Recovery from mental illness: a service user perspective on facilitators and barriers

Supporting Older Adults' Mental Health Against Suspected Mental Health Problems: The Moderating Role of an Age-Friendly Neighborhood

This study examined how compensatory and enabling domains of an Age-Friendly City (AFC) moderate the relationship between suspected mental health problems and depressive and anxiety symptoms among older adults. Four thousand six hundred and twenty-five Hong Kong Chinese aged ≥60 years completed a telephone survey between April and July 2022, including PHQ-2 and GAD-2. AFC indices sourced from prior territory-wide study. Linear mixed models showed that enabling AFC domains, namely, social participation, respect and social inclusion, and civic participation and employment, alleviated the effects of suspected mental health problems on respondents' depressive and anxiety symptoms (b = -0.40 to -0.56). Three-way interaction models revealed that the protective effects of all compensatory and enabling AFCC domains (b = -1.23 to -6.18), except civic participation and employment, were stronger in old-old (70-79 years) and oldest-old (≥80 years) than young-old (60-69 years). AFCC-based interventions should focus on compensatory and enabling domains to support older adults' mental health.

Spaces out of reach? Service user involvement in residents' meetings at recovery-oriented social housing facilities for young people with mental health disorders

Through anthropological fieldwork among people with severe mental health disorders, this article focuses on these service users' interactions and relations with the professionals and with other service users at recovery-oriented housing facilities in Denmark. We discuss how recovery-oriented spaces designed for the service users may feel out of reach to them, hence making the service users feel awkward and reluctant to participate. The study shows how service users, initially recognized as "unengaged," rather are to be understood as active actors involved in their recovery and forming social bonds. The research seeks to put forward new perspectives on recovery as a concept in psychosocial rehabilitation, arguing that recovery and healing may take up different forms in different spaces and that recognizing services users' enactment of reluctancy and disengagements could serve as an important part of recovery work in rehabilitation.

Exploring key determinants of health among individuals with serious mental Illness: qualitative insights from a first episode psychosis cohort, 20 years postdiagnosis

BACKGROUND

Individuals with serious mental illness (SMI) are more likely to experience functional decline, low well-being, comorbidities, shorter lifespan, and diminished quality of life than the general population. This qualitative study explores determinants of health that individuals with SMI perceive as important to their health, well-being, and ability to live a meaningful life.

METHOD

We conducted interviews with 13 individuals with early detected first episode psychosis as part of a 20-year follow-up study of a larger cohort. Interview data were analyzed using qualitative content analysis.

RESULTS

Analysis identified two themes comprising eight categories representing determinants of health. The first theme reflected management of mental and physical health. Categories in this theme were: access to mental healthcare adapted to individual needs, strategies during deterioration, use of psychotropic medication, maintenance of physical health and lifestyle. The second theme reflected social health determinants in coping with mental illness and comprised three categories: family and friends, engaging in meaningful hobbies and activities, and the influence of employment on mental health.

CONCLUSIONS

Individuals with SMI outlined mental, physical, and social determinants of health that were important for their health, well-being, and ability to live a meaningful life. In future clinical practice, coordinated care addressing the complexity of health determinants will be important.

Bodies and orientations. Perspectives and strategies among service users in psychosocial rehabilitation housing facilities in Denmark

Recovery-orientated approaches have grown more and more common in psychosocial rehabilitation in Denmark, thus shifting the focus to the dynamic status of mental health issues that were historically regarded as chronic. This change has caused an important shift towards recognizing service users as humans with equal rights and possibilities. But the recovery-oriented approach is also complex and difficult to apply in practice. Drawing on phenomenological concepts of bodies and orientations in space, the paper discusses how bodies, which are perceived as queer, seek to reorientate themselves. The discussion draws on three empirical cases involving service users from fieldwork at housing facilities for people with severe mental health issues. The paper concludes that psychosocial rehabilitation housing facilities may benefit from adopting a broader perspective on body orientations because this contributes with a focus on service users as active agents who strive to inhabit space.

A Estrutura Das Representações Sociais Do Recovery De Usuários Do Serviço De Saúde Que Fazem Uso Abusivo De Substâncias Psicoativas

Este estudio tuvo como objetivo comprender la estructura de las representaciones sociales de los Equipos de Salud de la Familia sobre la recuperación de usuarios de servicios que abusan de sustancias psicoactivas. Para su realización se optó por un estudio básico, de campo, exploratorio, descriptivo, transversal con enfoque cuantitativo y cualitativo, cuyo marco teórico fue la Teoría de las Representaciones Sociales. El escenario de estudio fue un municipio del norte de Minas Gerais. Los participantes fueron 101 profesionales de 10 Estrategias de Salud de la Familia. La recolección de datos se realizó mediante un cuestionario con preguntas cerradas y prueba de recuerdo de palabras. Los datos de evocación se analizaron mediante una tabla de cuatro casas con la ayuda del Software Ensembles de Programs Permettant l'Analyse des Evocations 2005 (EVOC®). Se observa que en la estructura de representación social formulada por los profesionales estudiados tanto en el núcleo central como en las periferias, se identifica que el proceso de formación de representaciones sociales sobre la Recuperación de usuarios de servicios de salud que abusan de sustancias psicoactivas se da a partir de profesionales 'contactos diarios con estos usuarios en los servicios de salud. Los elementos que caracterizan estas representaciones provienen de los cambios en las políticas de salud mental que ahora forman parte de la rutina de las UBS. Esto se puede aprehender, ya que la estructura de la RS sobre Recuperación se fundamenta en factores que según la literatura científica son facilitadores para el logro de la Recuperación, tales como cuestiones relacionadas con la afectividad, el apoyo familiar, la vida social y el apoyo profesional. 

System-level barriers to personal recovery in mental health: qualitative analysis of co-productive narrative dialogues between users and professionals

BACKGROUND

No co-productive narrative synthesis of system-level facilitators and barriers to personal recovery in mental illness has been undertaken.

AIMS

To clarify system-level facilitators and barriers to personal recovery of people with mental illness.

METHOD

Qualitative study guided by thematic analysis. Data were collected through one focus group, which involved seven service users and three professionals. This group had 11 meetings, each lasting 2 h at a local research institute, between July 2016 to January 2018.

RESULTS

The analysis yielded three themes: barriers inhibiting positive interaction within personal relationship networks, roots of barriers from mental health systems and the social cultural context, and possible solutions to address the roots. Barriers were acknowledged as those related to sense of safety, locus of control within oneself and reunion with self. The roots of barriers were recognised within mental health services, including system without trauma sensitivity, lack of advocacy support and limited access to psychosocial approaches. Roots from social cultural context were also found. There were no narratives relating to facilitators. A possible solution was to address the roots from systems. Social cultural change was called for that makes personalised goals most valued, with an inclusive design that overcomes stigma, to achieve an open and accepting community.

CONCLUSIONS

The analysis yielded system-level barriers specific to each recovery process. Roots of barriers that need transformation to facilitate personal recovery were identified within mental health services. Social interventions should be further explored to translate the suggested social cultural changes into action.

Recovery and its correlates in patients with schizophrenia

Little information is available from India, on psychological recovery in patients with schizophrenia. Accordingly, this study aimed to evaluate the correlates and stages of the psychological recovery of patients with schizophrenia. 100 patients, in clinical remission, were evaluated on Stages of Recovery Instrument (STORI), Functional Social Support Questionnaire, WHO Quality of life-BREF, Ways of Coping Checklist, Internalised Stigma of Mental Illness Scale, Scale to Assess Unawareness of Mental Disorder and Knowledge of mental illness scale. Majority of the patients (N = 50) belonged to the stage-5 (Growth), and this was followed by those in the stage-4 (stage of rebuilding; N = 22) and stage-3 (stage of preparation; N = 16) of recovery. A higher stage of recovery was associated with lower stigma in all the domains except stigma resistance. Higher use of confrontative coping and accepting responsibility was associated with a higher score in the awareness stage of recovery. In terms of insight, higher awareness about the effect of medication was associated with a higher stage of recovery. Higher disability in the domain of self-care was seen in the lower stage of recovery. Better quality of life in the physical health domain was associated with being in a higher stage of recovery. To conclude, findings of the present study suggest that stigma plays a significant role in determining the outcome in the form of personal recovery. These findings suggest that to organize the services to promote personal recovery, clinicians should not only aim at symptom amelioration but also must focus on stigma to promote psychological recovery.

An Exploration of Facilitators and Challenges to Young Adult Engagement in a Community-Based Program for Mental Health Promotion

Adolescence and young adulthood can be particularly daunting for those with mental health concerns. In one Canadian city, a community-based drop-in psychosocial mental health center (Center) was designed specifically for youth who self-identified as struggling with mental health issues. The purpose of this study was to identify the features of the program that promoted or discouraged engagement. Narrative inquiry was used to guide the project. One-on-one interviews were conducted with 10 Center users. Four major categories were identified: (a) Reasons for Coming: Motivated to Work on Goals; (b) Facilitators of Engagement and Beyond; (c) Challenges to Engagement; and (d) Benefits of Engaging: Finding My Way. These categories were further delineated into themes. All participants had experienced trauma, and the Center assisted them in their coping. The researchers believe that to aid recovery, agencies working with this population need to use trauma-informed and healing-centered engagement.

Estigma social hacia la enfermedad mental: factores relacionados y propiedades psicométricas del Cuestionario de Atribuciones-revisado

Este estudio persiguió analizar la estructura interna de la versión española del Cuestionario de Atribuciones-revisado (r-AQ-E) para evaluar el estigma social hacia la enfermedad mental en la adolescencia, así como investigar su relación con la edad, la familiaridad y el conocimiento sobre la enfermedad mental. La muestra estuvo constituida por 861 adolescentes de entre 12 y 16 años (M = 13.91; DE = 1.22). Los análisis factoriales exploratorios y confirmatorios no replicaron la estructura original del r-AQ-E, y revelaron una estructura unidimensional con cinco ítems y adecuada consistencia interna. Los resultados evidenciaron que los chicos mostraban más estigma que las chicas. En ambos casos, los niveles de estigma eran similares entre los 12 y 15 años, siendo inferiores a los 16 años. El estigma social se relacionaba con la familiaridad y el conocimiento sobre las características, la prevalencia y las causas de las enfermedades mentales. Estos resultados enfatizan la necesidad de implementar intervenciones para reducir el estigma mediante la mejora del conocimiento sobre la enfermedad mental y las oportunidades de contacto directo.

Measuring outcomes within inpatient child and adolescent mental health services: an evaluation of the Recovery Questionnaire for Young People

BACKGROUND

The notion of personal recovery has become central to the delivery of mental health services; however, no published subjective recovery measure has been validated in an inpatient adolescent mental health sample. We aimed to evaluate the psychometric properties of the Recovery Questionnaire for Young People (ReQuest-YP) in this inpatient context.

METHODS

Both cross-sectional and longitudinal self-report data were collected. The ReQuest-YP was administered to 65 adolescents (11 males, 52 females and 2 who identified as transgender) within inpatient child and adolescent mental health services (UK) along with a feedback questionnaire, to assess the face validity of the measure. The young person's Health of the National Outcome Scales (HoNOSCA) score, as rated by clinicians in inpatient services, was also obtained to assess the convergent validity of the measure.

RESULTS

The results demonstrated that the ReQuest-YP demonstrated excellent internal consistency (alpha ≥ .914), test-retest reliability (ICC = .91) and sensitivity to change (Z = -2.09). The measure did not correlate with the ratings on the HoNOSCA. Feedback indicated the ReQuest-YP was relevant and acceptable to young people. Suggestions were made about refining some questionnaire items.

CONCLUSIONS

The ReQuest-YP demonstrated clinical utility as a measure of subjective recovery in inpatient child and adolescent mental health services. Refinement of some of the questions along with further evaluation of the measure in this population is recommended. Key Practitioner Message The ReQuest-YP offers a potential tool for exploring, assessing and evaluating subjective or personal recovery for young people in inpatient units. The measure is potentially reliable, valid and acceptable to service users, and so clinicians may wish to consider use in these settings. There is indication that the questionnaire is also sensitive to change in an inpatient admission context, although further work is needed.

A Place to Call Home: Hearing the Perspectives of People Living with Homelessness and Mental Illness Through Service Evaluation

There is an ongoing need to incorporate the perspectives of people in supported community housing to improve the provision of integrated mental health services. This study aimed to explore the satisfaction and experiences of people who have received supported housing and mental health services. We conducted a retrospective, mixed methods study using a data mining approach, analyzing consumer satisfaction survey responses collected on discharge from the service over a 7-year period. Responses from 178 consumers aged between 20 and 62 years were included. Quantitative results indicated that consumers rated the quality of services as relatively high. Analysis of qualitative responses identified seven themes describing people's views on how they had benefitted from the service. Consumers reported benefits in terms of practical and emotional supports, responsiveness of the team to their needs, socialization and community integration, personal growth and recovery, and finding 'my place'. Themes of learning and skills development were also important. These results suggest that practical support, together with emotional expressions of care and compassion are most valued by people who participated in this service. This research has implications for service evaluation and for future research, which may include focusing on the key role of connectedness, 'my place' and hope for recovery.

Transitional housing in forensic mental health: considering consumer lived experience

BACKGROUND

For individuals involved in the forensic mental health system, access to transitional housing can offer a bridge between custody and independence. Using a methodology consistent with interpretative phenomenological analysis (IPA), this study considers the meaning associated with such participation. In this Canadian study, data was collected via interview with six individuals (n = 6) who resided, for a minimum six (6) months, in justice focused transitional housing that involved a partnership between a rural forensic mental health care facility and a nearby urban transitional housing provider.

RESULTS

Following each participant interview, data was transcribed verbatim and coded for themes. Multiple methods were employed to support trustworthiness. Results indicate that participation enabled enhanced social participation, self-esteem/efficacy, community integration and renewal of daily living skills. Participants identified that involvement in justice focused transitional housing enabled development of community living skills, cultivated self-confidence and enhanced personal resilience in their transition from a secure forensic mental health facility to more independent community tenure.

CONCLUSIONS

Participants in this research clearly identified the importance of transitional housing programs in supporting their move from a forensic mental health facility to the community. Not all forensic involved individuals will need this type or level of support to support their transition. Practically, however, the nature of forensic hospitalization can present real challenges for occupational participation and maintenance of community living skills. Transitional housing, accountable to unique forensic mental health and justice inputs, can offer a valuable bridge to the community.

Service user experiences of specialist mental health supported accommodation: A systematic review of qualitative studies and narrative synthesis

Specialist supported accommodation services have become a key component of most community-based mental healthcare systems. While mental health policies highlight the importance of service user involvement in service development and care planning, there are no comprehensive literature reviews synthesising services users' perspectives on, or experiences of, supported accommodation services. This systematic review was undertaken to fill this gap. We searched electronic databases (January 2015, updated June 2017), conducted hand searches and used forward-backward snowballing to identify 13,678 papers. We inspected the full-text of 110 papers and included 50 of these in the final review. Data extraction and quality assessments were conducted. We used narrative synthesis to develop a conceptual model of service users' experiences that included structural, process, relational and contextual factors, such as the characteristics of the service, relationships with staff and other service users, the intensity and nature of support, the physical environment, and social and community integration. The review highlights the complex interplay of individual, service-level and community factors in shaping the lived experience of service users and their impact on personal identity and recovery. Our approach addressed some of the widely reported limitations of the quantitative research in this field, providing a conceptual model relevant to service user experiences across supported accommodation service types, population groups and countries.

Intentions and experiences of effective practice in mental health specific supported accommodation services: a qualitative interview study

Background

Deinstitutionalisation in Europe has led to the development of community-based accommodation for people with mental health problems. The type, setting, and intensity of support provided vary and the costs are substantial. Yet, despite the large investment in these services, there is little clarity on their aims and outcomes or how they are regarded by staff and the clients.

Methods

We interviewed 30 staff and 30 clients from the three main types of supported accommodation in England (residential care, supported housing, floating outreach) to explore their perspectives on the purpose of these services, and the components of care considered most helpful. The interviews were coded and analysed using thematic analysis.

Results

There were generally consistent understandings amongst clients and staff across service types on the goals and purposes of supported accommodation services as: building independence and confidence; supporting people with their mental health; and providing safety and stability. We also noted a competing theme of anxiety about the continuity of support when clients move on from a service. Themes on the experience of what aided effective practice centred on: the supportive presence of others; incremental steps to progress; working together to avoid deskilling and dependency; feeling known and personally understood; tailoring support for social and community engagement; and building confidence through encouragement.

Conclusions

The findings provide an understanding of the commonalities in service approach, and goals of clients in these services, as well as the facilitators of goal attainment. However, they also highlight a common tension between providing safe and supportive living environments, whilst also promoting independence and facilitating rehabilitative change.

What does dependency on community mental health services mean? A conceptual review with a systematic search

PURPOSE

Although community mental health services aim to support patients' autonomy and independence, they have repeatedly been criticised for making patients dependent. Yet, it remains often unclear what exactly is meant with dependency in this context. This review aimed to identify the meaning of the term dependency on community services in the literature.

METHODS

A systematic search and conceptual review of papers where dependency is used in the context of community mental health services. Narrative synthesis was used to identify thematic concepts linked to dependency in these settings.

RESULTS

Fifteen papers met the inclusion criteria. The analysis identified five different concepts of dependency on community mental health services: dislocation from the outside world; inflexibility and lack of freedom; obligation as resentment or appreciation; living with or without meaningful activities; and security.

CONCLUSIONS

The findings suggest that, distinct from the exclusively negative connotation of the term dependency in a conventional medical context, dependency on community mental health services contains both negative and positive aspects. The different aspects might guide the future evaluation of the care provided in such services.