Italian Investigation on Mental Health Workers' Attitudes Regarding Personal Recovery From Mental Illness

Medical students' perception towards mental health recovery: a descriptive qualitative study

The conceptualisation of recovery in mental healthcare, for which two definitions ('clinical' and 'personal') prevail, remains inconclusive. In most curricula of medical education, undergraduates are taught straightforward concepts of clinical recovery, which result in their perfunctory and rudimentary understanding. A qualitative descriptive approach was adopted to explore medical undergraduates' perceptions of recovery for people with mental health conditions. Participants were recruited from a Singapore-based university through convenience sampling; the required sample size was determined by data saturation. Individual face-to-face interviews were conducted through Zoom, an online conferencing platform using semi-structured questions from March to July 2021. Recordings of the interviews were transcribed verbatim and thematically analysed. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist guided the reporting of this study. Seventeen medical students with the majority (fifteen) of them in their fourth year of medical undergraduate education participated in this study. Four themes were identified: the relationship between mental illnesses and well-being; opinions on mental well-being; understanding of mental illnesses; and perceptions of recovery from mental illnesses. The medical undergraduates in this study predominantly conceptualised recovery based on functions, although many also agreed on respecting patients' perspectives in defining it. This aligns with contemporary approaches that emphasise more shared decision-making opportunities and empowering people with mental health conditions. Accordingly, our findings highlighted the need for foundational medical education to incorporate these constructs in their curricula and strategise to provide more meaningful discussions about them.

Factors affecting knowledge of recovery-oriented practice amongst mental health nursing and medical staff working on acute mental health inpatient units

Over recent decades, the shift to recovery-oriented practice has been central to mental health policy. Despite this emphasis, mental health services can struggle to meet this expectation. This study explores the knowledge and attitudes in relation to the recovery-oriented practice of clinical staff working at an Australian acute inpatient mental health unit. The Recovery Knowledge Inventory (RKI) is a widely used self-report tool that assesses mental health professionals' knowledge and attitudes towards recovery; higher scores indicate higher levels of recovery knowledge and attitudes. Seventy-four staff members (44 nursing staff and 30 medical staff) completed the RKI via an online survey. The study has been reported according to the STROBE checklist for cross-sectional studies. The relationships between the RKI scores and a range of variables were considered using inferential statistics, including multivariate regression. Medical staff had higher mean RKI scores than nursing staff, although this did not meet the predefined threshold for a clinically significant difference. More years of mental health experience were associated with increased mean RKI scores for medical staff. This Australian inpatient staff cohort demonstrated higher mean RKI scores than have been observed in recent international studies of mental health professions. However, the recovery knowledge and attitude levels were disappointingly similar to those shown in earlier Australian research completed over a decade ago. Efforts are needed to further enhance the recovery knowledge of clinicians working in mental health inpatient units.

Easier Said Than Done: The Challenge to Teach "Personal Recovery" to Mental Health Professionals Through a Short, Targeted and Structured Training Programme

This study assesses the effectiveness of our short Personal Recovery Training Program (PRTP) for mental health professionals. Fifty-two healthcare professionals from Italian mental health services and forty students in psychiatric rehabilitation completed the Recovery Knowledge Inventory (RKI) pre- and post-training, divided into two groups: the PRTP (N = 45) and the Family Psychoeducational Training Program (FPTP; N = 47). Participants' understanding of personal recovery improved more significantly for those in the PRTP than for those in the FPTP group in two domains, "Roles and responsibilities" and "Non-linearity of the recovery process"; the FPTP group showed a significant improvement in the "Role of self-definition and peers in recovery" domain. Two consumers were involved in the PRTP and represented a resource to help participants understand the personal recovery process. Our findings indicate that a brief PRTP supported by consumers can improve staff and students' recovery orientation. The translation of the training into clinical practice remains unevaluated.

The effects of the reorganisation of an intensive care unit due to COVID-19 on nurses' wellbeing: An observational cross-sectional study

Objectives

To evaluate the effects of the reorganisation of an intensive care unit for COVID-19 patients in the context of the SARS-CoV-2 pandemic on wellbeing perceived by nurses.

Methods

An observational cross-sectional study was conducted to evaluate wellbeing perceived by nurses who during the study were on duty in the COVID-19 intensive care unit. The “Covid-19-Nurse Well-being at Work (NWB) scale” questionnaire consisting of 72 items divided into 13 sections, was validated and used to collect data.

Results

The level of wellbeing perceived by the nurses was very good (4.77; SD 0.83). Differences in the of level of perceived wellbeing were found for “years of experience” and the various levels of competence. We found a positive correlation between “female gender” and “nurses’ togetherness and collaboration”, a negative correlation between “male gender” and “satisfactory practical organisation of work, and a negative correlation between “work experience” and the overall “level of wellbeing at work.

Conclusions

The reorganisation had positive effects in terms of wellbeing perceived by the nurses. The factors that contributed mostly to the perception of wellbeing were in the area of “support”, “communication, and “socializing with colleagues”. It is appropriate to consider “gender differences”, “work experience” and “levels of competence” when implementing this type of reorganisation to respond to a pandemic or a health emergency.

The Meaning of Recovery: The Lived Experience of Patients with Bipolar Disorder in Turkey

Recovery in mental illness refers to a process with many aspects, steps and meanings. This study aims to provide a deeper understanding of the lived experience of recovery of patients with bipolar disorder. A qualitative approach with 28 participants was performed. Data were collected through semi-structured interviews. The experiences of the individuals regarding the recovery processes were themed with the journey metaphor: the beginning of the journey, the route of the journey, a stop in the journey, the meaning of the journey. This study suggests ways clinicians must be aware of and adopted contemporary approach which recovery is defined as a process beyond treatment.

Psychometric evaluation of the German version of the Opening Minds Stigma Scale for Health Care Providers (OMS-HC)

Background

Healthcare professionals can be a source of stigma and discrimination for people with mental illness, and anti-stigma programs are needed for this target group. However, there is no validated German language scale to assess attitudes of healthcare professionals towards people with mental illness. This study had the aim to validate the German language version of the Opening Minds Stigma Scale for Health Care Providers (OMS-HC), a self-report measure of stigmatizing attitudes.

Methods

Staff (n=392) on general psychiatric inpatient wards (excluding child, forensic and geriatric psychiatry) at five psychiatric hospitals in Switzerland (n=3) and Germany (n=2) participated in the study. The internal consistency of the OMS-HC was examined as well as its factor structure using exploratory and confirmatory factor analyses. To assess the scales concurrent validity, we used the Social Distance Scale.

Results

Internal consistency for the OMS-HC total score was good (=0.74), acceptable for the subscales Attitudes (=0.62) and Social Distance (=0.69), and poor for the Disclosure subscale (=0.55). The original three-factor structure fit our data well. The OMS-HC total score and the Social Distance subscale score were significantly correlated with the Social Distance Scale, supporting concurrent validity.

Conclusion

The German version of the OMS-HC demonstrated satisfactory psychometric properties and can be recommended for future research and intervention evaluation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00592-9.

What matters: Factors impacting the recovery process among outpatient mental health service users

OBJECTIVE

Understanding factors that promote and hinder the recovery process for people living with serious mental illness remains of critical importance. We examine factors, including limited literacy, associated with mental health recovery among public mental health service users.

METHOD

This study uses data from a mixed-methods, service-user informed project focused on the impact of limited literacy in the lives of people with serious mental illness. Data from structured interviews evaluate perceptions of recovery as assessed with the Recovery Assessment Scale (RAS). Regression models examine factors related to recovery controlling for sociodemographic factors, literacy, neurocognition, mental health status, perceived social support, and stigma.

RESULTS

Despite bivariate relationships between RAS and limited literacy, the full models suggest that other factors account for this relationship. These include mental health status, higher social support, higher self-reported community status, and higher stigma consciousness, as well as race for some models.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Our findings that social support and perceptions of community status are associated with higher scores on the RAS echo prior work demonstrating the importance of social connection and context in mental health recovery. Though literacy was not a predictor of recovery, further research should examine the relationship between literacy and recovery given the deep literature on literacy on health outcomes. In order to better support people in the recovery process it is important that more research is done to examine the complex relationship between stigma consciousness and recovery as well as understand the racial disparities that exist within the recovery subscales. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Knowledge and attitudes of mental health professionals and students regarding recovery: A systematic review

This review was conducted to synthesize and critically appraise the literature on knowledge, attitudes, understanding, perceptions, and expectations of mental health professionals (MHPs) and mental health professional (MHP) students' regarding recovery. A systematic search in Scopus, CINAHL, PsycINFO, Web of Science, Medline, and Embase as well as Google scholar and web-based repositories was conducted. The searches were conducted using a combination of key terms: "mental health professionals", "students", 'knowledge', "understanding", "perception" "attitude", "expectation", "recovery". After screening and quality assessment, the review included 29 studies (18 quantitative, 8 qualitative, and 3 mixed-method studies) published in English, from January 2006 to June 2019, and was analysed systematically using a mixed-method synthesis. The findings revealed that there is increasing evidence (especially among MHPs) of knowledge, attitudes, understanding, perceptions, and expectations regarding recovery. However, there are disparities in how MHPs perceive and understand recovery. While some understood it to mean a personal process, others explained it as a clinical process. In addition, there was limited knowledge among the MHPs and MHP students regarding the nonlinearity nature of the recovery process and expectations regarding recovery. The implications from these findings are the need for more in-service training for MHPs, and examination of the curriculum used to educate MHP students. In particular, they should be sufficiently informed about the nonlinearity nature of the recovery process and how to develop hopeful and realistic expectations for consumers throughout the recovery process. The review was preregistered with PROSPERO (Registration No: CRD42019136543).

The conditions of possibilities for recovery: A critical discourse analysis in a Danish psychiatric context

AIMS AND OBJECTIVES

This paper explores the conditions for the possibilities of recovery in a Danish mental healthcare practice, expressed from the perspective of nurses. The results and discussion of the study help to make visible and explore the muddle of conceptualisations of recovery in mental healthcare practice.

BACKGROUND

Few studies examine the possibilities of recovery for inpatients and outpatients in mental health centres from a nursing perspective.

DESIGN

A qualitative design using a critical social constructionist frame of understanding, in which the real world is considered as a series of social constructions.

METHOD

A Fairclough-inspired critical discourse analysis was chosen as the analytical strategy. The analysis is comprised of ten interviews in mental health care and notes, written by nurses, in medical records of ten patients with a mental illness admitted to a mental healthcare centre in 2016-2017. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline to secure accurate and complete reporting of the study (See Appendix S1).

RESULTS

From the findings of the textual analysis and the analysis of the discourse practice, it seems clear that the social relations and structures relating to recovery in Danish psychiatry are steered and controlled by discourses that reflect, in general terms, the essence of the core of neoliberal ideology.

CONCLUSION

Recovery is generally articulated from an overall discourse of neoliberalism with its embedded discourses of paternalism, biomedicine, self-care and holism. All these discourses coexist in nursing practice, but the paternalistic discourse becomes the framework for the conditions for the possibility of how recovery is expressed in practice.

RELEVANCE TO CLINICAL PRACTICE

Nurses need to be supported to seek clarity in the understanding and operationalisation of a recovery-oriented approach, if the agenda is to be truly adopted and strengthened.

Cognitive behavioral therapy (CBT) anxiety management and reasoning bias modification in young adults with anxiety disorders: A real-world study of a therapist-assisted computerized (TACCBT) program Vs. "person-to-person" group CBT

Computerized cognitive behavioral therapy (cCBT) appears to be a therapeutic strategy that is as effective as person-to-person CBT in the treatment of adults and young people with anxiety disorders. The aim of our controlled study was to evaluate the following in young adult users affected by anxiety disorders: (1) the feasibility of our simple "prototype" of a therapist-assisted computerized cognitive behavioral therapy (TacCBT); and (2) the effectiveness of two different interventions-group CBT and TacCBT-in an "enriched" format for anxiety management and reasoning bias modification as compared to a control group. Psychopathology, global functioning, and cognitive flexibility were examined in 13 users undergoing TacCBT and compared to those receiving "person-to-person" group CBT (CBT Group, n = 25), which controlled for their psychopharmacological treatment. Users were included in the arms of our real-word study on the basis of their treatment preferences. Twelve subjects were included in a Treatment as Usual (TAU) group. Following the intervention, all groups showed a significant improvement in symptoms. Both CBT groups showed an improvement in cognitive flexibility with respect to TAU, in addition to a reduction of their reasoning overconfidence. Our preliminary results show the benefits of the TacCBT program and highlight its advantages.