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Operations that require transaction log backups are not supported by the simple recovery model. The following features cannot be used in simple recovery mode: In the event of a disaster, those changes must be redone. Can recover only to the end of a backup. Full Requires log backups. No work is lost due to a lost or damaged data file. Can recover to an arbitrary point in time for example, prior to application or user error.
If the tail of the log is damaged, changes since the most recent log backup must be redone. Can recover to a specific point in time, assuming that your backups are complete up to that point in time. Some domains, such as substance use, psychiatric symptoms and cognitive impairment, may function as negative moderators only when they are at significant levels. Yet another limitation of the recovery construct is that there are no measures of recovery as defined by SAMHSA and only a handful that are based on other definitions Andersen et al 31 identified only one recovery measure in a search of the published literature.
Campbell-Orde et al 32 surveyed consumer and government organizations as well as the literature and identified eight measures, of which only six actually focus on recovery per se.
Results of these surveys reflect the fact that, for the most part, extant recovery instruments have been developed ad hoc by consumer groups and have not been published. They have evolved from small work group or consensus conferences with primary attention to face and consensual validity rather than a systematic psychometric program of scale development. Most are based on unsupported models or definitions of recovery. Some are too long to be practical, and others are too heterogeneous to be useful as overall outcome variables. In response to this situation we have developed a new measure based on our operationalized version of the SAMHSA recovery domains: The MARS is a item self-report instrument designed to assess recovery status in people with serious mental illness.
It was developed using an iterative process by a team of six doctoral level clinical scientists with expertise in serious mental illness and recovery in a series of ten face-to-face meetings, supplemented by structured interviews with six independent experts and a panel of consumers.
The MARS takes less than 10 minutes to complete and its items are written at a 4th grade reading level, making it practical for use in both research and for service delivery agencies. It should also be easy to translate to multiple languages. Notably, despite being developed to reflect the diverse SAMHSA recovery domains, a single primary factor accounts for the majority of variance. We are currently conducting a longitudinal study to evaluate our social learning model and examine mediators and moderators of recovery. With a sample of more than outpatients recruited to date, the data provide considerable support for our model.
Table 1 provides a summary of a step-wise regression analysis of a range of domains on the MARS. Self-efficacy and human agency account for the largest proportion of variance in MARS scores: Other recovery constructs, including hope and empowerment, also account for a significant proportion of variance, but do not add appreciably to self-efficacy and agency.
Positive and negative symptoms, neurocognitive functioning, social support, subjective quality of life, and health status, or receipt of recovery oriented treatment also add modest amounts of variance. These data suggest that recovery is not a simple by-product of traditional outcome domains, such as symptoms, and is not a proxy for quality of life. Rather, it seems to be a distinct construct that may have important implications for understanding consumers with serious mental illness and for evaluating the outcomes of treatment programs.
However, it should also be noted that the MARS was not highly correlated with either the receipt of recovery oriented treatment or with satisfaction with treatment. As indicated above, these data are preliminary and should be interpreted with caution. In addition, subjects were all receiving services at Veterans Administration hospitals in the United States. We are currently recruiting a larger and more diverse sample and will be assessing consumers 1 year after the baseline assessment.
This will give us a picture of the influence of the diverse outcome and environmental factors on recovery over time, as well as how recovery status influences psychosocial functioning. National Center for Biotechnology Information , U. Journal List World Psychiatry v. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC.
Abstract The consumer recovery model has had increasing influence on mental health practices in the United States, Western Europe, and several other countries. Recovery, serious mental illness, consumer movement, self-efficacy, social learning model. A social cognitive model of recovery A major limitation of the consumer model of recovery is that is it not grounded in established psychological principles, and refers to vague constructs that have not been objectively defined Open in a separate window.
Figure 1 A model of the relationship between self-efficacy and recovery. Mediators and moderators of recovery Another limitation of the current literature on the consumer model is that it is not clear to what extent recovery is mediated or moderated by functional outcome domains, such as work and social relationships: Assessing recovery Yet another limitation of the recovery construct is that there are no measures of recovery as defined by SAMHSA and only a handful that are based on other definitions Recovery from severe mental illnesses: Recovery from psychotic illness: Do patients with schizophrenia ever show periods of recovery?
A year multi-follow-up study. Liberman RP, Kopelowicz A. Scientific and consumer models of recovery in schizophrenia: New Freedom Commission on Mental Health. Another positive feature of this definition is the focus on health and wellness, which includes physical health and quality of life, as well as the ability to live independently and function adequately in work or school and in social relationships. Although this does not encompass the full range of phenomenological and personal elements included in consumer definitions see below , it is an important addition to the narrower clinical perspective provided by Liberman et al.
All extant scientific definitions are limited in that they have been determined consensually, rather than empirically. Issues such as the requisite duration of recovery, residual symptom levels that are acceptable, and the level of role functioning that must be achieved have not been analyzed to determine concurrent or predictive validity: Similarly, the diverse perspectives of professionals, family members, and consumers have not been systematically integrated.
These diverse views are reflected in the Nasrallah et al. A related problem is that the field lacks well-validated measures of key elements, such as role functioning and productive activity. For example, work would appear to be a straightforward dimension to measure eg, hours worked per month, income , but there are a number of complexities in the context of recovery: Finally, recovery is better conceptualized as a multidimensional construct rather than as an objective status or level of functioning.
There is no gold standard against which to evaluate definitions and measures. Consequently, it should be evaluated in the context of utility and convergent and discriminant validity. Path analysis and structural equation modeling may be more appropriate analytic strategies than correlations or regressions with concurrent and predictive criteria.
In comparing consumer-oriented and scientific definitions of recovery, it is important to recognize that they have evolved from very different perspectives, different historical contexts, and with different goals. In contrast, consumer definitions have evolved from something akin to a civil rights movement among consumers and a sociopolitical change in public attitudes about mental illness. The goals of consumer-oriented definitions include consciousness raising among consumers and family members and changes in mental health policies and practices, not comparative evaluation of treatments or analysis of disease process.
The target audience is consumers, family members, politicians, policymakers, and clinicians, not clinical scientists. Beginning at least in the late s, a growing group of consumers and professionals have been expressing increased dissatisfaction with what has been seen as a paternalistic and unresponsive mental health system. As with many social movements, there is a continuum of views about mental health services among consumers. At its most extreme, the consumer movement has vilified professionals and seen traditional mental health services as iatrogenic, generating feelings of hopelessness and helplessness, promoting dependence, and fostering stigma.
Some consumers identify themselves as survivors not of mental illness but of the mental health system. There is no precise history to account for the changes in attitudes and the consumer movement, but several factors have contributed.
Recovery models are designed to control transaction log maintenance. Studies are required to understand factors that contribute to consumer-defined recovery and determine its course. It supports the view that they should get on with their lives, do things and develop relationships that give their lives meaning. The scientific definitions view recovery as an outcome. Receive exclusive offers and updates from Oxford Academic. Are there tools to help service users and mental health services? Efficacy was found to have a strong negative relationship with perceived discrimination and self-stigma, and a strong positive relationship with empowerment in an outpatient schizophrenia cohort 27 , and it was inversely related to depression and perceived loss of independence in a schizophrenia spectrum sample
A growing cadre of individuals, including mental health professionals, have publicly identified themselves as mental health consumers and become very effective spokespersons for the consumer community. They have not only advocated for changes in the service delivery system but have also very effectively illustrated the fact that recovery from severe mental illness is possible. In addition, they have effectively argued that recovery may be something very different from the disease-oriented, scientific-clinical concept.
Two important reports from the US federal government provided considerable momentum to the recovery movement. First, the surgeon general's report on mental health 11 concluded that all mental health care should be consumer- and family-oriented and have the promotion of recovery as its primary aim.
While this report did not have the force of law to produce changes, it served as a focal point for change among many state and municipal mental health systems, and it stimulated discussion among advocacy organizations and the professional community. This position was echoed more forcefully in the report of the President's New Freedom Commission, Achieving the Promise: Transforming Mental Health Care in America.
The principles enunciated in the surgeon general's report and the New Freedom Commission report have been adopted by several state mental health systems, including Connecticut, Ohio, Wisconsin, and New Mexico. VA is the largest health care system in the United States, and adoption of a recovery model in VA will undoubtedly serve as a model and stimulus for action by other governmental agencies at the national and state levels.
In the context of the consumer movement and these policy statements, the recovery concept represents a model of care, as well as a conceptualization of possible outcomes. Internal conditions include the attitudes and processes that lead to change, including a hope that recovery is possible; b healing, which entails developing a sense of self separate from illness and the ability to cope with symptoms; c empowerment, which corrects for a sense of powerlessness and dependence that results from traditional mental health care; and d connection, which entails reestablishing social connections with others.
External conditions are the experiences, policies, and practices that lead to recovery: The scientific definitions view recovery as an outcome. In contrast, consumer definitions consider it to be a process that occurs over time, in a nonlinear fashion. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness. Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness.
It fails to address the fact that the scientific and consumer communities have distinctly different conceptions of what recovery means, each of which may be valid for different purposes. Although most consumer-oriented definitions of recovery and the recovery model convey a clear and powerful message, they are relatively nonspecific and are markedly limited as criteria for research, for evaluating the effectiveness of clinical programs, or for developing public policy.
For example, the VA's Action Agenda mandated 82 systemwide changes based closely on the New Freedom Commission report but appointed a series of workgroups to develop detailed implementation plans.
Similarly, in late the Substance Abuse and Mental Health Services Administration SAMHSA held a 2-day National Consensus Conference on Mental Health Recovery and Transformation to develop a definition of recovery, reach a consensus on its key principles and elements, and identify essential characteristics of effective recovery-oriented services, as a first step in transforming the mental health system nationally. Sponsored by the federal agency charged with developing and implementing national health policies, the product of this workshop will likely have important implications for clinical practice and reimbursement in the United States.
The following draft definition was developed: Ten characteristics of effective recovery-oriented services were identified: A complete discussion of these parameters and the implications for research and treatment services is beyond the scope of this article, but several points warrant mention. There is a clear emphasis on treatment as a partnership between clinician, consumer, and family when family members are involved.
The traditional top-down, clinician-driven approach is seen as unhelpful at best and harmful at worst. Similarly, there is an emphasis on empowerment: In that regard, both the VA Action Agenda and the National Health Service in the United Kingdom 20 have actively promoted the recruitment of peers as service providers.
Consumers lead, control, exercise choice over, and determine their own path of recovery. There are multiple pathways to recovery based on the individual person's unique needs, preferences, and experiences. Consumers have the authority to exercise choices and make decisions that impact their lives and are educated and supported in so doing. Recovery encompasses the varied aspects of an individual's life including mind, body, spirit, and community. Recovery is not a step-by-step process but one based on continual growth with occasional setbacks. Recovery focuses on valuing and building on the multiple strengths, resiliency, coping abilities, inherent worth, and capabilities of the individual.
The invaluable role of mutual support in which consumers encourage one another in recovery is recognized and promoted. Community, systems, and societal acceptance and appreciation of consumers—including the protection of consumer rights and the elimination of discrimination and stigma—are crucial in achieving recovery. Consumers have personal responsibility for their own self-care and journeys of recovery. Recovery provides the essential and motivating message that people can and do overcome the barriers and obstacles that confront them.
This point is poignantly made in a paper by Patricia Deegan, a consumer-survivor: And in an effort to avoid the biologically disastrous effects of profound hopelessness, people with psychiatric disabilities do what other people do. We grow hard of heart and attempt to stop caring.
It is safer to become helpless then [ sic ] to become hopeless. In light of the momentum behind the recovery model, it is reasonable to ask whether, in fact, recovery is a reasonable goal. It certainly stands in contrast to the traditional view of schizophrenia as a chronic, possibly deteriorating condition. Not surprisingly, concerns have been raised that the model is little more than old wine in new bottles and that it offers false hopes to consumers and their families. First-person accounts published in the scientific literature for more than 25 years eg, in Schizophrenia Bulletin , as well as numerous survey papers, 24 conceptual papers, 21,25,26 and public addresses by consumers provide ample, albeit not scientifically controlled, evidence to that effect.
Of course, just as one can define recovery in such a stringent way as to make it an impossible goal, it can also be defined so broadly as to make its achievement unimportant. Perhaps more important from the perspective of most readers of Schizophrenia Bulletin , there is now a growing scientific literature demonstrating a more optimistic picture of the course of illness. A full explication of this literature is beyond the scope of this article, and the reader is referred to a recent book by Davidson, Harding, and Spaniol, 27 along with other reviews that provide extensive discussions of the literature.
Beginning with the Vermont Longitudinal Study, 5,28 there are now upwards of 20 contemporary trials of the long-term outcome of schizophrenia. Two recent examples of long-term outcomes are illustrative.
The International Study of Schizophrenia 31 conducted and year follow-ups of subjects originally recruited for earlier international trials. In this study The Chicago Follow-up Study 6 has followed a cohort of patients for 15 years, conducting assessments at 5 occasions. However, relatively few patients were in continuous recovery: These data suggest some patients who do well may not need to take maintenance medications.
However, this is a complex issue. Some of these patients may have done better if they were maintained on medication. There are also data to suggest that duration of untreated psychosis is a strong predictor of subsequent course of illness, 31 and a growing literature on first-episode cases suggest that early treatment can play a substantial role in improving outcomes. The long-term outcome data can be interpreted as a glass half full or half empty. There is little evidence that a large proportion of patients have a benign course of illness with substantial symptom remission and return of function after a brief period of acute dysfunction.
The majority of people with schizophrenia have a long period of intermittent or continuous disability. Conversely, it appears as if many, if not most, people with the illness have periods of relatively good functioning, which increase in frequency and duration as they pass through middle age. At least half of the population can be expected to achieve and maintain scientific criteria for recovery for extended periods of time during their lives.
Moreover, the empirical data may actually underestimate the actual prevalence of good outcomes. It is widely assumed that there is a population of good outcome patients who are not treated in public mental health systems and therefore are less likely to be recruited into studies than patients who are doing poorly. Anecdotal data and commentary by the many impressive consumer spokespersons for the recovery model are informative, but it is difficult to extrapolate from these sources of information.
It is clear that the professional and scientific communities have not sufficiently appreciated the subjective experiences of people with schizophrenia and their ability to recover from the debilitating effects of the illness. Similarly, there has not always been adequate consideration of the value of engaging the consumer as a partner with decision-making authority in the treatment process.
Conversely, it is not clear if the experiences of consumer-professionals are characteristic of the broader population of people with schizophrenia or if they represent a distinct good-outcome subgroup.