Assessing Mental Illness Recovery
Condition: Serious Mental Illness
MeSH terms: Mental Disorders
Study type: Observational

Summary: 
      In 2003 the VA Undersecretary's Action Agenda mandated that mental health services throughout
      the system be transformed to a recovery model. That mandate and many of the Workgroup
      recommendations have since been formalized in the Uniform Mental Health Services Package,
      which specifies a range of recovery-oriented services that must be available to veterans. A
      key aspect of these policy mandates is the need to assess recovery status of veterans and to
      monitor their progress over time as a way to evaluate the effectiveness of recovery services.
      However, there is no established instrument that is suitable for system-wide application. The
      purpose of this project is to develop a reliable, valid and practical measure of recovery,
      and use the measure in a study to better understand recovery in individuals with serious
      mental illness.
    

Detailed description: 
      Mental health care in the United States and Western Europe is undergoing a seismic shift in
      values. The paternalistic, medical model of care that has dominated practice for more than
      75-years is being challenged by an activist group of consumer-survivors, with the support of
      public officials and an increasing number of professionals. The centerpiece of this shift is
      the recovery model, which assumes that all consumers have the capacity to improve and develop
      a life distinct from their illness. The consumer model of recovery involves a non-linear
      process in which the consumer gradually adapts to, and moves beyond the illness. It
      emphasizes hope, empowerment, and control of one's life. This model stands in contrast to
      scientific and clinical models, which view recovery as an outcome, primarily involving
      reduced symptoms and improved functional capacity.

      The public health significance of the consumer perspective is underscored by the President's
      New Freedom Commission on Mental Health (2003), which enunciated two guiding principles for
      mental health services in the US: First, services and treatments must be consumer and family
      centered, geared to give consumers real and meaningful choices about treatment options and
      providers. Second, care must focus on increasing consumers' ability to successfully cope with
      life's challenges, on facilitating recovery, and on building resilience, not just managing
      symptoms. In response to the Commission report the VA has mandated a shift to a recovery
      model and committed a large amount of resources to implementing it throughout the system.

      Despite this political and programmatic change, there is little scientific literature on the
      nature of recovery or the factors that contribute to it. Systems change is being driven by
      social mandate and consensual agreement rather than empirical support. It is essential that
      the consumer model of recovery be subjected to empirical study if it is to have a meaningful
      and lasting impact on systems and patterns of care. It is also critical to evaluate the
      recovery-oriented systems of care that have been developed. Two factors that have limited
      empirical study of the construct and treatment programs are: a) the absence of a
      scientifically grounded conceptual model of recovery, and b) the lack of a reliable and valid
      assessment instrument to measure recovery status. The purpose of this project is to develop
      and evaluate a psychometrically sound assessment scale using Bandura's social cognitive
      theory as a conceptual model for the recovery construct.

      The Specific Aims are: 1) to evaluate and refine the draft version of the Maryland Assessment
      of Recovery in Serious Mental Illness (MARS), 2) evaluate its test-retest reliability and
      validity, and 3) to examine recovery status and the relationship of recovery to hypothesized
      mediators and moderators over a 1-year retest interval.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        We have elected to focus on individuals meeting accepted criteria for serious mental
        illness, including a diagnosis of schizophrenia or schizoaffective disorder, bipolar I
        disorder (with mania), and major depression with psychosis. Individuals meeting these
        criteria represent a large population with significant costs and health concerns for VA.
        Further, they are the primary target of efforts to transform mental health care in VA to a
        recovery model, making this an arena in particular need of a sound recovery instrument.

        We have elected to limit our sample to people in treatment for several reasons. One can
        surmise that most people not in treatment are new cases, very ill (e.g., homeless), or
        doing very well.
      
Biospecimen description: 
      no specimens collected
    
Keywords: recovery; serious mental illness