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Papastavrou Brooks C, Kafle E, Butt N, Chawner D, Day A, Elsby-Pearson C, Elson E, Hammond J, Herbert P, Jenkins CL, Johnson Z, Keith-Roach SH, Papasileka E, Reeves S, Stewart N, Gilbert N, Startup H. Co-producing principles to guide health research: an illustrative case study from an eating disorder research clinic. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:84. [PMID: 37730642 PMCID: PMC10510247 DOI: 10.1186/s40900-023-00460-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/26/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND There is significant value in co-produced health research, however power-imbalances within research teams can pose a barrier to people with lived experience of an illness determining the direction of research in that area. This is especially true in eating disorder research, where the inclusion of co-production approaches lags other research areas. Appealing to principles or values can serve to ground collaborative working. Despite this, there has not been any prior attempt to co-produce principles to guide the work of a research group and serve as a basis for developing future projects. METHODS The aim of this piece of work was to co-produce a set of principles to guide the conduct of research within our lived experience led research clinic, and to offer an illustrative case for the value of this as a novel co-production methodology. A lived experience panel were recruited to our eating disorder research group. Through an iterative series of workshops with the members of our research clinic (composed of a lived experience panel, clinicians, and researchers) we developed a set of principles which we agreed were important in ensuring both the direction of our research, and the way in which we wanted to work together. RESULTS Six key principles were developed using this process. They were that research should aim to be: 1) real world-offering a clear and concrete benefit to people with eating disorders, 2) tailored-suitable for marginalised groups and people with atypical diagnoses, 3) hopeful-ensuring that hope for recovery was centred in treatment, 4) experiential-privileging the 'voice' of people with eating disorders, 5) broad-encompassing non-standard therapeutic treatments and 6) democratic-co-produced by people with lived experience of eating disorders. CONCLUSIONS We reflect on some of the positives as well as limitations of the process, highlighting the importance of adequate funding for longer-term co-production approaches to be taken, and issues around ensuring representation of minority groups. We hope that other health research groups will see the value in co-producing principles to guide research in their own fields, and will adapt, develop, and refine this novel methodology.
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Affiliation(s)
- Cat Papastavrou Brooks
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK.
| | - Eshika Kafle
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
| | - Natali Butt
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
| | - Dave Chawner
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
- Comedy for Coping, Aesthetics Research Centre, University of Kent, Room 2.16, Jarman Building, Canterbury, Kent, CT2 7UG, UK
| | - Anna Day
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
| | - Chloë Elsby-Pearson
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
| | - Emily Elson
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
| | - John Hammond
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
| | - Penny Herbert
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
| | - Catherine L Jenkins
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
| | - Zach Johnson
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
| | - Sarah Helen Keith-Roach
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
| | - Eirini Papasileka
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
- Department of Psychology, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Stella Reeves
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
- School of Human and Behavioural Sciences, Bangor University, Bangor, LL57 2DG, UK
| | - Natasha Stewart
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
| | - Nicola Gilbert
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
- Maudsley Learning, ORTUS Conferencing and Events Venue, 82-96 Grove Lane, London, SE5 8SN, UK
| | - Helen Startup
- SPIRED Clinic, Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK
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Aggestrup AS, Martiny F, Faurholt-Jepsen M, Hvenegaard M, Christensen R, Davidsen AS, Martiny K. Interventions promoting recovery from depression for patients transitioning from outpatient mental health services to primary care: Protocol for a scoping review. PLoS One 2023; 18:e0291559. [PMID: 37713450 PMCID: PMC10503712 DOI: 10.1371/journal.pone.0291559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/01/2023] [Indexed: 09/17/2023] Open
Abstract
INTRODUCTION Patients with severe Major Depressive Disorder (MDD) have an increasing risk of new psychiatric hospitalizations following each new episode of depression highlighting the recurrent nature of the disorder. Furthermore, patients are not fully recovered at the end of their treatment in outpatient mental health services, and residual symptoms of depression might explain why patients with MDD have a high risk of relapse. However, evidence of methods to promote recovery after discharge from outpatient mental health services is lacking. The proposed scoping review aims to systematically scope, map and identify the evidence and knowledge gaps on interventions that aims to promote recovery from MDD for patients transitioning from outpatient mental health services to primary care. MATERIALS AND METHODS The proposed scoping review will follow the latest methodological guidance by the Joanna Briggs Institute (JBI) in tandem with the Preferred Reporting Items for Systematic reviews and Meta-Analysis-extension for Scoping Reviews (PRISMA-ScR) checklist. The review is ongoing. Four electronic databases (Medline via PubMed, PsycINFO, CINAHL, and Sociological Abstracts) were systematically searched from 20 January 2022 till 29 March 2022 using keywords and text words. The review team consists of three independent screeners. Two screeners have completed the initial title and abstract screening for all studies retrieved by the search strategy. Currently, we are in the full text screening phase. Reference lists of included studies will be screened, and data will be independently extracted by the review team. Results will be analyzed qualitatively and quantitatively. DISCUSSION The chosen methodology is based on the use of publicly available information and does not require ethical approval. Results will be published in an international peer reviewed scientific journal, at national and international conferences and shared with relevant authorities. REGISTRATION A pre-print has been registered at the medRxiv preprint server for health sciences (doi.org/10.1101/2022.10.06.22280499).
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Affiliation(s)
- Anne Sofie Aggestrup
- Copenhagen Affective Disorder Research Centre (CADIC), New Interventions in Depression (NID) Group, Mental Health Centre Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Martiny
- The Research Unit for and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Social Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Centre (CADIC), Mental Health Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Morten Hvenegaard
- Competence Centre for Rehabilitation and Recovery, Mental Health Centre Ballerup, Ballerup, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital & Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Annette Sofie Davidsen
- The Research Unit for and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Martiny
- Copenhagen Affective Disorder Research Centre (CADIC), New Interventions in Depression (NID) Group, Mental Health Centre Copenhagen, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Rapaport P, Kidd G, Jeraldo RE, Mason A, Knapp M, Manthorpe J, Shulman C, Livingston G. A qualitative exploration of older people's lived experiences of homelessness and memory problems - stakeholder perspectives. BMC Geriatr 2023; 23:556. [PMID: 37700235 PMCID: PMC10498566 DOI: 10.1186/s12877-023-04250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/23/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The numbers of older people experiencing both homelessness and memory problems are growing, yet their complex health, housing and care needs remain undelineated and unmet. There is a critical gap in understanding what can improve the care, support and experiences of this group. In this qualitative study we explore how stakeholders understand memory problems among older people in the context of homelessness and consider what they judge gets in the way of achieving positive outcomes. METHOD We conducted reflexive thematic analysis of qualitative interviews (n = 49) using a semi-structured topic guide, with 17 older people (aged ≥ 50 years) experiencing memory problems and homelessness, 15 hostel staff and managers, and 17 health, housing and social care practitioners. We recruited participants from six homelessness hostels, one specialist care home and National Health and Local Authority Services in England. RESULTS We identified four overarching themes. The population is not taken seriously; multiple causes are hard to disentangle; risk of exploitation and vulnerability; and (dis)connection and social isolation. The transience and lack of stability associated with homelessness intensified the disorienting nature of memory and cognitive impairment, and those providing direct and indirect support required flexibility and persistence, with staff moving beyond traditional roles to advocate, provide care and safeguard individuals. Memory problems were perceived by frontline staff and older people to be overlooked, misinterpreted, and misattributed as being caused by alcohol use, resulting in pervasive barriers to achieving positive and desired outcomes. CONCLUSIONS Efforts to meet the needs of older people living with memory problems and experiencing homelessness and future interventions must reflect the complexity of their lives, often in the context of long-term alcohol use and current service provision and we make suggestions as to what could be done to improve the situation.
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Affiliation(s)
- Penny Rapaport
- UCL Department of Mental Health of Older People, Division of Psychiatry, Wing B, Floor 6 Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK.
| | - Garrett Kidd
- UCL Department of Mental Health of Older People, Division of Psychiatry, Wing B, Floor 6 Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
| | - Rosario Espinoza Jeraldo
- UCL Department of Mental Health of Older People, Division of Psychiatry, Wing B, Floor 6 Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
| | - Ava Mason
- UCL Department of Mental Health of Older People, Division of Psychiatry, Wing B, Floor 6 Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK
- NIHR Applied Research Collaboration (ARC) South London, London, UK
| | - Caroline Shulman
- Pathway, London, UK
- Healthy London Partnership, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Gill Livingston
- UCL Department of Mental Health of Older People, Division of Psychiatry, Wing B, Floor 6 Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Granholm Valmari E, Melander M, Hariz GM, Naesström M, Lindström M. Translation and linguistic validation of the Swedish recovering quality of life (ReQoL) - A brief research report. Front Psychiatry 2023; 14:1059406. [PMID: 36824668 PMCID: PMC9941141 DOI: 10.3389/fpsyt.2023.1059406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/18/2023] [Indexed: 02/10/2023] Open
Abstract
In research and among clinicians, the focus has shifted from mainly symptom reduction and increasing functionality to a more recovery-oriented focus. Although there are instruments measuring recovery, there has been a lack of instruments sensitive enough to measure the quality of life for people with severe mental health disorders. Therefore, this study aimed to obtain a Swedish version of the Recovering Quality of Life (ReQoL) questionnaire adhering to best practice guidelines using various steps of translation, linguistic validation, and cognitive debriefing. The cognitive debriefing was conducted with seven participants, and all felt the items in the questionnaire were relevant to their health, apprehensible, and easy to complete. However, some issues were raised regarding wording and the concepts behind certain items. All feedback was considered, and some items were revised in response to criticism after continuous discussions. A Swedish version of ReQoL now exists, and although there is a need for ReQoL in different clinical research settings in Sweden, further research is required to psychometrically test the construct validity as well as reliability of the Swedish version in Sweden.
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Affiliation(s)
- Elin Granholm Valmari
- Occupational Therapy Unit, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Marianne Melander
- Psychiatric Unit, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Gun-Marie Hariz
- Occupational Therapy Unit, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.,Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Matilda Naesström
- Psychiatric Unit, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Maria Lindström
- Occupational Therapy Unit, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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Johansson JA, Holmes D. The use of recovery model in forensic psychiatric settings: A Foucauldian critique. Int J Ment Health Nurs 2022; 31:752-760. [PMID: 35434836 DOI: 10.1111/inm.13005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Abstract
Recovery, a model of care aimed at patient-led nursing practice emphasizing autonomy, hope and self-determination, has in recent years been adapted for the secure forensic psychiatric setting. Often referred to as 'secure recovery', this model suggests the aims of recovery are achievable even in highly restrictive settings. This paper will adopt a Foucauldian perspective to offer a critical analysis of recovery in forensic settings. In providing recovery-oriented care, nurses utilize pastoral power in guiding patients to institutionally preferred outcomes. Akin to Christian religious conversion, nurses engage in a neo-religious conversion of patients to a neoliberal subjectivity of homo-economicus. This path of recovery is grounded in an ethos of personal responsibility and self-government, inseparable from the greater context of neoliberal governmentality. Despite attempts at transforming forensic nursing practice into more egalitarian directions, recovery remains a coercive practice, and fails to meet the overall goals of this paradigm in secure settings.
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Affiliation(s)
| | - Dave Holmes
- University of Ottawa, Ottawa, Ontario, Canada
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Trustam E, Chapman P, Shanahan P. Making recovery meaningful for people with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:252-260. [PMID: 34676652 DOI: 10.1111/jar.12944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND A recovery approach within mental health services has gained momentum. Its meaning for adults with intellectual disabilities recovering from mental health disorders is less understood. Peoples' experiences of recovery were explored to help inform recovery-focused recommendations for clinical practise. METHOD A qualitative design using interpretative phenomenological analysis was applied. Nine interviews with people with intellectual disabilities who had experienced mental health disorders were conducted. RESULTS Two themes that emerged focusing on entry to service and the recovery experience. Subthemes for entry to service included unfair treatment, valuing information and managing expectations. The recovery experience subthemes were therapeutic alliance, self-management, emotional development, autonomy, connectedness, positive identity and a belief in recovery. CONCLUSIONS Hearing peoples' experiences directly allowed the current themes to emerge in the context of living with lifelong disabilities. This article adds to the sparse literature and highlights considerations for recovery-based interventions for people with intellectual disabilities.
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Affiliation(s)
- Emma Trustam
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Kent, UK.,Mental Health Learning Disabilities, South London and Maudsley NHS Foundation Trust, London, UK.,Your Healthcare CIC, Surbiton, UK
| | | | - Paul Shanahan
- Your Healthcare CIC, Surbiton, UK.,Department of Psychology, University of Surrey, Surrey, UK
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Bennett A, Hanna P. Exploring the Experiences of Male Forensic Inpatients' Relationships with Staff within Low, Medium and High Security Mental Health Settings. Issues Ment Health Nurs 2021; 42:929-941. [PMID: 33914668 DOI: 10.1080/01612840.2021.1913683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Therapeutic relationships within psychiatric settings are highlighted as important throughout the literature. However, research from the forensic inpatient perspective is limited. We address this gap by exploring the patient-staff relationships within forensic mental health inpatient services, from the patient's perspective. Thirty adult male forensic inpatients were interviewed about their experiences on the ward and their interactions with staff. Our analysis examines inpatients experiences of respectful and reciprocal relationships, relationships that empower, a disinterest in their patients' and authoritarian relationships. This study concludes by highlighting the need to prioritise the development of reciprocal relationships within forensic services.
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Affiliation(s)
- Alice Bennett
- Department of Psychological Interventions, University of Surrey, Guildford, UK
| | - Paul Hanna
- Department of Psychological Interventions, University of Surrey, Guildford, UK
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Implementation of a positive psychology group program in an inpatient eating disorders service: a pilot study. Eat Weight Disord 2021; 26:679-688. [PMID: 32350775 DOI: 10.1007/s40519-020-00908-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/15/2020] [Indexed: 10/24/2022] Open
Abstract
CONTEXT Eating disorders (ED) are very difficult conditions to treat. Therefore, interventions in this field are shifting their main target towards the disorder's impact in quality of life, rather than ED symptomatology in itself. In this sense, a focus in the promotion of positive emotions and well-being is emerging to ameliorate the harmful effects caused by ED. However, evidence of the potential benefits of this type of interventions is still scarce. PURPOSE This study introduces a 4-week positive psychology group program specifically designed for ED patients' needs and to present data about feasibility and acceptability. METHOD Seven female inpatients of an eating disorder service aged from 13 to 38 years old attended the group. Measures of affect and optimistic thinking were taken before the program and after each session. RESULTS The program was very well rated by participants, and there was no attrition. Furthermore, possible benefits were found in terms of optimistic thinking at the end of the group program, and these benefits were noticeable, but non-significant, in the case of affect. CONCLUSIONS This study opens the door to conduct larger and controlled studies for testing interventions aimed at promoting positive emotions and well-being in ED populations. Thus, these interventions could support the efficacy of current treatments in order to improve patients' quality of life. LEVEL OF EVIDENCE Level IV, multiple time series analysis, with the intervention.
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Roth C, Wensing M, Koetsenruijter J, Istvanovic A, Novotni A, Tomcuk A, Dedovic J, Djurisic T, Milutinovic M, Kuzman MR, Nica R, Bjedov S, Medved S, Rotaru T, Hipple Walters B, Petrea I, Shields-Zeeman L. Perceived Support for Recovery and Level of Functioning Among People With Severe Mental Illness in Central and Eastern Europe: An Observational Study. Front Psychiatry 2021; 12:732111. [PMID: 34621196 PMCID: PMC8490702 DOI: 10.3389/fpsyt.2021.732111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/23/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Many people with severe mental illness experience limitations in personal and social functioning. Care delivered in a person's community that addresses needs and preferences and focuses on clinical and personal recovery can contribute to addressing the adverse impacts of severe mental illness. In Central and Eastern Europe, mental health care systems are transitioning from institutional-based care toward community-based care. The aim of this study is to document the level of functioning and perceived support for recovery in a large population of service users with severe mental illness in Central and Eastern Europe, and to explore associations between perceived support for recovery and the degree of functional limitations. Methods: The implementation of community mental health teams was conducted in five mental health centers in five countries in Central and Eastern Europe. The present study is based on trial data at baseline among service users across the five centers. Baseline data included sociodemographic, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for functional limitations, and the Recovery Support (INSPIRE) tool for perceived staff support toward recovery. We hypothesized that service users reporting higher levels of perceived support for their recovery would indicate lower levels of functional limitation. Results: Across all centers, the greatest functional limitations were related to participation in society (43.8%), followed by daily life activities (33.3%), and in education or work (35.6%). Service users (N = 931) indicated that they were satisfied overall with the support received from their mental health care provider for their social recovery (72.5%) and that they valued their relationship with their providers (80.3%). Service users who perceived the support they received from their provider as valuable (b = -0.10, p = 0.001) and who reported to have a meaningful relationship with them (b = -0.13, p = 0.003) had a lower degree of functional limitation. Conclusion: As hypothesized, the higher the degree of perceived mental health support from providers, the lower the score in functional limitations. The introduction of the community-based care services that increase contact with service users and consider needs and which incorporate recovery-oriented principles, may improve clinical recovery and functional outcomes of service users with severe mental illness.
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Affiliation(s)
- Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, Heidelberg, Germany
| | - Jan Koetsenruijter
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, Heidelberg, Germany
| | - Ana Istvanovic
- Croatian Institute of Public Health, Rockefellerova, Zagreb, Croatia
| | - Antoni Novotni
- University St. Cyril and Methodius, University Clinic of Psychiatry, Skopje, North Macedonia
| | - Aleksandr Tomcuk
- Health Institution Special Psychiatric Hospital Dobrota Kotor, Mental Health Promotion and International Cooperation Department and Department of Forensic Psychiatry, Kotor, Montenegro
| | - Jovo Dedovic
- Health Institution Special Psychiatric Hospital Dobrota Kotor, Mental Health Promotion and International Cooperation Department and Department of Forensic Psychiatry, Kotor, Montenegro
| | | | - Milos Milutinovic
- University St. Cyril and Methodius, University Clinic of Psychiatry, Skopje, North Macedonia
| | - Martina Rojnic Kuzman
- Zagreb University Hospital Centre and the Zagreb School of Medicine, Zagreb, Croatia
| | - Raluca Nica
- Institute Liga Romana Pentru Sanatate Mintala, Bucuresti-Sector, Romania
| | - Sarah Bjedov
- Zagreb University Hospital Centre, Clinic for Psychiatry and Psychological Medicine, Zagreb, Croatia
| | - Sara Medved
- Zagreb University Hospital Centre, Clinic for Psychiatry and Psychological Medicine, Zagreb, Croatia
| | - Tiberiu Rotaru
- Siret Psychiatric Hospital, Psychotherapy Unit, Siret, Romania
| | - Bethany Hipple Walters
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Department of Mental Health Prevention and Expertise Centre for Tobacco Control, Utrecht, Netherlands
| | - Ionela Petrea
- INSIGHT International Institute for Mental Health and Integrated Health Systems, Amsterdam, Netherlands
| | - Laura Shields-Zeeman
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Department of Mental Health Prevention and Expertise Centre for Tobacco Control, Utrecht, Netherlands
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Mothwa NG, Moagi MM, van der Wath AE. Challenges experienced by South African families caring for state patients on leave of absence. S Afr J Psychiatr 2020; 26:1453. [PMID: 32934840 PMCID: PMC7479420 DOI: 10.4102/sajpsychiatry.v26i0.1453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 06/15/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Families of state patients experience challenges related to the patient's mental illness and history of criminal behaviour. Family members who act as guardians when patients are on leave of absence take responsibility for the patient's basic needs, activities of daily living and treatment regimen. They need to safeguard the patient from potential self-harm and harming others. Few studies have explored the burden these family members experience. AIM The aim of this study was to explore and describe the challenges experienced by families caring for mental state patients who are on leave of absence. SETTING An urban area in South Africa. METHODS A qualitative approach was applied to answer the research question, 'what are the challenges experienced by families caring for mental state patients on leave of absence?' A purposive sample of nine participants who were caring for state patients on leave of absence was selected. Individual in-depth interviews were used to collect data. Data were analysed using thematic analysis. Ethical considerations and trustworthiness guided the study. RESULTS Three themes illustrate the challenges experienced by family members, namely, challenges related to state patient's behaviour, emotional challenges and social challenges. A fourth theme focuses on the ways families used to cope with these challenges. CONCLUSION Mental healthcare professionals may use the results of this study to design therapeutic interventions for family members of state patients who focus on empathetic understanding and the mobilisation of effective coping skills and social support.
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Affiliation(s)
- Nchaesa G. Mothwa
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Miriam M. Moagi
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Anna E. van der Wath
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Joyce C, Greasley P, Weatherhead S, Seal K. Beyond the Revolving Door: Long-Term Lived Experience of Eating Disorders and Specialist Service Provision. QUALITATIVE HEALTH RESEARCH 2019; 29:2070-2083. [PMID: 31165677 DOI: 10.1177/1049732319850772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this study, we undertook a narrative analysis of participants' long-term lived experience of eating disorders and specialist service provision. Eight participants were recruited with service experience across five National Health Service (NHS) Trusts in the United Kingdom. All participants had a minimum of 10 years self-reported experience living with an eating disorder. The data are presented across different temporal stages that demonstrate the development of participants' self-construct in relation to their first contact with specialist services, what had happened in their lives for this to become necessary, and their current relationships with services, before exploring what participants need from services to help them feel heard going forward. Findings suggest that current methods of service delivery result in delayed and inappropriate supports and a consequent "battling" against professionals, which can provide an obstacle to compassionate and collaborative working and promote "revolving door" experiences.
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Affiliation(s)
- Ciara Joyce
- Lancaster University, Lancaster, United Kingdom
- Trinity College Dublin, Dublin, Ireland
| | | | | | - Karen Seal
- Lancashire Care NHS Foundation Trust, Preston, United Kingdom
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Zhong S, Guo H, Wang Y, Cook S, Chen Y, Luo C, Peng K, Wang F, Liang X, Chen H, Li Q, Zhou J, Wang X, Chen R. The experience of long-stay patients in a forensic psychiatric hospital in China: a qualitative study. BMC Health Serv Res 2019; 19:617. [PMID: 31477102 PMCID: PMC6721342 DOI: 10.1186/s12913-019-4458-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/25/2019] [Indexed: 12/02/2022] Open
Abstract
Background Long stay in forensic psychiatric hospitals is common in patients who are defined as “not criminally responsible on account of mental disorder”. However, little is known about how these patients experience and perceive the long stay within these settings. The aim of this study is to explore the perception and needs of long-stay patients in forensic psychiatric hospitals in China. Methods In-depth semi-structured interviews were conducted with 21 participants who had lived in the forensic psychiatry hospital for more than 8 years. We used thematic analysis strategies to analyse the qualitative data. Results Participants’ perceptions clustered seven themes: hopelessness, loneliness, worthlessness, low mood, sleep disturbances, lack of freedom, and lack of mental health intervention. Conclusions The views and opinions expressed by long-stay patients showed that psychological distress is prevailing in forensic psychiatric hospitals. Adequate and effective care and mental health interventions are recommended to be tailored for their special needs. Electronic supplementary material The online version of this article (10.1186/s12913-019-4458-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shaoling Zhong
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders; China National Technology Institute on Mental Disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, 410011, Hunan, China
| | - Huijuan Guo
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders; China National Technology Institute on Mental Disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, 410011, Hunan, China
| | - Yuanyuan Wang
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Stephanie Cook
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Yanan Chen
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders; China National Technology Institute on Mental Disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, 410011, Hunan, China
| | - Chenyuli Luo
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders; China National Technology Institute on Mental Disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, 410011, Hunan, China
| | - Ke Peng
- The George Institute for Global Health, UNSW, Sydney, Australia.,School of Public Health, The University of Sydney, Sydney, Australia
| | - Fanglan Wang
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders; China National Technology Institute on Mental Disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, 410011, Hunan, China
| | - Xiaoxi Liang
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders; China National Technology Institute on Mental Disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, 410011, Hunan, China
| | - Hui Chen
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders; China National Technology Institute on Mental Disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, 410011, Hunan, China
| | - Qiguang Li
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders; China National Technology Institute on Mental Disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, 410011, Hunan, China
| | - Jiansong Zhou
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders; China National Technology Institute on Mental Disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, 410011, Hunan, China
| | - Xiaoping Wang
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders; China National Technology Institute on Mental Disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, 410011, Hunan, China.
| | - Runsen Chen
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders; China National Technology Institute on Mental Disorders; Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, Changsha, 410011, Hunan, China. .,The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China. .,Department of Psychiatry, University of Oxford, Oxford, UK.
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13
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Ballesteros-Urpi A, Slade M, Manley D, Pardo-Hernandez H. Conceptual framework for personal recovery in mental health among children and adolescents: a systematic review and narrative synthesis protocol. BMJ Open 2019; 9:e029300. [PMID: 31420391 PMCID: PMC6701600 DOI: 10.1136/bmjopen-2019-029300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Personal recovery has been defined as 'a profound personal and unique process for the individual to change their attitudes, values, feelings, goals, abilities and roles in order to achieve a satisfactory, hopeful and productive way of life, with the possible limitations of the illness'. However, research on personal recovery has focused almost exclusively on adults. This project aims to systematically review the available literature on definitions of personal recovery among children and adolescents with mental health conditions and to undertake a narrative synthesis to develop a conceptual framework of recovery. METHODS AND ANALYSIS Systematic review and narrative synthesis consisting (1) searching scientific literature databases, (2) handsearching, (3) citation tracking, (4) grey literature searching, (5) web-based searching and expert consultation. We will include qualitative and quantitative studies or systematic reviews providing a definition, theoretical or conceptual framework, domains or dimensions of personal recovery among eligible participants. The study will follow standard systematic review methodology for study selection and data extraction. We will assess quality of the evidence using tools appropriate for each study design. We will develop a new conceptual framework using a modified narrative synthesis approach, as follows: (1) describing eligible studies and conducting a preliminary synthesis, (2) determining relationships within and between studies and (3) determining the robustness of the synthesis. ETHICS AND DISSEMINATION We obtained a waiver of approval from our local Research Ethics Committee. Results will be disseminated via publications in international peer-reviewed journals and conference proceedings.This study will result in a theoretical framework that is based on an exhaustive review of the literature and the input of experts in the field of recovery. We expect that this framework will foster a better understanding of the stages and processes of recovery in children and adolescents with mental health conditions. PROSPERO REGISTRATION NUMBER CRD42018064087.
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Affiliation(s)
- Anna Ballesteros-Urpi
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Education, Universitat de Barcelona, Barcelona, Spain
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - David Manley
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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14
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Aga N, Laenen FV, Vandevelde S, Vermeersch E, Vanderplasschen W. Recovery of Offenders Formerly Labeled as Not Criminally Responsible: Uncovering the Ambiguity From First-Person Narratives. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2019; 63:919-939. [PMID: 28893122 DOI: 10.1177/0306624x17730617] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The recovery paradigm is a widely accepted strength-based approach in general mental health care. Particular challenges arise when applying this paradigm in a forensic context. To address these issues, the present study examined recovery based on first-person narratives of offenders formerly labeled as not criminally responsible of whom the judicial measure was abrogated. Eleven in-depth interviews were conducted to obtain information on lived experiences and recovery resources of this hard-to-reach and understudied population. The interviews focused on recovery and elements that indicated a sense of progress in life. Key themes were derived from the collected data. Descriptions of recovery resources followed recurrent themes, including clinical, functional, social, and personal resources. Participants also reported ambiguous experiences related to features of the judicial trajectory. This was defined as forensic recovery and can be seen as an additional mechanism, besides more established recovery dimensions, that is unique to mentally ill offenders.
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15
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Fish R, Morgan H. "Moving on" through the locked ward system for women with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:932-941. [PMID: 30950144 PMCID: PMC6850027 DOI: 10.1111/jar.12586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 11/26/2022]
Abstract
Background The move to community support for all people with intellectual disabilities is an aspiration with international significance. In this article, we draw on rich accounts from women with intellectual disabilities detained under the Mental Health Act (E&W) 1983 and staff at an National Health Service secure setting in England to explore how “moving on” is defined and perceived. Methods The study reports on an ethnographic study using the field‐notes and the 26 semi‐structured interviews with detained women and staff on three wards. Results We first explore staff conceptions of moving on, which include behavioural change and utilizing coping strategies. Then, we discuss the areas of analysis that women discussed: taking back responsibility, success in arranged relationships, acceptance of regime and resistance to progression. Conclusion The concepts of moving on were not determined by the women but by the service. We recommend further research which explores women's own rehabilitation requirements.
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Affiliation(s)
- Rebecca Fish
- Centre for Disability Research, Lancaster University, Bailrigg, UK
| | - Hannah Morgan
- Centre for Disability Research, Lancaster University, Bailrigg, UK
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16
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Beckers T, Koekkoek B, Tiemens B, Jaeqx-van Tienen L, Hutschemaekers G. Substituting specialist care for patients with severe mental illness with primary healthcare. Experiences in a mixed methods study. J Psychiatr Ment Health Nurs 2019; 26:1-10. [PMID: 30270481 DOI: 10.1111/jpm.12499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/19/2018] [Accepted: 09/26/2018] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Care planning and coordination are currently insufficiently based on scientific insights due to a lack of knowledge on this topic. Most patients with severe mental illness receive long-term treatment from specialized mental health services. This long-term, highly intensive treatment is not always the best option for two reasons. Firstly, because as long as a patient receives intensive treatment aimed at safety, it is hard for that patient to take full responsibility for their own life. Secondly, because care is not available unlimitedly, some patients are waiting to receive specialist mental healthcare while others who do not need it anymore still receive it. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Most stable patients with severe mental illness can be treated outside of specialized mental health services. Some patients are too dependent on a specific mental healthcare professional to be referred to primary healthcare. In such instances, a referral will most likely lead to destabilization and the referral will therefore be unsuccessful. Patients preferred primary healthcare to specialized mental health services, mainly because of the absence of stigma associated with the latter. There should be more attention for personal recovery (especially the social support system) of patients with severe mental illness who are referred to primary healthcare services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Most stable patients with severe mental illness can be treated in primary healthcare. Professionals in primary healthcare should keep personal recovery in mind when treating patients, focusing on problem solving skills and also making use of social support systems. ABSTRACT: Aim/question Care planning and coordination are currently insufficiently based on scientific insights due to a lack of knowledge on this topic. In the United Kingdom and the Netherlands, most patients with severe mental illness receive long-term specialized mental healthcare, even when they are stable. This study aims to explore the outcome of these stable patients when they are referred to primary healthcare. Methods Patients (N = 32) receiving specialized mental healthcare that were referred to primary healthcare were interviewed in focus groups, as were the involved professionals (N = 6). Results 84% of the participants still received primary healthcare after 12 months. Despite the successful referral, the patient's personal recovery did not always profit. The participants of the focus groups agreed that some patients were too dependent on a specific mental healthcare professional to be referred to primary healthcare. Discussion Most stable patients with severe mental illness can be referred to primary healthcare. Personal recovery and dependency on a specific healthcare provider should be considered when referring a patient to primary healthcare. Implications for practice Professionals in community mental healthcare teams should consider a referral to primary mental healthcare in stable patients. Professionals in primary healthcare should keep the patient's personal recovery in mind.
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Affiliation(s)
- Thijs Beckers
- Research Group Social Psychiatry and Mental Health Nursing, Hogeschool Arnhem Nijmegen University of Applied Science, Nijmegen, The Netherlands.,METggz, Roermond, The Netherlands.,Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Bauke Koekkoek
- Research Group Social Psychiatry and Mental Health Nursing, Hogeschool Arnhem Nijmegen University of Applied Science, Nijmegen, The Netherlands.,Pro Persona, Research Institute, Wolfheze, The Netherlands
| | - Bea Tiemens
- Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Pro Persona, Research Institute, Wolfheze, The Netherlands.,Indigo, Utrecht, The Netherlands
| | | | - Giel Hutschemaekers
- Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Pro Persona, Research Institute, Wolfheze, The Netherlands.,Indigo, Utrecht, The Netherlands
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17
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Reavey P, Brown S, Kanyeredzi A, McGrath L, Tucker I. Agents and spectres: Life-space on a medium secure forensic psychiatric unit. Soc Sci Med 2019; 220:273-282. [DOI: 10.1016/j.socscimed.2018.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/25/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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18
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Kim YR, Cardi V, Lee GY, An S, Kim J, Kwon G, Kim JW, Eom JS, Treasure J. Mobile Self-Help Interventions as Augmentation Therapy for Patients with Anorexia Nervosa. Telemed J E Health 2018; 25:740-747. [PMID: 30325700 DOI: 10.1089/tmj.2018.0180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: It has been suggested that patients with anorexia nervosa (AN) who are resistant to first-line treatment would benefit from second-level interventions targeting specific features, an adaptive form of intervention. Guided self-help programs administered via mobile technology have the dual focus of instigating behavior change and managing anxiety associated with eating disorders in the moment and in users' naturalistic environments. Introduction: We evaluated the feasibility, acceptability, and preliminary augmentative effects of mobile-based, guided self-help interventions (Recovery vodcasts) after initial unsuccessful first-line treatments for patients with AN. Materials and Methods: Patients with AN who were unsuccessful in their treatments were recruited to access Recovery vodcasts as augmentation treatment for 3 weeks in Korea. Acceptability and feasibility of the intervention were evaluated, and qualitative feedback was collected. Preliminary treatment effects of adding the Recovery vodcasts were assessed, including eating disorder pathology, anxiety and depression symptoms, and body mass index. Results: The Recovery vodcasts were acceptable for patients with AN. The patients' psychopathologies of eating disorders improved with augmentation of the vodcasts in their first-line treatments. In addition, there was a tendency toward improvement of affective symptoms. The participants' feedback suggested that the intervention could be improved. Conclusions: The study demonstrated that the Recovery vodcasts were well accepted by Korean patients with AN. Moreover, augmentation of the Recovery vodcasts could facilitate improvements in psychopathology of eating disorders, anxiety, and mood symptoms for patients with AN.
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Affiliation(s)
- Youl-Ri Kim
- 1Department of Neuropsychiatry, Seoul Paik Hospital, Inje University, Seoul, South Korea.,2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Valentina Cardi
- 3Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Gi Young Lee
- 2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Sohyun An
- 2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Jione Kim
- 2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Gemma Kwon
- 2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Jong Won Kim
- 4Department of Healthcare Information Technology, Inje University, Gimhae, South Korea
| | - Jin-Sup Eom
- 5Department of Psychology, Chungbuk National University, Cheongju, South Korea
| | - Janet Treasure
- 3Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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19
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Enrique A, Bretón-López J, Molinari G, Roca P, Llorca G, Guillén V, Fernández-Aranda F, Baños RM, Botella C. Implementation of a Positive Technology Application in Patients With Eating Disorders: A Pilot Randomized Control Trial. Front Psychol 2018; 9:934. [PMID: 29942272 PMCID: PMC6004415 DOI: 10.3389/fpsyg.2018.00934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/22/2018] [Indexed: 01/31/2023] Open
Abstract
Background: Positive psychological interventions (PPIs) have been suggested to produce benefits in patients with eating disorders (ED) by improving well-being, which might act as a buffer of the harmful effects caused by the disorder. Best Possible Self (BPS) is a PPI which consists of writing and envisioning a future where everything has turned out in the best possible way. In this regard, positive technology (PT) can be of considerable benefit as it allows to implement specific PPIs that have already shown efficacy. Objective: This study tested the preliminary efficacy of the BPS exercise implemented through a PT application and carried out for 1 month, in improving positive functioning measures, compared to a control condition, in patients with ED. Follow-up effects were also explored at 1 and 3 months later. Methods: This is a pilot randomized controlled trial, with two experimental conditions. Participants were 54 outpatients, who were receiving ongoing specialized treatment in ED services. 29 participants were randomly allocated to the BPS intervention and 25 to the control exercise. The sample was composed mostly by females and the mean age was 27 years. In the intervention group, participants had to write about their BPS. In the control group participants had to write about their daily activities. The exercise was conducted through the Book of Life, which is a PT application that allows users to add multimedia materials to the written content. Measures of future expectations, affect, dispositional optimism, hope and self-efficacy were assessed at different time frames. Results: Findings showed that all participants improved over time and there were no statistically significant differences between conditions on the specific measures. These effects were not influenced by prior levels of ED severity. Within-group effect sizes indicate a greater benefit for the participants in the BPS condition, compared to the control condition, on nearly all the measures. Conclusion: Results indicated that PT produced modest improvements in patients with EDs that are receiving current treatment for ED. More empirical attention is needed to explore the potential benefits of PPIs as supporting tools in the prevention and treatment of EDs. Trial registration: clinicaltrails.gov Identifier: NCT03003910, retrospectively registered December 27, 2016.
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Affiliation(s)
- Angel Enrique
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Juana Bretón-López
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Guadalupe Molinari
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Pablo Roca
- Department of Personality, Assessment and Psychological Treatment, Complutense University of Madrid, Madrid, Spain
| | - Ginés Llorca
- Psychiatry Service, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - Verónica Guillén
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Fernando Fernández-Aranda
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.,Department of Psychiatry, University Hospital of IDIBELL - Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Rosa M Baños
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Cristina Botella
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
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20
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De Ruysscher C, Vandevelde S, Vanderplasschen W, De Maeyer J, Vanheule S. The Concept of Recovery as Experienced by Persons with Dual Diagnosis: A Systematic Review of Qualitative Research From a First-Person Perspective. J Dual Diagn 2017; 13:264-279. [PMID: 28699834 DOI: 10.1080/15504263.2017.1349977] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES In recent years, the concept of recovery has gained ground in the treatment of persons with dual diagnosis. Recovery refers to living a meaningful life despite limitations caused by mental illness and substance use disorders. It also implies that support for persons with dual diagnosis should be organized according to the personal needs and wishes of its users. Therefore, it is important to gain insight into the aspects that persons with dual diagnosis deem important for their recovery process. This systematic review aims to summarize existing qualitative research on the meaning of recovery from the perspective of persons with dual diagnosis. METHODS A literature search was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic reviews in the following databases: Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Medline, Embase, and Web of Science. RESULTS Sixteen studies using a qualitative research design were retained in which four overarching themes could be identified. The first theme focused on feeling supported by family and peers and being able to participate in the community. The second theme focuses on the need for a holistic and individualized treatment approach, seeing the persons "behind the symptoms." The third theme that emerged was having personal beliefs, such as fostering feelings of hope, building a new sense of identity, gaining ownership over one's life, and finding support in spirituality. The last theme identified was the importance of meaningful activities that structure one's life and give one motivation to carry on. CONCLUSIONS In this review, the participants pleaded for "flexibility" in mental health care, i.e., an approach that allows for both successes and failures. However, in order to come to a more comprehensive theoretical model of recovery in persons with dual diagnosis, future research is necessary to gain insight into the underlying mechanisms of recovery processes.
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Affiliation(s)
- C De Ruysscher
- a Department of Special Needs Education , Ghent University , Ghent , Belgium
| | - S Vandevelde
- a Department of Special Needs Education , Ghent University , Ghent , Belgium
| | - W Vanderplasschen
- a Department of Special Needs Education , Ghent University , Ghent , Belgium
| | - J De Maeyer
- b Department of Health , Education & Social Work, University College Ghent , Ghent , Belgium
| | - S Vanheule
- c Department of Psychoanalysis and Clinical Consulting , Ghent University , Ghent , Belgium
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21
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Kaite CP, Karanikola MN, Vouzavali FJD, Koutroubas A, Merkouris A, Papathanassoglou EDE. The experience of Greek-Cypriot individuals living with mental illness: preliminary results of a phenomenological study. BMC Psychiatry 2016; 16:343. [PMID: 27716117 PMCID: PMC5053043 DOI: 10.1186/s12888-016-1051-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/24/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Research evidence shows that healthcare professionals do not fully comprehend the difficulty involved in problems faced by people living with severe mental illness (SMI). As a result, mental health service consumers do not show confidence in the healthcare system and healthcare professionals, a problem related to the phenomenon of adherence to therapy. Moreover, the issue of unmet needs in treating individuals living with SMI is relared to their quality of life in a negative way. METHODS A qualitative methodological approach based on the methodology of van Manen phenomenology was employed through a purposive sampling of ten people living with SMI. The aim was to explore their perceptions and interpretations regarding: a) their illness, b) their self-image throughout the illness, c) the social implications following their illness, and d) the quality of the therapeutic relationship with mental health nurses. Participants were recruited from a community mental health service in a Greek-Cypriot urban city. Data were collected through personal, semi-structured interviews. RESULTS Several main themes were identified through the narratives of all ten participants. Main themes included: a) The meaning of mental illness, b) The different phases of the illness in time, c) The perception of the self during the illness, d) Perceptions about the effectiveness of pharmacotherapy, e) Social and personal consequences for participants following the diagnosis of mental illness, f) Participants' perceptions regarding mental health professionals and services and g) The therapeutic effect of the research interview on the participants. CONCLUSIONS The present study provides data for the enhancement of the empathic understanding of healthcare professionals regarding the concerns and particular needs of individuals living with SMI, as well as the formation of targeted psychosocial interventions based on these needs. Overall, the present data illuminate the necessity for the reconstruction of the provided mental healthcare in Cyprus into a more recovery- oriented approach in order to address personal identity and self-determination issues and the way these are related to management of pharmacotherapy. Qualitative studies aiming to further explore issues of self-identity during ill health and its association with adherence to therapy, resilience and self-determination, are also proposed.
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Affiliation(s)
- Charis P. Kaite
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou str, 3041 Limassol, Cyprus
| | - Maria N. Karanikola
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou str, 3041 Limassol, Cyprus
| | - Foteini J. D. Vouzavali
- Department of Nursing, Vocational High School of Nurse Assistants & Laboratory Instructor, Technological Educational Institute of Athens, Cholargos, Athens, Greece
| | - Anna Koutroubas
- Children’s Hospital “A & P Kyriakou” Oncology Department, Athens, Greece
| | - Anastasios Merkouris
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou str, 3041 Limassol, Cyprus
| | - Elizabeth D. E. Papathanassoglou
- Faculty of Nursing, University of Alberta, 5–262 Edmonton Clinic Health Academy (ECHA), 11405-87th Ave., Edmonton, AB T6G 1C9 Canada
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22
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Kelly J, Gallagher S, McMahon J. Developing a recovery college: a preliminary exercise in establishing regional readiness and community needs. J Ment Health 2016; 26:150-155. [DOI: 10.1080/09638237.2016.1207227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Joy Kelly
- Department of Psychology,
- Centre for Social Issues Research, University of Limerick, Limerick, Ireland, and
| | - Stephen Gallagher
- Department of Psychology,
- Centre for Social Issues Research, University of Limerick, Limerick, Ireland, and
| | - Jennifer McMahon
- School of Education and
- Centre for Social Issues Research, University of Limerick, Limerick, Ireland, and
- i-TEACH, Teaching for Inclusion Research Lab, University of Limerick, Ireland
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23
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Stuart SR, Tansey L, Quayle E. What we talk about when we talk about recovery: a systematic review and best-fit framework synthesis of qualitative literature. J Ment Health 2016; 26:291-304. [DOI: 10.1080/09638237.2016.1222056] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Simon Robertson Stuart
- Clydesdale Psychological Therapies Team, NHS Lanarkshire, Carluke, UK,
- Clinical Psychology, NHS Lothian, Edinburgh, UK, and
- Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, UK
| | - Louise Tansey
- Clinical Psychology, NHS Lothian, Edinburgh, UK, and
| | - Ethel Quayle
- Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, UK
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McKeown M, Jones F, Foy P, Wright K, Paxton T, Blackmon M. Looking back, looking forward: Recovery journeys in a high secure hospital. Int J Ment Health Nurs 2016; 25:234-42. [PMID: 26871912 DOI: 10.1111/inm.12204] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/18/2015] [Accepted: 11/23/2015] [Indexed: 11/29/2022]
Abstract
A qualitative study of staff and service users' views of recovery was undertaken in a UK high secure hospital working to implement recovery practices. 30 staff and 25 service users participated in semi-structured interviews or focus groups. Thematic analysis identified four broad accounts of how recovery was made sense of in the high secure environment: the importance of meaningful occupation; valuing relationships; recovery journeys and dialogue with the past; and recovery as personal responsibility. These themes are discussed with an emphasis on service user strategies of cooperation or resistance, respectively advancing or impeding progress through the system. In this context the notion of cooperation is, for many, commensurate with compliance with a dominant medical model. The policy framing of recovery opens up contemplation of treatment alternatives, more participatory approaches to risk management, and emphasise the value of relational skills, but may not elude the overarching bio-psychiatric episteme.
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Affiliation(s)
- Mick McKeown
- University of Central Lancashire, Preston, England
| | | | - Paul Foy
- Ashworth Hospital, Merseyside, England, UK
| | - Karen Wright
- University of Central Lancashire, Preston, England
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Stickley T, Higgins A, Meade O, Sitvast J, Doyle L, Ellilä H, Jormfeldt H, Keogh B, Lahti M, Skärsäter I, Vuokila-Oikkonen P, Kilkku N. From the rhetoric to the real: A critical review of how the concepts of recovery and social inclusion may inform mental health nurse advanced level curricula - The eMenthe project. NURSE EDUCATION TODAY 2016; 37:155-163. [PMID: 26687142 DOI: 10.1016/j.nedt.2015.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 09/29/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES This critical review addresses the question of how the concepts of recovery and social inclusion may inform mental health nurse education curricula at Master's level in order to bring about significant and positive change to practice. DESIGN This is a literature-based critical review incorporating a rapid review. It has been said that if done well, this approach can be highly relevant to health care studies and social interventions, and has substantial claims to be as rigorous and enlightening as other, more conventional approaches to literature (Rolfe, 2008). DATA SOURCES In this review, we have accessed contemporary literature directly related to the concepts of recovery and social inclusion in mental health. REVIEW METHODS We have firstly surveyed the international literature directly related to the concepts of recovery and social inclusion in mental health and used the concept of emotional intelligence to help consider educational outcomes in terms of the required knowledge, skills and attitudes needed to promote these values-based approaches in practice. RESULTS A number of themes have been identified that lend themselves to educational application. International frameworks exist that provide some basis for the developments of recovery and social inclusion approaches in mental health practice, however the review identifies specific areas for future development. CONCLUSIONS This is the first article that attempts to scope the knowledge, attitudes and skills required to deliver education for Master's level mental health nurses based upon the principles of recovery and social inclusion. Emotional intelligence theory may help to identify desired outcomes especially in terms of attitudinal development to promote the philosophy of recovery and social inclusive approaches in advanced practice. Whilst recovery is becoming enshrined in policy, there is a need in higher education to ensure that mental health nurse leaders are able to discern the difference between the rhetoric and the reality.
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Affiliation(s)
- Theodore Stickley
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Institute of Mental Health Building, Triumph Road, Innovation Park, Nottingham, NG7 2TU, United Kingdom.
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | - Oonagh Meade
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
| | - Jan Sitvast
- University of Applied Sciences HU, Bolognalaan 101, 3584CJ Utrecht, The Netherlands.
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | - Heikki Ellilä
- Dep. Health and Wellbeing, Turku University of Applied Sciences, Ruiskatu 2, 20720 Turku, Finland.
| | | | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin 2, Ireland.
| | - Mari Lahti
- University of Applied Science Turku, Ruiskatu 8, 20810 Turku, Finland.
| | | | | | - Nina Kilkku
- Tampere University of Applied Sciences, Kuntokatu 3, 33520 Tampere, Finland.
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Robinson PH, Kukucska R, Guidetti G, Leavey G. Severe and enduring anorexia nervosa (SEED-AN): a qualitative study of patients with 20+ years of anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2016; 23:318-26. [PMID: 26059633 DOI: 10.1002/erv.2367] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/28/2015] [Accepted: 03/05/2015] [Indexed: 11/10/2022]
Abstract
Little is known about how patients with long-term eating disorders manage their clinical problems. We carried out a preliminary qualitative study (using Thematic Analysis) of patients with severe and enduring anorexia nervosa (SEED-AN) in which we undertook recorded interviews in eight participants whose conditions had lasted 20-40 years. We found 15 principle features in physical, psychological, social, family, occupational and treatment realms. Psychological and social realms were most affected. Severe physical problems were reported. They described feelings of unworthiness, frugality regarding money and obsessive time-keeping. Persisting with negligible social networks, participants described depression and hopelessness, while somehow achieving a sense of pride at their endurance and survival in spite of the eating disorder. They emphasized the importance of professional help in managing their care. The severe and enduring description, often reserved for people with psychotic illness, is appropriately applied to SEED-AN, which has major impacts in all realms.
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Affiliation(s)
- Paul H Robinson
- Barnet Enfield and Haringey Mental Health Trust, UK.,University College London, UK
| | | | | | - Gerard Leavey
- University College London, UK.,Ulster University, UK
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Kaite CP, Karanikola M, Merkouris A, Papathanassoglou EDE. "An ongoing struggle with the self and illness": α meta-synthesis of the studies of the lived experience of severe mental illness. Arch Psychiatr Nurs 2015; 29:458-73. [PMID: 26577563 DOI: 10.1016/j.apnu.2015.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/16/2015] [Accepted: 06/26/2015] [Indexed: 12/30/2022]
Abstract
The diverse experiences of severely mentally ill persons, most of the times, have not been taken into account, or integrated to the treatment procedures. This meta-synthesis aimed to examine what is like to live with severe mental illness narratives by employing a meta-ethnographic synthesis of seventeen published peer reviewed qualitative studies. Third order analysis revealed as core theme "An ongoing struggle for reconciliation with the self and the illness". Other themes included amongst others: loss of identity, pain of having had one's life stolen, being an outcast. The identification of the importance of the alterations of self-identity throughout the continuum of the severe mental disorder may be the focus of targeted psychosocial interventions.
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Affiliation(s)
- Charis P Kaite
- Cyprus University of Technology Department of Nursing, School of Health Sciences, Vragadinou, 3041-Limassol, Cyprus.
| | - Maria Karanikola
- Cyprus University of Technology Department of Nursing, School of Health Sciences, Vragadinou, 3041-Limassol, Cyprus.
| | - Anastasios Merkouris
- Cyprus University of Technology Department of Nursing, School of Health Sciences, Vragadinou, 3041-Limassol, Cyprus.
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Gillard S, Turner K, Neffgen M. Understanding recovery in the context of lived experience of personality disorders: a collaborative, qualitative research study. BMC Psychiatry 2015; 15:183. [PMID: 26227023 PMCID: PMC4521354 DOI: 10.1186/s12888-015-0572-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 07/22/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Concepts of recovery increasingly inform the development and delivery of mental health services internationally. In the UK recent policy advocates the application of recovery concepts to the treatment of personality disorders. However diagnosis and understanding of personality disorders remains contested, challenging any assumption that mainstream recovery thinking can be directly translated into personality disorders services. METHODS In a qualitative interview-based study understandings of recovery were explored in extended, in-depth interviews with six people purposively sampled from a specialist personality disorders' service in the UK. An interpretive, collaborative approach to research was adopted in which university-, clinical- and service user (consumer) researchers were jointly involved in carrying out interviews and analysing interview data. RESULTS Findings suggested that recovery cannot be conceptualised separately from an understanding of the lived experience of personality disorders. This experience was characterised by a complexity of ambiguous, interrelating and conflicting feelings, thoughts and actions as individuals tried to cope with tensions between internally and externally experienced worlds. Our analysis was suggestive of a process of recovering or, for some, discovering a sense of self that can safely coexist in both worlds. CONCLUSIONS We conclude that key facilitators of recovery - positive personal relationships and wider social interaction - are also where the core vulnerabilities of individuals with lived experience of personaility disorders can lie. There is a role for personality disorders services in providing a safe space in which to develop positive relationships. Through discursive practice within the research team understandings of recovery were co-produced that responded to the lived experience of personality disorders and were of applied relevance to practitioners.
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Affiliation(s)
- Steve Gillard
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Kati Turner
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Marion Neffgen
- South West London & St George's Mental Health NHS Trust, Springfield University Hospital, Glenburnie Way, London, SW17 7DJ, UK.
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Williams J, Leamy M, Bird V, Le Boutillier C, Norton S, Pesola F, Slade M. Development and evaluation of the INSPIRE measure of staff support for personal recovery. Soc Psychiatry Psychiatr Epidemiol 2015; 50:777-86. [PMID: 25409867 DOI: 10.1007/s00127-014-0983-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 11/10/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND No individualised standardised measure of staff support for mental health recovery exists. AIMS To develop and evaluate a measure of staff support for recovery. DEVELOPMENT initial draft of measure based on systematic review of recovery processes; consultation (n = 61); and piloting (n = 20). Psychometric evaluation: three rounds of data collection from mental health service users (n = 92). RESULTS INSPIRE has two sub-scales. The 20-item Support sub-scale has convergent validity (0.60) and adequate sensitivity to change. Exploratory factor analysis (variance 71.4-85.1 %, Kaiser-Meyer-Olkin 0.65-0.78) and internal consistency (range 0.82-0.85) indicate each recovery domain is adequately assessed. The 7-item Relationship sub-scale has convergent validity 0.69, test-retest reliability 0.75, internal consistency 0.89, a one-factor solution (variance 70.5 %, KMO 0.84) and adequate sensitivity to change. A 5-item Brief INSPIRE was also evaluated. CONCLUSIONS INSPIRE and Brief INSPIRE demonstrate adequate psychometric properties, and can be recommended for research and clinical use.
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Affiliation(s)
- Julie Williams
- Health Service and Population Research Department (Box P029), Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK,
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Markström U, Lindqvist R. Establishment of community mental health systems in a postdeinstitutional era: a study of organizational structures and service provision in Sweden. JOURNAL OF SOCIAL WORK IN DISABILITY & REHABILITATION 2015; 14:124-144. [PMID: 25671370 DOI: 10.1080/1536710x.2015.1014535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article analyzes the state of community mental health services for people with psychiatric disabilities and the interplay between different organizational levels. The study is based on document analysis and interviews with stakeholders in 10 Swedish municipalities. The results show how systems are slow to change and are linked to local traditions. The services are often delivered in closed settings, and the organizations struggle to meet the needs of a new generation of users. There is a gap between local systems and national policies because the latter pays attention to the attributes of a recovery approach.
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Affiliation(s)
- Urban Markström
- a Department of Social Work , Umeå University , Umeå , Sweden
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McKenna B, Furness T, Dhital D, Ireland S. Recovery-Oriented Care in Older-Adult Acute Inpatient Mental Health Settings in Australia: An Exploratory Study. J Am Geriatr Soc 2014; 62:1938-42. [DOI: 10.1111/jgs.13028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Brian McKenna
- School of Nursing; Midwifery and Paramedicine; Australian Catholic University; Fitzroy Vic. Australia
- NorthWestern Mental Health; Royal Melbourne Hospital; Parkville Vic. Australia
| | - Trentham Furness
- School of Nursing; Midwifery and Paramedicine; Australian Catholic University; Fitzroy Vic. Australia
- NorthWestern Mental Health; Royal Melbourne Hospital; Parkville Vic. Australia
| | - Deepa Dhital
- School of Nursing; Midwifery and Paramedicine; Australian Catholic University; Fitzroy Vic. Australia
- NorthWestern Mental Health; Royal Melbourne Hospital; Parkville Vic. Australia
| | - Susan Ireland
- NorthWestern Mental Health; Royal Melbourne Hospital; Parkville Vic. Australia
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McKenna B, Furness T, Dhital D, Ennis G, Houghton J, Lupson C, Toomey N. Recovery-oriented care in acute inpatient mental health settings: an exploratory study. Issues Ment Health Nurs 2014; 35:526-32. [PMID: 24963853 DOI: 10.3109/01612840.2014.890684] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Australian mental health nurses will need to care with consumers of mental health services, within the domains of recovery. However, in acute inpatient mental health settings, nurses are without a clear description of how to be recovery-oriented. The intent of this qualitative study was to ask nurses to reflect on and describe current practice within acute inpatient services that are not overtly recovery-oriented. Results show that nurses can identify recovery and articulate with pragmatic clarity how to care within a recovery-oriented paradigm. Pragmatic modes of care described by nurses support using "champions" to assist with eventual system transformation in the delivery of mental health services.
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Affiliation(s)
- Brian McKenna
- Australian Catholic University, School of Nursing, Midwifery and Paramedicine, Fitzroy and NorthWestern Mental Health, Melbourne Health, Parkville, Australia
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Cornes M, Manthorpe J, Joly L, O'Halloran S. Reconciling recovery, personalisation and Housing First: integrating practice and outcome in the field of multiple exclusion homelessness. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:134-143. [PMID: 24112117 DOI: 10.1111/hsc.12067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 06/02/2023]
Abstract
'Recovery' is a key concept in the organisation and delivery of interdisciplinary support for people experiencing multiple exclusion homelessness (MEH, that is, situations where homelessness overlaps with a range of other complex problems such as mental health issues and drug and alcohol dependencies). At the level of individual support planning, practitioners are expected to 'work together' to motivate service users to make positive changes to their lives and to secure outcomes (results) such as employment and permanent accommodation. Drawing on the accounts of 34 (n = 34) people with first-hand experience of MEH in England, we outline some of the limitations of 'recovery-orientated practices', namely the exclusion of people with unresolved needs and the implications this may have for continuity of provision. To address this issue, we argue that there is a need for a more personalised and inclusive practice model, which can accommodate 'recovery' (change outcomes) alongside those for maintenance and prevention. In proposing one such model, we show how this might also take forward the principles of 'Housing First' (a US blueprint for tackling entrenched homelessness), which has already begun to challenge the orthodox view that permanent accommodation should be provided only when recovery has been achieved.
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Affiliation(s)
- Michelle Cornes
- Social Care Workforce Research Unit, King's College London, London, UK
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Cherner R, Aubry T, Ecker J, Kerman N, Nandlal J. Transitioning into the Community: Outcomes of a Pilot Housing Program for Forensic Patients. INTERNATIONAL JOURNAL OF FORENSIC MENTAL HEALTH 2014; 13:62-74. [PMID: 24683312 PMCID: PMC3962049 DOI: 10.1080/14999013.2014.885472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The Transitional Rehabilitation Housing Pilot (TRHP) was designed to transition hospitalized forensic patients to the community. Twenty clients and their clinicians in two Ontario cities completed measures on functioning, substance use, recovery, social support, and quality of life at admission to the program and then every 6 months until 18 months post-admission. Clients also responded to open-ended questions on the impact of the program and living in the community on their recovery. Three (15%) clients re-offended. Eleven clients (55%) experienced rehospitalization; however, brief rehospitalization was seen as part of the recovery process. Level of community functioning was stable across time and 35% of clients had a decrease in the restrictiveness of their disposition order. Clients described numerous characteristics of community living that contributed to improvements in functioning, such as integration into the community, social contact, and newfound independence. Some aspects of TRHP that encouraged recovery included developing new skills and knowledge, staff support, and the programming that engaged clients in treatment and recovery-oriented activities. Findings suggest that forensic patients can transition successfully into the community with appropriate support and housing.
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Affiliation(s)
- Rebecca Cherner
- School of Psychology and Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Canada
| | - Tim Aubry
- School of Psychology and Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Canada
| | - John Ecker
- School of Psychology and Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Canada
| | - Nick Kerman
- Community Support and Research Unit, Centre for Addiction and Mental Health, Toronto, Canada
| | - Joan Nandlal
- John Howard Society of Waterloo-Wellington, Kitchener, Canada
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What do people in forensic secure and community settings think of their personality disorder diagnosis? A qualitative study. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1161-8. [PMID: 23117817 DOI: 10.1007/s00127-012-0616-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 10/19/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of this study was to explore the experience of having a personality disorder diagnosis within the context of forensic secure and community services. METHODS We used an interpretative phenomenological analysis to analyse interviews with 10 service users purposively recruited from services in South London. RESULTS Participants described two facets of their lived experience: (1) the way they see themselves now, in light of their offending and social background and (2) the pejorative nature of the personality disorder label, its relationship to mental illness and their need to distance themselves from it. CONCLUSIONS Having a forensic identity affects participants' perceptions of their diagnosis and its treatment as well as their views about themselves.
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Gillard SG, Edwards C, Gibson SL, Owen K, Wright C. Introducing peer worker roles into UK mental health service teams: a qualitative analysis of the organisational benefits and challenges. BMC Health Serv Res 2013; 13:188. [PMID: 23705767 PMCID: PMC3673834 DOI: 10.1186/1472-6963-13-188] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 05/18/2013] [Indexed: 11/21/2022] Open
Abstract
Background The provision of peer support as a component of mental health care, including the employment of Peer Workers (consumer-providers) by mental health service organisations, is increasingly common internationally. Peer support is strongly advocated as a strategy in a number of UK health and social care policies. Approaches to employing Peer Workers are proliferating. There is evidence to suggest that Peer Worker-based interventions reduce psychiatric inpatient admission and increase service user (consumer) empowerment. In this paper we seek to address a gap in the empirical literature in understanding the organisational challenges and benefits of introducing Peer Worker roles into mental health service teams. Methods We report the secondary analysis of qualitative interview data from service users, Peer Workers, non-peer staff and managers of three innovative interventions in a study about mental health self-care. Relevant data was extracted from interviews with 41 participants and subjected to analysis using Grounded Theory techniques. Organisational research literature on role adoption framed the analysis. Results Peer Workers were highly valued by mental health teams and service users. Non-peer team members and managers worked hard to introduce Peer Workers into teams. Our cases were projects in development and there was learning from the evolutionary process: in the absence of formal recruitment processes for Peer Workers, differences in expectations of the Peer Worker role can emerge at the selection stage; flexible working arrangements for Peer Workers can have the unintended effect of perpetuating hierarchies within teams; the maintenance of protective practice boundaries through supervision and training can militate against the emergence of a distinctive body of peer practice; lack of consensus around what constitutes peer practice can result in feelings for Peer Workers of inequality, disempowerment, uncertainty about identity and of being under-supported. Conclusions This research is indicative of potential benefits for mental health service teams of introducing Peer Worker roles. Analysis also suggests that if the emergence of a distinctive body of peer practice is not adequately considered and supported, as integral to the development of new Peer Worker roles, there is a risk that the potential impact of any emerging role will be constrained and diluted.
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Abstract
AIMS Mental health policy internationally varies in its support for recovery. The aims of this study were to validate an existing conceptual framework and then characterise by country the distribution, scientific foundations and emphasis in published recovery conceptualisations. METHODS Update and modification of a previously published systematic review and narrative synthesis of recovery conceptualisations published in English. RESULTS A total of 7431 studies were identified and 429 full papers reviewed, from which 105 conceptualisations in 115 papers were included and quality assessed using established rating scales. Recovery conceptualisations were identified from 11 individual countries, with 95 (91%) published in English-speaking countries, primarily the USA (47%) and the UK (25%). The scientific foundation was primarily qualitative research (53%), non-systematic literature reviews (24%) and position papers (12%). The conceptual framework was validated with the 18 new papers. Across the different countries, there was a relatively similar distribution of codings for each of five key recovery processes. CONCLUSIONS Recovery as currently conceptualised in English-language publications is primarily based on qualitative studies and position papers from English-speaking countries. The conceptual framework was valid, but the development of recovery conceptualisations using a broader range of research designs within other cultures and non-majority populations is a research priority.
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Abstract
PURPOSE OF REVIEW To examine recent publications on implications of recovery for the provision of mental health services. RECENT FINDINGS Predominantly, the concept of recovery, implications for professional mental health services, and the impact of peer workers on the provision of healthcare are discussed. SUMMARY Recovery in the context of mental health issues refers to multiple dimensions of the individual's development. According to recent publications, the dimension of an individual journey, measurable through subjective parameters and accounts, is complementary to the traditional objectives of symptom reduction, improvement of functioning, and social inclusion. To foster recovery orientation in mental health services subjective measures should be included in clinical practice, research, and teaching. Moreover, services striving to support recovery need to implement strategies in terms of policy, concepts, structures, and professional attitude. This challenging paradigm shift is claimed to be supported by the integration of peer workers with own lived experience in the provision of mental healthcare. Some exponents of the social recovery movement criticize this recent international development to implement recovery into traditional services, as it would uphold the established structures of power and control. Questions of impaired legal capacity, involuntary admissions and risk assessment related to recovery are rarely discussed.
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Williams J, Leamy M, Bird V, Harding C, Larsen J, Le Boutillier C, Oades L, Slade M. Measures of the recovery orientation of mental health services: systematic review. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1827-35. [PMID: 22322983 DOI: 10.1007/s00127-012-0484-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 01/28/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE The review aimed to (1) identify measures that assess the recovery orientation of services; (2) discuss how these measures have conceptualised recovery, and (3) characterise their psychometric properties. METHODS A systematic review was undertaken using seven sources. The conceptualisation of recovery within each measure was investigated by rating items against a conceptual framework of recovery comprising five recovery processes: connectedness; hope and optimism; identity; meaning and purpose; and empowerment. Psychometric properties of measures were evaluated using quality criteria. RESULTS Thirteen recovery orientation measures were identified, of which six met eligibility criteria. No measure was a good fit with the conceptual framework. No measure had undergone extensive psychometric testing and none had data on test-retest reliability or sensitivity to change. CONCLUSIONS Many measures have been developed to assess the recovery orientation of services. Comparisons between the measures were hampered by the different conceptualisations of recovery used and by the lack of uniformity on the level of organisation at which services were assessed. This situation makes it a challenge for services and researchers to make an informed choice on which measure to use. Further work is needed to produce measures with a transparent conceptual underpinning and demonstrated psychometric properties.
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Affiliation(s)
- J Williams
- Section for Recovery, Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, Box PO29, SE5 8AF, UK.
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Katsakou C, Rose D, Amos T, Bowers L, McCabe R, Oliver D, Wykes T, Priebe S. Psychiatric patients' views on why their involuntary hospitalisation was right or wrong: a qualitative study. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1169-79. [PMID: 21863281 DOI: 10.1007/s00127-011-0427-z] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 08/09/2011] [Indexed: 01/11/2023]
Abstract
PURPOSE To explore involuntary patients' retrospective views on why their hospitalisation was right or wrong. METHODS Involuntary patients were recruited from 22 hospitals in England and interviewed in-depth. The study drew on grounded theory and thematic analysis. RESULTS Most of the patients felt mentally unwell before admission and out of control during their treatment. Despite these common experiences, three groups of patients with distinct views on their involuntary hospitalisation were identified: those who believed that it was right, those who thought it was wrong and those with ambivalent views. Those with retrospectively positive views believed that hospitalisation ensured that they received treatment, averted further harm and offered them the opportunity to recover in a safe place. They felt that coercion was necessary, as they could not recognise that they needed help when acutely unwell. Those who believed that involuntary admission was wrong thought that their problems could have been managed through less coercive interventions, and experienced hospitalisation as an unjust infringement of their autonomy, posing a permanent threat to their independence. Patients with ambivalent views believed that they needed acute treatment and that hospitalisation averted further harm. Nonetheless, they thought that their problems might have been managed through less coercive community interventions or a shorter voluntary hospitalisation. CONCLUSIONS The study illustrates why some patients view their involuntary hospitalisation positively, whereas others believe it was wrong. This knowledge could inform the development of interventions to improve patients' views and treatment experiences.
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Affiliation(s)
- Christina Katsakou
- Unit for Social & Community Psychiatry, Barts and the London School of Medicine, Queen Mary University of London, Newham Centre for Mental Health, Cherry Tree Way, Glen Road, London, E13 8SP, UK.
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Katsakou C, Marougka S, Barnicot K, Savill M, White H, Lockwood K, Priebe S. Recovery in Borderline Personality Disorder (BPD): a qualitative study of service users' perspectives. PLoS One 2012; 7:e36517. [PMID: 22615776 PMCID: PMC3355153 DOI: 10.1371/journal.pone.0036517] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 04/02/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Symptom improvement in Borderline Personality Disorder (BPD) is more common than previously hypothesised. However, it remains unclear whether it reflects service users' personal goals of recovery. The present study aimed to explore what service users with BPD view as recovery. METHODS 48 service users were recruited from secondary mental health services and their views on their personal goals and the meaning of recovery were explored in in-depth semi-structured interviews. The study drew on grounded theory and thematic analysis. RESULTS Service users believed that recovery involved developing self-acceptance and self-confidence, gaining control over emotions, improving relationships, employment, and making progress in symptoms like suicidality and self-harming. They felt that psychotherapies for BPD often had an extreme focus on specific areas, like self-harming or relationships, and that some of their goals were neglected. Although full recovery was seen as a distant goal, interviewees felt that they could learn how to deal with their problems in more effective ways and make meaningful progress in their lives. CONCLUSIONS Specialist therapies for BPD explicitly address some of the recovery goals that are important to service users, whereas other goals are only indirectly or poorly addressed. Professionals might need to work with service users towards devising comprehensive individualised case formulations, including all treatment targets that are important to service users, their priorities, and long-term plans on how their targets might be met and which services might be involved.
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Affiliation(s)
- Christina Katsakou
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom.
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