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Operationalization of the SAMHSA model of recovery: a quality of life perspective

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Abstract

Purpose

To test empirically the Substance Abuse and Mental Health Services Administration (SAMHSA) recovery model.

Methods

Two hundred and four attendants aged 18–60, with schizophrenia spectrum disorder, from two participating outpatient clinics were interviewed with a number of inventories, including health-related quality of life measure (WHOQOL-BREF (HK)). Canonical correlation analysis was performed on two sets of variables (SAMHSA recovery components and QoL domain scores).

Results

There were significant correlations between most recovery components proposed in the SAMHSA recovery statement and the health-related quality of life measure. Age, duration of untreated psychosis, the degree of social support, the interaction of singlehood and the number of confidants, engagement in competitive careers, and the duration of participation in community support services were all found to be important predictors.

Conclusions

The SAMHSA consensus statement appeared to contain valid concepts for Chinese subjects. It presented new challenges for psychiatric rehabilitation and reminded the policy makers that there is much more psychiatric rehabilitation can achieve beyond symptom control and patient management. It also demonstrated that resolve and the commitment of resources to combat stigma, develop resilience, and foster patient empowerment were very much needed in Hong Kong and perhaps in Asia and elsewhere.

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References

  1. Substance Abuse and Mental Health Services Administration (2006) National Census Statement on Mental Health Recovery: National Mental Health Information Center, US Government.

  2. Yee, B. (2003). Asian Mental Health Recovery—Follow up to the Asian Report. Wellington, New Zealand: Mental Health Commission.

    Google Scholar 

  3. Ng, R. M., Pearson, V., Lam, M., Law, C. W., Chiu, C. P., & Chen, E. Y. (2008). What does recovery from schizophrenia mean? Perceptions of long-term patients. International Journal of Social Psychiatry, 54, 118–130.

    Article  PubMed  Google Scholar 

  4. Slade, M., & Hayward, M. (2007). Recovery, psychosis and psychiatry: Research is better than rhetoric. Acta Psychiatrica Scandinavica, 116, 81–83.

    Article  PubMed  Google Scholar 

  5. Schrank, B., & Slade, M. (2007). Recovery in psychiatry. Psychiatric Bulletin, 31, 321–325.

    Article  Google Scholar 

  6. Warner, R. (2009). Recovery from schizophrenia and the recovery model. Current Opinion in Psychiatry, 22, 374–380.

    Article  PubMed  Google Scholar 

  7. Hogan, M. F. (2003). The president’s new freedom commission: Recommendations to transform mental health care in America. Psychiatric Services, 54, 1467–1474.

    Article  PubMed  Google Scholar 

  8. Frese, F. J., 3rd, Knight, E. L., & Saks, E. (2009). Recovery from schizophrenia: With views of psychiatrists, psychologists, and others diagnosed with this disorder. Schizophrenia Bulletin, 35, 370–380.

    Article  PubMed  Google Scholar 

  9. Lieberman, J. A., Drake, R. E., Sederer, L. I., et al. (2008). Science and recovery in schizophrenia. Psychiatric Services, 59, 487–496.

    Article  PubMed  Google Scholar 

  10. Harvey, P. D., & Bellack, A. S. (2009). Toward a terminology for functional recovery in schizophrenia: Is functional remission a viable concept? Schizophrenia Bulletin, 35, 300–306.

    Article  PubMed  Google Scholar 

  11. Resnick, S. G., Rosenheck, R. A., & Lehman, A. F. (2004). An exploratory analysis of correlates of recovery. Psychiatric Services, 55, 540–547.

    Article  PubMed  Google Scholar 

  12. Wong, J. G. W. S., Cheung, E. P. T., Chen, E. Y. H., et al. (2005). An instrument to assess mental patients’ capacity to appraise and report subjective quality of life. Quality of Life Research, 14, 687–694.

    Article  PubMed  Google Scholar 

  13. Ritsher, B. J., Otilingam, P. G., & Grajales, M. (2003). Internalized stigma of mental illness: Psychometric properties of a new measure. Psychiatry Research, 121, 31–49.

    Article  PubMed  Google Scholar 

  14. Wagnild, G. M., & Young, H. M. (1993). Development and psychometric evaluation of the Resilience Scale. Journal of Nursing Measurement, 1, 165–178.

    CAS  PubMed  Google Scholar 

  15. Rogers, E. S., Chamberlin, J., Ellison, M. L., & Crean, T. (1997). A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatric Services, 48, 1042–1047.

    CAS  PubMed  Google Scholar 

  16. Hansson, L., & Bjorkman, T. (2005). Empowerment in people with a mental illness: Reliability and validity of the Swedish version of an empowerment scale. Scandinavian Journal of Caring Sciences, 19, 32–38.

    Article  PubMed  Google Scholar 

  17. Kearney, B. Y., & Fleischer, B. J. (1979). Development of an instrument to measure exercise of self-care agency. Research in Nursing and Health, 2, 25–34.

    Article  CAS  PubMed  Google Scholar 

  18. Riesch, S. K., & Hauck, M. R. (1988). The exercise of self-care agency: An analysis of construct and discriminant Validity. Research in Nursing and Health, 11, 245–255.

    Article  CAS  PubMed  Google Scholar 

  19. Pearlin, L., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2–21.

    Article  CAS  PubMed  Google Scholar 

  20. Bengtsson-Tops, A. (2004). Mastery in patients with schizophrenia living in the community: Relationship to sociodemographic and clinical characteristics, needs for care and support, and social network. Journal of Psychiatric And Mental Health Nursing, 11, 298–304.

    Article  CAS  PubMed  Google Scholar 

  21. Rosenfield, S. (1992). Factors contributing to the subjective quality of life of the chronic mentally ill. Journal of Health and Social Behavior, 33, 299–315.

    Article  CAS  PubMed  Google Scholar 

  22. Snyder, C. R., Sympson, S. C., Ybasco, F. C., & Borders, T. F. (1996). Development and validation of the state hope scale. Journal of Personality and Social Psychology, 70, 321–335.

    Article  CAS  PubMed  Google Scholar 

  23. Williams, G. C., Rodin, G. C., Ryan, R. M., Grolnick, W. S., & Deci, E. L. (1998). Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychology, 17, 269–276.

    Article  CAS  PubMed  Google Scholar 

  24. Ralph, R. O., Kidder, K., & Philips, D. (2000). Can we Measure Recovery? A Compendium of Recovery Measures. Cambridge, MA: Human Services Research Institute.

    Google Scholar 

  25. Yu, S. F., Lee, T. F., & Woo, J. (2004). Psychometric testing of the Chinese version of the medical outcomes study social support survey (MOS-SSS-C). Research in Nursing and Health, 27, 135–143.

    Article  PubMed  Google Scholar 

  26. Wilkinson, G., Hesdon, B., Wild, D., et al. (2000). Self-report quality of life measure for people with schizophrenia: The SQLS. British Journal of Psychiatry, 177, 42–46.

    Article  CAS  PubMed  Google Scholar 

  27. Chou, K. L. (2000). Assessing Chinese adolescents’ social support: The multidimensional scale of perceived social support. Personality and Individual Differences, 28, 299–307.

    Article  Google Scholar 

  28. Moreira-Almeida, A., & Koenig, H. G. (2006). Retaining the meaning of the words religiousness and spirituality: A commentary on the WHOQOL SRPB group’s “a cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life”. Social Science and Medicine, 63, 843–845.

    Article  PubMed  Google Scholar 

  29. WHOQOL SRPB Group. (2006). A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life. Social Science and Medicine, 62, 1486–1497.

    Article  Google Scholar 

  30. Chan, G., Ungvari, G. S., Shek, D. T. L., & Leung, J. J. P. (2003). Hospital and community-based care for patients with chronic schizophrenia in Hong Kong: Quality of life and its correlates. Social Psychiatry and Psychiatric Epidemiology, 38, 196–203.

    Article  PubMed  Google Scholar 

  31. Chan, S., & Yu, I. W. (2004). Quality of life of clients with schizophrenia. Journal of Advanced Nursing, 45, 72–83.

    Article  PubMed  Google Scholar 

  32. Lee, S., Lee, M. T., Chiu, M. Y., & Kleinman, A. (2005). Experience of social stigma by people with schizophrenia in Hong Kong. British Journal of Psychiatry, 186, 153–157.

    Article  PubMed  Google Scholar 

  33. Tsang, H. W. H., Tam, P. K. C., Chan, F., & Cheung, W. M. (2003). Stigmatizing attitudes towards individuals with mental illness in Hong Kong: Implications for their recovery. Journal of Community Psychology, 31, 383–396.

    Article  Google Scholar 

  34. Tsoi, W. F., & Kua, E. H. (1992). Predicting the outcome of schizophrenia 10 years later. Australian and New Zealand Journal of Psychiatry, 26, 257–261.

    Article  CAS  PubMed  Google Scholar 

  35. Robinson, D. G., Woerner, M. G., McMeniman, M., Mendelowitz, A., & Bilder, R. M. (2004). Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. American Journal of Psychiatry, 161, 473–479.

    Article  PubMed  Google Scholar 

  36. Jablensky, A., Sartorius, N., Ernberg, G., et al. (1992). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine. Monograph Supplement, 20, 1–97.

    Article  CAS  PubMed  Google Scholar 

  37. Leff, J., Sartorius, N., Jablensky, A., Korten, A., & Ernberg, G. (1992). The international pilot study of schizophrenia: 5 year follow-up findings. Psychological Medicine, 22, 131–145.

    Article  CAS  PubMed  Google Scholar 

  38. Wiersma, D., Nienhuis, F. J., Slooff, C. J., & Giel, R. (1998). Natural course of schizophrenic disorders: a 15-year followup of a Dutch incidence cohort. Schizophrenia Bulletin, 24, 75–85.

    CAS  PubMed  Google Scholar 

  39. Viinamaki, H., Niskanen, L., Jaaskelainen, J., et al. (1996). Factors predicting psychosocial recovery in psychiatric patients. Acta Psychiatrica Scandinavica, 94, 365–371.

    Article  CAS  PubMed  Google Scholar 

  40. Breier, A., & Strauss, J. S. (1984). The role of social relationships in the recovery from psychotic disorders. American Journal of Psychiatry, 141, 949–955.

    CAS  PubMed  Google Scholar 

  41. Corrigan, P. W., & Phelan, S. M. (2004). Social support and recovery in people with serious mental illnesses. Community Mental Health Journal [NLM–MEDLINE], 40, 513.

    Article  Google Scholar 

  42. McGurk, S. R. (2000). Neurocognition as a determinant of employment status in schizophrenia. Journal of Psychiatric Practice, 6, 190–196.

    Article  CAS  PubMed  Google Scholar 

  43. Priebe, S., Warner, R., Hubschmid, T., & Eckle, I. (1998). Employment, attitudes toward work, and quality of life among people with schizophrenia in three countries. Schizophrenia Bulletin, 24, 469–477.

    CAS  PubMed  Google Scholar 

  44. Hegarty, J. D., Baldessarini, R. J., Tohen, M., Waternaux, C., & Oepen, G. (1994). One hundred years of schizophrenia: A meta-analysis of the outcome literature. American Journal of Psychiatry, 151, 1409–1416.

    CAS  PubMed  Google Scholar 

  45. Harrison, G., Hopper, K., Craig, T., et al. (2001). Recovery from psychotic illness: A 15- and 25-year international follow-up study. British Journal of Psychiatry, 178, 506–517.

    Article  CAS  PubMed  Google Scholar 

  46. Harding, C. M., Brooks, G. W., Ashikaga, T., Strauss, J. S., & Breier, A. (1987). The Vermont longitudinal study of persons with severe mental illness, II: Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. American Journal of Psychiatry, 144, 727–735.

    CAS  PubMed  Google Scholar 

  47. Lundman, B., Strandberg, G., Eisemann, M., Gustafson, Y., & Brulin, C. (2007). Psychometric properties of the Swedish version of the Resilience Scale. Scandinavian Journal of Caring Sciences, 21, 229–237.

    Article  PubMed  Google Scholar 

  48. Jobe, T. H., & Harrow, M. (2005). Long-term outcome of patients with schizophrenia: A review. Canadian Journal of Psychiatry, 50, 892–900.

    Google Scholar 

  49. Lester, H., & Gask, L. (2006). Delivering medical care for patients with serious mental illness or promoting a collaborative model of recovery? British Journal of Psychiatry, 188, 401–402.

    Article  PubMed  Google Scholar 

  50. Ng, B. F., & Tsang, H. W. (2000). Evaluation of a goal attainment program using the goal attainment scale for psychiatric in-patients in vocational rehabilitation. Work, 14, 209–216.

    PubMed  Google Scholar 

  51. Green, S. B. (1991). How many subjects does it take to do a regression analysis? Multivariate Behavioral Research, 26, 449–510.

    Article  Google Scholar 

  52. Ho, W. W. N., Chiu, M. Y. L., Lo, W. T. L. & Yiu, M. G. C (2009) Recovery components as determinants of the health related quality of life among patients with Schizophrenia: A structural equation modeling analysis. Australian and New Zealand Journal of Psychiatry (in press).

  53. Leung, K. F., Tay, M. S. M., Cheng, S. W. S., & Lin, F. (1997). Hong Kong Chinese Version World Health Organization Quality of Life Measure—abbreviated version WHOQOL-BREF (HK). Hong Kong SAR: Hong Kong Hospital Authority.

    Google Scholar 

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Acknowledgment

Declaration of interest: None. This study is funded by a research grant of Hong Kong Baptist University (FRG/06-07/II-13).

Author information

Authors and Affiliations

  1. Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, People’s Republic of China

    Marcus Y. L. Chiu & Winnie W. N. Ho

  2. Kwai Chung Hospital, Kwai Chung, N.T., Hong Kong SAR, People’s Republic of China

    William T. L. Lo

  3. Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong SAR, People’s Republic of China

    Michael G. C. Yiu

Authors
  1. Marcus Y. L. Chiu
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  2. Winnie W. N. Ho
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  3. William T. L. Lo
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  4. Michael G. C. Yiu
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Corresponding author

Correspondence to Marcus Y. L. Chiu.

Appendix I

Appendix I

National Consensus Statement on Mental Health Recovery [1]

Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

The ten fundamental components of recovery

Self-direction

Consumers lead, control, exercise choice over, determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life.

Individualized and person centered

There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations.

Empowerment

Consumers have the authority to choose from a range of options and to participate in all decisions—including the allocation of resources—that will affect their lives and are educated and supported in so doing.

Holistic

Recovery encompasses an individual’s whole life, including mind, body, spirit, and community.

Nonlinear

Recovery is not a step-by-step process but one based on continual growth, occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move onto fully engage in the work of recovery.

Strength based

Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, consumers leave stymied life roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, employee). The process of recovery moves forward through interaction with others in supportive, trust-based relationships.

Peer support

Mutual support—including the sharing of experiential knowledge and skills and social learning—plays an invaluable role in recovery.

Respect

Community, systems, and societal acceptance and appreciation of consumers—including protecting their rights and eliminating discrimination and stigma—are crucial in achieving recovery. Self-acceptance and regaining belief in one’s self are particularly vital.

Responsibility

Consumers have a personal responsibility for their own self-care and journeys of recovery.

Hope

Recovery provides the essential and motivating message of a better future—that people can and do overcome the barriers and obstacles that confront them. Hope is internalized; but can be fostered by peers, families, friends, providers, and others.

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Chiu, M.Y.L., Ho, W.W.N., Lo, W.T.L. et al. Operationalization of the SAMHSA model of recovery: a quality of life perspective. Qual Life Res 19, 1–13 (2010). https://doi.org/10.1007/s11136-009-9555-2

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