Recovery in the Bin at #RCOT2018

Wow! What a day! Recovery in the Bin had their abstract accepted for a poster and short presentation at the Royal College of Occupational Therapists’ Conference in Belfast on the 12th of June 2018. We were very excited to be able to share our work at such a big and prestigious event.

This blog post is an opportunity to expand on our poster and presentation. It is also a resource for those who were unable to attend who may want to know a bit about us and our work. As it is for a wide range of audiences, we have included an Occupational Therapy Language Translator for those who are not familiar with the language used by occupational therapists – or maybe more appropriately – the way occupational therapists understand and use certain words : )

For in depth critiques on the notion of recovery, please feel free to browse the groups numerous blog posts.

To reference this blog please use the following:

Recovery in the Bin, Edwards, B. M., and E. Thomas (2018, June). Recovery in the Bin at #RCOT2018. Blog based on Facilitated Poster presented at the Royal College of Occupational Therapists’ Conference, Belfast, UK.

Occupational Therapy Language Translator!


Most people associate the word occupation with the words, job, career or vocation.  Some associate it with the occupation of land by military force.

However, occupational therapists use the word occupation differently.  In its broadest sense, the word occupation can refer to anything that somebody occupies their time doing – literally anything! 

Occupational therapists typically split occupations into 3 main categories – Self-care, Work and Leisure.  Work does not necessarily mean paid work – it can mean voluntary work and other things classed as work, for example house work, caregiving, DIY.  Importantly, the definition should always be made by the person themselves – some people might think DIY is a leisure occupation etc…

What was the presentation about?


We decided that the Unrecovery Star would be a good introduction to the groups philosophy and views on recovery – it is visual, and it has a catchy name!  Most importantly, we wanted to emphasise that our work is survivor and service user led, although we have members who are also health and social care professionals.

Why are Recovery in the Bin critical of recovery?


Everyone working in mental health services has heard of the word recovery.  You cannot read a mental health policy without coming across the word on multiple occasions.

So what’s wrong with this? Isn’t recovery a good thing?

Unfortunately, since recovery has become mainstream and has been implemented across health and social care services, it no longer represents its original ethos that made it so popular.

It is no longer service user or survivor led, and it is no longer radical: Professionals typically lead or control the recovery process and the services in which a recovery approach is delivered.

Conversely, the notion of recovery originated from grassroots service user / survivor organisations, which placed emphasis on personal meaning and agency, in contrast to a traditional professional led approach.

The current power imbalance in service provision is incompatible with recovery’s origins.

The impact of Neoliberalism and Austerity

Recovery in the Bin is critical of the influence our socio-political environment (primarily neoliberalism and austerity) has had on recovery’s implementation, and peoples understanding of recovery.  Recovery’s original emphasis on what is personally meaningful has evolved to reflect neoliberalism’s overemphasis on personal responsibility and choice.

Services and working practices have changed to reflect this.  The premise that continued involvement or contact with services results in ‘dependency’ and a lack of ‘responsibility’ is widespread.  Discharge is the goal, whether recovered or not.

Neoliberalism’s emphasis on personal responsibility and choice, fails to acknowledge the social injustices inherent in a neoliberal society that prevent choice and minimise others’ and societies responsibilities.  Recovery in the Bin challenges neoliberalism’s individualism by advocating a collectivist approach.  It highlights society’s role in addressing social injustice and creating a socio-political environment that enables a meaningful recovery.

What is the Unrecovery star?


The Unrecovery Star was developed through consensus based and participatory methods by Recovery in the Bin.  It visually depicts the socio-political barriers faced by people living with mental health conditions or distress, which inhibit recovery.  As such, it directly contrasts the individualised focus of the traditional ‘Recovery Star’: The Unrecovery Star does not place the responsibility and burden for recovery on the individual, rather, it situates recovery within the wider context of social change.

It is not a validated outcome tool. Instead, its purpose is to encourage clinicians to become aware of the way the recovery approach is implemented in practice, with an over emphasis on the individual as opposed to society. It promotes critical reflection on the recovery approach from a socio-political perspective.  It seeks to strengthen clinicians’ commitment to social justice

What implications does it have for occupational therapy?

  1. Holistic Practice:

Occupational Therapy Language Translator!


Occupational therapists use this word a lot.  It means that they look at the whole person, not just the ‘condition’ or difficulties a person may experience.  This includes their environment – physical, social etc, what’s important and meaningful to them – their values, their interests, their habits, what they enjoy doing and how they think and feel about themselves. 

As this blog was produced at short notice – this section will be updated to include examples of holistic practice!  Here’s an OT model of practice, which gives you an overview of what we mean by ‘holistic’.  This model does outline ‘Social and Economic Systems’ well.

RITB Holistic

As a holistic profession, occupational therapy purports the dynamic interaction between a person, their occupations and their environment (Taylor 2017).

As a tool to aid critical reflection, the Unrecovery Star can be used to enhance holistic practice by increasing occupational therapists’ awareness of the socio-political environment and its impact on occupational participation and recovery.

This could include welfare reform, for example, the Bedroom Tax, cuts to Employment and Support Allowance and DLA / PIP, which may limit the amount of money someone may have to access and participate in meaningful occupations.   Cuts to local government funding have meant that many local libraries have shut, and community groups have ceased to exist.  This restricts people’s occupational opportunities and the freedom people have to make occupational choices.  Packages of care are being restricted and so are programmes of intervention.  Recurrent ESA and PIP assessments may have an on-going long-term impact on someone’s occupational identity as a person: emphasis on work and productivity can diminish the value people believe they have as occupational beings.

These broader aspects of the socio-political environment can and often remain hidden.  Standardised assessments may not be particularly attuned to picking up these wider, insidious influences on occupational performance.  Critically reflecting on the recovery star can facilitate this insight which can be used during the assessment process to inform realistic plans of intervention.  In addition, it can aid critical reflection on the service and organisational environment within which occupational therapists work.  In particular, this could include the socio-political environments’ impact on the way the recovery approach is implemented locally.

2. Occupational Justice:


The Unrecovery Star’s emphasis on social justice closely aligns with the notion of occupational justice.  As Durocher et al (2014) states, “occupational justice extends the notion of social justice” (p421):  Just social structures are necessary when seeking occupational justice.  The Unrecovery star raises awareness of the particular social injustices people with mental health conditions experience, which must be addressed when seeking occupational justice.

Both occupational and social justice call for political action.  Given the socio-political injustices, including austerity and welfare reform, that people with mental health conditions and distress experience, it is time to find and embrace a political voice.  As a profession, occupational therapists can bring these injustices to the attention of decision makers and governments through policy, lobbying, activism, petitions and protest.

Without political action, occupational and social injustices cannot be changed on a large scale.

Talking about occupational justice…We’d like to draw occupational therapists’ attention to the United Nation’s Committee on the Rights of Persons with Disabilities Report.  Their concerns regarding the ability of people living with a disability to live independently and be included in their communities in the UK are outlined at the end of this blog and the full document can be accessed here:

To conclude…


Post Presentation Questions (not word for word…relying on poor memory!):

Unrecovery can come across as quite a negative word. How would you respond to this challenge?

That’s a great question. Unrecovery should be seen as the same kind of ethos as ‘unconference’ or ‘antiuniversity’*. It’s about including the excluded, going back to the grassroots. Surprisingly, Recovery in the Bin is not actually opposed to ‘recovery’. What we want to bin Is the ‘Recovery Approach’ in the form it often takes in services that can be very far from Recovery’s original values: commitment to the service user and personal meaning.

*Unconference can be described as participant-driven meetings that try to avoid top down organisation, fees, sponsorship typical of conventional conferences. Antiuniversity is about free and inclusive learning events and as such challenges academic and class hierarchy that may exclude people who aren’t privileged in society.

How can Recovery in the Bin’s materials be used in a Recovery College?

The Unrecovery Star could be used to discuss Recovery’s original values and give service users the opportunity to talk about how it may be being implemented in services. Perhaps it could be shared with participants as part of discussion about how to challenge professionals or colleagues or managers who may be implementing recovery in a way that departs from the original values of recovery. It could also be used to think about how society’s responsibilities and duties toward people influence an individuals recovery and personal values, goals and meaning^

^We also have a blog on Recovery Colleges. This hard hitting satire was meant to challenge. It had a very positive impact resulting in an editorial in a per reviewed journal, by the founders of Recovery College’s focusing on how colleges could return to their original principles when they drifted into the kind of practices satirised by RITB’s ‘Stepford Recovery College’ blog.

The United Nation’s Committee on the Rights of Persons with Disabilities Report. 

Living independently and being included in the community (art. 19)

44.The Committee is concerned about:

(a)The fact that the State party’s legislation fails to recognize living independently and being included in the community as a human right that enshrines individual autonomy, control and choice as intrinsic aspects of that right;

(b)Policies and measures that affect the ability to live independently in the community, such as the reduction in social protection schemes related to housing, household income and budgets for independent living, as well as the closure of the Independent Living Fund;

(c)The fact that responsibility for supporting independent living has been transferred to the devolved administrations and local authorities without providing appropriate and earmarked budget allocation;

(d)The fact that many persons with disabilities are still institutionalized and deprived of the right to live independently and be included within the community, when: (i) they lack the financial resources to afford personal assistance; (ii) local authorities are of the opinion that they can provide assistance within care homes; and (iii) the cost rationale constitutes the main parameter of an assessment;

(e)The lack of support services and accessible public facilities, including personal assistance, for persons with disabilities, regardless of sex, gender, age and other status, to live independently and be included in the community.

  1. The Committee recommends that the State party, in line with the Committee ’ s general comment No. 5 (2017) on living independently and being included in the community and the Committee ’ s report on its inquiry concerning the United Kingdom of Great Britain and Northern Ireland carried out under article 6 of the Optional Protocol to the Convention:

(a) Recognize the right to living independently and being included in the community as a subjective right, recognize the enforceability of all its elements, and adopt rights-based policies, regulations and guidelines to ensure implementation;

(b) Conduct periodic assessments in close consultation with organizations of persons with disabilities to address and prevent the negative effects of policy reforms through sufficiently funded and appropriate strategies in the area of social support and living independently;

(c) Provide adequate, sufficient earmarked funding to local authorities and administrations, including the devolved governments, to be able to continuously allocate adequate resources allowing persons with disabilities to live independently and be included in the community and to exercise their right to choose their place of residence and where and with whom to live;

(d) Set up a comprehensive plan, developed in close collaboration with organizations of persons with disabilities, aimed at the deinstitutionalization of persons with disabilities, and develop community-based independent living schemes through a holistic and cross-cutting approach, including education, childcare, transport, housing, employment and social security;

(e) Allocate sufficient resources to ensure that support services are available, accessible, affordable, acceptable, adaptable and are sensitive to different living conditions for all persons with disabilities in urban and rural areas.


RITB Presentation To Royal College of Occupational Therapists

These are the slides from the Recovery In The Bin presentation to the Royal College of Occupational Therapists [12/06/2018] PDF HERE > RCOT Presentation RITB

To reference these slides please use the following reference:

Recovery in the Bin, Edwards, B. M., and E. Thomas (2018, June). The Unrecovery Star: A survivor led critical discourse on the notion of recovery in mental health. Facilitated poster, presented at the Royal College of Occupational Therapists’ Conference, Belfast, UK.


This is covered by a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License

The Left Must Challenge The State’s Reduction Of Mental Health To Market Agendas

This interview first appeared in the Morning Star

Psychotherapist Paul Atkinson talks to Richard House about being a mental well-being activist and the daily difficulties faced by those on the therapeutic front line

Richard House [RH]: Paul, activism takes many forms – including ‘psy activism’ (my term) in the realm of mental health; and you’re one of the most committed psy activists I know. Can you say something, first, about what you see as the key commitments of a psy activist who also works professionally in the mental health field?

Paul Atkinson [PA]: For me as a psychotherapist, the key commitment is an ongoing awareness of the inevitable and complex power relationship between psy professionals and clients/service users. This applies to activism, and also to the consulting room itself. Psy professionals often claim an apolitical neutrality and an enhanced empathic sensitivity in their relationships with other people. Unless we’re willing to continually pay attention to the limits of our assumptions and experience, and keep learning from the people we’re working with, we’re likely to be projecting subtle, and not-so-subtle messages of knowing more than we know, of being a little (or a lot) more important than we are, and protecting ourselves with a whiff of authority that’s overbearing or condescending.

One of the particular characteristics of mental health politics, of course, is that what we call “mental ill-health” is very likely to be a response to the abuse or misuse of others’ power over us at different periods and settings in our lives. So the fact that so much service mental health provision is top-down – in the form of the politics of commissioning and funding, as well as the diagnostic and treatment decisions of psy professionals – is a fundamental issue for mental health activism. As far as possible, political activism around mental health must be shaped and led by service users and survivors. For psy professionals, trust can only be earned over time through action, alongside and in support of survivors. Obviously we professionals have plenty of political issues within our own working remits, around which we can take the lead. But we’re so much more powerful in our campaigns if we have allies campaigning with us who are on the receiving end of the dysfunctionality of the psy professions.

RH: There’s a lot there, Paul! Can you tell us how far away current mental health provision is from the “bottom-up” approach you’re advocating here? – and whether you think a radical-left government could really make a difference to that – and if so, how? magine Iyou’re the new minister for mental health and you have five years!…

PA: I think there are fantastic examples of grass-roots activity among service users. I’m thinking of people I’ve met from the Mental Health Resistance Network, Disabled People Against Cuts (DPAC – regularly featured in the Star, of course), Recovery in the Bin, Friends of East London Loonies, the National Survivor User Network, Kindred Minds, the Survivor Researcher Network and Making Waves, as well as hundreds of small user, refuser and survivor-run groups involved in peer support, political campaigning, the creative arts, in manifold ways of sharing and valuing each other’s lived experience. But the culture-gap that exists between these forms of local “activism” and mainstream top-down mental health services provided by the NHS, or by some of the big mental health charities like MIND, can be enormous, and often very toxic for people suffering psychological distress.

Do I think a radical-left government could really make a difference? The political transformation required to rethink mental ill-health as a function of society’s ill-health is profound. In a way, mental-health politics is at the heart of any real questioning of what kind of society we want to live in, how we want to relate and be related to, what and whom society’s for. The first three jobs of a radical minister for mental health should be: (1) To ask user groups and individuals all over the country what “mental illness” means to them, and what would be of help to them. Mean it, listen, and then carry on listening. If the Labour Party were serious about any kind of radical transformation of mental health policy, it should be doing this right now. Are they?… (2) Give people the material resources to support their basic needs without condition. (3) Ban all forms of coercion in the name of “treating” people’s psychological suffering/distress.

RH: That’s a resoundingly clear statement – and challenge – to Labour’s shadow health team, Paul: let’s hope they’re open to listening, both to your conspectus here and to the experience of those who desperately need to be listened to – and who, to date, rarely have been by the Establishment. I really like how you place your emphasis on political receptivity and user empowerment, rather than on top-down initiative-itis. I assume you’re less than impressed by current state therapy provision and its top-down nature?

PA: Well, NHS primary care therapy provision – Improving Access to Psychological Therapies (or IAPT) – is seriously top-down. It’s organised as a sort of factory-system or conveyor-belt of mental health treatment, offering on average six or so sessions of cognitive behavioural therapy (CBT), or perhaps mindfulness, relaxation, or online self-guided exercises – aimed really at getting people suffering from depression and/or anxiety back into the everyday reality of their lives under capitalism. What kind of therapy you get is decided for you through a diagnostic check-box interview which may be held on the phone, or even by computer. There’s very little room for “user choice”. Out of 1.4 million people referred last year, two-thirds either never entered or failed to finish a course of IAPT treatment. They simply disappear from the statistics. I’m afraid it’s hard not to feel that IAPT is more about providing cover for the mental ill-health of capitalism than it is responding to the psychological suffering of the people.

Beyond IAPT, I think all forms of therapy carry the danger of encouraging a way of thinking about one’s self and the world that’s imposed on clients, rather than evolving through a process of mutual exchange between a therapist and a client.

RH: That’s sobering stuff, Paul; but I suppose we shouldn’t be too surprised when (state) capitalism creates a form of therapy that’s cast in its own image. Finally, could you say something about the once-again mooted state regulation of the psy therapies, and why you think this would be harmful to the field and to the work of therapy?

PA: Obviously therapists want their work with clients to be accountable. The problem with state regulation is the state’s desire for psychotherapy. As we see in other fields like education, medicine, and the law, the neoliberal state is increasingly engaged in violently undermining and taking political control of professional practice whose values and traditions conflict with the interests of the market. Psychotherapy, especially in the independent sector, operates at its best as a sort of free association and open exploration of meaning between people, a process that fosters possibilities for individual and social transformation. In the hands of the state, it will gradually and inevitably be reduced into the service of market agendas.

Paul Atkinson is a psychotherapist in independent practice in London, and a member of the Free Psychotherapy Network. Richard House is a Corbynista activist living in Stroud.