Exploration of patients’ lived experience of recovery from severe mental illness: Α systematic review of qualitative studies

Background: Τhe process of recovery from severe mental illness is an important phase in ill health. Aim: Exploration of the experience of recovery from severe mental illness (SMI) through the narratives of patients. Method: A systematic review of qualitative studies was undertaken during January of 2015 in the following databases: CINAHL, Medline, PubMed, Psych Info, Psychology and Behavioral Science Collection. The following terms were used as key words: “recovery”AND/OR “severe mental illness” AND/OR “qualitative studies”. The following inclusion criteria were applied: (a) publication in the English language and in a peer reviewed journal, (b) qualitative design, aiming to explore the lived experience of recovery, mainly of bipolar disorder or psychosis, (c) publication date from 2000 to present. The studies excluded from the present systematic were: (a) case-studies or studies based on the life history of solely one person, (b) based on narratives/ perspective of the lived experience of SMI of people who were not patients. The Critical Appraisal Skills Program (CASP) tool was used for the assessment of the rigor of the selected studies. Thirty one qualitative studies were finally included. Results: Recovery from SMI seems to be an external to the individual process, since it is described as irrelevant to the patho-physiological course of the disorder, thus mainly determined by social factors. According to patients’ narratives, medication does not seem to be the optimal factor that promotes recovery. In particular, supportive relationships with family, friends and health professionals, as well as supportive social networks have been described as the most effective means towards recovery. Also, the major obstacles towards recovery seem to be social stigma and lack of incomes. Moreover, the difficulty of reframing personal and social identity within the context of disease has been also revealed as a barrier for effective rehabilitation. Conclusions: Recovery from SMI is a complex process, which entails multi-dimensional interventions. These interventions need to be focused on mental health patients, family members, health professionals and mental health care system, and to broader social institutions, too. Furthermore, special focus must be given to interventions aiming to (a) empower empathy of mental health care professionals, (b) decrease social stigma of mental disorders, and (c) promote employment and social rehabilitation of mentally ill people. In addition, interventions for the empowerment of personal identity and enhancement of coping strategies towards dysfunctional perceptions due to the chronic course of mental diseases are also proposed.