Imp. 68-74

For many years, the conventional wisdom in the field of mental health has been that severe mental illnesses, particularly schizophrenia, inevitably result in progressive deterioration. Professional practice has then understandably focused on managing psychopathology and its symptoms. Research efforts in the 1960s, 1970s and 1980s documented the heterogeneity of outcomes, particularly for individuals with schizophrenia (1-3), including often regaining functioning over the long term, developing friendships and reporting satisfying lives (4-7). The practice field, however, continued to be organized to fend off relapse and deterioration (8,9). It is unfortunate but not surprising that it has taken the practice field so long to adopt this forty year old understanding of the possibility of recovery. The large gap between research findings and adoption in practice has been often cited as a major barrier to innovation in mental health (10-13). In fact, recent analyses of the state of mental health systems in the United States have concluded that mental health care in America fails a wide variety of individuals, but particularly fails those with serious mental illnesses (14), because it is “not oriented to the single most important goal of the people it serves, that of recovery” (15). Furthermore, the U.S. President’s New Freedom Commission report strongly urged the adoption of the notion of recovery as possible for all and as the guiding vision for the system. Bringing the vision of recovery into the practice field requires an understanding of what is meant by recovery, the research findings that provide a rationale for recovery and the implications of these findings for the delivery of services (15).