Patterns of recovery from severe mental illness: a pilot study of outcomes

Abstract

We performed a pilot study examining the patterns of recovery from severe mental illness in a model integrated service delivery system using measures from the Milestones of Recovery Scale (MORS), a valid and reliable measure of recovery outcomes which ranges from 1 to 8 (8 levels). For purposes of presentation, we constructed an aggregate MORS (6 levels) where the levels are described as follows: (1) extreme risk; (2) unengaged, poorly self-coordinating; (3) engaged, poorly self-coordinating; (4) coping and rehabilitating; (5) early recovery, and (6) self reliant. We analyzed MORS data on individuals followed over time from The Village in Long Beach, California (658 observations). Using Markov Chains, we estimated origin-destination transition probabilities, simulating recovery outcomes for 100 months. Our models suggest that after 12 months only 8% of "extreme risk" clients remain such. Over 40% have moved to "engaged, poorly self-coordinating." After 2 years, almost half of the initial "extreme Risk" clients are "coping/rehabilitating", "early recovery" or "Self reliant." Most gains occur within 2 years.

Fig. 1

Example of Markov process. Note: this is not actual data and is for illustrative purposes only

Fig. 2

Probability that members who begin as “extreme risk” will continue as “extreme risk”, or become “unengaged”, “poorly self-coordinating”, “coping/rehabilitating”, “early recovery”, or “self reliant” over a two year period. 95% Confidence Intervals displayed as dotted lines

Fig. 3

Probability that members who begin as “unengaged” will continue as “unengaged”, or become “extreme risk”, “poorly self-coordinating”, “coping/rehabilitating”, “early recovery”, or “self reliant” over a two year period. 95% Confidence Intervals displayed as dotted lines

Fig. 4

Probability that members who begin as “poorly self-coordinating” will continue as “poorly self-coordinating”, or become “extreme risk”, “unengaged”, “coping/rehabilitating”, “early recovery”, or “self reliant” over a two year period. 95% Confidence Intervals displayed as dotted lines

Fig. 5

Probability that members who begin as “coping/rehabilitating” will continue as “coping/rehabilitating”, or become “extreme risk”, “unengaged”, “poorly self-coordinating”, “early recovery”, or “self reliant” over a two year period. 95% Confidence Intervals displayed as dotted lines

Fig. 6

Probability that members who begin as “early recovery” will continue as “early recovery”, or become “extreme risk”, “unengaged”, “poorly self-coordinating”, “coping/rehabilitating”, or “self reliant” over a two year period. 95% Confidence Intervals displayed as dotted lines

Fig. 7

Probability that members who begin as “self reliant” will continue as “self reliant” over a two year period. 95% Confidence Intervals displayed as dotted lines