165 General discussion The importance of resilience as a contributor, as found in chapter 6, indicates that promoting positive schemas and coping strategies may result in better personal recovery (91-94). Facilitating social functioning and interaction can lead to more personal recovery by supporting meaningful connections and reducing loneliness, for instance in clubhouses, support groups, and arts-based workshops (95-98). In the light of the findings in the current thesis, the plea of Van Os et al. is interesting, that there needs to be a fundamental change in the organization of mental healthcare from evidence-based practice of symptom reduction to “a small-scale healing community fostering connectedness and strengthening resilience in learning to live with mental vulnerability.” They mention, among others, e-communities, peer and citizen support and user-rated self-management tools as possible interventions (99). More recently, they introduced they idea of a Mental Health Ecosystem, that consists of collaboration between healthcare providers, social care organizations, and peersupport community organizations (100). Also, in measuring outcome of treatment, there needs to be a shift from only assessing clinical factors to also include personal recovery (101). As mentioned in the introduction, The Individual Recovery Outcomes Counter (I.ROC) might be a good tool to discuss with an individual patient what is needed to support his or her recovery process (102, 103). Whether outcome measures fit the perspective of patients, should constantly be evaluated (104). The second point showing that recovery goes beyond illness, is the finding that patients and non-patients share supportive factors of personal recovery. This may suggest opportunities that carers, as well as professionals, can use their own experiences with coping to reach mutual understanding and help patients to recover. How this should look like in clinical practice and how this relates to peer support is a question that remains to be answered. It has been found that according to patients with SMI interpersonal components, such as trust and support, are as important as functional help in the relationship with a professional (105). Some professionals have already written about using own experience with mental illness in the contact with patients or other professionals (106-108). If used adequately, it can enhance the treatment relationship and reduce stigma (109-112). Also, recognition of the recovery process of carers/family, alongside that of the patient, is essential (113, 114). In chapter 7 the importance of mutual understanding is again illustrated, in this case within the triad of patient, family and professional, with a basis of having unconditional and meaningful contact. Diverging perspectives on recovery need to be acknowledged and discussion and alignment between the parties is crucial. Perceived choice has been shown to influence the relationship between symptoms and personal recovery, supporting again the significance of (triadic) shared-decision 8
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