Levels of Recovery from Psychotic Disorders

Developed by Sharon Sousa Ph.D. and Jean Crocker of the Alliance for the Mentally Ill. Further editorial changes by the Guidelines Review Panel

    Active Illness
(Danger to Self & Others)
Active Illness
(Controlled Psychosis)
Stable but not Improving Stable & Improving  Normalized Activity
Staff Supervision Needed Hospital Ward
Locked ward
24 hour nursing care
Custodial Care
Unlocked ward
Day hospital
partial hospital
Community Residence Staffed
Rehabilitation house
3/4, 1/2, 1/4 way house
Staff Supported Apartment
Includes other's home
Independent Living
Independent home
Flexible support from staff
Positive Symptoms of Illness          
  Potential for Violence High to moderate  Limited risk  Minor risk Minor risk Minor or no risk
  Voices Present most of the time, unpleasant Present much of the time, unpleasant Present much of the time, unpleasant Less intrusive, viewed as part of illness None or minimal
  Thinking Bizarre unpleasant Less bizarre, unpleasant More organized, unpleasant Organized, goal directed Organized, goal directed
  Reality Testing Poor Fair More reality based Reality based most of time Good
  Knowledge regarding illness & compliance with treatment Poor Poor Fair - with some denial Fair - less denial Good
Negative Symptoms of Illness             
  Facial Expression Distressed, anxious or flat Distressed, anxious or flat Less distressed, anxious Demonstrates spontaneous humor Adequate range of expression
  Speech Monotonous voice Initiates some conversation Better tone, volume Give-and-take dialogue Good conversations
  Interest in Others Avoids close relationships Does not initiate relationships Shows interest in others Cooperates with others Enjoys relationships with others
Work & Education             
  (Volunteer or Paid) Very limited
Concentration for tasks poor
Housekeeping room minimal
More time with tasks
Improved concentration
Housekeeping own area
Day treatment program
Psychosocial rehab program
Sheltered employment
TEP (1/2 time/clubhouse)
Supported education
Job training
Independent employment P/T, F/T
Independent education
Independent volunteer
Social Skills            
  Personal Hygiene Care Poor Grooming, hygiene requires staff encouragement Limited interest in grooming Adequate attention to grooming Enjoys good personal presentation
  Social Interaction Skills  Poor Eye contact, body language poor Improved eye contact, smiling, better non-verbal communication Good Involved in normal social interaction
Advocacy          
    Self Advocacy No self advocacy 
No future orientation to goals
Limited self advocacy
Limited future orientation to goals
Increasingly voicing own desires
More future goal orientation
Improved sense of self
Goals present & future focused
Plans and executes long term goals