Recovery Journey Research Articles

The supportive care needs of individuals recovering from first episode psychosis: A scoping review.

First episode psychosis (FEP) can be a traumatic experience that may alter an individual's ability to meet their own needs. The Supportive Care Needs Framework (SCNF) could complement the recovery-oriented, person-centred approach that is the current foundation of mental health care. To identify the supportive care needs (SCNs) of individuals recovering from a FEP. A scoping review of the literature was undertaken. Review questions were developed, and relevant studies were identified through database and hand searches of peer-reviewed journal articles. Data from selected articles were tabulated, and contextual meaning was given to the data through a process of collating, summarizing, and reporting. A total of 14 peer-reviewed journal articles met inclusion criteria. SCNs were identified at different stages of recovery, ranging from initial treatment to 7 years postdiagnosis. Emotional, informational, practical, psychological, and social needs were identified in over half of the included articles, while needs in the physical and spiritual domains were identified in less than five. Unmet needs in each of the seven domains of need of the SCNF were identified in this population. There are a number of gaps in the literature relating to the specific needs of this population and the timing for which individuals may require more supportive care in their recovery journey.

Mental health recovery, goal setting and working alliance in an Australian community-managed organisation.

This article examines the relationships between goal setting and achievement, working alliance and recovery in an Australian mental health community-managed organisation. The study gathered data over a 14-month period after the introduction of routine outcome measures. Both goal achievement and the strength of the working alliance were shown to have a positive effect on the personal recovery of the clients in the study. Both working alliance and goal achievement are robustly supportive at whatever point a person is on in the recovery journey. The brief goals card used is a useful adjunct to other tools.

WHO SHOULD BE THE CASE MANAGER FOR PERSONS WITH MENTAL ILLNESS? SOCIAL WORKER, NURSE OR OCCUPATIONAL THERAPIST?

Case manager for persons with mental illness is a skilled professional who works directly with clients and administers specialized care to them. The ultimate goal is to facilitate clients to re-integrate into the community during their recovery process. In Hong Kong, professionals usually employed as case manager in the community setting are social workers, psychiatric nurses and occupational therapists. In principle, every member of the recovery team could be the case manager. However, who is the best fit for this role? This article discusses which professional would best fill the role of case manager. The role of case manager and their relationship with clients are examined. The article explores the core values, roles, functions and work practice of three disciplines in caring for the mentally ill. The code of ethics, training and characteristic of approaches employed from each discipline are reviewed and discussed. In conclusion, social workers, nurses and occupational therapists share similarities in philosophy and theoretical foundations. Expertise from each discipline complements one another and contributes to the symphony in the recovery journey.

ARDEO: From Page to Stage

ARDEO: From Page to Stage Jacqueline E. Lawton (bio) In 2003, my mother, who had worked for many years as a nurse, was injured while working with a patient. Initially, she was told that the pain she felt was associated with arthritis. It wasn’t until she had an MRI that she understood the true extent of her injury. She had her first back surgery in 2008 and went back to work. She couldn’t afford not to work and continued to push through excruciating pain. It wasn’t until after her second surgery in 2010 that her body no longer allowed her to put in the long, strenuous hours of a nurse. As I watched her healthcare team attend to the needs of her body, I longed for them to address her psychological health: how this injury would shift who she is in the world. On the other hand, outside of asking her how she was adjusting and encouraging her through physical therapy, I myself didn’t know what more I could do to help her or patients like her adjust to life after dramatic physical change for her or for other patients like her. Sometimes, however, the stars align and a change of circumstances place you exactly where you need to be in order to accomplish something unexpected and extraordinary. In January of 2015, a couple of weeks after I started my new job as an assistant professor in the Department of Dramatic Art at the University of North Carolina at Chapel Hill, I attended a fascinating discussion about science and theatre. Hosted by the Science and Entertainment Exchange, a program of the National Academy of Science (NAS), JD Talasek, the director of cultural programs at NAS, gathered Washington, D.C.–area theatre artists, administrators, and scholars to gauge their interest in producing and writing plays about science. After a roundtable of introductions, choreographer, performer, and educator Liz Lerman spoke about her recent project, The Matter of Origins. Key points from her talk that resonated with me were: • Both theatre and science exist in a space of inquiry. Artists and scientists seek knowledge and understanding about the world through their work. • Artists can help scientists communicate thoughts, discoveries, and challenges to a wider public community in compelling and creative ways. • Scientists can help artists see the power and impact of the research and discovery. • Also, scientific research structures can help artists understand the importance, even the necessity of failure in the development of a new work. This meeting was invigorating and deeply informative. It inspired research for a new play that I was beginning to write called Among These Wild Things, which explores intersections between human rights and genetics. It also reignited an interest in narrative medicine that began as I watched my mother recover from her multiple surgeries. I felt called to focus on a play that would put narrative medicine at the center of its explorations. When I returned to Chapel Hill, I shared this idea with Adam Versenyi (chair of the Department of Dramatic Art) and he introduced me to Bruce Cairns, the director of the North Carolina Jaycee Burn Center. Together, Dr. Cairns and I began to think of ways to collaborate. Our opportunity came in April 2015 when I applied for and was awarded a Kenan Creative Collaboratory grant to [End Page E-1] research, write, and develop ARDEO, a one-act play inspired by personal narratives of healthcare practitioners and patients at the Jaycee Burn Center. With the support of Jules Odendahl-James, who served as our dramaturg and research consultant, and Nicole Damari, a UNC–Chapel Hill medical student who helped me craft research questions and took and transcribed copious notes, I got to work. In February, I spoke with former patients and healthcare practitioners. I spent the first two weeks of March researching the history of the Jaycee Burn Center, the educational backgrounds and career paths of various healthcare professionals involved in catastrophic medical care, and the varied recovery journeys of burn victims. From the end of March and all of April I wrote the play. In May, we had a weeklong new-play development workshop and rehearsal. With...

"It Had Only Been a Matter of Time Before I Had Relapsed Into Crime": Aspects of Care and Personal Recovery in Forensic Mental Health.

Forensic psychiatry has the dual task of focusing on the prevention of reoffending as well as maintaining psychiatric rehabilitation. No previous studies addressing the patients' own views on reducing their risk of serious reoffending were found. This study describes forensic psychiatric inpatients' own views on what aspects of care and personal recovery are important in reducing their risk of serious reoffending. A structured qualitative approach was used. Data were collected from semistructured interviews and analyzed with a systematic qualitative content analysis. The results highlight aspects of care and personal recovery. Four themes emerged: "time: opportunity for change," "trust: creating a context with meaningful relations," "hope: to reach a future goal," and "toolbox: tools needed for recovery." The themes present with a continuum. At one end, there are patients who appreciated possibilities to participate actively in care and treatment. At the other end, patients felt they had no use for their care. Interestingly, although patients in our study were asked for their opinion on how they could reduce their dangerousness, all themes fit into established personal recovery processes found in general psychiatric populations. The theme "time: opportunity for change" seems to have an overarching importance. By understanding the specific content along these themes, relevant to the individual patient, carers may be able to better support their personal recovery journey. Because time spent as inpatients in forensic psychiatry is an overarching issue, carers need to be persistent over time.

Impact evaluation of an Independent Mental Health Advocacy (IMHA) service in a high secure hospital: a co-produced survey measuring self-reported changes to patient self-determination

PurposeThe purpose of this paper is to measure any impact that IMHA support had on patient’s self-determination.Design/methodology/approachThe study used a questionnaire design, co-produced with patients to ensure question relevance, accessibility and ease of use. The theoretical framework used by the study was Deci & Ryan’s empirically validated self-determination theory (SDT) as it is predictive, across cultures and domains (including healthcare), of psychological well-being and self-determined action following the satisfaction of three fundamental human needs for autonomy, competence and relatedness.FindingsFollowing advocacy support, increased self-determination, was found in 70 percent of the patients surveyed. In this study, increased self-determination was inferred by patients’ subjective responses to survey questions which measured satisfaction with contextual aspects of autonomy, competence and relatedness. The extensive SDT research has identified that the satisfaction of these needs is essential for psychological well-being and a prerequisite for self-determined and motivated action. Research has also linked psychological needs fulfilment to the personal recovery journey for those diagnosed with a mental illness.Originality/valueAlthough limited, qualitative research evidence has identified that IMHA support helps to empower their partners (referred to in the text as patients or patient partners) to be more self-determined. This is an important finding, particularly for those patient partners detained under the Mental Health Act, given the often disempowering and autonomy reducing nature of mental illness and the characteristics of detained environments. However, a gap in the literature exists for quantitative outcome data identifying the specific impact that IMHA support has for patients. Obtaining measurable outcome data which seek to understand how and why Independent Mental Health Advocacy support impacts its patient partners is essential for developing and validating outcome measures that can lead to best practice improvements in IMHA service delivery. Furthermore, this knowledge is pivotal in optimizing IMHA services’ potential for empowering patients and providing commissioners with the much-needed evidence for effective commissioning of such services.

ASAP-ID: substance abuse programme for a forensic ID population

Purpose There are a lack of recourses for substance abuse (SA) treatment for forensic clients with intellectual disabilities (ID). Many complexities arise when treating this population, calling for the creation of comprehensive resources which not only address the SA, but also account for the risk and offending issues. The purpose of this paper is to detail a pilot programme which aims to provide treatment for forensic ID clients with substance abuse issues as well as a significant risk of reoffending. Design/methodology/approach Six participants completed a 27-week SA treatment programme (the Alcohol and Substance Abuse Programme-Intellectual Disability) which incorporated the use of dialectical behavioural therapy (DBT) and the Good Lives Model concepts. Pre- and post-measures aimed to assess readiness for change and confidence in ability to stay clean and sober. Findings Preliminary findings showed a marked improvement in confidence of the participants’ ability to stay clean and sober in risk-related situations as well as an increase in overall readiness for change. Originality/value This research paper addresses a gap in the current forensic ID research and clinical treatment options pertaining to SA, by focussing on supporting forensic ID clients in their recovery journey from SA. Being at the forefront of SA treatment for forensic ID, further research in this domain should attempt to consolidate the findings of this programme.

Inclusive adapted sport and adventure training programme in the PTSD recovery of military personnel: A creative non-fiction

ObjectivesThe purpose of this paper was to use a storytelling approach to explore the role of a 5-day inclusive residential adapted sport and adventurous training (AS & AAT) programme in the recovery of military personnel diagnosed with PTSD. Design: Narrative storytelling approach. MethodA first-person story was developed from the participant's own words taken verbatim from an in-depth semi-structured interview. A series of focus groups were conducted with members of the general public (n = 20) to reflect upon the story. ResultsThe story provides a rich and holistic account of the participant's experiences and unique insight to the complex interaction between the social and psychological factors associated with illness and recovery. The story also highlights the value attributed to the AS & AAT in an individual's recovery journey. ConclusionsThis paper offers important insights into the personal meaning and value of participation in a bespoke 5-day AS & AAT programme. Feedback from the participant and focus groups with members of the general public who engaged with the story suggest judgement criteria appropriate for a creative non-fiction representation were achieved.

Special Issue: Relational Trauma and Family Therapy

Special Issue: Relational Trauma and Family Therapy

Recovery in Psychosis from a Service User Perspective: A Systematic Review and Thematic Synthesis of Current Qualitative Evidence.

There is a growing number of qualitative accounts regarding recovery from psychosis from a service user perspective. The aim of this study was to conduct a systematic review of these qualitative accounts. A thematic synthesis was utilised to synthesise and analyse seventeen studies included in the review. Studies were included if they used a qualitative methodology to explore service users' experiences of recovery from psychosis as a primary research question. All included studies were subjected to a quality assessment. The analysis outlined three subordinate themes: the recovery journey, facilitators of recovery (e.g. faith and spirituality, personal agency and hope), and barriers to recovery (e.g. stigma and discrimination, negative effects of mental health services and medication). Recovery is an idiosyncratic process but includes key components which are important to people who experience psychosis. These should be explored within clinical practice.

Understanding everyday life and mental health recovery through CHIME

PurposeThe purpose of this paper is to understand how daily life reflects the recovery journeys of individuals with serious mental illness (SMI) living independently in the community.Design/methodology/approachThe go-along technique, which blends participant observation and interviewing, was used to gather data from 19 individuals with SMI living in supported housing. Data were analyzed through the CHIME framework of personal recovery, which includes social connectedness, hope and optimism, identity, meaning in life, and empowerment.FindingsApplying the CHIME framework to qualitative data reveals the multiple ways in which everyday experiences, within and beyond formal mental healthcare environments, shapes personal recovery processes.Research limitations/implicationsCombining novel methods and conceptual frameworks to lived experiences sharpens extant knowledge of the active and non-linear aspects to personal recovery. The role of the researcher must be critically considered when using go-along methods.Practical implicationsPractitioners working with this population should account for the role of socially supportive and financially accessible spaces and activities that support the daily work of recovery beyond the context of formal care and services.Originality/valueThis study utilizes an innovative method to illustrate the crucial role of daily and seemingly banal experiences in fostering or hindering personal recovery processes. It is also the one of the first studies to comprehensively apply the CHIME framework to qualitative data in order to understand the recovery journeys of individuals with SMI living in supported housing.

Music Connects

Psychiatric rehabilitation aims to promote health recovery from significant losses, both physical and psychological, that have derailed the lives of adults and young adults so that they can actively participate in rebuilding and recreating themselves. The population faces premature morbidity and experiences higher than average rates of chronic and life-threatening diseases, including diabetes, obesity, metabolic syndrome, cardiovascular disease, and pulmonary diseases. When participants join any of the Center for Psychiatric Rehabilitation programs, they take on the role of student, increasing their knowledge, skills, and supports to further their personal goals and recovery journeys. Most of the mind-body, rehabilitation interventions I design and teach utilize music to boost mood and motivation, facilitate social connection, increase concentration, improve memory, create new memories, deepen respiration, promote movement, and elicit the relaxation response. In addition, I use seated and walking meditation (often combined with nature sounds, music, chanting, and/or singing) to cultivate attention, curiosity, awareness, acceptance, an expanded perspective, accurate perceptions, compassion, and optimism. The poem Music Connects was inspired primarily by my 13-week intervention entitled Developing Spirituality for Stress Resilience that I recently taught spring semester 2017. I have been teaching and developing this course since 2007. The 17 participants were adults and young adults diagnosed with one or more of the following: trauma- and stressor related disorders, schizophrenia, anxiety, depression, bipolar disorder, autism spectrum disorder, attention deficit/ hyperactivity disorder, and/or obsessive-compulsive disorder. Each class of Developing Spirituality for Stress Resilience encouraged its participants in class to engage in a variety of music-related activities to inspire hope, feel part of a community, and let their spirits soar by together listening to music, reading aloud song lyrics, reflecting upon and discussing the lyrics’ relevance to their lives, and singing. Music Connects was written during the second week of the semester when there was quite a bit of resistance from four participants to singing aloud. After writing the poem, I shared it with everyone the following week. The results are found in the poem.

Taking a coproduction approach to integrating recovery orientated care in Irish Mental Health Services

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Sexual violence, masculinity, and the journey of recovery.

Sexual violence, masculinity, and the journey of recovery.

Recovery-focussed care: How it can be utilized to reduce aggression in the acute mental health setting.

Consumer aggression is common in the acute mental health inpatient setting. Mental health nurses can utilize a range of interventions to prevent aggression or reduce its impact on the person and others who have witnessed the event. Incorporating recovery-focussed care into clinical practice is one intervention, as it fosters collaborative partnerships with consumers. It promotes their engagement in decisions about their care and encourages self-management of their presenting behaviours. It also allows the consumer to engage in their personal recovery as their mental health improve. Yet there is a paucity of literature on how nurses can utilize recovery-focussed care with consumers who are hospitalized and in the acute phase of their illness. In the present study, we report the findings of a scoping review of the literature to identify how recovery-focussed care can be utilized by nurses to reduce the risk of consumer aggression. Thirty-five papers met the inclusion criteria for review. Four components were identified as central to the use of recovery-focussed care with consumers at risk of becoming aggressive: (i) seeing the person and not just their presenting behaviour; (ii) interact, don't react; (iii) coproduction to achieve identified goals; and (iv) equipping the consumer as an active manager of their recovery. The components equip nurses with strategies to decrease the risk of aggression, while encouraging consumers to self-manage their challenging behaviours and embark on their personal recovery journey. Further research is required to evaluate the translation of these components clinically in the acute care setting.

Place and recovery from alcohol dependence: A journey through photovoice

It has been suggested that place, and interaction with the environment, may play a role in recovery from alcohol dependence. In this paper we report findings from a project that used an adapted photovoice methodology to better understand individuals’ experience and perceptions of the role of place in recovery from alcohol dependence. Individuals attending a recovery café in central Scotland documented their environment and, in focus group settings, the individuals discussed and analysed their photographs. Here we report aspects of the environment, both therapeutic and risky, experienced by individuals negotiating the journey of dependence recovery. Elements of the natural environment were largely referred to as supportive and therapeutic, as were other more quotidian spaces, such as the home and café. The largest place-based risk faced by participants was the persistent availability and marketing of alcohol. The results demonstrate that the journey of recovery from alcohol dependence is contextually shaped, with place both supporting and hindering this journey.

“From the Edge of the Abyss to the Foot of the Rainbow – Narrating a Journey of Mental Health Recovery” The Process of a Wounded Researcher

In the UK, mental health service users are asked to “tell their stories” within clinical settings as a tool for diagnosis, formulation and treatment plans. Retelling, reliving and reflecting on traumatic and distressing experiences is not a benign activity. Yet the process of reframing lived experience within a personal narrative could support the development of: a more positive identity; self-management skills and improved social connections (Slade, 2009) and therefore contribute to mental health recovery. This is an exploration of my process as a wounded researcher in the development of a version of my narrative as an autoethnography. I developed a series of 54 vignettes that described memories of my lived experience. To start, I used memorable quotes - the voices of others within my narrative. Developing and analyzing my autoethnography was visceral. It highlighted aspects of my process (and the likely process of others) and raised many unresolved dilemmas. For example: what was left out or left unsaid and the issue of “narrative truth” (Craib, 2004); reordering the vignettes for coherence; the role of relational ethics; and the impact on my identity of this difficult on-going process. It impacted on my mental health, but it has been a crucial part of my recovery.

Challenges experienced during rehabilitation after traumatic multiple rib fractures: a qualitative study

Background: People with multiple rib fractures rarely receive rehabilitation aimed specifically at their chest wall injuries. This research explores patient perceptions of rehabilitation and recovery.Materials and methods: A qualitative study exploring how a purposive sample of 15 people with traumatic multiple rib fractures at a Major Trauma Centre in the United Kingdom make sense of their recovery. Data collected during one-to-one interviews 4 to 9 months after injury. Transcripts analysed using Interpretative Phenomenological Analysis.Results: Struggling with breathing and pain: Difficulties with breathing and pain were initially so severe ?it takes your breath away? and people felt scared they may not survive. These symptoms gradually improved but feeling “out of puff” often persisted.Life on hold: Healing was considered a natural process which people couldn't influence, creating frustration whilst waiting for injuries to heal. Many believed they would never fully recover and accepted limitations.Lucky to be alive: All participants expressed a sense of feeling lucky to be alive. The seriousness of injury prompted a change in attitude to make the most of life.Conclusion: Rib fractures can be painful, but also frightening. A rehabilitation intervention promoting pain management, normalises trauma and restores physical activity may improve recovery.Implications for RehabilitationPatients identified challenges with rehabilitation throughout the entire recovery journey, and their rehabilitation needs evolved with time.People find it difficult to regain pre-injury fitness even after their fractures heal and pain subsides.A belief there is nothing that can be done to help rib fractures contributed to people lowering their expectations of achieving a full recovery and developing a sense of “making do”.Rehabilitation and patient education after traumatic multiple rib fractures should focus on improving pain management, respiratory fitness and emotional well-being.

Recovery From Substance Abuse Among Zimbabwean Men: An Occupational Transition.

Substance abuse is a rising global problem, associated with medical, psychiatric, family, occupational, legal, political, financial, and spiritual problems. Recovery is an important area of consideration in occupational therapy's quest to promoting health and well-being. This narrative inquiry explored the journey of recovery from substance abuse among young adult Zimbabwean men. Three men were purposively selected to participate in in-depth narrative interviews about their occupations during recovery. Data were analyzed using a narrative analysis. Explanatory stories and three superordinate themes illustrated how substance abuse was associated with both positive and negative outcomes. The recovery process emerged as an ongoing occupational transition, influenced by occupational identity and involving changes in occupational participation. Recovery from substance abuse can be conceptualized as an occupational transition. Ongoing participation in "healthy" and meaningful occupations is key factor in this process. Construction of a positive occupational identity is also central.

Processes of recovery through routine or specialist treatment for borderline personality disorder (BPD): a qualitative study

Background: Recovery processes in borderline personality disorder (BPD) are poorly understood.Aims: This study explored how recovery in BPD occurs through routine or specialist treatment, as perceived by service users (SUs) and therapists.Methods: SUs were recruited from two specialist BPD services, three community mental health teams, and one psychological therapies service. Semi-structured interviews were conducted with 48 SUs and 15 therapists. The “framework” approach was used to analyse the data.Results: The findings were organized into two domains of themes. The first domain described three parallel processes that constituted SUs’ recovery journey: fighting ambivalence and committing to taking action; moving from shame to self-acceptance and compassion; and moving from distrust and defensiveness to opening up to others. The second domain described four therapeutic challenges that needed to be addressed to support this journey: balancing self-exploration and finding solutions; balancing structure and flexibility; confronting interpersonal difficulties and practicing new ways of relating; and balancing support and independence.Conclusions: Therapies facilitating the identified processes may promote recovery. The recovery processes and therapeutic challenges identified in this study could provide a framework to guide future research.