Recovery from serious mental illness: examining traditional clinical and psychosocial factors

The aim of the current study was to advance the current understanding of recovery from serious mental illness (SMI) by examining the construct and some of the associated factors. The study used the consumer-driven notion of recovery describing a personal process of overcoming SMI. SMI was defined as an enduring psychiatric, emotional, or dual diagnosis that has a serious impact on a person’s quality of life, functioning ability, and health. The dependent variables were recovery and functional disability. An assessment of functioning is often used to assess outcomes, and was used in the study to compare findings with recovery. The current study examined a selection of psychosocial variables alongside some of the more traditional clinical variables used in the SMI research literature and treatment. Psychosocial factors were drawn from an attachment framework (i.e., attachment style, schemas, and coping style). Clinical predictors were selected from more traditional clinical outcome research in the SMI literature (i.e., medication adherence, substance use, severity of illness, and functional disability). The study was a cross-sectional design using a quantitative measure of recovery (the Recovery Assessment Scale; Giffort, Schmook, Woody, Vollendorf, & Gervain, 1995). One hundred and fifty-four participants were recruited from Mind Australia, a non-government psychiatric rehabilitation service. Participants completed a questionnaire at the recruitment sites and relevant information was also collected from the participant’s case files and support staff. Hierarchical regression found that an active coping style and low negative evaluations of self were the strongest unique predictors of recovery. Structural equation modeling showed a series of interactions between psychosocial variables and recovery involving attachment anxiety and avoidance, self-schemas, and active RECOVERY FROM SERIOUS MENTAL ILLNESS iv coping. Of the clinical variables, the number of hospitalisations and degree of medication adherence had the strongest relationships with recovery, but demonstrated smaller magnitude associations relative to the psychosocial variables. While research and clinical practice continually strive to maximise outcomes for those with an SMI, the current findings suggest that interventions targeting psychosocial variables (particularly those relating to active coping and self-views) would make a significant contribution to recovery, over and above the contribution of traditional clinical programs that target medication adherence and substance use. This in no way suggests that clinical variables are not important; rather, that an excessive focus on traditional clinical variables may occur at the expense of psychosocial variables which are amenable to psychosocial interventions. Furthermore, the use of subjective measures of recovery in research can provide unique information that is not always accessible using measures based solely on symptoms. The study’s findings have important implications for research, clinical practice, and policy. RECOVERY FROM SERIOUS MENTAL ILLNESS v Acknowledgements I would like to sincerely thank my supervisor Professor Michael Kyrios for his widereaching knowledge, brilliant mind, and ability to find the precise words (such as “zeitgeist”) needed to convey my ideas. Thank you to Dr. Greg Murray for his ability to approach things from a new and intriguing perspective. Thank you to Denny Meyer for her endless patience and dedication to her teachings that brought out my “inner geek” and sparked a new interest for me. Thank you Richard for your help with my statistics, and thank you Jennifer for lending me your precious time and your eye for detail. Thank you to all of my wonderful friends and family for your relentless enquiry into my progress and convincing interest, despite only a fuzzy understanding of my responses. Your care has made every success more exciting, and every disappointment bearable. To my mum who provides me with a model of strength, and always takes my side when any injustice had been dealt to her daughter. To Rick, who has read over endless essays for 10 years, and taught me how to convey my entirely chaotic ideas into a somewhat sensical format. To my father, who instilled me with determination, and encouraged me to always question the norm. To my beautiful sister Shey, whose pride in my achievements reminds me to be proud of myself. Thank you to Marc, the beautiful man at my side who has been so flexible, tolerant, and loving. Thank you for reminding me to take time out to play, and coming home each night to break up my socially deprived days. The Australian Post Graduate Awards, Department of Human Services, and Mind Australia provided funding for this research. The completion of this project would not have been possible without their generous financial support. Finally, I would like to thank the consumers whom I have worked with and learned from. I thank you for sharing your stories of anguish and hope. You have inspired me as a psychologist, researcher, and as a fellow human being. RECOVERY FROM SERIOUS MENTAL ILLNESS vi Declaration of Authorship I certify that the attached material is my original work. To the best of my knowledge, it contains no material previously published or written by another person, without due acknowledgement and reference made in the text. Except where stated that I have used some of this material elsewhere, it has not been presented by me for examination in any other course or subject at this or any other institution. The thesis is less than 100,000 words in length, exclusive of references and appendices. The research undertaken for this thesis was approved by the Swinburne University Ethics Committee (SUHREC Project 0607/213).