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Conceptualizations, Assessments, and Implications of Personal Recovery in Mental Illness: A Scoping Review of Systematic Reviews and Meta-Analyses

Authors:
Jaap van Weeghel at Tilburg University
Jaap van Weeghel
Catherine van Zelst
Catherine van Zelst
Catherine van Zelst
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Dienke Boertien
Dienke Boertien
Dienke Boertien
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Ilanit Hasson-Ohayon at Bar Ilan University
Ilanit Hasson-Ohayon
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Abstract

Objective: Recovery, defined as a personal process of living with mental illness, has become a prominent concept in mental health care. We aimed to map the state of the art of conceptualizing recovery, its promoting and impeding factors, recovery-oriented practice, and the assessment of recovery. Method: A scoping review of systematic reviews and meta-analyses was performed. Systematic searches were conducted, supplemented with hand-searching in reference lists. Results: Of 228 articles that were identified and 33 that were reviewed, a total of 25 were included. This review showed that the CHIME conceptual framework for personal recovery is widely endorsed, containing the elements of connectedness, hope and optimism, identity, meaning in life, and empowerment. Although personal recovery first and foremost starts from individual preferences, the CHIME framework should be adapted according to culture and unique population characteristics. "Difficulties and trauma" should be added, and the person's choice, risk taking, and coping with challenges should be emphasized. Barriers to recovery are stigma and negative effects of mental health services and medication. Facilitators of recovery include spirituality, personal agency, and social support. Recovery-focused interventions, in which peer providers are involved, enhance recovery, hope, and empowerment. For assessing recovery outcomes, multiple instruments are accepted as methodologically sound. Conclusions: Personal recovery is conceptualized as complementary to clinical recovery and represents processes rather than outcomes. Additional work is needed to bridge the gap between the concept of recovery-oriented practice and routinely provided interventions. A broad framework of recovery is needed, and more research is needed into the working mechanisms of personal recovery processes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Conceptualizations, Assessments, and Implications of Personal Recovery in
Mental Illness: A Scoping Review of Systematic Reviews and
Meta-Analyses
Jaap van Weeghel
Phrenos Center of Expertise, Utrecht, the Netherlands, and
Tilburg University
Catherine van Zelst
Maastricht University
Dienke Boertien
Phrenos Center of Expertise, Utrecht, the Netherlands
Ilanit Hasson-Ohayon
Bar-Ilan University
Objective: Recovery, defined as a personal process of living with mental illness, has become a
prominent concept in mental health care. We aimed to map the state of the art of conceptualizing
recovery, its promoting and impeding factors, recovery-oriented practice, and the assessment of
recovery. Method: A scoping review of systematic reviews and meta-analyses was performed.
Systematic searches were conducted, supplemented with hand-searching in reference lists. Results:
Of 228 articles that were identified and 33 that were reviewed, a total of 25 were included. This
review showed that the CHIME conceptual framework for personal recovery is widely endorsed,
containing the elements of connectedness, hope and optimism, identity, meaning in life, and
empowerment. Although personal recovery first and foremost starts from individual preferences, the
CHIME framework should be adapted according to culture and unique population characteristics.
“Difficulties and trauma” should be added, and the person’s choice, risk taking, and coping with
challenges should be emphasized. Barriers to recovery are stigma and negative effects of mental
health services and medication. Facilitators of recovery include spirituality, personal agency, and
social support. Recovery-focused interventions, in which peer providers are involved, enhance
recovery, hope, and empowerment. For assessing recovery outcomes, multiple instruments are
accepted as methodologically sound. Conclusions: Personal recovery is conceptualized as comple-
mentary to clinical recovery and represents processes rather than outcomes. Additional work is
needed to bridge the gap between the concept of recovery-oriented practice and routinely provided
interventions. A broad framework of recovery is needed, and more research is needed into the
working mechanisms of personal recovery processes.
Impact and Implications
Personal recovery entails the idea of learning to live a good life in the face of mental illness. It refers
to a process rather than to an outcome, including elements of connectedness, hope and optimism,
identity, meaning in life, empowerment, responsible risk taking, and coping with challenges.
Recovery-oriented practices should encompass direct work not only with clients but also with
families, systems, and communities.
Keywords: personal recovery, severe mental illness, recovery-oriented practice, scoping review
This article was published Online First March 7, 2019.
Jaap van Weeghel, Phrenos Center of Expertise, Utrecht, the Neth-
erlands, and Tranzo Department, Tilburg University; Catherine van
Zelst, Department of Psychiatry and Neuropsychology, Maastricht Uni-
versity; Dienke Boertien, Phrenos Center of Expertise, Utrecht, the
Netherlands; Ilanit Hasson-Ohayon, Department of Psychology, Bar-
Ilan University.
Correspondence concerning this article should be addressed to Jaap van
Weeghel, Phrenos Center of Expertise, Da Costakade 45, 5321 VS,
Utrecht, the Netherlands. E-mail: jweeghel@kcphrenos.nl
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Psychiatric Rehabilitation Journal
© 2019 American Psychological Association 2019, Vol. 42, No. 2, 169–181
1095-158X/19/$12.00 http://dx.doi.org/10.1037/prj0000356
169
... The Recovering Quality of Life-Utility Index (ReQoL-UI) which was developed based on the ReQoL-20, showed moderate correlation with the EQ-5D-5 L in the general population of Hong Kong [43]. In addition, recovery from severe mental illness involves developing a sense of control over one's illness through personal agency (i.e., what people can do on their own) [44], is facilitated by personal agency [45][46]. Therefore, the Five-item Subjective and Personal Agency scale (SPA-5: [47]) may be highly correlated with ReQoL Based on global evidence of its psychometric properties, ReQoL has consequently become a recommended scale as one of the standard outcome measures in the mental health field [48]. ...
... Therefore, findings being consistent with conceptual associations between variables indicated convergent validity. In particular, personal agency plays an important role in recovery from severe mental illness, as it is one of the facilitators of recovery [45,46]. Our findings support this claim, showed relationship QoL in recovery and personal agency. ...
Psychometric properties of Japanese version of the Recovering Quality of Life (ReQoL)
Article
Full-text available
  • Mar 2025
  • BMC PSYCHIATRY
Purpose This study aims to examine the psychometric properties of the Recovering Quality of Life– Japanese version (ReQoL-J) for use in the community setting. Methods This cross-sectional study was conducted among service users of community mental health service facilities. A series of confirmatory factor analyses (CFAs) was performed. After the best-fitting model was identified, omega indices, and intraclass correlation (ICC) were calculated to evaluate dimensionality and reliability. The correlation coefficients between the ReQoL-J scores and the other scales were calculated for testing construct validity. We also estimated the correlation coefficients between the ReQoL-J-10 and − 20. Results A total of 395 service users from 23 facilities in Japan participated in this study. Of these, 66 responded to the test-retest reliability. The bifactor model showed the best fit to the data: χ²/df = 1.74, CFI = 0.993, RMSEA = 0.031, and SRMR = 0.038. ECV and OmegaH indicated unidimensionality. ICC for the Re-QoL-J-10 and − 20 were 0.700 and 0.766, respectively. The ReQoL-J-10 showed a high correlation with the ReQoL-J-20 (r =.95, p <.001). The EQ-5D-5 L, a new brief scale for subjective personal agency (SPA-5), well-being and the quality of life scale (QLS) scores were positively correlated with the ReQoL-J score. On the other hand, the patient health questionnaire-9 (PHQ-9) and the WHODAS scores were negatively correlated with the ReQoL-J score. Conclusion Factor structure, internal consistency, test-retest reliability, and construct validity of the ReQoL-J were confirmed. The ReQoL-J is a promising tool as a patient-reported outcome measure in mental health services for the Japanese community setting.
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... Rather, our aim is to rethink what recovery is. Recovery thinking centers on the idea of recovering a life worth living by finding coherence, sense, and hope despite or even because of having symptoms (Barber 2012;Van Weeghel et al. 2019). Personal recovery is defined as "learning to live better in the face of mental illness" (Davidson 2012, p. 261). ...
... It is called personal recovery. Recovery, for example, is defined as regaining meaning, hope, and coherence in spite of or even because of symptoms in order to regain a life worth living (Barber 2012;Van Weeghel et al. 2019). "Learning to live better in the face of mental illness" is another definition of recovery (Davidson 2012, p. 261). ...
The Existential Dimension in Recovery: Crisis, Loss, and Grief in the Context of Severe Mental Illness
Article
Full-text available
  • Feb 2025
The recovery movement in mental health care has played an important role in the recent renewed and growing focus on understanding the function of meaning and spirituality in the context of severe mental illness. Current recovery thinking is firmly embedded in a body of thought according to which people have meaningful lives. It is characterized by various emphases, among which positive transformation. Though valuable and laudable in itself, this bias toward future-oriented improvement leaves our understanding of the nature and implications of a mental health crisis as a crisis in meaning underdeveloped. In this article, we approach recovery from a phenomenological angle and explore mental health crisis as an existential crisis characterized by disruption and radical alteration of sense-making and meaning. In particular, we show how themes of loss and grief are part of this existential crisis and its aftermath. It is argued that themes of loss and grief are crucial aspects of the recovery process. Several fruitful ways are suggested to incorporate those themes. This, it is maintained, provides a more thorough, realistic, integrated, and, therefore, more nuanced view of the complex process of recovery in the context of severe mental illness.
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... Functional recovery relates to performance of daily tasks (independent living, work, learning), engaging in social interactions and role performance [6][7][8]. Personal recovery starts from the perspective of individuals with SMI [9][10][11]. Reports of personal recovery entail autobiographical, qualitative work. ...
... Several conceptualizations of experiences of personal recovery have been developed [11] of which the CHIME framework by Leamy et al. [10] is widely accepted. This conceptual framework, based on a literature review and narrative synthesis, identified five key recovery processes making the acronym CHIME: (1) Connectedness-having good relationships and being positively connected to others; (2) Hope-the feeling that recovery is possible; ...
Assessing personal recovery in individuals with severe mental illness: validation of the Dutch Brief INSPIRE-O
Article
Full-text available
  • Jan 2025
  • SOC PSYCH PSYCH EPID
Purpose Recovery is a key objective in mental health services for people with severe mental illness (SMI). In addition to clinical and functional recovery, personal recovery has gained increasing attention. The CHIME Framework identifies five personal recovery processes—Connectedness, Hope, Identity, Meaning, Empowerment—and is the theoretical foundation for the Brief INSPIRE, a validated Patient-Rated Experience Measure (PREM) to evaluate recovery support. Brief INSPIRE was modified to a five-item Patient-Rated Outcome Measure (PROM) assessing recovery, called Brief INSPIRE-Outcome (Brief INSPIRE-O). Subject of this study are the psychometric properties of the Brief INSPIRE-O. Methods Data on validity and reliability gathered through annual routine outcome monitoring were collected for 861 individuals with SMI of Flexible Assertive Community Treatment teams and a follow-up measurement was available for 232 of these individuals. Test–retest reliability was evaluated in a separate subset of 30 individuals with SMI. Results The Brief INSPIRE-O shows good internal consistency (Cronbach’s alpha 0.77), test–retest reliability, construct validity, sensitivity to change and no floor or ceiling effects. Furthermore, change in Brief INSPIRE-O was positively related to changes in quality of life and negatively to problems in clinical functioning and unmet care need. Conclusion Brief INSPIRE-O can be used for research and monitoring to better understand and improve processes of personal recovery in individuals with SMI.
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... Despite the invitation to pay more attention to the subjectivity of people in recovery, research has found a lack of theoretical clarity on the task of supporting personal recovery in service practice, where the definition of recovery offered by staff does not always align with that proposed by users [49]. Stuart et al. [50] and Van Weeghel et al. [51] highlight the need to broaden the conceptualisation of personal recovery by taking into consideration the difficulties that people who embark on these paths may encounter. Celebrating only the strengths of those who appear to be successful might perpetuate the idea that recovery is something attainable by all who simply apply themselves. ...
One or Many Recoveries? Recoveries in the Plural for a Better Understanding of One's Healing Journey
Article
Full-text available
Background Since the 60s, the recovery‐oriented approach has greatly influenced mental health policy and practice, and much research has been devoted to exploring it. In the face of a generic definition of the ‘recovery’ construct, to which many articles refer, a closer examination of the literature reveals a plurality of theories and ways about how changes related to the recovery occur and how to evaluate them. Aims This narrative review explores the different definitions of recovery available in the literature, by investigating the adjectives that qualify it and the theoretical construct the adjective refers to. Method From the online databases PubMed, Scopus, Google Scholar and PsycINFO, 43 articles were selected for the review. Results Seven definitions of recovery emerged, each supported by specific theoretical perspectives: clinical, personal, narrative, social, family, cultural and relational recovery. The adjectives refer to theoretical frameworks often very distant from each other and in epistemological competition; nevertheless, many papers assume a reconcilability and possible integration. The authors critically discuss the advantages and risks of considering such different constructs as complementary. Conclusions Keeping theoretical descriptions and models of healing open and plural means enabling mental health practitioners not to monologise discourses of change by imposing their point of view on users. It means supporting users to authentically seek their healing pathways without conforming to clinicians' expectations. It also means abandoning misleading and naive simplifications and strictly using the appropriate terms relevant to the specific healing construct that researchers refer to from time to time. This is particularly important when it comes to the relational component, which seems to be receiving more and more attention in the literature, and about which there is more confusion. Patient or Public Involvement The study involved two experts by experience, or peer support specialists, in a more than active role as components of the research team. They participated equally with the other team members in all phases of the work: the design and conduct of the study, the discussion of findings and advice about implications and dissemination.
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... This concept was initially theorized by Deegan [8], a researcher who identify as a psychiatric survivor-a person who have experienced psychiatric treatment and now contribute to research from that perspective-before being appropriated and popularized by different professional healthcare researchers, notably by Anthony, a pioneer in the field of psychosocial rehabilitation [9]. Although the concept of recovery also lacks a consensual definition [10], the conceptual framework most commonly used in the literature today is known as Connectedness, Hope and Optimism, Identity, Meaning and Purpose, and Empowerment (CHIME) [11]. ...
Validation of a French version of the empowerment scale for mental health service users
Article
Full-text available
  • Mar 2025
  • BMC PSYCHIATRY
Background As the concept of empowerment is increasingly adopted across various mental health care contexts, there is a growing need for standardized measures to assess the effectiveness of empowerment approaches. The Empowerment Scale is widely utilized and translated within the field of mental health, despite its varied psychometric properties. This study aimed to translate the Empowerment Scale into French and assess its internal consistency, validity, and responsiveness. Methods This study was part of a larger research project involving 394 participants. The Empowerment Scale was translated into French following cross-cultural adaptation guidelines, with a translation committee consisting of experts and a professional translator. Psychometric properties were assessed using classical test theory. The factor structure was determined through principal component analysis, exploratory factor analysis, and confirmatory factor analysis. Internal consistency was measured using Cronbach’s alpha, while validity was evaluated through convergent, discriminant, and concurrent validity analyses. Responsiveness was assessed by comparing empowerment scores to changes in recovery rates. Results The factor analyses supported a four-factor, 18-item model, showing good fit indices (CFI = 0.97, TLI = 0.97, AGFI = 0.97, SRMR = 0.07, RMSEA = 0.07). Internal consistency was acceptable for the overall scale (alpha = 0.84) and the “self-esteem-self-efficacy” dimension (alpha = 0.88) but lower for the other dimensions. The scale demonstrated moderate correlations with recovery (r = 0.47) and quality of life (r = 0.28). The Empowerment Scale demonstrated low or insignificant responsiveness, except for the “self-esteem-self-efficacy” dimension, which showed moderate responsiveness. Conclusions The French version of the Empowerment Scale has a good factor structure with 4 factors and 18 items. The “self-esteem” dimension demonstrates good concurrent validity and reliability, and moderate responsiveness, while other dimensions require additional validation.
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... Despite the described differences between the constructs of personal/subjective recovery and clinical/objective recovery, many researchers have pointed out that these two perspectives should be viewed as complementary rather than alternative and that both should be taken into account to provide appropriate care [61][62][63][64]. To provide an integrated framework, some studies investigated the relationship between the two approaches and among the involved factors. ...
Recovery-oriented and trauma-informed care for people with mental disorders to promote human rights and quality of mental health care: a scoping review
Article
Full-text available
  • Feb 2025
  • BMC PSYCHIATRY
Background In several countries, the growing emphasis on human rights and the ratification of the Convention on the Rights of Persons with Disabilities (CRPD) have highlighted the need for changes in culture, attitudes and practices of mental health services. New approaches, such as recovery-oriented care (ROC) and trauma-informed care (TIC) emphasize the users’ needs and experiences and promote autonomy and human rights. Aims To provide an overview of the literature on recovery-oriented care (ROC) and trauma-informed care (TIC) and their relevance to the promotion of human rights and quality of mental health care. Method We conducted a scoping review by searching the following databases: PubMed, Scopus, PsycINFO. We performed a qualitative synthesis of the literature aimed at reviewing: (1) current conceptualisations of recovery in mental health care; (2) recovery-oriented practices in mental health care; (3) current conceptualizations of trauma and TIC in mental health care; (4) trauma-informed practices in mental health care; (5) the relationship between ROC and TIC, with a particular focus on their shared goal of promoting alternatives to coercion, and on trauma-informed and/or recovery oriented alternatives to coercion. Results According to prevailing conceptual frameworks, ROC and TIC share many underlying principles and should be regarded as complementary. Both approaches affirm the conceptualization of service users as persons, foster their autonomy and rely on their involvement in designing and monitoring mental health services. Both approaches promote human rights. A wider consensus on conceptual frameworks, tools and methodologies is needed to support ROC and TIC implementation and allow comparison among practices. Recovery-oriented and trauma-informed models of care can contribute to the implementation of non-coercive practices, which show promising results but warrant further empirical study. Conclusions Recovery-oriented and trauma-informed practices and principles may contribute to the shift towards rights-based mental health care and to the implementation and successful uptake of alternatives to coercion. Local and international work aimed to promote and test these approaches may provide a contribution to improving mental health care world-wide. Future research should focus on the outcomes of all involved stakeholders’ and include the perspectives of both staff members and service users in different contexts.
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... An additional approach is a recovery perspective based on a holistic approach to care (Jacob, 2015). The goal in such a perspective is to feel satisfaction in life and the recovery can then be likened to a process or a personal journey where important relational and social aspects of life are considered in order to find new ways of relating (Tew et al., 2011;Topor et al., 2022;van Weeghel et al., 2019). ...
Lived experiences of how the care relationship in primary healthcare contributes to recovery from stress-related disorders: a reflective lifeworld research study
Article
Full-text available
  • Feb 2025
Purpose The aim of the study was to describe how the care relationship in primary healthcare has contributed to the recovery of persons with stress-related disorders. Methods This study was based on the phenomenological approach, Reflective Lifeworld Research (RLR). Fifteen persons who had recovered from stress-related disorders and who had experience of being cared for in primary healthcare were included. Lifeworld interviews were conducted, and the data were analysed according to the RLR principles of openness, flexibility and bridling. Results The participants experienced that the care relationship in primary healthcare contributed to their recovery from stress-related disorder by enabling them to land and be embraced in a safe relationship. This opened up a space for rest and growth that included time, being listened to and a permitting space for existential reflection based on one’s life story. The results also showed that a sense of disharmony in the care encounter constitutes a threat to recovery and reinforces vulnerability. Conclusions Sensing security and hope is a crucial element in the care relationship in primary healthcare when recovering from stress-related disorders. This includes the importance of being treated with respect, being given space to tell one’s story, being listened to and being supported in an existential reflection of one’s life situation.
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Conceptualisation of Mental Health Recovery by Health Professionals and Students in Southeast Asia: A Qualitative Systematic Review and Meta-Aggregation
Article
  • Feb 2025
  • J PSYCHIATR MENT HLT
Introduction While the recovery approach is gaining recognition in non‐Western countries, it remains underexplored in Southeast Asia. This study addressed this gap by examining how health professionals and students conceptualised recovery, providing insights for enhancing mental health practices. Aim To synthesise how health professionals and students in Southeast Asian countries understand mental health recovery. Methods A search across CINAHL, MEDLINE, PsycINFO, Scopus, and the Web of Science identified ten qualitative studies (2006–2024). Data extraction, quality appraisal, and synthesis were conducted following the JBI methodology. Results The findings highlighted a medically driven and determined return to normal functioning for individuals living with mental illness. This was classified into six categories: return to being a ‘normal person’, symptom‐free status, medication adherence, access to mental health services, living with residual symptoms, and holistic care with a psychosocial focus. Discussion Medical‐oriented practices have dominated mental health care, creating a power imbalance. Training, education, culture, socioeconomic status, and stigma have shaped the understanding of recovery. Implications for Practice and Recommendations Shared decision‐making and formal training prioritising lived experiences are vital to reducing power imbalances. A shift towards recovery‐oriented approaches is critically needed to enhance mental health practices in Southeast Asia.
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Spirituality among People Who Are Transgender: A Nationally Representative Examination and Comparison with Members of the Public
Article
  • Feb 2025
  • SOC WORK
Spiritual practices are important strengths for many members of the general public, but little is known about practices among transgender people. To address this gap in the literature, this study investigated the frequency with which self-identified transgender adults participate in a diverse array of spiritual practices and compared their level of participation with that of members of the general population. To conduct this nationally representative study, data were abstracted from the National Religion and Spirituality Survey 2020. Frequencies are reported for 17 spiritual practices, and logistic regression was used to determine differences in participation. The results indicate transgender adults participate in spiritual practices at levels equal to, or greater than, that of other adults. Transgender adults were significantly more likely than other adults to participate in 10 spiritual practices: yoga, meditation, tarot cards/fortune telling, fasting, attending other spiritual/religious groups, art, being in nature, writing, acts of protest, and teaching in a spiritual/religious setting. With one exception, moderate to large effects were observed across all 10 spiritual practices. The results highlight the importance of administering spiritual assessments with transgender clients to identify potential spiritual practices that might be operationalized to assist clients cope with or ameliorate problems.
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How effective is the comprehensive approach to rehabilitation (CARe) methodology? A cluster randomized controlled trial
Article
Full-text available
  • Dec 2017
  • BMC PSYCHIATRY
Background The CARe methodology aims to improve the quality of life of people with severe mental illness by supporting them in realizing their goals, handling their vulnerability and improving the quality of their social environment. This study aims to investigate the effectiveness of the CARe methodology for people with severe mental illness on their quality of life, personal recovery, participation, hope, empowerment, self-efficacy beliefs and unmet needs. MethodsA cluster Randomized Controlled Trial (RCT) was conducted in 14 teams of three organizations for sheltered and supported housing in the Netherlands. Teams in the intervention group received training in the CARe methodology. Teams in the control group continued working according to care as usual. Questionnaires were filled out at baseline, after 10 months and after 20 months. A total of 263 clients participated in the study. ResultsQuality of life increased in both groups, however, no differences between the intervention and control group were found. Recovery and social functioning did not change over time. Regarding the secondary outcomes, the number of unmet needs decreased in both groups. All intervention teams received the complete training program. The model fidelity at T1 was 53.4% for the intervention group and 33.4% for the control group. At T2 this was 50.6% for the intervention group and 37.2% for the control group. Conclusion All clients improved in quality of life. However we did not find significant differences between the clients of the both conditions on any outcome measure. Possible explanations of these results are: the difficulty to implement rehabilitation-supporting practice, the content of the methodology and the difficulty to improve the lives of a group of people with longstanding and severe impairments in a relatively short period. More research is needed on how to improve effects of rehabilitation trainings in practice and on outcome level. Trial registrationISRCTN77355880, retrospectively registered (05/07/2013).
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Identifying fundamental criteria for eating disorder recovery: A systematic review and qualitative meta-analysis
Article
Full-text available
  • Nov 2017
Background Outcome studies for eating disorders regularly measure pathology change or remission as the only outcome. Researchers, patients and recovered individuals highlight the importance of using additional criteria for measuring eating disorder recovery. There is no clear consensus on which additional criteria are most fundamental. Studies focusing on the perspectives of recovered patients show criteria which are closely related to dimensions of positive functioning as conceptualized in the complete mental health model. The aim of this study was to identify fundamental criteria for eating disorder recovery according to recovered individuals. Methods A systematic review and a qualitative meta-analytic approach were used. Eighteen studies with recovered individuals and meeting various quality criteria were included. The result sections of the included papers were searched for themes that were stated as criteria for recovery or ‘being recovered’. All themes were analyzed using a meta-summary technique. Themes were labeled into criteria for recovery and the frequency of the found criteria was examined. Results In addition to the remission of eating disorder pathology, dimensions of psychological well-being and self-adaptability/resilience were found to be fundamental criteria for eating disorder recovery. The most frequently mentioned criteria were: self-acceptance, positive relationships, personal growth, decrease in eating disorder behavior/cognitions, self-adaptability/resilience and autonomy. Conclusions People who have recovered rate psychological well-being as a central criterion for ED recovery in addition to the remission of eating disorder symptoms. Supplementary criteria, besides symptom remission, are needed to measure recovery. We recommend including measurements of psychological well-being and self-adaptability/resilience in future research, such as outcome studies and in routine outcome measurement.
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The Relationship Between Clinical and Personal Recovery in Patients With Schizophrenia Spectrum Disorders: A Systematic Review and Meta-analysis
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Full-text available
  • Jul 2017
Patients describe experiencing personal recovery despite ongoing symptoms of psychosis. The aim of the current research was to perform a meta-analysis investigating the relationship between clinical and personal recovery in patients with schizophrenia spectrum disorders. A comprehensive OvidSP database search was performed to identify relevant studies. Correlation coefficients of the relationship between clinical and personal recovery were retrieved from primary studies. Meta-analyses were performed, calculating mean weighted effect sizes for the association between clinical and personal recovery, hope, and empowerment. Additionally, associations between positive, negative, affective symptoms, general functioning, and personal recovery were investigated. The results show that heterogeneity across studies was substantial. Random effect meta-analysis of the relationship between symptom severity and personal recovery revealed a mean weighted correlation coefficient of r = -.21 (95% CI = -0.27 to -0.14, P < .001). We found the following mean weighted effect size for positive symptoms r = -.20 (95% CI = -0.27 to -0.12, P < .001), negative symptoms r = -.24 (95% CI = -0.33 to -0.15, P < .001), affective symptoms r = -.34 (95% CI = -0.44 to -0.24, P < .001) and functioning r = .21 (95% CI = -0.09 to 0.32, P < .001). The results indicate a significant small to medium association between clinical and personal recovery. Psychotic symptoms show a smaller correlation than affective symptoms with personal recovery. These findings suggest that clinical and personal recovery should both be considered in treatment and outcome monitoring of patients with schizophrenia spectrum disorders.
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Recovery and Serious Mental Illness: A review of current clinical and research paradigms and future directions
Article
Full-text available
  • Sep 2017
Introduction: Recovery from serious mental illness has historically not been considered a likely or even possible outcome. However, a range of evidence suggests the courses of SMI are heterogeneous with recovery being the most likely outcome. One barrier to studying recovery in SMI is that recovery has been operationalized in divergent and seemingly incompatible ways, as an objective outcome, versus a subjective process. Areas Covered: This paper offers a review of recovery as a subjective process and recovery as an objective outcome; contrasts methodologies utilized by each approach to assess recovery; reports rates and correlates of recovery; and explores the relationship between objective and subjective forms of recovery. Expert Commentary: There are two commonalities of approaching recovery as a subjective process and an objective outcome: (i) the need to make meaning out of one's experiences to engage in either type of recovery and (ii) there exist many threats to engaging in meaning making that may impact the likelihood of moving toward recovery. We offer four clinical implications that stem from these two commonalities within a divided approach to the concept of recovery from SMI.
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Explication and Definition of Mental Health Recovery: A Systematic Review
Article
Full-text available
  • Jan 2018
  • ADM POLICY MENT HLTH
This review assessed the concordance of the literature on recovery with the definition and components of recovery developed by the Substance Abuse and Mental Health Services Administration (SAMHSA). Each SAMHSA identified recovery component was first explicated with synonyms and keywords and made mutually exclusive by authors. Inter-rater reliability was established on the coding of the presence of 17 recovery components and dimensions in 67 literature reviews on the recovery concept in mental health. The review indicated that concordance varied across SAMHSA components. The components of recovery with greatest concordance were: individualized/person centered, empowerment, purpose, and hope.
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Recovery from Borderline Personality Disorder: A Systematic Review of the Perspectives of Consumers, Clinicians, Family and Carers
Article
Full-text available
Purpose Longitudinal studies support that symptomatic remission from Borderline Personality Disorder (BPD) is common, but recovery from the disorder probably involves a broader set of changes in psychosocial function over and above symptom relief. A systematic review of literature on both symptomatic and personal recovery from BPD was conducted including the views of consumers, clinicians, family and carers. Materials and Methods A PRISMA guided systematic search identified research examining the process of recovery from BPD. Longitudinal studies with a follow-up period of five or more years were included to avoid treatment effects. Results There were 19 studies, representing 11 unique cohorts (1,122 consumers) meeting the review criteria. There was a limited focus on personal recovery and the views of family and carers were absent from the literature. Rates of remission and recovery differ depending upon individual and methodological differences between studies. Data on symptomatic remission, recurrence and diagnosis retainment suggests that BPD is a stable condition, where symptomatic remission is possible and the likelihood of recurrence following a period of remission is low. Conclusion Symptomatic remission from BPD is common. However, recovery including capacities such as engaging in meaningful work was seldom described. Future research needs broader measures of recovery as a sub-syndromal experience, monitoring consumer engagement in meaningful vocation and relationships, with or without the limitations of BPD.
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Person-Oriented Recovery of Individuals With Serious Mental Illnesses: A Review and Meta-Analysis of Longitudinal Findings
Article
  • Dec 2017
Objective: Although there is a significant literature examining changes over time in the functional recovery of those with serious mental illnesses, relatively little is known about the longitudinal nature of person-oriented recovery. The purpose of this review and meta-analysis is to synthesize findings pertaining to the study of person-oriented recovery constructs over time and concomitants of change. Methods: Systematic searches up to February 2017 were conducted, and were supplemented by hand-searching of reference lists and contact with study authors. Twenty three independent studies that included a sample of individuals with serious mental illnesses and quantitatively measured person-oriented recovery, empowerment, and/or hope over at least two time points were included in the review, of which seven randomized controlled trials were included in the meta-analysis. Data were independently extracted by two reviewers. Aggregate effect sizes for person-oriented recovery outcomes were calculated, and individual, intervention, and methodological characteristics served as moderators in meta-regression analyses. Results: The meta-analysis (1,739 participants) demonstrated that consumers experience greater (and sustained) improvement in person-oriented recovery outcomes when they are involved in recovery-oriented mental health treatment versus usual care or other types of treatment. Only type of intervention provider was a significant moderator; a study of an intervention that was delivered by both mental health professionals and peer providers demonstrated the greatest differences between treatment and control groups. Conclusions: Recovery-focused interventions, especially those that involve collaborations between mental health professionals and peer providers, may serve to foster increased recovery, hope, and empowerment among individuals with serious mental illnesses.
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The Concept of Recovery as Experienced by Persons with Dual Diagnosis: A Systematic Review of Qualitative Research From a First-Person Perspective
Article
  • Jul 2017
Objectives: In recent years, the concept of recovery has gained ground in the treatment of persons with dual diagnosis. Recovery refers to living a meaningful life despite limitations caused by mental illness and substance use disorders. It also implies that support for persons with dual diagnosis should be organized according to the personal needs and wishes of its users. Therefore, it is important to gain insight into the aspects that persons with dual diagnosis deem important for their recovery process. This systematic review aims to summarize existing qualitative research on the meaning of recovery from the perspective of persons with dual diagnosis. Methods: A literature search was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic reviews in the following databases: Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Medline, Embase, and Web of Science. Results: Sixteen studies using a qualitative research design were retained in which four overarching themes could be identified. The first theme focused on feeling supported by family and peers and being able to participate in the community. The second theme focuses on the need for a holistic and individualized treatment approach, seeing the persons "behind the symptoms." The third theme that emerged was having personal beliefs, such as fostering feelings of hope, building a new sense of identity, gaining ownership over one's life, and finding support in spirituality. The last theme identified was the importance of meaningful activities that structure one's life and give one motivation to carry on. Conclusions: In this review, the participants pleaded for "flexibility" in mental health care, i.e., an approach that allows for both successes and failures. However, in order to come to a more comprehensive theoretical model of recovery in persons with dual diagnosis, future research is necessary to gain insight into the underlying mechanisms of recovery processes.
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An introduction to peer-supported open dialogue in mental healthcare
Article
  • Sep 2016
Peer-supported open dialogue is a variant of the ‘open dialogue’ approach that is currently practised in Finland and is being trialled in several countries around the world. The core principle of the approach is the provision of care at the social network level, by staff who have been trained in family, systems and related approaches. These staff include peer workers, who will help to enhance the democratic nature of the meetings around which care is centred, as well as enabling such meetings to occur where networks are frag-mented or lacking. Certain organisational and practice features and underlying themes are key to the approach. Crucially, open dialogue is also a system of service provision. Staff trained in peer-supported open dialogue from six National Health Service (NHS) trusts will launch pilot teams in 2016, as part of an intended national multicentre randomised controlled trial.
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What is the work of Recovery-Oriented Practice? A systematic literature review
Article
  • Jul 2016
  • Int J Ment Health Nurs
Concepts of personal and social recovery in mental illness are constantly evolving because the journey is fluid and subject to change over time. Dynamic interactions between the complexities of human nature and mental illness create ever-altering landscapes of perplexity. The acknowledged ebb and flow of recovery in the presence of chronic and serious mental illness requires health professionals to provide a flexible suite of care, delivered through skills and methods that are responsive and meaningful to the recipient. We conducted a systematic search for qualitative literature that articulated the work of personally-supportive recovery-oriented practice (ROP) to determine the specific components of recovery-supportive work. Twenty-one articles were identified as meeting the inclusion criteria and were synthesized using a coding framework derived from Normalization Process Theory. We identified three kinds of recovery-supportive work required from health professionals: alleviating stigma, delivering effective recovery-supportive responses in the presence of complex health and social situations and managing challenges associated with the work of ROP. We discuss the resources needed for ROP and the barriers that inhibit health professionals' engagement in this work. By elucidating the work of ROP, we highlighted a disparity between health professionals' aspirations and achievements. These revelations could inform service delivery in order to better support consumer recovery in serious mental illness.
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