Valued social roles and measuring mental health recovery: examining the structure of the tapestry.

The concept of mental health recovery has become central to changes in United States mental health policy and practice at both the state and national levels (Anthony, 1993; Davidson, O’Connell, Tondora, Styron, & Kangas, 2006; Davidson et al., 2007). During the past decade, increased attention has been given to the definition and measurement of recovery in order to support mental health system transformation and facilitate recovery outcomes research. This process lead to the acknowledgment that both the concept of recovery and recovery measurement are complex— in part because of the multiple components related to recovery (Davidson, Lawless, & Leary, 2005; Resnick, Fontana, Lehman, & Rosenheck, 2005). For example, the Substance Abuse and Mental Health Services Administration (2006) developed a consensus statement on mental health recovery defining recovery as “a journey of healing and transformation” that includes 10 fundamental components: self-direction, individualized and person-centered, empowerment, holistic, nonlinear, strengths-based, peer support, respect, responsibility, and hope. Other components or domains that have been the focus of mental health recovery research include community integration, family relationships, living arrangements, mental health symptoms, navigating social services, optimism, safety, social networks and supportive relationships, and spirituality (Baxter & Diehl, 1998; Davidson et al., 2001). The sheer number and breadth of components that currently define the tapestry of mental health recovery makes systematic examination of recovery processes and outcomes difficult. Inherent in many recovery elements, the larger concept of social roles acts as a barely visible underlying structure, a kind of warp in the weave of the tapestry. Despite being hidden, this structure allows consumers, practitioners, researchers, policymakers, and citizens to better visualize the richness and multifaceted nature of mental health recovery. For example, discussions of social roles are inherent in writings about community integration (Anthony, 1993; Davidson et al., 2001; Ridgway, 2001), literature on family relationships (Janzen & Muhajarine, 2003; Stein, Mann, & Hunt, 2007), and studies of peer support for adults with mental illness (Barber, Rosenheck, Armstrong, & Resnick, 2008; Goldberg & Resnick, 2010; Sells, Black, Davidson, & Rowe, 2008). However, the notion of valued social roles for adults living with a mental illness is typically relegated to a subordinate position in discussions of mental health recovery despite studies that have shown a relationship between a greater number of valued social roles and higher levels of well-being and less psychological symptomotology (Spreitzer, Snyder, & Larson, 1980; Thoits, 1991). Moreover, there is relatively little discussion regarding operationalization and measurement of the construct of social roles in the context of mental health recovery beyond describing a social role as being a member of a social group or joining in an activity described as “social” such as a book club. As noted below in the description of role theories, the word social in this context is used to connote a focus on beliefs/behaviors in relation to a social context rather than whether or not one “socializes” as part of a role. This article reviews seminal social role theories and operationalizes aspects of social roles thought to relate directly to mental health recovery research and practice. This article provides a critical analysis of the ability of social role concepts to contribute to effective ways to facilitate and support recovery for individuals and inform mental health systems transformation.