Reflections on the value of lived experience and mutual peer support in recovery from all forms of mental illness, including psychosis.

Suicide is a devastating public health problem, and research indicates that people with prior attempts are at the greatest risk of completing suicide, followed by persons with depression and other major mental and substance use conditions. Because there has been little direct input from individuals with serious mental illness and a history of suicidal behavior concerning suicide prevention efforts, this study examined how this population copes with suicidal thoughts. Participants in 14 regional consumer-run Hope Dialogues in New York State (N=198) wrote up to five strategies they use to deal with suicidal thoughts. Strategies were classified according to grounded theory. First responses included spirituality, talking to someone, positive thinking, using the mental health system, considering consequences of suicide to family and friends, using peer supports, and doing something pleasurable. Although a majority reported that more formal therapeutic supports were available, only 12% indicated that they considered the mental health system a frontline strategy. Instead, respondents more frequently relied on family, friends, peers, and faith as sources of hope and support. Consumers' reliance on formal therapeutic supports and support from peers and family suggests that education and support for dealing with individuals in despair and crisis should be targeted to the social networks of this high-risk population. The disparity between availability of formal mental health services and reliance on them when consumers are suicidal suggests that suicide prevention efforts should evaluate whether they are effectively engaging high-risk populations as they struggle to cope with despair.

WHAT IS KNOWN ON THE SUBJECT?: Large numbers of mental health professionals live with their own mental health challenges. Despite working in mental health care, they can experience stigma in the workplace. Mental health professionals with lived experience of mental illness can find it a challenge to integrate their identities as both mental health professional and mental health service user. There are currently limited options available to them. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is a personal reflection from a mental health nurse and lecturer, who lives with a severe and enduring mental illness. It offers a lived experience account of the identity struggles of a mental health professional living with a mental illness. This article attempts to redefine the identity of professionals with personal lived experience in a more positive manner. They can be valued and celebrated for their unique perspective on mental illness and mental health care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There remains a stigma attached to people living with mental health conditions. This article challenges some of this stigma. It will empower and encourage other health professionals with lived experience to embrace all aspects of their identity with authenticity and courage. ABSTRACT: There are growing numbers of mental health professionals with their own lived experience of mental illness. This is both in part due to increased visibility and openness, and students embarking on professional courses motivated by their own personal mental health history. The somewhat limited research in this area highlights the difficulty practitioners have in navigating this distinct identity. There are limited options, including a wounded healer, an impaired professional and professional survivor. All have their limitations. We need to revise the conceptualisation of mental health professionals with personal lived experience of mental illness. Our identity needs to be celebrated and valued, as are the roles of peer support worker and expert by experience. Through personal reflection, I describe my own challenges in negotiating my identity as a mental health nurse, lecturer, and service user. My solution is to embrace authenticity and havethe courage to stand in vulnerability and strength, embracing all aspects of myself. I call for others to do the same.

A conceptual framework for the revision of the ICD‐10 classification of mental and behavioural disorders

Canadian youth can experience a range of mental health problems and mental illness, many of which perpetuate into adulthood. In contrast with preventative and medical care for physical problems, youth who experience difficulties with mental health or illness meet restricted access to evaluation, diagnostic and treatment services. Obstacles vary from low funding levels for services to the fear of being stigmatised by society. Conventional therapies could be complemented by the use of arts-based therapies, which are reported to offer a tangible alternative and could relieve delays in treatment. However, research regarding the treatment options, monitoring and assessment of outcomes is based largely on narrative evidence or idiographic studies, thus constraining the dissemination of supporting evidence and limiting the range of treatments for use by practitioners. While arts-based therapies receive support from many areas, including people with lived experience of mental health problems and illness, it is argued that the development of a theoretical foundation and extensive empirical research are required to develop the potential that arts-based therapies have to offer.

Anti-discrimination actions in mental health.

The health crisis of mental health stigma

Mental illness is a leading cause of disease burden amongst children and young people (CYP). This is exacerbated in low- and middle-income (LMIC) countries which often have embryonic care structures. Understanding and targeting illness beliefs is a potentially efficacious way of optimising the development of health prevention interventions. These beliefs remain relatively underexplored in CYP in LMIC contexts. Aim: To develop an in-depth understanding of CYPs beliefs about mental health and illness in Indonesia. Semi-structured interviews (n = 43) combined with photo elicitation methodology were undertaken with CYP aged 11-15 from Java, Indonesia. Our sample comprised those living with (n = 19) and without (n = 24) high prevalence mental health conditions, specifically anxiety or depression. Data were analysed using framework analysis, informed by the Common Sense Model of Self-Regulation of Health and Illness. Positive mental health and illness were dichotomised in accounts with mental health typically characterised as an absence of mental disturbance. This contributed to attributions of abnormality and the marginalisation of those with mental illness. Mental illness was conceptualised as a single entity, commonly arising from individual failings. This prompted feelings of self-stigma in those with lived experience of mental illness. Analysis identified marked differences in the perceived time dimensions of positive mental health and illness with mental illness conceived as less transient than episodes of positive mental health. Illness beliefs appeared relatively consistent across the two groups of CYP although some nuanced differences were identified. CYP with anxiety and depression were less likely to believe that mental illness could be diagnosed visually, more likely to uphold multiple causal factors and endorse the potential efficacy of professional input. Public health interventions to increase understanding may be necessary to develop healthcare systems to reduce treatment barriers, optimise return on investment and enhance population health effect.

Plain English summaryInvolving people in health research is increasingly recognised as being important to make sure that research is focused more on the needs of people who use health services. At present, ideas about what should be researched most often comes from researchers and/or health professionals like doctors and nurses rather than people with a lived experience of mental illness. In this study, we will talk with this group of people from across Wales to explore what they think research into their health services should focus on. The findings from this work will help to influence the work of the National Centre for Mental Health Research Partnership Group; as well as` researchers and health professionals and others who concentrate on mental health research. The Research group is a partnership between people with a lived experience of mental ill health and professionals with an interest in mental ill health. The group plan to take forward the ideas that came from this research and some of the ideas have already been used to increase funding in the area of mental health research.Background This paper is the result of continued collaboration between members of the Service User and Carer Research Partnership, based in Wales and supported by the National Centre for Mental Health, Health and Care Research Wales, and Hafal. The aim of this study was to explore the research priorities of people with experience of mental health services which include people with a lived experience of mental ill health, their carers, and professionals.Method A nominal group technique was used to gather data. A one-day workshop ‘Getting Involved in Research: Priority Setting’ was held to gather the ideas and suggestions for research priorities from people who have experience of mental health services.Results Twenty-five participants attended the workshop. 5 were mental health professionals, 20 had a lived experience of mental ill health, (of which 3 were also carers). 11 were male and 14 were female. 120 research ideas were generated across 6 ‘Ideas Generating Workstations’. Participants took part in a 3 stage vote to narrow down the ideas to 2 main research priorities.Conclusion The two main research priority areas that were identified:‘Developing the knowledge of mental health issues amongst school-aged children’ as a vehicle to overcome stigma and discrimination, and to support young people to manage their own mental health.‘Developing education as a tool for recovery’, for example by peer support. In addition, participants engaged in a notable discussion over the research priority: ‘How are carers supported during the recovery of the person for whom they care?’

BackgroundMental illness is a leading cause of disease burden amongst children and young people (CYP). This is exacerbated in low- and middle-income (LMIC) countries which often have embryonic care structures. Understanding and targeting illness beliefs is a potentially efficacious way of optimising the development of health prevention interventions. These beliefs remain relatively underexplored in CYP in LMIC contexts. Aim: To develop an in-depth understanding of CYPs beliefs about mental health and illness in Indonesia.Methods and findingsSemi-structured interviews (n = 43) combined with photo elicitation methodology were undertaken with CYP aged 11–15 from Java, Indonesia. Our sample comprised those living with (n = 19) and without (n = 24) high prevalence mental health conditions, specifically anxiety or depression. Data were analysed using framework analysis, informed by the Common Sense Model of Self-Regulation of Health and Illness. Positive mental health and illness were dichotomised in accounts with mental health typically characterised as an absence of mental disturbance. This contributed to attributions of abnormality and the marginalisation of those with mental illness. Mental illness was conceptualised as a single entity, commonly arising from individual failings. This prompted feelings of self-stigma in those with lived experience of mental illness. Analysis identified marked differences in the perceived time dimensions of positive mental health and illness with mental illness conceived as less transient than episodes of positive mental health. Illness beliefs appeared relatively consistent across the two groups of CYP although some nuanced differences were identified. CYP with anxiety and depression were less likely to believe that mental illness could be diagnosed visually, more likely to uphold multiple causal factors and endorse the potential efficacy of professional input.ConclusionsPublic health interventions to increase understanding may be necessary to develop healthcare systems to reduce treatment barriers, optimise return on investment and enhance population health effect.

Community-Based Recreation Therapy and Mental Health Recovery:A Mixed-Media Participatory Action Research Study Jessica J Ariss, MRSc, Alison Gerlach, PhD, J.B. Baker, Keith Barry, Lyn Cooper, Theressa L. de Vries, Kevin Halligan, and Monica Lacroix What Is the Purpose of this Study? • To understand how community-based recreation therapy can support mental health recovery, from the perspectives of people diagnosed with mental illness. • To guide the development, delivery, and evaluation of recovery-oriented mental health services. What Is the Problem? • The concept of personal recovery, as defined by mental health service users, emphasizes the importance of lived experience of mental illness. Few studies about recreation therapy in community mental health settings have involved partnerships with people who use mental health services. • Recreation therapists who strive to provide recovery-oriented services do not have enough evidence, informed by the lived experience of mental illness, to understand the role of therapeutic recreation in the recovery process. What Are the Findings? • Community-based recreation therapy can support the recovery process by providing a safe and fun environment that encourages self-determination in leisure while promoting hope and building confidence. • Service recipients' unique preferences and perspectives must be integral to service development, delivery, and evaluation to provide services that are truly recovery oriented. Who Should Care Most? • Mental health service providers (particularly in community-based settings). • Senior administrators in the mental health sector. • People who use mental health services. • Recreation therapists. • Mental health researchers. [End Page 125] Recommendations for Action • Involve mental health service users in service development, delivery, and evaluation. • Provide paid and volunteer peer support positions. • Listen to service users and provide personalized services according to each person's unique preferences. • Offer open access to a wide variety of recreation/leisure supplies at community-based mental health facilities and maximize opportunities to express personal choice. [End Page 126] Jessica J Ariss Waypoint Centre for Mental Health Care Alison Gerlach School of Child & Youth Care, Faculty of Human & Social Development, University of Victoria, Coast Salish Territories J.B. Baker HERO Centre Keith Barry HERO Centre Lyn Cooper HERO Centre Theressa L. de Vries HERO Centre Kevin Halligan HERO Centre Monica Lacroix HERO Centre Copyright © 2019 Johns Hopkins University Press

Directly engaging with People with lived experiences of mental illness from the communities in India

How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.

Social contact strategy or social contact based anti-stigma intervention, where a person with lived experience (PWLE) of mental illness shares his/her lived experiences with the target group, has been found to be effective in reducing stigma and discrimination. A culturally appropriate social contact based anti-stigma intervention training module would be helpful in training PWLE. Since there is no culturally appropriate training module available in India, there is a need to develop a training module for PWLE of mental illness to deliver a social contact based anti-stigma intervention. Thus, the proposed mixed-methods study aims to develop and test the efficacy of a training module for PWLE of mental illness, using social contact strategy to reduce stigma and discrimination towards people with mental illness amongst undergraduate students. The proposed study will be carried out in three phases; Phase-I: formative work will be conducted using an explorative research design. After a formative and extensive literature review, the culturally appropriate training module will be developed and subsequently reviewed and validated by mental health experts and service users. Phase-II: PWLE of mental illness will be trained using the developed manual adopting a case series design. Phase-III: To test the efficacy of the training, a quasi-experimental research design will be used, in which the target group’s knowledge, attitudes and behaviour towards mental illness will be assessed pre- and post and at three-month follow-up. Socio-demographic data will be analysed using descriptive statistics. Qualitative data (Phase-I and Phase-III) will be analysed through thematic analysis. Based on normality distribution, a parametric test like RMANOVA or an equivalent non parametric test will be adopted during phase III for efficacy testing. In addition, the outcomes amongst the PWLE, i.e., self-stigma and self-esteem, will be assessed and use of the training module will be analysed using thematic analysis.

Background: The development of peer work models that are integrated into health systems is at the heart of national and international reform agenda in mental health. Peer work differs from other mental health roles as it is provided by people who have a lived experience of mental illness and recovery and does not assume a medical model. Peer work in mental health services for older people is not well established and to address this gap we developed, implemented and evaluated a peer work model for older patients of a specialist mental health service.Method: The findings discussed in this paper are part of a broader evaluation and consist of qualitative observations made by the peer workers during focus groups. Three focus groups were conducted during the first year of the project to identify the peer workers’ perspectives, feelings and thoughts around the developing peer work model and how they were impacted by the work. Data collection and analysis was inductive and informed by grounded theory principles. Observations from peer workers are discussed in relation to the literature as well as observations made by the researchers during project implementation.Results: Analysis suggests that older peer workers have a level of maturity and experience with recovery that benefit the peer workforce in a number of ways namely (a) significant experience with recovery to draw on when helping others; (b) a well-established sense of identity and coping strategies that support wellbeing and (c) ability to cope with ambiguity and uncertainty inherent in peer work practice. We propose that having a strong sense of self or personal identity may be important in peer work, particularly as the peer work role is often challenged, questioned and unclear.Conclusion: Older peer workers provide a valuable contribution to the peer workforce and bring with them an array of strengths that can help overcome some of the common peer work implementation barriers.

County-Level Estimates of Need for Mental Health Professionals in the United States