Community Mental Health Journal

, Volume 49, Issue 3, pp 323–330 | Cite as

Measuring the Later Stages of the Recovery Journey: Insights Gained from Clubhouse Members

  • Nicola Hancock
  • Anita Bundy
  • Anne Honey
  • Stephanie Helich
  • Sally Tamsett
Original Paper


The Recovery Assessment Scale (RAS) is a frequently used measure of recovery from mental illness but has previously been shown to poorly differentiate between more recovered consumers. This research aimed to: (1) identify components of later recovery stages; (2) ascertain the extent to which these are measured in the RAS; and (3) suggest modifications to improve the ability of the RAS to differentiate between more recovered consumers. Clubhouse members who scored high on the RAS participated in focus groups in which they discussed areas of recovery most recently or yet to be achieved. Constant comparative analysis of data indicated that later stages of recovery are characterized by: (a) accepting your illness and gaining control over symptoms (b) self love and optimism, (c) doing things for and experiencing pleasure, (d) contributing through meaningful activity, (e) having a diversity of friendships, (f) being needed and valued by others and (g) coming to terms with family relationships. Results suggest the RAS would be improved by addition of items, particularly in functional and social recovery domains.


Recovery Clubhouse Measurement Relationships Meaningful activity 


  1. Andresen, R., Caputi, P., & Oades, L. (2006). Stages of recovery instrument: Development of a measure of recovery from serious mental illness. Australian and New Zealand Journal of Psychiatry, 40, 972–980.PubMedCrossRefGoogle Scholar
  2. Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11–23.CrossRefGoogle Scholar
  3. Australian Health Ministers. (2003). National mental health plan 20032008. Canberra: Australian Government. Retrieved September 5th, 2007, from
  4. Beard, J. H., Propst, R. N., & Malamud, T. J. (1982). The Fountain House model of psychiatric rehabilitation. Psychosocial Rehabilitation Journal, 5, 47–53.Google Scholar
  5. Breier, A., & Strauss, J. S. (1984). The role of social relationships in the recovery from psychotic disorders. American Journal of Psychiatry, 141, 949–955.PubMedGoogle Scholar
  6. Burgess, P., Pirkis, J., Coombs, T., & Rosen, A. (2011). Assessing the value of existing recovery measures for routine use in Australian mental health services. Australian and New Zealand Journal of Psychiatry, 45, 267–280.PubMedCrossRefGoogle Scholar
  7. Campbell-Orde, T., Chamberlin, J., Carpenter, J., & Leff, H. S. (2005). Measuring the promise: A compendium of recovery measures (Volume 2). Cambridge, MA: The evaluation centre @ Human Services Research Institute.Google Scholar
  8. Chiba, R., Miyamoto, Y., & Kawakami, N. (2010). Reliability and validity of the Japanese version of the Recovery Assessment Scale (RAS) for people with chronic mental illness: Scale development. International Journal of Nursing Studies, 47, 314–322.PubMedCrossRefGoogle Scholar
  9. Corrigan, P., Salzer, M., & Ralph, R. O. (2004). Examining the factor structure of the Recovery Assessment Scale. Schizophrenia Bulletin, 30, 1035–1041.PubMedCrossRefGoogle Scholar
  10. Cronbach, L. J., Meehl, P. E. (1995). Construct validity in psychological testing. Psychological Bulletin, 52(4), 281–302.CrossRefGoogle Scholar
  11. Deegan, P. (1997). Recovery and empowerment for people with psychiatric disabilities. Social Work in Health Care, 25(3), 11–24.PubMedCrossRefGoogle Scholar
  12. Department of Health. (2007). Commissioning framework for health and well-being. Retrieved July 5th, 2007, from
  13. Giffort, D., Schmook, A., Woody, C., Vollendorf, C., & Gervain, M. (1995). Recovery Assessment Scale. Cambridge, MA: Human Services Research Institute.Google Scholar
  14. Glaser, B. C., & Strauss, A. L. (1969). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine Publishing Company.Google Scholar
  15. Hancock, N., Bundy, A., Honey, A., James, G., & Tamsett, S. (2011). Improving measurement properties of the Recovery Assessment Scale (RAS) with Rasch analysis. American Journal of Occupational Therapy, 65, e77–e85. doi: 10.5014/ajot.2011.001818.CrossRefGoogle Scholar
  16. International Centre for Clubhouse Development. (2010). International Clubhouse Directory Retrieved January 4th, 2011, from
  17. Jacobson, N., & Curtis, L. (2000). Recovery as a policy in mental health services: Strategies emerging from the states. Psychiatric Rehabilitation Journal, 23, 333–341.CrossRefGoogle Scholar
  18. Kitzinger, J. (1995). Introducing focus groups (qualitative research, part 5). British Medical Journal, 311, 299–303.PubMedCrossRefGoogle Scholar
  19. Koppelman, N. F., & Bourjolly, J. N. (2001). Conducting focus groups with women with psychiatric disabilities: A methological overview. Psychiatric Rehabilitation Journal, 25, 142–151.PubMedCrossRefGoogle Scholar
  20. Krueger, R. A., & Casey, M. A. (2000). Focus groups: A practical guide for applied research (3rd ed.). California: Sage Publications, Inc.Google Scholar
  21. Liberman, R., & Kopelowicz, A. (2005). Recovery from schizophrenia: A concept in search of research. Psychiatric Services, 56, 735–742.PubMedCrossRefGoogle Scholar
  22. Lloyd, C., Waghorn, G., & Williams, P. L. (2008). Conceptualising recovery in mental health rehabilitation. British Journal of Occupational Therapy, 71, 321–328.Google Scholar
  23. McNaught, M., Caputi, P., Oades, L. G., & Deane, F. P. (2007). Testing the validity of the Recovery Assessment Scale using an Australian sample. Australian and New Zealand Journal of Psychiatry, 41, 450–457.PubMedCrossRefGoogle Scholar
  24. Morgan, D. L. (1997). Focus groups as qualitative research (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
  25. Pettie, D., & Triolo, A. M. (1999). Illness as evolution: The search for identity and meaning in the recovery process. Psychiatric Rehabilitation Journal, 22, 255–262.CrossRefGoogle Scholar
  26. QSR. (2008). NVivo 8 qualitative data analysis software. QSR International Pty Ltd.Google Scholar
  27. Ralph, R. O., Kidder, K., & Phillips, D. (2000). Can we measure recovery? A compendium of Recovery and Recovery-related instruments. Cambridge, MA: Human Services Research Institute and Centre for Mental Health Services.Google Scholar
  28. Salyers, M. P., Godfry, J. L., Mueser, K. T., & Labriola, S. (2007). Measuring illness measurement outcomes: A psychometric study of clinician and consumer rating scales for illness self management and recovery. Community Mental Health Journal, 43, 459–480. doi: 10.1007/s10597-007-9087-6.PubMedCrossRefGoogle Scholar
  29. Shrivastava, A., Johnston, M., Shah, N., & Bureau, Y. (2010). Redefining outcome measures in schizophrenia: Integrating social and clinical parameters. Current Opinion in Psychiatry, 23, 120–126.PubMedCrossRefGoogle Scholar
  30. Slade, M. & Hayward, M. (2007). Recovery, psychosis and psychiatry: Research is better than rhetoric. Acta Psychiatrica Scandinavica, 116, 81–83.PubMedCrossRefGoogle Scholar
  31. U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration Center for Mental Health Services. (2006). National Consensus Statement on Mental Health Recovery Retrieved May 2nd, 2007, from
  32. Verhaeghe, M., Bracke, P., & Bruynooghe, K. (2008). Stigmatization and self-esteem of persons in recovery from mental illness: The role of peer support. International Journal of Social Psychiatry, 54, 206–218.PubMedCrossRefGoogle Scholar
  33. Weeks, G., Slade, M., & Hayward, M. (2010). A UK validation of the stages of recovery instrument. International Journal of Social Psychiatry, Online early.Google Scholar
  34. Whitley, R., & Drake, R. (2010). Recovery: A dimensional approach. Psychiatric Services, 61, 1248–1250.PubMedCrossRefGoogle Scholar
  35. Young, S. L., & Ensing, D. S. (1999). Exploring recovery from the perspective of people with psychiatric disabilities. Psychiatric Rehabilitation Journal, 22, 219–231.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Nicola Hancock
    • 1
  • Anita Bundy
    • 1
  • Anne Honey
    • 1
  • Stephanie Helich
    • 2
  • Sally Tamsett
    • 2
  1. 1.The University of SydneyLidcombeAustralia
  2. 2.Pioneer ClubhouseSydneyAustralia

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