Stotland Nada L, Mattson Matthew G, Bergeson Sue
Rush Medical College, Chicago, USA.
J Psychiatr Pract. 2008 May;14 Suppl 2:45-54. doi: 10.1097/01.pra.0000320126.76552.9c.
This article presents an overview of the concept of recovery in serious and persistent mental illness from the perspective of both clinicians and consumers. Dr. Stotland, a psychiatrist, first highlights how treatment goals for bipolar disorder have changed in recent years, moving beyond symptomatic recovery to also encompass functional recovery (return to the level of functioning the person enjoyed before onset of the illness). She then discusses factors that play an important role in the recovery process, including resilience, the consumer's understanding of and participation in the treatment and recovery process, and collaboration between clinician and patient in setting specific functional goals as treatment progresses. She also focuses on the need for policy and system changes to facilitate recovery, including improved funding for recovery-oriented care, implementation of recovery-oriented, collaborative care models that bring together psychiatrists and primary care providers, and dissemination of improved tools for monitoring symptoms and functioning over time. Two relevant performance measures for monitoring changes in symptoms and level of functioning are discussed, with results of their field testing. Matthew Mattson, Director of Training for the Depression and Bipolar Support Alliance (DBSA), and Sue Bergeson, President of DBSA, then present the consumer's perspective on recovery-oriented care. Drawing on recommendations from the Institute of Medicine, the President's New Freedom Commission, the U.S. Surgeon General, and the Annapolis Coalition on the Behavioral Health Workforce, they stress that the ultimate goal of treatment must be recovery; that, to the greatest extent possible, care should based on consumers' needs and values; that consumers should take an active role in the design and delivery of their own care; and that a priority of all care delivery should be to engender hope. Promising research on peer support groups and the use of peer sup-port specialists as consumer-providers is then reviewed. The article concludes with 20 specific recommendations to help mental health professionals move beyond a focus on symptom reduction alone to more recovery-oriented care.
本文从临床医生和患者的角度，对严重持续性精神疾病的康复概念进行了概述。精神科医生斯托特兰博士首先强调了近年来双相情感障碍治疗目标的变化，从症状缓解转向同时涵盖功能恢复（恢复到疾病发作前患者所具有的功能水平）。她接着讨论了在康复过程中发挥重要作用的因素，包括恢复力、患者对治疗和康复过程的理解与参与，以及随着治疗进展临床医生与患者在设定具体功能目标方面的协作。她还着重指出政策和系统变革对于促进康复的必要性，包括增加对以康复为导向的护理的资金投入、实施将精神科医生和初级保健提供者聚集在一起的以康复为导向的协作护理模式，以及推广用于长期监测症状和功能的改进工具。文中讨论了两项用于监测症状变化和功能水平的相关绩效指标及其现场测试结果。抑郁症与双相情感障碍支持联盟（DBSA）培训主任马修·马特森和DBSA主席苏·伯格森随后阐述了患者对以康复为导向的护理的看法。他们借鉴医学研究所、总统新自由委员会、美国卫生局局长以及行为健康劳动力问题安纳波利斯联盟的建议，强调治疗的最终目标必须是康复；在最大程度上，护理应基于患者的需求和价值观；患者应在自身护理的设计和提供过程中发挥积极作用；并且所有护理提供的一个优先事项应该是唤起希望。接着回顾了关于同伴支持小组以及使用同伴支持专家作为患者提供者的有前景的研究。本文最后提出了20条具体建议，以帮助心理健康专业人员从仅关注症状减轻转向更注重以康复为导向的护理。
