Recovery-oriented Mental Health Practice Research Articles

Development of a culturally safe recovery-oriented mental health practice

Development of a culturally safe recovery-oriented mental health practice

The patient's perspective on participation in a multidisciplinary team meeting: A phenomenological study.

In mental health care settings, inpatients are increasingly engaged in their care process, allowing them to participate in multidisciplinary team meetings. Research into how mental health patients (MHPs) experience participating in such meetings is, however, limited. This study aimed to explore inpatients' experiences when participating in multidisciplinary team meetings in a Belgian inpatient mental health unit. This study used a phenomenological design with data collection including semistructured interviews. Twelve individuals participated in the study. Participants were MHPs admitted to a mental health unit that works according to the model of recovery-oriented mental health practice. Findings were analysed utilising thematic analysis. Results showed that the MHPs' experiences were mainly positive but intense. Themes included: 'Feeling honoured to be invited', 'Sense of obligation', 'Feeling nervous', 'Transparency in team members' insights', 'Feeling supported by the (primary) nurse' and 'Duality about the presence of relatives'. By taking these findings into account, (mental) healthcare workers gain insight into the patient's lived experiences, allowing them to provide more person-centred care when inpatients participate in multidisciplinary team meetings. Moreover, these findings can support mental health units in implementing or optimising patient participation in multidisciplinary team meetings. Finally, other (mental health) patients can also benefit from these findings as it can help them to put feelings and thoughts into perspective when participating in a multidisciplinary team meeting during a hospital admittance.

Practicing Cultural Humility Will Achieve Recovery-oriented Mental Health Practice and Service Delivery.

The authors have proposed incorporating the concept of cultural humility to achieve better recovery outcomes. While agencies have mandated staff training in cultural competence, health outcomes have not shown promising results. Given the shortcomings of cultural competence training, cultural humility is being suggested as a complementary approach. When providers adopt cultural humility into their interactions with service users, it encompasses underlying principles and values consistent with recovery-oriented practices. Cultural humility addresses power imbalances and emphasizes ongoing self-reflection and openness to interpersonal relationships. The authors believe that embracing cultural humility will promote dignity and respect, create a culture of collaboration and partnership, acknowledge the uniqueness of each individual, enhance person-centered care, and foster self-determination and autonomy. The application of a cultural humility lens can promote a recovery-oriented culture within mental health services, and it is the responsibility of providers to actively cultivate cultural humility. Overall, cultural humility presents new opportunities for practice, and its adoption may be a key factor in promoting a recovery-oriented culture within mental health services.

Posttraumatic growth and recovery among a sample of Egyptian mental health service users: a phenomenological study

BackgroundDelivery of recovery-oriented mental health practice is fundamental to personal recovery. Yet, there is lack of service users’ accounts on what constitutes mental health recovery in Egypt.ObjectivesThe aim of this study was to explore mental health recovery meaning informed by people with personal experience of recovery.MethodsA phenomenological research design was used. Semi-structured qualitative interviews were conducted with 17 adult community-dwelling individuals who identified as recovered/recovering from mental health issues. An inductive thematic analysis approach was used to analyses participants’ responses.ResultsParticipants predominately reported personal and functional definitions of mental health recovery. Posttraumatic growth was the strongest theme comprising: relation to others, spirituality, new possibilities, identity & strengths, and appreciation of life. Themes of acceptance and forgiveness, functional and clinical recovery, and finding hope were also identified.ConclusionsThis is the first study to explore mental health recovery meaning among a sample of people with lived experience of mental health issues in Egypt. Findings suggest that developing and implementing psychosocial interventions to support posttraumatic growth among people with mental health issues is a priority.

Perspectives on mental health recovery from Egyptian mental health professionals: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT?: Personal recovery concept is dominant in mental health systems when service user involvement is emphasized; however, service user involvement in mental health research and practice does not exist in Egypt. Definitions of recovery from high-income and English-speaking countries should be carefully adapted to other settings. Nurses providing mental health care in Egypt generally do not have specialized mental health nursing qualifications. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Both cultural and contextual uniqueness of Egypt as a Middle Eastern, low-middle-income country were clear in the findings of this paper. There are differences in the definition of family and service user engagement in the current study and in high-income countries. Seeking faith healers as a barrier to mental health recovery is culturally unique. Functional recovery prevails as a model in Egypt as there is limited service user involvement. Nursing values and code of ethics are consistent with enablers of mental health recovery. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Changing the pre-registration nursing education to prepare specialized graduates in mental health nursing. Training of mental health professionals on recovery approaches which involve service users is needed in Egypt. Mental health nurses in Egypt can use the current findings to implement national campaigns to raise public awareness of mental health problems. ABSTRACT: Introduction Recovery-oriented mental health practice is an emerging approach that aims to empower individuals to define their goals and take responsibility for their own recovery. However, mental health practice in Egypt is still custodial. Aim To explore perspectives of Egyptian mental health professionals on recovery. Method Semi-structured interviews were conducted with 15 mental health professionals identified through snowball sampling. Results The current study identified that functional recovery outweighed other definitions. Four facilitators of mental health recovery were identified: therapeutic relationship; family engagement; cultural sensitivity; and professionals' self-awareness. Six barriers to recovery were found, comprising mental health stigma and lack of awareness, seeking traditional healers, shortage of psychiatrists, cost of treatment, lack of training and effective rehabilitation programs. Discussion The concept of functional recovery predominates among nurses and other mental health professionals, which may be due to limited training and the historical lack of service user involvement in Egypt. Lack of support from family and society, inadequate training MHPs and perceived system inefficiencies are also major impeding factors for recovery. Implications for Practice There is a need for nurses to be involved in designing intervention programs targeting the general public and to support increased involvement of people with mental health issues.

The impact of workplace culture on the accountability of mental health nurses to involve consumers in care planning: A focused ethnography.

Recovery-oriented mental health practice guidelines recommend regular consumer involvement in care plans, yet in many acute settings, these are not routinely created thereby compromising accountability. This study explored the impact of workplace culture on the capacity of mental health nurses to involve consumers in care planning and consequently to work accountably. A focused ethnography was undertaken in one Australian inpatient unit involving mental health nurses and other health professionals. Data were derived from in-depth semistructured interviews with 12 nurses and 6 months of nonparticipant observation of multidisciplinary meetings and clinical handovers. Workplace culture had an impact on mental health nurses' accountability practices. A culture that prioritized reduction in length of stay resulted in less recovery-oriented care. Health professionals who paid more attention to crisis and risk management resulted in fewer opportunities for consumer-involved care planning.

Relationship-building in recovery-oriented mental health practice: valuing the role of emotions

Despite increased interest in relationships and emotions in social work, not enough is known about the role of emotions in recovery-oriented mental health care settings. Reflecting on my graduate research, I explore the inconsistent understandings and comfort levels with emotions in mental health social work practice. I make connections with findings which show that uneven attempts at relationship-building lead to missed opportunities for connection, understanding, and supporting recovery. I discuss the tensions faced by mental health practitioners implementing recovery-oriented interventions within a new public management and risk reduction paradigm of care and the ways that attending to emotions might help critique or dismantle the status quo. These reflections suggest pathways to resist these tensions through realizing the potential of emotions as a source of knowledge in constructing recovery-oriented mental health care interventions.

Well-being and needs of Malay carers of people with mental illness in Singapore.

Despite the importance of carers supporting the lives of people with mental illness, there are limited studies investigating the well-being and needs of Malay carers in multicultural Singapore. The Malays consist of 13.4% of Singapore's population. A mixed methods qualitative dominant research approach was used to explore the well-being and needs of Malay carers in a voluntary welfare organisation. The Kessler-10, Friendship Scale and Carers' and Users' Expectations of Services-Carer version were used to assess the needs and well-being of 17 Malay carers. Findings show that Malay carers experienced poor well-being and had numerous unmet needs. Four main themes were found: (a) Concerns related to relatives with mental illness, (b) Mental health practices related to carers, (c) Holistic support for carers and (d) Preference for greater spiritual support in mental health. Recovery-oriented mental health practice implications are discussed. Spirituality of Malay carers needs to be given greater consideration in recovery-oriented mental health services.

Recovery Attitudes and Recovery Practices Have an Impact on Psychosocial Outreach Interventions in Community Mental Health Care.

The most recent mental health policies implemented in the province of Québec, Canada, have emphasized recovery-oriented mental health practice. Part of this impetus has resulted in significant importance placed on the development of community mental health models in the public health system. The forms of community mental health programs have evolved considerably over time in Québec but are largely inspired by the evidence-based model of Assertive Community Treatment (ACT). However, if mental health policies and programs in Québec are now emphasizing the role of community mental health, it is also clear that actors on the field are implementing the evolving practice paradigms that dominate our mental health policies, such as recovery, participation, citizenship, in a variable way (1, 2). This article presents an ethnographic inspired research study conducted in 2014 and aims to contribute to the understanding of how recovery-oriented mental health policies are understood and implemented in an ACT team in downtown Montréal, Québec. With the aim of developing integrated knowledge on the issue of recovery in mental health and the conditions it presupposes, this research draws on field experiences from various actors, including service users with severe mental health problems, typically with concomitant disorders and complicated by substance use and/or living in a situation of homelessness. Using a critical constructivist approach, the research sought to a) explore how participants (stakeholders, users, and psychiatrists) achieve their social order; b) understand the meaning of recovery in mental health for participants and the actions associated with recovery as a process or as a practice; c) apprehend the potential of community interventions to connect the individual to the collective. The results indicate that the (over)use of medicolegal tools and the unchanging conception of “madness” represent obstacles to the sustained development of interventions centered on the person, his living conditions, and his recovery. Nevertheless, many interactions between service providers and service users indicate the potential for emerging recovery-oriented practice interventions, particularly when those interactions are based on positive and egalitarian conceptions between service providers and service users that led to the development of spaces for the co-construction innovative practice approaches.

Changing attitudes: The impact of Expert by Experience involvement in Mental Health Nursing Education: An international survey study.

Reform to nursing education is essential to ensure future generations of nurses are strongly positioned to value, know, and deliver strength-based, recovery-oriented mental health practice. A promising pathway to effectively drive reform is the coproduction of curricula by nursing academics and people with lived experience of recovery from mental distress referred to as Experts by Experience. The Co-production in Mental Health Nursing Education (COMMUNE) project is an international collaboration for development and implementation of consumer coproduced curricula. This study evaluated the inclusion of Expert by Experience-led mental health nursing education on nursing students' attitudes to people labelled with mental illness, mental health nursing, and consumer participation. A repeated self-report measures design was implemented in Australia, Ireland, and Finland to ascertain level of generalizability of consumer involvement within undergraduate nursing programmes. Data were collected from nursing students (n=194) immediately before and after the education module, using three self-report instruments on attitudes (Mental Health Nurse Education Survey, Consumer Participation Questionnaire, and Opening Minds Scale). Data were analysed using descriptive and inferential statistics. Eighty-nine per cent of the 27 points of change reflected more favourable and accepting attitudinal change. Of these, 41% were significant at Bonferroni adjusted alpha of 0.0025. There was a statistically significant increase in preparedness for practice in the mental health field in each of the three countries. The most pronounced change is related to the social and systemic inclusion of people with a diagnostic label and recovery-oriented care more broadly.

Review of Child and Adolescent Mental Health Recovery Literature: Concordance and Contention

This review explores and thematically analyzes recently published literature on personal mental health recovery for children and adolescents aiming to determine whether personal recovery-oriented mental health practice is wholly or partially applicable for children and adolescents with mental health issues. The study utilized a scoping review methodology to identify and explore the extent of English language peer reviewed literature specifically relating to mental health recovery for young people up to 18 years of age. Themes that emerged from these data were mapped to the five elements of the CHIME framework. Eight papers were identified that met the inclusion criteria illustrating a dearth of literature in the area of child and/or adolescent mental health recovery. Themes from the review included; developmental inclusion, recovery goals, hope and empowerment, locus of control, and connections with parents and family and peers, and connections with services and wider community. Recovery components were consistent with the CHIME framework and generally thought applicable for adolescents but require consideration of child development needs and familial influences to be relevant for younger children. Personal recovery-oriented practice is considered suitable for adolescents with modifications for children. Future research and practice are suggested to increase understanding in this area.

Recovery-Oriented Mental Health Practice in a Community Care Unit: An Exploratory Study.

A recovery-oriented model of care has become the major focus of mental health service delivery in the state of Victoria, Australia. However, there is a total absence of knowledge of recovery-oriented mental health practice in community care units (CCUs). Therefore, the aims of this exploratory study were to: (a) describe what aspects of the current model of care fit within the domains of recovery; and (b) describe the pragmatic processes that staff use to mold their care within the domains of recovery. Twenty-one key stakeholders provided informed voluntary consent to participate in one-to-one interviews. Six content domains evolved to include: (a) a common vision: "a continuous journey"; (b) promoting hope; (c) promoting autonomy and self-determination; (d) meaningful engagement; (e) holistic and personalized care; and (f) community participation and citizenship. The CCU appeared to be on a journey of transformation toward personal recovery. However, clinicians were grappling with an identified tension among personal recovery and clinical recovery. The tension among personal recovery and clinical recovery may be attributed to the psychosocial rehabilitation model of care, which was previously systemic in Victorian CCUs.

Recovery-Oriented Mental Health Practice: A Social Work Perspective

This paper explores the concept of recovery-oriented social work practice in mental health settings as it is understood and practised by social workers. The authors describe an investigation of the implementation of mental health reforms in Quebec. This study explored the gap between the reforms' philosophical orientations of mental health recovery and its practical realisation. Specifically, we will discuss the ways in which the social work field encompasses approaches that potentially espouse contradictory understandings of recovery. The study highlights the external and internal obstacles and facilitators to recovery-oriented social work practice. This qualitative research project used semi-structured interviews with eleven primary care mental health social workers in two health care agencies to better understand how they situate themselves with respect to the recovery orientation. The findings illustrate the impact of organisational constraints on social workers' attempts to practise from a recovery-oriented perspective. Specifically, they show that (i) managerial orientations espoused by the reforms have paradoxically led to systemic barriers to recovery-oriented practice and (ii) recovery practice by social workers is facilitated in part by their understanding of this philosophy and by leadership on the part of their managers. This paper will allow for a better understanding of social work perspectives and practical frustrations regarding current primary care mental health practice.

From experience to action in recovery-oriented mental health practice: A first person inquiry

This article reports on the development of critical subjectivity, in a cooperative inquiry study, which aimed to use principles of consumer participation to explore and develop recovery-oriented care in a regional mental health service in rural Australia. The development of critical subjectivity occurred when the lead researcher began to understand her role as an ‘insider’ in perpetuating dominant institutional culture through her work practices. The findings illustrate the way lived experience perspectives were excluded, invisible and considered ‘outsider’ in relation to dominant biomedical epistemology. As the researcher participated in a more relational participatory process and documented her thinking, her knowledge of her work practices began to change and this contributed to the transformation in her practice. Action research is a tool that supports shared dialogue to enable culture change necessary for recovery-oriented practice.

Spiritual Interventions with Consumers in Recovery from Mental Illness

With the onset and persistence of severe mental illness, consumers face major challenges to their spiritual values and belief systems. They experience disruptions to their sense of self and, as such, often dwell openly on concerns related to purpose and meaning in life. Assessing and intervening with respect to consumers' spiritual concerns is thus often important in recovery-oriented mental health practice. The purpose of this article is to consider how direct practitioners can help consumers address and develop their spiritual inclinations when they identified among their personal goals.

A Basic Criterion for Transformation

Back to table of contents Next article Taking IssueFull AccessA Basic Criterion for TransformationLarry Davidson Ph.D.,Larry Davidson Ph.D.Search for more papers by this author,Published Online:1 Aug 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail As systems of care take up the challenge of transformation, various perspectives will arise on the desired outcomes of this process. Systems enter the process at different points, with different resources, and with different ideas of what they seek to achieve. This diversity can be useful, as homegrown strategies can be tested, successful approaches shared, and solutions tailored to ever-changing conditions.I am concerned, however, that systems have already begun labeling as "recovery oriented" some services they have been providing for the past 30 years and have introduced as "transformative" new programs that leave much of the existing system intact. This concern is reinforced by the report in this issue by Rogers and colleagues, in which psychiatrists viewed the implications of recovery as limited to increased funding for rehabilitation, not appreciating how all mental health care, including their own practice, needs to be reoriented toward recovery. Such limited changes fall well short of the "fundamental refashioning" called for by the President's New Freedom Commission and risk repackaging old wine in new bottles. To avoid this temptation, perhaps we could achieve a consensus on the bare minimum we need to accomplish before transformation can be said to have occurred. I would like to propose one such minimum criterion.The "promise" we have yet to achieve, to which the title of the New Freedom Commission report refers, was the promise first made a half century ago, that people with mental illnesses would be able to live "in the community in a normal manner." Given that the New Freedom Commission's vision is likewise "a life in the community for everyone," I propose that people do not have a life in the community as long as, and to the degree to which, they remain hospitalized. Having a life in the community should not equate with residing in an institution. Hospitals serve an important function in recovery-oriented systems of care, offering acute care for acute episodes. Since the Olmstead decision, however, hospitals can no longer be considered acceptable places to live. Systems that invest scarce resources in training inpatient staff in person-centered planning, hoping to transform care by offering patients choices of meal times, neglect the fact that most people confined to hospitals would choose to live in the community. Such individuals, who still number in the tens of thousands, need safe, affordable housing options with responsive supports. Although transformation can involve more than this, it should not involve less. As the commission report makes clear, we now know how to afford people a life in the community. Achieving this promise is where and when true transformation will begin. Department of Psychiatry, Yale University FiguresReferencesCited byDetailsCited ByThe meaning of recovery in a regional mental health service: an action research study5 July 2014 | Journal of Advanced Nursing, Vol. 71, No. 1From experience to action in recovery-oriented mental health practice: A first person inquiry26 May 2014 | Action Research, Vol. 12, No. 4Not Just an Individual Journey: Social Aspects of Recovery15 October 2009 | International Journal of Social Psychiatry, Vol. 57, No. 1 Volume 58Issue 8 August, 2007Pages 1029-1029PSYCHIATRIC SERVICES August 2007 Volume 58 Number 8 Metrics PDF download History Published online 1 August 2007 Published in print 1 August 2007