When I think about recovery and progress, I think, first, of my own experience with schizophrenia. I think about my own recovery often, for several reasons. The most important reason is that thinking about progress keeps me positive, a stance, no doubt, backed by studies on mental health disorders. The second reason is that I am able to stay solutions-focused.
Instead of thinking about all the problems ahead, or that I’ve had to endure as a result of my condition, I think about problem-solving, skills to remember at all times, and most of all, that I have overcome my disorder and will continue to live my life to the fullest regardless of the obstacles hurled in my path. But I hear it all the time from patients: ‘How long will I be this way?’ or: ‘When do you think I will be discharged from the hospital?’
I remember back to my first in-patient hospitalisation. I asked the social worker how long I would have to stay in the hospital? The social worker told me that, in very real terms in the context of my life, this would be a very short hospitalisation. She emphasised to me to keep it all in perspective.
In the context of my life, this period would be very short-lived. For most patients in the hospital or going through a crisis, the question of prognosis is first and foremost on their mind. Unfortunately, limited research continues to target prognosis and the lifespan of illnesses.
Thinking about progress is critical for both consumers and practitioners, as well as researchers and those with a vested interest in creating space in the field for creative pathways. Those creative pathways can empower people with a diagnosis to be motivated in their recovery and truly track, in their own terms, their success in treatment.
In therapeutic settings, therapists monitor the progress of their patients. This is done in several ways, depending on the type of therapy (for example, the modality, setting and treatment milieu) and needs to also be taught to consumers of treatment, so both practitioner and patient can work more closely and in greater clinical harmony.
In Article 31 Mental Health Clinics, clinicians complete treatment plans which, if in congruency with the state regulations, will include measures. These measures allow the practitioner to track, in very real terms, through person-centred language, gains made by patients in the course of their treatment. Every three months, a review of these plans are completed, and new measures are either added or removed, hopefully revised to reflect new life circumstances, either relapse or ongoing recovery.
Clinicians are encouraged, or need, to be aware of ongoing changes within the patient’s clinical picture, during weekly, bi-weekly, or medication management sessions, on a monthly perhaps quarterly basis. But how is progress truly measured by clinicians and by patients alike?
In evidence-based practice (EBP) measures are usually more module-based, prescribed, and very much mapped out in highly ornate and complex sets of measurements, tools, etc. Measures beyond the capacity of most Article 31 clinics in terms of rigour, efficacy, and reproducibility, given the poor retention rates of staffing, no-show’s by patients who miss sessions, either due to symptom interference, poverty, transportation issues, and all the circumstances free-standing clinics suffer from compared to mobile teams, and more organic treatment settings that target connectivity issues, and systemic problems associated with extreme rural or urban settings.
For most therapists, either in private practice or in this Article 31, there are methods of tracking progress without using complex, cumbersome, and expensive treatment modalities to implement and train staff.
This can be done in several ways – keeping in mind that measures need to be person-centred, and in the terms of the consumer – basic progress can be tracked by client reporting, collateral reporting, and direct observation in a session of a client’s mental status using a standard MMSE (Mini Mental Status Exam).
But, ultimately, these measures – both the under-developed Article 31’s clumsy and, at times, disorganised approach to tracking recovery, and its converse, the over-intellectualised, ornate, and highly prescribed new, hip, modalities – which are so difficult to train with enough latitude to reach the mass base of practitioners, that identifying a common language to measure client and collateral reporting during interdisciplinary meetings or even unidisciplinary collaboration, become impossible and present yet another impasse to treatment.
The DSM-5, and other manuals, research, can only provide generic research for diagnosis. Meaning, research and prognosis is measured in broad strokes, and is based on studies, populations, and circumstance, but is limited in its ability to truly put numbers and language around a person-centred prognosis for people with a mental health disorder.
This is a problem for people who want to know what’s ahead, plan for it, and what to expect, in their own terms, while living out their life with a diagnosis. Underneath diagnosis, and even less researched, is rate-of-recovery, and the speed (duration of illness and the symptoms) of a person to experience progress and relief from their symptoms.
I recommend, without further delay, immediate research and studies charged with the measurement of recovery, in very real terms, that truly allows patients and practitioners to know what to expect, when to expect it, and plan ahead so problems can be addressed before they occur.
There are currently treatment modalities which evaluate the frequency and duration of symptoms with very complex, computerised graphs. Again, these modalities are time-consuming, in terms of training new clinicians, and learning how to evaluate outcomes can be confusing for older and less technology-oriented clinicians. More importantly, these modalities only map out the frequency and intensity of the symptoms.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.
