A social construction of remission for people with a diagnosis of schizophrenia
Authors: Ford Keith 
Published: March 2018

Purpose
The purpose of this paper is to provide a social construction of remission in relation to schizophrenia by the people affected most. The qualitative perspective utilised is a contrast to the majority of papers around, which have been quantitative when addressing the concept of remission for people with a diagnosis of schizophrenia. This paper acknowledges and demonstrates evidence of listening to the stakeholder groups affected by the issues associated with remission and recovery, and delivers clarity around the phenomena of remission in relation to recovery.

Design/methodology/approach
A constructivist grounded theory approach was employed, exploring participants’ interpretation of the concept of remission in schizophrenia. A purposive sample, of nine professionals, ten service users and seven carers, was recruited from two community mental health teams in the UK. Semi-structured interviews were employed to yield the data and all interview transcripts were analysed utilising “qualitative codes” thereby defining what is seen in the data. Diagramming and concept mapping was employed. Theoretical sensitivity was applied to demonstrate remission in abstract terms and to illustrate the openness, transparency and intention of the study.

Findings
The findings resulted in a conceptual map of the themes generated from the data. From this map four possible trajectories were developed, each highlighting a route which could be taken and the issues faced along the way. Positive and negative aspects of the trajectories offer discussion points for service users and practitioners alike to consider in their professional relationship. In addition a representation of the current interplay between recovery and remission is highlighted to offer clarity in relation to present service provision.

Research limitations/implications
The perspective and opinion from practitioners in Primary Care services was not proposed or included within this study. To gain an improved and realistic insight into this perspective a range of practitioners from primary care could provide valuable data for any future study as this would prove to be a valuable enhancement. This study offered a broad overview of professional groups with the ability to discuss mental health services, although it did not allow for a concentration from specific professional groups and therefore they were not able to fully represent their professional group.

Practical implications
This paper has illuminated the area of remission for people with schizophrenia and will therefore have practical implications in respect of on-going service development. In particular the interface between primary and secondary services which have struggled to employ consistent terminology serving only to confuse service users and service providers alike. The trajectories illustrated in this study offer clarity and understanding and direction for improved practice to facilitate recovery for people with a diagnosis of schizophrenia. Shared understanding of concepts between service users and providers could be a large move in a positive direction.

Social implications
The movement of people formerly diagnosed with schizophrenia from secondary mental health services back to primary care may have huge social implications. Resistance, stigma and ignorance play a large part in services “having to” retain people within secondary mental health services. Misunderstandings around diagnosis, and terms such as remission and recovery fuel such confusion resulting in a risk averse position for most. This study clarifies some of the issues in relation to the transition back to society and citizenship for people and offers scope for further research of a qualitative nature too.

Originality/value
Previous studies around the concept of remission for people with a diagnosis of schizophrenia have centred on medication efficacy, utilising remission criteria to determine changes in symptomolotolgy. These quantitative papers have not addressed service users, carers or practitioners in healthcare in relation to their understanding of the term remission, in relation to recovery; or whether they feel it would be of use in clinical practice. This study addressed those issues gaining valuable in-depth data from participants, deriving the social construction of remission and the impact it may have in clinical practice in a non-pathologising perspective.