A two-year study of patients with schizophrenia, schizoaffective disorder, bipolar disorder, or affective psychosis reveals four recovery trajectories and the factors that affect those outcomes. Generally speaking, those four trajectories are:

• Stable with a high level of recovery
• Stable with a lower level of recovery
• Fluctuating high-level recovery
• Fluctuating low-level recovery

Of the factors that affect recovery, having access to good-quality mental health care—defined as including satisfying relationships with clinicians, responsiveness to needs, satisfaction with psychiatric medications, receipt of services at needed levels, support in managing deficits in resources and strains, and care for general medical conditions—may facilitate or improve recovery trajectories.

These results are promising, because all too often, serious mental illness is seen as incurable, permanent, and progressively deteriorating. The reality is that as many as 60% to 70% of patients can achieve a measurable level of recovery. Carla Green Ph.D., M.P.H., and colleagues of the Center for Health Research at Kaiser Permanente Northwest, in Portland, Ore., reported the findings in their report, “Recovery From Serious Mental Illness: Trajectories, Characteristics, and the Role of Mental Health Care” in the December Psychiatric Services.

“Few demographic or diagnostic factors differentiated clusters at baseline. Consistent predictors of trajectories included psychiatric symptoms, physical health, resources and strains, and use of psychiatric medications.” 

The most consistent predictors of recovery were psychiatric symptoms and changes in those symptoms. Those in turn are dependent on good-quality care, which includes satisfaction with their clinicians and with the medications they are taking. “Providing such care has the potential to change recovery trajectories over time.”