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Chinn V, Creagh E, Gardiner T, Drysdale B, Ramritu P, Mansoor Z, Every-Palmer S, Jenkins M. Lived Experience of Health and Wellbeing Among Young People with Early Psychosis in Aotearoa New Zealand. Community Ment Health J 2024; 60:1068-1080. [PMID: 38492121 PMCID: PMC11199281 DOI: 10.1007/s10597-024-01259-6] [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: 05/17/2023] [Accepted: 02/18/2024] [Indexed: 03/18/2024]
Abstract
First episode psychosis (FEP) can disrupt a young person's life and future health. Those with lived experience of FEP can inform effective support. This study investigated how young people with FEP experience good health and wellbeing living in Aotearoa New Zealand. Recent clients of early intervention services (n = 12) shared their stories across varying traditional and creative platforms. Thematic analysis revealed seven themes important for living well with FEP: whanaungatanga (relationships), addressing stigma, finding out who I am with psychosis, getting the basics right, collaborative healthcare, understanding psychosis, and access to resources. The themes informed five supporting processes: whakawhanuangatanga (relationship-building), using holistic approaches, creating space for young people, reframing, and improving access to appropriate resources. These findings deepen our understanding of how we can support young people to live well with FEP. This study highlights the value of creative methods and partnering with lived experience experts to conduct meaningful health research.This trial was registered at Australian New Zealand Clinical Trials Registry (ANZCTR) CTRN12622001323718 on 12/10/2022 "retrospectively registered"; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384775&isReview=true .
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Affiliation(s)
- Victoria Chinn
- School of Health, Victoria University of Wellington, Te Herenga Waka, Wellington/Te Whanganui-a-Tara, Aotearoa, New Zealand.
| | - Ella Creagh
- Department of Psychological Medicine, University of Otago Wellington, Wellington/Te Whanganui-a-Tara, Aotearoa, New Zealand
| | - Tracey Gardiner
- Department of Psychological Medicine, University of Otago Wellington, Wellington/Te Whanganui-a-Tara, Aotearoa, New Zealand
| | - Briony Drysdale
- Department of Psychological Medicine, University of Otago Wellington, Wellington/Te Whanganui-a-Tara, Aotearoa, New Zealand
| | - Pāyal Ramritu
- Department of Psychological Medicine, University of Otago Wellington, Wellington/Te Whanganui-a-Tara, Aotearoa, New Zealand
| | - Zara Mansoor
- Department of Psychological Medicine, University of Otago Wellington, Wellington/Te Whanganui-a-Tara, Aotearoa, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington/Te Whanganui-a-Tara, Aotearoa, New Zealand
| | - Matthew Jenkins
- Department of Psychological Medicine, University of Otago Wellington, Wellington/Te Whanganui-a-Tara, Aotearoa, New Zealand
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Simonsen C, Åsbø G, Slade M, Wold KF, Widing L, Flaaten CB, Engen MJ, Lyngstad SH, Gardsjord E, Bjella T, Romm KL, Ueland T, Melle I. A good life with psychosis: rate of positive outcomes in first-episode psychosis at 10-year follow-up. Psychol Med 2024:1-10. [PMID: 38389456 DOI: 10.1017/s0033291724000205] [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] [Indexed: 02/24/2024]
Abstract
BACKGROUND More knowledge about positive outcomes for people with first-episode psychosis (FEP) is needed. An FEP 10-year follow-up study investigated the rate of personal recovery, emotional wellbeing, and clinical recovery in the total sample and between psychotic bipolar spectrum disorders (BD) and schizophrenia spectrum disorders (SZ); and how these positive outcomes overlap. METHODS FEP participants (n = 128) were re-assessed with structured clinical interviews at 10-year follow-up. Personal recovery was self-rated with the Questionnaire about the Process of Recovery-15-item scale (total score ⩾45). Emotional wellbeing was self-rated with the Life Satisfaction Scale (score ⩾5) and the Temporal Experience of Pleasure Scale (total score ⩾72). Clinical recovery was clinician-rated symptom-remission and adequate functioning (duration minimum 1 year). RESULTS In FEP, rates of personal recovery (50.8%), life satisfaction (60.9%), and pleasure (57.5%) were higher than clinical recovery (33.6%). Despite lower rates of clinical recovery in SZ compared to BD, they had equal rates of personal recovery and emotional wellbeing. Personal recovery overlapped more with emotional wellbeing than with clinical recovery (χ2). Each participant was assigned to one of eight possible outcome groups depending on the combination of positive outcomes fulfilled. The eight groups collapsed into three equal-sized main outcome groups: 33.6% clinical recovery with personal recovery and/or emotional wellbeing; 34.4% personal recovery and/or emotional wellbeing only; and 32.0% none. CONCLUSIONS In FEP, 68% had minimum one positive outcome after 10 years, suggesting a good life with psychosis. This knowledge must be shared to instill hope and underlines that subjective and objective positive outcomes must be assessed and targeted in treatment.
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Affiliation(s)
- Carmen Simonsen
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Gina Åsbø
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham NG7 2TU, UK
- Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, 7801 Namsos, Norway
| | - Kristin Fjelnseth Wold
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Line Widing
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Camilla Bärthel Flaaten
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus Johan Engen
- Nydalen DPS, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Siv Hege Lyngstad
- Nydalen DPS, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erlend Gardsjord
- Section for Treatment of Early Psychosis, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Thomas Bjella
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristin Lie Romm
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Quistgaard M, Myklebust OLP, Aure T, Austin SF, Berring LL, Vernal DL, Storebø OJ. Psychosocial interventions promoting personal recovery in people with schizophrenia: a scoping review protocol. BMJ Open 2023; 13:e073901. [PMID: 38070925 PMCID: PMC10729100 DOI: 10.1136/bmjopen-2023-073901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Personal recovery is an important aspect for many individuals diagnosed with schizophrenia, as people can live rich, fulfilling lives despite ongoing symptoms. Prior reviews have found several factors to be associated with personal recovery, but a comprehensive overview of the psychosocial interventions aimed at improving personal recovery in schizophrenia is needed. METHODS AND ANALYSIS Key terms relating to personal recovery and psychosocial interventions to promote personal recovery will be searched for in the following databases: PubMed, EMBASE, PsycINFO, CINAHL, MEDLINE, Google Scholar, Web of Science Core Collection and Cochrane. Additionally, a simple search for grey literature will be conducted in The Networked Digital Library of Theses and Dissertations. Two reviewers will individually screen and extract the data, and the selection of sources will be documented in a Preferred Reporting Items for Systematic reviews and Meta-Analyses flow chart. A content analysis will be conducted on the data, and the findings will be presented in tables, and narratively synthesised. Lastly, research gaps will be identified, and recommendations for future research will be proposed. ETHICS AND DISSEMINATION Ethics approval was not required for the development or publishing of this protocol. Findings will be disseminated through conferences, meeting with patient organisations and consumers, and published in a peer-reviewed scientific journal.
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Affiliation(s)
- Maria Quistgaard
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
| | | | | | - Stephen Fitzgerald Austin
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Mental Health Services, East, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene Lauge Berring
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Institute for Regional Sundhedsforskning (IRS), University of Southern Denmark, Odense, Denmark
| | - Ditte Lammers Vernal
- Psychiatry, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, North Denmark Region, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Jun WH, Na H. The Mediating Role of Positive Thinking on the Relationship Between Depression and Functional Recovery in Community-Dwelling People With Schizophrenia. J Psychosoc Nurs Ment Health Serv 2023; 61:44-52. [PMID: 36322868 DOI: 10.3928/02793695-20221027-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Functional recovery as a consumer-centered approach is critical to recovery for community-dwelling people with schizophrenia. The current study investigated the mediating role of positive thinking in the relationship between depression and functional recovery in community-dwelling people with schizophrenia in South Korea. Depression, positive thinking, and functional recovery measures were completed by 158 people with schizophrenia in the community with self-reported questionnaires. Depression had a significantly negative influence on functional recovery. Positive thinking fully mediated the relationship between depression and functional recovery. An effective intervention strategy for functional recovery in this population may reinforce positive thinking and depression management. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 44-52.].
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Austin SF, Hjorthøj C, Baagland H, Simonsen E, Dam J. Investigating personal and clinical recovery processes in people with first episode psychosis. Early Interv Psychiatry 2022; 16:1102-1111. [PMID: 34825487 DOI: 10.1111/eip.13258] [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: 02/12/2021] [Revised: 10/04/2021] [Accepted: 11/07/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Schizophrenia is a serious mental illness characterized by a range of symptoms such as distortions in reality, emotional abnormalities and deficits in cognition. Recovery from severe mental illness can be conceptualized in a number of ways. Clinical recovery has a focus on symptoms and functioning whilst personal recovery describes the process of developing new meaning and purpose in life beyond mental illness. OBJECTIVE This longitudinal study examined the relationship between clinical and personal recovery processes within a group of people with first episode psychosis (FEP) receiving early intervention treatment over a period of up to 2 years. METHODS The study sequentially recruited people with FEP that accepted into early intervention treatment. Participants were evaluated at baseline, 12 months and completion of treatment for clinical and personal recovery. RESULTS A total of 51 participants were recruited, completed treatment and assessments. Modest but significant correlations (r = 0.38-0.51) were found between personal recovery and certain aspects of clinical recovery (negative symptoms and functioning). Improvements in functioning (vocational and social activities) predicted both personal and clinical recovery whilst negative symptoms predicted attaining clinical recovery. Reductions in negative symptoms (global, apathy and anhedonia) during treatment were associated with moving towards personal recovery. Psychotic symptoms were not significantly associated with the attainment of clinical or personal recovery. CONCLUSIONS Results indicated that clinical and personal recovery are interdependent and complementary processes. Mental health services may need implement interventions that simultaneously target clinical and personal recovery processes in order to meet the treatment needs of people with psychosis.
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Affiliation(s)
- Stephen F Austin
- Psychiatric Research Unit, Psychiatry Region Zealand, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Dam
- Psychiatric Center North Zealand, Hillerød, Denmark
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Kouvaras S, Guiotto M, Schrank B, Slade M, Riches S. Character Strength-Focused Positive Psychotherapy on Acute Psychiatric Wards: A Feasibility and Acceptability Study. Psychiatr Serv 2022; 73:1051-1055. [PMID: 35378993 DOI: 10.1176/appi.ps.202100316] [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: 11/30/2022]
Abstract
OBJECTIVE A manualized single-session positive psychotherapy intervention was developed and tested on acute psychiatric wards. METHODS Participants were invited in 2018-2019 to identify positive experiences, link them to a personal character strength, and plan a strengths-based activity. The intervention's feasibility was evaluated through fidelity to session components, character strengths identification, and activity completion. Acceptability was evaluated with self-reported pre- and postsession mood ratings, a postsession helpfulness rating, and narrative feedback. RESULTS Participants (N=70) had complex and severe mental health conditions. In 18 group sessions, 89% of components were delivered with fidelity; 80% of the participants identified a character strength, of whom 71% identified a strengths-based activity, and 58% completed the activity. The mean±SD helpfulness rating (N=23) was 8.5±1.5 (on a 10-point Likert scale), and positive mood significantly increased postsession (5.9 presession vs. 7.2 postsession). CONCLUSIONS Positive psychotherapy is feasible in challenging inpatient settings, and service users with severe and complex mental health conditions find it helpful.
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Affiliation(s)
- Stef Kouvaras
- South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom (Kouvaras, Guiotto, Riches); Salomons Institute of Applied Psychology, Faculty of Social and Applied Sciences, Canterbury Christ Church University, Tunbridge Wells, Kent, United Kingdom (Kouvaras); Department of Psychiatry, Karl Landsteiner University of Health Sciences, Krems, Austria (Schrank); Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom (Slade); Social, Genetic and Developmental Psychiatry Centre and Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London (Riches)
| | - Martina Guiotto
- South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom (Kouvaras, Guiotto, Riches); Salomons Institute of Applied Psychology, Faculty of Social and Applied Sciences, Canterbury Christ Church University, Tunbridge Wells, Kent, United Kingdom (Kouvaras); Department of Psychiatry, Karl Landsteiner University of Health Sciences, Krems, Austria (Schrank); Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom (Slade); Social, Genetic and Developmental Psychiatry Centre and Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London (Riches)
| | - Beate Schrank
- South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom (Kouvaras, Guiotto, Riches); Salomons Institute of Applied Psychology, Faculty of Social and Applied Sciences, Canterbury Christ Church University, Tunbridge Wells, Kent, United Kingdom (Kouvaras); Department of Psychiatry, Karl Landsteiner University of Health Sciences, Krems, Austria (Schrank); Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom (Slade); Social, Genetic and Developmental Psychiatry Centre and Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London (Riches)
| | - Mike Slade
- South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom (Kouvaras, Guiotto, Riches); Salomons Institute of Applied Psychology, Faculty of Social and Applied Sciences, Canterbury Christ Church University, Tunbridge Wells, Kent, United Kingdom (Kouvaras); Department of Psychiatry, Karl Landsteiner University of Health Sciences, Krems, Austria (Schrank); Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom (Slade); Social, Genetic and Developmental Psychiatry Centre and Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London (Riches)
| | - Simon Riches
- South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom (Kouvaras, Guiotto, Riches); Salomons Institute of Applied Psychology, Faculty of Social and Applied Sciences, Canterbury Christ Church University, Tunbridge Wells, Kent, United Kingdom (Kouvaras); Department of Psychiatry, Karl Landsteiner University of Health Sciences, Krems, Austria (Schrank); Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom (Slade); Social, Genetic and Developmental Psychiatry Centre and Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London (Riches)
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Chu MHW, Lau B, Leung J, Chan SC, Tang B, Lau C, Newby C, Chiu R, Lo WTL, Schrank B, Slade M. Positive psychotherapy for psychosis in Hong Kong: A randomized controlled trial. Schizophr Res 2022; 240:175-183. [PMID: 35030447 DOI: 10.1016/j.schres.2021.12.044] [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: 04/22/2021] [Revised: 11/21/2021] [Accepted: 12/25/2021] [Indexed: 10/19/2022]
Abstract
Recovery-oriented practice has been advocated in mental health services in Hong Kong since 2009. Well-being has become an important area of focus for mental health services. Positive Psychotherapy for Psychosis (PPP) is a well-being-focused intervention for use in psychosis, with preliminary evidence from a randomized controlled trial in the United Kingdom of impact on well-being and symptomatology. The aim of this study was to test the effectiveness of PPP on the well-being of people with psychosis in Hong Kong. The study was a randomized controlled trial with two-arm parallel groups. Both groups received treatments as usual, and in addition the intervention group received a 13-session intervention based on a Cantonese Chinese translation of the PPP manual. Intention-to-treat analysis was used. The trial was registered (ANZCTR: ACTRN12620000464965). A total of 154 participants (78 intervention, 76 control) were recruited. As compared to control group, intervention group participants showed significant changes over time on the primary outcome of well-being assessed using the Chinese Short Warwick-Edinburgh Mental Well-being Scale (p = 0.001) and on secondary outcomes of hope (Agency subscale: p = 0.029) and self-efficacy (p = 0.001). Positive Psychotherapy for Psychosis was found to be an effective treatment in improving the well-being and other mental health outcomes for people with psychosis. It can be recommended for use in mental health services to promote recovery.
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Affiliation(s)
- Menza Hon-Wai Chu
- Occupational Therapy Department, Kwai Chung Hospital, Hong Kong, People's Republic of China.
| | - Bien Lau
- Occupational Therapy Department, Kwai Chung Hospital, Hong Kong, People's Republic of China
| | - Joey Leung
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong, People's Republic of China
| | - Sheung Chun Chan
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong, People's Republic of China
| | - Betty Tang
- Occupational Therapy Department, Kwai Chung Hospital, Hong Kong, People's Republic of China
| | - Charles Lau
- Occupational Therapy Department, Kwai Chung Hospital, Hong Kong, People's Republic of China
| | | | - Rose Chiu
- Occupational Therapy Department, Kwai Chung Hospital, Hong Kong, People's Republic of China
| | - William Tak-Lam Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong, People's Republic of China
| | - Beate Schrank
- Karl Landsteiner University of Health Sciences, Department of Psychiatry, Krems, Austria
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, United Kingdom
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Improvements in Hope, Engagement and Functioning Following a Recovery-Focused Sub-Acute Inpatient Intervention: a Six-Month Evaluation. Psychiatr Q 2021; 92:1611-1634. [PMID: 34125366 DOI: 10.1007/s11126-021-09934-7] [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] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Few studies have examined the post-discharge benefits associated with recover-oriented programs delivered in inpatient and sub-acute mental health settings. The aim of this study was to evaluate the medium-term outcomes of a 6-week sub-acute inpatient intervention program for 27 service users with a diagnosis of serious mental illness (mean age = 33.22 years, 70.4% with a psychosis diagnosis). Recovery data were collected on admission, at discharge, and at 3- and 6-months post-discharge using self-report, collaborative and clinical measures. The three clinician-rated measures (assessing therapeutic engagement, functioning, and life skills) revealed linear improvements from admission to 6-month follow-up (with mean z-change ranging from 0.72 to 1.35), as did the self-reported social connection measure (Mental Health Recovery Star, MHRS; mean z-change: 1.05). There were also curvilinear improvements in self-determination and self-reported MHRS symptom management and functioning scores; however, only modest changes were detected in hope (Herth Hope Index) and MHRS self-belief scores. Change scores based on self-reported and clinician-rated measures tended to be uncorrelated. An exploration of client-level outcomes revealed three recovery trajectory subgroups: transient (21.7%), gradual (34.8%), or sustained (43.5%) improvement; with members of the latter group tending to have longer illness durations. The study's findings are encouraging, to the extent that they demonstrate recovery-focused sub-acute inpatient programs can promote clinical recovery and aspects of personal recovery. However, they also suggest that recovery perspectives differ between clients and clinicians, and that far more work is required to understand the psychological factors that generate and sustain the hope that recovery is possible.
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Jameel L, Valmaggia L, Barnes G, Cella M. mHealth technology to assess, monitor and treat daily functioning difficulties in people with severe mental illness: A systematic review. J Psychiatr Res 2021; 145:35-49. [PMID: 34856524 DOI: 10.1016/j.jpsychires.2021.11.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/18/2021] [Accepted: 11/20/2021] [Indexed: 11/21/2022]
Abstract
Severe mental illness (SMI) is associated with poor daily functioning; however available interventions currently under-deliver on their recovery prospect. Mobile digital health (mHealth) interventions are increasingly being developed and evaluated, and have the potential to support recovery. This review evaluates the use of mHealth technology to assess, monitor and reduce functioning difficulties in people with SMI. Studies were systematically searched on multiple databases. Study quality was assessed and double-rated independently. Findings were organised using a narrative synthesis and results were summarised according to the mHealth device purpose, i.e., assessment and monitoring or intervention. Thirty-eight studies comprised of 2262 participants met the inclusion criteria. Smartphones were the most popular mHealth device; personal digital assistants, wearables and tablets were also used. mHealth was widely found to be acceptable and feasible, with preliminary findings suggesting it can support functional recovery by augmenting an intervention, simplifying the assessment, increasing monitoring frequency and/or providing more detailed information. Considerations for overcoming barriers to implementation, recommendations for future research to establish effectiveness, personalisation and specification of mHealth devices and methodologies are discussed. The value of mHealth for remote delivery of recovery based interventions is also considered.
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Affiliation(s)
- Leila Jameel
- South London and the Maudsley NHS Trust, UK; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Lucia Valmaggia
- South London and the Maudsley NHS Trust, UK; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Katholieke Leuven Universitet, Belgium
| | - Georgina Barnes
- South London and the Maudsley NHS Trust, UK; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Matteo Cella
- South London and the Maudsley NHS Trust, UK; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Picton C, Fernandez R, Moxham L, Patterson CF. Experiences of outdoor nature-based therapeutic recreation programs for persons with a mental illness: a qualitative systematic review. JBI Evid Synth 2021; 18:1820-1869. [PMID: 32813402 DOI: 10.11124/jbisrir-d-19-00263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this review was to identify, appraise, and synthesize the best available evidence related to participation in outdoor nature-based therapeutic recreation programs for adults with a mental illness living in the community. INTRODUCTION Therapeutic recreation is posited to be beneficial for persons living with a mental illness. Research evidence indicates that therapeutic recreation programs can foster mental health recovery. It is important to understand the effectiveness of this from the perspective of persons living with mental illness how outdoor nature-based therapeutic recreation programs are meaningful and helpful for recovery. INCLUSION CRITERIA This review considered studies that collected qualitative data on the experiences and perspectives of adults with a mental illness regarding their participation in outdoor nature-based therapeutic recreation programs. METHODS The databases PsycINFO, CINAHL, MEDLINE, Scopus, and Informit, as well as unpublished sources in gray literature (Google Scholar, OpenGrey), were searched and reference lists were checked to locate any additional studies. Studies published in English were considered, with a date range from inception to 2019. Three reviewers independently assessed the methodological quality of the studies that met the inclusion criteria using the JBI critical appraisal approach for qualitative research. Data were extracted by one reviewer using the standardized qualitative extraction tool and checked for accuracy by three other reviewers. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings, and a level of confidence was assigned to both synthesized findings. RESULTS Eighteen papers met the inclusion criteria and were included in the data extraction phase. A total of 84 findings were extracted and aggregated into six categories based on similarity of meaning and two synthesized findings. The methodological quality of the studies varied, and the overall level of confidence of the synthesized findings was determined to be moderate. CONCLUSIONS This review identified that persons living with mental illness perceive outdoor nature-based therapeutic recreation as enjoyable and that therapeutic recreation makes a positive contribution to mental health. Congruent with the literature, therapeutic recreation offers a socially inclusive and psychologically safe environment. The intentionally structured social milieu enhances the formation of social relationships and meaningful connections for persons with mental illness. Elements linked with psychological well-being, such as intrinsic motivation, overcoming perceived challenges, and finding purpose and meaning, are enhanced through participation in therapeutic recreation in outdoor nature-based settings. Increased levels of physical activity, greater self-esteem, and enhanced sense of identity were some of the perceived positive changes. This review provides important insights into the subjective needs of persons with mental illness who undertake therapeutic recreation in outdoor nature-based settings. The qualitative findings can inform health care providers, or those interested in therapeutic recreation programming, to use alongside quantitative evidence of effectiveness to design nature-based therapeutic recreation activities that are meaningful for persons with mental illness. Limitations of the research were that papers published in languages other than English were not searched, and papers not located may have influenced the findings of this review.
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Affiliation(s)
- Caroline Picton
- School of Nursing, University of Wollongong, Wollongong, Australia.,Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence
| | - Ritin Fernandez
- School of Nursing, University of Wollongong, Wollongong, Australia.,Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence
| | - Lorna Moxham
- School of Nursing, University of Wollongong, Wollongong, Australia.,Global Challenges Program, University of Wollongong, Wollongong, Australia
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Riches S, Pisani S, Bird L, Rus-Calafell M, Garety P, Valmaggia L. Virtual reality-based assessment and treatment of social functioning impairments in psychosis: a systematic review. Int Rev Psychiatry 2021; 33:337-362. [PMID: 34121587 DOI: 10.1080/09540261.2021.1918648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People with psychosis can experience social functioning impairments. Virtual reality (VR) has been used to assess and treat these difficulties. This systematic review (Prospero CRD42015026288) provides an evaluation of these VR applications. PsycINFO, MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus were searched until May 2020. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess studies. Database searching identified 3810 titles. Fifty-eight studies (published 2005-2020; N = 2,853), comprising twenty-six head-mounted display studies (20 assessment, 6 treatment) and thirty-two immersive 2D screen studies (23 assessment, 9 treatment), were included. There were forty-eight observational studies and ten randomised controlled trials, with 1570 participants (of which, 185 were at ultra-high risk of psychosis) in VR test groups. Nearly half the studies were published since 2016. Assessments targeted cognitive and behavioural indicators of social functioning, e.g. paranoia, eye gaze, or interpersonal distance. Treatments promoted cognitive-behavioural social skills or job interview training. Studies indicate feasibility, acceptability, and effectiveness of VR for social functioning impairments in psychosis. Limitations of studies include the narrow scope of social functioning, small sample sizes, and limited randomised controlled trials and standardised interventions. Findings suggest VR has potential to be integrated with existing psychological approaches.
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Affiliation(s)
- Simon Riches
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Sara Pisani
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Leanne Bird
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Mar Rus-Calafell
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
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12
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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.
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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.
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13
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Yu Y, Xiao X, Yang M, Ge XP, Li TX, Cao G, Liao YJ. Personal Recovery and Its Determinants Among People Living With Schizophrenia in China. Front Psychiatry 2020; 11:602524. [PMID: 33362611 PMCID: PMC7759546 DOI: 10.3389/fpsyt.2020.602524] [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: 09/03/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022] Open
Abstract
Objective: The past few decades have seen an evolution in the understanding of recovery from a clinical-based view that focuses on symptoms and functioning to a more consumer-oriented perspective that focuses on personal recovery. The present study aimed to assess personal recovery among people living with schizophrenia and determine its predictors. Methods: This cross-sectional study recruited a random sample of 400 people living with schizophrenia (PLS) from twelve community health centers of Hunan, China. Recovery was assessed using the short-form 8-item Recovery Assessment Scale (RAS-8). PLS disability and functioning were assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Global Assessment of Functioning (GAF), respectively. Results: Participants had a mean personal recovery score of 20.29 (SD: 9.31, Range: 8-40). Personal recovery was predicted by both socio-demographic and clinical characteristics. Older age (r = -0.17, p < 0.001), being female (r = -2.29, p = 0.019), and higher disability (r = -0.22, p < 0.001) were independently associated with worse personal recovery, while having a college education (r = 5.49, p = 0.002), and higher functioning (r = 0.09, p = 0.017) were independently associated with better personal recovery. Conclusion: Interventions to improve recovery among PLS may be best served by reducing the impact of disability and improving functioning, with targeted interventions for individuals who are older, female and less educated in order to increase their likelihood of recovery.
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Affiliation(s)
- Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Xi Xiao
- Department of Psychiatry, Changsha Psychiatric Hospital, Changsha, China
| | - Min Yang
- Department of Psychiatry, Changsha Psychiatric Hospital, Changsha, China
| | - Xiao-Ping Ge
- Department of Geriatrics, Changsha Psychiatric Hospital, Changsha, China
| | - Tong-Xin Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Gui Cao
- Department of Health Insurance and Long Term Care, Chinese Academy of Labor and Social Security, Beijing, China
| | - Ying-Jun Liao
- Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital, Central South University, Changsha, China
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14
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Slade M, Rennick-Egglestone S, Blackie L, Llewellyn-Beardsley J, Franklin D, Hui A, Thornicroft G, McGranahan R, Pollock K, Priebe S, Ramsay A, Roe D, Deakin E. Post-traumatic growth in mental health recovery: qualitative study of narratives. BMJ Open 2019; 9:e029342. [PMID: 31256037 PMCID: PMC6609070 DOI: 10.1136/bmjopen-2019-029342] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/12/2019] [Accepted: 05/31/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Post-traumatic growth, defined as positive psychological change experienced as a result of the struggle with challenging life circumstances, is under-researched in people with mental health problems. The aim of this study was to develop a conceptual framework for post-traumatic growth in the context of recovery for people with psychosis and other severe mental health problems. DESIGN Qualitative thematic analysis of cross-sectional semi-structured interviews about personal experiences of mental health recovery. SETTING England. PARTICIPANTS Participants were adults aged over 18 and: (1) living with psychosis and not using mental health services (n=21); (2) using mental health services and from black and minority ethnic communities (n=21); (3) underserved, operationalised as lesbian, gay, bisexual and transgender community or complex needs or rural community (n=19); or (4) employed in peer roles using their lived experience with others (n=16). The 77 participants comprised 42 (55%) female and 44 (57%) white British. RESULTS Components of post-traumatic growth were present in 64 (83%) of recovery narratives. Six superordinate categories were identified, consistent with a view that post-traumatic growth involves learning about oneself (self-discovery) leading to a new sense of who one is (sense of self) and appreciation of life (life perspective). Observable positively valued changes comprise a greater focus on self-management (well-being) and more importance being attached to relationships (relationships) and spiritual or religious engagement (spirituality). Categories are non-ordered and individuals may start from any point in this process. CONCLUSIONS Post-traumatic growth is often part of mental health recovery. Changes are compatible with research about growth following trauma, but with more emphasis on self-discovery, integration of illness-related experiences and active self-management of well-being. Trauma-related growth may be a preferable term for participants who identify as having experienced trauma. Trauma-informed mental healthcare could use the six identified categories as a basis for new approaches to supporting recovery. TRIAL REGISTRATION NUMBER ISRCTN11152837.
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Affiliation(s)
- Mike Slade
- Institute of Mental Health, University of Nottingham School of Health Sciences, Nottingham, UK
| | | | - Laura Blackie
- Department of Psychology, University of Nottingham, Nottingham, UK
| | - Joy Llewellyn-Beardsley
- Institute of Mental Health, University of Nottingham School of Health Sciences, Nottingham, UK
| | - Donna Franklin
- Institute of Mental Health, NEON Lived Experience Advisory Panel, Nottingham, UK
| | - Ada Hui
- Institute of Mental Health, University of Nottingham School of Health Sciences, Nottingham, UK
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Stefan Priebe
- Unit of Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Amy Ramsay
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - David Roe
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Emilia Deakin
- Institute of Mental Health, University of Nottingham School of Health Sciences, Nottingham, UK
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15
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Puschner B, Repper J, Mahlke C, Nixdorf R, Basangwa D, Nakku J, Ryan G, Baillie D, Shamba D, Ramesh M, Moran G, Lachmann M, Kalha J, Pathare S, Müller-Stierlin A, Slade M. Using Peer Support in Developing Empowering Mental Health Services (UPSIDES): Background, Rationale and Methodology. Ann Glob Health 2019; 85:53. [PMID: 30951270 PMCID: PMC6634474 DOI: 10.5334/aogh.2435] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Peers are people with lived experience of mental illness. Peer support is an established intervention in which peers offer support to others with mental illness. A large proportion of people living with severe mental illness receive no care. The care gap is largest in low- and middle-income countries, with detrimental effects on individuals and societies. The global shortage of human resources for mental health is an important driver of the care gap. Peers are an under-used resource in global mental health. OBJECTIVES To describe rationale and methodology of an international multicentre study which will scale-up peer support for people with severe mental illness in high-, middle-, and low-income countries through mixed-methods implementation research. METHODS UPSIDES is an international community of research and practice for peer support, including peer support workers, mental health researchers, and other relevant stakeholders in eight study sites across six countries in Europe, Africa, and Asia. During the first two years of UPSIDES, a series of qualitative studies and systematic reviews will explore stakeholders' perceptions and the current state of peer support at each site. Findings will be incorporated into a conceptual framework to guide the development of a culturally appropriate peer support intervention to be piloted across all study sites. All intervention and study materials will be translated according to internationally recognised guidelines.Expected Impact: UPSIDES: will leverage the unique expertise of people with lived experience of mental illness to strengthen mental health systems in high-, middle- and low-income countries. UPSIDES will actively involve and empower service users and embed patient-centeredness, recovery orientation, human rights approaches, and community participation into services. The focus on capacity-building of peers may prove particularly valuable in low-resource settings in which shortages of human capital are most severe.
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Affiliation(s)
- Bernd Puschner
- Department of Psychiatry and Psychotherapy II, Ulm University, DE
| | - Julie Repper
- ImROC (Implementing Recovery through Organisational Change), Department of Learning and Organisational Development, Nottinghamshire Healthcare Foundation NHS Trust, Nottingham, UK
| | - Candelaria Mahlke
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, DE
| | - Rebecca Nixdorf
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, DE
| | | | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, UG
| | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, UK
| | | | | | | | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Beer Sheva, IL
| | - Max Lachmann
- Department of Social Work, Ben Gurion University of the Negev, Beer Sheva, IL
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, IN
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, IN
| | | | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, UK
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16
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Abstract
BACKGROUND Traditionally, treatment of psychosis has focused on the amelioration of psychopathology and return to adequate functioning: clinical recovery although there is growing recognition of the importance of subjective experiences associated with recovery: personal recovery. Positive psychiatry extends the focus of psychiatric treatment to go beyond the reduction of psychiatric symptoms and and improvement of functional disability to promote the attainment of well-being. AIM This article examined the conceptualization of well-being from the context of treatment for psychosis, its relationship with clinical recovery and highlighted some of challenges and implications for mental health services in promoting well-being. DISCUSSION Recovery from psychosis is a complex and individual process, where well-being is more than just the absence of mental illness. Clinical and personal recovery processes may contribute to well-being although further longitudinal studies are required. A recent framework for understanding well-being in psychosis helps address the lack of consensus in this field. There is a considerable overlap between the indicators of well-being in this model and the CHIME framework for personal recovery. Thus, interventions targeting personal recovery processes may be a potential way to promote well-being. Current mental health services face a considerable challenge if they are to fulfill the dual role of reducing psychopathology and/or disability whilst concurrently addressing personal recovery to promote well-being. The attainment of well-being may not only be a desirable treatment goal in recovery-orientated mental health services but also a potential protective factor against serious mental illness.
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Affiliation(s)
- Stephen Fitzgerald Austin
- a Psychiatric Research Unit, Region Zealand Psychiatry , Slagelse , Denmark.,b Psychiatric Research Unit, Region North Zealand Psychiatry , Copenhagen University Hospital , Hillerød , Denmark
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17
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Chan RCH, Mak WWS, Chio FHN, Tong ACY. Flourishing With Psychosis: A Prospective Examination on the Interactions Between Clinical, Functional, and Personal Recovery Processes on Well-being Among Individuals with Schizophrenia Spectrum Disorders. Schizophr Bull 2018; 44:778-786. [PMID: 28981851 PMCID: PMC6007346 DOI: 10.1093/schbul/sbx120] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Well-being is not just the absence of mental disorder but also involves positive feelings and contentment (emotional well-being), meaningful engagement (psychological well-being), and contribution of one's community or society (social well-being). Recovery processes, which encompass mitigation of clinical symptomatology (clinical recovery), improvement in occupational, social, and adaptive functioning (functional recovery), and development of personally valued goals and identity (personal recovery), have demonstrated to be important markers of well-being. This study examined the relative contribution of clinical, functional, and personal recovery processes on well-being among individuals with schizophrenia and explored the effect of personal recovery on people with varying levels of symptom severity and functional ability. A longitudinal quantitative research design was used in which 181 people with schizophrenia spectrum disorders were assessed at baseline and 6 months. At baseline, 28.2% of the participants were considered as flourishing. Around half of the participants (52.5%) were moderately mentally healthy, while 19.3% were identified as languishing. Results showed that clinical recovery was predictive of better well-being at 6-month postbaseline. Personal recovery was found to positively predict well-being, above and beyond the effects of clinical and functional recovery. Moderation analysis showed that the effect of personal recovery on well-being did not depend on clinical and functional recovery, which implied that people with schizophrenia can participate in the process of personal recovery and enjoy positive well-being regardless of their clinical stability and functional competence. Given the robust salutogenic effect of personal recovery, greater emphasis should be placed on developing person-centered, strength-based, recovery-oriented services.
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Affiliation(s)
- Randolph C H Chan
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong,To whom correspondence should be addressed; tel: (852) 3943–6577, fax: (852) 2603–5019, e-mail:
| | - Floria H N Chio
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong
| | - Alan C Y Tong
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong
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18
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Riches S, Maskey R, Dishman P, Benjamin Mbe J, Waddingham R, Tebrook C, Mundy E, Roberts P, Fisher HL. Development, implementation and evaluation of Altered States of Consciousness: an immersive art exhibition designed to increase public awareness of psychotic experiences. Arts Health 2018; 11:1-19. [PMID: 31038445 DOI: 10.1080/17533015.2018.1443948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The arts can increase public awareness of mental health. Stigma about psychosis remains high despite common occurrences of psychotic experiences in the general population (e.g. hearing voices, seeing visions, and other unusual sensory experiences). Targeted approaches may therefore benefit stigma reduction. This project aimed to produce an immersive art installation that increased public understanding of psychotic experiences. METHODS Development stages included workshops with people with lived experience, training actors to perform "voices", sourcing artworks, and producing a voice hearing simulation and video installation. RESULTS The exhibition was implemented as intended, gained positive visitor feedback (N = 150), felt immersive, enhanced subjective understanding of voice hearing, increased compassion and was not unduly stressful. A production team meeting (N = 10) identified exhibition strengths, challenges, and potential modifications. CONCLUSIONS This successful, large-scale pilot of an immersive art exhibition combined creative, academic, and experiential perspectives. It enabled visitors to "hear voices" and increased their understanding of psychotic experiences.
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Affiliation(s)
- Simon Riches
- a Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience , King's College London , London , UK
| | | | | | | | | | - Charlie Tebrook
- e School of Psychology , University of Bedfordshire , Luton , UK
| | - Eve Mundy
- d Voice Collective, Mind in Camden , London , UK
| | | | - Helen L Fisher
- a Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience , King's College London , London , UK
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19
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Picton C, Patterson C, Moxham L, Taylor EK, Perlman D, Brighton R, Heffernan T. Empowerment: The experience of Recovery Camp for people living with a mental illness. Collegian 2018. [DOI: 10.1016/j.colegn.2017.04.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Galbusera L, Fellin L, Fuchs T. Towards the recovery of a sense of self: An interpretative phenomenological analysis of patients' experience of body-oriented psychotherapy for schizophrenia. Psychother Res 2017; 29:234-250. [PMID: 28532254 DOI: 10.1080/10503307.2017.1321805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Increasing evidence supports the efficacy of body-oriented psychotherapy (BPT) for schizophrenia. Yet, so far no research has investigated outcome in relation to therapy process: Why and how BPT is effective. In this study, we qualitatively explore participants' experience of a manualized BPT for schizophrenia to shed light on the process of therapeutic change. METHOD We conducted in-depth interviews with 6 participants who completed a 10-week BPT group intervention. Interviews explored participants' experience of change and helpful aspects of therapy and were analysed using interpretative phenomenological analysis. FINDINGS We identified six master themes across the interviews: (i) Being a whole: body-mind connection; (ii) Being agentic and being able; (iii) Being unique and worthy: Being accepted for who one is; (iv) Changing interactions: Engaging in authentic interpersonal contact; (v) Being part of a group: Feeling integrated; and (vi) Hope and investing in the future. CONCLUSION We discuss the clinical implications for each theme and bring the findings together by describing therapeutic change in schizophrenia as a recovery of sense of self at different but interlocked levels. Moreover, we put forward recommendations for both specific and common factors for schizophrenia therapy. Clinical or methodological significance of this article: The clinical significance of this study is twofold. On the one hand, the findings of this analysis might inform the theory and practice of BPT and might directly feedback into a further development of the manual guidelines. On the other hand, common helpful factors have been identified thatmight also be relevant for the more general clinical practice concerning patients with schizophrenia. Here, we summarize our key messages for the clinical practitioner emerging from the findings: The inclusion of bodily aspects and a focus on pre-reflective experience in psychotherapy can help persons with schizophrenia recover the sense of being a body-mind unity. Empowering persons with schizophrenia, instead of instructing them, seems to foster a sense of agency and self-confidence, which are crucial to the recovery process. A twofold therapeutic stance characterized by openness towards the other and authenticity was experienced by patients as facilitating the rapport building. This might help persons with schizophrenia engage in the relation. Social inclusion might enhance therapeutic change and recovery in schizophrenia. Group therapy might be helpful for fostering a feeling of social belonging, but the inclusion in the wider social and community context remains a critical issue. The experience of joyful moments in psychotherapy might positively contribute to therapeutic change in that it fosters a sense of hope for the future. Overall our paper contributes to the literature aiming at expanding the range of therapeutic modalities, focussing on the creation and use of mixed models of therapy within and beyond talking practices.
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Affiliation(s)
- Laura Galbusera
- a Clinic for General Psychiatry , University of Heidelberg , Heidelberg , Germany
| | - Lisa Fellin
- b School of Psychology , University of East London , London , UK
| | - Thomas Fuchs
- a Clinic for General Psychiatry , University of Heidelberg , Heidelberg , Germany
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21
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Schrank B, Brownell T, Jakaite Z, Larkin C, Pesola F, Riches S, Tylee A, Slade M. Evaluation of a positive psychotherapy group intervention for people with psychosis: pilot randomised controlled trial. Epidemiol Psychiatr Sci 2016; 25:235-46. [PMID: 25698298 PMCID: PMC6998731 DOI: 10.1017/s2045796015000141] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/18/2015] [Accepted: 01/19/2015] [Indexed: 12/13/2022] Open
Abstract
AIMS Third-wave psychological interventions have gained relevance in mental health service provision but their application to people with psychosis is in its infancy and interventions targeting wellbeing in psychosis are scarce. This study tested the feasibility and preliminary effectiveness of positive psychotherapy adapted for people with psychosis (WELLFOCUS PPT) to improve wellbeing. METHODS WELLFOCUS PPT was tested as an 11-week group intervention in a convenience sample of people with psychosis in a single centre randomised controlled trial (ISRCTN04199273) involving 94 people with psychosis. Patients were individually randomised in blocks to receive either WELLFOCUS PPT in addition to treatment as usual (TAU), or TAU only. Assessments took place before randomisation and after the therapy. The primary outcome was wellbeing (Warwick-Edinburgh Mental Well-Being Scale, WEMWBS). Secondary outcomes included symptoms (Brief Psychiatric Rating Scale), depression (Short Depression-Happiness Scale), self-esteem, empowerment, hope, sense of coherence, savouring beliefs and functioning, as well as two alternative measures of wellbeing (the Positive Psychotherapy Inventory and Quality of Life). Intention-to-treat analysis was performed. This involved calculating crude changes and paired-sample t-tests for all variables, as well as ANCOVA and Complier Average Causal Effect (CACE) Analysis to estimate the main effect of group on all outcomes. RESULTS The intervention and trial procedures proved feasible and well accepted. Crude changes between baseline and follow-up showed a significant improvement in the intervention group for wellbeing according to all three concepts assessed (i.e., WEMWBS, Positive Psychotherapy Inventory and Quality of Life), as well as for symptoms, depression, hope, self-esteem and sense of coherence. No significant changes were observed in the control group. ANCOVA showed no main effect on wellbeing according to the primary outcome scale (WEMWBS) but significant effects on symptoms (p = 0.006, ES = 0.42), depression (p = 0.03, ES = 0.38) and wellbeing according to the Positive Psychotherapy Inventory (p = 0.02, ES = 0.30). Secondary analysis adapting for therapy group further improved the results for symptom reduction (p = 0.004, ES = 0.43) and depression (p = 0.03, ES = 0.41) but did not lead to any more outcomes falling below the p = 0.05 significance level. CACE analysis showed a non-significant positive association between the intervention and WEMWBS scores at follow-up (b = 0.21, z = 0.9, p = 0.4). CONCLUSIONS This study provides initial evidence on the feasibility of WELLFOCUS PPT in people with psychosis, positively affecting symptoms and depression. However, more work is needed to optimise its effectiveness. Future research might evaluate positive psychotherapy as a treatment for comorbid depression in psychosis, and consider alternative measurements of wellbeing.
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Affiliation(s)
- Beate Schrank
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Tamsin Brownell
- Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Zivile Jakaite
- Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Charley Larkin
- Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Francesca Pesola
- Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Simon Riches
- Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Andre Tylee
- Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Mike Slade
- Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Developing a change model for peer worker interventions in mental health services: a qualitative research study. Epidemiol Psychiatr Sci 2015; 24:435-45. [PMID: 24992284 PMCID: PMC8367355 DOI: 10.1017/s2045796014000407] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS A range of peer worker roles are being introduced into mental health services internationally. There is some evidence that attests to the benefits of peer workers for the people they support but formal trial evidence in inconclusive, in part because the change model underpinning peer support-based interventions is underdeveloped. Complex intervention evaluation guidance suggests that understandings of how an intervention is associated with change in outcomes should be modelled, theoretically and empirically, before the intervention can be robustly evaluated. This paper aims to model the change mechanisms underlying peer worker interventions. METHODS In a qualitative, comparative case study of ten peer worker initiatives in statutory and voluntary sector mental health services in England in-depth interviews were carried out with 71 peer workers, service users, staff and managers, exploring their experiences of peer working. Using a Grounded Theory approach we identified core processes within the peer worker role that were productive of change for service users supported by peer workers. RESULTS Key change mechanisms were: (i) building trusting relationships based on shared lived experience; (ii) role-modelling individual recovery and living well with mental health problems; (iii) engaging service users with mental health services and the community. Mechanisms could be further explained by theoretical literature on role-modelling and relationship in mental health services. We were able to model process and downstream outcomes potentially associated with peer worker interventions. CONCLUSIONS An empirically and theoretically grounded change model can be articulated that usefully informs the development, evaluation and planning of peer worker interventions.
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Pinfold V, Sweet D, Porter I, Quinn C, Byng R, Griffiths C, Billsborough J, Enki DG, Chandler R, Webber M, Larsen J, Carpenter J, Huxley P. Improving community health networks for people with severe mental illness: a case study investigation. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IntroductionPolicy drivers in mental health to address personal recovery, stigma and poor physical health indicate that new service solutions are required. This study aimed to understand how connections to people, places and activities were utilised by individuals with severe mental illness (SMI) to benefit health and wellbeing.MethodsA five-module mixed-methods design was undertaken in two study sites. Data were collected from 150 network-mapping interviews and 41 in-depth follow-up interviews with people with SMI; in-depth interviews with 30 organisation stakeholders and 12 organisation leaders; and 44 telephone interviews with practitioners. We undertook a three-stage synthesis process including independent lived experience feedback, and a patient and public involvement team participated in tool design, data collection, analysis and write-up.ResultsThree personal network types were found in our study using the community health network approach: diverse and active; family and stable; formal and sparse. Controlled for other factors we found only four variables significantly associated with which network type a participant had: living alone or not; housing status; formal education; long-term sickness or disability. Diagnosis was not a factor. These variables are challenging to address but they do point to potential for network change. The qualitative interviews with people with SMI provided further understanding of connection-building and resource utilisation. We explored individual agency across each network type, and identified recognition of the importance and value of social support and active connection management alongside the risks of isolation, even for those most affected by mental illness. We identified tensions in personal networks, be that relationships with practitioners or families, dealing with the impact of stigma, or frustrations of not being in employment, which all impact on network resources and well-being. The value of connectedness within personal networks of people, place and activity for supporting recovery was evident in shaping identity, providing meaning to life and sense of belonging, gaining access to new resources, structuring routines and helping individuals ‘move on’ in their recovery journey.Health-care practitioners recognised that social factors were important in recovery but reported system-level barriers (workload, administrative bureaucracy, limited contact time with clients) in addressing these issues fully. Even practitioners working in third-sector services whose remit involved increasing clients’ social connection faced restrictions due to being evaluated by outcome criteria that limited holistic recovery-focused practices. Service providers were keen to promote recovery-focused approaches. We found contrasts between recovery ideology within mental health policy and recovery practice on the ground. In particular, the social aspects of supporting people with SMI are often underprioritised in the health-care system. In a demanding and changing context, strategic multiagency working was seen as crucial but we found few examples of embedded multisector organisation partnerships.ConclusionWhile our exploratory study has limitations, findings suggest potential for people with SMI to be supported to become more active managers of their personal networks to support well-being regardless of current network type. The health and social care system does not currently deliver multiagency integrated solutions to support SMI and social recovery.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | | | - Ian Porter
- Primary Care Group, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Cath Quinn
- Primary Care Group, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Richard Byng
- Primary Care Group, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | | | | | - Doyo Gragn Enki
- Primary Care Group, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Ruth Chandler
- Sussex Partnership NHS Foundation Trust, West Sussex, UK
| | - Martin Webber
- International Centre for Mental Health Social Research, University of York, York, UK
| | | | - John Carpenter
- Department of Social Work and Applied Social Sciences, University of Bristol, Bristol, UK
| | - Peter Huxley
- Centre for Social Work and Social Care Research, University of Swansea, Swansea, UK
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Schrank B, Brownell T, Riches S, Chevalier A, Jakaite Z, Larkin C, Lawrence V, Slade M. Staff views on wellbeing for themselves and for service users. J Ment Health 2015; 24:48-53. [PMID: 25587818 DOI: 10.3109/09638237.2014.998804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Wellbeing is an important outcome in the context of recovery from mental illness. The views of mental health professionals on wellbeing may influence their approach to supporting recovery. AIMS This study aims to explore views held by mental health staff about factors influencing their own wellbeing and that of service users with psychosis. METHODS Semi-structured interviews were conducted with 14 mental health staff in South London who had worked with people with psychosis. Thematic analysis was used to analyse the data and comparisons were made between staff views of wellbeing for themselves and service users. RESULTS Staff participants held similar conceptualisations of wellbeing for themselves and for service users. However, they suggested a differential impact on wellbeing for a number of factors, such as balance, goals and achievement, and work. Staff employed a more deficit-based perspective on wellbeing for service users and a more strengths-based view for themselves. CONCLUSIONS Staff stated a recovery orientation in principle, but struggled to focus on service user strengths in practice. A stronger emphasis in clinical practice on amplifying strengths to foster self-management is indicated, and staff may need support to achieve this emphasis, e.g. through specific interventions and involvement of peer support workers.
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Affiliation(s)
- Beate Schrank
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience (Box P029) , De Crespigny Park, London , UK and
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Brownell T, Schrank B, Jakaite Z, Larkin C, Slade M. Mental Health Service User Experience of Positive Psychotherapy. J Clin Psychol 2014; 71:85-92. [DOI: 10.1002/jclp.22118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Beate Schrank
- King's College London; Institute of Psychiatry
- Medical University of Vienna
| | | | | | - Mike Slade
- King's College London; Institute of Psychiatry
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Schrank B, Riches S, Coggins T, Rashid T, Tylee A, Slade M. WELLFOCUS PPT - modified positive psychotherapy to improve well-being in psychosis: study protocol for a pilot randomised controlled trial. Trials 2014; 15:203. [PMID: 24888479 PMCID: PMC4057564 DOI: 10.1186/1745-6215-15-203] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 05/20/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The promotion of well-being is an important goal of recovery oriented mental health services. No structured, evidence-based intervention exists that aims to increase the well-being in people with severe mental illness such as psychosis. Positive psychotherapy (PPT) is a promising intervention for this goal. Standard PPT was adapted for use with people with psychosis in the UK following the Medical Research Council framework for developing and testing complex interventions, resulting in the WELLFOCUS Model describing the intended impact of WELLFOCUS PPT. This study aims to test the WELLFOCUS Model, by piloting the intervention, trial processes, and evaluation strategy. METHODS/DESIGN This study is a non-blinded pragmatic pilot RCT comparing WELLFOCUS PPT provided as an 11-session group therapy in addition to treatment as usual to treatment as usual alone. Inclusion criteria are adults (aged 18-65 years) with a main diagnosis of psychosis who use mental health services. A target sample of 80 service users with psychosis are recruited from mental health services across the South London and Maudsley NHS Foundation Trust. Participants are randomised in blocks to the intervention and control group. WELLFOCUS PPT is provided to groups by specifically trained and supervised local therapists and members of the research team. Assessments are conducted before randomisation and after the group intervention. The primary outcome measure is well-being assessed by the Warwick-Edinburgh Mental Well-being Scale. Secondary outcomes include good feelings, symptom relief, connectedness, hope, self-worth, empowerment, and meaning. Process evaluation using data collected during the group intervention, post-intervention individual interviews and focus groups with participants, and interviews with trial therapists will complement quantitative outcome data. DISCUSSION This study will provide data on the feasibility of the intervention and identify necessary adaptations. It will allow optimisation of trial processes and inform the evaluation strategy, including sample size calculation, for a future definitive RCT. TRIAL REGISTRATION Current Controlled Trials ISRCTN04199273 - WELLFOCUS study: an intervention to improve well-being in people with psychosis, Date registered: 27 March 2013, first participant randomised on 26 April 2013.
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Affiliation(s)
- Beate Schrank
- Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, United Kingdom
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Simon Riches
- Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, United Kingdom
| | - Tony Coggins
- South London and Maudsley NHS Foundation Trust, Mental Health Promotion, London, United Kingdom
| | - Tayyab Rashid
- Health & Wellness Centre, University of Toronto, Toronto, Canada
| | - Andre Tylee
- Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, United Kingdom
| | - Mike Slade
- Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, United Kingdom
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Abstract
Assessing the outcomes of interventions in mental health care is both important and challenging. The aim of this paper is to advance the field of outcomes research by proposing a taxonomy of the decisions that clinicians and researchers need to consider when evaluating outcomes. Our taxonomy has eight components, framed as decisions: Whose outcome will be considered? Which scientific stage is being investigated? What outcome domain(s) matter? What level of assessment will be used? Will clinical and/or recovery outcomes be assessed? Whose perspective will be considered? Will deficits and/or strengths be the focus? Will invariant or individualized measures be preferred? We propose a future focus on understanding what matters most to people using mental health services, and on the use of measures rated by service users as the primary approach to evaluating outcome.
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Affiliation(s)
- Graham Thornicroft
- King's College London, Health Service and Population Research Department; Institute of Psychiatry; Denmark Hill London SE5 8AF UK
| | - Mike Slade
- King's College London, Health Service and Population Research Department; Institute of Psychiatry; Denmark Hill London SE5 8AF UK
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