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The notion of recovery has become a dominant force in mental health policy, evident in reports of the Surgeon General and President's New Freedom Commission. In both reports, recovery is stipulated as the overarching goal of care and foundation for reforms at state and local levels. Little consensus exists regarding the nature of recovery in mental illness, however, or about the most effective ways to promote it. The authors offer a conceptual framework for distinguishing between various uses of the term, provide a definition of recovery in mental health, and conclude with a discussion of the implications of this concept for meaningful reform. Keywords: recovery, serious mental illness, disability, civil rights

Background: "Recovery supports", often provided by persons in recovery themselves, have emerged over the last decade as important components of recovery-oriented systems of care for persons with substance use disorders. Aims: This study assesses the benefit of adding peer recovery supports to the care of adults with co-occurring psychosis and substance use. Method: 137 adults with both disorders who had at least one prior admission within the past year were recruited during an index hospitalization into a randomized trial of standard care vs skills training with and without a peer-led social engagement program. Participants were assessed at admission and at three and nine months post-discharge on symptoms, functioning, substance use, and other factors. Results: At three months, skills training was effective in reducing alcohol use and symptoms, with the addition of peer-led support resulting in higher levels of relatedness, self-criticism, and outpatient service use. At nine months, skills training was effective in decreasing symptoms and inpatient readmissions and increasing functioning, with the addition of peer support resulting in reduced alcohol use. Conclusions: Adding peer-led support may increase engagement in care over the short term and reduce substance use over the longer-term for adults with co-occurring disorders. [ABSTRACT FROM AUTHOR]

Participatory research, in which people with lived experience of the study phenomenon are involved as collaborators, has been conducted for decades; however, these innovations have struggled to take hold in mental health settings—until recently. The slow uptake of community partnered research in mental health has been unfortunate, especially because this field already suffers from poor community relations, pervasive community mistrust, and racial and ethnic disparities. But now, people with lived experience of severe mental illness—long considered to be "incapable" of functioning as co-researchers—are beginning to be included on research teams. However, training and opportunities for conducting such work are still lacking. This report describes a two-year initiative to improve the quality and quantity of participatory research being conducted in a department of psychiatry at a large medical school, which culminated in an innovative training program for both researchers and patients, developed in direct collaboration with stakeholders. In addition to detailing this program, we also discuss the deep legacy of mental health mistrust and our own efforts to address issues of social justice and health equity. [ABSTRACT FROM AUTHOR]

Objective: This article presents findings from a randomized controlled trial of a peer support mentorship intervention designed for individuals with serious mental illness and frequent, recurrent psychiatric hospitalizations.Methods: Seventy-six individuals who were diagnosed as having a major psychotic or mood disorder and who had at least two psychiatric hospitalizations or more than three emergency department visits within the 18 months prior to the index hospitalization participated in this trial. Participants were randomly assigned to one of two conditions: standard care or a peer mentor plus standard care. Substance use, psychiatric symptoms, psychosocial functioning, and hope were assessed at baseline and at three and nine months after hospital discharge.Results: Participants assigned to the peer mentor condition reported significantly greater reductions in substance use and psychiatric symptoms and greater improvements in functioning compared with participants assigned to standard care. Moreover, participants in the peer mentor program remained out of the hospital for significantly longer periods of time compared with those assigned to standard care.Conclusions: Peer services for those who are hospitalized recurrently hold promise as an effective component of behavioral health care for persons with serious mental illnesses. [ABSTRACT FROM AUTHOR]

Objective: This study examined social network structure and function among a sample of 460 homeless veterans who participated in an experimental trial of the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program.Methods: Participants were randomly assigned to HUD-VASH (housing subsidies and case management), case management only, or standard care. Mixed-model longitudinal analysis was used to compare treatment groups on social network outcomes over 18 months.Results: Veterans in HUD-VASH reported significantly greater increases in social support than veterans in the two other groups, as well as greater frequency of contacts, availability of tangible and emotional support, and satisfaction with nonkin relationships over time. These gains largely involved relationships with providers and other veterans encountered in treatment.Conclusions: Supported housing may play a pivotal role in fostering constructive new relationships with persons associated with service programs but may have a more limited impact on natural support networks. [ABSTRACT FROM AUTHOR]

This study assessed the effectiveness of an intervention based on a theoretical framework of citizenship on reducing psychiatric symptoms, alcohol use, and drug use, and increasing quality of life for persons with serious mental illness (SMI) and criminal justice involvement. One-hundred fourteen adults with SMI and a history of criminal justice involvement participated in a 2 × 3 longitudinal randomized controlled trial of a four-month citizenship intervention versus usual services. Linear mixed model analyses were used to assess the intervention's impact on quality of life, symptoms, and substance use. After controlling for baseline covariates, participants in the experimental condition reported significantly increased quality of life, greater satisfaction with and amount of activity, higher satisfaction with work, and reduced alcohol and drug use over time. However, individuals in the experimental condition also reported increased anxiety/depression and agitation at 6 months (but not 12 months) and significantly increased negative symptoms at 12 months. Findings suggest that community-oriented, citizenship interventions for persons with SMI and criminal justice histories may facilitate improved clinical and community outcomes in some domains, but some negative clinical findings suggest the need for post-intervention support for intervention participants. Implications for practice and future research are discussed. [ABSTRACT FROM AUTHOR]

Objective: Studies have demonstrated that supported housing is an effective intervention for individuals who are homeless and have a mental illness or substance use disorder. This study examined data from an experimental trial of the U.S. Department of Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program to identify differences in the program's impact on subgroups defined by sociodemographic or clinical characteristics. Methods: Data were analyzed from 259 male homeless veterans with substance abuse problems who were randomly assigned to HUD-VASH (intensive case management [ICM] plus rent subsidy vouchers), ICM only, or treatment as usual between June 1992 and December 1995. Four subgroups were defined: African American versus Caucasian, younger versus older than 42.3 years, co-occurring diagnoses of mental illness versus diagnosis of a substance use disorder only, and active versus less active substance use upon program entry. Mixed models were used to identify significant interactions between HUD-VASH assignment and each subgroup. Results: Compared with ICM alone, HUD-VASH was associated with more positive housing outcomes for Caucasians, veterans with cooccurring mental disorders, and veterans who were active substance users. HUD-VASH was associated with more positive sociocinical outcomes for African Americans. No differences were observed in housing or sociodimcal outcomes as a function of age. Conclusions: Among homeless veterans with a substance use disorder, Caucasians and those with active substance use showed greater housing benefits than other veterans from HUD-VASH than from ICM alone. African Americans showed greater socioclinical benefit than Caucasians from HUD-VASH versus ICM. Interaction analysis deserves further study. [ABSTRACT FROM AUTHOR]

Objective: This study used participatory methods and concept-mapping techniques to develop a greater understanding of the construct of citizenship and an instrument to assess the degree to which individuals, particularly those with psychiatric disorders, perceive themselves to be citizens in a multifaceted sense (that is, not in a simply legal sense).Methods: Participants were persons with recent experience of receiving public mental health services, having criminal justice charges, having a serious general medical illness, or having more than one of these "life disruptions," along with persons who had not experienced any of these disruptions. Community-based participatory methods, including a co-researcher team of persons with experiences of mental illness and other life disruptions, were employed. Procedures included conducting focus groups with each life disruption (or no disruption) group to generate statements about the meaning of citizenship (N = 75 participants); reducing the generated statements to 100 items and holding concept-mapping sessions with participants from the five stakeholder groups (N = 66 participants) to categorize and rate each item in terms of importance and access; analyzing concept-mapping data to produce citizenship domains; and developing a pilot instrument of citizenship.Results: Multidimensional scaling and hierarchical cluster analysis revealed seven primary domains of citizenship: personal responsibilities, government and infrastructure, caring for self and others, civil rights, legal rights, choices, and world stewardship. Forty-six items were identified for inclusion in the citizenship measure.Conclusions: Citizenship is a multidimensional construct encompassing the degree to which individuals with different life experiences perceive inclusion or involvement across a variety of activities and concepts. [ABSTRACT FROM AUTHOR]

The article discusses the promotion of self-determination for patients with serious mental illnesses. The article discusses two treatment methodologies: assistance through shared decision-making and attending to problematic environmental factors. Other topics include how people with serious mental illnesses have a low rate of participation with evidence-based practices and the role of self-determination in health decisions.

The present study examined the relationship between case managers' expectations about the abilities of persons diagnosed with schizophrenia and the outcomes (as indicated via chart review) of a randomly selected sample of clients diagnosed with schizophrenia on their caseload. Results indicate that clients of case managers with higher expectations averaged significantly more months of progress in employment than clients of case managers with lower expectations. Case manager expectations were also better predictors of the number of days employed than other case manager and consumer characteristics, however the type of expectation was a critical determinant of the direction of the effect. Case manager expectations were not related to outcomes in living situation. [ABSTRACT FROM AUTHOR]

Objective: The study examined the feasibility and effectiveness of using peer support to reduce recurrent psychiatric hospitalizations.Methods: A randomized controlled design was used, with follow-up at nine months after an index discharge from an academically affiliated psychiatric hospital. Patients were 18 years or older with major mental illness and had been hospitalized three or more times in the prior 18 months. Seventy-four patients were recruited, randomly assigned to usual care (N=36) or to a peer mentor plus usual care (N=38), and assessed at nine months.Results: Participants who were assigned a peer mentor had significantly fewer rehospitalizations (.89 ± 1.35 versus 1.53 ± 1.54; p=.042 [one-tailed]) and fewer hospital days (10.08 ± 17.31 versus 19.08 ± 21.63 days; p<.03, [one tailed]).Conclusions: Despite the study's limitations, findings suggest that use of peer mentors is a promising intervention for reducing recurrent psychiatric hospitalizations for patients at risk of readmission. [ABSTRACT FROM AUTHOR]

Objective: Research suggests that subsidized housing combined with mental health services may be an effective intervention for successfully placing individuals who have a mental illness and a history of homelessness into community housing. However, there is limited longitudinal information available about the risk of loss of housing after a successful exit from homelessness. Methods: The study presented here examined the risk and predictors of returning to homelessness after successful housing in a sample of 392 formerly homeless veterans involved in an experimental trial of case management plus rent subsidy vouchers, ease management only, or standard care. Results: Over the course of a five-year period, 44% of all participants experienced a period of homelessness for at least one day after successful placement into housing. Cox regression analysis found that participants in the case management plus voucher condition had significantly longer periods of continuous housing, compared with participants in the other two groups. Other predictors of decreased housing tenure were drug use and a diagnosis of post- traumatic stress disorder. Conclusions: Subsidized housing vouchers, combined with intensive case management, are advantageous both for facilitating the initial transition from homelessness to being housed and for reducing the risk of discontinuous housing, even among individuals with more severe substance abuse problems. [ABSTRACT FROM AUTHOR]

Objective: This study compared the effectiveness of two interventions in reducing alcohol use, drug use, and criminal justice charges for persons with severe mental illnesses: first, a community-oriented group intervention with citizenship training and peer support that was combined with standard clinical treatment, including jail diversion services, and second, standard clinical treatment with jail diversion services alone.Methods: A total of 114 adults with serious mental illness participated in a 2 x 3 prospective longitudinal, randomized clinical trial with two levels of intervention (group and peer support for the experimental condition and standard services for the control) and three interviews (baseline, six months, and 12 months). Self-report questionnaires assessed alcohol and drug use, and program databases assessed criminal justice contacts. The authors used a mixed-models analysis to assess alcohol and drug use, repeated-measures analysis of covariance to assess criminal justice charges, and correlational analyses to assess the relation between intervention participation and outcome variables.Results: The experimental group showed significantly reduced alcohol use in comparison with the control group. Further, results showed a significant group-by-time interaction, where alcohol use decreased over time in the experimental group and increased in the control group. Drug use and criminal justice charges decreased significantly across assessment periods in both groups.Conclusions: Of the outcomes, only decreased alcohol use was attributable to the experimental intervention. Although this may be a chance finding, peer- and community-oriented group support and learning may facilitate decreased alcohol use over time. [ABSTRACT FROM AUTHOR]

Compares the familiarity with and attitudes about psychiatric advance directives among multiple community stakeholders in two Ohio communities. Involvement of one community in a pilot psychiatric advance directive education project; Total number of clergy, legal and law enforcement personnel, healthcare professionals, mental and health professionals, consumers and family members who completed a newly developed measure of opinions about psychiatric advance directives; Differences in opinions among members of the various stakeholder groups.

This article describes challenges and successes seen in the first four years of efforts the state of Connecticut has made to reorient its behavioral health system to promoting recovery. Beginning in 2000, the Connecticut initiative was conceptualized as a multi-year, systemic process that involved the following interrelated steps: a) developing core values and principles based on the input of people in recovery; b) establishing a conceptual and policy framework based on this vision; c) building workforce corn petencies and skills; d) changing programs and service structures; e) aligning fiscal and administrative policies; and, finally, t) monitoring, evaluating, and adjusting these efforts. Following descriptions of the first four steps, the authors offer a few lessons that might benefit other states engaged in similar processes of transformation. [ABSTRACT FROM AUTHOR]

Following development of a 46-item of measure citizenship, a framework for supporting the full membership in society of persons with mental illness, this study tested the measure's reliability and validity. 110 persons from a mental health center completed a questionnaire packet containing the citizenship measure and other measures to assess internal consistency and validity of the citizenship instrument. Correlation matrices were examined for associations between the citizenship instrument and other measures. Stepwise regression examines demographic factors, sense of community, and social capital as predictors of citizenship, recovery, and well-being. Analyses revealed that the measure is psychometrically sound. The measure captures subjective information about the degree to which individuals experience rights, sense of belonging, and other factors associated with community membership that have been previously difficult to assess. The measure establishes a platform for interventions to support the full participation in society of persons with mental illnesses.

Permanent supported housing has increasingly been identified as a central approach to helping homeless individuals with disabilities exit from homelessness. Given that one third or more of homeless individuals actively use substances, it is important to determine the extent to which individuals who report using alcohol and/or drugs at the time of housing benefit from such programs. The current study examines data from the evaluation of the United States Department of Housing and Urban Development-Veterans Affairs (HUD-VA) Supported Housing (HUD-VASH) program to determine differences in housing and clinical outcomes among participants with two different levels of active alcohol or drug use at time of housing entry. Whereas veterans with 1-15 days of active use and 15-30 days of active use had significantly more days homeless than abstainers, albeit with small effect sizes (.06 and .19, respectively), there were no significant differences in days housed or days in institutions. Interaction analysis suggests that the highest frequency substance users who spent time in residential treatment prior to housing had the poorest housing outcomes, while those who were not in residential treatment had outcomes comparable to abstainers. Although active substance users clearly benefit from supportive housing with small differences in outcomes from abstainers, high frequency substance users who were admitted to residential treatment before housing placement, may be an especially vulnerable population., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)