Preventing, identifying, and managing sepsis in the community: research and clinical priorities.

Behavioral healthcare often prioritizes symptomatic remission when measuring treatment outcomes, sometimes overlooking other important outcomes. Within treatment of major depressive disorder (MDD), researchers commonly define “response” as a ≥ 50% reduction in depression symptoms and “remission” as scores below a certain threshold []. This symptom-focused approach reflects the medical model of illness and prioritizes return to previous levels of functioning and symptoms []. As behavioral health systems continue to adopt measurement-based care, defined as the routine use of validated patient-reported outcomes to inform diagnosis, monitor progress, and guide treatment decisions [], there remains a critical need to better understand which outcomes are most important to measure []. The emerging literature shows that patients prioritize outcomes beyond symptomatic reduction [, ], and there is a growing movement to measure more “positive” mental health outcome measures []. While there is yet to be a consensus on “positive” mental health assessment instruments or even well-established definitions [], the constructs of flourishing [-] and personal recovery [] are two emerging constructs that operationalize and capture broader dimensions of well-being that extend beyond symptoms. “Flourishing” is a multidimensional outcome measure that is broadly understood as an evolving state of optimal well-being and functioning across multiple domains of an individual’s life, including emotional, psychological, and social functioning [-]. Personal recovery emerged from perspectives of individuals with lived experience of mental illness [] and can be defined by the idiosyncratic process of changing one’s attitude, value, feelings, and goals, and developing meaning in life beyond illness. Personal recovery is characterized by connection, hope, identity, meaning, and empowerment []. Assessing “positive” outcomes, such as flourishing and personal recovery, may have benefits for patient and population health. First, defining “positive” goals may mitigate stigma and improve help-seeking behavior []. Secondly, service users and clinicians tend to focus on different treatment outcomes []. Understanding the outcomes that service users care most about may improve the therapeutic relationship between clinicians and service users []. Lastly, from a population health perspective, assessing flourishing and recovery outcomes may offer a more comprehensive way to characterize overall health [, ]. A budding body of research suggests that overall mental health should be characterized by two dimensions: “positive” mental health and symptoms of mental illness. Instead of a single continuum from mental illness to mental well-being, in a “dual-continua” model of mental health, individuals can be classified into four states: (A) high “positive” mental health without mental illness, (B) high “positive” mental health with mental illness, (C) low “positive” mental health without mental illness, and (D) low “positive” mental health with mental illness [, ]. Despite these potential benefits, few mental health research studies and few mental health clinicians assess “positive” outcomes such as flourishing and personal recovery [, ].