Development and validation of Attitudes towards Recovery Questionnaire across Chinese people in recovery, their family carers, and service providers in Hong Kong

A systematic review of measures of the personal recovery orientation of mental health services and staff

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.

Culture-dependent and universal constructs and promoting factors for the process of personal recovery in users of mental health services: qualitative findings from Japan

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.

Professional perspectives on providing recovery-oriented services in Taiwan: a qualitative study

BACKGROUND

The experiences of professionals in well-established recovery-oriented programs are valuable for professionals in similar practice settings. This study explored professionals' experiences with providing recovery-oriented services in community psychiatric rehabilitation organizations.

METHODS

Semi-structured interviews were conducted with 14 professionals from five recovery-oriented psychiatric rehabilitation organizations in Taiwan. The interviews were recorded and transcribed verbatim. Thematic analysis was used for the qualitative data analysis.

RESULTS

The analyses documented three main themes with 13 subthemes. Recovery-oriented service implementation included seven subthemes: Enabling clients to set their own goals and make decisions, using a strengths-based approach, establishing partnerships with clients, improving individuals' self-acceptance, encouraging community participation, seeking family, peer, and organizational support, and building team collaboration. Problems with implementing recovery-oriented services included limited policy and organizational support, a lack of understanding of recovery among professionals, stigma, clients' lack of motivation or self-confidence in their own ability to achieve recovery, and passive or overprotective family members. Strategies to resolve implementation problems included policy changes and organizational support, improving the recovery competence and confidence of professionals, and family and public education.

CONCLUSIONS

To date, this is the first known study examining the perspectives of mental health professionals who have experience implementing recovery-oriented services in Asia. The participants identified family collaboration, anti-stigma efforts, and changes in policy and attitudes as critical to successful implementation and delivery of recovery-oriented services.

Recovery From Severe Mental Health Problems: A Systematic Review of Service User and Informal Caregiver Perspectives

Introduction: The recovery approach aims to have users' perspectives at the heart of service development and research; it is a holistic perspective that considers social needs, personal growth and inclusion. In the last decade recovery-oriented research and practice has increased greatly, however, a comprehensive model of recovery considering exclusively the perspectives of people with lived experience has not been devised. Aims: This review aimed to develop a framework and contextualize service users' and informal caregivers' understanding of recovery from severe mental health problems. Methods: We systematically searched 6 databases including key terms related to knowledge, experience and narratives AND mental health AND personal recovery. The search was supplemented with reference sourcing through gray literature, reference tracking and expert consultation. Data analysis consisted of a qualitative meta-synthesis using constant comparative methods. Results: Sixty-two studies were analyzed. A pattern emerged regarding the recovery paradigms that the studies used to frame their findings. The resulting recovery framework included the domains Social recovery; Prosperity (Legal, political, and economic recovery); Individual Recovery; and Clinical Recovery Experience (SPICE). Service users' definitions of recovery tended to prioritize social aspects, particularly being accepted and connecting with others, while caregivers focused instead on clinical definitions of recovery such as symptom remission. Both groups emphasized individual aspects such as becoming self-sufficient and achieving personal goals, which was strongly linked with having economic means for independence. Conclusions: The recovery model provided by this review offers a template for further research in the field and a guide for policy and practice. Predominant definitions of recovery currently reflect understandings of mental health which focus on an individual perspective, while this review found an important emphasis on socio-political aspects. At the same time, only a small number of studies took place in low-income countries, focused on minoritized populations, or included caregivers' perspectives. These are important gaps in the literature that require further attention. Systematic Review Registration: The review protocol was registered on PROSPERO (CRD42017076450); https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=76450.

Psychometric Properties of the Brief Resilient Coping Scale in a Sample of Stable Severe Mental Disorder Patients

The aim of this study was to analyze the psychometric properties of the Brief Resilient Coping Scale (BRCS). 57 stable severe mental disorder patients (42 men, 73.7%, and 15 women, 26.3%), ranging in age between 23 and 64 years, (M = 46.25; SD = 7.52) answered to the BRCS and the World Health Organization Quality of Life Assessment (WHOQOL-BREF). Descriptive analyses, estimations of internal consistency, and confirmatory factor analysis were conducted, and correlations between the BRCS and the WHOQOL-BREF were calculated. The factorial validity of the scale was tested using confirmatory factor analysis, with a single dimension of resilience. The BRCS showed acceptable internal consistency (alpha of .69). Correlations between the BRCS and WHOQOL-BREF were positive, r(PhH-R) = .42, r(PsH-R) = .40, r(SR-R) = .33, r(E-R) = .35, and significant (p < .01). In conclusion, the Spanish adaptation of the BRCS seems to be a reliable and valid measure of resilience in stable severe mental disorder patients.

Brief Psychoeducation Program to Enhance Recovery Knowledge and Attitudes of Mental Health Service Providers and Users: Randomized Controlled Trials

Recovery-oriented transformation of mental health service systems not only necessitates changes in mental health policies and practices, it also requires an adoption of recovery-oriented mindset, which includes knowledge and attitudes, among service providers. It is also important that service users are informed about the changes and can fully participate in the process. The present study developed and evaluated the efficacy of a recovery psychoeducation program in enhancing recovery-oriented knowledge and attitudes among mental health service providers and users in Hong Kong. In study 1, 111 service providers were randomly assigned to 2-day psychoeducation group or control group. Results showed that participants in psychoeducation group had significantly better recovery knowledge and more positive attitudes towards recovery after the intervention than the control counterparts. The effect of the recovery psychoeducation program on recovery attitudes was fully mediated by the improvement in recovery knowledge. In study 2, 93 people with mental illness were randomized into 2-week psychoeducation group or control group. Participants in the psychoeducation group had a significant improvement in the level of recovery-oriented knowledge immediately after the workshops, but the effect could not be sustained at follow-up. To transform into a recovery-oriented service system, having an effective program to orient service providers and users to recovery is essential. This study provided initial support to the use of a brief psychoeducational program for recovery-oriented knowledge enhancement. Given the short-term efficacy and feasibility of the interventions, service leaders and managers in different clinical and social service settings should consider implementing the programs as part of staff and users' service orientation to build a recovery-supporting workforce and empower their service users early in the recovery process.