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of emotional and physical symptoms as well as restoration of a full capacity for functioning may be present. The individual may return to work and resume personal interests and hobbies while restoring personal relationships.

To evaluate a change in adherence intention, the individual must take medications as prescribed. Since there is no diagnostic test to identify changes in the clinical aspect of depression, the only way to determine if medications are being taken is by self-reporting. This may be unreliable, so interventions such as monitored medication management, regular visits that include visually observing pill counts, refill data from the pharmacist, and actual change in mental status may need to be put in place.

Much work still needs to be done in discovering ways to promote adherence in the treatment of mental illness. The National Institute of Mental Health currently has studies underway to identify standard measures of need for treatment. Research on adherence and behavior change is taking place through basic behavioral studies. Adherence and response to treatment depends on whether people do or do not seek help for mental illness. Equally important is the formulation of provider strategies and behaviors to enhance recruitment, retention, and adherence, especially among minorities.35

Adherence is the hope of recovery. Defining the philosophy of recovery continues, but at present, the Consumer Advisory Panel for Implementing Evidence-Based Practices Project states that the principles of recovery should include the following:

  • Hope

  • Personal responsibility

  • Education

  • Self-advocacy

  • Support

It is important to understand that cessation of symptoms does not necessarily mean recovery. Each individual should define recovery for themselves. Recovery can be a “process” rather than a place or thing. Support is another area that requires clarification. The process of recovery should not allow problem-solving by another person; this is not what is meant by support. The best thing that someone can do for the individual with mental illness is demonstrate acceptance and to simply listen. Making judgments, giving advice and problem-solving for the depressed or mentally ill patient actually disempowers them. Empowerment is essential to recovery.85

Response to treatment can also be evaluated by using the tools originally used to evaluate for depression, such as PHQ-9, BSDS, and HAM-D. CMAG tools for assessment are also meant to be dynamic and may be used to evaluate progress once categorized into a quadrant.




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