Personal Recovery Processes Research Articles

Electronically enabled synergies between mental health treatment and peer support: A catalyst for quality improvement

Background and objective: Quality improvement (QI) programs aim to put into place ways of assessing health service performance and in pinpointing areas of improvement in line with available evidence. Patient and service user involvement is a core pillar in QI. In this study, based on user involvement principles, an Internet-based tool aiming to promote recovery and service user saprovider collaboration was pilot-tested by 32 mental health service users and at least one of their providers for a minimum of 6 months and maximum 12 months. Two community mental health services in the north and south of Norway participated this action-oriented study. Accessed through a secure log-on, service users ‘owned’ the tool which augmented ongoing treatment. The options offered by the tool were used however service users and their providers saw fit. Providers had access to portions of the service user-generated content. In addition to secure messaging between service users and providers and an anonymous peer-led discussion forum (not accessible to providers), the tool offered resources to support service users in articulating and monitoring their personal recovery processes, e.g.: life domain status, goals, medications, network map, diary and exercises (e.g. mindfulness). In this paper we ask; how are service users’ uses and experiences with the peer-support forum associated with QI? Methods: To be included, participants had to have received mental health treatment least 6 months prior to inclusion, and have expectations of needing treatment at least 6 months ahead. The forum was hosted by an employed peer-consultant/co-researcher who ensured a safe and supportive environment, and who introduced topics for discussion (e.g. recovery, collaboration). Service users from both community sites were pooled in one forum. Data was derived from 1050 forum postings, 3 focus groups with service users and 3 with providers, 11 individual interviews and 12 peer-led, face-to-face workshops (‘cafes’). These were conducted strategically throughout the pilot period, audio-taped, transcribed and entered into NVivo. Qualitative data were analyzed using a thematic analysis approach and one of the themes identified was (preliminarily) categorized as QI. Results: Participants’ ongoing treatment, and how to improve it, became one of a wide range of topics discussed in the forum. Examples of QI-related topics include; how to help providers listen more carefully to participant needs by being more specific and assertive in stating their needs; how use of the goal-module during in-person consultations helped in getting the provider to focus more on specific personal goals. Over time, some service users took actions based on these types of discussions, the results of which were reported and assessed in subsequent supportive discussions. Discussion and conclusion : Tool uses and participant reports offer rich illustrations of service user involvement in their own treatment in ways that did not exist prior to tool use. The three-way link between ongoing treatment, participant access to a common recovery tool and a peer-support forum provides a unique arena for pinpointing areas where service quality may be improved. Future studies are needed to determine how to optimally leverage this innovation and to assess the impact that alternative models of use may have on service quality.

Making sense of changing health landscapes- new demands for research and evaluations

Making sense of changing health landscapes- new demands for research and evaluations

Facilitators of recovery for step-up and step-down clients of a sub-acute residential mental health service

Background: Sub-acute residential mental health services provide care for people who are not acutely unwell but require more support than generally available when living in the community. Little is known about how these services facilitate recovery and whether these facilitators differ for clients entering from the community (step-up) or from inpatient settings (step-down).Aim: To identify features of a sub-acute residential service that have assisted step-up and step-down clients in their recovery.Method: Semi-structured interviews were conducted with 16 step-up and 21 step-down clients. Interview transcripts were examined using an inductive, semantic content analysis approach.Results: Themes identified included the community context, personal support, the formal program offered and assistance in personal recovery processes, with the level of support for these themes differing for step-up and step-down clients.Conclusions: Step-up and step-down clients have differing needs to be addressed in a sub-acute service. These services can better meet the needs of clients if they are aware of the setting the client has come from and tailor their services accordingly. Step-up clients prefer support in developing social skills and illness management techniques; step-down clients prefer a less structured environment with assistance in living skills and personal processes of recovery.

Personal recovery within forensic settings--Systematic review and meta-synthesis of qualitative methods studies.

Many mental health services now explicitly aim to support personal recovery. Are there special ethical and practical considerations for application of this model in forensic mental health services? Is there, for example, any conflict in this context between personal empowerment and risk management? Our aim was to develop a model of the personal recovery processes for people needing forensic mental health services. A systematic literature review was conducted and meta-synthesis applied to data from relevant papers. Five studies were identified through the search process and combined through meta-synthesis. Three key overarching themes were synthesised: safety and security as a necessary base for the recovery process, the dynamics of hope and social networks in supporting the recovery process and work on identity as a changing feature in the recovery process. The themes identified provide for theoretically informed and testable developments in care that could enhance the quality of recovery and rehabilitation for offender patients through explicitly enhancing personal sense of safety, understanding the patient's sense of personal identity and their social networks and transitioning between institutional and community support.

Psychosocial outcomes after traumatic brain injury: life satisfaction, community integration, and distress.

To examine the relationship between life satisfaction, community integration, and emotional distress in adults with traumatic brain injury (TBI). This was an archival study of a longitudinal data set on the outcome and recovery process of persons with TBI. Participants were 253 consecutive adults with mild complicated, moderate, and severe TBI who were enrolled in a large, longitudinal study of persons with TBI. Main measures included the Satisfaction with Life Scale, the Positive Affective and Negative Affective Schedule, the Craig Hospital Assessment and Reporting Technique Short-Form, the Community Integration Measure, and the Brief Symptom Inventory-18. The three-factor model adequately fit the data, and a higher-order model did not necessarily improve model fit but revealed significant relationships with first-order constructs and one second-order construct. Life satisfaction, community integration, and emotional distress were found to be related yet unique concepts in persons with TBI. Life satisfaction was positively related to community involvement and inversely related to emotional distress. Community integration was inversely related to emotional distress. In addition, these concepts are related to a higher-order concept of psychosocial status, a global representation of subjective and objective functioning. These findings demonstrate the interrelated and dynamic nature of psychosocial well-being after brain injury and highlight the need for integrative and holistic treatment plans.

Towards a new professionalism: the case of using a multi-system collaboration approach to enhancing the recovery process of persons with severe mental illness

Towards a new professionalism: the case of using a multi-system collaboration approach to enhancing the recovery process of persons with severe mental illness

Toward Understanding Music Therapy as a Recovery-Oriented Practice within Mental Health Care: A Meta-Synthesis of Service Users' Experiences.

The perspective of mental health recovery is increasingly shaping mental health care policies. Current texts in music therapy identify the importance of this critical and user-oriented perspective, but the relevance and implications for music therapy need to be outlined. This study explores service users' experiences of music therapy in mental health care, and the potential role of music therapy in the development of recovery-oriented service provision. We conducted a qualitative meta-synthesis of studies examining service users' experiences in music therapy; included were 14 studies with a total of 113 participants. Both first-hand account of participants and the researchers' representations of such statements were taken into account in the analysis. A taxonomy of four areas of users' experiences was identified: "having a good time;" "being together;" "feeling;" and "being someone." These core categories point towards music therapy as an arena that can be used by persons with mental health problems in their personal and social recovery process. Music therapy can contribute to the quality of mental health care by providing an arena for stimulation and development of strengths and resources that may contribute to growth of positive identity and hope for people with mental illness. The findings from this meta-synthesis indicate that the provision of music therapy closely resembles recognized benefits of a recovery-oriented practice. Awareness of users' self-determination and the development of a strength-based and contextual approach to music therapy that fosters mutual empowering relationships are recommended.

Measuring recovery: Validity of the “Recovery Process Inventory” and the “Recovery Attitudes Questionnaire”

Considerable lack of publications and inconsistent results on construct validity make it difficult to choose an appropriate instrument to measure recovery. The aim of the present study was to evaluate additional psychometric aspects of two established measures of personal recovery with differing focusses. Bivariate associations of the recovery measures with personal, clinical and subjective factors were conducted as indicators of concurrent (convergent and divergent) validity. The scales were also tested concerning internal consistency. The sample comprised of 81 inpatients on an acute psychiatric ward (main diagnoses: 27% substance-related disorders, 27% schizophrenic disorders, 25% affective disorders, 10% neurotic or stress-related disorders, and 11% personality disorders). The “Recovery Attitudes Questionnaire (RAQ)” has to be reevaluated before further administration due to serious psychometric shortcomings concerning internal consistency and concurrent validity. The “Recovery Process Inventory (RPI)” total scale showed acceptable concurrent and within-scale validity and can be recommended in order to measure the personal recovery process for clinical and scientific purposes.

I am Me! Experiencing Parenting While Dealing With One's Own Bipolar Disorder

This article aims at achieving insight into acquiring an understanding of parenting while dealing with one's own bipolar disorder. It is based on results from in-depth interviews of six parents with bipolar disorder, and analyzed using guidelines from interpretative phenomenological analysis (IPA). The results from the study suggest the parents experienced diverse, complex, compound, and demanding challenges. However, the results also highlighted the fact that parents went through a “change and growth” process, in which they developed an experience-based competence perceived as being useful due to their living situation, including the strengthening of their parenting function and their personal recovery process. Aspects about how the time dimension in recovery, as well as how parents' dependence on their children can play both a central and paradoxical role in their lives, are discussed, which is then followed by implications for the support system.

P-1186 - The recovery process of persons living with psychiatric disabilities: values and principles of nova aurora community association psychosocial rehabilitation program

The Nova Aurora Community Association psychosocial rehabilitation program was developed based in the most current values of Psychosocial Rehabilitation. Some nuclear assumptions were considered, such as a) suppressing the disease stigma, b) defocusing from the mental ill role, promoting empowerment and self-determination, c) developing personal competencies directly related to the individuals’ social integration specific context (readiness, cognitive, social, emotional stress management, employability). To present the rational of this program and the outcomes of a pilot study designed to test if this psychiatric rehabilitation program effectively helps persons living with psychiatric disabilities become more successful and satisfied in living, learning, working, and social environments of their choice. The program is being implemented for 13 months to 38 persons living with psychiatric disabilities and it is developed in 2 main levels: a) tranversal competencies (neurocognitive, stress and illness management, healthy lifestyle, self efficacy and anti-self-stigma); b) specific competencies directly related to the individuals’ social integration specific context (employability/housing, social cognition, etc). All users still frequent an empowerment center and develop sport and leisure activities. It is also available home support and family psicoeducation. The program effectiveness assessment integrated pre and post tests, evaluating all these different functional domains and life quality and program satisfaction. Preliminary results point towards very positive outcomes, specifically regarding personal competencies development, satisfaction level with the program, reduction of relapse, and absence rates. Although these results are promising, this research is an initial step in establishing the efficiency of this rehabilitation program.