Recovery Care Research Articles

Psychometric evaluation of the Symptom-Checklist-K-9 among U.S. working-age adults with psychiatric disabilities.

The Symptom Checklist 90-Revised (SCL-90-R; Derogatis, 1992) is a widely used self-report measure of psychiatric symptoms (Prinz et al., 2013), but it is longer than many screening measures used in certain settings. Recently, a nine-item form of the SCL-90-R, the Symptom-Checklist-K-9 (SCL-K-9), has been gaining traction despite the limited research examining its psychometric properties in the United States. The purpose of this study is to conduct a psychometric evaluation of the SCL-K-9 scores in U.S. working-age adults with psychiatric disabilities. Six hundred and thirty participants with self-reported psychiatric disabilities completed the SCL-K-9 and other psychosocial self-report measures. Confirmatory factor analysis (CFA) was conducted to evaluate the SCL-K-9 scores' dimensionality. Coefficient omega was used to assess the scores' internal consistency. Convergent and discriminant validity were assessed by examining the strength and direction of correlation coefficients between the SCL-K-9 and other psychosocial measures. Measurement invariance across sex, age, and primary diagnostic groups was also examined. CFA revealed a one-factor solution with satisfactory reliability (coefficient omega = .828). Convergent validity was supported by the relatively high correlation coefficients between the SCL-K-9 with neuroticism, self-stigma, and psychiatric disability acceptance, and discriminant validity by relatively low correlation coefficients with perceived social stigma and hope. Full measurement invariance for sex and partial invariance for diagnostic groups was supported. Overall, this study provides preliminary reliability and validity evidence for the SCL-K-9 scores among U.S. working-age adults with psychiatric disabilities. Further investigation is warranted to support its use for research and treatment progress monitoring in recovery-oriented care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perspectives of key informants before and after implementing UPSIDES peer support in mental health services: qualitative findings from an international multi-site study

BackgroundPeer support is an essential part of recovery-oriented care worldwide. Contextual factors have an impact on the implementation of peer support work. However, research has paid little attention to similarities and differences of implementation factors in settings varying by income-level and cultural values. The aim of this study is to assess the factors influencing the implementation of a peer support intervention across study sites in low-, middle- and high-income countries in line with the Consolidation Framework for Implementation Research (CFIR).Method6 focus groups with a total of 54 key informants with relevant contextual (organisational) knowledge regarding implementation facilitators and barriers were conducted at six study sites Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be’er Sheva (Israel), and Pune (India) before and 1.5 years after the start of UPSIDES peer support. Transcripts were analysed using qualitative content analysis.ResultsAcross study sites key informants reported benefits of peer support for service users and peer support workers as implementation facilitators. At study sites with lower resources, reduced workload for mental health workers and improved access to mental health services through peer support were perceived as implementation facilitators (CFIR Domain 1: Intervention characteristics). The degree of engagement of mental health workers (CFIR Domain 3: Inner Setting/Domain 4: Individuals involved) varied across study sites and was seen either as a barrier (low engagement) or a facilitator (high engagement). Across study sites, adequate training of peer support workers (CFIR Domain 5: Implementation process) was seen as animplementation facilitator, while COVID-19 as well as low resource availability were reported as implementation barriers (CFIR Domain 2: Outer setting).ConclusionsThis study highlights the importance of considering contextual factors when implementing peer support, including previous experience and perceived benefits. Particular attention should be given to organisational benefits such as workload reduction and the allocation of sufficient resources as key drivers in LMICs. In HICs, the potential of organisational benefits for successful implementation should be further investigated and promoted.

Mental Health Staff Perspectives on Personal Recovery: A Narrative Study on Positive Professional Impact of Recovery-Oriented Care

Objectives
 Mental health staff play an important role in facilitating personal recovery. We examined how mental health staff perceived personal recovery and the impact of their experience with supporting personal recovery.
 Research Design and Methods
 Forty-eight mental health staff wrote a narrative about a service user with severe mental illness that they believed to be in personal recovery and elaborated on the impact of this professional experience. Interpretive phenomenological analysis was used to illuminate 1) conceptualizations of personal recovery, 2) professional contribution to recovery, and 3) positive impact of recovery-oriented care on staff.
 Results
 Conceptualizations of recovery focused on social connections and positive subjective states, and also symptom remission and illness management. Professional contributions were narrated as encompassing treatment, relationships and conversations as well as time and team collaboration. Impact on the staff included strong positive emotions, professional gains with respect to learning and self-esteem, motivation for and meaning in work as well as belief in recovery.
 Conclusions
 This latter finding suggests that sharing narratives about service users in personal recovery may increase work pleasure and help reduce burn out in mental health staff.

Ethical challenges for nurses delivering coercive interventions in community mental health settings: A scoping review.

The number of Australians subject to coercive interventions in community mental health services continues to increase. This is in the context of a growing awareness of the harms from coercion, increasing concerns about potential breaches of human rights and an ongoing uncertainty regarding the clinical benefits of community treatment orders, the primary instrument of legislated coercion in community mental health services. Nurses in community mental health services are on the frontline with regard to coercion. They police the requirements of the community treatment order, administer medication to people in community settings without their consent and facilitate re-hospitalisation if indicated. Coercive practice contradicts the person-centred, recovery-oriented and trauma-informed care principles that inform contemporary mental health nursing. This contradiction may generate ethical challenges for nurses and result in ethical distress. The aim of this scoping review was to map the research literature on how nurses in community mental health settings recognise and manage the harm associated with the administration of coercive interventions and consider the ethical challenges that may arise within this practice. The search strategy yielded 562 studies with author consensus determining a total of three articles as meeting the inclusion criteria. The resulting literature identified three themes: (1) maintaining the therapeutic relationship, (2) promoting autonomy and (3) using subtle forms of control. This review demonstrated that there is minimal research that has considered the ethical challenges related to the use of coercion by nurses in community mental health 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

Understanding Peerness in Recovery-Oriented Mental Health Care.

Emotional and interpersonal support systems are fundamental to recovery-oriented support programs. Peerness represents the quality of shared lived experience that enhances such support programs. Through peerness, providers of formal peer support (FPS) strategically disclose their lived experience to help service recipients reach their goals. FPS disclosure is limited compared with the kind of free sharing in mutual support programs, with FPS focusing on information that specifically helps service recipients on their recovery journey. Peerness has additional value for shared experiences relevant for diversity, equity, and inclusion efforts. This Open Forum also considers where peerness conceptually fits into research of recovery-based services.

Improving the standardisation, timeliness and efficiency of the occupational therapy admission process in an older adult inpatient service

Occupational therapists (OTs) are at the forefront of providing recovery-oriented care for older people through timely assessments of patient’s engagement in daily living activities among many other interventions. This aids...

Correction: Conceptualisation of Personal Recovery and Recovery-Oriented Care for Youth: Multisystemic Perspectives

Correction: Conceptualisation of Personal Recovery and Recovery-Oriented Care for Youth: Multisystemic Perspectives

Recovery-oriented psychotherapy: Practical recommendations for psychologists in organized care settings.

The concept of recovery has become an increasingly common framework for organizing mental health care, thus many psychologists find themselves working in settings that espouse a recovery orientation to service delivery. However, the concepts of recovery and recovery-oriented services are complex and have many definitions and psychologists struggle to know whether or not the psychotherapy they provide is aligned with recovery-oriented care. This article provides practical recommendations on how to integrate recovery into the common processes of psychotherapy that cut across all theoretical orientations or particular treatment approaches. Specifically, this article details the process of building a therapeutic bond, conceptualizing a client's problems and goals, implementing a treatment plan, and discharge planning, all from a recovery-oriented perspective. A case demonstration and analysis is presented to illustrate the recovery-oriented psychotherapy process described in this article. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

“Now I Have My Own Key”: The Impact of Housing Stability on Recovery and Recidivism Reduction Using a Recovery Capital Framework

The National Institute on Drug Abuse (2020) reported 85% of the U.S. prison population had a substance use disorder (SUD) or was incarcerated for drug-use crimes. Applying Comprehensive Opioid, Stimulant, Substance Use Program funds, the Palm Beach County Office of Behavioral Health, and SUDs developed a comprehensive person-centered, recovery-oriented approach. This mixed-methods study (N= 36) examined how social capital, housing stability, and recovery-oriented care impacted personal capital, rearrest, and housing stability in criminal-justice-involved individuals with SUDs. Of the 36 participants, 86% (n= 31) did not have a rearrest, and 70% of participants were then employed shortly after their Comprehensive Opioid Stimulant Substance Use Program enrollment. Three major themes emerged from the interviews (n= 8): beginning recovery, peer navigation, and housing stability. This study demonstrates that housing stability, peer-support specialists, and care coordination are vital to increase recovery capital, aiding recovery, and reducing recidivism.

Conceptualisation of Personal Recovery and Recovery-Oriented Care for Youth: Multisystemic Perspectives

AbstractThere is a substantial body of evidence on the construct of personal recovery and the value of recovery-oriented mental health care worldwide. Personal recovery refers to the lived experience of those with mental illness overcoming challenges and living satisfying lives within the limitations of mental health symptomology. Conceptualisations such as CHIME have primarily relied on adult frameworks. With growing concerns about youth mental health, the present study aimed to understand the experiences of personal recovery and recovery-oriented care for youth. Given the multisystemic influences on youth development, the study analysed narratives from youth, caregivers, and mental health professionals. The analysis revealed two developmentally unique recovery processes involving the restoration of capabilities and existing relationships (restorative processes) and the bolstering of protective influences and strengths (resilience processes). Deductive analysis identified alignment to the CHIME framework. Implications of the findings for recovery-oriented care for youth are discussed.

The experience of healthcare professionals implementing recovery-oriented practice in mental health inpatient units: A qualitative evidence synthesis.

WHAT IS KNOWN ON THE SUBJECT?: The principles of personal recovery are primarily applied in outpatient and community settings as these settings provide continuity of care and recovery-based community programs supporting consumers' recovery journey. A range of healthcare professionals are involved in the care of people within mental health in-patient units, including nurses, psychiatrists, psychologists, occupational therapists and social workers. The integration of recovery-oriented care in mental health inpatient units may be impaired by a lack of confidence among mental health professionals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Developing hope and a safe place is an integral part of recovery-oriented practice within mental health inpatient units. Instilling connectedness is a relevant recovery principle; however, there may be greater barriers in mental health settings which traditionally prioritise safety and risk mitigation practices to prevent perceived harmful behaviours. Staff workload and inadequate understanding of recovery concepts present challenges to promoting recovery-oriented care in everyday practice. Using strength-based practice is critical in promoting a safe space for consumers by providing psychosocial interventions and person-centred care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The provision of recovery-oriented practice requires adopting a collaborative approach that places a strong emphasis on the involvement of consumers and their families. Empowering mental health professionals to believe that recovery-oriented practice is possible in mental health inpatient units is crucial. Mental health professionals need to create a safe environment and positive relationships through respect and empathy for consumers and their family members. ABSTRACT: Introduction Recovery-oriented practice underpins an individual's personal recovery. Mental health nurses are required to adopt a recovery-oriented approach. Globally, a paucity of literature exists on mental health professionals' experience of recovery-oriented practice in mental health inpatient units. Aim The aim of this synthesis was to explore the experiences of healthcare professionals regarding recovery-oriented care in mental health inpatient units by appraising and synthesising existing qualitative research. Method Three databases, including MEDLINE, PsycINFO and CINAHL were searched between 2000 and 2021. Data were extracted and synthesised using thematic integrative analysis. The quality of included studies was assessed with the CASP Critical Appraisal Checklist. Results Ten qualitative research projects met the inclusion criteria. Four themes were identified (i) developing a safe and hopeful space, (ii) promoting a healing space, (iii) instilling connectedness and (iv) challenges to realising recovery-oriented care. Discussion Mental healthcare professionals perceived the principles of recovery-oriented care to be positive and include: therapeutic space, holistic care and person-centred care. Nevertheless, findings revealed limited knowledge and uncertainty of the recovery concept to be key barriers that may hinder implementation into practice. Implications for Practice Recovery-oriented practice must underpin consumer and family engagement, treatment choices and continuity of care to facilitate consumer's personal recovery.

Phenomenology yesterday, today, and tomorrow: a proposed phenomenological response to the double challenges of contemporary recovery-oriented person-centered mental health care.

This paper argues that a dialectical synthesis of phenomenology's traditional twin roles in psychiatry (one science-centered, the other individual-centered) is needed to support the recovery-oriented practice that is at the heart of contemporary person-centered mental health care. The paper is in two main sections. Section I illustrates the different ways in which phenomenology's two roles have played out over three significant periods of the history of phenomenology in 20th century psychiatry: with the introduction of phenomenology in Karl Jaspers' General Psychopathology in 1913; with the development a few years later of structural phenomenological psychopathology; and in the period of post-War humanism. Section II is concerned with the role of phenomenology in contemporary mental health. There has been a turn to phenomenology in the current period, we argue, in response to what amounts to an uncoupling of academic psychiatry from front-line clinical care. Corresponding with the two roles of phenomenology, this uncoupling has both scientific aspects and clinical aspects. The latter, we suggest, is most fully expressed in a new model of "recovery," defined, not by the values of professionals as experts-by-training, but by the values of patients and carers as experts-by-experience, specifically, by what is important to the quality of life of the individual concerned in the situation in question. We illustrate the importance of recovery, so defined, and the challenges raised by it for both the evidence-base and the values-base of clinical decision-making, with brief clinical vignettes. It is to these challenges we argue, that phenomenology through a synthesis of its twin roles is uniquely equipped to respond. Noting, however, the many barriers to such a synthesis, we argue that in the current state of development of the field, it is by way of a dialectical synthesis of phenomenology's roles that we should proceed. From such a dialectic, a genuine synthesis of roles may ultimately emerge. We conclude with a note on the wider significance of these developments, arguing that contrary to 20th century stereotypes, they show psychiatry to be leading the way for healthcare as a whole, in developing the resources for 21st century person-centered clinical care.

Perceptions of nurses working in mental health services regarding the recovery-oriented care approach: Findings from Africa.

The recovery-oriented care approach in mental health is recognised as the vision for mental health. People with a diagnosis of mental illness value the support and the individualistic approach emphasised in the recovery-oriented mental health care approach as they believe it facilitates their recovery. However, as a developing country, Botswana has a long way to go in availing mental health care resources to people with mental illness, let alone adopting new mental health approaches such as recovery. The study aimed to explore the perceptions of nurses working in mental health care facilities of recovery-oriented mental health care. Four mental health facilities from Botswana consented to participate in the study. A descriptive qualitative approach was utilised to explore nurses' views on how they perceive recovery from mental illness. Thirty nurses participated in the focus group discussions across the four study sites. All participants consented to participate and to be recorded. Tesch's (in Qualitative enquiry and research design: Choosing among five approaches. 3th ed. SAGE, 2013:198) thematic analysis was used for this study. Three main themes were identified in participants' perceptions of recovery-oriented care mental health: Recovery from mental illness is possible, the Meaning of recovery from mental illness and Factors facilitating recovery from mental illness. The study offers a perspective into how nurses perceive recovery-oriented approaches from a developing country and add to the gap existing in recovery-oriented mental health care approach from the African context.

The Belo Horizonte’s harm reducers as a possible and effective peer support experience

PurposeThis article aims to analyze the incorporation of harm reduction health workers with lived experience in all services focused on the care for drug users in Belo Horizonte’s mental health network, one of the largest Brazilian Psychosocial Care Networks (Rede de Atenção Psicossocial [RAPS]), and reports the findings of a qualitative study on the life stories, recovery journeys and the professional practice of harm reducers in Belo Horizonte.Design/methodology/approachFor the development of this research, the authors chose the following methodological tools: documentary research; follow-up of harm reduction interventions; access to harm reducers’ field diaries; joint writing of the life stories of the harm reducers.FindingsIt indicates that these professionals, as harm reducers empowered by their life experience, have developed various elements and active ingredients of peer support. Their practices and the results of their actions have consolidated their inclusion as Belo Horizonte RAPS’ health workers and highlight that recovery-oriented care and peer support are a real possibility in Brazil.Originality/valueIn this research, harm reducers are coauthors and report their own life experience. In this article, they also talk about the impact of this experience on their work and on the lives of users of mental health services, emphasizing the protagonism and exercise of citizenship by harm reducers.

Nurses' Perceptions on How Recovery-Oriented Mental Health Care Can Be Developed and Implemented.

This study explored how nurses working in inpatient mental health units perceived the development and implementation of a recovery-oriented mental healthcare programme (ROMHCP). The recovery-oriented mental healthcare approach (ROMHCA) in mental health is regarded as the future of mental health services and has been implemented in different countries worldwide. However, regarding developing and implementing the recovery approach, Africa appears to have been left behind by the rest of the continents. The study used a qualitative approach to describe how a recovery-oriented mental healthcare approach could be developed. Thirty nurses who worked in Botswana's four inpatient mental health facilities consented and voluntarily participated in the study. Data were collected from February to mid-March 2022 through online focus group discussions and analysed using thematic analysis. The COREQ checklist was used to report the findings. Two main themes emerged as follows: (i) developing and implementing a recovery-oriented mental healthcare programme is possible and (ii) certain elements are required to develop and implement ROMHCP. The participants believed that people diagnosed with mental illness could recover from the illness and suggested how it could be achieved. They also contended that the programme's success would lie mainly with multisectoral support from policymakers, facilities, hospital personnel, patients, and the community. Clinical Relevance. ROMHCP has the potential to benefit people with mental illness in the country. In addition, it would allow nurses to improve their knowledge and skills in managing mental illnesses. Patient or Public Contribution. The patients and the general public did not contribute to the study's concept, design, and outcomes. However, the nurses working in mental health facilities volunteered to participate in the study.

Community Psychiatric Mental Health Nursing: Practice and Challenges

Due to the rising incidence of social risk incidents, the Mental Health Act was amended to provide community treatment and community support for patients with mental illness. Community mental health centers have added a public sector function to follow-up with the care of mentally ill patients using case management as an integrated service model. Under this amendment, the unique role and task of community psychiatric mental healthcare should be framed and developed. The National Health Research Institutes have advocated recovery-oriented case management as a mental health policy. Thus, in line with this policy, the authors developed a need-tailored recovery program led by nurses that has demonstrated significant effectiveness with regard to the recovery of mentally ill patients. Also, a mobile-care platform was subsequently developed to assess the care needs of community-dwelling patients with mental illness, implement recovery-oriented care, and evaluate its effectiveness, which may be incorporated into evidence-based community psychiatric mental healthcare guidelines. To improve the practice of community psychiatric mental health nursing, this article addresses key community nursing contexts, including: psychiatric home treatment and care, community mental health centers, the needs-tailored recovery-oriented case management model, and the roles and certification of community psychiatric mental health nurses promoted by the psychiatric mental health nurses association. Finally, future challenges and strategies are proposed to improve the quality of community psychiatric mental healthcare and to assist patients move from mental disorder to recovery.

Community treatment orders: A qualitative study of stakeholder perspectives

IntroductionFor people with a serious mental disorder, a community treatment order (CTO) is a legal response that requires them to undergo psychiatric treatment unwillingly under certain conditions. Qualitative studies have explored the perspectives of individuals involved in CTOs, including persons with lived experiences of a CTO, family members and mental health care providers, who are directly involved in these procedures. However, few studies have integrated their different perspectives. MethodThis descriptive and qualitative study aimed to explore the experience associated with a CTO in hospital and community settings among individuals with a history of CTO, relatives, and mental health care providers. Using a participatory research approach, individual semi-structured interviews were conducted with 35 participants. The data were reviewed using content analysis. ResultsThree themes and seven sub-themes were identified: 1) differential positions as a function of meaning conferred to CTOs; 2) a risk management tool; and 3) coping strategies used to deal with CTOs. Overall, relatives' and mental health care providers' perspectives tended to be in opposition to those who went under a CTO. ConclusionsIn a context of recovery-oriented care, more research is needed to reconcile the seemingly contradictory positions of individual with experiential knowledge and the legal leverage that deprives them of their fundamental right to autonomy.

The ethical imperative of trauma-sensitive care for electroconvulsive therapy (ECT)

Background The empirical literature on the lived experience of electroconvulsive therapy (ECT) is limited, divergent, and largely focused on the experiences of procedures, (adverse) effects, information provision, or decision-making. Aims This study aimed to investigate aspects related to the lived experience and meaning-making of people who have had ECT. Method In-depth interviews with 21 women (21–65 years old) were analyzed using interpretative phenomenological analysis (IPA). Findings A subgroup of nine participants described more negative experiences with ECT. A common factor for these participants was the experience of trauma that remained under-treated. The superordinate themes identified were a lack of trauma-based and recovery-oriented treatment. The rest of the sample (12) expressed more positive experiences with ECT. Conclusions This study suggests that exploring more broadly the impacts of ECT at the long term offers insights that can help design more person-centered services aligned to the needs of the treatment recipients. Educational modules for mental health care staff should include, besides knowledge on the methods’ effectiveness, additional evidence about treatment recipients’ subjective concerns and the relevance of trauma and recovery-oriented care models.

Restrictive measures in forensic mental health and their role in recovery: a narrative literature review

Forensic mental health inpatient services are required to use restrictive interventions within their care and treatment, in the interests of security and risk management of people with mental illness and a history of criminal offence. However, such restrictive practices can often hinder the patient's process of recovery as well as the mental health professional's ability to provide recovery-oriented care. As some research suggests that restrictive measures are often favoured over more therapeutic options, there is a need to understand the influence this has on rehabilitation and the available alternatives. A narrative literature review was conducted to identify the specific restrictive measures that are used within these services and suggest alternative therapeutic strategies. A variety of methods of coercive treatment were identified, leading to recommendations around areas such as training, processes and therapeutic milieu.