Abstract
BackgroundNarratives of recovery from mental health distress have played a central role in the establishment of the recovery paradigm within mental health policy and practice. As use of recovery narratives increases within services, it is critical to understand how they have been characterised, and what may be missing from their characterisation thus far. The aim of this review was to synthesise published typologies in order to develop a conceptual framework characterising mental health recovery narratives.MethodA systematic review was conducted of published literature on the characteristics of mental health recovery narratives. Narrative synthesis involved identifying characteristics and organising them into dimensions and types; and subgroup analysis based on study quality, narrator involvement in analysis, diagnosis of psychosis and experience of trauma. The synthesis was informed by consultation with a Lived Experience Advisory Panel and an academic panel. The review protocol was pre-registered (Prospero CRD42018090188).Results8951 titles, 366 abstracts and 121 full-text articles published January 2000-July 2018 were screened, of which 45 studies analysing 629 recovery narratives were included. A conceptual framework of mental health recovery narratives was developed, comprising nine dimensions (Genre; Positioning; Emotional Tone; Relationship with Recovery; Trajectory; Use of Turning Points; Narrative Sequence; Protagonists; and Use of Metaphors), each containing between two and six types. Subgroup analysis indicated all dimensions were present across most subgroups, with Turning Points particularly evident in trauma-related studies.ConclusionsRecovery narratives are diverse and multidimensional. They may be non-linear and reject coherence. To a greater extent than illness narratives, they incorporate social, political and rights aspects. Approaches to supporting development of recovery narratives should expand rather than reduce available choices. Research into the narratives of more diverse populations is needed. The review supports trauma-informed approaches, and highlights the need to understand and support post-traumatic growth for people experiencing mental health issues.
Highlights
Recovery has become the established orientation within mental health policy and provision at national [1] and international [2] levels
The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care
The review was conducted as part of the Narrative Experiences Online (NEON) Programme, and the systematic review protocol was registered with PROSPERO
Summary
Recovery has become the established orientation within mental health policy and provision at national [1] and international [2] levels. It has been defined as “a deeply personal, unique process of change. Knowledge about recovery is based primarily on the individual stories and resulting insights of those with lived experience of psychological distress [4]. Stories of psychological distress and recovery emphasised empowerment and self-determination [6] Heard collectively, they enabled survivors and users to build solidarity and inspire hope in the face of widespread stigma, discrimination and denial of rights [7]. The aim of this review was to synthesise published typologies in order to develop a conceptual framework characterising mental health recovery narratives
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