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Understanding the whole person: Part One of a series of literature reviews on severe and multiple disadvantage

What are the common concepts for recovery and desistance across the fields of mental health, substance misuse, and criminology?

This paper looks at journeys of personal change. These journeys are undertaken by many individuals across the world, and although complex and difficult, they are often successful. Change is made up of a number of components and causes; each combination of factors is unique to each person, but there are common themes. The absence of something negative is not enough - it is about a life with purpose and meaning. While public services tend to focus on crisis and immediate need, these journeys involve building a fulfilling life over the long-term. However, for many people this means moving away from very marginalised, stigmatised and difficult experiences. Chronic drug or alcohol dependency, frequent offending, and institutionalised mental health care all make building a healthy, enjoyable life a considerable challenge.

Revolving Doors is producing a series of literature reviews as part of a research network project bringing together the evidence on severe and multiple disadvantage, or multiple and complex needs. Researchers from different backgrounds view people facing multiple needs through their disciplinary prisms, such as criminology, psychology, or homelessness. These all offer vital but partial perspectives. The focus of this literature review reflects the aims of the network: it reviews commonalities in research on the processes of recovery from (or in) mental illness; recovery from drug and alcohol problems; and desistance from crime.

Because many people experience a breadth of need, it is important to understand the cross-cutting themes across these three journeys as conceptualised by the fields of mental health, criminology and substance misuse, as well as the distinctive elements. This has key policy implications (although no easy solutions). Aspects of these journeys include developing social capital and a meaningful ‘role’ in life. However for people with multiple needs, things like a stable family or fulfilling employment may be very far away possibly because they have experienced such a combination of problems, including long-term social exclusion, very low educational attainment, childhood trauma and neglect (Bramley and Fitzpatrick, 2015). The combination of needs makes each journey harder: leaving a life of crime or drugs may lead to fewer friends, and isolation is bad for mental health. However, we know that people facing multiple needs can and do recover, and may well go through all three journeys.

Each person’s journey towards change will be unique and cannot be predicted based on the literature. Common themes may not apply to any one person; and factors of change are determined by personal, social, economic and community contexts. Understanding common themes is important for policy, research and individuals (see White, 2007), but these journeys cannot be imposed by a service or manufactured by an intervention. Opportunities for change have to be meaningful to individuals and their life. Additionally, people recover and desist from crime without or despite services - however there are still important policy implications.

In addition, the literature reviewed on these journeys focuses primarily on individuals, rather than macro-level causes of change. It is still important to understand how wider issues can shape experiences for different people, such as women and people from ethnic minorities. For example, in mental health, recovery has been critiqued for failing to incorporate the effects of racism on wellbeing.

Currently the evidence base for support for people facing multiple needs is under-developed (Revolving Doors and Centre for Mental Health, 2015). Understanding the common themes across these journeys brings us closer to knowing how difficult journeys of change are achieved, and how policymakers and professionals can either support or impede these journeys.