Australian Journal of Psychology 2018

doi: 10.1111/ajpy.12206

A new paradigm of youth recovery: Implications for youth mental

health service provision

Sean Rayner ,1 Monica Thielking,2 and Richard Lough1

1
Youth and Family Services, Each Social and Community Health and 2Department of Psychological Sciences,
Swinburne University, Melbourne, Australia

Abstract

The recovery model and practice orientation is promoted as a central feature of mental health service provision across the
English speaking world. Yet the model relies on adult frameworks and its applicability to the youth recovery experience has
not been established. The current qualitative study explored the common themes in the recovery experiences of 15 young people
aged 18–23 years with severe mental health conditions from the Eastern Metropolitan Region of Melbourne, Australia. The aim
of the study was to develop a thematic model of youth recovery utilising the experiences of young people with severe mental ill-
ness. These findings are then discussed in relation to common themes found in adult recovery research and in regard to the cur-
rent understanding of young people and recovery. Qualitative data was inductively coded into a thematic model of youth
recovery forming two overarching themes. The first was defined as ecological systems (ES) including three subthemes (personal,
systemic, and macro). The second was defined as youth recovery processes drawing narratives from across the ES to form five
subthemes (self-belief and resilience; responsibility and personal agency; identity, awareness and acceptance; connection; and
hope and positive expectations). The resulting themes revealed the critical importance of the ecological context in the personal
recovery experiences of young people. It is contended that recovery in this stage of the lifespan is best conceptualised within
this ecological framework. Implications for youth recovery conceptualisation and mental health service delivery are discussed.

Key words: adolescence, ecological, mental health, psychological disorders, recovery, youth

What is already known about the What this topic adds?

topic?
• Recovery is a core part of service delivery for all gov-
ernment funded specialist mental health services
within Australia, including those working with youth.
• The vast evidence base of recovery research is derived
primarily from qualitative studies that analyse the
narratives of adults with a lived experience of mental
illness. Research that focuses on the recovery experi-
ences of children, young people and older adults is
scarce. This is particularly the case for research on
young people with severe mental health conditions.
• Recovery by its very nature focuses on individual per-
sonal perspectives of recovery. While idiosyncratic to
the individual, a number of common themes in the
recovery process can be established through a qualita-
tive thematic analysis and narrative synthesis.
Correspondence: Sean Rayner, Each Social and Community Health,
33 Kingston Road, Surrey Hills, VIC 3127, Australia.
Email: raynersean@gmail.com
Received 02 November 2017. Accepted for publication 03
April 2018.
© 2018 The Australian Psychological Society
• Being the only recovery research that exclusively utilises
the narratives of young people aged 18–23 years of age
(mean age 20), the study provides evidence of common-
alities and differences between themes found in existing
adult research on this topic, where the mean age com-
monly ranges from 30 to 50 years. This has important
implications for the manner in which recovery-oriented
practice is carried out with young people.
• The study discovered two overarching themes:
(1) ecological systems (ES) placing narratives within
personal, systemic, and macro systems; and (2) youth
recovery processes that involved narratives across the
ES. The findings reinforce the need to develop and
refine ecological models for working with young peo-
ple experiencing severe mental illness.
• The study developed the first thematic model of
youth recovery displaying youth recovery processes
within an ecological context. The findings provide
insight into recovery and youth, filling a gap that sup-
ports application of recovery and integration with
existing paradigms in the context of youth mental
health service provision.
2 S. Rayner et al.
Mental illness commonly emerges and is at its highest
prevalence from late adolescence through to young adult-
hood (Alegria, Jackson, Kessler, & Takeuchi, 2001–2003;
Arnett, 2000; Australian Bureau of Statistics [ABS], 2007). It
has been noted that at this critical juncture in human devel-
opment, access to targeted mental health services is crucial in
addressing such issues (Davis, Koroloff, & Ellison, 2012;
Eccles, Barber, Stone, & Templeton, 2001; Wickrama, Con-
ger, Lorenz, & Jung, 2008). The recovery model (Anthony,
1991), including recovery oriented practice models (Oades,
Deane, Crowe, Lambert, & Kavanagh, 2005) have been
described as a practice ‘movement’ (Davidson, 2016), in that
it has been incorporated into most state-funded mental
health systems throughout the English speaking world and
for all people across the lifespan who access these services.
This includes the United States (Substance Abuse Mental
Health Services Administration (SAMHSA), 2010), England
(National Institute for Mental Health in England (NIMHE),
2005), and Australia (Department of Health, 2009). How-
ever, the vast majority of recovery research that informs this
model is concerned with adult populations.
This broad-stroke approach to research and service delivery
promotes a single and homogenous model of recovery, which
may ignore the idiosyncratic needs and narratives of sub-
groups such as children, young people and older adult popula-
tions (Barnett & Lapsley, 2006; Lal, 2010; Rankin & Petty,
2016). In relation to young people, the use of adult driven
recovery models may be ignoring the typical cognitive, beha-
vioural, environmental and social developmental factors that
are unique to this stage of development (Simonds, Pons, Stone,
Warren, & John, 2014). Drawing from the experiences of
young people with severe mental health conditions, the current
study’s aim is to address an important gap in recovery research
by developing a thematic model of youth recovery for young
people with severe mental illness. These results are further dis-
cussed in relation to recovery themes previously uncovered in
research with adults and the limited research available exploring
recovery and young people.
The recovery movement: Clinical and personal
Current literature often differentiates between two discrete
but interconnected conceptualisations of recovery
(Davidson, Lawless, & Leary, 2005; Glover, 2012). The first
is commonly referred to as ‘clinical recovery’, and is focused
on the reduction of symptoms, impairment and a return to
a level of functioning prior to the development of an illness.
The second approach, commonly referred to as personal
recovery, is focused on an individual’s journey of growth
and development, typically defined through social success
and personally defined goals (Macpherson et al., 2016). Per-
sonal recovery is thereby challenging to define due to its
individualised nature (Gilburt, Slade, Bird, Oduola, & Craig,
2013). However, a commonly cited definition by Anthony
(1993) describes personal recovery as:
a deeply personal, unique process of changing one’s attitudes,
values, feelings, goals, skills and/or roles. It is a way of living
a satisfying, hopeful and contributing life even with the limi-
tations caused by an illness. Recovery involves the develop-
ment of new meaning and purpose in one’s life as one grows
beyond the catastrophic effects of mental illness (p. 15).
The importance of personal narratives, as identified
within the personal recovery movement, only gained prom-
inence in the 1980s when people with a mental illness, and
a minority of professionals, responded against the domi-
nance of profession-based power and its association with
clinical recovery. Clinical recovery was viewed as disem-
powering as it emphasised the pre-eminence of professional
intervention and alluded to the permanency of severe men-
tal illness (Corrigan, 2002; Ralph & Corrigan, 2005). How-
ever, the two terms are arguably useful for different
purposes and populations (Davidson et al., 2005). A differ-
ence is displayed in divergence in participant ratings on clin-
ical and personal recovery outcome measures (Macpherson
et al., 2016). The current study utilises a narrative approach
to understanding recovery and is thereby more aligned with
personal recovery. We will utilise the term ‘recovery’ for
simplicity, referring to definitions of recovery originating
from personal recovery research.
Recovery characteristics, processes, and stages
The evidence base of recovery originates from the personal
experiences of adults living with severe mental illness
(Barnett & Lapsley, 2006; Slade et al., 2012). Despite the
highly individual nature of recovery, established narratives
appear to centre on a limited combination of personal char-
acteristics, processes, and stages of recovery (Leamy, Bird,
Boutillier, Williams, & Slade, 2011; Tew et al., 2012). Char-
acteristics include personal descriptions of the recovery
journey (i.e., ‘non-linear’ or ‘a struggle’). Processes are dis-
crete areas of change involving intrapersonal and interper-
sonal responses to the presence of an illness and changed
life circumstance. For example, a theme may be broad, such
as ‘rediscovring life’, and that theme may possess sub-
themes, like ‘role transformation’ and ‘reconnecting with
day-to-day activities’. Glover’s (2012) model outlined five
processes: (1) a passive to active sense of self; (2) hopeless-
ness and despair to hope; (3) moving from others in control
to having personal control and responsibility; (4) alienation
to discovery; and (5) disconnectedness to connectedness.
Further more, models of recovery that are based on the-
matic analysis often include a progression through a series
of stages that represent movement along a continuum from
less to more recovery. Andresen, Oades, and Caputi (2003)
© 2018 The Australian Psychological Society

studied personal recovery accounts to identify additional
processes such as ‘finding and maintaining hope’ and pro-
duced a validated stage model where individuals moved
along stages of a given trajectory. This research informed a
widely utilised psychiatric rehabilitation model called the
Collaborative Recovery Model (Oades et al., 2005).
The commonality between themes arising from separate
studies on recovery has given way to research focusing on
synthesising findings from multiple studies. Schrank and
Slade (2007) synthesised several studies that identified com-
mon components involved in the recovery process including:
hope, spirituality, responsibility, control, empowerment,
connection, purpose, self-identity, and stigma. Another com-
prehensive synthesis was carried out by Leamy et al. (2011)
utilising 87 studies of personal accounts of recovery in which
they identified five categories of individual recovery pro-
cesses outlined as the CHIME model of processes including:
connectedness; hope and optimism for the future; identity;
meaning and purpose; and empowerment.
Beyond a person centred process
While most studies exploring recovery are concerned with
personal themes and processes on a continuum from less
recovered to more recovered, others have adopted alterna-
tive ways of conceptualising recovery. Jacobson and Green-
ley (2001) described a model of recovery that included both
personal and external recovery conditions. Personal condi-
tions included recovery processes commonly outlined, such
as an individual journey of hope, healing, empowerment
and connection. Whereas, external conditions included
broader societal factors that influenced recovery, such as
human rights, a positive culture of healing and recovery-
oriented services. Alternatively, Onken, Craig, Ridgway,
Ralph, and Cook (2007) mapped out recovery concepts
within an ecological framework using a dimensional analysis
of existing recovery literature. The researchers conceptua-
lised recovery as an interactive process within an environ-
mental system that included internal and external resources
and challenges. Kaewprom, Curtis, and Deane (2011) con-
structed a broadened understanding of recovery, arising
from the opinions of Thai mental health nurses supporting
patients with schizophrenia. They identified both personal
and environmental facilitators and barriers to recovery. Tew
et al. (2012) explored the external influence of social factors
on recovery and concluded that existing models of recovery
are limited by not adequately taking into account the
dynamic relationship between social systems and recovery.
Recovery and young people
The terms ‘youth’ and ‘young people’ are often used inter-
changeably to define those who are in the pivotal period of
the lifespan between childhood and adulthood, which, from
© 2018 The Australian Psychological Society
Youth recovery model 3
a developmental perspective is known as ‘adolescence’. A
key feature of this period of development is biological, neu-
rological and psychosocial transition, including the expecta-
tion that the end of this period is marked by the successful
attainment of independence and adult roles (Arnett, 2000;
Eccles et al., 2001). There is, however, disparity both within
the literature and in global adolescent population research
designs of what age constitutes the start and beginning of the
adolescent period, which in turn impacts on the age of partic-
ipants that are included in adolescent studies, and then on
laws, policies, and programs designed to support those who
are in this period of the lifespan (Sawyer, Azzopardi, Wickre-
marathne, & Patton, 2018). The World Health Organisation
defines adolescence as spanning between the ages of 10 and
19 years of age (World Health Organisation, Unesco, &
Mathers, 2017). In contrast, some scholars argue that adoles-
cence should span from 10 to 24 years (i.e., Sawyer et al.,
2018), which would be more in line with the host of brain
imaging studies which show the extended period of time that
neurological changes are taking place (i.e., Paus, Keshavan,
Giedd, & Paus, 2008). In regards to studies of later adoles-
cence, researchers have regularly treated individuals over
18 or 21 years of age in line with their legal status as adults
and have therefore labelled participants as such (Davis et al.,
2012; Wickrama et al., 2008). From a service delivery and
study-context perspective, the national youth mental health
service in Australia, headspace, determines young people to
be those who are aged between 12 and 25 (Bassilios, Telford,
Rickwood, Spittal, & Pirkis, 2017), and as this study is con-
cerned with interviewing young people aged 18–23, the term
‘youth’ will be utilised.
Research on the recovery experiences of young people is
scarce. From those that are available, there are two types of
methodologies: top-down or deductive research and bottom-
up or inductive research. Top-down studies ask young people,
professionals, and family members whether existing models
of recovery are relevant to their experience (Friesen, 2007;
Mental Health Coordinating Council, 2014). These studies
impose an existing framework of recovery on study partici-
pants. Bottom-up studies interview young people directly
about their recovery experiences without limiting responses
to agreement or non-agreement to a prescribed model
(Barnett & Lapsley, 2006; Simonds et al., 2014). These studies
seek to add to the existing body of work in this area, in order
to inform a better understanding of this phenomenon.
Top-down approaches to recovery for young people
Top-down research has raised some important issues
around the applicability of the recovery paradigm to young
people (Friesen, 2007; Mental Health Coordinating Council
(MHCC), 2014). Using feedback from five young people, fam-
ily, and professionals, ‘The Recovery Paper for Young People’
4 S. Rayner et al.
(MHCC, 2014) includes a review of the CHIME model, con-
cluding that this may need to be slightly adjusted for young
people as it was said to be incongruent with young people still
progressing through a key developmental stage. The authors
outlined the notion of responsibility as an area of conjecture
as young people may still be inherently reliant on parents or
caregivers as they are only beginning a process of indepen-
dence and acquiring more responsibility in their lives.
Friesen (2007) completed a phased review of children
and youth recovery, resilience, and mental health that
included a literature review, a structured discussion process
with individuals and groups and a cross tabulation of differ-
ent and shared experiences of recovery, resilience and
systems of care principles. Friesen found that some profes-
sionals were advocates of the explicit application of a recov-
ery model to children and youth in services, while others
had significant misgivings. Some of the issues raised
included questions around what recovery might add beyond
existing systems of care, and how recovery related to exist-
ing early intervention and resilience models. The term
recovery itself was not consistently seen by participants as
desirable due to its literal focus on returning to a previous
state of functioning or wellbeing. Participants preferred a
developmental perspective of recovery, which, in contrast
requires a young person to advance beyond previous states of
functioning. Friesen (2007) argued that young people are
often without reference to former states of improved func-
tioning, leading participants to ask the question ‘recovery
from what?’. Common conceptions of recovery as a process
of returning to a previous state is somewhat of a juxtaposi-
tion for young people aged 12–25 who should be continuing
to develop forward rather than backwards to previous devel-
opmental stages (Robinson, 2006). Other points included the
notion that the term recovery is easily confused with the
common phraseology around ‘clinical’ recovery from illness.
This may lead people to misinterpret recovery within youth
mental health settings, by conceptualising recovery as having
undergone a ‘cure’ (Friesen, 2007).
Bottom-up exploration of young people’s recovery
experiences
One study conducted by Simonds et al. (2014) directly
explored the recovery narratives of young people, using a
sample of early adolescents (aged 12–16). Another study,
conducted by Barnett and Lapsley (2006) used a combina-
tion of older adolescents and adults (aged 18–29 years),
which they termed young adults.
The first study by Simonds et al. (2014) explored the per-
sonal narratives of 12 young participants who had been
diagnosed with depression and anxiety along with their
maternal parent. Simonds et al. adopted a bottom-up
approach by not referring to existing themes identified in
adult recovery literature. They discovered the following
themes: loss of self, renegotiating the self, and (limited)
anticipation of future self. The first two themes were consis-
tent with adult experiences of recovery and encapsulated
the notion of loss and rediscovery, such as and in relation to
loss of identity (i.e., Glover, 2012). Furthermore, the identi-
fied period of adjustment to living with mental illness, that
young people experienced, was characterised as contribut-
ing to disruption of self-identity and to a heightened sense
of self-other difference. The second theme represented a
period where young people reported increased self-
awareness and engagement in services. Simonds
et al. indicated that this phase included increased awareness
of personal strengths, resilience and a reduction in self-
other difference, which resulted in social re-engagement.
However, the last theme, ‘anticipation of future self’, was
argued to depart from existing recovery research paradigms,
with young people focusing mainly on symptom eradica-
tion, and displaying limited ability or inclination to look for-
ward into the future. Acknowledging the potential for
sampling bias, Simonds et al. proposed that, amongst other
things, younger adolescents may not yet have reached the
ability to reflect on and imagine possible future selves.
The second study by Barnett and Lapsley (2006) docu-
mented the experiences of 40 adolescents and young adults
aged 18–29 years with severe mental health problems
(i.e., two-thirds had been diagnosed with a psychosis spec-
trum disorder including schizophrenia and bipolar illnesses
and others were given diagnoses that included one or more
of the affective, anxiety, personality, eating or posttraumatic
stress disorders). While comparable to other studies of adult
recovery experiences, the existence of 18–25-year-old partic-
ipants in the sample is of interest to the authors considering
the dearth of recovery research on youth samples. With this
in mind, Barnett and Lapsley explored the nature of early
use of publicly funded mental health services and gathered
information on the factors that helped or hindered recovery
in the sample. They identified three overarching themes
related to recovery: (1) surviving day to day; (2) moving for-
ward; and (3) living well. While their themes were not con-
trasted against processes or themes identified in adult
recovery models, they are akin to documented adult stages
of recovery, whereby individuals move from an initial point
of distress, detachment and confusion to one of greater well-
being, awareness and autonomy (i.e., Leamy et al., 2011).
In summary, despite the recovery-oriented practice model
being a central component of mental health service provi-
sion in Australia and globally, the scarcity of research on
youth populations has arguably resulted in a questionable
‘one size fits all’ application of existing adult recovery
models to services for young people (Simonds et al., 2014).
While they may well be applicable (i.e., Leamy et al., 2011),
there may also be some nuanced differences in young
© 2018 The Australian Psychological Society

people’s recovery experiences, which are associated with the
specific developmental needs of this stage of the lifespan.
The lack of youth-specificity to recovery research is even fur-
ther diluted when one considers the differential develop-
mental needs of children, early adolescence, adolescence,
and emerging or young adulthood. Youth mental health ser-
vice providers who must rely on existing research to inform
their evidence-informed recovery practices need to be pro-
vided with a greater array of evidence, which focuses specifi-
cally on the recovery of young people with mental illness.
METHOD
Recruitment and sample
Research ethics approval was granted by Swinburne Uni-
versity’s Human Research Ethics Committee, project num-
ber 2015/268 that permitted data collection with young
service-recipients of a number of mental health services
operated by EACH social and community health a non-
government organisation operating a range of social and
community health services in the Eastern Metropolitan
Region of Melbourne, Australia. Participation in the
research interviews was offered to all young service users of
a youth mental health community support service, whereby
eligibility for the service included being 16–25 years old and
having a disability likely to be lifelong that is attributable to
a psychiatric condition with impairments resulting in sub-
stantial disruption to areas of day-to-day functioning
(i.e., severe mental illness). Participation was on a voluntary
basis, with participants compensated for their time and con-
tribution by way of a voucher. Interested participants were
provided with a plain language research information state-
ment and consent form that was completed and returned to
researchers. The final sample included 15 young people,
10 females and 5 males, aged between 18 and 23 years old
with a mean age of 20 years old. Participant diagnoses were
not limited to any one disorder and all reported one or
more co-occurring disorders made up of both high preva-
lence mental health conditions, such as anxiety and depres-
sion, and low prevalence mental health conditions, such as
schizophrenia, bipolar, and borderline personality disorder.
Procedure and instruments
Individual face-to-face audio-recorded interviews were con-
ducted by one researcher using a semi-structured interview
schedule derived from previous research by Simonds
et al. (2014). The structured questions included:
1. Can you tell me about the period when you first started
to experience problems with your mental health?
2. Can you tell me about the time you first began receiving
mental health services?
© 2018 The Australian Psychological Society
Youth recovery model 5
3. Can you tell me about your current situation?
4. What do you think has changed over these points
in time?
5. How do you think these changes came about?
6. How do you see yourself in the future in relation to the
issues you have experienced with mental health?
The interview process was influenced by recommenda-
tions around qualitative research by Davidson (2003)
including emphasising the participant as expert in their own
experience, collecting narratives of raw experience and fol-
lowing the participants lead. Data was collected for each
question until saturation was achieved. Recordings totalled
690 min with an average length of 46 min per interview.
Recovery as construct was never mentioned in the inter-
view to ensure experiences of young people where not
influenced by existing conceptualisations of recovery.
Data analysis
Audio-recorded interviews were transcribed into written
format in preparation for thematic analysis. Transcriptions
were anonymised by replacing participant names and other
identifiers with codes or pseudonyms. The primary
researcher, a youth mental health professional with
10 years’ experience carried out the thematic analysis pro-
cess using an inductive approach. Nvivo 11 software was
used as a platform to carry out steps of coding and thematic
analysis (Nvivo qualitative data analysis Software, Version
11. 2015; QSR International Pty Ltd., Melbourne, Austra-
lia). For reliability purposes, codes were also cross-checked
with the second researcher. Throughout the analysis pro-
cess, it was acknowledged that the process of coding and
thematic analysis is a co-construction of the narratives of
young people and the researchers’ interpretation of mean-
ing. Braun and Clark’s (2006) exploratory method was fol-
lowed, where all themes that emerged from interviews
were reported and none were excluded from the results.
The steps included: (1) researcher familiarisation with the
data within each interview; (2) generating initial codes by
listing and naming all components of a young person’s
interview and only excluding immaterial dialogue;
(3) searching for emerging themes and patterns within and
between individually coded interviews; (4) cross-checking
of themes with the second researcher; (5) reviewing and
compiling themes; (5) defining and naming themes; and
(6) producing a report.
RESULTS
The thematic analysis revealed two overarching themes:
(1) ecological systems (ES); and (2) youth recovery pro-
cesses (YRP) that were formed exclusively from the
6 S. Rayner et al.
Figure 1 Ecological youth recovery model.
narratives of young people. The first of these overarching
themes, ES, included three subtheme levels (personal, sys-
temic, and macro) and the second overarching theme, YRP,
included five subthemes (self-belief and resilience; responsi-
bility and personal agency; identity awareness and accep-
tance; connection; and hope and positive expectations,
see Fig. 1).
Ecological systems
This overarching theme included three subthemes related to
the context of where recovery narratives were occurring.
The personal level included intrapersonal change, including
modified individual attitudes, awareness and perspectives.
For example, Young Person 10, a 22 year old female, spoke
about her own personal struggles with trusting other people
enough to talk to about her schizophrenia, anxiety and
depression, and her own personal narrative about how she
manages her diagnoses:
‘No. I don’t talk to anyone about what’s going on in my
head, because they could use that against me and, I’ve
just learnt to shut-out from people and just be artificial.’
and ‘I’m still disciplined with my mind, and the motions
and that. I guess I’ve accepted anxiety and depression
because that wasn’t my fault, it was genetic, so I try and
manage it. I really try and manage it. The schizophrenia
I’ve accepted in a way, and because I have to learn to just
manage it without medication I use the term I have two
brains, the logical side, and then the illogical side…’.
The systemic level included social and geographic factors
within the individual’s immediate sphere such as family,
friends, school, and accessing professional supports. For
example, Young Person 6, a 19 year old female spoke about
the impact of finding school friends that she connected with
(after a period of being bullied at school) on her wellbeing:
‘In Year 8, I found a new bunch of friends… but I got
really lucky with that, we became quite close, and I still
see them now. And so I think that helped quite a bit,
finding a new bunch of people to hang out with’.
Similarly Young Person 5, 23 year old female, spoke
about the negative impact of being admitted to a hospital to
receive support for her anorexia:
‘At the Hospital (name removed) for about three, four
days, basically restore the body. And yep, my hospital
admission, I found the first one, it made me so much
worse, because I mean you had rules there, for example
you only have half an hour to eat dinner, you’d have to
eat it all, portion sizes, that kind of thing, and snacks’.
At the macro level, young people spoke about broader
social, political and technological forces that impacted on
the Personal and Systemic level factors. For example, Young
Person 7, 19 year old female, spoke about the impact of the
‘Better Access’ initiative on her ability to receive support:
‘Yeah, so I used to have counselling with her. It was usu-
ally once, well, it sort of varied, because through Medicare I
get 10 sessions free. So last year I did that.’
© 2018 The Australian Psychological Society

Youth recovery processes
The second overarching them included five subthemes,
each defining a separate recovery process, which resided
within and interacted with each level of the Ecological sub-
themes. For example, connection is a process that might
involve a personal change in attitude or desire, the capacity
to re-engage friends, the presence of friends and their
friends’ openness to engage an individual with a mental ill-
ness, where the macro factors include awareness of mental
health and stigma. Each individual recovery process is out-
lined further below with example quotes derived from the
interviews.
Youth recovery process 1: Self-belief and resilience
This recovery process outlines the reported development of
confidence, self-efficacy and self-belief and an accompany-
ing resilience that enabled young people to take on the vari-
ous challenges in life despite systemic (i.e., lack of
employment opportunities or social exclusion) and mental
health adversity. Young Person 4, 20 year old female:
‘It’s so much harder than I thought but I can so do it. It
makes you feel really proud of yourself when you can do
all this stuff and actually survive on your own’.
Self-belief and resilience often appeared when the young
person had made some initial successful steps towards
recovery or had endured difficulties that reinforced or were
reframed to produce a personal sense of capacity, distress
tolerance and further growth. Sometimes this followed an
initial position of decreased self-belief and an inability to
manage through their difficulties. Young Person 10, 22 year
old female stated:
‘Yeah. Well now I’m like, you know what, this isn’t going
to let me down, I’m going to try and beat this, or not
have it consume my life’.
Youth recovery process 2: Responsibility and personal
agency
This recovery process involved the development of a sense
of personal agency and control within young people’s lives.
Young people going through this process appeared to move
away from others who are in control of them and towards
self-control and autonomous direction. Young person 4, 20
year old female stated:
‘I just really started I suppose breaking things down in
terms of the goals and like working towards planning my
life out, the start of my life out.’ ‘It feels good to be able
to have some control over the way I am feeling. The
harder I work the better I feel.’
© 2018 The Australian Psychological Society
Youth recovery model 7
This was often initiated by events such as moving out of
home by choice or necessity, resulting in taking on more of
life’s responsibilities and this autonomy was often directly
verbalised as resulting in personal fulfilment. Responsibili-
ties were sometimes simple tasks such as cooking and clean-
ing, or more advanced activities such as commencing work
or returning to study. Young Person 10, 22 year old female
stated:
‘I’ve actually been able to help around the house, and
that, because I haven’t done anything to help the family
and they’ve done so much…. So, I’ll cook dinner, do
housework, I look after everyone,’
Youth recovery process 3: Identity, awareness and
acceptance
This recovery process involved the young person developing
a greater sense of themselves, their personal context and a
growing sense of acknowledgement and acceptance of their
mental health diagnosis, the challenges they face and their
unique strengths. Young Person 5, 23 year old female
stated:
‘Last year was when I developed acceptance of my mental
health, and that it’s okay. This is me. Labelled with diag-
noses. They are part of me but they don’t define me as a
person.’ ‘I think the first step…was the acceptance part.
That was a really big part of yeah, planning around the
future and how I’m going to manage and keep going.’
Young Person 12, 20 years old female discussed gaining a
stronger sense of identity, not only intrinsically, but out-
wardly too. She stated:
‘I have changed my hair so many times in the past twelve
months, two years whatever and that is kind of me trying
to figure out what I want, what I want to be and sort of
taking back control over my physical appearance’.
Youth recovery process 4: Connection
Young people spoke about moving from disconnection to
connection, especially in relation to their peers. At times,
this process involved actively disengaging from others.
Many had experiences of rejection and bullying by peers
throughout their school years. This often occurred years in
advance of and subsequent to the development of mental
health issues. Young Person 6, female 19 years old stated:
‘I think that’s probably been one of the biggest things
that’s impacted on my mental health is the lack of
connection.’
Conversely, young people reported that social connections
were often a vital component of recovery including
8 S. Rayner et al.
reconnecting with family, establishing trusting friendships,
meeting partners and creating a family. Young Person
12, 20 year old female stated:
‘I am trying to reach out more to a lot of my friends and
say hey let’s do something. I try to get to my sister’s
house one night a week and stay over.’
Youth recovery process 5: Hope and positive
expectations
This recovery process involved a shift in thinking, from one
of despair and hopelessness to the that of hope and positive
expectations for the future, including a belief that life would
improve despite current challenges. Young Person 9, 18
year old male stated:
‘I’ve slept in car washes, I’ve done that, been that. All
right, and when you’re scraping the… bottom of the bar-
rel you have nowhere else to look but….up. As soon as
you look up everything changed for me.’
This process often co-occurred with increased self-efficacy
and a notion that they are able to create better outcomes
for themselves now that they understood their illness better,
had improved coping strategies and increased supports.
There was often uncertainty around how the future would
unfold and young people drew from their existing experi-
ences to imagine and forge a path to a better future. Young
Person 4, 20 year old female stated:
‘Long term I actually want to go back and study. I really
want to start getting linked in with workers to help me
find a house…..I want to get my licence…. I am learning
more and more….about independent living like cooking
for myself, meal planning, actually how to run a house-
hold…. like adapting and still being able to be ok with that.
It’s so much harder than I thought, but I can so do it.’
DISCUSSION
The current study’s aim was to develop a thematic model of
youth recovery based around the personal recovery narra-
tives of young people ‘with severe mental illness’. The
results formed a thematic model of youth recovery includ-
ing two overarching themes, ES and YRP. The ES sub-
themes form an ecological context for narratives, emerging
within personal, systemic, and macro levels. The second
theme outlined five YRPs formed from narratives including
factors from each of the ES subthemes. These results are
important to discuss in relation to the main body of recov-
ery research derived from the experiences of adults. The
vast majority of adult based recovery research outlines
themes as personal processes and stages that occur on a
continuum from less to further recovered (Glover, 2012;
Leamy et al., 2011; Oades et al., 2005; Schrank & Slade,
2007; Simonds et al., 2014). This research supports the con-
ceptualisation of recovery as a personal process, which is
evident in one of the most cited definitions of recovery
(i.e., Anthony, 1993). It is however, arguable and indicated
by the current findings that a dynamic interplay between
person-environmental processes are an integral part of
young people’s experience of recovery processes. The cur-
rent research emphasises the interactive nature of recovery
for young people, sharing components with the original
ecological systems theory and risk-resilience models that
outline interactive personal and environmental factors,
cumulative protective and promoting factors, adversity and
trauma factors that contribute to an individual’s well-being
and developmental trajectories (Bronfenbrenner, 1979;
Gorter et al., 2014; Schilling, Aseltine, & Gore, 2008).
Withstanding the ecological conceptual differentiation, the
YRPs share many similarities with the diverse number of pro-
cesses found in adult populations (Glover, 2012; Oades et al.,
2005; Schrank & Slade, 2007). In contrasting the current
study’s findings with the CHIME model, arguably the most
comprehensive research synthesising adult recovery processes,
the current findings are highly consistent in underlying mean-
ing and terminology utilised to describe specific themes of
‘connection’, ‘Hope and positive expectations’ and ‘identity,
awareness and acceptance’. The two CHIME processes of
‘meaning and purpose’ and ‘empowerment’ were identified
as subcomponents of the themes of ‘self-esteem and resil-
ience’ and ‘personal agency and autonomy’ respectively.
A significant point of difference between this study’s the-
matic model of youth recovery and themes found in adult
literature was the clear importance of narratives occurring
across an ecological context, where factors fell into personal,
systemic, and macro environmental subthemes. The
emphasis on environmental factors as an integrative part of
(rather than impacting on) recovery have been explored in
a small number of previous studies (i.e., Jacobson & Green-
ley, 2001; Kaewprom, Curtis, & Deane, 2011; Onken et al.,
2007). There is also limited research exploring the mecha-
nisms or external factors involved in recovery (Silverstein &
Bellack, 2008). However, there are examples of studies
exploring systemic factors such as social contact as impor-
tant to recovery and emphasise the need for professionals to
facilitate interaction with communities, rather than only
focusing singularly on the personal process (Davidson,
2003; Tew et al., 2012). External factors have been
highlighted as crucial to recovery, contributing to personal
changes such as self-esteem and sense of self (Roe, 2001). It
is therefore arguable that external factors are vital and
inseparable from the broader construct of recovery. The cur-
rent findings reinforce recovery as a process involving inter-
action between the individual and their environment.
Recovery may include a combination of discrete processes
such as continuation of the psycho-social development, a
© 2018 The Australian Psychological Society

process heavily intertwined with the external environment
and more personal or internal changes that include adapta-
tion and accommodation. These discrete processes are likely
to occur concurrently with progress in one area cascading
positively or negatively. This is consistent with common
descriptions of recovery as non-linear with peaks and
troughs (Leamy et al., 2011).
Another important consideration is the current study’s
youth recover model’s contribution to the limited research
base exploring recovery and young people. Two previous
studies with different age ranges to the current study utilised
inductive designs to identify recovery themes that encapsu-
lated a process of moving from an initial point of distress,
detachment and confusion towards greater wellbeing,
awareness and autonomy (Barnett & Lapsley, 2006; Simonds
et al., 2014). Comparisons with Simonds et al’s research
need to be premised with the fact that their study utilised a
sample of young people aged 14–16 years diagnosed with
anxiety and depression. Despite this difference underlying
themes were highly consistent with the exception of
Simonds et al.’s third theme titled ‘anticipation of future self’,
which revealed that younger adolescents appeared to lack a
positive future orientation beyond the hope for symptom
eradication. This also contrasted with findings from adult
studies that typically displayed adults possessing a capacity to
anticipate and hold hope for the future despite the presence
of symptoms. Certainly there have been other studies, which
have found that children under 16 years have a reduced
capacity for future orientation (Steinberg et al., 2009). How-
ever, the current study found the narratives of young people
aged 18–23 years old had moved to a point of anticipation of
future challenges associated with having a mental illness that
occurred concurrently with hope and expectation for
improvement. This difference may be related to develop-
mental differences between the samples, with increased
experience and additional developmental years leading to
this capacity to envisage a future self that is able to better
cope with mental illness.
The outlined model of recovery provides a holistic defini-
tion of recovery identifying it as part of a personal journey
involving the physical and social ecological system. Impor-
tantly, this journey begins before any formal diagnosis is
received and continues after that point. It is posited that
recovery, like development, occurs in a dynamic ecological
context that includes both adversity and trauma, barriers to
human potential, and positive and promoting factors that
support interactive personal processes of recovery. It is in fact
contended that youth recovery is best conceptualised as an
interactive process that includes personal and ecological fac-
tors and caution should be applied in viewing recovery solely
from a personal perspective without reference to context.
The focus of the recovery movement, which has been on
the importance of the personal process and individual
© 2018 The Australian Psychological Society
Youth recovery model 9
experience, was formed in response to the historical domi-
nance of professional power and clinical recovery (Glover,
2012). However, this history may have unintentionally
reinforced the personal component of recovery over a more
unified definition of recovery that includes personal and
environmental interaction. Based on the current findings a
unified definition of recovery that includes a dynamic envi-
ronmental and personal process is of particular importance
in reference to young people who are still in a key develop-
mental period and who rely on others and interact heavily
with external factors to progress through developmental
milestones. Application of an ecological systemic lens to the
recovery conceptualisation may resolve concerns raised by
Friesen (2007) that commonly used recovery models are
overly person-centred to the detriment of family-centred
work. It also recognises the varying degrees of dependence
of many young people on systems of care, such as family or
school professionals, as they progress through this develop-
mental stage (MHCC, 2014).
Finally, the results have implications for the manner in
which professionals conceptualise their roles, as not only
supporting personal adaptation and accommodation to an
illness, but to support reintegration of young people who
may be disengaged from social and economic activities such
as family and peer relationships, education and work. This
is crucial in supporting psycho-social development, social
and economic participation and thereby recovery.
Limitations of the current research include the lack of differ-
entiation between individuals at different points in recovery
and the small sample size. In order to determine the extent of
generalisability of these findings further research is required
with other samples of similar cohorts to confirm themes identi-
fied. Future research could further explore the composition of
recovery narratives in terms of psycho-social development,
adaptation and accommodation to mental illness.
In conclusion, it is important to critically interrogate the
foundational definitions and conceptualisations of recovery
in relation to their relevance for supporting young people
with severe mental illness. The current research offers the
first attempt at a thematic model of recovery developed
with such young people, that displays the interactive nature
of the individual within an ecological context. Based on the
findings, interventions aimed at supporting young people
with severe mental illness may attempt to both target
opportunities and barriers within each individual’s ecologi-
cal context and support the individual young person’s per-
sonal processes and journey towards recovery.
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