Severe mental illnesses are costly conditions for individuals, families, societies, and health systems and are among the leading causes of disability in developed countries. Despite similarities in personal characteristics, histories, life circumstances, illness characteristics, and types of treatment, however, some individuals with these disorders struggle with mental health problems for most of their lives, some adapt successfully, and some recover completely. To date, we know little about what differentiates these individuals or about how to facilitate recovery among those who are faring less well. Using multiple data sources, this project will employ qualitative and quantitative methods to understanding of the factors that lead to recovery among people with severe mental illnesses. The project has three aims: (1) to identify processes, factors, actions, and experiences that facilitate recovery, (2) to describe the prior and current roles played by mental health care providers, and the mental health care system, in facilitating improvements in functioning, life satisfaction, quality of life, and happiness, and (3) to identify patterns in health plan service use for the year prior to study participation and two years following study entry, examining how volume and type of service use relate to participants' reports of symptom levels, functioning, life difficulties, and life satisfaction. To accomplish these aims, we will identify a group of HMO members with severe mental illnesses and follow them prospectively for 24 months. We will interview participants about the course of their lives and mental health problems, measure their quality of life, life satisfaction, happiness, and recovery, and extract health plan data about their service and medication use, linking those data to questionnaire and interview data. We will describe commonalities in what participants identify as important indicators of life satisfaction and the factors that have led to improvements in their lives and functioning, and describe how participants are currently affected by their mental health problems. Finally, we will describe and statistically model participants' recovery trajectories, and delineate the approaches they use in managing day-to-day life and the stressful situations they encounter. Few studies have systematically described what recovery means to individuals with severe mental illnesses or studied the factors consumers identify as influential in producing the recovery outcomes important to them. The proposed project will accomplish both of these goals and compare participant perspectives to traditional outcome measures. As such, proposed project will inform efforts to facilitate recovery individuals with severe psychiatric disabilities. ? ? ? ?
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