Recovery from severe mental illness: an intrapersonal and functional outcome definition

To promote research and improved clinical practice, three criteria are proposed to define recovery from severe mental illness: hope, self-responsibility and 'getting on with life' beyond illness. Each of these criteria can be measured at the intrapsychic-subjective, inter-personal-behavioral, and environmental levels. The criteria were identified through cumulative experiences of a decade of clinical services research at the New Hampshire-Dartmouth Psychiatric Research Center, contributions from consumers and family advocates, and focus groups. Measures of each criterion are proposed through the use of extant assessment instruments such as the Beck Hopelessness Scale, Locus of Control Questionnaire, instrumental and social role functioning scales, and subjective ratings of quality of life. Collateral sources of information are required to assure that the measures of the criteria for recovery are reliable, accurate and valid. The criteria selected to define recovery have already instigated the use of a broad array of tools to assess the course and outcome of schizophrenia in research and clinical practice. Concentrating on the importance of self-responsibility as a criterion should have the spin-off benefit of encouraging psychiatrists to more actively involve their clients in a collaborative enterprise for pharmacotherapy, including education in disease management and shared decision-making. To promote recovery using the three component definition will require rehabilitation practitioners to provide services that should facilitate clients managing and directing their own lives with greater autonomy. Services that enable clients to develop the social and independent living skills needed for community reintegration will engender hope, self-responsibility, and the development of a functional person who has recovered from a disabling mental disorder. Operationalizing recovery should accelerate hypothesis-testing research on this construct, including determining the attributes of treatment and rehabilitation services that are associated with optimal states of recovery.