Recovery-oriented Approach Research Articles

Recovery-Oriented Network Meetings in Mental Healthcare: A Qualitative Study

Recovery-oriented cross-sectoral collaboration is a cornerstone of the debate concerning health professionals and users of mental health services and constitutes an objective in government health policy in Scandinavia and other Western countries. Users do not find that professionals communicate with each other across specific sectors regarding plans that have been prepared. They often experience that they have to start over again every time they switch between treatment locations. The aim of this study is to develop a recovery-oriented model for network meetings. Health professionals and users with experience from mental health services participated in three workshops to discuss and achieve a plan for recovery-oriented network meetings. Knowledge was generated in dynamic research cycles that were experiential, presentational, propositional, and practical. Themes were developed and framed by a content analysis. Recommendations are presented as a narrative from all the participants involved. The overall theme was ‘more focus on personal recovery’ with subthemes such as ‘CHIME as a recovery-oriented approach’. In addition, other themes were generated such as ‘open dialogical meetings’, with subthemes such as ‘meeting structures’ and ‘open dialogues’. This study concludes recommendations to promote a recovery-oriented approach in cross-sectoral network meetings inspired by theoretical perspectives along with the experiences and knowledge of co-researchers.

Mental health service users’ lived experiences of recovery-oriented services: a scoping review

Purpose Over the past 15 years, mental health organisations have taken steps to move towards providing services that are more recovery-oriented. This review was undertaken to explore what is known about service users’ experience of services that have introduced a recovery-oriented approach to service provision. There is limited research evaluating consumers’ lived experiences of recovery-orientated care; a scoping review was chosen to provide an overview of the available research in this area (Munn et al., 2018). The purpose of this review was to summarize and synthesize current qualitative research exploring consumers’ experience of recovery orientated mental health care provision. Design/methodology/approach This scoping review was undertaken as outlined by Arksey and O'Malley (2005). The five steps consisted identifying the research question; searching for relevant studies; selecting the studies; charting the studies; and collating, summarising and reporting the findings. Findings Three key themes emerged from this review: translation of recovery policy to practice; ward environment; and recovery principles with five subthemes: engagement; not being listened to; shared decision-making; informational needs; and supportive and collaborative relationships. The themes and subthemes identified in each of the 18 studies are presented in Table 3. Research limitations/implications This review highlights the different degree to which service users have received recovery-oriented recovery care. In the majority of cases, most service users reported few opportunities for nursing engagement, poor communication, inadequate information provision, a lack of collaborative care and mostly negative experiences of the ward environment. Because of the limited studies on mental health service users’ lived experiences of a recovery-oriented service, more clinical studies are needed and in different cultural contexts. Practical implications On hindsight, the authors should have included service users in this review process as consumer inclusion is progressively emphasised in mental health educational and research activities. This review highlights that not all studies have involved service users or consumers in their research activity. Social implications Service users need relevant information in a timely manner to participate in decision-making regarding their treatment and care. This review found that either no information was provided to the service users or it was provided in a limited and fragmented manner. This review also found inpatients reported limited opportunities to have meaningful participation in decision-making about their care. These findings have important social implications, as greater consumer engagement in the design and delivery of mental health services will increase community trust in the care provided. This in turn has the potential to facilitate greater community engagement in preventative mental health care. Originality/value This is the first review to systematically synthesis consumers perspectives on the extent to which service providers are achieving the goal of implementing recovery-orientated practice into their service provision. Despite important policy changes, the findings of this review demonstrate that more work is needed to truly operationalise and translate these principles into practice.

Family Group Conferences as a Shared Decision-Making Strategy in Adults Mental Health Work.

Family Group conferences (FGC) provide a system by which a client and their family reach jointly key intervention decisions, from a number of options proposed by professionals. The system originated in child protection social work.Conceptually FGC is based on the assumption that the family is potentially a supportive social system for an individual with a variety of difficulties, including mental ill health. Reaching a family network agreement can lead to long term positive outcomes in self-confidence and social relationships. This strategy of shared decision making (SDM) can re-unite the family around the client's needs and wishes. It fits well the strengths based and the recovery-oriented approaches to mental ill health.Methodologically, this article provides a narrative review of existing empirical research about FGC in the context of adult mental health. In addition, two community case studies consisting of videos of a mother experiencing mental ill health and a daughter are analysed in terms of their subjective experience of the FGCs they were involved in, and looks at both the process and the outcomes of FGCs.The key findings demonstrate a high level of satisfaction from participating in the FGC meeting, while the evidence pertaining to the outcomes is inconclusive. Only very few systematic review studies, or comparative studies of different approaches to family decision making, exist, and there are no studies which offer cost effectiveness analysis.Discussion: The observed gap between the satisfaction from the process of FGC by the participants vs. the inconclusive outcomes relates to the implementation phase, in which the decisions made by the family are tested. Evaluating FGC processes and outcomes is complex. A systematic and comprehensive research of the implementation process is missing at this stage.In conclusion, FGC is a promising strategy of SDM in adult mental health. The research evidence indicates the need for further exploration of its implementation process, evaluative methodology and methods.

Exploring recovery-focused educational programmes for advancing mental health nursing: An integrative systematic literature review.

Recovery-focused educational programmes have been implemented in mental health services in an attempt to transform care from a purely biomedical orientation to a more recovery-oriented approach. Mental health nurses have identified the need for enhancing their abilities and confidence in translating recovery knowledge into mental health nursing practice. However, recovery-focused educational programmes have not fully address nurses' learning needs. Therefore, this review synthesized the evidence of the effectiveness of recovery-focused educational programmes for mental health nurses. A systematic search of electronic databases and hand-searched references was conducted. It identified 35 programmes and 55 educational materials within 39 studies. Synthesizing the literature revealed three themes and nine subthemes. The first theme, a framework for understanding and supporting consumers' recovery, had four subthemes: consumers' involvement, multidisciplinary approach, profession-specific training, and performance indicators. The second theme, contents of educational materials, included the subthemes: knowledge development and recovery-focused care planning. The final theme, nurses' learning experiences, included the subthemes: understanding recovery, the positive effects of recovery-focused educational programmes, and implementation of recovery-oriented practices. Based on these findings, a mental health nursing recovery-focused educational programme framework is proposed. Further research should investigate the effectiveness of the framework, especially in relation to recovery-focused care planning and consumer and carer involvement in the development, delivery, participation, and evaluation of these educational programmes.

Self- and caregiver-perceived disability, subjective well-being, quality of life and psychopathology improvement in long-acting antipsychotic treatments: a 2-year follow-up study

Objective Switching to long-acting injectable (LAI) antipsychotic maintenance treatment (AMT) represents a valuable strategy for schizophrenia. In a recovery-oriented approach, patient-reported outcomes (PROs) such as perceived disability, subjective well-being, and quality of life cannot be neglected. Methods Forty clinically stable outpatients with schizophrenia treated with oral second-generation antipsychotics were enrolled at the time of switching to the equivalent dose of LAI. 35 subjects completed this 2-year longitudinal, prospective, open-label, observational study. Patients were assessed at baseline, after 1 year, and after 2 years of LAI-AMT, using psychometric scales (Positive And Negative Syndrome Scale, PANSS; Young Mania Rating Scale, YMRS; Montgomery-Åsberg Depression Rating Scale, MADRS), PROs (Subjective Well-Being under Neuroleptics short form, SWN-K; Short Form-36 health survey, SF-36; 12-item World Health Organisation Disability Assessment Schedule, WHODAS 2.0), and caregiver-reported outcomes (12-item WHODAS 2.0). Results No psychotic relapses were observed. Psychopathology measures (PANSS total and subscales – excluding negative symptoms), mood symptoms (YMRS, MADRS), perceived disability (patient- and caregiver-administered WHODAS 2.0), subjective well-being (SWN-K), and quality of life (SF-36) showed a concomitant amelioration after 1 year, without further significant variations. Discussion Switching to LAI-AMT may decrease perceived impairment, and increase subjective well-being and quality of life in clinically stable outpatients with schizophrenia. Highlights LAI treatment may improve outcomes by reducing psychopathology levels and relapses. In a recovery-oriented approach, patient-reported outcomes cannot be neglected. LAI antipsychotics may optimise the subjective experience of treatment. Switching to LAI therapy may result in a reduction in perceived disability. There is a significant correlation between proxy- and patient-reported disability.

Factors influencing the implementation of mental health recovery into services: a systematic mixed studies review

BackgroundCountries around the world have committed in policy to transforming their mental health services towards a recovery orientation. How has mental health recovery been implemented into services for adults, and what factors influence the implementation of recovery-oriented services?MethodsThis systematic mixed studies review followed a convergent qualitative synthesis design and used the best-fit framework synthesis method. Librarians ran searches in Ovid- MEDLINE, Ovid-EMBASE, Ovid-PsycInfo, EBSCO-CINAHL Plus with Full Text, ProQuest Dissertations and Theses, Cochrane Library, and Scopus. Two reviewers independently screened studies for inclusion or exclusion using DistillerSR. Qualitative, quantitative, and mixed methods peer-reviewed studies published since 1998 were included if they reported a new effort to transform adult mental health services towards a recovery orientation, and reported findings related to implementation experience, process, or factors. Data was extracted in NVivo12 to the 38 constructs of the Consolidated Framework for Implementation Research (CFIR). The synthesis included a within-case and a cross-case thematic analysis of data coded to each CFIR construct. Cases were types of recovery-oriented innovations.ResultsSeventy studies met our inclusion criteria. These were grouped into seven types of recovery-oriented innovations (cases) for within-case and cross-case synthesis. Themes illustrating common implementation factors across innovations are presented by CFIR domain: Intervention Characteristics (flexibility, relationship building, lived experience); Inner Setting (traditional biomedical vs. recovery-oriented approach, the importance of organizational and policy commitment to recovery-transformation, staff turnover, lack of resources to support personal recovery goals, information gaps about new roles and procedures, interpersonal relationships), Characteristics of Individuals (variability in knowledge about recovery, characteristics of recovery-oriented service providers); Process (the importance of planning, early and continuous engagement with stakeholders). Very little data from included studies was extracted to the outer setting domain, and therefore, we present only some initial observations and note that further research on outer setting implementation factors is needed.ConclusionThe CFIR required some adaptation for use as an implementation framework in this review. The common implementation factors presented are an important starting point for stakeholders to consider when implementing recovery-oriented services.

Homelessness and Mental Health: Part 2. The Impact of Housing Interventions.

Back to table of contents Previous article Next article Editor’s ChoiceFull AccessHomelessness and Mental Health: Part 2. The Impact of Housing InterventionsLilanthi Balasuriya, M.D., Lisa B. Dixon, M.D., M.P.H.Lilanthi BalasuriyaSearch for more papers by this author, M.D., Lisa B. DixonSearch for more papers by this author, M.D., M.P.H.Published Online:5 May 2021https://doi.org/10.1176/appi.ps.72504AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This Editor’s Choice collection was published online in April 2021. To review all collections, please visit the Editor’s Choice section of ps.psychiatryonline.org.This second installment of a double collection on homelessness and mental health focuses on the impact of housing interventions for individuals experiencing homelessness. Homelessness disproportionately affects vulnerable populations, including individuals with mental health conditions. This collection identifies evidence-based interventions that target homelessness and associated adverse outcomes. Articles examine Housing First, a recovery-oriented approach to housing that has been shown to improve quality of life and reduce service utilization for individuals experiencing homelessness, as well as combinations of Housing First paired with assertive community treatment (ACT) models for patients with serious mental illness. Additionally, the impact of supportive housing on mental health and social relationships, shared housing approaches, and factors associated with exiting housing are reviewed. Finally, the collection offers pieces that explore the importance of addressing the housing, mental health, and social needs of youths experiencing homelessness. Individuals experiencing homelessness and mental illness face unprecedented challenges that warrant evidence-based interventions to advance both the care and health of our patients and communities.The impacts of housing firstArticlesTrajectories of Homeless Shelter Utilization in the At Home/Chez Soi Trial of Housing FirstChu CMT, Moodie EEM, Streiner DL, et al.Psychiatr Serv 2020; 71:648–655https://doi.org/10.1176/appi.ps.201900260ArticlesCost-Effectiveness of Housing First With Assertive Community Treatment: Results From the Canadian At Home/Chez Soi TrialLatimer EA, Rabouin D, Cao Z, Ly A, et al.Psychiatr Serv 2020; 71:1020–1030https://doi.org/10.1176/appi.ps.202000029ArticleEffects of Housing First on Employment and Income of Homeless Individuals: Results of a Randomized TrialPoremski D, Stergiopoulos V, Braithwaite E, et al.Psychiatr Serv 2016; 67:603–609https://doi.org/10.1176/appi.ps.201500002ArticleAssociations of Housing First Configuration and Crime and Social Connectedness Among Persons With Chronic Homelessness HistoriesWhittaker E, Flatau PR, Swift W, et al.Psychiatr Serv 2016; 67:1091–1097https://doi.org/10.1176/appi.ps.201500446ArticlesFidelity to the Housing First Model and Variation in Health Service Use Within Permanent Supportive HousingGilmer TP, Stefancic A, Henwood BF, et al.Psychiatr Serv 2015; 66:1283–1289https://doi.org/10.1176/appi.ps.201400564Brief reportsWillingness of Housing First Participants to Consider Supported-Employment ServicesPoremski D, Hwang SWPsychiatr Serv 2016; 67:667–670https://doi.org/10.1176/appi.ps.201500140Housing first models with assertive community treatmentArticleOne-Year Outcomes of a Randomized Controlled Trial of Housing First With ACT in Five Canadian CitiesAubry T, Tsemberis S, Adair CE, et al.Psychiatr Serv 2015; 66:463–469https://doi.org/10.1176/appi.ps.201400167Impacts of housing on mental health outcomesArticleHousing Programs for Homeless Individuals With Mental Illness: Effects on Housing and Mental Health OutcomesBenston EAPsychiatr Serv 2015; 66:806–816https://doi.org/10.1176/appi.ps.201400294ArticleLife Changes Among Homeless Persons With Mental Illness: A Longitudinal Study of Housing First and Usual TreatmentNelson G, Patterson M, Kirst M, et al.Psychiatr Serv 2015; 66:592–597https://doi.org/10.1176/appi.ps.201400201Brief reportsImpact of Supported Housing on Social Relationships Among Homeless VeteransO’Connell MJ, Kasprow WJ, Rosenheck RAPsychiatr Serv 2017; 68:203–206https://doi.org/10.1176/appi.ps.201500276Shared housing approachesFrontline reportsOpening More Doors to End Homelessness Through a Shared Housing ApproachBrown MPsychiatr Serv 2016; 67:1161https://doi.org/10.1176/appi.ps.67100FACTORS Associated with exiting supportive housingArticleFactors Associated With Premature Exits From Supported HousingGabrielian S, Burns AV, Nanda N, et al.Psychiatr Serv 2016; 67:86–93https://doi.org/10.1176/appi.ps.201400311Meeting the housing, mental health, and social needs of youths experiencing homelessnessSpecial articleAddressing Intersecting Social and Mental Health Needs Among Transition-Age Homeless Youths: A Review of the LiteratureWiniarski DA, Glover AC, Bounds DT, Karnik NSPsychiatr Serv 2021; 72:317–324https://doi.org/10.1176/appi.ps.201900498ArticlesThe Unique Needs of Homeless Youths With Mental Illness: Baseline Findings From a Housing First TrialKozloff N, Stergiopoulos V, Adair CE, et al.Psychiatr Serv 2016; 67:1083–1090https://doi.org/10.1176/appi.ps.201500461ArticlesFidelity of a Strengths-Based Intervention Used by Dutch Shelters for Homeless Young AdultsKrabbenborg MAM, Boersma SN, Beijersbergen MD, et al.Psychiatr Serv 2015; 66:470–476https://doi.org/10.1176/appi.ps.201300425 FiguresReferencesCited byDetailsCited ByNone Volume 72Issue 5 May 01, 2021Pages 618-619 Metrics PDF download History Published online 5 May 2021 Published in print 1 May 2021

A review of literature of peer-based recovery support in substance abuse and the implications for effective implementation in Seychelles

ABSTRACT Background Despite the development of enhanced professional and specialized care for substance use disorder (SUD) patients, relapse rates remain high. In tacit recognition of this, health-care services have turned toward recovery-oriented approaches, which include incorporating various forms of peer-based recovery support (P-BRS) (peer support) to reduce relapse rates. While P-BRS has been implemented in the United States and Europe with huge success in facilitating long-term recovery from SUD, little is known about its effectiveness in Seychelles. Aim This literature review focuses on the role of P-BRS for those with SUD, by defining peer-based support, assessing its effectiveness, and describing the benefits and challenges presented in carrying out peer-based support in SUD treatment, as well as informing effective implementation in Seychelles. Method An inclusive search of published peer-reviewed and non-peer-reviewed literature on P-BRS and SUD between 2015-2019 was done using search engines of PubMed, PsychInfo and Google Scholar. Results The search reveals that P-BRS is effective in SUD recovery as it decreases the rate of re-hospitalization, gives social support, reduces stigma and empowers people in substance abuse, which positively affects the lives of peers and improves treatment outcomes. Recommendations are made as to how peer support can be effectively implemented in Seychelles to reduce relapse rates and enhance well-being for SUD patients.

Implementation of Psychodynamic Multifamily Groups for Severe Mental Illness: A Recovery-Oriented Approach.

Background: Among Family-Based Services for the treatment of severe mental illnesses, multi-family models gained particular attention, given the potential usefulness of mutual feed-back, motivation and encouragement among families.Methods: The Psychodynamic Multi-Family Group Model has been proposed since 1997 in some Community Mental Health Services in Rome. Since 2011 multifamily groups are held weekly in all the six Districts of the Department of Mental Health that serves a population of more than one million people, and data have been collected since 2015 in three Districts. A total of 794 individuals attended the meetings in the period 2015–2019.Results: Eighty-six percent of those who started, attended more than one meeting. The mean of occurrences of participation among patients was 18.6, among mothers 25.6 and among fathers 21.6. The 794 participants belonged to 439 family units, among which 180 comprised only the patient, 76 only parent(s) or other close person(s), and 183 comprised parent(s) or close person(s) with the patient. Patients participating alone were older than those of families who participated as a whole. Families including the patient showed the longest duration of attendance and the highest prevalence of a diagnosis of schizophrenia in the index patient. Families who had been attending the multifamily groups since a long time maintained a high rate of attendance.Conclusions: Multifamily groups represent a setting where patients can meet with other people and professionals in a free still structured way, and with not strictly therapeutic objectives. The high number of patients who attended alone suggests that such participation corresponds to a self-perceived need of open and free setting facilitating sharing of problems and solutions. The good tenure of the interventions, the high participation, and the feasibility in the long-term suggest that multifamily groups can be implemented in the mental health services of a large city, are sustainable over many years, and can represent a valuable resource for many patients and families.

Recovery in schizophrenia: A network analysis of inter-relationships among disease-related variables, personal resources, context-related factors and real-life functioning

Abstract BodyCentral to recovery-oriented approaches in schizophrenia are treatment integration and personalization, targeting key variables beyond symptom reduction. The Italian network for research on psychoses conducted a study demonstrating, using network analysis, the central role of community activities in bridging the effects of symptoms, cognition, functional capacity and service engagement on real-word functioning. A 4-year follow-up study was recently completed and the presentation will illustrate the findings. Network analysis was used to test whether relationships among all variables at baseline were similar at follow-up. In addition, the network structure was compared between subjects classified as recovered or non-recovered at follow-up. Six hundred eighteen subjects were assessed at both baseline and 4-year follow-up. Results showed that the network structure was stable from baseline to follow-up, and the overall strength of the connections among variables did not significantly change. Functional capacity and everyday life skills were the most central variables in the network at both baseline and follow-up, while psychopathological variables were more peripheral. The network structure of non-recovered patients was similar to the one observed in the whole sample, but very different from that of recovered subjects, showing few connections among the different nodes. These data strongly suggest that connections among symptoms/dysfunctions tend to maintain over time, contributing to poor outcome in schizophrenia. Early treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia.DisclosureArmida Mucci has been a consultant and/or advisor to or has received honoraria from Gedeon Richter Bulgaria, Janssen Pharmaceuticals, Lundbeck, Otsuka, Pfizer and Pierre Fabre. None of these has any impact on this abstract and on the presented study.

Evaluating the Reliability of the Needs in Recovery Assessment (NiRA) with Simulated Patients

Introduction The Needs in Recovery Assessment (NiRA) is a tool designed to support recovery-oriented and person-centred approaches in mental health services through facilitating the identification and prioritisation of needs. The aim of this study was to evaluate the interrater reliability of the NiRA. Method: Ten mental health clinicians from various professional backgrounds used the NiRA to facilitate assessment interviews with Simulated Patients. Completed and semi-completed NiRA forms, questionnaires, and audio-visual recordings of assessment interviews were collected for analysis. The interrater reliability of the NiRA was calculated using percent agreement and Gwet’s Agreement Coefficient (AC)1. Results: Percent agreement across all items of the finalised tool was 0.84 (item range: 0.55 to 1.0). Overall interrater reliability (Gwet’s AC1) was 0.70 (95% CI 0.64-0.76) with items ranging from −0.08 to 1.0. Conclusion: The NiRA is a reliable tool and is ready to be trialled in a feasibility study in clinical settings. It is anticipated that the NiRA will facilitate a deeper understanding of service users’ needs and a more targeted approach to meeting unmet needs.

Living a Meaningful Life While Struggling with Mental Health: Challenging Aspects Regarding Personal Recovery Encountered in the Mental Health System.

Based upon academic and clinical experience from Denmark, this article aims to highlight international research-based knowledge concerning challenging aspects about the understanding and implementation of recovery-oriented practice. Three key points are located: (a) An integrative biopsychosocial approach considering both the clinical and personal recovery perspectives is relevant for research and practice. (b) Barriers in implementing a recovery-oriented approach include both individual and systemic challenges. This is well documented in the research-based literature, highlighting the need for changes. (c) A shift from professional control to a service-user orientation is seen as crucial. Examples of a positive shift are seen, helping the health professionals in their development and practicing of skills and competences through education and personal formation. Within these perspectives, a paradigm shift from a one-dimensional biomedical approach to a biopsychosocial approach is suggested. Instead of focusing on rapid stabilisation and symptom relief as a clinical outcome, a humanistic approach building on social- and person-oriented values is fundamental for social and personal recovery leading to a meaningful life.

‘I (really) know what you mean’. Mechanisms of experiential peer support for young people with criminal behavior: a qualitative study

ABSTRACT Individuals with a criminal background are increasingly involved in support for people with criminal behavior. However, research into what happens in the relationship between these experiential peers (EPs) and clients is scarce. This qualitative study investigates EPs’ perspectives on the mechanisms of experiential peer support and how this compares to regular support by care providers without lived experiences. We interviewed seventeen EPs who provided support to young people with criminal behavior. The results suggest that shared experiences between EPs and their clients play a central role. EPs identify with their clients, leading to empathy and a non-judgmental attitude. Clients seem to perceive EPs as credible role models who offer hope. EPs’ lived experiences seem to induce a realistic view of desistance and an emphasis on a humane relationship with their client, which is characterized by equality, reciprocity, trust and sincerity. This recovery-oriented approach towards criminal behavior and desistance could also be utilized by non-EPs. Future research should investigate others’ perspectives on and experiences with experiential peer support, in particular those of clients and co-workers.

Training in community psychiatry

Training in community psychiatry is an essential aspect of psychiatric education in Europe. Community psychiatry is a branch of psychiatry that focuses on the prevention and treatment of mental illness in the community, with an emphasis on promoting recovery and social inclusion. Training in community psychiatry in Europe typically involves a combination of didactic and clinical experiences, including classroom lectures, group discussions, and supervised practice in community-based mental health services. The curriculum covers topics such as community mental health policy, community-based care, social determinants of mental health, and recovery-oriented approaches to care. The training also emphasizes the importance of inter professional collaboration and the need to work closely with other healthcare professionals, service users, and family members. Overall, training in community psychiatry in Europe is designed to equip psychiatrists with the knowledge, skills, and attitudes necessary to provide high-quality, person-centered care to individuals with mental illness in the community.

Art-making in mental health - a Fijian pilot study.

A pilot art-making and mental health recovery project addressed consumer and carer mental health and well-being in Suva, Fiji. Using feedback surveys, the project evaluated initial training, and a 12-month art programme for consumers, carers and staff across several mental health services. First person and stakeholder group reports from the project reflected broad-scale approval for the novel modality and its potential for continued application in keeping with local cultural values. A broad stakeholder base was involved in planning and participation, aligned with the values of inclusive recovery-oriented mental health service approaches. These results suggest that the programme can add value to mental health care being provided for people with a mental illness in Fiji.

Narrative Matters: Mental health recovery - considerations when working with youth.

Youth mental health and well-being is of increasing concern to practitioners and policy-makers. Youth experiencing mental health problems face many barriers in accessing care and often have different needs to those of adults experiencing mental health problems. In order to adequately respond to the needs of young people aged 12-25, it is necessary to understand, from their perspective, their diverse needs and their different realities, using a global health approach and through participation in the development of mental health services and care. There are documented difficulties in implementing a recovery-oriented practice approach that have led to misapplications, misunderstandings and critiques. That said, there is little research or discussion on mental health recovery by and for young people and young adults. To help child and adolescent mental health practitioners better assess the pertinence of the mental health recovery model in their practice, a focus on the emergence of the model can be helpful in order to adapt the current conceptions of mental health recovery for work with youth. Child and adolescent mental health professionals might want to consider the following three suggestions - consider developmental processes, focus on hope and create strong community ties.

Combining online and offline peer support groups in community mental health care settings: a qualitative study of service users\u2019 experiences

BackgroundPeer support for people with long-term mental health problems is central to recovery-oriented approaches in mental health care. Peer support has traditionally been conducted offline in face-to-face groups, while online groups on the Internet have increased rapidly. Offline and online peer support groups are shown to have differing strengths and weaknesses. However, little is known about how combining the two formats might be experienced by service users, which this paper aims to illuminate.MethodsIn this exploratory and descriptive study, a recovery-oriented Internet-based portal called ReConnect was used by service users in two mental health communities in Norway for 6–12 months. The portal included an online peer support group which also facilitated participation in local offline peer support groups. Both group formats were moderated by an employed service user consultant. Qualitative data about service users’ experiences were collected through focus groups and individual interviews and inductively analyzed thematically.ResultsA total of 14 female service users 22–67 years of age with various diagnoses participated in three focus groups and 10 individual interviews. Two main themes were identified: (1) balancing anonymity and openness, and (2) enabling connectedness. These themes are further illustrated with the subthemes: (i) dilemmas of anonymity and confidentiality, (ii) towards self-disclosure and openness, (iii) new friendships, and (iv) networks in the local community. Three of the subthemes mainly describe benefits, while challenges were more implicit and cut across the subthemes. Identified challenges were related to transitions from anonymity online to revealing one’s identity offline, confidentiality, and barriers related to participation in offline peer support groups.ConclusionsThis study suggests that online and offline peer support groups complement each other, and that combining them is mainly described as beneficial by service users. Identified benefits appeared to arise from service users’ options of one format or the other, or that they could combine formats in ways that suited their individual values and comfort zones. Moderation by a trained service user consultant appeared essential for both formats and can be used systematically to address identified challenges. Combining online and offline peer support groups is a promising concept for facilitating recovery-oriented care and warrants continued research.

The conditions of possibilities for recovery: A critical discourse analysis in a Danish psychiatric context.

This paper explores the conditions for the possibilities of recovery in a Danish mental healthcare practice, expressed from the perspective of nurses. The results and discussion of the study help to make visible and explore the muddle of conceptualisations of recovery in mental healthcare practice. Few studies examine the possibilities of recovery for inpatients and outpatients in mental health centres from a nursing perspective. A qualitative design using a critical social constructionist frame of understanding, in which the real world is considered as a series of social constructions. A Fairclough-inspired critical discourse analysis was chosen as the analytical strategy. The analysis is comprised of ten interviews in mental health care and notes, written by nurses, in medical records of ten patients with a mental illness admitted to a mental healthcare centre in 2016-2017. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline to secure accurate and complete reporting of the study (See Appendix S1). From the findings of the textual analysis and the analysis of the discourse practice, it seems clear that the social relations and structures relating to recovery in Danish psychiatry are steered and controlled by discourses that reflect, in general terms, the essence of the core of neoliberal ideology. Recovery is generally articulated from an overall discourse of neoliberalism with its embedded discourses of paternalism, biomedicine, self-care and holism. All these discourses coexist in nursing practice, but the paternalistic discourse becomes the framework for the conditions for the possibility of how recovery is expressed in practice. Nurses need to be supported to seek clarity in the understanding and operationalisation of a recovery-oriented approach, if the agenda is to be truly adopted and strengthened.

Easier to Say \u2018Recovery\u2019 than to Do Recovery: Employees\u2019 Experiences of Implementing a Recovery-Oriented Practice

The aim is to investigate the change towards a recovery-supporting model for health care services in a Norwegian municipality. The model is founded on the five processes identified by Leamy et al. (British Journal of Psychiatry, 199, 445–452, 2011): Connectedness, Hope, Identity, Meaning and Empowerment, described as the acronym CHIME. To examine this change, we used focus groups, which provided a basis for qualitative content analysis. The participants were recruited from several departments of the Mental Health and Substance Use unit. We found three themes: reflections on attitudes and actions, patients not participating in matters regarding their situation, balancing paternalistic attitudes and patients’ autonomy. The findings suggest that workers have an understanding of recovery but do not know what to do differently. We advocate that there is a need for tools, mechanisms and structures on how to support a recovery-oriented approach for patients needing mental health and substance use treatment.

Exploring Needs and Quality of Life of Forensic Psychiatric Inpatients in the Reformed Italian System, Implications for Care and Safety

The Italian forensic psychiatric system underwent drastic reforms. The newly developed facilities are inspired by psychiatric community services, embracing a recovery-oriented approach. Needs and quality of life are broader concepts that consider the more rehabilitative and humanitarian aspects of treatment. In one of the new Italian forensic psychiatric services, this cross-sectional study aimed to investigate the needs and quality of life of forensic psychiatric patients. A second aim was to validate the Italian version of the Forensic inpatient Quality of Life questionnaire Short Version (FQL-SV). Overall, 42 forensic psychiatric patients were assessed using the Forensic version of the Camberwell Assessment of Need (CANFOR), the Historical-Clinical-Risk-Management-20 (HCR-20), the FQL-SV, and the World Health Organization Quality of Life (WHOQoL-Bref). Patients reported significantly fewer needs, whether met or unmet, than their treating clinicians. The general level of agreement between patients and clinicians on specific needs was low Kappa values were < .40 for 64% of the total needs and 46% of the unmet needs. Risk factors according to the HCR-20 mean scores were 13.1, 4.6, and 6.4 for the historical, clinical and risk management subscale. Quality of life was moderate to high for 74% of the patients. Our results showed that lower numbers of needs, whether reported by patients or clinicians, were associated with a better quality of life. The Italian FQL-SV had a Cronbach's alpha of 0.86 and correlated as expected with the WHOQoL-Bref. The FQL-SV is a valid and reliable tool, justifying its use for routinely assessing QoL in Italian forensic psychiatric services. This study enhances our understanding of needs and quality of life of forensic psychiatric patients and how their assessment could have an additional value for recovery-oriented treatment in forensic psychiatry. Although the detained status of forensic patients imposes real limits on the capacity for autonomy and choice, incorporating the patient's perspective on decision-making processes, in relation to aspects of treatment, care, and daily life, may have benefits such as a better treatment adherence or therapeutic alliance. Future research should clarify how routinely assessing needs and quality of life can contribute to the recovery of these forensic psychiatric patients.