Recovery Orientation Research Articles

The "Critical" Elements of Illness Management and Recovery: Comparing Methodological Approaches.

This study examined three methodological approaches to defining the critical elements of Illness Management and Recovery (IMR), a curriculum-based approach to recovery. Sixty-seven IMR experts rated the criticality of 16 IMR elements on three dimensions: defining, essential, and impactful. Three elements (Recovery Orientation, Goal Setting and Follow-up, and IMR Curriculum) met all criteria for essential and defining and all but the most stringent criteria for impactful. Practitioners should consider competence in these areas as preeminent. The remaining 13 elements met varying criteria for essential and impactful. Findings suggest that criticality is a multifaceted construct, necessitating judgments about model elements across different criticality dimensions.

The transformation from custodial to recovery-oriented care: a paradigm shift that needed to happen.

As custodial mental health services are beginning to adopt a recovery-oriented model of care, it is imperative that successes in the transformation to recovery are captured. The aim of this illustrative case study was to describe the organizational procedure that enabled the systematic transformation of a custodial mental health service to a service with a self-professed recovery orientation as its model of service delivery. One-to-one interviews with key stakeholders and a document analysis were completed to thoroughly describe the transformation of the service. Four major themes arose from the data: (a) "We had this whole paradigm shift that needed to happen;" (b) "Think recovery," the development of a manualized guide; (c) "Stepping out my recovery;" adaptation of the service guide to the secure care context; and (d) developing the culture. The "developing the culture" major theme was subcategorized to consist of (a) the right people, (b) education, (c) reflective learning, and (d) leadership. The themes provided insights to assist mental health nurses to understand the processes involved in systems transformation. However, the major successes of the service, although only recently evaluated, commenced over a decade ago and yet continue to evolve.

Patients’ subjective perspective on recovery orientation on an acute psychiatric unit

Background: Evaluations of the recovery orientation of mental health services have focused on outpatient and rehabilitative rather than acute inpatient facilities. Aim: This naturalistic observational study seeks to evaluate the subjective perspective and functional outcome of inpatients before and after structural alterations. The changes made were the introduction of treatment conferences and conjoint treatment planning, reduction of the total time spent on reports about patients (in their absence), and recovery-oriented staff training on an acute psychiatric unit of the University Hospital of Psychiatry, Zurich, Switzerland. Methods: During 1 year (2011/2012) eligible patients on the study unit were interviewed on a voluntary basis using established instruments to assess several recovery-relevant aspects. Two different samples (before and after the project; n = 34 and n = 29) were compared with regard to subjective parameters (e.g. patients’ attitudes toward recovery, quality of life, perceived coercion, treatment satisfaction, and hope), clinical and socio-demographic basic data, as well as the functional outcome according to the Health of the Nation Outcome Scales (HoNOS). Results: Some patient attitudes towards recovery and their self-assessment of the recovery process improved during the study. Other subjective parameters remained stable between samples. Functional outcome was better in subjects who were treated after the implementation of the new concept. The length of stay remained unchanged. Conclusions: The implementation of recovery-oriented structures and providing the necessary theoretical underpinning on an acute psychiatric unit is feasible and can have an impact on attitudes and knowledge of personal recovery.

The recovery-orientation of three mental health units

Purpose– The purpose of this paper is to measure service user and staff views of the recovery orientation of three mental health rehabilitation units; two “open” and one “locked”. It identified elements of recovery that were important to service users. It measured the units’ performance on domains of recovery, attending to differences between staff members’ and service users’ perceptions and between the locked and open units.Design/methodology/approach– A cross-sectional design was used. Staff and service users completed the “Developing Recovery Enhancing Environment Measure (DREEM)”.Findings– Findings revealed some differences between staff and service user views. Service users in the locked unit reported the organisational climate to be more recovery oriented on some domains than those in the open units. Service users’ responses highlighted potential areas for service improvement.Research limitations/implications– The sample was small but reflected the applied setting. Some service users were not invited to participate because of significant communication or cognitive difficulties and it is recognised that they may have had alternative views that remain unrepresented.Practical implications– The DREEM provided valuable information about current practice and potential for service development. Both locked and open units can provide recovery-oriented environments. Services should be aware of discrepant views between staff and service users.Originality/value– To the knowledge, this is the first study to use the DREEM to evaluate the recovery orientation of a locked recovery unit and to compare locked and unlocked units.

Competing priorities: staff perspectives on supporting recovery.

Recovery has come to mean living a life beyond mental illness, and recovery orientation is policy in many countries. The aims of this study were to investigate what staff say they do to support recovery and to identify what they perceive as barriers and facilitators associated with providing recovery-oriented support. Data collection included ten focus groups with multidisciplinary clinicians (n = 34) and team leaders (n = 31), and individual interviews with clinicians (n = 18), team leaders (n = 6) and senior managers (n = 8). The identified core category was Competing Priorities, with staff identifying conflicting system priorities that influence how recovery-oriented practice is implemented. Three sub-categories were: Health Process Priorities, Business Priorities, and Staff Role Perception. Efforts to transform services towards a recovery orientation require a whole-systems approach.

Towards a model for collaborative practice in community mental health care

Collaborative practice in health care is hailed by Zwarenstein, Goldman, and Reeves (2009), and Hopkin (2010), as an approach that can produce improved health outcomes by preventing fragmentation in healthcare and strengthening healthcare systems. A great deal of efforts is being extended by international organizations such as WHO and national health directorates to improve collaboration in healthcare provision. As a key approach to enhance collaborative practice at the service level, a model of collaborative practice focusing on collaborative processes is proposed in this paper. A model of collaborative practice in community mental health care is based on the results of two case studies and supported by relevant literature. The model has four components – (a) the frameworks for practice consisting of person-centered practice and recovery orientation; (b) the structure of collaborative practice that includes intra-system collaboration and collaboration in service processes; (c) three principles for collaboration as self-understanding, mutual understanding, and shared decision-making; and (d) the key processes in collaboration identified as open dialogue and participatory engagement. Collaborative practice in community mental health care depicted in this model puts service users at the center of service provision and processes with the goal of addressing service users' needs from their perspectives. The model provides a framework to develop and test practice guidelines for community mental health care.

Social recovery and the move beyond deficit models of depression: A feminist analysis of mid-life women's self-care practices

In Australia, like other advanced liberal democracies, the adoption of a recovery orientation was hailed as a major leap forward in mental health policy and service provision. We argue that this shift in thinking about the meaning of recovery requires further analysis of the gendered dimension of self-identity and relationships with the social world. In this article we focus on how mid-life women constructed meaning about recovery through their everyday practices of self-care within the gendered context of depression. Findings from our qualitative research with 31 mid-life women identified how the recovery process was complicated by relapses into depression, with many women critically questioning the limitations of biomedical treatment options for a more relational understanding of recovery. Participant stories revealed important tacit knowledge about recovery that emphasised the process of realising and recognising capacities and self-knowledge. We identify two central themes through which women's tacit knowledge of this changing relation to self in recovery is made explicit: the disciplined self of normalised recovery, redefining recovery and depression. The findings point to the need to reconsider how both recovery discourses and gendered expectations can complicate women's experiences of moving through depression. We argue for a different conceptualisation of recovery as a social practice through which women realise opportunities to embody different 'beings and doings'. A gendered understanding of what women themselves identify is important to their well-being, can contribute to more effective recovery oriented policies based on capability rather than deficit.

The recovery orientation of patients and staff in a high secure hospital

AbstractBefore and after introducing the recovery approach at Broadmoor Hospital the views of patients and staff were assessed using two subscales of the Developing Recovery Enhancing Environments Measure (DREEM), which is used to assess recovery. Findings indicated a limited or negative effect on t

Consumer measures and research co-production: a pilot study evaluating the recovery orientation of a mental health program collaboration

A clinical service and a community-managed service have collaborated to deliver a service supporting people with severe and enduring mental illness and complex needs. This study aims to evaluate the recovery-orientation of the service by means of a consumer-led program evaluation utilising validated measures and qualitative interviews. The Recovery Self-Assessment (RSA) and the Recovery Enhancing Environment measure (REE) indicated that the things done well included goal setting and monitoring, practical assistance and encouragement. Things to improve were access to records; variety in treatment options; contributing to advisory boards; and support regarding sexuality, spirituality and relationships. Consumers interviewed peer-to-peer actively engaged with the evaluation.

Brief version of the Internalized Stigma of Mental Illness (ISMI) scale: Psychometric properties and relationship to depression, self esteem, recovery orientation, empowerment, and perceived devaluation and discrimination.

The internalized stigma of mental illness impedes recovery and is associated with increased depression, reduced self-esteem, reduced recovery orientation, reduced empowerment, and increased perceived devaluation and discrimination. The Internalized Stigma of Mental Illness (ISMI) scale is a 29-item self-report questionnaire developed with consumer input that includes the following subscales: Alienation, Discrimination Experience, Social Withdrawal, Stereotype Endorsement, and Stigma Resistance. Here we present a 10-item version of the ISMI containing the two strongest items from each subscale. Participants were all outpatient veterans with serious mental illness. Following the rigorous scale-reduction methods set forth by Stanton and colleagues (2002), we selected the 10 items, tested the psychometrics of the shortened scale in the original validation sample (N = 127), and cross-checked the results in a second dataset (N = 760). As expected, the ISMI-10 retained the essential properties of the ISMI-29, including adequate internal consistency reliability and external validity in relation to depression, self-esteem, recovery orientation, perceived devaluation and discrimination, and empowerment. The ISMI-10 scores are normally distributed and have similar descriptive statistics to the ISMI-29. The reliability and depression findings were replicated in a cross-validation sample. We conclude that the ISMI-10 has strong psychometric properties and is a practical, reliable, and valid alternative to the original ISMI-29. Future work should test the ISMI-10 in more diverse samples. This shorter version should reduce respondent burden in program evaluation projects that seek to determine whether participation in psychosocial rehabilitation programming reduces internalized stigma.

Appraising Research on Positive Mental Health for Person Centered Medicine

The author appraises studies on positive mental health relevant to person centered medicine, with an emphasis on qualitative research designs dealing with personal and social resources, resilience and individual recovery processes of psychiatric patients. These studies and developments may have an enriching and stimulating impact on a person-centred medicine since they deal with patients’ inner subjective experiences and healthy aspects in midst of mental illness processes. Also the recent service user involvement in mental health research – a main component of the recovery movement – can be seen as an innovative step towards a new culture of research on subjective illness experience. Furthermore, the convergence of recovery orientation and person-centred care perspectives are delineated.

Advancing the Recovery Orientation of Hospital Care Through Staff Engagement With Former Clients of Inpatient Units

This study was undertaken to assess the impact of consumer narratives on the recovery orientation and job satisfaction of service providers on inpatient wards that focus on the treatment of schizophrenia. It was developed to address the paucity of literature and service development tools that address advancing the recovery model of care in inpatient contexts. A mixed-methods design was used. Six inpatient units in a large urban psychiatric facility were paired on the basis of characteristic length of stay, and one unit from each pair was assigned to the intervention. The intervention was a series of talks (N=58) to inpatient staff by 12 former patients; the talks were provided approximately biweekly between May 2011 and May 2012. Self-report measures completed by staff before and after the intervention assessed knowledge and attitudes regarding the recovery model, the delivery of recovery-oriented care at a unit level, and job satisfaction. In addition, focus groups for unit staff and individual interviews with the speakers were conducted after the speaker series had ended. The hypothesis that the speaker series would have an impact on the attitudes and knowledge of staff with respect to the recovery model was supported. This finding was evident from both quantitative and qualitative data. No impact was observed for recovery orientation of care at the unit level or for job satisfaction. Although this engagement strategy demonstrated an impact, more substantial change in inpatient practices likely requires a broader set of strategies that address skill levels and accountability.

Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems.

An understanding of recovery as a personal and subjective experience has emerged within mental health systems. This meaning of recovery now underpins mental health policy in many countries. Developing a focus on this type of recovery will involve transformation within mental health systems. Human systems do not easily transform. In this paper, we identify seven mis-uses ("abuses") of the concept of recovery: recovery is the latest model; recovery does not apply to "my" patients; services can make people recover through effective treatment; compulsory detention and treatment aid recovery; a recovery orientation means closing services; recovery is about making people independent and normal; and contributing to society happens only after the person is recovered. We then identify ten empirically-validated interventions which support recovery, by targeting key recovery processes of connectedness, hope, identity, meaning and empowerment (the CHIME framework). The ten interventions are peer support workers, advance directives, wellness recovery action planning, illness management and recovery, REFOCUS, strengths model, recovery colleges or recovery education programs, individual placement and support, supported housing, and mental health trialogues. Finally, three scientific challenges are identified: broadening cultural understandings of recovery, implementing organizational transformation, and promoting citizenship.

Recovery-Oriented Concepts, Values and Practices are Widely Accepted in the Addiction Profession, but Gaps Still Remain

Recovery concepts have always run through the fabric of the addiction profession, the members of its workforce, and the services they provide, albeit with varying strength over time. The addiction profession, founded by individuals in recovery, laid the groundwork to provide addiction services within a recovery orientation.

Veterans' perceptions of behavioral health care in the veterans health administration: a national survey.

This study provided national estimates of perceptions of behavioral health care services among patients of the Veterans Health Administration (VHA) with a diagnosis of bipolar I disorder, major depression, posttraumatic stress disorder, schizophrenia, or substance use disorder. A stratified random sample of 6,190 patients completed telephone interviews from November 2008 through August 2009. Patients (N=5,185) who reported receiving VHA behavioral health care in the prior 12 months were asked about their need for housing and employment services, timeliness and recovery orientation of their care, satisfaction with care, and perceived improvement. Half of patients reported always receiving routine appointments as soon as requested, and 42% were highly satisfied with their VHA mental health care. Approximately 74% of patients reported being helped by the treatment they received, yet only 32% reported that their symptoms had improved. After controlling for covariates, the analyses showed that patients with a substance use disorder reported lower satisfaction with care and perceived their treatment to be less helpful compared with patients without a substance use disorder. Although matched sample comparison data were not available, the results showed that overall patient perceptions of VHA mental health care were favorable, but there was significant room for improvement across all areas of assessment. A majority reported being helped by treatment, but few reported symptom improvement. Variations in perceptions among patients with different disorders suggest the potential importance of psychiatric diagnosis, particularly substance use disorder, in assessing patient perceptions of care.

The Recovery Continuum: How Do Meaningful Activities for Consumers Fit?

In many developed countries today, a recovery orientation is the mental health policy ethos from hospitals through to the community (Australian Government, 2010). Two of the criticisms consumers of...

Measuring the recovery orientation of assertive community treatment

Eine recovery-orientierte Behandlung hat im psychiatrischen Gesundheitsversorgungssystem der anglo-amerikanischen Länder höchste Priorität. Eine entsprechende Gesetzgebung sowie anerkannte Behandlungsleitlinien sollen sicherstellen, dass die Anbieter psychiatrische Versorgungsprogramme vorhalten, die die Vision von Recovery und Hoffnung auf Genesung unterstützen.

Transplanting recovery: Research and practice in the Nordic countries

BackgroundThe conceptual framework which describes recovery from mental illness is based primarily on studies conducted in English-speaking countries. Knowledge and development of recovery orientation within other cultures and mental health systems is still limited.AimThe aim of this study was to compile, describe and discuss the research on personal recovery and recovery-oriented practice within the psychiatric and social fields in the Nordic countries.MethodA systematic literature review of Nordic research on recovery from mental illness.ResultsThe research literature is limited, and primarily replicates designs and confirms findings first presented in studies conducted in the USA and Great Britain. The majority of the studies are qualitative, and point to the importance of social relations, environmental factors and peer support.ConclusionsThere is a need to identify and describe factors in Nordic mental health systems that may influence the recovery process. A corresponding challenge will be to translate and further develop outcome indicators that can promote a recovery-oriented health system.

Variations in Full Service Partnerships and Fidelity to the Housing First Model

In California, the Mental Health Services Act allocated substantial funding to Full Service Partnerships (FSPs): programs that do whatever it takes to improve residential stability and mental health outcomes. The state-guided, but stakeholder-driven, approach to FSPs resulted in a set of programs that share core similarities but vary in their specific approaches. This qualitative study examines FSP variations within the framework of fidelity to the Housing First model. Semistructured interviews with 21 FSP program managers identified through purposeful sampling were coded and analyzed to identify variations across programs in their approaches to housing and services. Through the process of constant comparison, FSP characteristics were condensed into a set of broad themes related to fidelity to the Housing First model. We identified three broad themes: (a) FSPs varied in the degree to which key elements of Housing First were present; (b) program recovery orientation and staff experience were associated wit...

Recovery Prevalence and Health Profile of People in Recovery: Results of a Southeastern Pennsylvania Survey on the Resolution of Alcohol and Other Drug Problems

The emergence of recovery as an organizing construct for behavioral health public policy and the resulting push to increase the recovery orientation of addiction treatment have sparked renewed questions about the prevalence of substance use disorder (SUD) remission/recovery within the general population. The present study reports findings on recovery-related questions imbedded within a public health survey conducted in Philadelphia and four adjacent counties in Southeastern Pennsylvania. The results reveal an adult recovery prevalence rate (9.4%) comparable to rates found in national surveys, but key measures of physical, emotional, and social health of adults in recovery suggest the need for assertive, sustained, and community-based approaches to recovery management that transcend brief episodes of professional intervention.