8. Economic & Vocational Factors
• Supported employment leading
evidence-based intervention for those
with established mental illness
• Employment can enhance social
participation, inclusion, functional
outcome
(Killackey et al., 2006)
• Access to mental health services
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9. Social Factors
• Those who had experienced psychosis
reported that social networks provided
security and stability, more so than
family
• Friends’ validation of them and their
experience was also identified as an
important part of recovery
(Tooth et al., 2003)
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10. Family Relationships & Attachment
• Berry et al. (2007) review of role of
adult attachment style in psychosis
• Greater security associated with better
compliance with treatment
• Clinician’s attachment style a recovery
factor
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11. Cultural Factors
• WHO study (1979)
• Recovery rate twice as high in developing
countries than industrial countries
• Findings replicated (Jablensky et al.,
1992)
• Socially oriented approach to healing,
inclusion, community connections
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12. Supportive Therapy
• Quality of therapeutic alliance key
determinant of outcome (Tatton &
Tarrier, 2000)
• Engaging service-user important for
effective communication
• Collaborative approach
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13. Consumer-focused Treatment
• Service users commonly report that
they ‘recovered in spite of and despite
access to services’
• Need to move away from maintenance,
monitoring, symptom management and
relapse prevention
• Objective expert vs subjective personal
experience
(Glover, 2005)
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14. Early Intervention
• Consistent relationship between
duration of untreated psychosis and
outcome (Killackey & Yung, 2007)
• 3 year follow-up of RCT, cognitive
therapy reduced likelihood of being
prescribed anti-psychotic medication
• Significantly reduced likelihood of
progression to psychosis as defined
using PANSS (Morrison et al., 2006)
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15. Medication & Side Effects
• Regular monitoring of medication (NICE
Guidelines, 2003)
• Potential for disengagement
• Encourage choice, offer range of
alternatives
• Emphasis on use as a tool to facilitate
psychosocial interventions
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16. Other Internal Factors
• Hope, belief in recovery
• Enjoyment of life
• Self-esteem
• Sprituality
(Stewart, 2003; Dorrer, 2006)
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17. Summary of Factors
Important in Recovery
• Social & Cultural factors
• Economic & Vocational factors
• Family Relationships & Attachment
• Supportive Therapy & Consumer-focused
Treatment
• Early Intervention
• Medication & Side Effects
• Other Internal Factors
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18. Implications for Further Research
• Issue of defining recovery – subjective
process, personal meaning
• Goodness of fit – issue of how recovery
is measured, traditional outcome
measures may not tap into recovery
• Draw upon experience of those who
have recovered from psychosis
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19. Limitations of this Review
• Brief overview of only a selection of
publications in the literature
• Ideally, systematic, comprehensive
review of relevant peer-reviewed
literature
• Exploration of methodological issues
• Not possible due to time constraints and
unfamiliarity with this field
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20. References
• Berry, A., Barrowclough, C., Wearden, A. (2007). A review of the role of adult attachment style in
psychosis: Unexplored issues and questions for further research.
• Cooper, B. (2006). Immigration and schizophrenia: The social causation hypothesis revisited. The British
Journal of Psychiatry , 186, 361-363.
• Dorrer, N. (2006). Evidence of Recovery: The ‘Ups’ and ‘Downs’ of Longitudinal Outcome Studies. SRN
Discussion Paper Series. Report No.4. Glasgow, Scottish Recovery Network.
• Glover, H. (2005). Recovery based service delivery: are we ready to transform the words into a
paradigm shift? Australian e-Journal for the Advancement of Mental Health, 4, 3.
• Jablensky, A., Sartorius, N., Ernberg, G., Anker, M., Korten, A., Cooper, J.E., Day, R., & Bertelsen, A.
(1992). Schizophrenia: Manifestations, incidence and course in different cultures, a World Health
Organization ten-country study. Cambridge: Cambridge University Press.
• Killackey, E.J., Jackson, H.J., Gleeson, J., Hickie, I.B., & McGorry, P.D. (2006). Exciting career opportunity
beckons! Early intervention and vocational rehabilitation in first-episode psychosis: Employing
cautious optimism. Australian and New Zealand Journal of Psychiatry, 40, 951–962.
• Killackey, E.J., & Yung, A.R. (2007). Effectiveness of early intervention in psychosis. Current Opinion in
Psychiatry, 20, 121–125.
Monday, 14 May 2012
21. References
• Liberman, R.P., & Kopelowicz, A. (2002). Recovery from schizophrenia: A challenge for the 21st century.
International Review of Psychiatry, 14, 4, 245-255.
• Morrison, A.P., French, P., Parker, S., Roberts, M. Stevens, H., Bentall, R.P., & Lewis, S.W. (2006). Three-
year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis
in people at ultrahigh risk. Schizophrenia Bulletin, 33, 3, 682–687.
• National Institute for Clinical Excellence (2003). Schizophrenia: Full national clinical guideline
on core interventions in primary and secondary care. London: NICE. http://
www.nice.org.uk/guidance/CG1 [accessed 09/10/2007]
• Stewart, E. (2003). The Ohio consumer’s Outcome Initiative: the relationship between empowerment and
symptom distress. International Association of Psychosocial Rehabilitation Services Conference,
Atlanta, USA.
• Tattan, T., & Tarrier, N. (2000). The expressed emotion of case managers of the seriously mentally ill: The
influence of expressed emotion on clinical outcomes. Psychological Medicine, 30, 195−204.
• Tooth, B., Kalyanasundaram, V., Glover , H., & Momenzadah, S. (2003). Factors consumers identify as
important to recovery from schizophrenia. Australasian Psychiatry, 11 (Supplement), 70-77.
• World Health Organisation (1979). Schizophrenia: an international follow-up study. New York: Wiley.
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