Assessing Recovery

Mental health care in the United States and Western Europe is undergoing a seismic shift in
values. The paternalistic, medical model of care that has dominated practice for more than
75-years is being challenged by an activist group of consumer-survivors, with the support of
public officials and an increasing number of professionals. The centerpiece of this shift is
the recovery model, which assumes that all consumers have the capacity to improve and
develop a life distinct from their illness. The consumer model of recovery involves a
non-linear process in which the consumer gradually adapts to, and moves beyond the illness.
It emphasizes hope, empowerment, and control of one's life. This model stands in contrast to
scientific and clinical models, which view recovery as an outcome, primarily involving
reduced symptoms and improved functional capacity.

The public health significance of the consumer perspective is underscored by the President's
New Freedom Commission on Mental Health (2003), which enunciated two guiding principles for
mental health services in the US: First, services and treatments must be consumer and family
centered, geared to give consumers real and meaningful choices about treatment options and
providers. Second, care must focus on increasing consumers' ability to successfully cope
with life's challenges, on facilitating recovery, and on building resilience, not just
managing symptoms. In response to the Commission report the VA has mandated a shift to a
recovery model and committed a large amount of resources to implementing it throughout the
system.

Despite this political and programmatic change, there is little scientific literature on the
nature of recovery or the factors that contribute to it. Systems change is being driven by
social mandate and consensual agreement rather than empirical support. It is essential that
the consumer model of recovery be subjected to empirical study if it is to have a meaningful
and lasting impact on systems and patterns of care. It is also critical to evaluate the
recovery-oriented systems of care that have been developed. Two factors that have limited
empirical study of the construct and treatment programs are: a) the absence of a
scientifically grounded conceptual model of recovery, and b) the lack of a reliable and
valid assessment instrument to measure recovery status. The purpose of this project is to
develop and evaluate a psychometrically sound assessment scale using Bandura's social
cognitive theory as a conceptual model for the recovery construct.

The Specific Aims are: 1) to evaluate and refine the draft version of the Maryland
Assessment of Recovery in Serious Mental Illness (MARS), 2) evaluate its test-retest
reliability and validity, and 3) to examine recovery status and the relationship of recovery
to hypothesized mediators and moderators over a 1-year retest interval.

Inclusion Criteria:

1. SCID diagnoses of: schizophrenia, schizoaffective disorder, bipolar disorder I (with
mania), or major depression with psychotic features, with a history of a minimum of 2
psychotic exacerbations, or Psychosis NOS

2. A minimum of 2 psychotic exacerbations(confirmed by medical record, provider report,
or patient self-report);

3. Are receiving services from participating study sites and have had a minimum of two
service visits within the last 6 months;

4. Have received mental health services for a minimum of 3-years;

5. Age between 25 and 65;

6. Able to provide informed consent; and

7. Able to complete protocol assessments (estimation from medical record and/or mental
health provider that person can read at 5th grade level and sustain attention to
study tasks for required period of time).

Exclusion Criteria:

1. Severe or profound mental retardation as indicated by chart review