Developing a recovery college: a preliminary exercise in establishing regional readiness and community needs

The Process of Home-Visiting Nurses Supporting People with Mental Disorders

The number of people with mental disorders (PMD) living in the community is increasing; however, it is unclear how home-visiting nurses (HVNs) supporting them in the community acquire their support skills. This study aimed to reveal the process of how HVNs learn support skills for PMD. Semi-structured interviews were conducted with 14 HVNs supporting PMD living in the community. The grounded theory approach was used for data analysis. As a result, two stages were present: "Explore the personal recovery of PMD" and "Believe in the potential of PMD and accompanying them". The first stage is further divided into two themes: "Overlapping the worlds of PMD and HVNs", and "Easing difficulty in living for PMD". In the first stage, HVNs gained a better understanding of PMD and obtained insight into the support they needed in their daily lives. In the second stage, HVNs became to provide the support that PMD truly needed. HVNs gained a deeper understanding of the reality of PMD through their support. After HVNs found the support PMD required, they sought to provide it, ultimately resulting in finding ways to facilitate the personal recovery of PMD.

Personal recovery within positive psychiatry

BACKGROUND

One goal within positive psychiatry is to support the personal recovery of persons with mental illness and providing opportunities for well-being.

AIM

The current article aims to introduce readers to the concept of personal recovery and the potential and importance of recovery-oriented services and measures.

METHODS

A literature review was conducted to help consider the domains of 'personal recovery', 'recovery-oriented services/interventions', and 'measures'. A database search was complemented with a web-based search. Both medical subject heading (MESH) terms and free-text search terms were used.

RESULTS

Literature from research journals, grey literature, and websites were included. Within this context, recovery does not refer to a cure but involves a process in which a person acts as an agent to develop new goals and meaning in life, despite and beyond limitations posed by the illness and its consequences. A positive focus on recovery is in sharp contrast to historical deterministic and pessimistic concepts of mental illnesses. Recovery-oriented services such as peer support, assertive community treatment, supported employment/education/housing, illness self-management, and decreasing self-stigma are highlighted. A review of 27 measures that focus on personal recovery and promotion of well-being are also discussed.

CONCLUSIONS

The literature overview presents perspectives and knowledge of how to develop positive psychiatry, how mental health services and their partner organizations may become more recovery oriented and help persons reach well-being and a better quality of life. This study is limited to a narrative review and may precede future systematic reviews.

Best practice framework for Patient and Public Involvement (PPI) in collaborative data analysis of qualitative mental health research: methodology development and refinement

BACKGROUND

Patient and Public Involvement (PPI) in mental health research is increasing, especially in early (pre-funding) stages. PPI is less consistent in later stages, including in analysing qualitative data. The aims of this study were to develop a methodology for involving PPI co-researchers in collaboratively analysing qualitative mental health research data with academic researchers, to pilot and refine this methodology, and to create a best practice framework for collaborative data analysis (CDA) of qualitative mental health research.

METHODS

In the context of the RECOLLECT Study of Recovery Colleges, a critical literature review of collaborative data analysis studies was conducted, to identify approaches and recommendations for successful CDA. A CDA methodology was developed and then piloted in RECOLLECT, followed by refinement and development of a best practice framework.

RESULTS

From 10 included publications, four CDA approaches were identified: (1) consultation, (2) development, (3) application and (4) development and application of coding framework. Four characteristics of successful CDA were found: CDA process is co-produced; CDA process is realistic regarding time and resources; demands of the CDA process are manageable for PPI co-researchers; and group expectations and dynamics are effectively managed. A four-meeting CDA process was piloted to co-produce a coding framework based on qualitative data collected in RECOLLECT and to create a mental health service user-defined change model relevant to Recovery Colleges. Formal and informal feedback demonstrated active involvement. The CDA process involved an extra 80 person-days of time (40 from PPI co-researchers, 40 from academic researchers). The process was refined into a best practice framework comprising Preparation, CDA and Application phases.

CONCLUSIONS

This study has developed a typology of approaches to collaborative analysis of qualitative data in mental health research, identified from available evidence the characteristics of successful involvement, and developed, piloted and refined the first best practice framework for collaborative analysis of qualitative data. This framework has the potential to support meaningful PPI in data analysis in the context of qualitative mental health research studies, a previously neglected yet central part of the research cycle.

Evaluation of Arts based Courses within a UK Recovery College for People with Mental Health Challenges

No previous studies have evaluated arts based recovery college courses. Yet arts may assist in personal recovery, as often defined by service users, through social connection and personal meaning. This interdisciplinary study evaluated (i) whether self-reported wellbeing and arts activities increased following arts based recovery college courses, and (ii) how students, peer trainers and artist-trainers understood courses’ impact. The design was mixed-methods. Of 42 service user students enrolling, 39 completed a course and 37 consented to provide data. Of these, 14 completed pre and post course questionnaires on mental wellbeing and 28 on arts participation. Post course focus groups were held with six of eight peer trainers and five of seven artist-trainers, and 28 students gave written feedback. Twenty-four students were interviewed up to three times in the subsequent nine months. There were statistically significant increases in self-reported mental wellbeing and range of arts activities following course attendance. At follow-up 17 of 24 students reported improved mental wellbeing, while seven reported little or no change. Some spoke of increased social inclusion and continuing to use skills learned in the course to maintain wellbeing. Initial in-course experience of ‘artistic growth’ predicted follow-up reports of improvement. Future controlled studies should employ standardized measures of social inclusion and arts participation.

The meaning of co-production for clinicians: An exploratory case study of Practitioner Trainers in one Recovery College

WHAT IS KNOWN ON THE SUBJECT

Analysis of co-production in mental health and specifically Recovery Colleges has not previously considered the impact on clinicians and their clinical practice. Co-production as a concept is open to multiple interpretations. Core components of co-produced work are as follows: a focus on assets, mutuality, peer support and the use of a facilitative approach. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Senior clinicians who have chosen to become Practitioner Trainers describe the experience of collaboration with service users in an educational rather than clinical context. Working together in this educational environment led to some shifts in their perceptions of professional power and authority, in some cases leading to personal disclosures about their mental health. This study suggests the mechanisms by which co-production may transform professional practice: being in an educational rather than clinical context, the experience of being supported, the challenge of negotiating multiple roles (including that of being a colleague to someone with mental health needs) and experiencing a gradual shift of role emphasis as co-trainer relationships develop. The practical challenge of holding a simultaneous role as clinician for and co-trainer with Peer Trainers has been articulated, with the caveat that mental health support may be a feature of collegiate as well as clinical roles. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Being a Practitioner Trainer could be a professionally transformative experience. Ground rules for how to support colleagues' mental health needs should be established and refined during co-produced working. Negotiating personal disclosure and professional role identity must be explored further in both co-production research and practice.

ABSTRACT

Introduction Co-production between service users and clinicians is a desirable element of recovery-oriented practice in mental health, but the effect of co-production on clinicians has not been explored thoroughly. Aim To explore the meaning of co-production for clinicians based on their experience of co-production in a Recovery College. Method Thematic analysis of eight semi-structured interviews with clinicians who have co-produced and co-delivered workshops with a Recovery College Peer Trainer. Results The "meaning of co-production" had four themes: definitions, power dynamics, negotiating roles and influence on practice. Clinicians' experience of co-production meant a reassessment of their expert role and power. They said that this altered their clinical practice, particularly the language they used and the personal information they shared. Discussion Role negotiation between Practitioner and Peer Trainers is an iterative process, whereby clinicians may revise their perspectives on personal disclosure, professional identity and collegiate support. The Peer and Practitioner Trainer relationship is characterized by reciprocity and mutuality, and there is some evidence that Practitioner involvement in a co-produced activity has the potential to transform service user and provider relationships beyond the Recovery College setting. Implications for practice Engaging in co-produced educational workshops can alter clinicians' perspectives on roles, power and clinical expertise. Findings from this case study must be tested against research on other Recovery Colleges.

Collaboration in the design and delivery of a mental health Recovery College course: experiences of students and tutors

BACKGROUND

Recovery Colleges address mental health challenges using an educative approach underpinned by a collaborative recovery orientated philosophy. Research has been limited with no studies identified reporting research on the design and delivery of a specific course.

AIMS

To understand how Recovery College students and tutors experience the design and delivery of a mental health Recovery College course, specifically the "'Building Resilience" course.

METHOD

Thematic analysis of qualitative data related to the experience and process of collaboration in recovery college course design and delivery. Data included 13 qualitative individual interviews with course students and tutors and "naturally occurring" data generated through course preparation and delivery.

RESULTS

Findings drew attention to the centrality of: prior experience and design related to students, tutors and the course structure; co-delivery related to tutors and co-learner impacts; and to the course methods and environment.

CONCLUSIONS

Commitment to collaboration in design and delivery of Recovery College courses can mobilise the diverse experiences and expertise of tutors and students. The environment and methods of learning have a significant impact and should be considered alongside content. Boundaries between people and areas of knowledge and experience that arise can be viewed as sources of creativity that can enrich courses.