What is recovery?
Psychosis, like other mental health problems, can be successfully treated. Most people make a good recovery.
Recovery can be defined in many ways. It is most often measured in terms of symptom reduction and quality of life. One of the primary goals of treatment is to reduce symptoms. This helps people living with psychosis go on with their everyday lives. Another goal is to improve the person's quality of life in areas that are meaningful and important to them.
It is difficult to say when a person is "fully" recovered from a psychotic episode. Recovery is more of a process than a specific end point or destination. Saying someone has "recovered" often depends on a consensus between the person who has experienced psychosis, their health care providers, and family members. The definition of recovery can be different from person to person. It mostly depends on whether the person feels he/she has reached a good balance for him/herself in terms of symptom reduction and quality of life.
What can be expected?
The recovery process will vary from person to person. There is a range of individual factors that influence how quickly or how fully a person will recover. Some people will recover quickly and be ready to return to their life and responsibilities. They may need little on-going support. Others will need time to respond to treatment. They may need to gradually return to their regular responsibilities. They may benefit from support over a longer period.
Typically however, recovery from the first episode of psychosis usually takes a number of months. If symptoms remain or return, the recovery process may be prolonged. Some people experience a difficult period lasting months or even years before things really settle down.
There is increased understanding of psychosis, which has led to new types of treatments. Many of these services can be provided in the community, with the person staying in their own home. If people do need to go into hospital for treatment, it is usually only for a brief period of time.
Once the psychosis has responded to treatment, problems such as depression, anxiety, decreased self-esteem and social difficulty may also need to be addressed during the recovery phase.
Getting and staying well requires the person to take an active part in his/her recovery and be willing to listen to and seek help from others. Some of the processes that people go through as they get back on track and strategies for staying well are outlined below. It is important to note that a person's treatment and support team can provide assistance to the person and their family in all of these areas in different ways over time.
The experience of psychosis can affect a person's self-esteem. Rebuilding self-esteem is an important part of recovery. It takes time, patience and the support of friends and family.
It is important that people recovering from psychosis have people around them who are positive and non-judgmental. Often people in recovery are very self-critical. Methods for reinforcing a more accurate self-description are important. Examples include looking back at accomplishments and talents or using affirmations in the present moment. Using such methods, people can get a more realistic view of their positive attributes and qualities.
Being with a group of people who are supportive is also helpful in many ways. A supportive group becomes part of a person's social network. Having the support of others can help with better self-care. People can be supported to make changes in their lifestyle. Setting short-term goals can aid in recovery and rebuild self-esteem. By reflecting back a more accurate picture of the person, groups can help people build on their individual skills and talents and help people feel better about their decision-making skills.
Getting back to school
It is important to set realistic goals for returning to school. Reviewing previous academic records and accomplishments is a starting point. Choosing classes and activities that enhance the person's skills and interests can also be a way to help ease the process.
It may be a good idea for the person and/or family to meet with the school counselor or academic advisor to discuss their return to school. They can help by educating them about psychosis. They can share how it has impacted the person's abilities. A note from the doctor can help. Giving written permission for the teacher/counsellor to talk to the person's clinician or doctor may also be a good idea.
Sometimes it is best for a friend or family member to go with the person for the first little while, so they can help the person adjust.
Returning to work
It is also important to set realistic goals for returning to work. Some people will be able to return to work full-time after a period away. For others, starting back part-time is a better way of easing into it. For many, volunteer work is a good first step.
The person will want to discuss with his/her treatment and support team about how much information to disclose in the workplace. While knowledge typically helps to reduce stigma, determining what and how much to disclose should be explored and decided upon based on the individual's unique situation and work context. Educating the employer and the staff about the experience of psychosis and recovery may be important. Practicing what to say and having a doctor's note can help. Having a professional come in with the person may be the right way to go for some people.
Lifestyle changes to support recovery
Lifestyle habits are an essential part of maintaining good mental health for everyone, not just those who have experienced psychosis. Healthy lifestyle choices will improve physical and mental health. They can help to decrease stress levels and help to get more out of life.
Some ways to maintain a healthy lifestyle include:
Of course all of the above are easier said than done. The person's treatment team can be used to help the person develop strategies to make and maintain lifestyle choices that support their recovery over time.
Social relationships and support
Social relationships play an influential role in promoting recovery from psychosis. They help people keep healthy and promote well-being. Unfortunately, individuals affected by psychosis often withdraw. They can become socially isolated. It is also common for the family to become socially isolated as well.
It is important for the person to avoid losing current social relationships. If the person has lost contact with friends and family, it is important to try and build new social relationships and find sources of social support.
Even when recovering, it can be hard to develop a supportive network. Psychosis can continue to cause isolation. The medication used can cause problems with energy levels. Although it can be hard some times, reaching out to friends, family, and others can be rewarding. Having a social support network means that the person won't have to cope alone. They will have a group of people with whom to celebrate all of their achievements.
Strategies to stay well
Working with the treatment team and sticking with the treatment plan
Getting the person healthy is the main goal of his/her treatment team. The person's doctor, case manager, and the other people who work with him/her will support the person through his/her recovery.
The person, his/her family and the treatment team will develop a treatment plan. It may include taking medication, having regular appointments and participating in various workshops and other activities. Each person's treatment and recovery plan will be unique and based on their specific needs.
Sometimes people will not want to follow their treatment plan. The reasons for this can vary. Sometimes the medications can cause unwanted side effects. Sometimes the treatment plan works so well that the person thinks they don't need to adhere to it anymore. The person's needs may change so that the previous treatment plan doesn't work as well as before. Sometimes it is just hard to maintain vigilance over one's health.
Following recovery from a first episode, a large number of people will never experience a second episode, or a relapse, again. However the risk of relapse is greater if people stop taking their medication and participating in their other treatments too soon. Being open and honest with one's treatment team and working with them to address issues as they arise is a good way to maintain one's health in the long term. The chance of a complete and lasting recovery is much better with the right treatment and support over time.
Avoiding drugs and alcohol
Drugs and alcohol can have serious negative effects on people's health. They can interfere with medications. They can increase the chance of relapse. For these reasons, it is a good idea to avoid drugs and alcohol.
It is important for people to be honest with their treatment teams about their drug and alcohol use. The treatment team is not there to judge them. They are there to support them. They know people who experience psychosis often use drugs. They will not be surprised. They need to know this information when setting up a treatment plan and will encourage people to talk to them about how much they drink or use drugs.
Setting up a routine
Establishing a routine can go a long way towards improving a person's health in the long term. An effective routine could include regular meal times, enough time set aside for personal and self-care, established times for work and rest, and regular social events and family time.
Knowing approximately what each day will look like helps people predict when things are going to happen and helps to reduce anxiety and stress.
Setting priorities among one's responsibilities and focusing on completing those responsibilities first each day can also help to avoid and reduce stress.
Having goals is good for everyone, whether or not one is living with psychosis. Goals can be big or as small. Maybe preparing a nutritious meal might be the day's goal. Perhaps the goal of the day is applying for a job. Whatever the goal, it is important to make sure that it is realistic.
For a big goal it is often easier to break the goal down into smaller parts. For example, if a person's goal is to go back to school, the parts could include finding out how much class time and workload the person can handle, deciding which school to go to, enrolling in classes, and so on. Doing so can make larger goals seem less big. This way they are easier to achieve.
Taking time out to relax and managing stress
Managing stress is a crucial aspect to improving a person's health for the long term. Learning some tricks to reduce stress can help a person to better cope with daily problems. Also, learning to manage stress will help one more effectively deal with 'big' stressors like moving or changing jobs. Positive life events can be stressful too. Holidays, weddings, and birthdays bring their own set of stressors, even if they are celebrations that people really enjoy.
One of the best ways to manage stress is to take time out to relax. Everyone should make sure there is some time in their schedules every day to do the things they enjoy. This could be time to go for a walk, read a book, or do hobbies.
Taking up a hobby
Hobbies are good for a lot of reasons. Hobbies help keep people from being bored. They can also be rewarding and are a good way to get out and meet others. Taking up hobbies that involve other people can be a good way to make some new friends. Doing sports or taking part in group hikes can be good social hobbies. If artistically inclined, many communities offer arts classes through agencies and local colleges.
Keeping in touch
Staying in touch with friends is important. Friends can be a support and they can keep a person in contact with what's going on in the world. People should be encouraged to pick up the phone or send emails to their friends to let them know they're around and interested in staying connected.
Some people feel like they want to be private about what they are going through. It is important to include family in the process of recovery. Families typically care and most often want to know what is going on so they can help. If talking with family is not an option, people should be encouraged to talk to trusted friends instead.
Maintaining overall health
There are several aspects of lifestyle that include diet, exercise, physical and mental wellbeing, social life, work life, and so on. Keeping a healthy lifestyle is a good idea for anyone. Most often having a healthy life means one has a balanced life. Leading a balanced life can be hard to do because sometimes one area of life encroaches on others. It can be incredibly hard to strike a healthy balance when a person is trying to take care of him/herself, work or do school, stay socially active, eat properly, and exercise - and this list doesn't even include all the other responsibilities people have!
A good way to start leading a balanced lifestyle is to start with the basics. This can be things like physical activity and nutrition. Being physically active is especially important because some of the medications used can cause weight gain. Being physically active is one of the best ways to deal with the weight gain from medications. Being physically active doesn't necessarily mean having to exercise in the traditional sense. It just means having to move around more. Walking, biking, hiking, swimming, skiing, and snowboarding are all good physical activities. Kicking a ball around or playing catch gets one moving. Dancing is another good way to get moving. Getting active with friends often makes it easier to get moving.
Nutrition is the other basic part of living a healthy lifestyle. Eating nutritious and delicious food helps people to have more energy and feel better in general. Eating lots of fruits, vegetables and whole grain foods is always a good idea. Avoiding a lot of sugary foods is also a good idea. The highs and lows of a sugary diet can bring on mood swings. Including a lot of protein and fibre in your diet is a good thing too. Generally a healthy diet means that eating a balance of foods. This can include some junk food from time to time!
Learning about what is happening to oneself is one of the keys to good health. There are a lot of good resources available to learn about psychosis, medication, and taking care of oneself. Learning about psychosis helps one understand why medication is so strongly recommended for the majority of people. It also helps people understand why they should avoid drugs and alcohol. Education helps people understand their symptoms which helps them cope with them better.
One of the best ways for people to educate themselves is to ask their treatment team. They are there to support people through the process of recovery. They will be happy to answer any questions they can. And if they don't have the answers, they should direct people to sources that do.