The recovery concept: clinician and consumer perspectives

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.