1
|
Sánchez-Guarnido AJ, Ruiz-Granados MI, Garrido-Cervera JA, Herruzo J, Herruzo C. Implementation of the Recovery Model and Its Outcomes in Patients with Severe Mental Disorder. Healthcare (Basel) 2024; 12:952. [PMID: 38727509 PMCID: PMC11083556 DOI: 10.3390/healthcare12090952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/22/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The recovery model assumes that the patient can experience personal growth even while maintaining symptoms of a mental disorder. In order to achieve this recovery, the practices of professionals must also change. However, in our setting, there are limited data on the implementation of practices based on the recovery model and their effect on personal recovery. OBJECTIVE To describe the association between professionals' practices and patients' personal recovery. METHODS An observational and cross-sectional study in which the Recovery Self-Assessment (RSA) was used to assess the degree of implementation of the different practices and the Recovery Assessment Scale (RAS) was used to assess the personal recovery of 307 patients with severe mental disorders. RESULTS Patients attended by professionals who followed the recovery model obtained a greater personal recovery (p < 0.001, d = 1.10). The dimension associated with greater recovery was that of working toward life goals. The least implemented dimensions had to do with offering treatment options and patient participation in decision-making. This study was conducted in accordance with STROBE (STrengthening the Reporting of OBservational studies in Epidemiology). CONCLUSIONS Although this is a cross-sectional study that does not allow us to establish causal relationships, it shows that the model with which mental health professionals work is associated with patients' chances of recovery. We therefore consider that it is important to foster the implementation of practices based on the recovery model within mental health care.
Collapse
Affiliation(s)
| | | | | | - Javier Herruzo
- Department of Psychology, University of Cordoba, 14071 Cordoba, Spain; (M.I.R.-G.); (J.H.)
| | - Carlos Herruzo
- Department of Psychology, University of Cordoba, 14071 Cordoba, Spain; (M.I.R.-G.); (J.H.)
| |
Collapse
|
2
|
Arendt IMTP, Gondan M, Juul S, Hastrup LH, Hjorthøj C, Bach B, Videbech P, Jørgensen MB, Moeller SB. Schema therapy versus treatment as usual for outpatients with difficult-to-treat depression: study protocol for a parallel group randomized clinical trial (DEPRE-ST). Trials 2024; 25:266. [PMID: 38627837 PMCID: PMC11022394 DOI: 10.1186/s13063-024-08079-9] [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: 01/16/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND About one third of patients with depression are in a condition that can be termed as "difficult-to-treat". Some evidence suggests that difficult-to-treat depression is associated with a higher frequency of childhood trauma and comorbid personality disorders or accentuated features. However, the condition is understudied, and the effects of psychotherapy for difficult-to-treat depression are currently uncertain. The aim of this trial is to investigate the beneficial and harmful effects of 30 sessions of individual schema therapy versus treatment as usual for difficult-to-treat depression in the Danish secondary, public mental health sector. METHODS In this randomized, multi-centre, parallel-group, superiority clinical trial, 129 outpatients with difficult-to-treat depression will be randomized (1:1) to 30 sessions of individual schema therapy or treatment as usual; in this context mainly group-based, short-term cognitive behaviour or psychodynamic therapy. The primary outcome is the change from baseline in depressive symptoms 12 months after randomization, measured on the observer-rated 6-item Hamilton Rating Scale for Depression. The secondary outcomes are health-related quality of life assessed with the European Quality of Life 5 Dimensions 5 Level Version, functional impairment assessed with the Work and Social Adjustment Scale, psychological wellbeing assessed with the WHO-5 Well-being Index, and negative effects of treatment assessed with the Negative Effects Questionnaire. Exploratory outcomes are improvement on patient self-defined outcomes, personal recovery, anxiety symptoms, anger reactions, metacognitive beliefs about anger, and perseverative negative thinking. Outcomes will be assessed at 6, 12, and 24 months after randomization; the 12-month time-point being the primary time-point of interest. Outcome assessors performing the depression-rating, data managers, statisticians, the data safety and monitoring committee, and conclusion makers for the outcome article will be blinded to treatment allocation and results. To assess cost-effectiveness of the intervention, a health economic analysis will be performed. DISCUSSION This trial will provide evidence on the beneficial and harmful effects, as well as the cost-effectiveness of schema therapy versus treatment as usual for outpatients with difficult-to-treat depression. The results can potentially improve treatment for a large and understudied patient group. TRIAL REGISTRATION ClinicalTrials.gov NCT05833087. Registered on 15th April 2023 (approved without prompts for revision on 27th April 2023).
Collapse
Affiliation(s)
- Ida-Marie T P Arendt
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
- Department of Trauma- and Torture Survivors, Mental Health Services in the Region of Southern Denmark, Vestre Engvej 51, 7100, Vejle, Denmark.
| | - Matthias Gondan
- Department of Psychology, Universität Innsbruck, Innrain 52, 6020, Innsbruck, Austria
| | - Sophie Juul
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
- Research Unit of Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Stolpegaardsvej 20, 2820, Gentofte, Denmark
| | - Lene Halling Hastrup
- Psychiatric Research Unit, Psychiatry in Region Zealand, Faelledvej 6, 4200, Slagelse, Denmark
- Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark
| | - Bo Bach
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2a, 1353, Copenhagen K, Denmark
- Center for Personality Disorder Research, Mental Health Services in Region Zealand, Fælledvej 6, 4Th Floor, 4200, Slagelse, Denmark
| | - Poul Videbech
- Centre for Neuropsychiatric Depression Research, Nordstjernevej 41, Mental Health Centre Glostrup, 2600, Glostrup, Denmark
| | - Martin Balslev Jørgensen
- Psychiatric Centre Copenhagen, Mental Health Services, Capital Region of Denmark, Frederiksberg Hospital, Hovedvejen 17, 2000, Frederiksberg, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Stine Bjerrum Moeller
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- Department of Trauma- and Torture Survivors, Mental Health Services in the Region of Southern Denmark, Vestre Engvej 51, 7100, Vejle, Denmark
| |
Collapse
|
3
|
Burke A, Davoren MP, Arensman E, Harrington JM. Psychoeducational interventions for people living with chronic communicable disease: a systematic review. BMJ Open 2024; 14:e077007. [PMID: 38521523 PMCID: PMC10961541 DOI: 10.1136/bmjopen-2023-077007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE Psychoeducation is increasingly recognised for its value in facilitating adaption to a chronic disease diagnosis. This study aimed to synthesise available literature on the psychoeducation interventions available to adults living with chronic communicable disease. METHODS PubMed, CINAHL, Embase, SocINDEX, PsycINFO and PsycArticles were systematically searched up to May 2023. Peer-reviewed studies, published in English, investigating the impact of psychoeducational interventions on adults living with chronic communicable disease were included, across a range of outcome measures. Narrative synthesis was performed. The Effective Public Health Practice Project tool and Critical Appraisal Skills Programme tool were used to assess risk of bias. RESULTS In total, 22 studies were included in the review. The majority (n=16) of study populations focused on people living with HIV, followed by hepatitis C (n=5) and genital herpes (n=1). Interventions were delivered online (n=2), via telephone (n=1) and in-person (n=19). The majority of interventions were delivered in group sessions (n=16) and studies emphasised the value of group cohesion for social support, encouraging participants to share their own knowledge in addition to standard didactic presentations. Four studies facilitated peer-led delivery of the psychoeducation. Studies aiming to improve psychological well-being were beneficial in reducing depressive symptoms and/or emotional distress or showed improvement in the participant group overall. There was some evidence to suggest psychoeducation can improve readiness to attend treatment and medication adherence. CONCLUSION The findings of this review highlight potential benefits of psychoeducation but indicate more robust clinical trials will be required to examine their effectiveness and elucidate the mechanisms by which they best operate. Future interventions incorporating a broader focus on resilience enhancement and coping skills specific to stigmatisation could more comprehensively serve the needs of adults living with chronic communicable disease, particularly with HIV. The role of peer support in group psychoeducation merits further exploration. PROSPERO REGISTRATION NUMBER CRD42021243058.
Collapse
Affiliation(s)
- Aoife Burke
- School of Public Health, University College Cork, Cork, Ireland
| | - Martin P Davoren
- School of Public Health, University College Cork, Cork, Ireland
- Sexual Health Centre, Cork, Ireland
| | - Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | | |
Collapse
|
4
|
Leamy M, Foye U, Hirrich A, Bjørgen D, Silver J, Simpson A, Ellis M, Johan-Johanson K. A systematic review of measures of the personal recovery orientation of mental health services and staff. Int J Ment Health Syst 2023; 17:33. [PMID: 37849003 PMCID: PMC10580616 DOI: 10.1186/s13033-023-00600-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
PURPOSE This review aimed to update and extend the Williams and colleagues 2012 systematic review of measures of recovery-orientation of mental health services by examining whether any of the specific knowledge gaps identified in this original review had subsequently been addressed. METHODS A systematic review using CINAHL, ASSIA, Embase, PsycINFO, Medline and other sources, searched from 2012 until 2021. The conceptualisation of recovery and recovery-orientation of services was explored. Psychometric properties of measures were evaluated using quality criteria and according to ease of use. RESULTS Fourteen measures assessing aspects of the recovery orientation of services and staff were identified, of which ten met the eligibility. Psychometric properties were evaluated, and conceptualisations of recovery and recovery-orientation of services investigated. CONCLUSION After over a decade of research in the field of recovery outcome measurement, there remains a lack of a single gold-standard measure of recovery-orientation of mental health services. There is a need for researchers to develop a new gold standard measure of recovery-orientation of services that is psychometrically valid and reliable, demonstrates sensitivity to change and is easy to use. It needs to show a good fit to an underpinning conceptual model/ framework of both personal recovery and recovery-oriented services and/or systems, with different versions for stakeholders at each level of an organisation or system.
Collapse
Affiliation(s)
- Mary Leamy
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
| | - Una Foye
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Anne Hirrich
- KBT Competence Center for lived experience and service development, Trondheim, Norway
| | - Dagfin Bjørgen
- KBT Competence Center for lived experience and service development, Trondheim, Norway
| | | | - Alan Simpson
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Madeline Ellis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Karl Johan-Johanson
- KBT Competence Center for lived experience and service development, Trondheim, Norway
| |
Collapse
|
5
|
Duncan A, Kirst M, Dainty KN, Wodchis WP, Stergiopoulos V. Case managers' reflections of a brief case management intervention in Canada. Front Psychiatry 2023; 14:1151904. [PMID: 37448491 PMCID: PMC10336220 DOI: 10.3389/fpsyt.2023.1151904] [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: 01/26/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction As demand for intensive case management services continues to outpace supply, community mental health agencies in Toronto, Ontario, introduced Short-Term Case Management (STCM). Objective This study sought to explore case managers' perspectives and experiences with this new service delivery model. Methods Focus groups were conducted with twenty-one case managers, and transcripts analyzed using thematic analysis. Results Emerging themes suggest that despite embracing a recovery approach, case managers expressed mixed views on the acceptability and appropriateness of this service delivery model as an intervention. Conclusion The ideal population for this intervention are adults with mental health issues in need of system navigation, and those motivated to address their goals. Further research is needed to establish fidelity criteria.
Collapse
Affiliation(s)
- Andrea Duncan
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Maritt Kirst
- Community Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Katie N Dainty
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
6
|
Exploring the Lived Experience on Recovery from Major Depressive Disorder (MDD) among Women Survivors and Five CHIME Concepts: A Qualitative Study. Behav Sci (Basel) 2023; 13:bs13020151. [PMID: 36829380 PMCID: PMC9952474 DOI: 10.3390/bs13020151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE Depression is estimated to be the leading cause of disease by 2030 and is already the leading cause in women worldwide. In Malaysia, nearly 2.3 million people have experienced depression at least once. Yet, this problem has not been thoroughly investigated and addressed. Thus, a study exploring the lived experience of the survivors needs to be carried out. With most Major Depressive Disorder (MDD) patients being women compared to men, this study focused on women MDD survivors to understand their journey to recovery. Survivors or also called 'People with Lived Experience' (PWLE) have a range of first-hand experiences with treatment and recovery, making them an expert by experience. METHOD A qualitative study was conducted using purposive sampling of four women survivors. This method was able to explore the experience of informants rigorously as it gave flexibility and encouraged discussion between researchers and informants. The data from in-depth interviews conducted were then analyzed using thematic analysis, focusing on the key concepts of CHIME conceptual framework of recovery. RESULTS This study found four major themes with fifteen subordinate themes: survivor's efforts, challenges, social support, and hopes. The findings of this study were then integrated with CHIME framework, also known as the guiding philosophy of recovery for mental illness patients. CONCLUSION These findings contributed to a better understanding of the recovery process and supports needed for MDD patients to recover. In addition, this study also gives hopes that MDD patients can recover, therefore breaking the social stigma still prevalent in the community. Based on these first-hand experiences shared by the survivors, it is hoped that the present interventions conducted by related organizations and caregivers can yield improvements so that the current patients who are still struggling with MDD can recover faster holistically. Limitations and implications for future research have also been discussed.
Collapse
|
7
|
Høgh Egmose C, Heinsvig Poulsen C, Hjorthøj C, Skriver Mundy S, Hellström L, Nørgaard Nielsen M, Korsbek L, Serup Rasmussen K, Falgaard Eplov L. The Effectiveness of Peer Support in Personal and Clinical Recovery-Systematic Review and Meta-Analysis. Psychiatr Serv 2023:appips202100138. [PMID: 36751908 DOI: 10.1176/appi.ps.202100138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Peer support has been shown to support personal recovery from mental illness. It is unclear whether the effects of peer support across different mental illnesses depend on the organizational setting. The authors reviewed the effectiveness of peer support for both personal recovery and clinical recovery of adults with any mental illness and evaluated the effectiveness of peer support in different settings. METHODS A systematic review of randomized controlled trials (RCTs) was conducted in PubMed, PsycInfo, CINAHL, Cochrane Library, and Web of Science. A meta-analysis of outcomes of personal and clinical recoveries at the end of interventions was conducted. RESULTS In total, 49 RCTs with 12,477 participants with any mental illness were included. Most of the trials had a high risk for bias. Results of the meta-analysis indicated that peer support in general had a small positive effect on personal recovery (standard mean difference [SMD]=0.20; 95% CI=0.11-0.29) and decreased anxiety symptoms (SMD=-0.21; 95% CI=-0.40 to -0.02), with most trials evaluating peers added to mental health-related hospital services. No data for peers in established service roles were available for the meta-analysis. Peer-designed interventions developed to be provided independently of hospital services and delivered in community settings had a modest effect on self-advocacy. A small nonsignificant effect on personal recovery for peer support delivered online was also observed. CONCLUSIONS The effect on personal recovery from mental illness was most evident in peer support added to hospital services. High-quality RCTs with comparable cocreated interventions and clear descriptions of mechanisms of change are needed to further investigate peer support efficacy.
Collapse
Affiliation(s)
- Cecilie Høgh Egmose
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Chalotte Heinsvig Poulsen
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Sara Skriver Mundy
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Lone Hellström
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Mette Nørgaard Nielsen
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Lisa Korsbek
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Klavs Serup Rasmussen
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Lene Falgaard Eplov
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| |
Collapse
|
8
|
Higgins A, Murphy R, Barry J, Eustace-Cook J, Monahan M, Kroll T, Hevey D, Doyle L, Gibbons P. Scoping review of factors influencing the implementation of group psychoeducational initiatives for people experiencing mental health difficulties and their families. J Ment Health 2022; 31:859-872. [PMID: 31994955 DOI: 10.1080/09638237.2020.1714002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Despite evidence to support the effectiveness of psychoeducation for people experiencing mental health difficulties and their families, understanding issues around the implementation of such programmes is limited. AIM The aim of this scoping review was to synthesise the peer-reviewed literature on barriers and enablers influencing the implementation of group psychoeducation in adult mental health services. METHODS Using a pre-defined search strategy and PRISMA guidelines, four databases were systematically searched. Two reviewers independently screened and applied exclusion/inclusion criteria. Qualitative, quantitative, and mixed-methods studies were included if they provided empirical evidence on the barriers and enablers. Three reviewers independently extracted data. Following this, data were analysed using a five-level implementation framework. RESULTS Eight articles met the inclusion criteria. Barriers to implementation were identified at all five levels of the framework: participant; practitioner; intervention; organisational; and structural level. Enablers to implementation were evident at four levels: participant; provider; intervention; and organisational level. CONCLUSIONS The findings of the review provide preliminary information on factors that impact implementation. However, large-scale studies informed by implementation theories are required. In addition, other studies are needed to address the potential impact of different models of intervention and explore strategies to minimize obstacles and support sustainability.
Collapse
Affiliation(s)
- Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Rebecca Murphy
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Jennifer Barry
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Mark Monahan
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Patrick Gibbons
- Kildare West Wicklow Mental Health Service, Naas Hospital, Naas, Ireland
| |
Collapse
|
9
|
Kuek JHL, Raeburn T, Chow MYZ, Wand T. Lived experiences of mental health conditions in Singapore: A constructivist grounded theory study. Int J Soc Psychiatry 2022; 69:735-743. [PMID: 36352825 DOI: 10.1177/00207640221135111] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND Since the 1990s, the mental healthcare field has begun shifting to conceptualisations of personal mental health recovery, emphasising the heterogeneous nature of how people develop and overcome the difficulties associated with mental ill health. Despite three decades of research on the topic, most recovery-oriented studies have been conducted in predominantly Western cultures, lacking the necessary nuances when applied in Asian settings. AIMS We sought to contribute to a growing body of research to fill this gap by exploring the experiences of people who experience mental ill-health in Singapore. METHOD We adopted a constructivist grounded theory approach and interviewed 21 people who had been diagnosed as experiencing a mental health condition. RESULTS The core category emerging from interview participant perspectives was a 'roller coaster ride of confusion'. This overarching category was made up of the following four sub-categories - 'not understanding what was happening', 'losing control over self', 'unpacking the root of challenges' and 'trying to make sense of the situation'. CONCLUSIONS Taken together, the journey of a person experiencing mental health recovery in Singapore is filled with obstacles and uncertainty due to various social and cultural influences such as family pressures, the competitiveness of society and the high-pressure nature of Singapore's educational system. Future research needs to better understand if these are generalisable experiences, and interventions to mitigate their impact need to be explored. Given the strong societal influences, change will take time. Still, this study gives a voice to the lived experiences of people who face mental health challenges in Singapore in the hope that their insights may assist future generations in developing a more mentally healthy society.
Collapse
Affiliation(s)
- Jonathan Han Loong Kuek
- Susan Wakil School of Nursing and Midwifery
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Toby Raeburn
- Faculty of Nursing and Midwifery, Health Sciences & Physiotherapy, The University of Notre Dame, NSW, Australia
| | | | - Timothy Wand
- Susan Wakil School of Nursing and Midwifery
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| |
Collapse
|
10
|
Piat M, Wainwright M, Rivest MP, Sofouli E, von Kirchenheim T, Albert H, Casey R, Labonté L, O’Rourke JJ, LeBlanc S. The impacts of implementing recovery innovations: a conceptual framework grounded in qualitative research. Int J Ment Health Syst 2022; 16:49. [PMID: 36210449 PMCID: PMC9548307 DOI: 10.1186/s13033-022-00559-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Implementing mental health recovery into services is a policy priority in Canada and globally. To that end, a 5 year study was undertaken with seven organisations providing mental health and housing services to people living with a mental health challenge to implement guidelines for the transformation of services and systems towards a recovery-orientation. Multi-stakeholder implementation teams were established and a facilitated process guided teams to choosing and planning for the implementation of one recovery innovation. The recovery innovations chosen were hiring peer support workers, Wellness Recovery Action Planning (WRAP), a family support group, and staff recovery training. Methods This study reports on data collected at the post-implementation stage. 90 service users, service providers, family members, managers, other actors and knowledge users participated in 41 group, individual or dyad semi-structured interviews. The interview guides included open-ended questions eliciting participants’ impressions regarding the impact of implementing the innovation on service users, service providers and organisations. We applied a collaborative qualitative content analysis approach in NVivo12 to coding and interpreting the data generated from these questions. Results Eighteen impacts of implementing recovery innovations from the perspectives of diverse stakeholder groups were identified. Three impacts of working as an implementation team member and as part of a research project were also identified. Impacts were developed into a conceptual framework organised around four overall categories of impact: Ways of being, Ways of interacting, Ways of thinking, and Ways of operating and doing business. Conclusions The IMpacts of Recovery Innovations (IMRI) framework version 1 can assist researchers, evaluators and decision-makers identify, explore and understand impact in the context of recovery innovations. The framework helps fill a gap in conceptualising service and organisation-level impacts. Future research is needed to validate the framework and map it to existing methods for studying impact. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00559-2.
Collapse
|
11
|
Hancock J, Perich T. Personal recovery in psychological interventions for bipolar disorder: a systematic review. AUSTRALIAN PSYCHOLOGIST 2022. [DOI: 10.1080/00050067.2022.2083484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Jasmine Hancock
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Tania Perich
- School of Psychology, Western Sydney University, Sydney, Australia
| |
Collapse
|
12
|
Goodman-Casanova JM, Cuesta-Lozano D, Garcia-Gallardo M, Duran-Jimenez FJ, Mayoral-Cleries F, Guzman-Parra J. Measuring mental health recovery: Cross-cultural adaptation of the 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP). Int J Ment Health Nurs 2022; 31:650-664. [PMID: 35277913 PMCID: PMC9314871 DOI: 10.1111/inm.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 11/27/2022]
Abstract
Mental health services need reliable and valid instruments to measure mental health recovery outcomes, and the only available one in Spanish is arduous. Adapting an instrument is more efficient than creating a new one as it enables international comparison research. The aim of this study was to conduct a cross-cultural adaptation of the 15-item Questionnaire about the Process of Recovery. Fifty-four participants engaged in a five-stage systematic and standardized process carried out from November 2019 to November 2020. Professional translators (n = 4) from the Translation Service Center for Foreign Languages of the Universidad de Alcalá participated in the direct translation, synthesis and back translation stages, and mental health professionals (n = 33) and service users (n = 17) from the Hospital Regional Universitario de Málaga and the Hospital Universitario Virgen de la Victoria in Andalucía (Spain), with an average of 19.2 (SD 12.86) years of experience in mental health, participated in the committee of experts and pilot debriefing stages. Additionally, legibility was assessed. Out of the 15-items of the questionnaire, three (20%) were equal amongst translations, three items (20%) of the back translations matched the original questionnaire and discrepancies identified were adapted accordingly. Seven items (46.7%) were approved online by experts and consensus of alternative translations was reached for the rest. The average time spent completing the questionnaire by service users during the face-to-face pilot was 4.12 min (SD 2.25). Internal consistency obtained was ω = 0.95 and α = 0.91. Debriefing findings reported the questionnaire as comprehensible (97.1%), adequate in wording (91.2%), formal in language (55.9%) and adequate in terms of length (100%). The questionnaire scored 65.53, 'normal' readability, on the Inflesz scale. The adapted instrument has conceptual, linguistic, cultural and metric equivalence to the original instrument.
Collapse
Affiliation(s)
- Jessica Marian Goodman-Casanova
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Departamento de Enfermería y Fisioterapia, Universidad de Alcalá, Madrid, Spain
| | | | - Marta Garcia-Gallardo
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Francisco Javier Duran-Jimenez
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Fermin Mayoral-Cleries
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Jose Guzman-Parra
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| |
Collapse
|
13
|
Mathias S, Tee K, Helfrich W, Gerty K, Chan G, Barbic SP. Foundry: Early learnings from the implementation of an integrated youth service network. Early Interv Psychiatry 2022; 16:410-418. [PMID: 34008340 PMCID: PMC9292689 DOI: 10.1111/eip.13181] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/16/2022]
Abstract
AIMS To provide the first profile of the demographic and service characteristics of young people (aged 12-24 years) who access Foundry, a provincial network of integrated youth health and social service centres in British Columbia, Canada and to share early learnings about implementation and service innovation. METHODS Using a retrospective chart review, we conducted a census of all young people accessing a Foundry centre in a 'proof of concept' phase. Six centres were assessed between October 2015 and March 2018. Data included demographics, mental health service access history, service type the youth was seeking, and information about how they found out about the centre. RESULTS A total of 4783 young people presented during this proof of concept period, for a total number of 35 791 visits. The most frequently accessed category of service was mental health/substance use (57%) followed by physical health (25%). Young people were most likely to be female, aged 15-19, and White. Youth demographic characteristics showed an over-representation of Indigenous and LGBTQ2 youth and under-representation of males and youth aged 20-24. Youth were most likely to learn about Foundry from a friend (44%) or family member (22%). Most youth (58%) reported that they would have gone 'nowhere' if not for Foundry. CONCLUSIONS Foundry is a model of integrated health and social services delivery, focused on early intervention, prevention and accessibility, driven by the needs and priorities of young people and their families. Leveraging international integrated youth health service evidence, the model addresses urgent priorities in Canadian health service delivery.
Collapse
Affiliation(s)
- Steve Mathias
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Karen Tee
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada
| | - Warren Helfrich
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada
| | - Krista Gerty
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada
| | - Godwin Chan
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada
| | - Skye Pamela Barbic
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Providence Health Care Research Institute, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
14
|
Khan N, Tracy DK. The challenges and necessity of situating 'illness narratives' in recovery and mental health treatment. BJPsych Bull 2022; 46:77-82. [PMID: 33597058 PMCID: PMC9074157 DOI: 10.1192/bjb.2021.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In mental health services, recovery constitutes a guiding principle that is endorsed in professional medical guidelines and has become central to mental health policies across the world. However, for many clinicians, it can be a challenge to effectively embed recovery concepts into professionally directed treatment of disease without distortion, and ostensibly away from what matters to those who use the services. We discuss the evolving and multifaceted concept of 'recovery', including illness narratives to frame our discussion. We demonstrate how integration between a person-directed management of illness and a professionally directed treatment of disease can converge, resulting in positive outcomes for people with mental illness.
Collapse
Affiliation(s)
| | - Derek K Tracy
- Oxleas NHS Foundation Trust, UK.,King's College London, UK
| |
Collapse
|
15
|
Kanehara A, Koike H, Fujieda Y, Yajima S, Kabumoto A, Kumakura Y, Morita K, Miyamoto Y, Nochi M, Kasai K. Culture-dependent and universal constructs and promoting factors for the process of personal recovery in users of mental health services: qualitative findings from Japan. BMC Psychiatry 2022; 22:105. [PMID: 35144562 PMCID: PMC8832737 DOI: 10.1186/s12888-022-03750-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 01/28/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The conceptualization of personal recovery began in Europe and North America and has spread worldwide. However, the concept of personal recovery in addition to recovery-promoting factors may be influenced by culture. We explored how users of mental health services in Japan perceive their own personal recovery and the factors that promote it. METHODS We conducted semi-structured interviews and focus group interviews with individuals using mental health services. The interview data were analysed using thematic analysis with a grouped framework analysis approach. We used a coding framework based on the existing CHIME framework (connectedness, hope and optimism about the future, identity, meaning in life, and empowerment). RESULTS Data were obtained from 30 users of mental health services (mean age: 40.4 years; 46.7% women; 50.0% with schizophrenia). "Compassion for others" was newly extracted in "Connectedness", and "Rebuilding/redefining identity not being as shaped by social norms" was newly extracted in "Identity" as personal recovery. "Positive experiences in childhood" (including positive parenting support from neighbours) was newly extracted as a recovery-promoting factor. CONCLUSIONS Our unique findings on the rebuilding identity/defining identity free from conformity to social norms due to interactions with familiar people, including peers, may be culture dependent. This study raises overarching questions regarding how socio-cultural values influence the development of identity and personal values and how they are in turn reflected in personal recovery.
Collapse
Affiliation(s)
- Akiko Kanehara
- Department of Neuropsychiatry, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Haruna Koike
- grid.419280.60000 0004 1763 8916Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yumiko Fujieda
- grid.412708.80000 0004 1764 7572Department of Rehabilitation, University of Tokyo Hospital, Tokyo, Japan
| | - Sayaka Yajima
- grid.412708.80000 0004 1764 7572Department of Rehabilitation, University of Tokyo Hospital, Tokyo, Japan
| | - Asami Kabumoto
- grid.412708.80000 0004 1764 7572Department of Rehabilitation, University of Tokyo Hospital, Tokyo, Japan
| | - Yousuke Kumakura
- grid.26999.3d0000 0001 2151 536XDepartment of Mental Health/ Psychiatric Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kentaro Morita
- grid.412708.80000 0004 1764 7572Department of Rehabilitation, University of Tokyo Hospital, Tokyo, Japan
| | - Yuki Miyamoto
- grid.26999.3d0000 0001 2151 536XDepartment of Psychiatric Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masahiro Nochi
- grid.26999.3d0000 0001 2151 536XDepartment of Clinical Psychology, University of Tokyo, Tokyo, Japan
| | - Kiyoto Kasai
- grid.26999.3d0000 0001 2151 536XDepartment of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ,grid.26999.3d0000 0001 2151 536XThe International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), Tokyo, Japan
| |
Collapse
|
16
|
Jørgensen K, Rasmussen T, Hansen M, Andreasson K, Karlsson B. Recovery-Oriented Network Meetings in Mental Healthcare: A Qualitative Study. Issues Ment Health Nurs 2022; 43:164-171. [PMID: 34469284 DOI: 10.1080/01612840.2021.1961178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Recovery-oriented cross-sectoral collaboration is a cornerstone of the debate concerning health professionals and users of mental health services and constitutes an objective in government health policy in Scandinavia and other Western countries. Users do not find that professionals communicate with each other across specific sectors regarding plans that have been prepared. They often experience that they have to start over again every time they switch between treatment locations. The aim of this study is to develop a recovery-oriented model for network meetings. Health professionals and users with experience from mental health services participated in three workshops to discuss and achieve a plan for recovery-oriented network meetings. Knowledge was generated in dynamic research cycles that were experiential, presentational, propositional, and practical. Themes were developed and framed by a content analysis.Recommendations are presented as a narrative from all the participants involved. The overall theme was 'more focus on personal recovery' with subthemes such as 'CHIME as a recovery-oriented approach'. In addition, other themes were generated such as 'open dialogical meetings', with subthemes such as 'meeting structures' and 'open dialogues'. This study concludes recommendations to promote a recovery-oriented approach in cross-sectoral network meetings inspired by theoretical perspectives along with the experiences and knowledge of co-researchers.
Collapse
Affiliation(s)
- Kim Jørgensen
- The Research Collaboration, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Tonie Rasmussen
- Department of Social and Health, Center for Quality and Development, Birkerød, Denmark
| | - Morten Hansen
- FACT Team 1, Psychiatric Outpatient Clinic, Copenhagen, Denmark
| | - Kate Andreasson
- The Research Collaboration, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Bengt Karlsson
- Mental Health Care, Center for Mental Health and Substance Abuse, Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, Universitetet I Sørøst-Norge, Notodden, Norway
| |
Collapse
|
17
|
McGuire AB, Kukla M, Rollins AL, Garabrant J, Henry N, Eliacin J, Myers LJ, Flanagan ME, Hunt MG, Iwamasa GY, Bauer SM, Carter JL, Salyers MP. Recovery-oriented acute inpatient mental health care: Operationalization and measurement. Psychiatr Rehabil J 2021; 44:318-326. [PMID: 34323532 PMCID: PMC8664980 DOI: 10.1037/prj0000494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The current article describes efforts to develop and test a measure of recovery-oriented inpatient care. METHOD The Recovery-oriented Acute INpatient (RAIN) scale was based on prior literature and current Veterans Health Administration (VHA) policy and resources and further revised based on data collection from 34 VHA acute inpatient units. RESULTS A final scale of 23, behaviorally anchored items demonstrated a four-factor structure including the following factors: inpatient treatment planning, outpatient treatment planning, group programming, and milieu. While several items require additional revision to address psychometric concerns, the scale demonstrated adequate model fit and was consistent with prior literature on recovery-oriented inpatient care. Conclusions and Implementations for Practice: The RAIN scale represents an important tool for future implementation and empirical study of recovery-oriented inpatient care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
|
18
|
Roth C, Wensing M, Kuzman MR, Bjedov S, Medved S, Istvanovic A, Grbic DS, Simetin IP, Tomcuk A, Dedovic J, Djurisic T, Nica RI, Rotaru T, Novotni A, Bajraktarov S, Milutinovic M, Nakov V, Zarkov Z, Dinolova R, Walters BH, Shields-Zeeman L, Petrea I. Experiences of healthcare staff providing community-based mental healthcare as a multidisciplinary community mental health team in Central and Eastern Europe findings from the RECOVER-E project: an observational intervention study. BMC Psychiatry 2021; 21:525. [PMID: 34689733 PMCID: PMC8543797 DOI: 10.1186/s12888-021-03542-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Community Mental Health Teams (CMHTs) deliver healthcare that supports the recovery of people with mental illness. The aim of this paper was to explore to what extent team members of five CMHTs newly implemented in five countries perceived that they had introduced aspects of the recovery-oriented, strength-based approach into care after a training week on recovery-oriented practice. In addition, it evaluated what the team members' perceptions on their care roles and their level of confidence with this role were. METHOD An observational intervention study using a quantitative survey that was administered among 52 health professionals (21 Nurses, 13 Psychiatrists, 9 Psychologists, 8 Social Workers) and 14 peer workers including the Recovery Self-Assessment Tool Provider Version (RSA-P), the Team Member Self-Assessment Tool (TMSA), and demographic questions was conducted. The measures were self-reported. Descriptive statistics were used to calculate the means and standard deviations for continuous variables and frequencies and percentages for categorical variables (TMSA tool and demographic data). The standard technique to calculate scale scores for each subscale of the RSA-P was used. Bivariate linear regression analyses were applied to explore the impact of predictors on the subscales of the RSA-P. Predictors with significant effects were included in multiple regression models. RESULT The RSA-P showed that all teams had the perception that they provide recovery-oriented practice to a moderately high degree after a training week on recovery-oriented care (mean scores between 3.85-4.46). Health professionals with fewer years of professional experience perceived more frequently that they operated in a recovery-oriented way (p = 0.036, B = - 0.268). Nurses and peer workers did not feel confident or responsible to fulfil specific roles. CONCLUSION The findings suggest that a one-week training session on community-based practices and collaborative teamwork may enhance recovery-oriented practice, but the role of nurses and peer workers needs further attention. TRIAL REGISTRATION Each trial was registered before participant enrolment in the clinicaltrials.gov database: Croatia, Zagreb (Trial Reg. No. NCT03862209 ); Montenegro, Kotor (Trial Reg. No. NCT03837340 ); Romania, Suceava (Trial Reg. No. NCT03884933 ); Macedonia, Skopje (Trial Reg. No. NCT03892473 ); Bulgaria, Sofia (Trial Reg. No. NCT03922425 ).
Collapse
Affiliation(s)
- Catharina Roth
- grid.5253.10000 0001 0328 4908Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130, 69120 Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany.
| | - Martina Rojnic Kuzman
- grid.412688.10000 0004 0397 9648Clinic for Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Kišpatićeva ul. 12, 10000 Zagreb, Croatia ,grid.4808.40000 0001 0657 4636Zagreb School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sarah Bjedov
- grid.412688.10000 0004 0397 9648Clinic for Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Kišpatićeva ul. 12, 10000 Zagreb, Croatia
| | - Sara Medved
- grid.412688.10000 0004 0397 9648Clinic for Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Kišpatićeva ul. 12, 10000 Zagreb, Croatia
| | - Ana Istvanovic
- grid.413299.40000 0000 8878 5439Croatian Institute of Public Health, Rockefellerova ul. 7, 10000 Zagreb, Croatia
| | - Danijela Stimac Grbic
- grid.413299.40000 0000 8878 5439Croatian Institute of Public Health, Rockefellerova ul. 7, 10000 Zagreb, Croatia
| | - Ivana Pavic Simetin
- grid.413299.40000 0000 8878 5439Croatian Institute of Public Health, Rockefellerova ul. 7, 10000 Zagreb, Croatia
| | - Aleksandar Tomcuk
- Health Institution Special Psychiatric Hospital Dobrota Kotor, Dobrota bb, 85330 Kotor, Montenegro
| | - Jovo Dedovic
- Health Institution Special Psychiatric Hospital Dobrota Kotor, Dobrota bb, 85330 Kotor, Montenegro
| | - Tatijana Djurisic
- Public Health Institute of Montenegro, Dzona Dzeksona bb, 81000 Podgorica, Montenegro
| | - Raluca Ileana Nica
- Institute Liga Romana pentru Sanatate Mintala, Sos. Mihai Bravu 90-96, Bucuresti-Sector 2, Romania
| | - Tiberiu Rotaru
- Siret Psychiatric Hospital, Strada 9 Mai 5, 725500 Siret, Romania
| | - Antoni Novotni
- grid.452081.aUniversity Clinic of Psychiatry, Мајка Тереза 17, Mother Teresa 17, Skopje, 1000 North Macedonia
| | - Stojan Bajraktarov
- grid.452081.aUniversity Clinic of Psychiatry, Мајка Тереза 17, Mother Teresa 17, Skopje, 1000 North Macedonia
| | - Milos Milutinovic
- grid.452081.aUniversity Clinic of Psychiatry, Мајка Тереза 17, Mother Teresa 17, Skopje, 1000 North Macedonia
| | - Vladimir Nakov
- National Centre of Public Health and Analyses, Directorate Mental Health and Prevention of Addictions, Acad. Ivan Evst. Geshov 15 blvd., 1431 Sofia, Bulgaria
| | - Zahari Zarkov
- National Centre of Public Health and Analyses, Directorate Mental Health and Prevention of Addictions, Acad. Ivan Evst. Geshov 15 blvd., 1431 Sofia, Bulgaria
| | - Roumyana Dinolova
- National Centre of Public Health and Analyses, Directorate Mental Health and Prevention of Addictions, Acad. Ivan Evst. Geshov 15 blvd., 1431 Sofia, Bulgaria
| | - Bethany Hipple Walters
- grid.416017.50000 0001 0835 8259Dutch Institute for Mental Health and Addiction/Trimbos Institute, Da Costakade 45, 3521 Utrecht, VS Netherlands
| | - Laura Shields-Zeeman
- grid.416017.50000 0001 0835 8259Dutch Institute for Mental Health and Addiction/Trimbos Institute, Da Costakade 45, 3521 Utrecht, VS Netherlands
| | - Ionela Petrea
- grid.416017.50000 0001 0835 8259Dutch Institute for Mental Health and Addiction/Trimbos Institute, Da Costakade 45, 3521 Utrecht, VS Netherlands ,Present Address: INSIGHT International Institute for Mental Health and Integrated Health Systems, Cornelis Anthoniszstraat 23-1, 1071VP Amsterdam, Netherlands
| |
Collapse
|
19
|
Erazo-Chavez LJ, La-Rotta EIG, Onocko-Campos RT. Cross-cultural adaptation of the Recovery Self-Assessment RSA-R Family/Brazil: Validity evidence based on test content. CIENCIA & SAUDE COLETIVA 2021; 26:3693-3704. [PMID: 34468663 DOI: 10.1590/1413-81232021269.2.32692019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/27/2020] [Indexed: 11/21/2022] Open
Abstract
In the cross-cultural adaptation of instruments, the qualitative component of adaptation is generally poorly reported, sometimes being superficially addressed. In this study we aimed to describe the qualitative component of the cross-cultural adaptation process and to demonstrate validity evidence based on test content of the Recovery Self-Assessment-RSA-R Family/Brazil. We conducted a qualitative study that included the steps of preparation, translation, back-translation, expert's assessment, workshop with a researcher from Yale University, and two pilot studies involving family members of patients attended at mental health services. Among the results, we found considerable validity evidence based on test content with a percentage of agreement above 80%. Pilot studies contributed to accentuating this evidence, assisting in the cultural adequacy of the statements and in the operational equivalence of the instrument. The adaptation process of the RSA-R Family/Brazil proved to be complex. From this experience, we concluded that presenting validity evidence based on test content is important to ensure the applicability tools to the target culture. The instrument will still be evaluated as for psychometric characteristics through statistical techniques.
Collapse
Affiliation(s)
- Leidy Janeth Erazo-Chavez
- Universidade Estadual de Campinas. Cidade Universitária Zeferino Vaz s/n, Barão Geraldo. 13083-970 Campinas SP Brasil.
| | | | - Rosana Teresa Onocko-Campos
- Universidade Estadual de Campinas. Cidade Universitária Zeferino Vaz s/n, Barão Geraldo. 13083-970 Campinas SP Brasil.
| |
Collapse
|
20
|
Narratives about the Experience of Mental Illness: the recovery Process in Brazil. Psychiatr Q 2021; 92:573-585. [PMID: 32827099 DOI: 10.1007/s11126-020-09824-4] [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] [Indexed: 10/23/2022]
Abstract
UNLABELLED This paper analyzes ten recovery narratives of people with a serious mental illness who received mental health services in the public health care system of the city of Campinas, Brazil. We describe the person's recovery process and their relationship with the clinical services they received. This is a very needed conversation because the incorporation of recovery and recovering citizenship concepts in clinical practice are still incipient in South America. Most importantly, this research adds to the dialogue around recovering citizenship in different cultures. METHODS We used phenomenological methodology to interpret data drawn from the participant's life course interview (using the McGill Illness Narrative Interview). RESULTS We found that a) Before receiving services, people were overwhelmed by symptoms, but did not know what was going on; b) Loved ones and clinicians explained symptoms as part of a mental illness, and the proposed treatment was largely accepted; c) Mental health treatment was seen as helpful but not enough to address what was meaningful for their lives; d) People regained a life in their community, they felt proud of their recovery process, and solidarity and collectivism seemed to play important roles in their recovery process. DISCUSSION We identified similarities and differences in the recovery process of people with serious mental illness receiving public mental health services in Campinas, Brazil, when compared to the international literature. Receiving mental health services was very helpful for participants, principally when feeling overwhelmed by symptoms. Mental health services seemed to be less effective in helping people regain a meaningful life in their communities. Solidarity from friends and family members was recognized as an important recovery asset.
Collapse
|
21
|
Piat M, Wainwright M, Sofouli E, Vachon B, Deslauriers T, Préfontaine C, Frati F. Factors influencing the implementation of mental health recovery into services: a systematic mixed studies review. Syst Rev 2021; 10:134. [PMID: 33952336 PMCID: PMC8101029 DOI: 10.1186/s13643-021-01646-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/22/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Countries around the world have committed in policy to transforming their mental health services towards a recovery orientation. How has mental health recovery been implemented into services for adults, and what factors influence the implementation of recovery-oriented services? METHODS This systematic mixed studies review followed a convergent qualitative synthesis design and used the best-fit framework synthesis method. Librarians ran searches in Ovid- MEDLINE, Ovid-EMBASE, Ovid-PsycInfo, EBSCO-CINAHL Plus with Full Text, ProQuest Dissertations and Theses, Cochrane Library, and Scopus. Two reviewers independently screened studies for inclusion or exclusion using DistillerSR. Qualitative, quantitative, and mixed methods peer-reviewed studies published since 1998 were included if they reported a new effort to transform adult mental health services towards a recovery orientation, and reported findings related to implementation experience, process, or factors. Data was extracted in NVivo12 to the 38 constructs of the Consolidated Framework for Implementation Research (CFIR). The synthesis included a within-case and a cross-case thematic analysis of data coded to each CFIR construct. Cases were types of recovery-oriented innovations. RESULTS Seventy studies met our inclusion criteria. These were grouped into seven types of recovery-oriented innovations (cases) for within-case and cross-case synthesis. Themes illustrating common implementation factors across innovations are presented by CFIR domain: Intervention Characteristics (flexibility, relationship building, lived experience); Inner Setting (traditional biomedical vs. recovery-oriented approach, the importance of organizational and policy commitment to recovery-transformation, staff turnover, lack of resources to support personal recovery goals, information gaps about new roles and procedures, interpersonal relationships), Characteristics of Individuals (variability in knowledge about recovery, characteristics of recovery-oriented service providers); Process (the importance of planning, early and continuous engagement with stakeholders). Very little data from included studies was extracted to the outer setting domain, and therefore, we present only some initial observations and note that further research on outer setting implementation factors is needed. CONCLUSION The CFIR required some adaptation for use as an implementation framework in this review. The common implementation factors presented are an important starting point for stakeholders to consider when implementing recovery-oriented services.
Collapse
Affiliation(s)
- Myra Piat
- Douglas Mental Health University Institute, 6875, boul. LaSalle, Montréal, Québec, H4H 1R3, Canada. .,McGill University, Québec, Canada.
| | - Megan Wainwright
- Douglas Mental Health University Institute, 6875, boul. LaSalle, Montréal, Québec, H4H 1R3, Canada.,Department of Anthropology, Durham University, Durham, Canada
| | - Eleni Sofouli
- Douglas Mental Health University Institute, 6875, boul. LaSalle, Montréal, Québec, H4H 1R3, Canada.,McGill University, Québec, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Université de Montréal, C.P. 6128, succursale Centre-ville, Montreal, Québec, H3C 3J7, Canada
| | - Tania Deslauriers
- School of Rehabilitation, Université de Montréal, 7077 avenue du Parc, Montreal, QC, H3N 1X7, Canada
| | - Cassandra Préfontaine
- Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
| | - Francesca Frati
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, 809, Sherbrooke W, Montreal, Québec, H3A 0C9, Canada
| |
Collapse
|
22
|
Johannessen DA, Geirdal AØ, Nordfjærn T. Investigating the factor structure of a translated recovery-orientation instrument in inpatient treatment for substance use disorder. Subst Abuse Treat Prev Policy 2021; 16:24. [PMID: 33741021 PMCID: PMC7980679 DOI: 10.1186/s13011-021-00363-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recovery has been outlined as a process of change through which involvement and empowerment enables individuals to reach their goals and aspirations. Recovery self-assessment (RSA) is an instrument that has been acknowledged as an applicable measure of recovery-orientation in services for people with mental health problems or substance use disorder (SUD). This study aimed to translate RSA from US English to Norwegian and to investigate the factor structure of the translated version (RSA-N). METHODS A translate/back-translate procedure was used. Confirmatory factor analysis (CFA) was applied to investigate the factor structure of RSA-N in a sample of clinicians (n = 407) working in inpatient SUD treatment facilities. RESULTS The results suggested that the hypothesised five-factor structure originally obtained by the developers showed an inadequate fit with the current data sample. RSA-N was modified and restructured by removing twelve misfitting items and combining factors with high covariance using data from one subsample. The alternative three-factor structure yielded an acceptable fit for the data from a second subsample. Acceptable alpha coefficients, suggesting good internal consistency, supported the adequacy of the three-factor structure. CONCLUSIONS Results from the present study are in line with previous findings, which have failed to replicate the hypothesised five-factor structure without modifications. Knowledge about the degree to which SUD services are recovery-oriented may contribute to SUD services' pursuit of establishing an inpatient treatment environment that fosters change and development of inpatients. The present study's findings imply RSA-N's potential as an instrument to assess recovery-orientation in inpatient SUD treatment.
Collapse
Affiliation(s)
- Dagny Adriaenssen Johannessen
- Blue Cross East, Oslo, Norway.
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Oslo, Norway.
| | - Amy Østertun Geirdal
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Trond Nordfjærn
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs Hospital, Clinic of Substance Use and Addiction Medicine, Trondheim, Norway
| |
Collapse
|
23
|
Organizational Climate and Support Among Peer Specialists Working in Peer-Run, Hybrid and Conventional Mental Health Settings. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:150-167. [PMID: 31564032 DOI: 10.1007/s10488-019-00980-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
As the peer specialist workforce continues to expand, it is critical to better understand peer providers' working conditions and workplace experiences. The current study utilized a targeted non-probability sample of 801 peer specialists to explore whether key organizational climate and support variables would yield distinct multivariate groups, and to investigate the correlates of these groups. Analyses yielded a seven-group solution, with peer run organizations comprising a substantially greater proportion of the groups with high organizational climate and support scores. In direct comparisons, peer-run programs outranked all other groups in the areas of perceived organizational climate, supports for career development and perceived service quality.
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Higgins A, Murphy R, Downes C, Barry J, Monahan M, Hevey D, Kroll T, Doyle L, Gibbons P. Factors impacting the implementation of a psychoeducation intervention within the mental health system: a multisite study using the consolidation framework for implementation research. BMC Health Serv Res 2020; 20:1023. [PMID: 33168003 PMCID: PMC7654573 DOI: 10.1186/s12913-020-05852-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/22/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical. METHODS The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n = 75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis. RESULTS Key enablers and barriers were identified across all CFIR domains of the framework with some factors (depending on context) being both an enabler and a barrier. Important factors in the outer setting domain included structural stability within national systems and the peer payment system, while the extent of a recovery-oriented culture, leadership, implementation readiness, and buy-in were influential factors in the inner setting. The characteristics of the intervention in terms of design, evidence-base and adaptability also shaped the intervention's implementation as did the knowledge, beliefs and self-efficacy of facilitators. In terms of processes, implementation was influenced by the degree of engagement of key individuals who championed and supported the programme. The results highlight that while some of the barriers were specific to the programme, many reflected systemic and structural challenges within health services more generally. CONCLUSION Findings from this study provide an enhanced understanding of the different layers of determinants to implementation of an intervention. Overcoming challenges will involve positive and ongoing engagement and collaboration across the full range of stakeholders that are active within each domain, including policy and operational levels. The quality of leadership at each domain level is of crucial importance to successful implementation.
Collapse
Affiliation(s)
- Agnes Higgins
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
| | - Rebecca Murphy
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
- Department of Psychology, Maynooth University, Kiladre, Ireland
| | - Carmel Downes
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
| | - Jennifer Barry
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
| | - Mark Monahan
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Louise Doyle
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, Ireland
| | | |
Collapse
|
26
|
Fleury MJ, Sabetti J, Bamvita JM. Modeling Relationships Involving Perceived Recovery Orientation of Mental Health Teams Among Quebec Mental Health Professionals. J Behav Health Serv Res 2020; 46:434-449. [PMID: 29511938 DOI: 10.1007/s11414-018-9591-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
While mental health (MH) services are expected to support client recovery, very little is known about services provided by MH teams in relation to this goal. This study explored relationships between a comprehensive collection of team effectiveness variables and the perspectives of MH professionals regarding the recovery orientation of their teams. A model developed by path analysis revealed eight team-related variables that were significantly and positively associated with recovery-oriented teams: primary care versus specialized MH services; greater proportions of clients with severe mental disorders or with suicide ideation on caseloads; knowledge sharing and knowledge production among team members; team climate; work role performance; and trust in coworkers. Results underline the importance of building knowledge and professional competence on MH teams, and the need for a positive team climate that offers flexibility and innovation for addressing the complex needs of people in MH recovery living in the community.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada. .,Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
| | - Judith Sabetti
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.,School of Social Work, McGill University, 3506 University Street, Montreal, QC, H3A 2A7, Canada
| | - Jean-Marie Bamvita
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| |
Collapse
|
27
|
Larivière N, Gauthier-Boudreault C, Morin P, Boyer R. Les visions du rétablissement dans des services résidentiels en santé mentale d’une région québécoise. SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1070241ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectif À la suite d’une réorganisation dans le secteur de l’hébergement en santé mentale dans une région québécoise, cette étude descriptive a évalué l’intégration des principes de rétablissement selon des utilisateurs de services (n = 25), des responsables de milieux d’hébergement (n=19) et des professionnels de la santé et de services sociaux (n = 30).
Méthode La version française du Recovery Self-Assessment a été remplie par tous. Les utilisateurs de services ont également rempli l’Échelle de satisfaction envers les domaines de la vie. Des questions qualitatives supplémentaires écrites ont été posées.
Résultats La plupart des utilisateurs de services étaient globalement satisfaits de leur résidence actuelle, mais ont noté que les options d’intervention et aborder les besoins sexuels pourraient être améliorés. Les intervenants considèrent qu’il y a une intégration significativement plus faible des différentes dimensions du rétablissement que les deux autres groupes (p < 0,001). Les trois groupes ont indiqué que les utilisateurs de services devraient être davantage impliqués dans la planification des services en résidence.
Conclusion L’intégration des points de vue a mis en lumière le besoin de travailler de façon collaborative pour soutenir le processus de rétablissement dans les milieux d’hébergement et impliquer davantage les personnes utilisatrices de services.
Collapse
Affiliation(s)
- Nadine Larivière
- Erg., Ph. D., École de réadaptation, Université de Sherbrooke ; Institut universitaire de première ligne en santé et services sociaux, Sherbrooke
| | | | - Paul Morin
- Ph. D., École de service social, Université de Sherbrooke ; Institut universitaire de première ligne en santé et services sociaux, Sherbrooke
| | - Richard Boyer
- Ph. D., Faculté de médecine, Université de Montréal ; Institut universitaire de santé mentale de Montréal
| |
Collapse
|
28
|
Rudd B, Karatzias T, Bradley A, Fyvie C, Hardie S. Personally meaningful recovery in people with psychological trauma: Initial validity and reliability of the Individual Recovery Outcomes Counter (I.ROC). Int J Ment Health Nurs 2020; 29:387-398. [PMID: 31697034 DOI: 10.1111/inm.12671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2019] [Indexed: 11/27/2022]
Abstract
Individual Recovery Outcomes Counter (I.ROC) is a brief tool measuring personal recovery designed for collaborative use within support. This study aimed to investigate the psychometric properties of a self-report version of the I.ROC within a trauma population. A total of 107 adults attending trauma interventions in an NHS service in Scotland completed I.ROC alongside measures of self-esteem, mental illness symptoms, and functional impairment. Scores on each measure were compared to evaluate the convergent validity of I.ROC. Internal consistency and factor analytical techniques were also used to assess the structural validity and reliability of the measure. Results of internal consistency, convergent validity, and factor analysis provide preliminary support for I.ROC's validity within a trauma population. Previously proposed models were a poor fit for the current sample; principal components analysis suggested a three-factor structure with acceptable internal consistency, comprising ten of the original twelve items (I.ROC-10). Correlations with all measures reached significance for the original and modified I.ROC and its subscales. I.ROC appears to be a valid and reliable tool for use in measuring recovery within a trauma population, but further research is needed to examine the structural validity of I.ROC.
Collapse
Affiliation(s)
- Bridey Rudd
- Department of Psychology, Abertay University, Dundee, UK.,Penumbra, Norton Park, Edinburgh, UK
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.,NHS Lothian, Rivers Centre, Fountainbridge Library Building, Edinburgh, UK
| | - Aoife Bradley
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Claire Fyvie
- NHS Lothian, Rivers Centre, Fountainbridge Library Building, Edinburgh, UK
| | - Scott Hardie
- Department of Psychology, Abertay University, Dundee, UK
| |
Collapse
|
29
|
Ibrahim N, Thompson D, Nixdorf R, Kalha J, Mpango R, Moran G, Mueller-Stierlin A, Ryan G, Mahlke C, Shamba D, Puschner B, Repper J, Slade M. A systematic review of influences on implementation of peer support work for adults with mental health problems. Soc Psychiatry Psychiatr Epidemiol 2020; 55:285-293. [PMID: 31177310 DOI: 10.1007/s00127-019-01739-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/03/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The evidence base for peer support work in mental health is established, yet implementation remains a challenge. The aim of this systematic review was to identify influences which facilitate or are barriers to implementation of mental health peer support work. METHODS Data sources comprised online databases (n = 11), journal table of contents (n = 2), conference proceedings (n = 18), peer support websites (n = 2), expert consultation (n = 38) and forward and backward citation tracking. Publications were included if they reported on implementation facilitators or barriers for formal face-to-face peer support work with adults with a mental health problem, and were available in English, French, German, Hebrew, Luganda, Spanish or Swahili. Data were analysed using narrative synthesis. A six-site international survey [Germany (2 sites), India, Israel, Tanzania, Uganda] using a measure based on the strongest influences was conducted. The review protocol was pre-registered (Prospero: CRD42018094838). RESULTS The search strategy identified 5813 publications, of which 53 were included. Fourteen implementation influences were identified, notably organisational culture (reported by 53% of papers), training (42%) and role definition (40%). Ratings on a measure using these influences demonstrated preliminary evidence for the convergent and discriminant validity of the identified influences. CONCLUSION The identified influences provide a guide to implementation of peer support. For services developing a peer support service, organisational culture including role support (training, role clarity, resourcing and access to a peer network) and staff attitudes need to be considered. The identified influences provide a theory base to prepare research sites for implementing peer support worker interventions.
Collapse
Affiliation(s)
- Nashwa Ibrahim
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK.,Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Dean Thompson
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Rebecca Nixdorf
- Department of Psychiatry, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | | | - Galia Moran
- Ben Gurion University of the Negev, Beer Sheva, Israel
| | | | - Grace Ryan
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Julie Repper
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK.
| |
Collapse
|
30
|
Apostolopoulou A, Stylianidis S, Issari P, Chondros P, Alexiadou A, Belekou P, Giannou C, Karali EK, Foi V, Tzaferou F. Experiences of Recovery in EPAPSY's Community Residential Facilities and the Five CHIME Concepts: A Qualitative Inquiry. Front Psychiatry 2020; 11:24. [PMID: 32116841 PMCID: PMC7031485 DOI: 10.3389/fpsyt.2020.00024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/10/2020] [Indexed: 11/13/2022] Open
Abstract
In the context of the reform of psychiatric services in Greece, the debate about the concept of recovery is still growing. Recovery is defined as a path through which individuals facing mental health challenges are enabled to regain and further develop significant relationships with family, friends, the community, and themselves and at the same time to cope with the detrimental effects of stigma through empowerment. The present qualitative study aims to explore the experiences of people living in EPAPSY's (Association for Regional Development and Mental Health) community residential facilities focusing mainly upon the key concepts of the CHIME (connectivity, hope, identity, meaning, and empowerment) conceptual framework of recovery. To this end, semi-structured interviews were conducted with seven participants living and receiving mental health care in a residential facility of EPAPSY. The participants' accounts were analyzed using thematic analysis in a deductive and inductive manner. The research findings highlighted, among others, the challenges the participants faced during their early years in family and school, the experience of the revolving door effect, and the perceived turn their life took when they were transferred to a community residential facility, thus opening a new chapter in their lives. Of the five CHIME concepts, all are present in the participants' accounts, with emphasis given to a meaningful present, a need to feel "normal" again, and a positive outlook for the future, both for themselves and their relationships, despite the persistence of certain difficulties.
Collapse
Affiliation(s)
| | - Stelios Stylianidis
- Department of Psychology, Panteion University for Social and Political Sciences, Athens, Greece
| | - Philia Issari
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Chondros
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Amalia Alexiadou
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Pepy Belekou
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Charalambos Giannou
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Eleni K. Karali
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Vana Foi
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Fotini Tzaferou
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| |
Collapse
|
31
|
Kotake R, Kanehara A, Miyamoto Y, Kumakura Y, Sawada U, Takano A, Chiba R, Ogawa M, Kondo S, Kasai K, Kawakami N. Reliability and validity of the Japanese version of the INSPIRE measure of staff support for personal recovery in community mental health service users in Japan. BMC Psychiatry 2020; 20:51. [PMID: 32028913 PMCID: PMC7006071 DOI: 10.1186/s12888-020-2467-y] [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: 11/29/2018] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Supporting personal recovery in people with mental health difficulties is central to mental health services. This study aimed to develop the Japanese version of INSPIRE and Brief INSPIRE measure of staff support for personal recovery and to evaluate its reliability and validity. METHODS A questionnaire survey was conducted from October to December 2015. The authors asked users to participate in the survey of 14 community mental health services in the Kanto region of Japan. The service users completed self-administered questionnaires that include the Japanese version of INSPIRE, the Recovery Assessment Scale, the Client Satisfaction Questionnaire, the patient version of the Scale to Assess Therapeutic Relationship in Community Mental Health care and the Short Form Health Survey. Internal consistency was assessed using Cronbach's alpha coefficient, and test-retest reliability was assessed using the intraclass correlation coefficient (ICC) and weighted kappa. Convergent validity was examined by assessing correlation with other scales. Factor validity was evaluated by exploratory factor analysis (EFA) with generalized least-squares mean and oblimin rotation. In addition, confirmatory factor analysis was used to check the fitness of the factor structure models derived from the EFA. RESULTS A total of 195 out of 212 users gave written informed consent and participated in the study. Data from 190 respondents were analyzed (response rate 89.6%). INSPIRE, Brief INSPIRE, and the subscales all showed Cronbach's alpha coefficient over 0.78. ICC and weighted kappa derived more than 0.92 for subscales and Brief INSPIRE. These numerical values indicated good reliability. The convergent validity of Brief INSPIRE and the subscales was significantly positively correlated with the other scales. Different from the previous study, the factor structure was extracted using EFA. Both factor structures were checked by CFA, but the degree of fitness index was not good in either. Therefore, the factor analysis did not show goodness of fit. CONCLUSIONS This study found the Japanese version of INSPIRE and Brief INSPIRE to be reliable and valid for use among community mental health service users in Japan.
Collapse
Affiliation(s)
- Risa Kotake
- grid.26999.3d0000 0001 2151 536XDepartment of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033 Japan
| | - Akiko Kanehara
- grid.26999.3d0000 0001 2151 536XDepartment of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655 Japan
| | - Yuki Miyamoto
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan.
| | - Yousuke Kumakura
- grid.26999.3d0000 0001 2151 536XDepartment of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033 Japan
| | - Utako Sawada
- grid.26999.3d0000 0001 2151 536XDepartment of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033 Japan
| | - Ayumi Takano
- grid.265073.50000 0001 1014 9130Department of Mental Health and Psychiatric Nursing, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8510 Japan
| | - Rie Chiba
- grid.31432.370000 0001 1092 3077Department of Nursing, Graduate School of Health Sciences, Kobe University, 7-10-2, Tomogaoka, Suma-ku, Kobe, Hyogo 654-0142 Japan
| | - Makoto Ogawa
- grid.419280.60000 0004 1763 8916National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8553 Japan
| | - Shinsuke Kondo
- grid.412708.80000 0004 1764 7572Department of Neuropsychiatry, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655 Japan
| | - Kiyoto Kasai
- grid.412708.80000 0004 1764 7572Department of Neuropsychiatry, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655 Japan ,grid.26999.3d0000 0001 2151 536XThe International Research Center for Neurointelligence (WPI-IRCN), The University of Tokyo Institutes for Advanced Study (UTIAS), 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033 Japan
| | - Norito Kawakami
- grid.26999.3d0000 0001 2151 536XDepartment of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033 Japan
| |
Collapse
|
32
|
Hirdes JP, van Everdingen C, Ferris J, Franco-Martin M, Fries BE, Heikkilä J, Hirdes A, Hoffman R, James ML, Martin L, Perlman CM, Rabinowitz T, Stewart SL, Van Audenhove C. The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care. Front Psychiatry 2020; 10:926. [PMID: 32076412 PMCID: PMC6978285 DOI: 10.3389/fpsyt.2019.00926] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.
Collapse
Affiliation(s)
- John P. Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Coline van Everdingen
- Psychiatry and Neuropsychology Department, Maastricht University, Maastricht, Netherlands
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Brant E. Fries
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Jyrki Heikkilä
- Division of Psychiatry, Turku University Hospital, Turku, Finland
| | - Alice Hirdes
- Graduate Program in Health Promotion, Human Development and Society, Lutheran University of Brazil, Canoas, Brazil
| | - Ron Hoffman
- School of Criminology and Criminal Justice, Nipissing University, North Bay, ON, Canada
| | - Mary L. James
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Lynn Martin
- Department of Health Sciences for Lynn Martin, Lakehead University, Thunder Bay, ON, Canada
| | - Christopher M. Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Shannon L. Stewart
- Faculty of Education, Althouse College, Western University, London, ON, Canada
| | - Chantal Van Audenhove
- LUCAS Center for Care Research and Consultancy & Academic Center for General Practice in the Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium
| |
Collapse
|
33
|
Penas P, Uriarte JJ, Gorbeña S, Moreno-Calvete MC, Ridgway P, Iraurgi I. Psychometric Adequacy of Recovery Enhancing Environment (REE) Measure: CHIME Framework as a Theory Base for a Recovery Measure. Front Psychiatry 2020; 11:595. [PMID: 32714217 PMCID: PMC7344157 DOI: 10.3389/fpsyt.2020.00595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/09/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The aim of this study was to assess to what extent the recovery elements of the Recovery Enhancing Environment (REE) instrument measured the dimensions proposed by the CHIME framework, (Connectedness, Hope and optimism about future, Identity, Meaning in life and Empowerment dimensions), so as to evaluate personal recovery in people with severe mental illness. METHODS Two processes were conducted. Firstly, five experts matched the elements of recovery evaluated by the REE items with the CHIME domains and subdomains. Then, the resulting structure from those experts agreement was analyzed with different confirmatory factor analyses (CFA) using responses to the recovery elements dimension of the REE of 312 mental health service users. RESULTS The percentage of agreements and the kappa coefficients were adequate taking into account the CHIME dimensions (κ = 0.57 to 0.69, total κ = 0.74); however, lower agreement was found at the subdimensions level. Some indexes of the CFA were acceptable for a second order factor analysis [χ 2 (242)= 346.03, p < 0.001, CFI= 0.931, RMSEA= 0.037 (0.028 to 0.046)] and the most adequate solution was obtained from the bi-factorial structure (χ 2 (223)=233.19, p=0.306, CFI= 0.993, RMSEA= 0.012 [0.000 to 0.027]). CONCLUSIONS Despite the subjective and complex nature of the personal recovery construct, the REE measure can be a valid instrument to verify the existing CHIME conceptual framework, since two of the models tested have resulted in adequate indexes and were also congruent with the theoretical framework and the statistical solution. Thus, REE can be used to obtain a global index of Personal Recovery dimension, and the five indicators proposed by the CHIME framework.
Collapse
Affiliation(s)
- Patricia Penas
- Department of Personality, Assessment and Psychological Treatment, University of Deusto, Bilbao, Spain
| | - Jose Juan Uriarte
- Red de Salud Mental, Biocruces Bizkaia Health Research Institute, Basque Health Service, Bizkaia Mental Health Network, Bilbao, Spain
| | - Susana Gorbeña
- Department of Personality, Assessment and Psychological Treatment, University of Deusto, Bilbao, Spain
| | - Maria Concepcion Moreno-Calvete
- Red de Salud Mental, Biocruces Bizkaia Health Research Institute, Basque Health Service, Bizkaia Mental Health Network, Bilbao, Spain
| | | | - Ioseba Iraurgi
- Department of Personality, Assessment and Psychological Treatment, University of Deusto, Bilbao, Spain
| |
Collapse
|
34
|
Green R, Mitchell PF, Lee K, Svensson E, Toh JW, Barentsen C, Copeland M, Newton JR, Hawke KC, Brophy L. Key features of an innovative sub-acute residential service for young people experiencing mental ill health. BMC Psychiatry 2019; 19:311. [PMID: 31646990 PMCID: PMC6813091 DOI: 10.1186/s12888-019-2303-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous studies across international settings have highlighted a need to improve the appropriateness and continuity of services for young people experiencing mental ill health. This paper examines key features of a sub-acute youth mental health residential service model, Youth Prevention and Recovery Care (Y-PARC) service. Y-PARC provides up to 4 weeks care to 16 to 25 year-olds at risk of hospitalisation and to those transitioning out of hospital inpatient units. The research was conducted at one of three Y-PARCs located in Victoria, Australia. METHODS This paper presents findings from analysis of two data sources collected during evaluation of a Y-PARC service in 2015-17. Routinely collected administrative data of Y-PARC residents (n = 288) were analysed and semi-structured interviews were conducted with 38 participants: a) former residents (n = 14); b) family members of group a) (n = 5); key stakeholders (n = 9); and, Y-PARC staff (n = 10 respondents in 3 group interviews). Analysis of the qualitative data was thematic and structured by the interview guide, which covered the key service aims. RESULTS Consistent with the aims of the service, respondents described practice at Y-PARC that aligns with recovery-oriented care. Key features emphasised were: a safe and welcoming environment for residents and families; provision of person-centred care; promotion of autonomy and self-help; informal interactions with staff allowing for formation of naturalistic relationships; time spent with other young people with similar experiences; and, assurance upon exit that the 'door is always open.' High levels of satisfaction were reported. Outcomes described included: improved resilience; better understanding of mental health; the importance of seeking help; and, stronger connections to therapeutic services. Longer and multiple stays were associated with progressive and sustained change. Family members and stakeholders widely reported that the service fills a gap between community services and acute inpatient mental health hospital wards. Some challenging areas of practice identified included: integration of evidence-based psychosocial interventions; provision of care within a model that blends clinical and psychosocial support services; and, negotiation of family-inclusive practice. CONCLUSIONS The Y-PARC service model shows promise with young people experiencing mental ill health, particularly in improving the range and availability of options across a spectrum of need.
Collapse
Affiliation(s)
- Rachael Green
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria 3053 Australia
| | - Penelope Fay Mitchell
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria 3053 Australia
| | - Kira Lee
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria 3053 Australia
| | - Ella Svensson
- Orygen, the National Centre of Excellence in Youth Mental Health, 35 Poplar Roadd, Parkville, Victoria 3052 Australia
| | - Jia-Wern Toh
- Orygen, the National Centre of Excellence in Youth Mental Health, 35 Poplar Roadd, Parkville, Victoria 3052 Australia
| | - Carolyn Barentsen
- Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199 Australia
| | - Michala Copeland
- Mind Australia, 86-92 Mount Street, Heidelberg, Victoria 3084 Australia
| | - J. Richard Newton
- Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199 Australia
| | | | - Lisa Brophy
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria 3053 Australia
- Mind Australia, 86-92 Mount Street, Heidelberg, Victoria 3084 Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria Australia
| |
Collapse
|
35
|
Abstract
BACKGROUND Recovery is a key goal for individuals, and services' recovery orientation can facilitate this process. The independent mental health sector is increasingly important in Ireland, particularly in counselling and suicide prevention. We aimed to evaluate Pieta House as a recovery-oriented service through clients' self-rated recovery; and clients' and therapists' evaluation of the service. METHODS Clients completing therapy over a 3-month period were invited to complete the Recovery Assessment Scale (RAS) and the Recovery Self Assessment-Revised (RSA-R). Therapists completed the RSA-R staff version. RESULTS Response rate was 36.7% for clients (n=88), 98% for therapists (n=49). Personal recovery was endorsed by 73.8% of clients, with highest agreement for factors 'Willingness to Ask for Help' (84.5%), and 'Reliance on Others' (82.1%). A smaller number agreed with factors 'Personal Confidence and Hope' (61.3%) and 'No Domination by Symptoms' (66.6%). Clients' and therapists' evaluation of the service showed high levels of agreement with factors of 'Choice' (90.9% clients, 100% therapists); 'Life Goals' (84.1% clients, 98% therapists) and 'Individually Tailored Services' (80.6% clients, 79.6% therapists). Client involvement in service management had the lowest level of agreement (36.4% clients, 30.6% therapists). Clients' self-rated recovery correlated with their rating of the service (correlation value 0.993, p=0.01). CONCLUSIONS Clients' self-rated recovery and the recovery orientation of Pieta House were rated highly, with areas for improvement in service user involvement, peer support and advocacy. The correlation of personal recovery and recovery orientation of the service may merit further study.
Collapse
|
36
|
Wong EC, Collins RL, Breslau J, Burnam MA, Cefalu MS, Roth E. Associations between provider communication and personal recovery outcomes. BMC Psychiatry 2019; 19:102. [PMID: 30922292 PMCID: PMC6439978 DOI: 10.1186/s12888-019-2084-9] [Citation(s) in RCA: 3] [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: 10/01/2018] [Accepted: 03/18/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This study examined whether two types of provider communication considered important to quality of care (i.e., shows respect and explains understandably) are associated with mental health outcomes related to personal recovery (i.e., connectedness, hope, internalized stigma, life satisfaction, and empowerment). This study also tested whether these associations varied by the type of provider seen (i.e., mental health professional versus general medical doctor). METHODS This sample included participants from the 2014 California Well-Being Survey, a representative survey of California residents with probable mental illness, who had recently obtained mental health services (N = 429). Multiple regression was used to test associations between provider communication and personal recovery outcomes and whether these associations were modified by provider type. RESULTS Providers showing respect was associated with better outcomes across all five of the personal recovery domains, connectedness (β = 1.12; p < .001), hope (β = 0.72; p < .0001), empowerment (β = 0.38; p < .05), life satisfaction (β = 1.10; p < .001) and internalized stigma (β = - 0.49; p < .05). Associations between provider showing respect and recovery outcomes were stronger among those who had seen a mental health professional only versus a general medical doctor only. CONCLUSIONS Respectful communication may result in greater personal recovery from mental health problems. Respecting consumer perspectives is a hallmark feature of both recovery-oriented services and quality care, yet these fields have operated independently of one another. Greater integration between these two areas could significantly improve recovery-oriented mental health outcomes and quality of care.
Collapse
Affiliation(s)
- Eunice C. Wong
- 0000 0004 0370 7685grid.34474.30RAND Corporation, 1776 Main Street, Santa Monica, CA USA
| | - Rebecca L. Collins
- 0000 0004 0370 7685grid.34474.30RAND Corporation, 1776 Main Street, Santa Monica, CA USA
| | - Joshua Breslau
- 0000 0004 0370 7685grid.34474.30RAND Corporation, 1776 Main Street, Santa Monica, CA USA
| | - M. Audrey Burnam
- 0000 0004 0370 7685grid.34474.30RAND Corporation, 1776 Main Street, Santa Monica, CA USA
| | - Matthew S. Cefalu
- 0000 0004 0370 7685grid.34474.30RAND Corporation, 1776 Main Street, Santa Monica, CA USA
| | - Elizabeth Roth
- 0000 0004 0370 7685grid.34474.30RAND Corporation, 1776 Main Street, Santa Monica, CA USA
| |
Collapse
|
37
|
Recovery-oriented training programmes for mental health professionals: A narrative literature review. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.mhp.2019.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
38
|
The Clinical Interview for Psychotic Disorders (CIPD): Preliminary results on interrater agreement, reliability and qualitative feedback. Psychiatry Res 2019; 272:723-729. [PMID: 30832192 DOI: 10.1016/j.psychres.2018.12.176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/10/2018] [Accepted: 12/31/2018] [Indexed: 11/23/2022]
Abstract
Given the recent treatment paradigm shift in psychosis, focusing on the recovery process, new assessment tools are needed. The Clinical Interview for Psychotic Disorders (CIPD) is an integrative and comprehensive assessment tool for psychotic disorders. CIPD encompasses the evaluation of diagnosis, psychosocial correlates and most relevant comorbidities. The study's aims were to examine CIPD inter-rater reliability, the relationships between CIPD and other instruments assessing positive and negative symptoms and functionality, and to explore participants' qualitative feedback. The sample included 30 individuals with psychotic disorders, aged between 18 and 62 years old. Two experts in clinical psychology conducted the interviews and independently rated other assessment tools (PANSS, GAF and PSP) to determine severity of psychotic symptoms and levels of functionality. Results indicated high inter-rater reliability for the majority of CIPD items and agreement regarding diagnosis was between 73% and 93%. Moreover, positive and moderate to strong correlations were found between CIPD, PANSS, GAF and PSP. From the qualitative analysis five themes emerged, namely: CIPD applicability and utility, comparison with previous interviews, interviewer aspects, negative and positive aspects. Overall, these preliminary results suggest that CIPD is a reliable and valid assessment instrument that seems to be well suited for people with psychosis.
Collapse
|
39
|
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]
|
40
|
Chao J, Siu AMH, Leung O, Lo A, Chu M, Lee WK, Auw C, Lee V, Chien CW. Chinese version of the Recovery Self-Assessment scale: psychometric evidence from Rasch analysis and reliability estimates. J Ment Health 2018; 28:206-212. [PMID: 30449213 DOI: 10.1080/09638237.2018.1521931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Recovery Self-Assessment (RSA) is a popular and well-validated instrument for assessing recovery-oriented service around the world. AIMS This study aims to develop a Chinese version of the RSA, which assesses the recovery orientation of hospital-based mental health services. METHODS We conducted forward and backward translations of the RSA and modify the translated Chinese based on comments by content experts. We recruited 350 people with mental illnesses who regularly attend hospital and community mental health services. The participants completed the Chinese Recovery Self-Assessment Service User version (CRSA-SU) and convergent measures on hope and mental well-being. RESULTS The Rasch analysis supported five of the six factors in the instrument and suggests that the "Life Goal" factor could be further split into two factors. We identified three misfit items (items 6, 12 and 17) that could be considered for removal. Both the internal consistency and test-retest reliability are between satisfactory and very good within each subscale, with the exception of the Choice subscale. The seven subscales had low positive correlations with measures of hope and mental well-being, which supported the convergent validity of CRSA-SU. CONCLUSIONS The results supported the factor structure, reliability and validity of the CRSA-SU.
Collapse
Affiliation(s)
- June Chao
- a Hong Kong Hospital Authority , Kowloon , Hong Kong
| | - Andrew M H Siu
- b Faculty of Health and Social Sciences, Department of Rehabilitation Sciences , The Hong Kong Polytechnic University , Kowloon , Hong Kong
| | - Odelia Leung
- b Faculty of Health and Social Sciences, Department of Rehabilitation Sciences , The Hong Kong Polytechnic University , Kowloon , Hong Kong
| | - Ada Lo
- b Faculty of Health and Social Sciences, Department of Rehabilitation Sciences , The Hong Kong Polytechnic University , Kowloon , Hong Kong
| | - Menza Chu
- b Faculty of Health and Social Sciences, Department of Rehabilitation Sciences , The Hong Kong Polytechnic University , Kowloon , Hong Kong
| | - Wing Kin Lee
- b Faculty of Health and Social Sciences, Department of Rehabilitation Sciences , The Hong Kong Polytechnic University , Kowloon , Hong Kong
| | - Chris Auw
- a Hong Kong Hospital Authority , Kowloon , Hong Kong
| | - Victor Lee
- c Mental Health Association of Hong Kong , Kowloon , Hong Kong
| | - Chi-Wen Chien
- b Faculty of Health and Social Sciences, Department of Rehabilitation Sciences , The Hong Kong Polytechnic University , Kowloon , Hong Kong
| |
Collapse
|
41
|
Fleury MJ, Sabetti J, Grenier G, Bamvita JM, Vallée C, Cao Z. Work-related variables associated with perceptions of recovery-oriented care among Quebec mental health professionals. BJPsych Open 2018; 4:478-485. [PMID: 30450228 PMCID: PMC6235999 DOI: 10.1192/bjo.2018.66] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Provider working conditions are important in mental health service delivery. AIMS To identify variables associated with perceived recovery-oriented care among mental health professionals. METHOD A total of 315 mental health professionals and 41 managers across four Quebec service networks completed questionnaires. Univariate and multilevel mixed-effects linear regressions for bivariate and multivariate analyses were performed using independent variables from the input-mediator-output-input model and recovery-oriented care. RESULTS Recovery-oriented care related to: working in primary care or out-patient mental health services, team support, team interdependence, prevalence of individuals with suicide ideation, knowledge-sharing, team reflexivity, trust, vision (a subset of team climate), belief in multidisciplinary collaboration and frequency of interaction with other organisations. CONCLUSIONS Optimising team processes (for example knowledge-sharing) and emergent states (for example trust) may enhance recovery-oriented care. Adequate financial and other resources, stable team composition, training on recovery best practices and use of standardised assessment tools should be promoted, while strengthening primary care and interactions with other organisations. DECLARATION OF INTEREST None.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Professor, Department of Psychiatry, McGill University and Researcher, Douglas Mental Health University Institute Research Centre, Canada
| | - Judith Sabetti
- Adjunct Professor, McGill University School of Social Work and Research Agent, Douglas Mental Health University Institute Research Centre, Canada
| | - Guy Grenier
- Research Associate, Douglas Mental Health University Institute Research Centre, Canada
| | - Jean-Marie Bamvita
- Research Agent, Douglas Mental Health University Institute Research Centre, Canada
| | - Catherine Vallée
- Associate Professor, Rehabilitation Department, Université Laval, Canada
| | - Zhirong Cao
- Research Agent, Douglas Mental Health University Institute Research Centre, Canada
| |
Collapse
|
42
|
Maxwell A, Tsoutsoulis K, Menon Tarur Padinjareveettil A, Zivkovic F, Rogers JM. Longitudinal analysis of statistical and clinically significant psychosocial change following mental health rehabilitation. Disabil Rehabil 2018; 41:2927-2939. [PMID: 29978733 DOI: 10.1080/09638288.2018.1482505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: With appropriate mental health rehabilitation, schizophrenia is increasingly associated with reports of recovery and stability. However, there is little empirical evidence evaluating the efficacy of services delivering this care. This study evaluated the effectiveness of rehabilitation for improving psychosocial function in consumers with schizophrenia.Methods: An electronic database of standardized assessment instruments mandated and maintained by the health service was retrospectively reviewed to extract ratings of psychosocial function, daily living skills, and mood state from consecutive admissions to an inpatient rehabilitation service. Outcomes were compared at admission, discharge, and one-year follow-up to identify statistically significant change. Individual reliable and clinically significant change was also assessed by comparison with a normative group of clients functioning independently in the community.Results: From admission to discharge the rehabilitation group made statistically significant gains in psychosocial function and daily living skills. Improvements were reliable and clinically significant in one-quarter to one-third of individual consumers. Approximately half sustained their improvements at follow-up, although this represented only a small fraction of the overall cohort. Consumers not demonstrating gains exhibited psychometric floor effects at admission.Conclusions: Rehabilitation can produce statistically and clinically significant immediate improvement in psychosocial function for a sub-set of consumers with elevated scores at admission. The durability of any gains is less clear, and strategies promoting longer-term maintenance are encouraged. Furthermore, currently mandated outcome measures are confounded by issues of sensitivity and reporting compliance, and exploration of alternative instruments for assessing recovery is recommended.Implications for RehabilitationRoutinely collected standardized outcome measures can be used to investigate the effectiveness of mental health rehabilitationIn addition to statistical significance, the clinical significance of outcomes should be evaluated to identify change that is individually meaningfulCurrently mandated outcomes instruments do not adequately evaluate many individuals' recovery journeyMental health service evaluation and quality improvement processes would likely benefit from adoption of recovery-oriented measures.
Collapse
Affiliation(s)
- Anna Maxwell
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Katrina Tsoutsoulis
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Aparna Menon Tarur Padinjareveettil
- South Eastern Sydney Local Health District, Sydney, NSW, Australia.,School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
| | - Frank Zivkovic
- South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Jeffrey M Rogers
- South Eastern Sydney Local Health District, Sydney, NSW, Australia
| |
Collapse
|
43
|
Barbic SP, Kidd SA, Durisko ZT, Yachouh R, Rathitharan G, McKenzie K. What Are the Personal Recovery Needs of Community-Dwelling Individuals with Mental Illness? Preliminary Findings from the Canadian Personal Recovery Outcome Measurement (C-PROM) Study. ACTA ACUST UNITED AC 2018. [DOI: 10.7870/cjcmh-2018-005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
44
|
Abstract
SummaryProfessional practice explicitly focused on supporting the recovery of those it serves is broadly backed by an emerging profile of necessary knowledge, key skills and innovative collaborations, although there is no universally accepted practice ‘model’. This article outlines these components and discusses the associated need for change in the culture of provider organisations along with implementation of wider social and economic policies to support peoples' recovery and social inclusion. This is a values-led approach supported by persuasive advocacy and international endorsement but still in need of further development, systematic evaluation and confirmatory evidence.
Collapse
|
45
|
Chiba R, Umeda M, Goto K, Miyamoto Y, Yamaguchi S, Kawakami N. The property of the Japanese version of the Recovery Knowledge Inventory (RKI) among mental health service providers: a cross sectional study. Int J Ment Health Syst 2017; 11:71. [PMID: 29299055 PMCID: PMC5745615 DOI: 10.1186/s13033-017-0178-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022] Open
Abstract
Background The Recovery Knowledge Inventory (RKI) is one of the influential scales to assess knowledge and attitude toward recovery-oriented practices among mental health service providers. In the present study, we aimed to develop a Japanese version of RKI and examine the validity and reliability. Methods We translated RKI into Japanese by reference to the guidelines for translating and adapting psychometric scales. A cross-sectional questionnaire survey was conducted with mental health service providers. Of a total of 475 eligible professionals, we used data from the 299 participants without missing value for the analyses (valid response rate = 62.9%). The questionnaire included Japanese RKI, Recovery Attitudes Questionnaire, The positive attitudes scale, and Japanese-language version of the Social Distance Scale. To examine the factorial validity of RKI, explanatory factor analysis and confirmatory factor analysis was employed. Convergent validity was assessed by calculating Pearson’s correlation coefficients between the total RKI score and the scores for the other three scales. We also calculated Cronbach’s α coefficients for the total score and for each domain of RKI to assess internal consistency reliability. Results The participants’ mean age was 40.4 years and 30.4% were men. 20-item RKI did not provide any adequate or interpretable factor solutions at any number of factors by EFAs. Thus four items (#1, 4, 5, and 13) were subsequently eliminated in stages, then 16-item RKI was employed as a consequence for further analyses. EFA with four factor structures yielded marginally interpretable constitution. Each factor represented the knowledge regarding psychiatric symptoms and recovery; knowledge about the recovery process; the understanding of what is important for recovery; and the understanding of the challenges and responsibility in recovery, respectively. Subsequent CFA suggested good fit to the data. Good convergent validity and understandable internal consistency reliability were also observed. Conclusions The Japanese 16-item RKI revealed reasonable factorial validity, good convergent validity, and understandable internal consistency reliability among mental health professionals. Japanese cultural settings seemed to influence the four-factor structure in the present study. It can be used for future study in Japan, while future large-scale research is required to ensure robust verification.
Collapse
Affiliation(s)
- Rie Chiba
- Research Institute of Nursing Care for People and Community, University of Hyogo, 13-71 Kitaoji-cho, Akashi, Hyogo 673-8588 Japan
| | - Maki Umeda
- Department of Public Health Nursing, Graduate School of Nursing, St Luke's International University, 10-1, Akashi-cho, Chuo-ku, Tokyo, 104-0044 Japan
| | - Kyohei Goto
- Tokyo Musashino Hospital, 4-11-11, Komone, Itabashi-ku, Tokyo, 173-0037 Japan
| | - Yuki Miyamoto
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Sosei Yamaguchi
- Department of Psychiatric Rehabilitation, Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8553 Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| |
Collapse
|
46
|
Khenti A, Mann R, Sapag JC, Bobbili SJ, Lentinello EK, Maas MVD, Agic B, Hamilton H, Stuart H, Patten S, Sanches M, Corrigan P. Protocol: a cluster randomised control trial study exploring stigmatisation and recovery-based perspectives regarding mental illness and substance use problems among primary healthcare providers across Toronto, Ontario. BMJ Open 2017; 7:e017044. [PMID: 29162572 PMCID: PMC5719263 DOI: 10.1136/bmjopen-2017-017044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/13/2017] [Accepted: 08/10/2017] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Primary care settings are often the first and only point of contact for persons with mental health and/or substance use problems. However, staff experience and training in this area are often limited. These factors as well as a multitude of other components such as structural and systemic stigma experienced by staff can lead to clients being stigmatised, leading to poorer outcomes. By developing a comprehensive intervention for primary care staff working at community health centres (CHCs) aimed at reducing stigma towards people with mental health and substance use problems (MHSUP), we sought to test an innovative and contact-based intervention consisting of staff training, raising awareness, a recovery-focused art programme and an analysis of internal policies and procedures. All of these components can inform and support staff so they can provide better care for people who are experiencing MHSUP. CHC staff members and clients will be included in this project as active participants. METHODS AND ANALYSIS This mixed-methods project will consist of repeated surveys of staff and clients, as well as in-depth, semistructured interviews with a sample of clients and staff. A cluster randomised control trial design will test the effectiveness of an antistigma intervention for CHCs in Toronto, Canada. Six CHCs-three receiving the intervention and three controls-will be included in the study. Using a variety of measures, including the Opening Minds Scale for Health Care Providers (OMS-HC), Mental Illness: Clinicians Attitudes (MICA) Scale, Modified Bogardus Social Distance Scale, Perceived Devaluation-Discrimination Scale, Discrimination Experience subscale of the Internalized Stigma of Mental Illness (ISMI) Scale and the Recovery Assessment Scale (RAS), we hope to gain a thorough understanding of staff members' attitudes and beliefs and clients' perceptions of staff beliefs and behaviours. In-depth interviews will reveal important themes related to clients' experiences of stigma both within and outside the healthcare setting. ETHICS AND DISSEMINATION If demonstrated to be successful, this intervention can be used as a model for future initiatives aimed at reducing MHSUP-related stigma among healthcare providers in an organisational context. Adapting this work in other settings is a key strategic goal of this project. The project will also advance knowledge about stigma reduction and the experience of encountering stigma within a healthcare setting. TRIAL REGISTRATION NCT03043417; Post-results.
Collapse
Affiliation(s)
- Akwatu Khenti
- IMHPR, Centre for Addiction and Mental Health-Russell Street Site, Toronto, Ontario, Canada
| | - Robert Mann
- IMHPR, Centre for Addiction and Mental Health-Russell Street Site, Toronto, Ontario, Canada
| | - Jaime C Sapag
- IMHPR, Centre for Addiction and Mental Health-Russell Street Site, Toronto, Ontario, Canada
| | - Sireesha J Bobbili
- IMHPR, Centre for Addiction and Mental Health-Russell Street Site, Toronto, Ontario, Canada
| | - Emily K Lentinello
- IMHPR, Centre for Addiction and Mental Health-Russell Street Site, Toronto, Ontario, Canada
| | - Mark van der Maas
- IMHPR, Centre for Addiction and Mental Health-Russell Street Site, Toronto, Ontario, Canada
| | - Branka Agic
- IMHPR, Centre for Addiction and Mental Health-Russell Street Site, Toronto, Ontario, Canada
| | - Hayley Hamilton
- IMHPR, Centre for Addiction and Mental Health-Russell Street Site, Toronto, Ontario, Canada
| | - Heather Stuart
- Community Health & Epidemiology, Queen's University, Kingston, Ontario, Canada
| | | | - Marcos Sanches
- Clinical Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Patrick Corrigan
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| |
Collapse
|
47
|
Piat M, Sofouli E, Sabetti J, Lambrou A, Chodos H, Briand C, Vachon B, Curran J. Protocol for a mixed studies systematic review on the implementation of the recovery approach in adult mental health services. BMJ Open 2017; 7:e017080. [PMID: 28855202 PMCID: PMC5724147 DOI: 10.1136/bmjopen-2017-017080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Recovery is integral to mental health planning in G-8 countries including Canada. A recovery-oriented approach to care aims to promote personal empowerment, illness self-management and a life beyond services for people with serious mental illness (SMI), while reducing the financial burden associated with mental illness. Although there is a growing body of literature on recovery, no synthesis of research on the implementation of recovery into mental health services exists. OBJECTIVES The objective is to conduct a mixed studies systematic review on the operationalisation of recovery into mental health services for adults with SMI. It will inform the transformation of Canadian services to a recovery orientation, but may be applicable to other countries. METHODS AND ANALYSIS Seven databases including PubMed, Ovid Medline, Ovid Embase, Ovid PsycInfo, CINAHL, the Cochrane Library and Scopus will be searched for peer-reviewed empirical studies published from 1998 to December 2016. Systematic reviews and studies using quantitative, qualitative and mixed methodologies will be included. Secondary searches will be conducted in reference lists of all selected full text articles. Handsearches will also be performed in the tables of contents of three recovery-focused journals for the last 5 years. International experts in the field will be contacted for comments and advice. Data extraction will include identification and methodological synthesis of each study; definition of recovery; information on recovery implementation; facilitators and barriers and study outcomes. A quality assessment will be conducted on each study. The data will be synthesised and a stepwise thematic analysis performed. ETHICS AND DISSEMINATION Ethics approval is not required for this knowledge synthesis. Findings will be disseminated through knowledge translation activities including: (1) a 1-day symposium; (2) presentations in national and international conferences and to local stakeholders; (3) publications in peer-reviewed journals; (4) posts on the organisational websites.
Collapse
Affiliation(s)
- Myra Piat
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- School of Social Work, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Research Centre, Montreal, Quebec, Canada
| | - Eleni Sofouli
- Douglas Mental Health University Institute, Research Centre, Montreal, Quebec, Canada
| | - Judith Sabetti
- School of Social Work, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Research Centre, Montreal, Quebec, Canada
| | - Angella Lambrou
- Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montreal, Quebec, Canada
| | - Howard Chodos
- Mental Health Commission of Canada-Ottawa, Ottawa, Ontario, Canada
| | - Catherine Briand
- Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada
| | - Brigitte Vachon
- Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada
| | - Janet Curran
- School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
48
|
Ali MK, Hack SM, Brown CH, Medoff D, Fang L, Klingaman EA, Park SG, Dixon LB, Kreyenbuhl JA. Racial Differences in Mental Health Recovery among Veterans with Serious Mental Illness. J Racial Ethn Health Disparities 2017; 5:235-242. [PMID: 28411327 DOI: 10.1007/s40615-017-0363-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Abstract
Black consumers with serious mental illness (SMI) face significant challenges in obtaining quality mental health care and are at risk for experiencing significant disparities in mental health care outcomes, including recovery from mental illness. Patient-provider interactions may partly contribute to this disparity. The purpose of the current study was to understand the effects of race, psychosis, and therapeutic alliance on mental health recovery orientation among Veterans with SMI. Participants were Veterans who had an SMI being treated at two Veteran Affairs outpatient mental health clinics by a psychiatrist or nurse practitioner. Participants completed the Behavior and Symptom Identification Scale (BASIS-24), Mental Health Recovery Measure, and patient-report Scale to Assess the Therapeutic Relationship (STAR-P) which includes three subscales: positive collaboration, positive clinician input, and non-supportive clinician input. Regression analyses were used to determine interactive effects of race, psychosis severity, and therapeutic alliance variables. The sample was 226 Veterans (50% black, 50% white). Black participants were slightly older (p < .05), had higher baseline psychosis (p < .05), higher mental health recovery (p < .05), and perceived less non-supportive clinician input (p < .01) than white participants. Regression analyses indicated a significant three-way interaction among race, psychosis, and positive collaboration (p < .01). Greater positive collaboration attenuated the negative effect of higher levels of psychosis on mental health recovery orientation for black participants. Conversely, for white participants, positive collaboration had little effect on the negative relationship between psychosis severity and mental health recovery orientation. Increased levels of psychosis may inhibit patients' perceptions of their ability to recover from SMI. However, for black participants, positive collaboration with mental health providers may moderate the effects of psychotic symptomatology.
Collapse
Affiliation(s)
- Mana K Ali
- Department on Physical Medicine and Rehabilitation, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
| | - Samantha M Hack
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Clayton H Brown
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Howard Hall Suite 200, 660 W. Redwood Street, Baltimore, MD, 21201, USA
| | - Deborah Medoff
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Lijuan Fang
- School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Elizabeth A Klingaman
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Stephanie G Park
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Julie A Kreyenbuhl
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| |
Collapse
|
49
|
Nugent A, Hancock N, Honey A. Developing and Sustaining Recovery-Orientation in Mental Health Practice: Experiences of Occupational Therapists. Occup Ther Int 2017; 2017:5190901. [PMID: 29097969 PMCID: PMC5612613 DOI: 10.1155/2017/5190901] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 01/24/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/AIM Internationally, mental health policy requires clinicians to shift from a medical to a recovery-oriented approach. However, there is a significant lag in the translation of policy into practice. Occupational therapists have been identified as ideally situated to be recovery-oriented yet limited research exploring how they do this exists. This study aimed to explore Australian occupational therapists' experiences of developing and sustaining recovery-orientation in mental health practice. METHODS Semistructured, in-depth interviews were conducted with twelve occupational therapists working across different mental health service types. Participants identified themselves as being recovery-oriented. Data were analysed using constant comparative analysis. RESULTS Occupational therapists described recovery-oriented practice as an active, ongoing, and intentional process of seeking out knowledge, finding fit between understandings of recovery-oriented practice and their professional identity, holding hope, and developing confidence through clinical reasoning. Human and systemic aspects of therapists' workplace environment influenced this process. CONCLUSIONS Being a recovery-oriented occupational therapist requires more than merely accepting a specific framework. It requires commitment and ongoing work to develop and sustain recovery-orientation. Occupational therapists are called to extend current leadership activity beyond their workplace and to advocate for broader systemic change.
Collapse
Affiliation(s)
- Alexandra Nugent
- The University of Sydney, Cumberland Campus, 74 East St., Lidcombe, NSW 2141, Australia
| | - Nicola Hancock
- The University of Sydney, Cumberland Campus, 74 East St., Lidcombe, NSW 2141, Australia
| | - Anne Honey
- The University of Sydney, Cumberland Campus, 74 East St., Lidcombe, NSW 2141, Australia
| |
Collapse
|
50
|
Frost BG, Tirupati S, Johnston S, Turrell M, Lewin TJ, Sly KA, Conrad AM. An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges. BMC Psychiatry 2017; 17:22. [PMID: 28095811 PMCID: PMC5240195 DOI: 10.1186/s12888-016-1164-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over past decades, improvements in longer-term clinical and personal outcomes for individuals experiencing serious mental illness (SMI) have been moderate, although recovery has clearly been shown to be possible. Recovery experiences are inherently personal, and recovery can be complex and non-linear; however, there are a broad range of potential recovery contexts and contributors, both non-professional and professional. Ongoing refinement of recovery-oriented models for mental health (MH) services needs to be fostered. DISCUSSION This descriptive paper outlines a service-wide Integrated Recovery-oriented Model (IRM) for MH services, designed to enhance personally valued health, wellbeing and social inclusion outcomes by increasing access to evidenced-based psychosocial interventions (EBIs) within a service context that supports recovery as both a process and an outcome. Evolution of the IRM is characterised as a series of five broad challenges, which draw together: relevant recovery perspectives; overall service delivery frameworks; psychiatric and psychosocial rehabilitation approaches and literature; our own clinical and service delivery experience; and implementation, evaluation and review strategies. The model revolves around the person's changing recovery needs, focusing on underlying processes and the service frameworks to support and reinforce hope as a primary catalyst for symptomatic and functional recovery. Within the IRM, clinical rehabilitation (CR) practices, processes and partnerships facilitate access to psychosocial EBIs to promote hope, recovery, self-agency and social inclusion. Core IRM components are detailed (remediation of functioning; collaborative restoration of skills and competencies; and active community reconnection), together with associated phases, processes, evaluation strategies, and an illustrative IRM scenario. The achievement of these goals requires ongoing collaboration with community organisations. CONCLUSIONS Improved outcomes are achievable for people with a SMI. It is anticipated that the IRM will afford MH services an opportunity to validate hope, as a critical element for people with SMI in assuming responsibility and developing skills in self-agency and advocacy. Strengthening recovery-oriented practices and policies within MH services needs to occur in tandem with wide-ranging service evaluation strategies.
Collapse
Affiliation(s)
- Barry G. Frost
- School of Psychology, Faculty of Science and Technology, University of Newcastle, Callaghan, NSW 2308 Australia ,Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia
| | - Srinivasan Tirupati
- Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | | | - Megan Turrell
- Hunter New England Mental Health, Newcastle, NSW 2300 Australia
| | - Terry J. Lewin
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Ketrina A. Sly
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Agatha M. Conrad
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| |
Collapse
|