the definitions, processes and outcomes of engagement in recovery and lifelong learning.
  It was found that recovery and lifelong learning are indivisible, inter-twined processes and that lifelong learning is an essential part of mental disorder recovery.
 The findings indicate that greater access to and provision of lifelong learning opportunities should be provided for those who experience mental disorder to help facilitate their recovery.
Key words: recovery, lifelong learning, social inclusion.


 
Introduction
This paper will start by providing brief definition and background on the theoretical constructs of recovery and lifelong learning, and the processes that are involved in each. It will then describe how these twin concepts and associated processes are closely interrelated and how recovery can be viewed as a type of lifelong learning. The focus will then move on to describe how lifelong learning can be used to aid the process of recovery. What we are seeking to elucidate here is an approach which locates the experience of and recovery from mental disorder as essentially part of a process of adult lifelong learning. This approach emerges out of the belief that both recovery and lifelong learning are experiences in which all adults are involved, whether they have mental disorder or not. In this sense we put forward the proposal that lifelong learning and recovery are intertwined as human experiences, adaptive systems, and goals. By highlighting the importance and centrality of lifelong learning in recovery it is hoped that policy makers, educators and mental health services will increase the provision and access to lifelong learning for individuals experiencing mental disorder.
 
Context
This paper has emerged out of the work of the Empowerment of Mental Illness Service Users: Lifelong Learning and Action (EMILIA) project. EMILIA is a European Union Framework Six research project, provided with €3.4 million funding for 54 months in the thematic area of lifelong learning. At the European policy level, the project seeks integration in three policy areas: lifelong learning, social inclusion, and employment. At the practice level, the eight demonstration sites (Athens, Barcelona, Bodo, London, Paris, Sarajevo, Stroestrum, and Warsaw) are seeking to develop and evaluate a variety of ways in which practical pathways can be found to facilitate the social inclusion and recovery of mental health service users through a process of lifelong learning. This has led us to extensive dialogue with mental health service users themselves, and through this to seriously consider ways of approaching recovery issues which are non-stigmatising and which go beyond medical or, for that matter, social models of mental disorder.
 
Recovery
Recovery can be a voyage of self-discovery and personal growth: experiences of mental disorder can provide opportunities for change, reflection and discovery – of new values, interests and skills. According to Wallcraft (2005) recovery can provide a further step to developing coping strategies – a move on from mere survival or life management to engaging in the lifelong learning necessary to achieve an improved and personally defined quality of life. Rethink (2004) offers the following overview statement:
“Recovery can be defined as a personal process of tackling the adverse impacts of experiencing mental health problems, despite their continuing or long-term presence.  It involves personal development and change, including acceptance there are problems to face, a sense of involvement and control over one's life, the cultivation of hope and using the support from others, including direct collaboration in joint problem-solving between people using services, workers and professionals.  Recovery starts with the individual and works from the inside out. For this reason it is personalised and challenges traditional service approaches.”
Within the mental health field, over the last fifteen years or so, the recovery model has emerged as an integrating overarching set of statements, policies and goals (e.g., NIMHE, 2005). Since the 1990s many mental health programmes have identified themselves as recovery-oriented. Community mental health systems have been increasingly emphasising providing services and using interventions that support mental health service users recovering from severe mental disorder.
 
Lifelong Learning
Lifelong learning has been driven by the belief that everyone should have equal and open access to high quality learning opportunities. It acknowledges that learning is not just confined to the classroom, and to the delivery and achievement of academic awards, but can be taught through many different means. Lifelong learning can be broadly defined as learning that is pursued throughout life: learning that is flexible, diverse and continues in many different contexts and settings. Delors (1996) refers to the four ‘pillars’ of lifelong learning:
Learning to know – learning how to learn rather than specific sets of knowledge
Learning to do – developing the capability to adapt and respond creatively to new challenges and new demands
Learning to live together and with others – peacefully resolving conflict, discovering other people and their cultures, and fostering community capability
Learning to be – learning contributing to a person’s complete development, of mind and body, aesthetic and cultural appreciation, and spirituality 
 
The European Commission (COM 2001) stated that lifelong learning had four broad and mutually supportive objectives: personal fulfilment, active citizenship; social inclusion, and employability/adaptability. In this context lifelong learning was defined as “a continuously supportive process which stimulates and empowers individuals to acquire all the knowledge, values, skills and understanding they will require throughout their lifetime and to employ them with confidence, creativity and enjoyment in all roles, and circumstances… within a personal, civic social and\or employment-related perspective... encompassing the whole spectrum from formal, non-formal to informal learning” (COM, 2002). Somewhat more succinctly, Kogan (2000, p. 341) defined lifelong learning as “learning that equip[s] students (learners, individuals) to encounter with competence and confidence, the full range of working, learning and life experiences.”

Lifelong learning is therefore about gaining abilities knowledge and qualifications throughout life. It allows the individual to adapt and actively participate in all spheres of social and economic life and provides an individual with more control over his or her present and future (Knowles, 1984). Lifelong learning policy has a formal role in national education policies in many countries, with various governments throughout the world investing in and developing strategies to facilitate lifelong policies amongst its citizens. Primarily this has been to improve competitive advantage in the worldwide market place but there has also been a desire to improve quality of life and well-being for individual citizens.
 
Recovery as Lifelong Learning
It is arguable that de-institutionalization and the emergence of the recovery model have generated a greater need for lifelong learning in mental health service users. After all, very little new learning is required for an institutionalised life: there is little environmental change and the patient has little control over their lives. In contrast, life in the community involves experiencing continual change and requires mental health service users to have a greater degree of control over their lives; therefore, more extensive lifelong learning is required. In her paper discussing mental health recovery Anthony (1993, p. 21) stated that “any person with severe mental illness can grow beyond the limits imposed by his or her illness.” It may be that this potential to grow beyond any limits is partially determined by access to and the ability to acquire and apply lifelong learning.

Stocks (1995) and Anthony (1993) both provided definitions of recovery with similarities to lifelong learning definitions. Stocks stated that “recovery is an ongoing process of growth, discovery, and change” (p. 89) and Anthony stated that “recovery is a continuing, deeply personal, individual effort that leads to growth, discovery and the change of attitudes, values, goals and perhaps roles” (p. 14). Green (2004, p. 293) noted that “core recovery processes include development learning and healing, and their primary behavioural manifestation, adaptation.” If, as Green suggests, developmental learning is a core part of the recovery process, then the focus of enabling recovery changes from solely identifying treatments to one that involves providing support in acquiring learning to aid adaptation and the necessary accompanying developmental processes.

Recovery can in this sense be seen as a ‘special case’ of lifelong learning. As stress increases and life-change events accumulate, the motivation to cope with change through engagement in a learning experience may increase. Mental disorder often leads to massive life-change events such as loss of employment, involuntary hospital admission into acute hospital wards, and/or a change in social relationships. Such experiences can produce the need for, and motivation to seek out, new learning to adapt and to cope. Life for everyone is full of challenges and setbacks, both small and large, and our continued existence and success in this world, at a biological, psychological and social level is about recovering from and overcoming these challenges and setbacks. Our capability to engage in lifelong learning both enables this recovery and is added to through our experience of recovery.

Catastrophic events such as involuntary hospital admission negatively affect many areas of life, and many of those who experience mental disorder hope for a return or recovery of aspects of the life that they had before. Desire for a return of self confidence, self esteem, a positive hope for the future, etc., help provide an individual with the drive to seek to recover, to learn how to adapt to challenges they face and to find new ways of ‘being in the world’. The experience of mental disorder can and usually does profoundly affect the individual’s sense of self and personal identity. In times of crisis the self can cease to be capable of independent functioning and retreats to being an institutionally or service defined ‘product or entity’. The process of recovery can put into motion a process of lifelong learning in which the self is reclaimed by the individual. Painful episodes and experiences of mental disorder form a crucible in an individual’s story in which a new sense of self is formed which is not institutionally or externally defined.
Recovery from mental disorder involves many different factors and is much more than recovery from the disorder itself. “People with mental illness may have to recover from the stigma they have incorporated into their very being; from the iatrogenic effects of treatment settings; from lack of recent opportunities for self-determination; from the negative side effects of unemployment; and from crushed dreams” (Anthony, 1993, p. 19). A great deal of new learning is required for different aspects of an individual’s recovery in a complex and often drawn-out process. Lifelong learning and recovery are both part of the process of forging a meaningful, coherent pattern of the disparate and disjointed experiences that can be created through mental disorder. This process may lead to an increase in what Antonovsky (1979, p. 123) has termed a ‘sense of coherence’: an increase in the “extent to which one has a pervasive, enduring though dynamic feeling of confidence that one’s internal and external environments are predictable and that there is a high probability that things will work out as well as can be reasonably expected.”
 
Formal Lifelong Learning as an Aid to Recovery
Research into specific examples of formal learning has found that they can bring benefits on a wide variety of measures, for example, improvements in measures of coping skills, stress management, goal setting, quality of life, and well being (Griffiths, 2006). All of these potential benefits of lifelong learning can facilitate and form part of the process of recovery in/from mental disorder. Formal lifelong learning programmes can also empower those with mental disorder to make informed choices and decisions about their own needs and wishes and, through this, their feeling of control over their lives can steadily grow (NIACE, 2004). This empowerment can allow those with mental disorder to collaborate more with their healthcare providers in their own treatment, rehabilitation and recovery (Landsverk & Kane, 1998).

Hammond (2004, p.551) found that participation in formal learning had positive effects upon “well-being, protection and recovery from mental health difficulties, and the capacity to cope with potentially stress-inducing circumstances including the onset and progression of chronic illness and disability.” Hammond (2004, p. 551) also found that learning, through a process that is “quintessential to learning”, can have positive impact “upon psychosocial qualities; self-esteem, self-efficacy, a sense of purpose and hope, competences, and social integration.” Adding to these findings Feinstein & Hammond (2004, p. 199), who conducted research using the National Child Development Study, found that “participation in adult learning is a very important element in positive cycles of [personal and social] development and progression”. Furthermore, the results of Preston & Hammond’s (2003, p. 211) study into the wider benefits of further education showed that “self-esteem, self-efficacy, and the development of social networks are important benefits of FE [further education] and that purposive social interaction is a major factor in producing social benefits.” All of these social and individual factors that are products of lifelong learning are crucial factors in the generation of recovery (Repper & Perkins, 2006). In the lifelong learning/recovery process a positive cycle can be created with formal learning participation producing the beneficial effects stated, which can then lead to recovery gains, and these recovery gains can then lead to further participation in formal learning.

Landsverk & Kane (1998, p. 420) found that there is an “increasing body of evidence of research showing education to be an effective component in a comprehensive treatment approach to serious mental illness.” Using learning to help enable recovery can redefine an individual’s relationship with learning so that they see it as a positive tool and as an important part of their lives (Jackson, 2006). Learning can be considered to be a meaningful activity that will “help ignite the forces that fuel recovery processes and that provide opportunities for developing necessary competencies” (Green, 2004, p. 302). Learning and treatment can be involved in a reciprocal process to enable recovery. To recover an individual may require medication to reduce symptom levels to allow new adaptive leaning to be acquired, and newly acquired learning may result in improved medication regime adherence and hence recovery gains (Kopelowicz & Liberman, 2003).
 
Summary and Conclusions
This paper makes a case for lifelong learning and recovery being indivisible, inter-twined processes. Our thesis is that through lifelong learning mental health service users can become more empowered, have a higher degree of social inclusion, develop better coping skills, have higher levels of meaningfulness, enjoy life more, have higher self-esteem and well being, achieve personal goals, develop new and maintain existing supportive relationships, have greater access to work opportunities, and have a greater opportunity to contribute to society.
Policy makers in many parts of the world are now using formal learning to promote mental disorder recovery and they are trying to increase the inclusion of those with mental disorder in state funded formal lifelong learning provision. In addition, mental health services are increasingly offering learning programmes specifically targeted at aiding the recovery of those with mental disorder. In summary, the aims of these formal lifelong learning provisions are two fold: to increase the numbers of people with mental disorder who take part in formal lifelong learning and for that formal lifelong learning to aid recovery.
 
 

References
Anthony, W. A. (1993) Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16, 11–23.
 
Antonovsky, A. (1979). Health, stress, and coping: New perspectives on mental and physical well-being. San Francisco: Jossey-Bass Inc.
 
COM (2001a). Making a European Area of Life Long Learning. 678 Final. Brussels: Commission of the European Communities.
 
COM (2002). European Report on Quality Indicators of Lifelong Learning. Brussels: Commission of the European Communities.
 
Delors, J. (1996). Learning: the Treasure Within Report to UNESCO of the International Commission on Education for the Twenty First Century. UNESCO.
 
Green, C. A. (2004). Fostering recovery from life-transforming mental health disorders: A synthesis and model. Social Theory & Health, 2, 293-314.
 
Griffiths, C. (2006). The theories, mechanisms, benefits, and practical delivery of psychosocial educational interventions for people with mental health disorders.  International Journal of Psychosocial Rehabilitation, 11, 21-28.
 
Hammond, C. (2003).How education makes us happy. London Review of Education, 1, 67-78.
 
Hammond, C. (2004). Impacts of lifelong learning upon emotional resilience, psychological and mental health: Fieldwork evidence. Oxford Review of Education, 30, 551–568.
 
Jackson, S. (2006). Learning to live: the relationship between lifelong learning and lifelong illness. International Journal of Lifelong Education, 25, 51-73.
 
Knowles, M. S. et al. (1984) Andragogy in Action. Applying modern principles of adult education, San Francisco: Jossey Bass Publishers.
 
Kogan, M. (2000). Lifelong learning in the UK. European Journal of Education, 35, (3), 341-359.  
 
Kopelowicz, A. & Liberman, R. P. (2003). Integration of care: integrating treatment with rehabilitation for persons with major mental illnesses. Psychiatric Services, 54, 1491-1498.
 
Landsverk, S. S. & Kane, C. F. (1998). Antonovsky’s sense of coherence: theoretical basis of psychoeducation in schizophrenia. Issues in Mental Health Nursing, 19, 419-431.
 
NIMHE (2005). Guiding Statement on Recovery National Institute of Mental Health England. Retrieved March 5th, 2008, from
http://www.personalitydisorder.org.uk/assets/Resources/32.pdf
 
NIACE (2004). Briefing sheet: Learning and skills for people with mental health difficulties. National Institute of Adult Continuing Education. Retrieved July 12th, 2006, from
http://www.niace.org.uk/information/Briefing_sheets/Young_Adults_MHD.htm
Repper, J. & Perkins, R. (2006). Social Inclusion and Recovery. London: Balliere Tindall.

Rethink (2004). A Report on the work of the recovery learning sites and other recovery-orientated activities and its incorporation into the Rethink plan 2004-08. UK: Rethink.
Stocks, M. (1995). In the eye of the beholder. Psychiatric Rehabilitation Journal 19(1), 89-91.
 
Wallcraft, J. (2005). Recovery from Mental Breakdown. In J. Tew (Ed) (2005) Social Perspectives in Mental Health (pp. 200-215). London: Jessica Kingsley Publishers.
 
Wilken J. P. & den Hollander D. (2005). Rehabilitation and Recovery: A Comprehensive Approach. Amsterdam: SWP.
 
Young, S. L. & Ensing, D. S. (1999). Exploring recovery from the perspective of people with psychiatric disabilities. Psychiatric Rehabilitation Journal, 22, 219-231. 

 



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