The document discusses recovery from mental illness, specifically schizophrenia. It provides statistics on the prevalence and outcomes of schizophrenia. Despite advances in treatment, outcomes have not significantly improved, with only 13.5% meeting recovery criteria. The recovery program described aims to facilitate personal growth and transformation beyond acute symptoms through a collaborative, strengths-based approach focused on self-directed goal setting. It emphasizes hope, well-being, social inclusion and meaning rather than just treating illness. One patient's story of improving life through the program is shared.

1. Recovery from Mental Illness…Offering
Hope Through Your Personal Journey
Presented by: Dr. David Attwood, Heather
Masson RN CPMHN (C) Manager of Patient Care
Services, Recovery Program, Carlo Verdicchio
Peer Support Worker

3. Where have we
come
from………….

8. Other Strategies

9. Prevalence of Schizophrenia
• Between 1 to 2 per 100 people in general population will
have a psychotic disorder sometime in their lives (Life
time risk)
• Approximately 24 million have schizophrenia worldwide
• Approximate 240,000 Canadians have schizophrenia
• Every year 20-25 persons in a population of 100,000 will
develop the illness for the first time

10. Course of Illness
• Cognitive deterioration begins before onset of psychosis
• 25-50% have poor premorbid adjustment
• Disease process peaks in first 5-10 years
• Duration of untreated illness, as well as number of
relapses predict poorer outcome
• 55% moderately good outcomes, 45% poor outcomes in
25-40 year follow up studies
• Estimated treatment cost greater than for all cancers
combined

11. Despite 60 years of Pharmalogical
treatments…..
• Not everybody responds to antipsychotic treatment
• 28 – 35 % of cases are treatment refractory
• Response to an antipsychotic tends to be the condition
for benefitting from other treatments
• At least 30% of patients will not respond to Clozapine
• …and Schizophrenia remains…

12. Positive Symptoms
Delusions
Hallucinations
Disorganized speech
Catatonia
Cognitive Deficits
Attention
Memory
Executive functions
(e.g., abstraction)
Social/Occupational Dysfunction
Work
Interpersonal relationships
Self-care
Negative Symptoms
Affective flattening
Alogia
Avolition
Anhedonia
Social withdrawal
Comorbid Substance Abuse
Mood SymptomsMood Symptoms
Depression
Hopelessness
Suicidality
Anxiety
Agitation
Hostility
Schizophrenia:
The most devastating of illnesses
Metabolic
Morbidity

13. Hard to stay on track…

14. Trajectories of Clinical Outcome Following a
First Episode of Psychosis

15. Gap in Levels of Outcome: A Challenge?
• Response: Percentage decrease
in symptoms
• Remission (APA consensus): SAPS-
SANS global rating 2 or less or PANSS
item ratings of 3 or less
• Recovery: Independent functioning
(work, school, social relationships,
independent living); requiring minimal
or no support (societal perspective) and,
personal sense of well being (personal
perspective)
Andreasen NC, Carpenter WT Jr, Kane JM, et al. Remission in
schizophrenia: Proposed criteria and rationale for consensus. Am
J Psychiatry. 2005;162(3):441–449.

16. So how are we doing?
• Reviews of several hundred studies, 1895 – 2000
– 40 – 42% “Good outcomes”
• Recent metanalysis, 50 studies:
– 13.5 % met Recovery Criteria
– Poorer countries higher than developed countries
– No differences in sex, midpoint of intake period, strictness of the
diagnostic criteria, duration of follow-up
– 1 in 7 individuals with schizophrenia recover.
– Despite major changes in treatment options in recent decades,
the proportion of recovered cases has not increased.
Schizophr Bull. 2013;39(6):1296-1306. © 2013 Oxford University Press

17. Personal Objectives
• I treat primarily Schizophrenia
• Despite investment of time, medications, resources, Schizophrenia
remains a humbling illness
• Considering how much attention has been allocated to exploring the
onset of psychosis (eg, prodrome and early psychosis), it is
appropriate that a comparable degree of scrutiny also be accorded
to the recovery of psychosis
• Logical, persuasive, coercive techniques often prove ineffective, fail
to secure long term objectives, may actually alienate patients from
care
• The Recovery Program provides some opportunity for outcome
enhancement…

18. So this is where we start…..

19. Defining Mental Health
Mental health is a state of well-being in which an
individual realizes his or her own abilities, can
cope with the normal stresses of life, can work
productively and is able to make a contribution
to his or her community. In this positive sense,
mental health is the foundation for individual
well-being and the effective functioning of a
community.
World Health Organization (W.H.O.)

20. Mental Health Challenges Can Affect
An Individual’s…..
• Social Relationships
• Physical Health
• Ability to engage in meaningful activities
• Ability to work or attend school
• Finances
• Ability to see their own potential

21. Mental Health Commission of Canada,
Recovery
Recovery…involves a process of growth
and transformation as the person moves
beyond the acute distress often
associated with a mental health problem
or illness and develops new-found
strengths and new ways of being. Mental
Health Commission of Canada, 2010

23. Principles of Recovery
• Recovery is about building a meaningful and
satisfying life, as defined by the person
themselves, whether or not there are ongoing or
recurring symptoms or problems.
• Self-management is encouraged and facilitated.
The processes of self-management are similar,
but what works may be very different for each
individual. No ‘one size fits all’.

24. Principles of Recovery (cont’d…)
• The helping relationship between clinicians and
patients moves away from being expert / patient to being
‘coaches’ or ‘partners’ on a journey of discovery.
• People do not recover in isolation. Recovery is closely
associated with social inclusion and being able to take
on meaningful and satisfying social roles within local
communities, rather than in segregated services.
• Recovery is about discovering – or re-discovering – a
sense of personal identity, separate from illness or
disability.

25. Quality of Life

26. Hope

27. Peer Support in Recovery
“Research findings document that individuals who use peer
run services have decreased hospitalizations, suicide rates,
and substance use, an increase in social contacts, ability to
carry out activities of daily living and a positive impact on
participants’ recovery, including an increase in their
empowerment, hopefulness, and informal learning of
adaptive coping strategies.”
J. Campbell in On Our Own Together: Peer Programs for
People with Mental Illness:

28. Wellness

29. Wellness
From the December 2012 issue of the Canadian Foundation
for Healthcare Improvement’s Mythbusters :
“…a growing body of evidence is showing that recovery of a
meaningful life despite limitations imposed by illness is
possible and likely. People with lived experience have known
for some time that, with hope, empowerment and support
from others, recovery is possible. Promoting a mental health
system that views both personal and clinical recovery as the
objective can reduce the healthcare costs, enhance quality of
life, promote social inclusion, and help those living with
mental illness lead full and productive lives.”

30. Recovery Program at the Royal
• 32 bed inpatient unit located on the 1st floor of the
Royal Ottawa Place.
• 3-6 month length of stay
• Interdisciplinary Team (Psychiatry, Nursing, OT, SW,
RT, Dietary, Peer Support, Pharmacist on site)
• Recovery-focused treatment, education and
opportunities for skill-building.
• A holistic view of mental health that focuses on the
individuals strengths, not just symptoms

31. Who do we serve?
• Axis 1 diagnosis
• Age 18-65
• History of prolonged illness and hospitalization
• First episode psychosis
• Experiencing significant challenges in his or her ability to
successfully function within the community. This is
demonstrated by a lack of meaningful activity, social roles or
functional ability to manage self-care or live in the community
with minimal formal support.
• Capable of engaging in the recovery process
• Voluntary Program

32. Referral Process
• Referral Package complete
• Send through internal mail or fax
• Reviewed by intake team to determine
appropriateness of referral
• Team assessment of patient and tour
• Wait list
• Admission

33. An individual is ready to participate in the
program when…..
They are able and desire to …
• Engage in the recovery process with our
interdisciplinary team
• Identify short and long term goals
• Recognize responsibility for their wellness and
recovery
• Participate and engage in regular
programming

34. Program Goals and Discharge
• The goal is for people to move back into the
community and live as independently as possible,
accessing available community supports. People are
discharged when they;
 Successfully reach their goals
 Demonstrate a level of functioning in activities of daily
living required to live in the most appropriate environment
of their choice
 Progress to a point where they can no longer benefit from
the program

35. Treatment
“Recovery is described as a deeply personal,
unique process of changing one’s attitudes,
values, feelings, goals, skills, and/or roles. 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.” Anthony (1993)

36. • Treatment in recovery-focused care is:
- a collaborative process which focuses on
promoting well-being rather than simply
treating illness.
- Professional staff are encouraged to facilitate
a service-user in identifying, developing, and
working towards personally meaningful goals
for their well-being.
- As much as possible, the service user is the
ultimate decision-maker for how care is
directed.

37. The importance of self-directed goal-
setting
“It’s not really helpful to do activities just for the
sake of doing something, to really make a
difference it has to be meaningful.”
-patient in the Recovery Program

38. Recovery is Possible for Everyone..
“Persons suffering from mental or physical illness must not
define themselves by their illness, but rather the unique
individual that they are. Any illness may make your journey
through life more challenging. However, recovery is possible
for anyone. Recovery is a process in which an individual
suffering with mental illness acquires insight into their
strengths and abilities, and continues to work toward
meaningful goals despite residual symptoms of their illness.
Success is not measured by others, but rather the person
themselves.”
Heather Masson RN CPMHN (C)

39. Luc’s Story
Life Before Recovery
• Severe depression and
delusions
• Extremely secretly
suicidal
• No supports except
psychiatrist
• Last hope
Life in Recovery
• Medication Changes
• Support Team
• Access to a wealth of
resources
• Friends
• Volunteering

40. Luc’s Story cont….
Life After Recovery
• Expanded role in
volunteering
• Friends
• Another meds change for
the even better
• School and work

41. Questions?

42. Resources
Allott, P., Loganathan, L. and Fulford, K.W.M. (2002). Discovering hope for recovery: a review of a
selection of recovery literature, implications for practice and systems change in Lurie, S.,
McCubbin, M., & Dallaire, B. (Eds.). International innovations in community mental health [special
issue]. Canadian Journal of Community Mental Health, 21(3).
Mental Health Commission of Canada www.mentalhealthcommission.ca
Changing directions, changing lives. Mental Health Strategy for Canada
• Toward Recovery and Well-Being: A Framework for a Mental Health Strategy for Canada
• Voluntary National Standard of Canada for psychological health and safety in the workplace
released
http://www.mentalhealthcommission.ca/SiteCollectionDocuments/January_2013/MHCC_Standar
d_MediaRelease_ENG.pdf
Centre for Addiction and Mental health www.camh.ca
CAMH Knowledge Exchange http://knowledgex.camh.net
Canadian best practices portal for health promotion and chronic disease
prevention www.phac.gc.ca/cbpp
CMHA Mental health promotion tool kit http://www.cmha.ca/mh_toolkit/intro/index.htm
Evidence-based mental health promotion resource (VicHealth)
www.health.vic.gov.au/healthpromotion/downloads/mhr_social.pdf
Gottlieb, L. (2013). Strengths-Based nursing care. Health and healing for person and family. New
York: Springer
Interactive Domain Model of Best Practices IDM Best Practices website at www.idmbestpractices.ca
National Network for Mental Health (NNMH) http://www.nnmh.ca/

43. • http://www.mentalhealthcare.org.uk/recovery