By Kelley Kauffman, MSN, APRN-CNP, PMHNP-BC, Center for Health Equity Engagement Education and Research
“There are many ways to measure mental distress. But it’s far harder to predict, or even describe, the improvement that often follows.”-Benedict Carey, The New York Times.
For decades, researchers and clinicians have used standardized questionnaire measurement tools, including the Recovery Assessment Scale (RAS), Hamilton Depression Scale, and more to assess symptom management, or recovery from mental illness. However, two recent articles published in the journal Psychiatric Services have thrown the usefulness of these measures into question. In the first study of its kind, Dutch researchers administered the RAS to three groups of people: one with a diagnosis of a psychotic disorder; the siblings of members of the first group, who had no such diagnosis; and a control group of unrelated people who had no history of mental-health problems. The scale found little detectable differences between the groups. The study brings new light on an issue mental health consumers, or patients, have seen time and time again. These scales and clinical definitions of symptom relief do not capture the fullness of their personal recovery. For persons in recovery, they may still experience symptoms but recovery may mean that symptoms have changed and no longer cause distress; that they are able to maintain steady, good employment; or any multitude of combination of personally defined criteria. Recovery may differ from one person to the next and thus may be difficult to capture but the quest for knowledge starts with asking the right questions. Instead of asking, for instance, “Are the voices gone?” let us begin to ask, “Have the voices changed?” You may learn that this person still hears voices daily but now instead of belittling, the voices are encouraging and supportive so she no longer wants to get rid of the voices. She wants them to stay, they are a part of her, a part of her recovery.