Mental Health Recovery Measure Research Articles

The Association Between Change in Symptom Severity and Personal Recovery in Patients With Severe Mental Illness

Abstract This study examined the relationship between change in symptom severity and personal recovery in patients with severe mental illness (SMI). Forty-nine outpatients at Mentrum/Arkin, Amsterdam, the Netherlands, were assessed at baseline and 3 years later, using the Brief Psychiatric Rating Scale and the Mental Health Recovery Measure. Correlation coefficients and linear regression analyses were used. Further, the impact of severity of symptoms at baseline on change in personal recovery was evaluated. Results show that change in symptom severity explained 31.8% of the variance of change in personal recovery. Change in depression/anxiety explained 27.3% of the variance of change in personal recovery. Higher affective symptom severity at baseline significantly predicted positive change in personal recovery. In conclusion, besides change in symptom severity, other potential determinants of personal recovery should be addressed in treatment of patients with SMI, for example, self-esteem and social functioning. Treatment of depression/anxiety symptoms may increase personal recovery.

Measurement properties of the Thai translation of the Recovery Assessment Scale - Domains and Stages (RAS-DS) and comparison of recovery experiences between Thai and Australian consumers living with serious mental illness.

Personal recovery, a western conceptualisation that focuses on hope and living meaningful lives of choice rather than focusing on symptom reduction, is a more recent concept in many Asian countries including Thailand. One way to promote recovery-oriented service delivery is to use outcome measures that capture self-reported personal recovery. This study aimed to evaluate a Thai translation of a self-report measure of mental health recovery, the Recovery Assessment Scale - Domains and Stages (RAS-DS). The study also explored the cultural similarities and differences between Thai (n = 190) and Australian (n = 301) recovery experiences by comparing Thai and Australian participant responses to RAS-DS items. Data were analysed using Rasch analysis. Analyses revealed that the Thai version of the RAS-DS had adequate measurement properties. Cultural comparisons suggested that most aspects contained within the RAS-DS appear to be applicable across both Thai and Australian contexts. Three findings suggest linguistic or cultural differences in Thai and Australian recovery experiences: (i) a ceiling effect for Thai participants, (ii) some items were "harder" or "easier" for one cultural group to endorse than the other, and (iii) a few items were "misfitting" for Thai participants.

Towards an integrative hope-dysfunctional beliefs perspective to personal recovery in schizophrenia: a path analysis

BackgroundEvidence shows that negative symptoms of schizophrenia and underlying dysfunctional cognition are related to persistently low functioning and quality of life. However, despite the abundance of existing recovery programs for people with schizophrenia, few have examined whether and how the widely-adopted hope-motivation recovery pathway and the deficit-oriented cognitive pathway might converge to influence functioning and quality of life.MethodsA cross-sectional, quantative survey recruited a convenient sample of adult outpatients with DSM-5 schizophrenia spectrum disorders and low social functioning (n = 124). Self-reported measurements included personal recovery (30-item Mental Health Recovery Measure), social functioning (8-item Social Functioning Questionnaire), hope (12-item Hope Scale), quality of life (28-item World Health Organization Quality of Life Scale-Abbreviated Version-Hong Kong), defeatist beliefs (15-item extracted from Dysfunctional Attitude Scale), and asocial beliefs (15-item extracted from Revised Social Anhedonia Scale). Correlation analysis and structural equation modelling was applied to investigate how the two pathways intertwined to predict social functioning and quality of life.ResultsAsocial beliefs and hope separately mediated two partial mediation pathways from defeatist beliefs to recovery outcomes (social functioning and personal recovery). Meanwhile, defeatist beliefs, social functioning, and personal recovery further predicted quality of life.ConclusionsThis is one of the very few studies that provides empirical evidence of a deficit-strength linkage in the recovery from schizophrenia. Remediation of dysfunctional beliefs and the injection of hope and successful experiences should be undertaken concurrently in recovery as they are associated with differential effects on enhancing social functioning and personal recovery, which then converge and contribute to a better quality of life.

Shifting Mindsets: The Impact of a Patient Portal on Functioning and Recovery in a Mental Health Setting.

This study aims to understand whether higher use of a patient portal can have an impact on mental health functioning and recovery. A mixed methods approach was used for this study. In 2019-2021, patients with mental health diagnoses at outpatient clinics in an academic centre were invited to complete World Health Organization Disability Assessment Scale 12 (WHODAS-12) and Mental Health Recovery Measure surveys at baseline, 3 months, and 6 months after signing up for the portal. At the 3-month time point, patients were invited to a semistructured interview with a member of the team to contextualize the findings obtained from the surveys. Analytics data was also collected from the platform to understand usage patterns on the portal. Overall, 113 participants were included in the analysis. There was no significant change in mental health functioning and recovery scores over the 6-month period. However, suboptimal usage was observed as 46% of participants did not complete any tasks within the portal. Thirty-five participants had low use of the portal (1-9 interactions) and 18 participants had high usage (10+ interactions). There were also no differences in mental health functioning and recovery scores between low and high users of the portal. Qualitative interviews highlighted many opportunities where the portal can support overall functioning and mental health recovery. Collectively, this study suggests that higher use of a portal had no impact, either positive or negative, on mental health outcomes. While it may offer convenience and improved patient satisfaction, adequate support is needed to fully enable these opportunities for patient care. As the type of interaction with the portal was not specifically addressed, future work should focus on looking at ways to support patient engagement and portal usage throughout their care journey.

Understanding the Role of Patient Portals in Fostering Interprofessional Collaboration Within Mental Health Care Settings: Mixed Methods Study.

Patient portals are web-based systems through which patients can access their personal health information and communicate with their clinicians. The integration of patient portals into mental health care settings has been evolving over the past decade, as cumulated research to date has highlighted the potential role of portals in facilitating positive health outcomes. However, it is currently unknown whether portal use can foster interprofessional collaboration between clinicians and patients or whether the portal is a tool to support an already established collaborative relationship. This mixed methods study aimed to understand how the use of a patient portal within mental health settings can impact the level of interprofessional collaboration between clinicians and patients. This study was conducted in a large mental health care organization in Ontario, Canada. A convergent mixed methods design was used, where the primary data collection methods included questionnaires and semistructured interviews with patients who had experience using a portal for their mental health care. For the quantitative strand, participants completed the Health Care Communication Questionnaire and the Self-Empowerment subscale of the Mental Health Recovery Measure at 3 time points (baseline, 3 months of use, and 6 months of use) to measure changes in scores over time. For the qualitative strand, semistructured interviews were conducted at the 3-month time point to assess the elements of interprofessional collaboration associated with the portal. For the quantitative strand, 113 participants completed the questionnaire. For the Health Care Communication Questionnaire scores, the raw means of the total scores at the 3 time points were as follows: baseline, 43.01 (SD 7.28); three months, 43.19 (SD 6.65); and 6 months, 42.74 (SD 6.84). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.70). For the Mental Health Recovery Measure scores, the raw mean total scores at the 3 time points were as follows: baseline, 10.77 (SD 3.63); three months, 11.09 (SD 3.81); and 6 months, 11.10 (SD 3.33). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.34). For the qualitative strand, 10 participants were interviewed and identified various elements of how interprofessional collaboration can be supplemented through the use of a patient portal, including improved team functioning, communication, and conflict resolution. Although the quantitative data produced nonsignificant findings in interprofessional collaboration scores over time, the patients' narrative accounts described how the portal can support various interprofessional collaboration concepts, such as communication, leadership, and conflict resolution. This provides useful information for clinicians to support the interprofessional relationship when using a portal within a mental health setting. RR2-10.1136/bmjopen-2018-025508.

An Assessment of the 10-Item Mental Health Recovery Measure in a Predominantly African American Sample of Adults with Serious Mental Illness.

Study objectives were to 1) assess the reliability and validity of the 10-item Mental Health Recovery Measure (MHRM-10) in sample of predominately African American participants with serious mental illness, and 2) evaluate differences in MHRM-10 scores between the present sample and two other samples of persons with serious mental illness with different racial compositions. Participants included 230 adults (85.7% African American) with chart diagnoses of schizophrenia-spectrum, bipolar-spectrum, and major depressive disorders receiving services from community mental health centers in Detroit, Michigan. In addition to the MHRM-10, participants completed measures of psychological symptoms (Brief Symptom Inventory (BSI)- General Severity Index (GSI) and depression subscale), well-being(12-Item World Health Organization Disability Assessment Schedule 2.0; WHODAS 2.0), and stress-related growth (Stress-Related Growth Scale - Short Form; SRGS-SF). Internal consistency and convergent validity of the MHRM-10 were examined. Differences in MHRM-10 scores between the present sample and other samples were characterized by effect sizes. The MHRM-10 demonstrated excellent internal consistency. Evidence for convergent validity of the MHRM-10 included moderate correlations with theBSI-GSI, BSI-depression subscale, SRGS-SF, and WHODAS 2.0. The present sample of predominately African American participants showed higher MHRM-10 scores than two other samples with smaller proportions of African American participants. The MHRM-10 demonstrates excellent internal consistency and good convergent validity among African Americans with serious mental illness. Although findings are promising, studies should further assess the psychometric properties of the MHRM-10 in African American samples. Additional research that examines racial differences in mental health recovery is needed.

Validity and Reliability Study of Mental Health Recovery Measure's Turkish Version.

The present study aims to translate into Turkish and investigate the validity and reliability of the Mental Health Recovery Measure (MHRM). The sample consisted of 343 outpatients - and in-patients under treatment for a variety of psychiatric diagnoses at a state hospital and a university research hospital. The MHRM along with the Subjective Recovery Assessment Scale (SRAS), Psychological Well Being Scale (PWBS), Emotional Eating Scale (EES), and The Internalized Stigma of Mental Illness Scale (ISMI). The mean MHRM total score was estimated at 31.66 (sd=10.02). Exploratory factor analysis revealed one single robust factor explaining 64% of the variance of the total scores. Alpha internal consistency coefficient was calculated as 0.94 and corrected item-total correlation coefficients were entirely above 0.60. The MHRM scores showed positive and strong correlations with the PWBS (r=0.695; p<0.001) and SRAS (r=0.732; p<0.001), negative and strong correlation with the ISMI (r=-0.696; p<0.001) and no correlation with the EES scores (r=-0.021; p=0.703). Our data provides initial evidence supporting the validity and reliability of the Turkish MHRM in evaluating the tendency for recovery of mental health consumers for clinical and research purposes. Further studies addressing psychometric properties of the scale are warranted.

Perceptions and understanding of mental health recovery for service users, carers, and service providers: A South African perspective.

Understandings of recovery in low- and middle-income countries, such as South Africa, are still emerging. This study explored recovery understandings by service users, carers, and service providers in South Africa. Thirty-seven in-depth, semistructured interviews and three focus groups with service users, carers, and service providers from three public tertiary psychiatric hospitals in the Western Cape province of South Africa were conducted in 2018 and 2019. Data were transcribed and analyzed, using atlas.ti and reflexive thematic analysis, to generate themes. Seven themes, with further subthemes, were generated: (a) relationship with others, (b) moving positively forward, (c) relationship with self, (d) relating to the world, (e) (re-)gaining of strengths, (f) awareness of difficulties, and (g) clinical understanding to support personal recovery. From the themes, a definition of recovery for the South African context was developed. The identified themes were not mutually exclusive-overlap is inevitable when describing personal recovery. These results and definition are informing the second phase of the overall study-developing a measure of personal mental health recovery for the South African context. The results can contribute to the wider clinical, academic and governmental comprehension of recovery, assist in the obtaining or retaining of funding for local recovery initiatives, and hopefully be useful for service users to understand their own process of recovery better and to be able to move along in that process. We recommend replicating the study and investigating recovery-conducive environments in South Africa with service users. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prevalence and correlates of PTSD in first episode psychosis: Findings from the RAISE-ETP study.

Posttraumatic stress disorder (PTSD) in young individuals is associated with an increased risk to develop psychosis or mania, and both trauma and PTSD rates are elevated in people with schizophrenia and other severe mental illnesses. However, less research has examined PTSD in people who have recently developed a first episode of psychosis (FEP). The present study is a secondary analysis of the baseline data collected for the National Institute of Mental Health Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study to examine the rates of trauma and PTSD, and to explore the demographic and clinical correlates of PTSD in a representative sample of 404 persons with an FEP. Approximately 80% of the study sample reported experiencing at least one traumatic event during their lives, with females more likely to report childhood sexual abuse and spousal abuse than males. A total of 20 participants (5.0%) met criteria for a lifetime diagnosis of PTSD, while another 15 participants (3.7%) met subthreshold diagnostic criteria for PTSD. Significant correlations were found between lifetime PTSD and the Calgary Depression Scale, the Mental Health Recovery Measure, the Stigma Scale, and duration of untreated psychosis, with higher scores on each variable associated with a diagnosis of PTSD. The association between PTSD and more severe depression, as well as lower perceptions of personal recovery, suggest that PTSD may be an important target for treatment programs for persons recovering from an FEP. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Identifying the minimal important difference in patient-reported outcome measures in the field of people with severe mental illness: a pre\u2013post-analysis of the Illness Management and Recovery Programme

PurposeComplementary interventions for persons with severe mental illness (SMI) focus on both personal recovery and illness self-management. This paper aimed to identify the patient-reported outcome measures (PROMs) associated with the most relevant and meaningful change in persons with SMI who attended the Illness Management and Recovery Programme (IMR).MethodsThe effect of the IMR was measured with PROMs concerning recovery, illness self-management, burden of symptoms and quality of life (QoL). From the QoL measures, an anchor was chosen based on the most statistically significant correlations with the PROMs. Then, we estimated the minimal important difference (MID) for all PROMs using an anchor-based method supported by distribution-based methods. The PROM with the highest outcome for effect score divided by MID (the effect/MID index) was considered to be a measure of the most relevant and meaningful change.ResultsAll PROMs showed significant pre–post-effects. The QoL measure ‘General Health Perception (Rand-GHP)’ was identified as the anchor. Based on the anchor method, the Mental Health Recovery Measure (MHRM) showed the highest effect/MID index, which was supported by the distribution-based methods. Because of the modifying gender covariate, we stratified the MID calculations. In most MIDs, the MHRM showed the highest effect/MID indexes.ConclusionTaking into account the low sample size and the gender covariate, we conclude that the MHRM was capable of showing the most relevant and meaningful change as a result of the IMR in persons with SMI.

Subjective health-related quality of life in community-dwelling middle-aged and older adults with early-onset schizophrenia

Background: Long-term outcome in schizophrenia remains unsatisfactory due to continued premature deaths and insufficient health treatment. Subjective quality of life (SQoL) measurements hold important information and have meaningful implications regarding ways of improving general health status. This study investigated the physical and mental SQoL and associated clinical and sociodemographic outcomes among community-dwelling middle-aged and older people with early-onset schizophrenia.Materials and methods: A cross-sectional interview study where participants residing in the Region of Southern Denmark were identified through The Danish Psychiatric Central Register. Of a total of 278 eligible individuals, 59 people aged 55–82 years old participated. The SQoL measure Medical Outcomes Short Form 36 version 2 (SF36) was used. Scores were compared by age groups with normative data for the Danish population. Associated outcomes were measured using Positive And Negative Symptom Scale Remission and others.Results: Increased mental SQoL was associated with schizophrenia in remission (adjusted B 9.43, p = .001), increased Mental Health Recovery Measure score (adjusted B 0.55, p < .001) and increased GAF score (adjusted B 0.32, p < .001). Comparing with Danish Normative data, mental SQoL was reduced (p = .001) among 55–64-year olds, but presented levels similar to the general population at ages over 65 years. Physical quality of life was similar to the general population.Conclusion: Over 65-year olds with schizophrenia seemed to have SQoL similar to their age peers in the general population. Aiming treatment at achieving state of remission or recovery would be an amenable measure toward increasing mental SQoL among middle-aged people with schizophrenia.

T234. MEASURING PERSONAL RECOVERY IN PEOPLE WITH A PSYCHOTIC DISORDER BASED ON CHIME: A COMPARISON OF RELIABILITY AND VALIDITY PROPERTIES ON THREE VALIDATED MEASURES

BackgroundLiving well in spite of residual symptoms of mental illness is measured with the construct of personal recovery. The CHIME framework might be suitable to evaluate personal recovery measures and guide instrument choice.MethodsThree validated measures were evaluated in Dutch patients with a psychotic disorder (N=52). We compared the Recovery Assessment Scale [RAS], the Mental Health Recovery Measure [MHRM] and the Netherlands Empowerment List [NEL]. The measures were assessed on six criteria: content validity (based on CHIME), convergent validity with a social support measure, internal consistency, floor and ceiling effects, item interpretability and ease of administration.ResultsThe MHRM scored high on content validity with a balanced distribution of items covering the CHIME framework. The MHRM and NEL showed moderate convergent validity with social support. In all three measures internal consistency was moderate and floor and ceiling effects were absent. The NEL scores demonstrated a high degree of item interpretability. Ease of administration was moderate for all three measures. Finally, the CHIME framework demonstrated good utility as a framework in guiding instrument choice and evaluation of personal recovery measures.DiscussionThe MHRM showed the best overall result. However, differences between measures were minimal. Generalization of the results is limited by cultural and linguistic factors in the assessment for the subjective measures (i.e. content validity and item interpretability). The broad and multi-dimensional construct of personal recovery might lead to ambiguous interpretations. Scientific consensus on a well-defined personal recovery construct is needed.

Complementary and alternative medicine (CAM) in Danish residential homes for people with severe mental illness: Use and perceived benefits of CAM in relation to recovery.

Mental health services in Denmark offer various rehabilitative treatment interventions to people with severe mental illness. Complementary and Alternative Medicine (CAM) such as National Acupuncture Detoxification Association (NADA) ear acupuncture are used as rehabilitative interventions. We investigated the use of CAM in four psychiatric residential homes, and whether CAM supports residents' rehabilitation and personal recovery. Residents in four selected residential homes participated in a questionnaire study, which elicited information on the use of CAM offered in a residential home setting. The study was conducted from February to November 2017. Recovery scores were assessed using the Mental Health Recovery Measure (MHRM). Of 131 eligible respondents, 68 (52%) participated. CAM was used by 84% of the residents. NADA ear acupuncture (38%) and music therapy (37%) were the most commonly used types of CAM. CAM is a commonly used rehabilitative intervention and more than 50% receiving treatment with CAM believed that it has supported their recovery process.

Measuring personal recovery in people with a psychotic disorder based on CHIME: A comparison of three validated measures.

Living well in spite of residual symptoms of mental illness is measured with the construct of personal recovery. The CHIME framework might be suitable to evaluate personal recovery measures and guide instrument choice. Three validated measures were evaluated in Dutch patients with a psychotic disorder (N = 52). We compared the Recovery Assessment Scale (RAS), the Mental Health Recovery Measure (MHRM), and the Netherlands Empowerment List (NEL). The measures were assessed on six criteria: content validity (based on CHIME), convergent validity with a social support measure, internal consistency, floor and ceiling effects, item interpretability, and ease of administration. The MHRM scored high on content validity with a balanced distribution of items covering the CHIME framework. The MHRM and the NEL showed moderate convergent validity with social support. In all three measures, internal consistency was moderate and floor and ceiling effects were absent. The NEL scores demonstrated a high degree of item interpretability. Ease of administration was moderate for all three measures. Finally, the CHIME framework demonstrated good utility as a framework in guiding instrument choice and evaluation of personal recovery measures. The MHRM showed the best overall result. However, differences between measures were minimal. Generalization of the results is limited by cultural and linguistic factors in the assessment for the subjective measures (i.e. content validity and item interpretability). The broad and multidimensional construct of personal recovery might lead to ambiguous interpretations. Scientific consensus on a well‐defined personal recovery construct is needed.

The relationship between community integration and mental health recovery in people with mental health issues living in the community: A quantitative study

WHAT IS KNOWN ON THE SUBJECT?: Mental health treatments have become patient-centred. Evaluating recovery in people with mental health difficulties living in the community can help to develop better client-centred services. Community integration is critical to recovery in patients with mental health difficulties. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This is the first study to use a single integrated measure of mental health recovery to evaluate the effect of community integration. Physical community integration was the easiest goal for most to reach. Developing independence/self-actualization was harder. In mental health recovery, most people were able to overcome stuckness. Developing abilities for basic functioning was harder. Participating in mental health centre day programmes promoted mental health recovery in people with mental health difficulties living in the community. Independence/self-actualization, psychological integration and social support improved mental health recovery in people with mental health difficulties living in the community. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a need to develop and actively promote programmes that attract people with mental health difficulties living in the community so that they will actively use mental health centre services. Offering systematic social skills training and occupational rehabilitation therapy to people with mental health difficulties living in the community may help them function independently. Mental health service programmes should provide volunteer opportunities for people with mental health difficulties living in the community to facilitate a sense of belonging. Mental health nurses should serve as a social support resource for people with mental health difficulties living in the community by providing education to family and friends on how to support patients' recovery, and invigorating integration projects such as "making healthy friends." Abstract Introduction Although community integration of people with mental health difficulties and a consumer-centred recovery paradigm are of global importance, little research has been conducted on community integration factors that directly affect mental health recovery. Aim This study investigated the relationship between community integration and mental health recovery in people with mental health difficulties living in the community in South Korea. Method Data were collected from 155 people with mental health difficulties living in the community, using the Self-Reporting Scale of Community Integration and the Mental Health Recovery Measure (Korean version), and analysed using hierarchical regression analysis. Results Among the community integration subscales, independence/self-actualization, psychological integration and social support were significant factors in mental health recovery, explaining 47.3% of the variance. Discussion An effective intervention strategy for mental health recovery of people with mental health difficulties living in the community may reinforce community integration by carefully considering independence/self-actualization, psychological integration and social support. Implications for practice Mental health nurses should provide intervention to people with mental health difficulties living in the community to help them develop strategies for functioning independently, experiencing a sense of achievement and developing a sense belonging in the community.

Recovery Assessment Scale-Domains and Stages: Measurement capacity, relevance, acceptability and feasibility of use with young people.

The Recovery Assessment Scale-Domains and Stages (RAS-DS) is a self-rated measure of mental health recovery. While this instrument has demonstrated good measurement properties and acceptability to clinicians and consumers in adult mental health services, it has not been evaluated in the context of youth-focused mental health services. This study was established to evaluate the measurement properties, feasibility and acceptability of the RAS-DS in a youth mental health service context. Young people accessing a youth mental health service were invited to complete the RAS-DS and both young people and clinicians provided feedback about its usefulness. Analyses of the measurement properties of the RAS-DS were completed using Rasch analysis. Usability feedback was analysed using descriptive statistics and constant comparative analysis. Fifty-eight consumer-clinician dyads participated. Analyses revealed that items on the RAS-DS generally demonstrated good fit with the expectations of the Rasch model and clinician and consumer feedback was generally positive. Ninety-one percent of young people completed the RAS-DS in less than 15 minutes. Thirty-four percent of young people had measure scores above the level of the "hardest" item on the RAS-DS, suggesting that measurement precision is lower for individuals at more advanced stages of recovery. This study demonstrates that the RAS-DS has acceptable measurement properties and was acceptable to young people and clinicians. Future research should explore the use of the RAS-DS by young people in other contexts as well as explore whether additional items could be added to capture the later stages of recovery for young people.

The impact of affective symptoms on personal recovery of patients with severe mental illness.

Clinical recovery is often defined as remission of symptoms. Personal recovery is described as growing beyond the catastrophic effects of mental illness, sometimes despite ongoing symptoms. To examine the relationship between the severity of clinical symptom domains and personal recovery in patients with severe mental illness (SMI). Symptom severity and personal recovery of 105 outpatients with SMI at Mentrum, part of Arkin Institute for Mental Health in Amsterdam, the Netherlands, were assessed using the Brief Psychiatric Rating Scale-Expanded Version (BPRS-E) and the Mental Health Recovery Measure (MHRM). Correlation and regression analyses were used to investigate the associations. The multiple regression analysis showed that only affective symptoms significantly predicted personal recovery, whereas neither positive nor negative symptom severity added to the explained variance in the model. The association between affective symptoms and personal recovery in patients with SMI implies that treatment of affective symptoms may advance personal recovery, and/or support of personal recovery may improve mood, whereas focussing on treatment of psychotic symptoms might not be the key to personal recovery. More research is needed to elucidate causal interrelations.

Psychometric evaluation of the hope, agency and opportunity (HAO); a brief measure of mental health recovery

Background: The development of safe and effective mental health services is a priority. This requires valid measures of personal recovery, yet these tools are not embedded in routine clinical practice. Brief “patient reported measures” are most likely to be acceptable to service-users and clinicians. The 4-item “Hope, Agency and Opportunity” (HAO) was co-produced to assess recovery outcomes and experience of mental health services.Aim: To evaluate the psychometric properties of the HAO.Method: A clinical sample from secondary healthcare services and a non-clinical sample were assessed at baseline and two weeks, on measures of personal recovery.Results: Factor analysis indicated goodness of fit for the HAO with both clinical and non-clinical samples. The measure demonstrated acceptable internal consistency, moderate to strong construct validity and substantial test-retest reliability over two weeks.Conclusions: The HAO demonstrates satisfactory psychometric properties. Co-production of the measure confers clinical credibility. The brevity of the tool means it can be incorporated into routine clinical practice to drive improvements in service quality.

Factor Structure and Sensitivity to Change of the Recovery Assessment Scale.

The focus on recovery, not just symptom reduction, in mental health care brings a need for psychometrically sound measures of recovery. This study examined the factor structure and sensitivity to change of a common measure of mental health recovery, the Recovery Assessment Scale (RAS). We conducted a secondary data analysis from a randomized clinical trial of self-management for depression (n=302). We tested both bifactor and the previously found five-factor model. Sensitivity to change was examined three ways: (1) between the intervention and control group; (2) across time in the intervention group; and (3) in those whose depression remitted. The previous five-factor model was supported. One subscale, no domination by symptoms, was particularly sensitive to change and showed sensitivity to change whereas the subscale reliance on others did not show change in any of the comparisons. Results suggest that the subscales of the RAS should be examined separately in future studies of recovery.

Measuring mental health in the clinical setting: what is important to service users? The Mini-Service user Recovery Evaluation scale (Mini-SeRvE)

Background: Since 2001, a policy of positive mental health recovery has been promoted in the UK, with service user involvement. This has not been easy to implement in the clinical setting.Aims: To develop and validate a brief self-report, service user-designed, outcome measure (Mini-SeRvE), for clinical use, including spiritual and religious issues.Methods: From the previously developed Service user Recovery Evaluation scale (SeRvE), 15 questions were selected for Mini-SeRvE which was self-completed by 207 people; 100 service users and, for comparison, 107 staff. Results were analysed using SPSS software (SPSS Inc., Chicago, IL).Results: Mini-SeRvE is reliable, Cronbach’s alpha 0.852. Correlation with another recovery scale, Mental Health Recovery Measure, was high, r = 0.819. Three reliable subscales emerged; existential well-being (EWB), mental ill-being (MIB) and religious well-being (RWB). Scores of the EWB and MIB subscales were higher for staff, consistent with higher mental well-being. Religious well-being scores were higher in service users, who also rated religion as more important to them.Conclusions: Mini-SeRvE is a valid measure of service user recovery. The importance of religion/spiritual belief for our users is highlighted, this being reflected in the subject matter of Mini-SeRvE. Mini-SeRvE assessments could show individual priorities, evaluate therapy and aid clinical decision-making.