125 Perspective matters in recovery BACKGROUND Personal recovery (referred to hereafter as “recovery”) from severe mental illness has been conceptualized as a deeply personal and unique, non-linear process of change, to which developments in connectedness, hope, identity, meaning of life and empowerment contribute (1, 2). However, it rarely is a journey undertaken without profound influences from significant others, from both social (family, friends, important others, referred to as “family” hereafter) and professional networks (involving an array of mental health professionals, referred to as “professionals” hereafter) (3, 4). These influences may have both positive and negative aspects. For example, family may react to the burden of mental illness with intensive involvement or by distancing themselves, and professionals use care paradigms, such as the medical model, to provide care (5). These modes may, or may not, align to individual recovery needs of someone with severe mental illness (6-8). Differences in view (“diverging perspectives”) on what is going on and what is needed between persons with severe mental illness, family and professionals are considered a central characteristic of persisting severe mental illness (9, 10). Persons with severe mental illness, especially during psychosis, may experience a pressing reality unseen and/or misunderstood by others (11, 12). Family may struggle to address problems they (for)see (13). Professionals may conceptualize the situation as lack of insight in having a mental illness, metacognitive deficits, or denial as a defence to disturbing thoughts or behavior (10, 14, 15). Diverging perspectives may be viewed as a root of problems or as a resource for change. Interventions aimed at involving family or enhancing collaboration between persons with severe mental illness, family and professionals result in better outcomes, such as reduced caregiver burden, or lower relapse and readmission rates (16-18). The recovery process itself may also benefit (19). As Seikkula and Arnkil put it, “there are surprising and unexpected resources to be found through thinking together (20).” In other words, mutual involvement of professionals, persons with severe mental illness and their family holds the potential to a larger problem-solving capacity. Mental health systems around the world have prioritised working together with families to facilitate recovery from severe mental illness (21-23). However, research also shows that parties involved in recovery experience barriers in involving families, related to the individual or relational level (e.g. relational difficulties in families), organisation of care (e.g. priority setting) and culture paradigm (e.g. stigma) (24). So, the collaboration between persons with severe mental illness, family and mental health professionals during recovery (referred to hereafter as a “triad”) comes with both opportunities and challenges. 7
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