What does recovery mean for me? Perspectives of Canadian mental health consumers.

OBJECTIVE: The objective of this study was to explore the meaning of recovery from the perspectives of consumers receiving mental health services in Canada. METHODS: Sixty semi-structured interviews were conducted with 54 mental health consumers in Montreal, Québec City and Waterloo-Guelph, Ontario. RESULTS: Two contrasting meanings of recovery emerged. The first definition strongly attached recovery to illness while the second definition linked recovery to self-determination and taking responsibility for life. CONCLUSIONS: The prominence of biomedical definitions of recovery suggests the need to find common ground between these two perspectives, if conceptualizations of recovery are to include the views of consumers who routinely experience the mental health system.

Through the eyes of another: improving the skills of forensic providers using a consumer-informed role-play procedure.

OBJECTIVE: We describe an intervention aimed at improving the quality of care delivered by forensic clinicians and at exposing them to the principles of client-centered care. METHOD: Thirty-five forensic clinicians belonging to various professional disciplines participated in a day-long, multi-modal training developed with the help of former residents of a maximum-security forensic hospital. The main components of the training included a 1.5-hour simulation during which participants role-played being hospital residents, a video on discrimination, and a panel discussion with several of the former hospital residents. RESULTS: Participants rated the training as very relevant to their work, very worthy of being recommended to their peers, and as a profoundly positive and enriching experience. The benefits derived from the training included greater connectedness among the staff and better understanding of the patients' experiences. CONCLUSION: Factors that appear to have contributed to the success of the training sessions include administrative support, use of a multi-modal approach, and use of small groups.

Recovering the self in schizophrenia: an integrative review of qualitative studies.

In this paper we review qualitative research on recovery from schizophrenia and summarize how persons' daily activities and experiences reflect mechanisms of recovery of the self. We begin by describing examples of persons' daily activities, suggesting that they have in common a stance labeled by E. Corin (1990) as positive withdrawal, representing negotiation of distance from the social milieu. We note that positive withdrawal may foster the creation of larger life frames, representing broad mechanisms through which to reconsider and ultimately recover a durable sense of self. We suggest that these mechanisms are not specific to people with schizophrenia, and briefly discuss implications of these ideas for models of outpatient treatment.

The relationship between anxiety and substance use disorders among individuals with severe affective disorders.

We sought to determine the association between anxiety disorders and substance use disorders among patients with severe affective disorders in a community-based outpatient treatment program. Two hundred sixty participants in a supported socialization program were assessed using the Structured Clinical Interview for DSM-III-R (SCID). Multivariate logistic regression analyses were used to determine the relationship between anxiety disorders and alcohol and substance use disorders among patients with severe and persistent affective disorders (i.e., major depression and bipolar disorder). Among patients with severe and persistent affective disorders, cocaine (odds ratio [OR] = 5.9 [1.4, 24.6]), stimulant (OR = 5.1 [1.2, 20.9]), sedative (OR = 5.4 [1.2, 24.7]), and opioid use disorders (OR = 13.9 [1.4, 138.7]) were significantly more common among those with, compared with those without, anxiety disorders. This association persisted after adjusting for differences in sociodemographic characteristics and comorbid psychotic disorders. Significant associations between panic attacks, social phobia, specific phobia, and obsessive-compulsive disorder (OCD) and specific substance use disorders were also evident. These findings are consistent with and extend previous results by documenting an association between anxiety disorders and substance use disorders, independent of comorbid psychotic disorders among patients in a outpatient psychiatric rehabilitation program. These data highlight the prevalence of comorbid anxiety disorders, a potentially undetected and therefore undertreated problem, among patients with severe affective disorders and substance use comorbidity. Future work is needed to determine the nature of this association and to determine whether treatment of one prevents onset of the other.