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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]

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]

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]