Cheryl Gagne

Implementing recovery oriented evidence based programs: identifying the critical dimensions.

In the decades of the 1990s many mental health programs and the systems that fund these programs have identified themselves as recovery-oriented. A program that is grounded in a vision of recovery is based on the notion that a majority of people can grow beyond the catastrophe of a severe mental illness and lead a meaningful life in their own community. First person accounts of recovery and empirical research have led to a developing consensus about the service delivery values underlying recovery. The emphasis on recovery-oriented programming has been concurrent with a focus in the field on evidence-based practices. We propose that evidence based practices be implemented in a manner that is recovery compatible. Program dimensions for evidence based practice, such as program mission, policies, procedures, record keeping and staffing should be consistent with recovery values in order for a program to be considered to be recovery-oriented. This article describes the critical dimensions of such value based practice, regardless of the service the recovery oriented mental health programs provide (e.g., treatment, case management, rehabilitation). The aim of this first attempt at conceptualizing recovery-oriented mental health programs is to both provide direction to those involved in program implementation of evidence based mental health practices, as well as providing a stimulus for further discussion in the field.

The process of recovery from schizophrenia

To facilitate future research on recovery from schizophrenia a qualitative, longitudinal analysis was conducted with individuals participating in rehabilitation to identify themes associated with improvement in functioning and subjective experience. Twelve individuals with a diagnosis of schizophrenia or schizoaffective disorder were randomly selected from a just concluded two-year study of psychiatric rehabilitation. Each individual was followed for an additional four years. Every four to eight months each person participated in a semistructured,audiotaped interview about his or her current life experiences. Tapes were evaluated independently by three assessors for themes and phases that emerged from these life experiences. The qualitative analysis characterized the process of recovery as having phases, dimensions, indicators, and barriers to recovery. This empirically derived description of the process of recovery, from the perspective of people who are experiencing it, can be used to generate research hypotheses for future studies to further our understanding and to promote recovery from schizophrenia.

Recovery: a common vision for the fields of mental health and addictions.

The vision of recovery is reshaping the fields of mental health and addiction services. This paper reviews how this broad vision is shaping common goals, principles, values and strategies across the two fields. We further examine how a common vision of recovery can positively impact the treatment of co-occurring disorders and speculate on how this vision can bridge the seeming differences between these two fields and reshape a mutual understanding of the essentials of recovery from severe mental illness and addiction.

Challenges Experienced by Paid Peer Providers in Mental Health Recovery: A Qualitative Study

Peer providers are increasingly employed in mental health services. We explored challenges experienced by 31 peer providers in diverse settings and roles using in-depth interviews, as part of a larger study focusing on their recovery (Moran et al. in Qual Health Res, 2012). A grounded theory approach revealed three challenge domains: work environment, occupational path, and personal mental health. Challenges in the work environment differed between conventional mental health settings and consumer-run agencies. Occupational domain challenges included lack of clear job descriptions, lack of skills for using one’s life story and lived experience, lack of helping skills, and negative aspects of carrying a peer provider label. Personal mental health challenges included overwork and symptom recurrence. Implications for all domains are discussed, with focus on training and skill development.

A framework for health promotion services for people with psychiatric disabilities.

The concepts of wellness and its complement, health promotion, have popularized the notion that health itself is more than simply the absence of disease. Furthermore, the wellness concept has advanced the idea of the importance of engaging in certain health promoting behaviors within healthy environments, not simply for the purpose of preventing or better managing a disease, but also to enhance ones well-being and quality of life (Green & Kreuter, 1991; Mullen, 1986). Encouraging this emphasis on wellness is Healthy People 2010 (U.S. Department of Health and Human Services, 2000), a national ten-year plan intended to increase quality and years of life and eliminate disparities which for the now features a new area that recognizes the importance of health promotion and disease prevention in the lives of people with disabilities. Increasingly, the value of promoting wellness--including for people with disabilities--is being recognized (Rimmer & Braddock, 2002).

Compeer Friends: a Qualitative Study of a Volunteer Friendship Programme for People with Serious Mental Illness:

Background: People with serious mental illness (SMI) experience numerous barriers to developing and maintaining friendships. Aims: To explore the benefits and drawbacks of an intentional friendship programme (Compeer, Inc), which develops new social relationships for people with SMI by matching them in one-to-one relationships with community volunteers for weekly social activities. Methods: Twenty clients and volunteers, in Compeer friendships for different lengths of time, participated in individual semi-structured qualitative interviews. Several volunteers were themselves current or former consumers of mental health services. Results: Participants reported numerous benefits to participating in Compeer. Clients and volunteers spoke enthusiastically about the benefits of gaining a friend. Many intentional relationships deepened over several years into mutually beneficial friendships. Most clients became more outgoing, sociable and active, with increased self-esteem, self-worth and self-confidence. Volunteers who had experienced mental illness themselves provided unique added benefits to the relationship. Drawbacks were minimal and financial and other costs to volunteers were low. Conclusions: Intentional friendships can be a potent yet cost-effective way to help people with SMI develop social skills, expand their social networks, and improve their quality of life. However, because relationships take several years to develop, quantitative evaluations using short follow-up periods may underestimate programme effectiveness.

A Randomized Controlled Trial of a Peer-Run Antistigma Photovoice Intervention

OBJECTIVE Psychiatric stigma is a major barrier to the recovery of persons with serious mental illnesses. This study tested the efficacy of an innovative peer-run photography-based intervention, called antistigma photovoice, which targets self-stigma and promotes proactive coping with public stigma. METHODS A total of 82 individuals with serious mental illnesses enrolled at a university-based recovery center were randomly assigned to the antistigma photovoice program or to a wait-list control group. Mixed-effects regression models were used to examine the impact of photovoice on self-stigma, coping with stigma, empowerment, perceived recovery, self-efficacy, and depression. RESULTS Participation in the photovoice intervention was associated with significantly reduced self-stigma, greater use of proactive coping with societal stigma, greater increase in a sense of community activism, and perceived recovery and growth. CONCLUSIONS The photovoice intervention demonstrated promise for reducing self-stigma and enhancing proactive coping with prejudice and discrimination.

The Recovery Framework in Rehabilitation and Mental Health

We have raised and responded to four basic questions about recovery. Because we are still uncovering this important process we need to acknowledge with sincere humility that there is still a long way to go and much to learn. But what we have learned is that people grow emotionally, physically, and intellectually as part of this process we call recovery. They grow emotionally through enhanced self-esteem, self-efficacy, self-respect, meaningful connections to others, meaningful work, a sense of hope, and personal empowerment. They grow physically through increased fitness, improved nutrition, and better health care. They grow intellectually through a better understanding of their disability, effective coping mechanisms, and the development and implementation of personal goals. It is through our connections with people who are experiencing mental illnesses that we will continue to learn and to grow in our knowledge about recovery.