Schizophrenia Bulletin Advance Access originally published online on April 26, 2006
Schizophrenia Bulletin 2006 32(3):430-431; doi:10.1093/schbul/sbj070
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Guest Editor Introduction: Promoting Recovery: Achieving the Promise
The report of the President's New Freedom Commission on Mental Health1 presents an ambitious agenda to transform the nation's mental health care systems (or current lack thereof) in order to better meet the needs of patients and families. One of the guiding principles for the report states that, in addition to ensuring that services and treatments are consumer- and family-centered, "care must focus on increasing consumers' ability to successfully cope with life's challenges, on facilitating recovery, and on building resilience, not just on managing symptoms."1 The report goes on, "Recovery refers to the process in which people are able to live, work, learn, and participate fully in their communities. For some individuals, recovery is the ability to live a fulfilling and productive life despite a disability. For others, recovery implies the reduction or complete remission of symptoms. Science has shown that having hope plays an integral role in the individual's recovery."1
What are the implications of the commission's report for persons with schizophrenia and our research agenda? In this issue we attend to the application of such a recovery orientation to the ongoing development of psychosocial treatments for persons with schizophrenia. The intent of concentrating here on psychosocial treatments in no way diminishes the essential role that pharmacological treatments play in promoting recovery, but rather it sheds light on the particular opportunities and challenges that lie ahead in making sure that psychosocial treatments address recovery.
The commission's report presents several challenges. It emphasizes that services must be consumer- and family-centered, meaning that the goals of services must be driven by the needs of patients and families, not by those of bureaucracies, guilds, payers, or industry. This leads to the commission's focus on treatments and services that promote patients' capacity to pursue their lives in their communities to the fullest possible extent, embracing the process of recovery. Hence, the outcomes relevant to this mission extend well beyond the reduction of symptoms. Of course, symptoms themselves can interfere dramatically with the capacity to experience life fully, and treatments that reduce symptoms can substantially contribute to the recovery process. However, the commission underscores that symptom reduction per se is hardly sufficient to promote the recovery of function and well-being, and it emphasizes the need for treatments and services that enhance these outcomes as well. This brings us to some critical and fundamental questions for research: How can the processes of research embrace the interests of consumers and families? What interventions should be developed and tested? What outcomes should be evaluated? How should our research infrastructure be modified to better incorporate consumer and family-centeredness and recovery?
Our research agenda is still heavily driven by the interests of investigators and "sponsors." Hence, the interventions studied and the outcomes assessed are largely determined by the research community and industry, not by consumers and families. How can the collaboration between researchers, consumers, families, and service systems be enhanced to promote a transformation? It is striking that when one examines our body of effectiveness research, the bulk of the attention has been given to "clinical" outcomes, symptom and relapse reduction, rather than functioning and well-being.2 This is as true for psychosocial research as it is for pharmacotherapy research. Also, the range of interventions evaluated remains quite narrow, such that it is not uncommon to hear stakeholders who are not researchers—eg, consumers, families, services providers, and state mental health directors—complain that for many of their most pressing service questions the body of research seems irrelevant or silent.3 The commission's report challenges researchers to be more collaborative with consumers and families in order to promote a recovery-oriented agenda. Such collaborations should include identifying and prioritizing the research questions, defining the terms and conditions of interventions and the "real world" circumstances under which research will be most relevant to patients' lives, and focusing on the outcomes that emphasize a recovery orientation.
To this end, this special section presents 5 explorations of psychosocial treatment research in schizophrenia with a critical eye toward the challenges ahead. Bellack4 examines the recovery concept and its implications for the development of evidence-based practices. Davidson and colleagues5 review the emerging area of "peer support" programs, presenting a conceptual framework for thinking about these services, preliminary research, and future directions. The emerging field of cognitive remediation is examined by Velligan and colleagues,6 with an emphasis on motivation and its influence on outcomes. Drake and colleagues7 consider the evidence on recovery among patients with co-occurring schizophrenia and substance abuse disorders, focusing on a broad range of recovery-related outcomes, including symptom reduction, remission from substance abuse, independent living, employment, social relations, and life satisfaction. Finally, Glynn et al.8 review the various interventions that have been evaluated to help families and pose some challenging questions about future research in this area that are raised by the commission's report.
We hope to inform, but even more to provoke thought about the implications of a recovery orientation for future research, treatments, and action to ensure that research and services address patients' needs in their process of recovery.
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Footnotes |
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1To whom correspondence should be addressed; e-mail: Alehman{at}psych.umaryland.edu
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References |
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 Top References |
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- New Freedom Commission on Mental Health Achieving the Promise: Transforming Mental Health Care in America, Executive Summary. Rockville, Md: US Dept of Health and Human Services 2003. DHHS publication SMA-03-3831.
- Lehman, AF, Kreyenbuhl, J, Buchanan, RW, et al. The schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations, 2003. Schizophr Bull . 2004; 30:193–217.
[Abstract/Free Full Text] - Hogan, MF. Translating research into practice: the schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull . 1998; 24:27–30.[Web of Science]
- Bellack, A. Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications. Schizophr Bull . In press.
- Davidson, L, Chinman, M, Sells, D, Rowe, M. Peer support among adults with serious mental illness: a report from the field. Schizophr Bull . In press.
- Velligan, DI, Kern, RS, Gold, JM. Cognitive rehabilitation for schizophrenia and the putative role of motivation and expectancies. Schizophr Bull . In press.
- Drake, RE, McHugo, GJ, Xie, H, Fox, M, Packard, J, Helmstetter, B. Ten-year recovery outcomes for clients with co-occurring schizophrenia and substance use disorders. Schizophr Bull . In press.
- Glynn, SM, Cohen, AN, Dixon, LB, Niv, N. The potential impact of the recovery movement on family interventions for schizophrenia: opportunities and obstacles. Schizophr Bull . In press.
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