This is a resubmission of an application for a Developing Center to Study Recovery in Social Contexts, at the Nathan Kline Institute-NYS OMH. Building on recent work in social sciences and insistent voices of consumers and families, we reformulate the charge of public mental health to include what makes a """"""""life worth living."""""""" The proposed Center will construct the conceptual frameworks, tools of inquiry, investigator expertise, and stakeholder partnerships to forge a research agenda that improves recovery prospects for people with severe mental illness. We take recovery to mean the ability to live, work, learn and participate fully in their communities. To this end, we will adapt and apply Sen's Capabilities Framework (CF). Psychiatric disability is assessed as a kind of poverty - in terms of the limitations it places on what afflicted individuals are actually able to do and be, the real opportunities (or capabilities) open to them. This shifts the research focus from the idiosyncrasies of individual journeys to the social question of how to provision them - the resources, rules, policy and cultural changes required to increase the chances of successfully achieving recovery. We begin with self-determination and social affiliation, which resonate powerfully with consumer concerns. Two projects are described: the first documents how formerly homeless mothers with severe mental illness participate in parenting responsibilities;the second explores the consequences of shared decision-making in medication management. Each seeks to capture an especially valued functioning in action and then to specify institutional supports that could sustain it more broadly. Three Year 1 Methods projects that will 1) develop a formal language for applying CF to psychiatric disabilities and seek solutions to novel measurement problems 2) develop ways to incorporate a behavioral theory - we begin with a Health Capital Model - into CF, and 3) identify environmental dimensions that support self determination and social affiliation. Critical to this agenda is a fully participatory research approach, one that includes service users, providers and policy makers in the activities of Center governance as well as the development and implementation of its research portfolio. The knowledge and experience base that pilot studies build in applying CF to issues in social recovery will be disseminated through an ongoing series of capabilities seminars and annual institutes. These in turn will inform how new questions about social recovery are framed, and how capability-enhancing practices might be developed, tested and institutionalized. The Center's long-range goal is to build the intellectual, practice and stakeholder capacity to support an application for an Advanced Center in five years to develop strategies that promote recovery across social contexts for people with severe mental illness.
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