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The roots of the recovery movement in psychiatry
As the global psychiatric community enters a new era of transformation, this book explores lessons learned from previous efforts with the goal of \"getting it right\" this time. In response to the common refrain that we know about and 'do' recovery already, the authors set the recovery movement within the conceptual framework of major thinkers and achievers in the history of psychiatry, such as Philippe Pinel, Dorothea Dix, Adolf Meyer, Harry Stack Sullivan, and Franco Basaglia. The book reaches beyond the usual boundaries of psychiatry to incorporate lessons from related fields, such as psychology, sociology, social welfare, philosophy, political economic theory, and civil rights. From Jane Addams and the Settlement House movement to Martin Luther King, Jr., and Gilles Deleuze, this book identifies the less well-known and less visible dimensions of the recovery concept and movement that underlie concrete clinical practice. In addition, the authors highlight the limitations of previous efforts to reform and transform mental health practice, such as the de-institutionalization movement begun in the 1950s, in the hope that the field will not have to repeat these same mistakes. Their thoughtful analysis and valuable advice will benefit people in recovery, their loved ones, the practitioners who serve them, and society at large. Foreword by Fred Frese, Founder of the Community and State Hospital Section of the American Psychological Association and past president of the National Mental Health Consumers' Association.
eBook
Personal Recovery and Mental Illness
Recovery is a concept which has emerged from the experiences of people with mental illness. It involves a shift away from traditional clinical preoccupations such as managing risk and avoiding relapse, towards new priorities of supporting the person in working towards their own goals and taking responsibility for their own life. This book sets an agenda for mental health services internationally, by converting these ideas of recovery into an action plan for professionals. The underlying principles are explored, and five reasons identified for why supporting recovery should be the primary goal. A new conceptual basis for mental health services is described - the Personal Recovery Framework - which gives primacy to the person over the illness, and identifies the contribution of personal and social identity to recovery. These are brought to life through twenty-six case studies from around the world.
eBook
Housing First for People with Severe Mental Illness Who are Homeless: A Review of the Research and Findings from the at Home—Chez soi Demonstration Project
Objective:
To provide a review of the extant research literature on Housing First (HF) for people with severe mental illness (SMI) who are homeless and to describe the findings of the recently completed At Home (AH)–Chez soi (CS) demonstration project. HF represents a paradigm shift in the delivery of community mental health services, whereby people with SMI who are homeless are supported through assertive community treatment or intensive case management to move into regular housing.
Method:
The AH–CS demonstration project entailed a randomized controlled trial conducted in 5 Canadian cities between 2009 and 2013. Mixed methods were used to examine the implementation of HF programs and participant outcomes, comparing 1158 people receiving HF to 990 people receiving standard care.
Results:
Initial research conducted in the United States shows HF to be a promising approach, yielding superior outcomes in helping people to rapidly exit homelessness and establish stable housing. Findings from the AH–CS demonstration project reveal that HF can be successfully adapted to different contexts and for different populations without losing its fidelity. People receiving HF achieved superior housing outcomes and showed more rapid improvements in community functioning and quality of life than those receiving treatment as usual.
Conclusions:
Knowledge translation efforts have been undertaken to disseminate the positive findings and lessons learned from the AH–CS project and to scale up the HF approach across Canada.
Journal Article
Illness (self) management, clinical and functional recovery as determinants of personal recovery in people with severe mental illnesses: A mediation analysis
This study analyzed the association between changes over time in illness self-management skills and personal recovery in patients with schizophrenia and other severe mental illnesses and determined the degree to which this association was mediated by changes in clinical and functional recovery. The rationale for the hypothesized directions of association and mediation originated from a recent randomized controlled trial (RCT) on Illness Management and Recovery (IMR), the relations between these concepts suggested in a conceptual framework of IMR, and from the results of three meta-analyses. Moreover, earlier studies indicated the relevance of examining personal recovery as an outcome for people with severe mental illnesses. Outpatient participants’ data were used in this RCT (N = 165). Difference scores were constructed for all concepts by subtracting scores measured at baseline (T1) from scores at follow-up measurement (T3). We used mediation analysis to describe pathways between changes in illness management (assessed using the Illness Management and Recovery scale client version) and changes in personal recovery (assessed using the Mental-Health Recovery Measure), mediated by changes in clinical (assessed using the Brief Symptom Inventory) and functional recovery (assessed using the Social Functioning Scale). We applied the baseline data of all concepts as covariates. As inferential tests to determine the significance of the indirect paths, confidence intervals were constructed using bootstrap techniques. The results showed that the improvement in overall illness management was directly associated with improvements in personal recovery (B = .30), and indirectly through improvements in clinical recovery (indirect effect = .13) and functional recovery (indirect effect = .08). The main conclusion is that self-reported illness management appears to be more strongly and directly associated with personal recovery than indirectly via clinical and functional recovery. This analysis supports the relevance of self-management interventions such as IMR for the personal recovery of people with severe mental illnesses.
Journal Article
Recovery's edge : an ethnography of mental health care and moral agency
\"In 2003 the Bush Administration's New Freedom Commission asked mental health service providers to begin promoting \"recovery\" rather than churning out long-term, \"chronic\" mental health service users. Recovery's Edge sends us to urban America to view the inner workings of a mental health clinic run, in part, by people who are themselves \"in recovery\" from mental illness. In this provocative narrative, Neely Myers sweeps us up in her own journey through three years of ethnographic research at this unusual site, providing a nuanced account of different approaches to mental health care. Recovery's Edge critically examines the high bar we set for people in recovery through intimate stories of people struggling to find meaningful work, satisfying relationships, and independent living. This book is a recipient of the Norman L. and Roselea J. Goldberg Prize from Vanderbilt University Press for the best book in the area of medicine\"--Provided by publisher.
Book
The Work and Social Adjustment Scale: a simple measure of impairment in functioning
Patients' perspectives concerning impaired functioning provide important information. AIMS; To evaluate the reliability and validity of the Work and Social Adjustment Scale (WSAS).
Data from two studies were analysed. Reliability analyses included internal scale consistency, test-retest and parallel forms. Convergent and criterion validities were examined with respect to disorder severity.
Cronbach's alpha measure of internal scale consistency ranged from 0.70 to 0.94. Test-retest correlation was 0.73. Interactive voice response administrations of the WSAS gave correlations of 0.81 and 0.86 with clinician interviews. Correlations of WSAS with severity of depression and obsessive-compulsive disorder symptoms were 0.76 and 0.61, respectively. The scores were sensitive to patient differences in disorder severity and treatment-related change.
The WSAS is a simple, reliable and valid measure of impaired functioning. It is a sensitive and useful outcome measure offering the potential for readily interpretable comparisons across studies and disorders.
Journal Article