Recovery Camp: Assisting consumers toward enhanced self-determination

Contributing to 'a sense of purpose' - Evaluating consumer recovery progress after attending a therapeutic-recreation intervention programme: A quantitative analysis

INTRODUCTION

The recommended objective for mental health plans and policies is the adoption of recovery approaches to mental healthcare. Mental health recovery is no longer defined by symptom resolution but as a journey towards a meaningful life from the consumer's own perspective. Recovery approaches focus on consumers' strengths, feelings of well-being and the achievement of personal goals. Designing recovery-oriented interventions is crucial for supporting people in their personal recovery journey.

AIM

This study sought to evaluate how attending a recovery-oriented intervention impacts the recovery of attending people living with serious mental illness.

METHODS

A quasi-experimental approach was utilised to examine changes in self-reported recovery progress in a purposive sample of consumers living with enduring mental illness (N = 105). Recovery progress was evaluated via the Recovery Assessment Scale - Domains and Stages (RAS-DS). Data were collected at entry and exit to a therapeutic recreation programme grounded in principles of recovery-oriented care and social contact theory. Pre-post scores were analysed via a repeated-measures multivariate analysis of variance (RM-MANOVA) per the four RAS-DS recovery domains.

RESULTS

After attending the therapeutic recreation programme, consumer recovery scores significantly increased in the functional, personal, and social recovery RAS-DS domains as measured by 'Doing Things I Value', 'Looking Forward', and 'Connecting and Belonging' (respectively). No changes were observed to consumers' clinical recovery progress, as assessed via the recovery domain 'Mastering my Illness'.

CONCLUSION

The results of this study demonstrate that therapeutic recreation camps can provide a recovery-based approach to mental healthcare, with positive effects on the three areas of: a purposeful life; connection and belonging; and optimism and hope. Recovery Camp has been previously identified by the Productivity Commission as having potential person-centred recovery benefits for mental health consumers. The results of this study now establish these benefits as evidence based and can be used to guide mental health practice and policy for the implementation of therapeutic recreation camps for mental health recovery.

Informing the development of a fit-for-purpose mental health nursing curriculum: A survey of mental health nurse academics in Australia

Inadequate mental health nursing content in pre-registration nursing curricula has been the topic of debate and concern since the introduction of comprehensive nursing education in Australia. Government-initiated inquiries and the efforts of mental health professional organizations and leaders have not successfully addressed this problem. The aim of the current study was to garner the perspectives and experiences of mental health nurse academics regarding the adequacy of mental health content in producing graduates able to work effectively in mental health settings and identify barriers and enablers to implementing and sustaining sufficient mental health content in pre-registration programs. A survey was distributed to mental health academics in Australian universities offering pre-registration nursing degrees. In total, 44 complete responses were included in the analysis. The results demonstrated the following: Most participants considered the current mental health content, theory and clinical hours insufficient to prepare graduates for practice in mental health settings. They reported a scarcity of tenured mental health nurse academics to deliver content effectively. Most participants were dissatisfied with the comprehensive approach to nurse education and preferred a double degree (nursing and mental health nursing), or a direct entry mental health nursing program. These findings provide further evidence for the current crisis in mental health nursing education and highlight the need for urgent action. People accessing health services have the right to receive high-quality care from appropriately qualified nurses. The inadequacy of mental health content in these programs effectively denies vulnerable people the standard of care and treatment they should be entitled to.

Using an arts-based approach to explore the building of social capital at a therapeutic recreation camp

Therapeutic recreation is beneficial for people with and without disabilities, promoting an empowered, connected, and joyful life. The present study aimed to analyse canvas art created on a therapeutic recreation programme called Recovery Camp, to discover what they reveal about the shared experiences which have occurred. This study utilized an arts-based research method and thematic analysis to discover what participants have communicated via their artwork from ten camps between 2018 and 2019. This study adheres to the COREQ guidelines for qualitative studies. Reflexive thematic analysis produced subthemes which informed three main themes and an identified core meaning of Social Capital. The three main themes were Togetherness and teamwork, Positivity, and Gratitude for Recovery Camp. Based on these findings, canvas art has revealed that shared experiences during a therapeutic recreation camp were positive and connecting. Social capital was created and bridged at Recovery Camp through teamwork and prosocial attitudes. Gratitude has also been disclosed by participants for their shared positive experience.

Experiences of outdoor nature-based therapeutic recreation programs for persons with a mental illness: a qualitative systematic review

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.

Using Q-methodology to explore mental health nurses' knowledge and skills to use recovery-focused care to reduce aggression in acute mental health settings

When nurses practise recovery-focused care, they contribute positively to the consumer's mental health recovery journey and empower the person to be actively engaged in the management of their illness. While using recovery-focused care is endorsed in mental health policy, many health professionals remain uncertain about its application with consumers who have a risk for aggression during their admission to an acute mental health inpatient setting. This paper reports on Australian research using Q-methodology that examined the knowledge and skill components of recovery-focused care that nurses use to reduce the risk for aggression. The data from forty mental health nurses revealed five factors that when implemented as part of routine practice improved the recovery outcomes for consumers with risk of aggression in the acute mental health settings. These factors were as follows: (I) acknowledge the consumers' experience of hospitalization; (II) reassure consumers who are going through a difficult time; (III) interact to explore the impact of the consumer's negative lived experiences; (IV) support co-production to reduce triggers for aggression; and (V) encourage and support consumers to take ownership of their recovery journey. These findings provide nurses with a pragmatic approach to use recovery-focused care for consumers with risk for aggression and contribute positively to the consumers' personal recovery.

Experiences of outdoor nature-based therapeutic recreation programs for persons with a mental illness: a qualitative systematic review protocol

OBJECTIVE

The objective of this review is to identify, appraise and synthesize the best available qualitative evidence on participation in outdoor 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 indicates that therapeutic recreation programs can foster mental health recovery. It is necessary to understand how nature-based therapeutic recreation programs are beneficial from the perspective of persons living with mental illness.

INCLUSION CRITERIA

The review will consider studies that have collected qualitative data on the experiences and perspectives of adults with a mental illness of their participation in nature-based therapeutic recreation programs.

METHODS

The databases PsycINFO, CINAHL, MEDLINE, Scopus and Informit and unpublished sources in gray literature databases (Google) will be searched and reference lists will be checked to locate any additional studies. Studies published in English will be considered with no date limit. Two reviewers will independently assess the methodological quality of the studies which meet the inclusion criteria using the Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research. Data will be extracted by one reviewer using the standardized qualitative extraction tool and checked for accuracy by a second reviewer. The qualitative research findings will be pooled using JBI methodology. The JBI process of meta-aggregation will be used to identify categories and synthesized findings.

Student beliefs about their practice within a non-traditional mental health clinical placement

Therapeutic recreation programs utilize leisure to maximize a person's overall health and well-being. The focus of this study is a professional experience placement held within an outdoor recreation center involving student nurses and people with a lived experience of mental illness. The study aimed to explore student nurse's beliefs about their practice within the program setting. An ethnographic case study approach was used to focus on the development of student nurse practice in this setting. The analytic strategy derived the themes of the ethnographic case study, namely 'who's who', 'clinical contrast' and 'recreation as practice'. A non-traditional mental health clinical placement would seem to have the potential in providing a new set of skills and experiences to these future nurses that may complement the scope of recovery-orientated care. The therapeutic recreation program provided the student with an experience where they could develop therapeutic relationships with people a lived experience of mental illness.

A Path Analysis of Self-determination and Resiliency for Consumers Living with Mental Illness

Over the last three decades, resilience has become a key area in mental health research, practice and policy, due to its potential to positively impact on wellbeing and quality of life. Research findings have identified that resilience positively correlates with an individual's subjective sense of well-being and decreased mental health problems. Given the potential benefits of resilience for those living with mental illness, research should examine ways in which these individuals can increase their resilience levels. One such method of examining resilience in people living with mental illness is through a motivational lens. Using Self-Determination Theory (SDT) lens, this study examined the potential of a proposed model for understanding the correlation and influence of motivational constructs on the resilience of people with a lived experience of mental illness. Results illustrated a goodness-of-fit for the proposed model. Results can be used to illustrate the importance of motivation and self-determination for people living with mental illness.

Perceptions of professional role in community mental health nurses: The interplay of power relations between nurses and mentally ill individuals

Nurses' professional role perception is related to the quality and safety of care. Limited data exist regarding professional role perception in community mental health nurses (CMHNs). The aim of the present study was to investigate the living experience of Greek-Cypriot CMHNs of their professional role. A phenomenological approach based on Munhall's methodology was applied. According to purposive sampling, five Greek-Cypriot CMHNs participated, following informed consent. The interplay of power relations between participants and mentally ill individuals during CMHNs' house calls was revealed as the core theme contributing to the perception of their status within their professional role. Participants' perception of their status as visitors in patients' homes rather than authoritative figures, an image held within hospital mental health services, was deemed as the greatest challenge of their professional role. Moreover, the necessity for autonomous and rapid decision-making during home visits was described as an absolute prerequisite for professional effectiveness. Overall, the main themes were grouped as follows: professional role perceptions, perception of self within professional role, feelings and expectations about professional role. Non-power relations between participants and patients, along with efficacy, control and adequate clinical autonomy for effective professional practice were highlighted as major prerequisites during house calls. Interventions towards nurses' psychosocial and organizational empowerment, as well as strengthening patients' self-determination are proposed.

The use of phenomenology in mental health nursing research

BACKGROUND

Historically, mental health research has been strongly influenced by the underlying positivism of the quantitative paradigm. Quantitative research dominates scientific enquiry and contributes significantly to understanding our natural world. It has also greatly benefitted the medical model of healthcare. However, the more literary, silent, qualitative approach is gaining prominence in human sciences research, particularly mental healthcare research.

AIM

To examine the qualitative methodological assumptions of phenomenology to illustrate the benefits to mental health research of studying the experiences of people with mental illness.

DISCUSSION

Phenomenology is well positioned to ask how people with mental illness reflect on their experiences. Phenomenological research is congruent with the principles of contemporary mental healthcare, as person-centred care is favoured at all levels of mental healthcare, treatment, service and research.

CONCLUSION

Phenomenology is a highly appropriate and suitable methodology for mental health research, given it includes people's experiences and enables silent voices to be heard.

IMPLICATIONS FOR PRACTICE

This overview of the development of phenomenology informs researchers new to phenomenological enquiry.

The experience of Greek-Cypriot individuals living with mental illness: preliminary results of a phenomenological study

BACKGROUND

Research evidence shows that healthcare professionals do not fully comprehend the difficulty involved in problems faced by people living with severe mental illness (SMI). As a result, mental health service consumers do not show confidence in the healthcare system and healthcare professionals, a problem related to the phenomenon of adherence to therapy. Moreover, the issue of unmet needs in treating individuals living with SMI is relared to their quality of life in a negative way.

METHODS

A qualitative methodological approach based on the methodology of van Manen phenomenology was employed through a purposive sampling of ten people living with SMI. The aim was to explore their perceptions and interpretations regarding: a) their illness, b) their self-image throughout the illness, c) the social implications following their illness, and d) the quality of the therapeutic relationship with mental health nurses. Participants were recruited from a community mental health service in a Greek-Cypriot urban city. Data were collected through personal, semi-structured interviews.

RESULTS

Several main themes were identified through the narratives of all ten participants. Main themes included: a) The meaning of mental illness, b) The different phases of the illness in time, c) The perception of the self during the illness, d) Perceptions about the effectiveness of pharmacotherapy, e) Social and personal consequences for participants following the diagnosis of mental illness, f) Participants' perceptions regarding mental health professionals and services and g) The therapeutic effect of the research interview on the participants.

CONCLUSIONS

The present study provides data for the enhancement of the empathic understanding of healthcare professionals regarding the concerns and particular needs of individuals living with SMI, as well as the formation of targeted psychosocial interventions based on these needs. Overall, the present data illuminate the necessity for the reconstruction of the provided mental healthcare in Cyprus into a more recovery- oriented approach in order to address personal identity and self-determination issues and the way these are related to management of pharmacotherapy. Qualitative studies aiming to further explore issues of self-identity during ill health and its association with adherence to therapy, resilience and self-determination, are also proposed.