S04: Recovery from Schizophrenia – an update and a tribute to Richard Warner MD.

By September 19, 2017 No Comments

Authors: Peter Huxley, Anne Krayer, Sanjaya Aryal

Year: 2017

Event: 2017 TheMHS Conference

Subject: Lived Experience, Recovery, Community, Culture, Society, Research & Evaluation Informing Practice

Type of resource: Conference Presentations and Papers

Abstract: Recovery from Schizophrenia (2004) was the late Richard Warners seminal work and influenced thinking not only about recovery, changing the then pessimistic view of the outcome of Schizophrenia to a more realistic and hopeful one, but also differences in outcome between cultures, the political economy of Psychiatry, and the relevance of meaningful work activities for recovery. Peter Huxley worked with him from 1989 to 2016 on a series of outcome related studies in the services established by Dick in Boulder Colorado, facilitated by the inspirational leadership skills of the Director Phoebe Norton. Over the years collaborative papers were published on case management, quality of life outcomes in community services such as the case management team, the Clubhouse, the Watshop - a sheltered work environment operating in the open market - the impact of Medicaid reforms, and a prevention service for at risk children. This paper will summarise briefly but for the first time in one place, the major findings and implications of this research, drawing attention to the issue of routine social outcome data collection and use in practice. In addition, the paper will include reference to the findings of an update of the literature that was started by Dick and Peter in 2016. The review of literature in 'Recovery from Schizophrenia' was the fundamental underpinning to the ideas in the book, including among others that the phenothiazine revolution was not the most significant driver of deinstitutionalisation as had been argued previously. Using the same methodology, which excluded studies that could introduce bias into the results, such as clinical trial data, or non-first episode studies, the authors repeated the literature search from 2000 to 2015. Recovery was defined in the same way as in the book, that is to include both clinical and social recovery. The purpose was to see if the fundamental changes taking place during this period had an effect on recovery rates. Changes include major funding changes, policy changes, economic changes including the 2008 financial crisis, and the growing recognition of the importance of work especially the change from the train and place model, to the place and train model. Following a description of the results of the review the presentation will consider the implications of the findings for policy, practice and future research and service monitoring.

Learning Objectives
Learning Objective 1: The audience will see the results of nearly 20 years of service research in the same place for the first time. This will enable them to make a judgement about the importance of a social view of outcomes in community settings. They will also have an understanding of the latest recovery research and how social changes over the last two decades has impacted upon recovery from Schizophrenia.

Learning Objective 2: The topics discussed are relevant to policy and practice. As well as reinforcing the need for social outcomes to reflect service user/consumer life priorities, the results confirm the value of using social outcome data to inform service changes, and the importance of social context to outcome.

References
Warner R, Recovery from Schizophrenia (3rd Edition) Brunner Routledge East Sussex, 2004.
Warner, R and Huxley, P.J,. (1998) Outcome for people with schizophrenia before and after the introduction of Medicaid Capitation. Psychiatric Services 46(6): 802-806.

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