Empirical evidence about recovery and mental health

Abstract

BackgroundTwo discourses exist in mental health research and practice. The first focuses on the limitations associated with disability arising from mental disorder. The second focuses on the possibilities for living well with mental health problems.DiscussionThis article was prompted by a review to inform disability policy. We identify seven findings from this review: recovery is best judged by experts or using standardised assessment; few people with mental health problems recover; if a person no longer meets criteria for a mental illness, they are in remission; diagnosis is a robust basis for characterising groups and predicting need; treatment and other supports are important factors for improving outcome; the barriers to receiving effective treatment are availability, financing and client awareness; and the impact of mental illness, in particular schizophrenia, is entirely negative. We selectively review a wider range of evidence which challenge these findings, including the changing understanding of recovery, national mental health policies, systematic review methodology and undertainty, epidemiological evidence about recovery rates, reasoning biased due to assumptions about mental illness being an illness like any other, the contested nature of schizophrenia, the social construction of diagnoses, alternative explanations for psychosis experiences including the role of trauma, diagnostic over-shadowing, stigma, the technological paradigm, the treatment gap, social determinants of mental ill-health, the prevalence of voice-hearing in the general population, and the sometimes positive impact of psychosis experience in relation to perspective and purpose.ConclusionWe propose an alternative seven messages which are both empirically defensible and more helpful to mental health stakeholders: Recovery is best judged by the person living with the experience; Many people with mental health problems recover; If a person no longer meets criteria for a mental illness, they are not ill; Diagnosis is not a robust foundation; Treatment is one route among many to recovery; Some people choose not to use mental health services; and the impact of mental health problems is mixed.

Understanding Long-term Outcome from the Patients’ Perspective: A Mixed Methods Naturalistic Study on Inpatient Psychotherapy

“…In accordance with the altered perspective of the participants in this study, a broader view on recovery can be noticed in the organisation of (mental) health care: a dichotomous understanding of “health” versus “illness” is increasingly replaced by a definition of “positive health” (Delespaul et al, 2016; Huber et al, 2011; Slade & Longden, 2015). The latter emphasizes the possibilities and abilities, given psychological, physical and social challenges and is considered more in line with clinical practice (Delespaul et al, 2016).…”

Varieties of Voice-Hearing: Psychics and the Psychosis Continuum

“…This is consistent with a recovery-oriented understanding of voice-hearing. 45 Indeed, a similar ability to control voice-hearing was first reported by Romme and Escher in their survey of non-help-seeking voice-hearers. 21 Furthermore, anthropological studies of voice-hearing in small face-to-face societies found that shamans, spiritual practitioners who work for the good of the group by channeling metaphysical powers, also maintained a degree of control over their experiences.…”

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

“…Beyond stigma, many people diagnosed with psychosis report that the diagnosis itself, especially when provided by institutions which appear to embrace stigma, is experienced as invalidating their potential identity and as an effort to control them in a paternalistic manner [150][151][152] . Indeed, independent studies have reported that clinical insight and stigma interact in a manner that results in the experience of reduced meaning 153 and self-clarity in life 154 .…”