Treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Unfortunately, people distressed by these illnesses often do not seek out services or choose to fully engage in them. One factor that impedes care seeking and undermines the service system is mental illness stigma. In this article, we review the complex elements of stigma in order to understand its impact on participating in care. We then summarize public policy considerations in seeking to tackle stigma in order to improve treatment engagement. Stigma is a complex construct that includes public, self, and structural components. It directly affects people with mental illness, as well as their support system, provider network, and community resources. The effects of stigma are moderated by knowledge of mental illness and cultural relevance. Understanding stigma is central to reducing its negative impact on care seeking and treatment engagement. Separate strategies have evolved for counteracting the effects of public, self, and structural stigma. Programs for mental health providers may be especially fruitful for promoting care engagement. Mental health literacy, cultural competence, and family engagement campaigns also mitigate stigma's adverse impact on care seeking. Policy change is essential to overcome the structural stigma that undermines government agendas meant to promote mental health care. Implications for expanding the research program on the connection between stigma and care seeking are discussed.

The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care

Objective: The consumer movement is advocating that rehabilitation services become recovery-orientated. The objectives of this study are to gain a better understanding of the concept of recovery by: (i) identifying a definition of recovery that reflects consumer accounts; and (ii) developing a conceptual model of recovery to guide research, training and inform clinical practice. Method: A review was conducted of published experiential accounts of recovery by people with schizophrenia or other serious mental illness, consumer articles on the concept of recovery, and qualitative research and theoretical literature on recovery. Meanings of recovery used by consumers were sought to identify a definition of recovery. Common themes identified in this literature were used to construct a conceptual model reflecting the personal experiences of consumers. Results: The definition of recovery used by consumers was identified as psychological recovery from the consequences of the illness. Four key processes of recovery were identified: (i) finding hope; (ii) re-establishment of identity; (iii) finding meaning in life; and (iv) taking responsibility for recovery. Five stages were identified: (i) moratorium; (ii) awareness; (iii) preparation; (iv) rebuilding; and (v) growth. Conclusion: A five-stage model compatible with psychological recovery is proposed, which offers a way forward for attaining recovery-orientated outcomes. After further empirical investigation, a version of this model could be utilized in quantitative research, clinical training and consumer education.

The experience of recovery from schizophrenia: towards an empirically validated stage model

Fidelity may be defined as the extent to which delivery of an intervention adheres to the protocol or program model originally developed. Fidelity measurement has increasing significance for evaluation, treatment effectiveness research, and service administration. Yet few published studies using fidelity criteria provide details on the construction of a valid fidelity index. The purpose of this review article is to outline steps in the development, measurement, and validation of fidelity criteria, providing examples from health and education literatures. We further identify important issues in conducting each step. Finally, we raise questions about the dynamic nature of fidelity criteria, appropriate validation and statistical analysis methods, the inclusion of structure and process criteria in fidelity assessment, and the role of program theory in deciding on the balance between adaptation versus exact replication of model programs. Further attention to the use and refinement of fidelity criteria is important to evaluation practice.

/pdf/fidelity-criteria-development-measurement-and-validation-229bb5xmo7.pdf

Fidelity Criteria: Development, Measurement, and Validation.

Context: The relationship between mental illness and violence has a significant effect on mental health policy, clinical practice, and public opinion about the dangerousness of people with psychiatric disorders. Objective: To use a longitudinal data set representative of the US population to clarify whether or how severe mental illnesses such as schizophrenia, bipolar disorder, and major depression lead to violent behavior. Design:Data on mental disorder and violence were collected as part of the National Epidemiologic Survey on AlcoholandRelatedConditions(NESARC),a2-wavefaceto-face survey conducted by the National Institute on Alcohol Abuse and Alcoholism. Participants: A total of34653 subjects completed NESARC waves 1 (2001-2003) and 2 (2004-2005) interviews. Wave 1 data on severe mental illness and risk factors were analyzed to predict wave 2 data on violent behavior.

/pdf/the-intricate-link-between-violence-and-mental-disorder-ny1vems62x.pdf

The intricate link between violence and mental disorder: Results from the national epidemiologic survey on alcohol and related conditions

Schizophrenia has traditionally been viewed as a chronic condition with a very pessimistic outlook, but that assumption may not be valid. There has been a growing consumer movement among people with schizophrenia that has challenged both the traditional perspective on the course of illness and the associated assumptions about the possibility of people with the illness living a productive and satisfying life. This new conception of the illness is supported by long-term studies that suggest that as much as 50% of people with the illness have good outcomes. There has also been a change in political and public health perspectives of the illness, stimulated in part by the President's New Freedom Commission on Mental Health. The purpose of this article is to provide an overview of some key themes about the recovery concept, as applied to schizophrenia. The article will address 3 questions: (1) What is recovery? (2) Is recovery possible? and (3) What are the implications of a recovery model for a scientific approach to treatment (ie, the use of evidence-based practices)? Scientific and consumer models of recovery are described, and commonalities and differences are discussed. Priorities for future research are suggested.

/pdf/scientific-and-consumer-models-of-recovery-in-schizophrenia-2g5213pttn.pdf

Scientific and Consumer Models of Recovery in Schizophrenia: Concordance, Contrasts, and Implications

Consumer advocacy has emerged as an important factor in mental health policy during the past few decades. Winning consumer support for evidence-based practices requires recognition that consumers' desires and needs for various types of treatments and services differ significantly. The authors suggest that the degree of support for evidence-based practices by consumer advocates depends largely on the degree of disability of the persons for whom they are advocating. Advocates such as members of the National Alliance for the Mentally Ill, who focus on the needs of the most seriously disabled consumers, are most likely to be highly supportive of research that is grounded in evidence-based practices. On the other hand, advocates who focus more on the needs of consumers who are further along their road to recovery are more likely to be attracted to the recovery model. Garnering the support of this latter group entails ensuring that consumers, as they recover, are given increasing autonomy and greater input about the types of treatments and services they receive. The authors suggest ways to integrate evidence-based practices with the recovery model and then suggest a hybrid theory that maximizes the virtues and minimizes the weaknesses of each model.

http://static1.1.sqspcdn.com/static/f/1072889/16305004/1327883371977/evidence+based+meds+NAMI+frese2001.pdf?token=we8U29g%2Bd2cpiEJIaDfuV5KvHNc%3D

Integrating evidence-based practices and the recovery model.

This article presents two views of the results of the MacArthur Violence Risk Assessment Study, which was conducted between 1992 and 1995 in order to ascertain the prevalence of community violence in a sample of people discharged from acute psychiatric facilities. The initial findings, which were published in 1998 in the Archives of General Psychiatry, have been cited by some advocates as proof that discharged psychiatric patients are not more dangerous than other persons in the general population. For the article presented here, Dr. Torrey and Mr. Stanley examined additional articles, book chapters, and a book about the MacArthur Study that have appeared since 1998 in order to ascertain whether the study's original conclusion should be modified and whether additional conclusions can be drawn from the subsequently published data. They present six points on which they disagree with the findings or fault the design of the MacArthur Study. After each point, Dr. Monahan, Dr. Steadman, and other authors of the MacArthur Study Group respond.

/pdf/the-macarthur-violence-risk-assessment-study-revisited-two-2n1qh81wuf.pdf

The MacArthur Violence Risk Assessment Study Revisited: Two Views Ten Years After Its Initial Publication

Evidence-Based Practices and Recovery

"Assisted outpatient treatment": an example of newspeak?: in reply.

https://www.mdpi.com/2227-9032/11/10/1411/pdf?version=1684815801

Jonathan Stanley

Papers

Integrating evidence-based practices and the recovery model.

The MacArthur Violence Risk Assessment Study Revisited: Two Views Ten Years After Its Initial Publication

Evidence-Based Practices and Recovery

"Assisted outpatient treatment": an example of newspeak?: in reply.

The Relationship between Internet Patient Satisfaction Ratings and COVID-19 Outcomes