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MENTAL HEALTH RECOVERY
AND WELLNESS: ROLE OF
OCCUPATIONAL THERAPY
Kathlyn L. Reed PhD, OTR, FAOTA, MLIS
Associate Professor Emerita
Texas Woman’s University: Houston
klreed3@juno.com
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Objectives
• Discuss concept of maintaining health and wellness after
recovering from a mental illness
• Describe programs developed by occupational therapists
designed to assist in maintaining wellness and recovery
• Illustrate examples of selected programs.
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Criteria for Article Selection
Included
• Original article or abstract in
English
• Published between 2000-14
• One or more authors is an
occupational therapist OR
methodology includes an
assessment developed by an
occupational therapist(s) OR
occupational therapy is used in
methodology section AND data
on one or more daily living
activity is reported
• 54 studies met criteria
Excluded
• Articles not in English
• Articles published before 2000
• Articles in which the
involvement of occupational
therapy or occupational
therapist(s) could not be
established (authorship, data
collector, therapist) or
occupational therapy was used
as the control group
• Books, chapters, blogs, web
pages, videos, news articles,
CATs, protocols, clinical trial or
grant proposals, Cochrane
reviews
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Search Strategy & Databases
Search Strategy
• Wellness OR recovery
OR self help AND mental*
ill* OR mental health OR
psychiatr* OR psychotic
OR psychosis OR
neuropsychiatr* OR
schizophrenia OR bipolar
AND occupational therap*
Databases
• MEDLINE
• Psychiatry & Behavioral
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Sciences
PsycINFO
CINAHL
Proquest Nursing & Allied
Health
Health Reference Center
OT Seeker
Google
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Definition: Wellness
• Wellness is a conscious, deliberate process that requires
a person to become aware of and make choices for a
more satisfying lifestyle
• A wellness lifestyle includes
• a self-refined balance of health habits:
• adequate sleep, rest, and good nutrition;
• productivity and exercise;
• participation in meaningful activity; and
• connection with people and communities that are supportive.
• Swarbrick M. (1997). A wellness model for clients. Mental
Health Special Interest Section Quarterly, 20, 1-4.
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Definition: Recovery
• Definitions depend on perspective
• Outcome: ability to lead a good and satisfying life despite
illness or presence of symptoms (Deegan, 2001)
• Process: a non-linear lived experience involving both selfdiscovery and transformation and culminating in an
understanding that symptoms of illness are not definitive in
terms of one’s self-identify (Davidson et al, 2005)
• Philosophical underpinnings: concepts such as hope,
connection, healing, empowerment, self-help, mutual-help, selfdetermination, family involvement, resiliency, choice, justice,
responsibility, skill building, community involvement, education
and role development, focus on strengths and possibilities,
positive culture for healing. (Casey, 2008)
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Changing Models
Medical Model
Wellness/Recovery
• Professional in charge
• Client centered
• Focus on illness and
• Focus on wellness and
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dysfunction
Focus on disability and lack of
competence
Focus on controlling or
reducing symptoms
Tends to be reductionistic
Goal is cure and eliminating
symptoms of illness
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function
Focus on ability and
competence
Focus on aspects of health,
well-being
Tends to be holistic
Goal is “doing” daily activity
regardless of symptoms
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Changing Models
Illness Centered Models
• Diagnosis is foundation
• Begins with assessment of
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symptoms of illness
Services bases on diagnosis &
treatment needed
Services work toward illness
reduction goals
Tx: symptom driven & rehab:
disability driven
Track illness progress toward
symptom reduction & cure
Use techniques that promote
illness control & reduction of
risk of damage from illness
Person Centered Models
• Relationship is foundation
• Begins with welcoming –
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outreach and engagement
Services based on personal
suffering & help needed
Services work toward qualify of
life goals
Treatment & rehabilitation are
goal driven
Track personal progress toward
recovery
Use techniques that promote
personal growth and self
responsibility
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Changing Models
Illness Centered
Person Centered
• Recovery from illness is
• Personal recovery is central
addressed first, then
disability
• Relationship only exists to
treat illness & is carefully
restricted throughout to
keep it professional
• Services end when illness
is cured
• www.mhala.org
from beginning to end of
intervention
• Relationship may change
and grow throughout and
continue even after services
end
• Services end when person
manages own life and
attains meaningful roles
• Author: Mark Ragins, MD
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Barriers to Wellness
• Lack of financing to support health promotion
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interventions
Lack of synergy between medical and mental health
services
Resistance to change in mental health service delivery
models, infrastructure, and settings
Negative attitudes and prejudice among health care
providers
Lack of health information that addresses the diverse
needs of people with psychiatric disabilities
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Barriers to Wellness
• Negative health care experiences by persons with mental
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illness that keep them away
Side effects of psychiatric medication
Membership in a diverse community (racial, ethic,
disability, sexual orientation, immigrant)
Access to quality health care
Inadequate health insurance coverage
Poverty
• Source: Center for Psychiatric Rehabilitation, Boston University
cpr.bu.edu/resources/newsletter/wellness-recovery-pledge
• AND Decreased involvement by occupational therapy
practitioners in mental health programing
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Assessments: Non OT
• Brief Symptom Inventory (BSI)
• Coping with Symptoms Checklist (SCS) Yanos, Knight &
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Bremer, 2003
Cybernetic Coping Scale (CCS) Edwards && Baglioni, 1993
IMR Scale Self-Report: Mueser & Gingerich, 2005
Norbeck Social Support Questionnaire (NSSQ). (Norbeck,
Lindsey, & Carrieri, 1981)
Perceived Social Support Scale (PSSS) Blumenthal et al, 1987
Qualify of Life Interview (QoL). Lehamn, 1988
Recovery Assessment Scale: Corrigna, Slazer, Ralph,
Sangster, & Keck, 2004
Rosenberg Self-Esteem scale (RSES) Rosenberg,
Symptom Distress Scale
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Adapted from Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29, (4), 311-314
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Dimensions of Wellness: Physical
• Physical involves maintenance of a healthy body, good
physical health habits, good nutrition and exercise and
obtaining appropriate health care.
• It is important to empower people to focus on nutrition,
exercise, smoking cessation, and stress awareness
reduction as means of self-care and prevention of cooccurring medical conditions.
• It is important to offer services and supports that empower
or serve users to establish health habits and routines and
access timely preventative and needed healthcare
services.
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Dimensions of Wellness: Physical
• Diet and nutrition
• Physical activity
• Sleep/Rest
• Stress management/relaxation
• Medical care/screenings
• Health habits and routines
• Swarbrick, M. 2013. Wellness and recovery: A self-defined
balance of health habits. Recovere-works
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Dimensions of Wellness: Intellectual
• Intellectual involves lifelong learning, application of
knowledge learned, and sharing knowledge.
• We need to recognize people’s creative abilities and help
individuals find ways to expand knowledge and skills
while helping them discover the potential for sharing those
gifts with others.
• Services and supports should help people pursue
personal interests and remain current on issues, as well
as offer opportunities to share ideas.
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Dimensions of Wellness: Environmental
• Environmental involves being able to be and feel
physically safe, in safe and clean surroundings and able
to access clean air, food, and water
• This includes both our micro-environment (places where
we live, learn, work, etc.) and our macro environment (our
communities, country, and planet).
• Services and support should help people to create living,
learning, and working spaces that promote learning,
contemplation and relaxation
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Dimensions of Wellness: Spiritual
• Spiritual involves having meaning and purpose and a
sense of balance and peace.
• This is one of two aspects of life which keep many people
going in their recoveries.
• The mental health system sometimes views spirituality as
pathology rather than helping people to connect with
cultural, religious, and/or spiritual traditions and
environments which enhance self-identity
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Dimensions of Wellness: Social & Emotional
• Social involves having relationships with friends, family,
and the community and having an interest in and concern
for the needs of others and humankind.
• Social support and connectedness is a key ingredient to
support recovery
• Emotional involves the ability to express feelings, enjoy
life, adjust to emotional challenges, and cope with stress
and traumatic life experiences.
• Emotional stability helps an individual recognize conflict
as being potentially health, and enhances selfacceptance, and contentment.
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Dimensions of Wellness: Financial
• Financial involves ability to have financial resources to
meet practical needs, and a sense of control and
knowledge about personal finances.
• Financial instability can result in emotional distress thus
attention to financial economic self-sufficiency is a central
focus of assessment and intervention.
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Dimensions of Wellness: Occupational
• Occupational involves participating in activities that
provide meaning and purpose, including employment,
volunteer work, and engagement on meaningful activity
connected to social roles.
• People find self-definition through their jobs, structure
their lives, develop a sense of self-efficacy, develop and
maintain relations, maintain incomes that support financial
wellness, and more.
• Under and over employment undermine recovery, thus
access to evidenced based supported employment
services is essential for any funded service delivery
system, and key to transcend the poverty trap too often
faced by service users.
• Swarbrick, M. (2012).
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Goal Setting Based on SMART Method
• Specific: Goals should be specific, using action words
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(walking, scheduling, purchasing etc.)
Measurable: Use specific criteria that indicate attainment
or degree of attainment: times per week, number of items
or things
Achievable: Goal should require some effort but be within
reach of the individual
Realistic: Goal should be possible to accomplish: avoid
too easy or never: use reduce or increase over time
Timely: Provide a clear target for completion of work
toward goal
• Brice, Swarbrick & Gill, 2014
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Goal Setting: Diet and Nutrition
• I will create healthy eating habits by maintaining a daily
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food, sleep, and stress log.
I will record number of hours slept, number of times I am
waking up in middle of night and time and what I ate.
I will record activity during day causing stress and
triggering eating habits
I will lose 5 lbs per month for next 3 months by eating
vegetables 3 days per week and walking 20 minute 2
days per week
I will take lunch to work three times per week
• Source: Brice, Swarbrich & Gill, 2014
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Goal Setting: Physical Activity
• I will do weekly physical activity (warm up, karate, or
calisthenics) for 30 minutes (3 days) and create a flexible
exercise schedule
• I will go to the YMCA on Tuesdays and Thursdays ad
continue my3 to 4 days per week of aerobic activity
• I will do aerobic yoga activity for 20 to 30 minutes 6 days
per week
• I will work on strength training twice per week, on
Tuesdays and Saturdays, 6 p.m. and 1 p.m. respectively
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Goal Setting: Relaxation/Stress
Management
• I will listen to gospel and rhythm and blues music on
Mondays, Wednesday, and Fridays for 2 hour
• I will read for enjoyment on Saturday afternoon or evening
for 30 minutes
• I will schedule relaxation 5 days per week for at least 45
minutes by logging day/length of time and activity (e.g.,
science fiction, DVD series, reading).
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Statistics
• Most Frequent Topics: diet and nutrition, physical activity,
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relaxation/stress management, sleep & rest
Average Contacts per Person: 10 session (range 4-17).
Time not stated.
Fifty-nine % achieved goals, 28% partially
Important to help clients identify strengths – and that
reaching goals can become strengths
Logs help: have clients keep a log/diary
• Brice, Swarbrick, & Gill, 2014
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Wellness Coaching: Swarbrick
• Coaching is a positive supportive relationship between the
coach and the person who wants to make a change
(Swarbrick, 2010, Wellness coaching: Supervisor manual, p. 6)
• Coaching includes:
• Help person to clarify problem/need for change or
improvement
• Determine if there is a clear goal
• Brainstorm actions to be taken
• Determine the action
• Set an accountability step
• Set a time frame to accomplish the action
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Model of Human Occupation
• Volition: when people have autonomy and control over their
lives they are better motivated to find values, interests and
purpose. The Recovery Model recognizes people have ‘hopes,
dreams, goals, and choices’
• Habituation: the Recovery Model encourages responsibility,
with the emphasis upon community and social environments.
This in turn facilitates individual having a daily routine that is
purposeful, fulfilling and structure which varies for each
individual depending upon his or her stage of recovery
• Mind-Brain-Body Performance: the Recovery Model
facilitates development of skills to enhance confidence, selfesteem, concentration and social interaction, leading to an
improvement in individual’s quality of life
• Wimberly & Peters, 2003, recovery in acute mental health, OT News, July, p.
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Recovery Star Model
OT News, October, 2012, p. 47
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Recovery Star Model
• Person follows a ‘ladder
of change’ comprised of
five stages with two
choices as each level
• Being stuck
• Accepting help
• Believing
• Learning
• Self reliance
• Using a scale of one to
10
• In 10 domains
• Managing mental health
• Trust & hope
• Identify & self-esteem
• Responsibilities
• Addictive behavior
• Relationships
• Work
• Social networdks
• Living skills
• Self-care
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Recovery Star: Self-Care Ladder
• Stuck
• I don’t look after myself
• I don’t look after myself but occasionally I realize I feel awful
• Accepting Help
• I didn’t used to feel so bad – I want help
• I’m working with someone to feel better
• Believing
• I want to take responsibility for looking after myself well
• I’m doing things differently because I want to feel better
• Learning
• I’m learning what makes me feel good
• I’m building a healthy way of life
• Self-Reliance
• I’m learning to maintain a healthy way of life
• I have a sense of well-being and know how to maintain it.
• MacKeith & Burns (2008). Mental Health recovery star: User guide. Mental health
Providers Form and Triangle Consulting.
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Clubhouse Model
• Clubhouses are local community centers that provide members
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with opportunities to build long-term relationships and obtain
employment education and housing including:
A work-ordered day in which talents & abilities of members are
recognized & utilized within Clubhouse
Participation in consensus-based decision making regarding all
important matters relating to running Clubhouse
Opportunities to obtain paid employment through Transitional
Employment program
Assistance in accessing community-based educational
resources
Access to crisis intervention services when needed
Evening/weekend social and recreational events
Assistance in securing & sustaining safe, decent & affordable
housing
• www.iced.org/whatis.html
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GROW Model: Twelve Stages of Decline
• We gave too much importance to ourselves & our feelings
• We grew inattentive to God’s presence & providence & God’s natural order in our
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lives
We let competitive motives, in our dealings with others, prevail over our common
personal welfare
We expressed our suppressed certain feelings against better judgment of
conscience or sound advice
We began thinking in isolation from others, following feelings & imagination
instead of reason
We neglected care and control of our bodies
We avoided recognizing our person decline & shrank from task of changing
We systematically disguised in our imaginations real nature of our unhealthy
conduct
We become a prey to obsessions, delusions & hallucinations
We practice irrational habits, under elated feelings of irresponsibility or despairing
feelings of inability or compulsion
We rejected advice & refused to co-operate with help
We lost all insight into our condition
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Grow Model: Twelve Steps of Recovery
• We admitted we were inadequate or maladjusted to life
• We firmly resolved to get well and co-operate with help that we
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needed
We surrendered to healing power of a wise loving God
We made a personal inventory and accepted ourselves
We made a moral inventory & cleaned out our hearts
We endured until cured
We took care & control of our bodies
We learned to think by reason rather than by feelings & imagination
We trained our wills to govern our feelings
We took our responsible & caring place in society
We grew daily closer to maturity
We carried GROW’s hopeful, healing, & transforming message to
others in need.
• GROW founded by Father Cornelius Keogh in Australia in 1957
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Wellness Recovery Action Plan: Copeland
• Six sections: Usually kept in a notebook
• Daily Maintenance List
• What I’m like when I am feeling all right
• Things I need to do for myself every day to keep myself feelings all
rights
• Additional things I might need to do (or that would be good to do)
• Triggers
• Things that, if they happen, might cause an increase in my symptoms
• Action Plan – Things that I can do if my triggers come up to keep them
from becoming more serious symptoms
• Early Warning Signs
• Some early warning signs that others have reported and/or I have
observed
• Things I must do if I experience early warning signs:
• Things I can do if they feel right to me
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WRAP Continued
• When Things are Breaking Down
• Signs/symptoms that indicate that things are getting worse
• Action Plan – Things that can help reduce my symptoms when they have
progressed to this point
• Crisis Plan
• Part 1 – What I’m like when I’m feeling well (reference Daily Maintenance List)
• Part 2 – SYMPTOMS that indicate that others need to take over full
responsibility for my care and make decision on my behalf
• Part 3 – These are my SUPPORTERS, the people who I want to take over for
me when the symptoms I listed in Part 2 come up
• Part 4 – Medications/Supplements
• Part 5 – Treatments
• Part 6 – Community Plan
• Part 7 – Treatment Facilities
• Part 8 – Help from others
• Post Crisis Plan: Inactivating the Crisis Plan
• Symptoms, lack of symptoms or actions that indicate that my supporters o
longer need to use this Crisis Plan
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Occupational Therapy Role
• Goals:
• Empower clients to take action for themselves:self manage, self
direct, and live well
• Develop competencies that enable participation, not just contain
illness (White, 2011)
• Models: Use
• Client centered approach
• Wellness and recovery strategies
• Collaborative and interdisciplinary techniques
• Learn-by-doing models (Swarbrick & Duffy, 2000)
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Occupational Therapy Role
• Develop and implement self-help center policy and procedure
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guidelines for conducting focus group
Assist in developing self-help center manual to facilitate management
and leadership structure
Assist consumers to engage in mutual group planning process to
formulate decisions and action plans
Help consumer groups identify and define issues, areas, and
components needed to address policy and procedures for
center/program administration
Support development of program components such as socialization,
recreation, self-help, peer counseling, advocacy and wellness and
recovery.
Work with groups of clients to develop and implement programs
Work with groups of client to develop manuals for consumer leaders
to use
• Swarbrick & Duffy, 2000
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Summary
• Consumer-Run Self-Help approaches appear to work best
for mood & anxiety disorders & those with physical health
issues (Goering et al, 2006)
• Most common issues are stable housing, employment,
and avoiding emergency room visits (Goering et al, 2006).
However, depends on what questions are asked in survey
questionnaire.
• Positive relationships are most important to people who
attend self-help centers and related directly to level of
satisfaction with program (Swarbrick, 2009; Swarbrick,
Schmidt & Pratt, 2009)
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References: Wellness/Recovery
• AOTA (2011). Occupational therapy’s role in mental health recovery. Bethesda,
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MD: Author
Asmundsdóttir, E.E. (2009). Creation of new services: Collaboration between
mental health consumers and occupational therapists. Occupational Therapy in
Mental Health, 25(2), 115-126. (Level V, interview, Iceland)
Ayash, H. (2007). Changing the way we work. OT News, 15 39. (Level V, program
description, UK)
Brice, G.H., Swarbrick, M.A., & Gill, K.J. (2014). Promoting the wellness of peer
providers through coaching. Journal of Psychosocial Nursing, 52(1), 41-45. (Level
Brown, C. (Ed.). (2001). Recovery and wellness: Models of hope and
emplowerment for people with mental illness. New York: Haworth Press.
Caldweell, B.A., Scianfani, M., Swarbrick, M. & Piren, K. (2010). Psychiatric
nursing practice & the recovery model of care. Journal of Psychosocial Nursing,
48(7), 42-48. (Level V, overview, USA)
Casey, R. (2008). Towards promoting recovery in Vancouver Community Mental
Health Services, International Journal of Psychosocial Rehabilitation, 12 (2),
1013. (Level V, literature review, Canada)
Chen, S.P., Krupa, T., Lysaght, R., McCay, E. & Piat, M. (2013). The development
of recovery competencies for in-patient mental health providers working with
people with serious mental illness. Administrative Policy in Mental Health, 40, 96116 (Level V, interview, Canada)
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References: Wellness/Recovery
• Clayton, J. & Tse, S. (2003). An educational journey towards recovery for
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individuals with persistent mental illness: A New Zealand perspective. Psychiatric
Rehabilitation Journal, 27(1), 72-78. (Level V, program description, New Zealand)
Copeland, M.E. (2001). Wellness recovery action plan: A system for monitoring,
reducing and eliminating uncomfortable or dangerous physical symptoms and
emotional feelings. Occupational Therapy in Mental Health, 17(3/4), 127-150.
(Level V, model, USA)
Crawley, M., Lovell, P. & Clarke, S. (2012) Understanding recovery through
creative means. OT News, 20(3), 31 (Level V, program description, UK)
Deegan, P.E. (2001). Recovery as a self-directed process of healing and
transformation. Occupational Therapy in Mental Health, 17(3/4), 5-21. (Level V,
narrative, USA)
Elliott, S., & Jenkins, V. (2011). Assisting recovery in adult mental health day
services. OT News, 20(4) 40-41. (Level V, program description, UK)
Fieldhouse, J. (2012). Community participation and recovery for mental health
service users: An action research inquiry. British Journal of Occupational Therapy,
75(9), 419-428. (Level V, interview, UK)
Gibson, R.W., D’Amico, M. Jaffe, L. & Arbesman, M. (2011). Occupational therapy
interventions for recovery in the areas of community integration and normative life
roles for adults with serious mental illness: A systematic review. AJOT, 65, 247256. (Systematic review, USA)
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References: Wellness/Recovery
• Hanssens, T. (2006). Revisiting recovery. Advance for Occupational Therapy
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Practitioners, 22(5), 12. (Level V, USA)
Hurley, E. & McKay, E.A. (2009). The recognition and adoption of the recovery
approach by occupational therapists in acute psychiatric settings in Ireland. Irish
Journal of Occupational Therapy, 37(2), 65-13. (Level V, Ireland)
Jahrami, H., Panchasharam, G. & Saif, Z. (2012). Wellness: The overlooked
intervention for individuals with psychosis in the Kingdom of Bahrain.
Occupational Therapy International, 19(3), 165-166. (Level V, Bahrain)
Kelly, M., Lamont, S. & Brunero, S. (2010). An occupational perspective on the
recovery journey in mental health. British Journal of Occupational Therapy, 73(3),
129-135. (Level V, Australia)
Knott, J. (2010). Wellbeing for life. OT News, 18(11), 29 (Level V, UK)
Krupa, T. & Clark, C. (2009). Using tensions in practice to promote the integration
of treatment and rehabilitation in a a recovery-oriented system. Canadian Journal
of Community Mental Health, 28, 47-59. (Level V, Canada)
Lal. S. (2010). Prescribing recovery as the new mantra for mental health: Does
one prescription serve all? Canadian Journal of Occupational Therapy, 77(2), 8289. (Level V, Canada)
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References: Wellness/Recovery
• Lloyd, C., King, R. McCarthy, M. & Scanlan, M. (2006). The association between
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leisure motivation and recovery: A pilot study. Australian Occupational Therapy
Journal, 54(1), 33-41. (Level V, correlation, Australia)
Lloyd, C., Waghorn, G. & Williams, P.L. (2008). Conceptualising recovery in
mental health rehabilitation. British Journal of Occupational Therapy, 71(8), 321328. (Level V, Australia)
McKendrick, N., White, M., McCutcheon, S., Craig, L. & Davidson, A. (2010).
Walking on the road to mental health recovery. OT News, 18(3), 36-37. (Level V,
program description, UK)
McKenzie, R. (2013). The recovery star in action. OT News, 21(1), 34-35. (Level
V, case study, UK)
Peloquin, S.M. (2010). Occupational therapy among women in recovery from
addiction. OT Practice, 15(May 24), 12-15, 22. (Level V, program description,
USA)
Pitts, D.B. (2004). Understanding the experience of recovery from persons
labeled with psychiatric disabilities. OT Practice, 9(5), CE1-CE8 (Level V,
overview, USA)
Potter, S. (2012). Implementing recovery through organisational change. OT
News, 20(10), 46-47. (Level V, program model, UK)
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References: Wellness/Recovery
• Pratt, C.W., Lu, W., Swarbrick, M. & Murphy, A. (2011). Selective provision of
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illness management and recovery modules. American Journal of Psychiatric
Rehabilitation, 14, 245-258. (Level V, USA)
Reberiro Gruhl, K.L. (2005). The recovery paradigm: Should occupational
therapists be interested? Canadian Journal of Occupational Therapy, 72(2), 96102. (Level V, overview, Canada)
Robertson, C. (2012). Home but away. OT News, 21(12), 32-33. (Level V, survey,
UK)
Sutton, D.J., Hocking, C.L. & Smythe, L.A. (2012). A phenomenological study of
occupational engagement in recovery from mental illness. Canadian Journal of
Occupational Therapy, 79(3), 142-150. (Level V, narratives, New Zealand)
Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal,
29(4), 311-313. (Level V, USA)
Swarbrick, M. (2010). Peer Wellness Coaching Supervisor Manual. Freehold, NJ:
Collaborative Support Programs of New Jersey, Institute for Wellness and
Recovery Initiatives. (Level V, program description, USA)
Swarbrick, P. (2010). Defining wellness. Words of Wellness, 3(7), 1-2. (Level V,
USA)
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References: Wellness/Recovery
• Swarbrick, M. (2012) A wellness approach to mental health recovery. In: A
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Rudnick (Ed). Recovery of people with mental illness, pp. 30-38 New York: Oxford
University Press. (Level V, USA)
Swarbrick, M. (2012). Putting wellness into personal practice. Words of Wellness,
5(9), 1-2. (Level V, USA)
Swarbrick, M. (2012). Wellness & Aging. Words of Wellness, 5(9), 3-4. (Level V,
overview, USA)
Swarbrick, M. (2013). A wellness and recovery model for state psychiatric
hospitals. Occupational Therapy in Mental Health, 25 (3-4), 343-351. (Level V,
program description, USA)
Swarbrick, M.A. (2013). Integrated care: Wellness-oriented peer approaches: a
key ingredient for integrated care. Psychiatric Services, 64(8), 723-726. (Level V,
overview, USA)
Swarbrick, M.A. (2013). Wellness-oriented peer approaches: A key ingredient for
integrated care. Psychiatric Services, 64(8), 723-726. (Level V, USA)
Swarbrick, M. & Brice, G.H. (2006). Sharing the message of hope, wellness, and
recovery with consumers psychiatric hospitals. American Journal of Psychiatric
Rehabilitation, 9, 101-109. (Level V, USA)
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References: Wellness/Recovery
• Swarbrick, P. & Burkhardt, A. (2000). Spiritual health: Implications for the
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