Service User Recovery Research Articles

‘Two sides of the one coin’: using reflection to examine co-production of human rights education within higher institutions in Ireland

ABSTRACT Encompassing human rights-based approaches within mental health service delivery is essential to supporting the recovery of service users, their family members/carers/supporters. This is being increasingly led by social workers due to their role in responding to psychosocial challenges. This is seen in today’s mental health services through their work in safeguarding service users and addressing familial concerns regarding all aspects of life. It is also evidenced in their openness to the concept of personal recovery—a movement aimed at defending and improving human rights for service users and their family members/carers/supporters through the recognition of international legislation. Recent debates within social work education have explored whether our critical and radical roots are declining or absent in practice. One argument for this has been the increasing pressures coming from neoliberal policies. This paper describes how both authors approached several co-produced sessions with social work students at an Irish university regarding mental health recovery and social work. The authors provide insight into this approach, including a description and exploration of a model of reflexivity used during this process which can be used by other educators, students, and practitioners [CS is an Assistant Professor of Social Work,MJN is a Consumer Academic].

Turkish Validity and Reliability of The Mini Service User Recovery Evaluation Scale

Objective: The aim of this research is to adapt the MiniService User Recovery Evaluation (MiniSeRvE) Scale to Turkish culture and establish its psychometric properties. Materials and Methods: This methodological study included 150 patients who applied to psychiatry outpatient clinics between March 2020 and January 2021. "The Personal Information Form," "The MiniService User Recovery Evaluation (MiniSeRvE) Scale," "The Subjective Recovery Assessment Scale," and "The Spiritual Well-Being Scale" were used to collect the data. Results: The CFA of the MiniSeRvE Scale determined that the three sub-dimensions and factor loadings were between 0.50 and 0.91, consistent with the original scale. The Cronbach's alpha coefficient was found to be 0.864 for the total scale and between 0.77 and 0.95 for the sub-dimensions. Conclusions: The MiniSeRvE Scale is a valid and reliable measurement tool.

Recovery-oriented care in long-term mental health settings: Relationship between the active recovery triad (ART) model, recovery-oriented care, and recovery of service users.

The active recovery triad (ART) model provides guidelines for recovery-oriented care in long-term mental health care. The aim of this study is to evaluate whether compliance to the principles of the ART model is related to recovery-oriented care, service user recovery and satisfaction. A prospective study was conducted including two measurements, in which we investigated compliance to the principles of the ART model (ART fidelity), recovery-oriented care as measured by the Recovery-Oriented Practices Index-Revised (ROPI-R) at team level (n = 18) and outcome measures on service user level (n = 101) related to personal recovery, social roles, level of functioning, clinical recovery, transition, and satisfaction. We used multilevel modeling to evaluate these relationships. There was a significant association between active recovery triad (ART) fidelity and the ROPI-R. We did not find a significant association between overall ART fidelity and service user outcomes. Yet, we did find that higher ART fidelity in the domains "cooperation in the triad," "professionalization of staff," and "team structure" were related to improved clinical recovery, functioning, social roles, and performance of activities. However, higher ART fidelity in the domain "healing environment" was related to poorer functioning, and a higher score in the domain "safety and prevention of coercion" was related to poorer social roles and performance of activities. We can conclude that compliance to the principles of the ART model is related to recovery-oriented care, measured with the ROPI-R. In addition, the findings suggest that in particular elements in the ART model are related to meaningful recovery outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Changing the Game? Increasing the Impact of Peer-Run Organizations.

Employment and deployment of peer support specialists in both clinical and non-clinical mental health settings has increased substantially since the 1990's. Peer-run organizations are defined as those led and managed by individuals with self-disclosed lived experience of mental health conditions. Many peer-run organizations promoting advocacy and offering services have been established during the past 30 years. Some adherents assert the effectiveness of peer-run organizations over hybrid mental health service providers in which peer support workers are integrated or partnered with existing community mental health agency multidisciplinary clinical and treatment teams. Although research has indicated the positive contributions of peer-run organizations to service user recovery, the impact of peer-run organizations on system transformation is not well documented. This concept paper explores benefits, accomplishments, and challenges faced by a peer-run organization during its 30-year evolution in offering self-help groups, supported housing, peer support services, peer specialist training, and systems change projects in Los Angeles County, California. Future research topics and policy options are suggested, along with recommendations for the SAMHSA Office of Recovery.

Experiences of Mental Health Carers Examined Using a Recovery Framework

ABSTRACT Carers are a crucial support in the recovery of people with mental illness in the community. As they are often severely affected by the impact of mental illness of the person they care for, carers need to recover from the impact alongside the care recipient. While mental health services focus on the recovery of people with mental illness, carers’ recovery is largely neglected. Using the CHIME (Connectedness, Hope and optimism about the future, Identity, Meaning in life and Empowerment) recovery framework, the authors of this study aimed to examine carers’ experiences and what they needed in their own recovery. A mixed methods approach was used to analyse the responses of 1,918 carers who completed the Australian 2020 National Carer Survey. Thematic analysis was used to identify themes regarding carers’ experiences against the elements of CHIME. Quantitative findings regarding subjective wellbeing and perception of support were used to complement the themes. Themes aligned with CHIME but indicated poor recovery. Recognition (R) was found to be an important recovery factor for carers. Without adequately addressing the needs and wellbeing of carers and giving due recognition for their contribution, carers have difficulty progressing in their own recovery. CHIME-R may be appropriate as a recovery framework for carers. IMPLICATIONS Caregiving needs and recovery of Australian mental health carers are largely neglected by mental health services and government departments. Recognition of carers should be taken into consideration as an important factor in carers’ recovery. Mental health and social services need to critically consider how they can promote family recovery, rather than focusing on the personal recovery of service users only.

Understanding organisational and nursing behaviour changes associated with a therapeutic engagement improvement tool in acute mental health inpatient settings: A qualitative analysis

BackgroundEnhancing the quality of therapeutic engagement between nurse and service user is related to positive impact on care, safety, and recovery outcomes. Achieving improved therapeutic engagement remains challenging in the acute mental health inpatient setting, characterised by complex social processes and contextual features that constrain behaviour change. The Therapeutic Engagement Questionnaire is an evidence-based tool co-produced with service users and nurses to improve therapeutic engagement. ObjectivesThe objectives of this quality improvement project were to identify the organisational and nursing behaviour changes associated with the Therapeutic Engagement Questionnaire and to understand the active behaviour change ingredients of the improvement tool and how they exert their influence. DesignA qualitative multi-site case study design in which data were collected from study site field notes and document review. SettingFour acute mental health inpatient case study sites in England. MethodsData referencing Therapeutic Engagement Questionnaire-linked behaviour change in project meeting field notes and documents from each study site were analysed using an inductive and deductive approach with thematic analysis. The Capability Opportunity Motivation-Behaviour model was employed as a theoretical framework. FindingsThe therapeutic engagement tool had the capacity to prompt behaviour change across all three components of the behaviour change model: Capability – through nurses sharing good therapeutic engagement practice and use of statements in the questionnaire to build nurses’ knowledge and skills; Opportunity – through organisational barriers being addressed and ward-level practice and culture changes; Motivation – through nurses’ awareness of their influence on service user recovery, nurses’ alertness to their therapeutic work, and connections between the therapeutic engagement tool and nursing core values. However, the tool did not accord with the values of some nurses, reported to be unmotivated by the recognition it gave their profession for contribution to service user recovery. In sites evidencing more prominent behaviour change, senior leader and ward-level agents of change played a valuable facilitative role. ConclusionThe therapeutic engagement tool had the potential to prompt behaviour changes at organisation and ward level and to the ways individual nurses therapeutically engage with service users, helping strengthen therapeutic engagement practice. Leadership at senior organisational and ward level was important to address contextual barriers to change. The project resulted in a conceptual framework to explain and understand the behaviour change techniques and functions linked to the therapeutic engagement tool. Longevity of the behaviour changes and their impact on service user quality of care requires future evaluation. Tweetable abstractA therapeutic engagement tool can prompt organisational and nursing behaviour change in acute mental health inpatient settings.

Supplemental Material for Recovery-Oriented Care in Long-Term Mental Health Settings: Relationship Between the Active Recovery Triad (ART) Model, Recovery-Oriented Care, and Recovery of Service Users

Supplemental Material for Recovery-Oriented Care in Long-Term Mental Health Settings: Relationship Between the Active Recovery Triad (ART) Model, Recovery-Oriented Care, and Recovery of Service Users

Psychometric validation of the 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP).

Reliable and valid instruments are needed to measure the impact of mental health services and programs on the journeys of recovery of service users. The aim of this study was to explore the psychometric properties of the cross-culturally adapted 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP). One hundred and ten participants from three locations in Spain (Málaga, Barcelona and Madrid), who were users of primary and specialized mental health services, were interviewed from October 2021 to June 2022. The internal consistency obtained was excellent: ω =.93 and α =.92. Temporal reliability using intraclass correlation coefficients was moderate (ICC=.684, p <.000). Regarding convergent validity, the QPR-15-SP had a moderate correlation with the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) (ρ =-.500, p <.000), a Visual Numeric Recovery Scale (VNRS) (ρ =.591, p <.000), and the Stages of Recovery Instrument (STORI) (r =.566, p <.000). Correlations between advanced stages of recovery and higher QPR-15-SP scores were found (Moratorium: ρ =-.579, p <.000; Awareness: ρ =-.130, p =.189; Preparation: r =-.043, P=.665; Rebuilding: r =.460, p <.000; Growth: ρ =.697, p <.000). In terms of divergent validity, the QPR-15-SP had low correlation with the DUKE-UNC Functional Social Support Scale (ρ =.273, p <.005). The confirmatory factor analysis of the 1-factor structure obtained reasonable goodness of fit indexes. The QPR-15-SP has acceptable psychometric properties, providing support for measuring recovery in Spain and allowing international comparison research.

Crisis plans in mental health: A scoping review.

Crisis situations are frequent among people with mental health disorders. Several interventions have been developed to act in prevention, including crisis plans recognized as particularly effective in reducing coercive measures. In the literature, several models of crisis plans are proposed with similar aims and contents. Based on the methodology proposed by the Joanna Briggs Institute, a scoping review was conducted to map the state of knowledge on crisis plans in adult mental health settings. The literature search conducted on six databases (CINAHL, PubMed, Medline, EMBASE, PsychINFO and Cochrane) yielded 2435 articles. Of these, 122 full-text articles were assessed for eligibility, and 78 met the inclusion criteria. Studies were critically appraised using the Joanna Briggs Institute appraisal tools, and data were extracted by two independent reviewers. Content analysis identified a typology of crisis plans: (1) the legal crisis plan and (2) the formal crisis plan. Five modalities were identified for its completion: the sections, the moment, the completion steps, the people involved and the training of key actors. Most identified outcomes are consistent with the main purpose of the intervention, which is crisis prevention. However, the most identified outcomes focused on the service user's recovery and indicated that crisis plans could provide an opportunity to operationalize recovery in mental healthcare, thus suggesting an evolution in the aim of the intervention. Future research should further focus on the modalities of crisis plans to guide the implementation in clinical practice.

Experiences of family caregivers in forensic mental health care-A qualitative evidence synthesis.

Internationally, research and policy agendas recommend that family caregivers of service users in mental health care be involved in care and treatment, to support the service user's recovery process. Family caregivers of service users in mental health care are often highly burdened. There is a lack of research-based knowledge about the experiences of family caregivers of service users in forensic mental health care (FMHC) and their involvement in care and treatment. This study indicates a persistent caregiver presence and/or caregiver advocacy in regard to care and treatment of the service user in FMHC. This study indicates that health care professionals (HCPs) might play a role in eliciting a persistent caregiver presence and/or caregiver advocacy. HCPs need to develop their collaborative skills and be more willing to listen to and understand caregivers' persistent presence and/or advocacy. HCPs need to be more skilled to understand caregivers' and families' living with the complexities of mental illness and offence. HCPs are encouraged to adjust the involvement of family caregivers in care and treatment to FMHC. Introduction There is a lack of research about experiences of family caregivers of service users in forensic mental health care (FMHC) and their involvement in care and treatment. Research shows that caregivers are burdened. Further knowledge is required, to provide a foundation for improving clinical practice. Aim To review research literature, to investigate existing knowledge about caregiver experiences and, secondly, caregivers' experiences of facilitators and barriers related to their involvement in care and treatment. Method Qualitative evidence synthesis undertaken in a thematic synthesis of thirteen peer-reviewed studies. Results The analysis identified three descriptive themes: violence against family; a great burden of responsibility; and difficult collaboration, together with an additional three analytical themes: bearing witness; persistent presence; and advocacy becomes necessary. Discussion Persistent caregiver presence and/or caregiver advocacy may be elicited by health care professionals' (HCPs') exclusion of caregivers from care and treatment. Caregivers' feelings of guilt in relation to the service user's offence may play an additional role in persistent presence and advocacy and, therefore, in HCPs' exclusion of them. Implications for Practice HCPs need to develop their collaboration with caregivers by their willingness to listen to caregivers to understand emotional complexities within families experiencing mental illness and offence.

Music therapy and social recovery in flexible assertive community treatment

ABSTRACT Introduction While recovery has been highlighted as a prime aspect in the flexible assertive community treatment (FACT) model, research on the application of this model in Norway suggests that there is still a potential for providing service users with better participation in the local society. Music therapy has been highlighted as a form of intersubjective activity that is relational and can promote empowerment and personal recovery. The social aspect of recovery has been highlighted in recent years, and this article explores how music therapy, offered through FACT, may support social recovery for service users. Method The research design was that of a qualitative interview study. Six semi-structured, joint interviews were conducted with FACT service users and their music therapist. Results Using reflexive thematic analysis, the main theme music therapy as social recovery was generated, with four relating sub-themes: musicking as activity, musicking as social handcraft, musicking as togetherness, and musicking as network. Discussion Using the framework of social recovery, this article discusses the potential of music therapy within FACT as a collaborative activity that can provide recovery capital – including social and musical capital – and potentially contribute to social recovery.

Therapeutic Landscapes and Psychiatric Care Facilities: A Qualitative Meta-Analysis.

The environment in healthcare facilities can influence health and recovery of service users and furthermore contribute to healthy workplaces for staff. The concept of therapeutic landscapes seems to be a promising approach in this context. The aim of this qualitative meta-analysis is to review the effects of therapeutic landscapes for different stakeholders in psychiatric care facilities. A systematic literature search was conducted in the four data bases PubMed, PsycInfo, CINAHL, and Web of Science. Thirteen predominately qualitative studies were included in this qualitative meta-analysis. The methodological quality of these qualitative studies was assessed, using an adapted version of the Journal Article Reporting Standards for Qualitative Research, and a thematic analysis was conducted. The results were categorised into the three main themes of the physical (built and natural), social, and symbolic dimensions of the therapeutic landscape. Given the heterogeneity of the summarised data and an overall methodological quality of the included studies that can be rated as medium, the results should be interpreted with caution. Current findings are based almost exclusively on qualitative studies. Therefore, there is a need for quantitative study designs that investigate the relationship between specific environmental elements and mental health outcomes for different stakeholders in psychiatric facilities.

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).

The Therapeutic Engagement Questionnaire (TEQ): a service user-focused mental health nursing outcome metric

BackgroundTherapeutic engagement (TE) has been described as the crux of mental health nursing but despite its perceived importance, to date, there is no measurement tool that captures it. As a result, there is no way of determining the contribution of mental health nursing interaction to service user recovery, in acute inpatient mental health settings or the wider care quality agenda.MethodsTo develop and validate a TE measurement tool in partnership with Service Users (SUs) and Registered Mental Health Nurses (RMHNs). The TEQ was developed in 3 stages: 1) item generation (and pre-testing), 2) item reduction using Principal Component Analysis (PCA), and 3) validation across Mental Health Trusts in England.ResultsThe final questionnaire has two versions, (SU and RMHN version), each scored within two contexts (1–1 SU-RMHN interactions and overall environment and atmosphere of the ward) and includes 20 items with two sub-scales (care interactions and care delivery). Psychometric evaluation of the TEQ shows high inter-scale correlations (0.66–0.95 SU; 0.57–0.90 RMHN), sound sub-scale internal consistency (> 0.95), concurrent validity (> 0.60) and adequate score variability for both versions of the TEQ. In summary, the TEQ behaves well as a measurement tool.ConclusionsThe TEQ can determine the collaborative and empathic nature of RMHN-SU interactions, capture if SUs are treated with dignity and respect and recognise that the principles of the recovery approach are being respected. The TEQ can also provide robust monitoring of nursing activity, offer opportunity for transparency of activity, feed into healthcare organizations’ key performance indicators and provide reassurance about the nature and quality of nurses’ work.

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)

Enhancing the therapeutic interaction skills of staff working in acute adult inpatient psychiatric wards: Outcomes of a brief intervention education programme

Background and objective: Clinical practice in acute inpatient environments is complex and demanding for clinical staff. To facilitate service user recovery, it is essential that personnel working in these environments are competent and confident in a range of therapeutic interaction skills, which can have impact in a brief period. This paper describes an exploratory study which determined the outcomes of a brief therapeutic engagement education and training short course for staff working in adult inpatient acute wards. As far as we know this was the first time, based on evidence from earlier research involving service users that Heron’s Six Category Intervention Analysis and solution focused brief therapy (SFBT) have been combined in an education and training short course that was coproduced and delivered in partnership with service users for staff working in acute environments.Methods: The short course explored the myriad applications of the six categories of intervention initially proposed by Heron and the widespread applicability of SFBT. The programme evaluation adopted focus group methodology and examined: (1) how useful the training content was to daily practice and how relevant the skills learn were to interactions with service user residing on the ward; (2) the factors than helped enable the transference of the learning to the ward environment as well as any barriers; (3) personal learning; and (4) strengths of the learning experience and suggestions for improvement to the training and learning experience.Results: Feedback from participants reflected a high degree of skill and knowledge acquisition and enhancement. Staff found the content of the training useful and helpful to their daily practice as it aided in increasing confidence, therapeutic interventions and care-planning. Skills learnt by the trainees were considered relevant to interactions with service users residing on the ward. Factors that helped to enable encounters with service users, as well as the barriers, when transferring the learning to the ward environment were discussed and included managerial support, demand for beds, time, opportunity and staffing shortages. Regarding personal learning, staff reported feeling more able to connect with service users when employing SFBT techniques and Heron’s intervention approaches and felt that the training validated their current working practice.Conclusions: The SFBT training appears to have provided an interactional communication toolkit for healthcare professionals and could be further embraced given the right circumstances e.g. managerial support and attitude change of nursing staff in general. Further research is needed to gain an understanding of the effect of short and concentrated education and training programmes aimed at staff members working within adult acute inpatient mental healthcare settings, as well as measuring whether the activity, i.e. healthcare professional–service user interactions, is meaningful to service user outcomes.

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.

The implementation of the Care Programme Approach for service users with a learning disability. Building Bridges to the same Old Horizons?

Introduction The Care Programme Approach was introduced in England to ensure services met the needs of people with mental health problems and a concurrent learning disability (dual diagnosis). The CPA implementation was patchy and services failed to work in partnership. Aim This study aimed to explore the factors shaping the recent implementation of the CPA for service users with a dual diagnosis. Method A single case study approach was undertaken. Data were collected through interview (n=26), documentary analysis (n=64), steering group observation (n=3) and the Partnership Assessment Tool (n=26). Data were analysed using the Framework Approach. Results The CPA was only effectively implemented for people who were deemed to present with a high level of risk. Discussion The problems associated with implementation in the 1990s continue more recently for those with a dual diagnosis. The CPA has become more aligned with risk management protocols than supporting individual service user's recovery. Implications for practice Service users should be involved in the implementation of policies which have an impact on their recovery. The CPA should only be applied for those who present with high-risk issues, whilst alternative user-led initiatives should be considered for other service users.

Community-based psychosocial rehabilitation for schizophrenia service users in the north west province of South Africa: A formative study

ABSTRACTPsychosocial support is recognized as important for recovery for service users with schizophrenia, in addition to provision of antipsychotic medication. This study aimed to develop a community-based psychosocial rehabilitation programme for service users with schizophrenia to be facilitated by auxiliary social workers, and to investigate acceptability and feasibility of the programme. A task-sharing approach was adopted in which auxiliary social workers were trained to facilitate psychosocial rehabilitation groups. In-depth individual qualitative interviews were conducted with six group members at baseline, midpoint, and endpoint (18 interviews in total). NVivo10 was used to store data and conduct qualitative framework analysis. Participants reported benefits of the programme, including improvements in group members’ self-esteem, social support, illness knowledge, self-care, and contribution to their households. A key barrier to acceptability was the lack of provision of income generating opportunities. Implementation challenges include difficulties in tracing and engaging service users and families, lack of an appropriate venue, and issues with supply of antipsychotic medication. This study has provided evidence for the benefits and acceptability of this contextually adapted programme. Key barriers to implementation can be addressed through the provision of the necessary resources for auxiliary social worker input in the community.

Intervening Early with Family Members during First-Episode Psychosis: An Evaluation of Mental Health Nursing Psychoeducation within an Inpatient Unit

Provision of psychoeducation to families of service users experiencing a first-episode psychosis has been found to assist with relapse prevention and promoting recovery for service users. Psychoeducation also assists families to reduce isolation and gain relevant information and support. This study aimed to clarify the role inpatient staff can best have with families, targeted to the acute phase and early stage of the illness. Family members were provided an inpatient carer psychoeducation meeting and recruited for a feedback interview 6 months later. Findings suggest that family members require information provision and support during the admission, in addition to beneficial psychoeducation groups offered later in the community.