85 Clinical treatment interventions and personal recovery INTRODUCTION Since the beginning of the 1990’s, recovery-oriented practices and research into recovery have emerged in mental health care worldwide (1, 2). Recovery is a broad term, which in general medicine tends to be defined as ‘return to a pre-existing state of health’. In the field of mental healthcare, though, recovery is typically divided into two types: clinical and personal recovery (3, 4). Sometimes, functional or societal recovery are distinguished as well (5, 6). Clinical recovery refers to remission of symptoms and sometimes also includes functional improvement, mostly based on clinical rating scales or interviews, such as the PANSS (Positive and Negative Syndrome Scale) over at least a 6 month period (710). It usually has been defined as a medical view and an outcome. Personal recovery has been based on accounts of patients overcoming their illness and refers to a subjective appraisal of recovery (11, 12). It is often described as an active, individual, unique, and non-linear process, or as a struggle or journey with different stages (1, 13, 14). Important processes, derived from recovery stories, are summarized in the acronym ‘CHIME’: ‘connectedness’, ‘hope’, ‘identity’, ‘meaning’ and ‘empowerment’ (15, 16). Although personal recovery is often seen as a process, for (quantitative) research purposes it also has been defined and measured as an outcome (17). In meta-analyses, small to medium associations were found between clinical and personal recovery in patients with a schizophrenia spectrum disorder (18, 19). This finding may result from varying relationships between clinical and personal recovery depending on the individual patient. Clinical recovery is supported by clinical treatment. It is important to gain more insight in which clinical treatment interventions are perceived by patients as helping or hindering, as clinicians may use this knowledge to adapt their practices to stimulate patients’ process of recovery (20). Earlier qualitative studies suggest that the opinions of patients about clinical treatment interventions are very divergent (21-23). Most of these studies have been performed in patients with schizophrenia spectrum disorders, although in clinical practice also patients with other diagnoses receive treatment in community mental health teams. Besides, earlier qualitative studies have not focused on the impact of a broad spectrum of clinical interventions on the personal recovery of patients, but usually on one or two aspects, for instance medication (24) or hospitalization (25). Therefore, the main objective of the current study is to explore the subjective experience of a range of clinical treatment interventions in personal recovery stories of patients with severe mental illness (SMI), both in a helping and hindering sense. 5
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