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Getting By, Getting Back, and Getting On - Exploring the implications of the STARS study for personal recovery

Brittney Doll-Schaeffer, MS, LMFT, CPS

September is National Recovery month. The Substance Abuse and Mental Health Services Administration (SAMSHA) sponsors this event as an effort to, “increase awareness and understanding of mental and substance use disorders and celebrate the people who recover.” So what does recovery mean?

The 1960s and 1970s have been called the era of deinstitutionalization within the mental health field. Clinicians began to recognize that individuals with severe and persistent mental illness (SPMI) had needs beyond symptom reduction. They began to explore the possibility that their clients needed more than the restraint of the hospital walls and a medication-induced stupor. Clients with psychiatric illnesses were not improving. So, in the 1970s, the National Institute of Mental Health (NIMH) developed the concept of a Community Support System (CSS). The idea was that the community would get involved in the lives of these clients and provide various resources to reduce restraint and seclusion (Anthony, 1993).

In the 1980s, clinicians were beginning to understand that terms such as illness, impairment, dysfunction, and disability were not helpful or useful to their clients. The Center for Psychiatric Rehabilitation went beyond symptom reduction to support their clients through rehabilitation, life enrichment, and personal empowerment. They called this the “caring system”—a mental health system that recognized the self-determination of each client and the possibility of recovery (Anthony, 1993).

This idea was truly revolutionary. The basic premise that the client determines when he feels ill or when he feels well spun the mental health field on its head. Researchers and clinicians began to see positive results because of the caring system…and were now paying attention.

The STARS Study

Following the rehabilitation movement of the 1990s, Kaiser Permanente conducted a study exploring the client (or consumer) definition of recovery. What they discovered through the Study of Transitions and Recovery Strategies (STARS) study was that recovery is a nonlinear movement through phases. Consumers defined these phases as: Getting By, Getting Back, and Getting On (Yarborough, 2016).

Getting By

In the Getting By phase, participants reported having low expectations for recovery and were simply trying to cope by maintaining some basis of self-control through adequate nutrition, sleep, and personal hygiene. Individuals that are Getting By still have some lingering mental health symptoms and report struggling with anxiety, paranoia, and fear. Interventions in this phase focus around symptom reduction through personal empowerment and relational support. Consumers reported wanting “a good fit” with peers and professionals—wanting to surround themselves with individuals that provide care and compassion in the midst of personal suffering (Green et al., 2008).

Getting Back

In the Getting Back phase, consumers reported experiencing more control over self and symptoms. They described more self-care goals such as maintaining employment, community involvement, and reengaging in hobbies and relationships. Recovery focused on the importance of having people in their lives that listen, understand, believe, and strive to know them. Particularly in relationship with clinicians, consumers reported the importance of mutual trust and collaboration. More than anything, consumers reported that having a voice in their own treatment and a choice over major treatment decisions was key in their mental health recovery (Green et al., 2008).

Getting On

In the Getting On phase, mental health symptoms were no longer the focus of life. Consumers experienced stability and freedom not experienced in the other two phases (Yarborough, 2016). In this phase, individuals identified strongly with an internal sense of hope for the future. They are also aware that there may be times when they are once again in the Getting By or Getting Back phases but have created a plan for those times (Green et al., 2008).

Recovery Means Self-Control

As stated above, shifting the mental health field from clinician-focused treatment to client empowerment, voice and choice was a revolutionary movement. Individuals that experience mental health symptoms have a deep need for personal empowerment through the caring support of family, friends, peers, clinicians, and community. Healthy relationships are the key to mental health. Mental health recovery means feeling in control of symptoms, triggers, and vulnerabilities. That level of personal control may ebb and flow, wax and wane over the years but recovery means that the consumer sets the pace to “get” where they want to go.

Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Rehabilitation Journal, 16(4), 11-23.

Green, C. A., Polen, M. R., Janoff, S. L., Castleton, D. K., Wisdom, J. P., Vuckovic, N. et al. (2008). Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results. Psychiatric Rehabilitation Journal, 32(1), 9-22.

Yarborough, BJ. H., Yarborough, M. T. Janoff, S. L., Green, C. A., (2016). Getting by, getting back, getting on: Matching mental health services to consumers’ recovery goals. Psychiatric Rehabilitation Journal, 39(2), 97-104.