Professor of Psychiatry, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire.
Assistant Professor of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec.
Can J Psychiatry. 2014 May;59(5):236-42. doi: 10.1177/070674371405900502.
The notion of recovery has been embraced by key stakeholders across Canada and elsewhere. This has led to a proliferation of definitions, models, and research on recovery, making it vitally important to examine the data to disentangle the evidence from the rhetoric. In this paper, first we ask, what do people living with severe mental illness (SMI) say about recovery in autobiographical accounts? Second, what do they say about recovery in qualitative studies? Third, from what we have uncovered about recovery, can we learn anything from quantitative studies about proportions of people leading lives of recovery? Finally, can we identify interventions and approaches that may be consistent or inconsistent with the grounded notions of recovery unearthed in this paper? We found that people with mental illness frequently state that recovery is a journey, characterized by a growing sense of agency and autonomy, as well as greater participation in normative activities, such as employment, education, and community life. However, the evidence suggests that most people with SMI still live in a manner inconsistent with recovery; for example, their unemployment rate is over 80%, and they are disproportionately vulnerable to homelessness, stigma, and victimization. Research stemming from rehabilitation science suggests that recovery can be enhanced by various evidence-based services, such as supported employment, as well as by clinical approaches, such as shared decision making and peer support. But these are not routinely available. As such, significant systemic changes are necessary to truly create a recovery-oriented mental health system.
恢复的概念已被加拿大和其他地区的主要利益相关者所接受。这导致了大量关于恢复的定义、模型和研究的出现，因此，检查数据以理清证据与言辞之间的关系至关重要。在本文中，我们首先要问的是，患有严重精神疾病（SMI）的人在自传体叙述中对恢复是怎么说的？其次，他们在定性研究中对恢复是怎么说的？第三，从我们对恢复的了解中，我们能否从关于恢复生活的人的比例的定量研究中得到一些启示？最后，我们能否确定干预措施和方法是否与本文中发现的恢复的基本概念一致或不一致？我们发现，精神疾病患者经常表示，恢复是一个旅程，其特点是越来越有自主性和自主权，以及更多地参与正常活动，如就业、教育和社区生活。然而，证据表明，大多数患有 SMI 的人仍然过着与恢复不一致的生活方式；例如，他们的失业率超过 80%，而且他们更容易无家可归、受到歧视和受害。康复科学的研究表明，各种基于证据的服务，如支持性就业，以及临床方法，如共同决策和同伴支持，可以增强恢复。但这些都没有得到常规应用。因此，需要进行重大的系统性变革，才能真正建立一个以恢复为导向的精神卫生系统。
