1
|
Lewin CDC, Leamy M, Palmer L. How do people conceptualize self-harm recovery and what helps in adolescence, young and middle adulthood? A qualitative meta-synthesis. J Clin Psychol 2024; 80:39-64. [PMID: 37610315 DOI: 10.1002/jclp.23588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/08/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Self-harm can be understood as any behavior individuals use to harm themselves, irrespective of motive. Evidence has extensively examined the epidemiology and function of self-harm to the individual, but less is known about the subjective processes underpinning recovery. Such insights could inform therapeutic interventions to better support individuals. The present aim was to synthesize qualitative themes from eligible literature to identify how adolescents, young adults, and those in middle adulthood conceptualize self-harm recovery and the factors impacting this process. METHODS Eleven studies were identified from a systematic search of five electronic research databases: PsycINFO, Embase, Medline, Global Health, and CINAHL. Studies were critically appraised using an adapted Critical Appraisal Skills Program tool for qualitative research. A meta-synthesis was conducted using reflexive thematic analysis to generate themes across the included studies. RESULTS Themes depicted recovery as a multidimensional, nonlinear, and subjective process, characterized by a "push and pull" between states of (re-)engagement and cessation/reduction. Transition between these states was influenced by intrapersonal and interpersonal factors which were embedded in a wider milieu of the meaning of self-harm to the individual. CONCLUSION Contemporary ideas of symptom eradication as the only marker of complete recovery may hinder individuals in the long-term, presenting an obstacle both to quality of life and therapeutic progress. Movement away from self-harm recovery as a uniform or singular phenomenon could enhance person-centered care.
Collapse
Affiliation(s)
- Caroline da Cunha Lewin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mary Leamy
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Laura Palmer
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
2
|
Moore T, Zeeman L. A psychosocial exploration of resistances to service user involvement in United Kingdom National Health Service (NHS) mental health services. Health (London) 2023; 27:1096-1114. [PMID: 35674318 DOI: 10.1177/13634593221099103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Policy promotes the active participation of those with lived experience of mental health difficulties in UK NHS mental health services, from the level of collaborative care-planning to service delivery, leadership and development. However, research indicates different forms of resistance to the implementation of such service user involvement. This article reports the findings of a qualitative, interview-based study which used Foucauldian discourse analysis and psychoanalytic theory to understand how resistances are produced through the interplay of clinical mental health professionals' subjectivity and their organisational context. Service user involvement was found to highlight conflicts within clinicians' roles. Central to this conflict was an ambivalent relationship to the power associated with these roles. Power could protect professionals from work related stresses, but could also be used to dominate, silence and coerce service users in ways that conflicted with the core function of providing care. Whilst important, raising awareness of such conflict will arouse discomfort and resistance where psychological defences are challenged. A parallel is drawn with psychotherapeutic change, in which resistance must be understood and worked with as part of meaningful change.
Collapse
|
3
|
Hardy J, Parker S, Hughes I, Anand M. Factors affecting knowledge of recovery-oriented practice amongst mental health nursing and medical staff working on acute mental health inpatient units. Int J Ment Health Nurs 2022; 31:1228-1238. [PMID: 35821364 DOI: 10.1111/inm.13032] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
Over recent decades, the shift to recovery-oriented practice has been central to mental health policy. Despite this emphasis, mental health services can struggle to meet this expectation. This study explores the knowledge and attitudes in relation to the recovery-oriented practice of clinical staff working at an Australian acute inpatient mental health unit. The Recovery Knowledge Inventory (RKI) is a widely used self-report tool that assesses mental health professionals' knowledge and attitudes towards recovery; higher scores indicate higher levels of recovery knowledge and attitudes. Seventy-four staff members (44 nursing staff and 30 medical staff) completed the RKI via an online survey. The study has been reported according to the STROBE checklist for cross-sectional studies. The relationships between the RKI scores and a range of variables were considered using inferential statistics, including multivariate regression. Medical staff had higher mean RKI scores than nursing staff, although this did not meet the predefined threshold for a clinically significant difference. More years of mental health experience were associated with increased mean RKI scores for medical staff. This Australian inpatient staff cohort demonstrated higher mean RKI scores than have been observed in recent international studies of mental health professions. However, the recovery knowledge and attitude levels were disappointingly similar to those shown in earlier Australian research completed over a decade ago. Efforts are needed to further enhance the recovery knowledge of clinicians working in mental health inpatient units.
Collapse
Affiliation(s)
- Jonathan Hardy
- Mental Health and Specialist Services, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Stephen Parker
- School of Medicine, Griffith University, Nathan, Queensland, Australia.,The Prince Charles Hospital, Metro North Addiction and Mental Health Service, Chermside, Queensland, Australia
| | - Ian Hughes
- Office for Research Governance and Development, Gold Coast Health, Southport, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Muthur Anand
- Psychiatrist, Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
4
|
Hristodoulidis D, Munro I, Brooks C. Exploration of personal recovery-oriented care on an acute mental health unit. Collegian 2022. [DOI: 10.1016/j.colegn.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
5
|
Williams A, Fossey E, Farhall J, Foley F, Thomas N. Impact of Jointly Using an e-Mental Health Resource (Self-Management And Recovery Technology) on Interactions Between Service Users Experiencing Severe Mental Illness and Community Mental Health Workers: Grounded Theory Study. JMIR Ment Health 2021; 8:e25998. [PMID: 34132647 PMCID: PMC8277385 DOI: 10.2196/25998] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/04/2021] [Accepted: 04/16/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND e-Mental health resources are increasingly available for people who experience severe mental illness, including those who are users of community mental health services. However, the potential for service users (SUs) living with severe mental illness to use e-mental health resources together with their community mental health workers (MHWs) has received little attention. OBJECTIVE This study aims to identify how jointly using an interactive website called Self-Management And Recovery Technology (SMART) in a community mental health context influenced therapeutic processes and interactions between SUs and MHWs from their perspective. METHODS We conducted a qualitative study using a constructivist grounded theory methodology. Data were collected through individual semistructured interviews with 37 SUs and 15 MHWs who used the SMART website together for 2 to 6 months. Data analysis involved iterative phases of coding, constant comparison, memo writing, theoretical sampling, and consultation with stakeholders to support the study's credibility. RESULTS A substantive grounded theory, discovering ways to keep life on track, was developed, which portrays a shared discovery process arising from the SU-worker-SMART website interactions. The discovery process included choosing to use the website, revealing SUs' experiences, exploring these experiences, and gaining new perspectives on how SUs did and could keep their lives on track. SUs and MHWs perceived that their three-way interactions were enjoyable, beneficial, and recovery focused when using the website together. They experienced the shared discovery process as relationship building-their interactions when using the website together were more engaging and equal. CONCLUSIONS Jointly using an e-mental health resource elicited recovery-oriented interactions and processes between SUs and MHWs that strengthened their therapeutic relationship in real-world community mental health services. Further work to develop and integrate this novel use of e-mental health in community mental health practice is warranted.
Collapse
Affiliation(s)
- Anne Williams
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia.,Living with a Disability Research Centre, La Trobe University, Melbourne, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia.,NorthWestern Mental Health, Melbourne Health, Melbourne, Australia
| | - Fiona Foley
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia
| |
Collapse
|
6
|
Chang YC, Chang LH, Hsu ST, Huang MW. Professional perspectives on providing recovery-oriented services in Taiwan: a qualitative study. BMC Psychiatry 2021; 21:154. [PMID: 33726694 PMCID: PMC7962288 DOI: 10.1186/s12888-021-03152-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/04/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The experiences of professionals in well-established recovery-oriented programs are valuable for professionals in similar practice settings. This study explored professionals' experiences with providing recovery-oriented services in community psychiatric rehabilitation organizations. METHODS Semi-structured interviews were conducted with 14 professionals from five recovery-oriented psychiatric rehabilitation organizations in Taiwan. The interviews were recorded and transcribed verbatim. Thematic analysis was used for the qualitative data analysis. RESULTS The analyses documented three main themes with 13 subthemes. Recovery-oriented service implementation included seven subthemes: Enabling clients to set their own goals and make decisions, using a strengths-based approach, establishing partnerships with clients, improving individuals' self-acceptance, encouraging community participation, seeking family, peer, and organizational support, and building team collaboration. Problems with implementing recovery-oriented services included limited policy and organizational support, a lack of understanding of recovery among professionals, stigma, clients' lack of motivation or self-confidence in their own ability to achieve recovery, and passive or overprotective family members. Strategies to resolve implementation problems included policy changes and organizational support, improving the recovery competence and confidence of professionals, and family and public education. CONCLUSIONS To date, this is the first known study examining the perspectives of mental health professionals who have experience implementing recovery-oriented services in Asia. The participants identified family collaboration, anti-stigma efforts, and changes in policy and attitudes as critical to successful implementation and delivery of recovery-oriented services.
Collapse
Affiliation(s)
- Yen-Ching Chang
- grid.64523.360000 0004 0532 3255Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ling-Hui Chang
- grid.64523.360000 0004 0532 3255Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan ,grid.64523.360000 0004 0532 3255Institute of Allied Health Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Su-Ting Hsu
- grid.414813.b0000 0004 0582 5722Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Meng-Wen Huang
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan.
| |
Collapse
|
7
|
Markham S. The Totalising Nature of Secure and Forensic Mental Health Services in England and Wales. Front Psychiatry 2021; 12:789089. [PMID: 34819890 PMCID: PMC8606637 DOI: 10.3389/fpsyt.2021.789089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022] Open
Abstract
This evidence-based opinion piece explores the totalising risk averse nature of secure and forensic mental health services and associated iatrogenic harms in England and Wales. Drawing on the research literature I consider the various influences, both external and internal which impact on the provision of such services and how both the therapeutic alliance and recovery potential for patients may be improved. Especial attention is paid to the deployment of restrictive practise, practitioner attitudes, the potential for non-thinking, and how these may impact on decision-making and the care and treatment of mentally disordered offenders.
Collapse
Affiliation(s)
- Sarah Markham
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
8
|
Gyamfi N, Bhullar N, Islam MS, Usher K. Knowledge and attitudes of mental health professionals and students regarding recovery: A systematic review. Int J Ment Health Nurs 2020; 29:322-347. [PMID: 32162835 DOI: 10.1111/inm.12712] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 02/06/2023]
Abstract
This review was conducted to synthesize and critically appraise the literature on knowledge, attitudes, understanding, perceptions, and expectations of mental health professionals (MHPs) and mental health professional (MHP) students' regarding recovery. A systematic search in Scopus, CINAHL, PsycINFO, Web of Science, Medline, and Embase as well as Google scholar and web-based repositories was conducted. The searches were conducted using a combination of key terms: "mental health professionals", "students", 'knowledge', "understanding", "perception" "attitude", "expectation", "recovery". After screening and quality assessment, the review included 29 studies (18 quantitative, 8 qualitative, and 3 mixed-method studies) published in English, from January 2006 to June 2019, and was analysed systematically using a mixed-method synthesis. The findings revealed that there is increasing evidence (especially among MHPs) of knowledge, attitudes, understanding, perceptions, and expectations regarding recovery. However, there are disparities in how MHPs perceive and understand recovery. While some understood it to mean a personal process, others explained it as a clinical process. In addition, there was limited knowledge among the MHPs and MHP students regarding the nonlinearity nature of the recovery process and expectations regarding recovery. The implications from these findings are the need for more in-service training for MHPs, and examination of the curriculum used to educate MHP students. In particular, they should be sufficiently informed about the nonlinearity nature of the recovery process and how to develop hopeful and realistic expectations for consumers throughout the recovery process. The review was preregistered with PROSPERO (Registration No: CRD42019136543).
Collapse
Affiliation(s)
- Naomi Gyamfi
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Navjot Bhullar
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Md Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Kim Usher
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| |
Collapse
|
9
|
Chiba R, Umeda M, Goto K, Miyamoto Y, Yamaguchi S. Factors related to recovery knowledge and attitudes among professionals in mental health in Japan. Jpn J Nurs Sci 2019; 17:e12295. [PMID: 31454176 DOI: 10.1111/jjns.12295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/23/2019] [Accepted: 07/12/2019] [Indexed: 11/29/2022]
Abstract
AIM To explore what factors may influence recovery knowledge and attitudes among professionals in mental health. METHODS We utilized an existing dataset from a study that surveyed 331 subjects among 475 eligible professionals. We used data from 289 participants without missing values for the analyses (valid response rate = 60.8%). The questionnaire included three psychometrically tested scales: (a) Recovery Knowledge Inventory (RKI); (b) Recovery Attitudes Questionnaire (RAQ); and (c) Internal Work Motivation, as well as other variables. Mean-based comparisons of the RKI and RAQ scores between several subgroups were examined. We also examined the correlation between RKI and RAQ scores and the continuous variables. Multiple linear regression was implemented to examine the simultaneous effects of the factors on RKI and RAQ scores. The mean age of participants was 39.9 years and 69.2% were female and 44.0% were nursing professionals. RESULTS Multiple linear regression analyses showed that the internal work motivation and the experience of discharging patients after a lengthy hospitalization were significantly and positively associated with recovery attitude. Working at community facilities and being young were significantly and weakly correlated with recovery knowledge. The experience of participation in self-help groups exhibited positive relationships with RKI and RAQ scores, while education exhibited positive but weak relationships with RKI and RAQ scores. No significant relationship was observed in the regression analyses. CONCLUSIONS Internal work motivation, the experience of discharging patients after a lengthy hospitalization, working at community facilities, and being young may positively contribute to better recovery knowledge and attitudes. Future research using a longitudinal design will explore other factors.
Collapse
Affiliation(s)
- Rie Chiba
- Department of Nursing, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Maki Umeda
- Research Institute of Nursing Care for People and Community, University of Hyogo, Akashi, Japan
| | - Kyohei Goto
- Faculty of Nursing, Kyoritsu Women's University, Chiyoda, Japan
| | - Yuki Miyamoto
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
| | - Sosei Yamaguchi
- Department of Community Mental Health & Law, Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| |
Collapse
|
10
|
Trankle SA, Reath J. Partners in Recovery: an early phase evaluation of an Australian mental health initiative using program logic and thematic analysis. BMC Health Serv Res 2019; 19:524. [PMID: 31349841 PMCID: PMC6660922 DOI: 10.1186/s12913-019-4360-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 07/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background Mental illness is a leading cause of illness and disability and around 75% of people suffering mental illness do not have access to adequate care. In Australia, nearly half the population experiences mental illness at some point in their life. The Australian Government developed a National program called Partners in Recovery (PIR) to support those with severe and persistent mental illness. The program was implemented through 48 consortia across Australia. One of these was led by the Nepean Blue Mountains Medicare Local who adapted the program according to its specific local needs. Methods We conducted an early evaluation of the PIR program in Nepean Blue Mountains (NBMPIR) using a program logic model (PLM) to frame the evaluation and complemented this with an additional thematic analysis. Participants (n = 73) included clients and carers, program management and staff of the Consortium and other partners and agencies, and clinical, allied health, and other service providers. Our PLM utilised multiple data sources that included document review, open and closed survey questions, and semi-structured interviews. Quantitative data received a descriptive analysis and qualitative data was analysed both in alignment with the PLM framework and inductively. Results We aligned our results to PLM domains of inputs, activities, outputs, outcomes and impacts. The NBMPIR consortium implemented a recovery approach and provided greater access to services by enhancing healthcare provider partnerships. Our thematic analysis further described five key themes of collaboration; communication; functioning of PIR; structural/organisational challenges; and understanding of PIR approaches. Facilitators and barriers to the NBMPIR program centred on the alignment of vision and purpose; building an efficient system; getting the message out and sharing information; understanding roles and support and training of staff; building capacity and systems change; addressing service gaps; and engaging peers. Conclusions Our study provided helpful insights into the coordinated management of complex mental illness. The NBMPIR’s focus on partnerships and governance, service coordination, and systems change has relevance for others engaged in this work. This PLM effectively mapped the program, including its processes and resources, and is a useful framework providing a baseline for future evaluations. Full report available at https://researchdirect.westernsydney.edu.au/islandora/object/uws:33977/ Electronic supplementary material The online version of this article (10.1186/s12913-019-4360-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Steven A Trankle
- School of Medicine, Department of General Practice, Western Sydney University, Campbelltown Campus, Building 30.3.18, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Jennifer Reath
- School of Medicine, Department of General Practice, Western Sydney University, Campbelltown Campus, Building 30.3.18, Locked Bag 1797, Penrith, NSW, 2751, Australia
| |
Collapse
|
11
|
East L, Dorozenko KP, Martin R. The construction of people in suicide prevention documents. DEATH STUDIES 2019; 45:182-190. [PMID: 31204901 DOI: 10.1080/07481187.2019.1626938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Suicide is a significant issue worldwide and despite comprehensive prevention activities, suicide stigma remains. To explore this issue, we used critical discourse analysis to examine how Australian suicide prevention documents (n = 8) constructed people living with thoughts of suicide. We found that risk and biomedical discourses dominated, with people experiencing suicide ideation constructed as dangerous, different, lacking coping skills, and burdensome. We propose that future suicide prevention activities address potentially stigmatizing language, broaden support and advocacy options, and meaningfully include people with lived experience of suicidal ideation or behavior in the development of policy and interventions.
Collapse
Affiliation(s)
- Lani East
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Kate P Dorozenko
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Robyn Martin
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| |
Collapse
|
12
|
Felton A, Repper J, Avis M. Therapeutic relationships, risk, and mental health practice. Int J Ment Health Nurs 2018; 27:1137-1148. [PMID: 29280259 DOI: 10.1111/inm.12430] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 11/27/2022]
Abstract
Despite significant changes to mental health services, nurses remain the professional group most likely to be in close contact with people who experience mental health problems. A core part of the contemporary identity of the mental health nurse is one who is able to provide acceptance and support for an individual's recovery through the therapeutic relationship. Yet there have always been some tensions with the mental health nursing role that can appear to challenge this relational focus. An increasing prominence of risk management in mental health care can position mental health nurses as responsible for enacting restrictions and has reignited interest in the role of mental health professionals in social control. This paper reports on one part of a multiple case study, which aimed to explore mental health professionals' experiences of such tensions in the context of decision-making. Interviews and observations were undertaken in acute ward and assertive outreach settings. Findings suggested that risk dominated decision-making to such an extent it defined the way service users were understood and treated. A distant relationship between professionals and service users helped to create and maintain this situation. There needs to be a greater focus on service users' subjective experiences in the decision-making process to challenge the definition of people with mental health problems as risky.
Collapse
Affiliation(s)
- Anne Felton
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Innovation Park, Nottingham, UK
| | | | - Mark Avis
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Innovation Park, Nottingham, UK
| |
Collapse
|
13
|
Reed NP, Josephsson S, Alsaker S. Community mental health work: Negotiating support of users' recovery. Int J Ment Health Nurs 2018. [PMID: 28646546 DOI: 10.1111/inm.12368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mental health services have changed over the past decades through an increased emphasis on deinstitutionalization and normalization, and with recovery processes situated in everyday life as a new locus of support. These changes have led to a need for new knowledge and methods concerning the provision of community mental health services. The aim of the present study was to explore how community mental health workers provide support to users, by investigating professionals' own narratives of how they work. Seven community mental health workers participated in narrative interviews, which were subject to a qualitative, interpretive analysis. A primary finding was that community mental health workers provide flexible and individually-adjusted support through engaging in negotiations with users, management, and others. Our findings show both opportunities and challenges of negotiating support, raising the following question for discussion: How and when are negotiations a valuable way for professionals and users to collaborate?
Collapse
Affiliation(s)
- Nina Petersen Reed
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Staffan Josephsson
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sissel Alsaker
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
14
|
Changes in Mental Health Providers’ Recovery Attitudes and Strengths Model Implementation Following Training and Supervision. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-9885-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
15
|
Chiba R, Umeda M, Goto K, Miyamoto Y, Yamaguchi S, Kawakami N. The property of the Japanese version of the Recovery Knowledge Inventory (RKI) among mental health service providers: a cross sectional study. Int J Ment Health Syst 2017; 11:71. [PMID: 29299055 PMCID: PMC5745615 DOI: 10.1186/s13033-017-0178-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022] Open
Abstract
Background The Recovery Knowledge Inventory (RKI) is one of the influential scales to assess knowledge and attitude toward recovery-oriented practices among mental health service providers. In the present study, we aimed to develop a Japanese version of RKI and examine the validity and reliability. Methods We translated RKI into Japanese by reference to the guidelines for translating and adapting psychometric scales. A cross-sectional questionnaire survey was conducted with mental health service providers. Of a total of 475 eligible professionals, we used data from the 299 participants without missing value for the analyses (valid response rate = 62.9%). The questionnaire included Japanese RKI, Recovery Attitudes Questionnaire, The positive attitudes scale, and Japanese-language version of the Social Distance Scale. To examine the factorial validity of RKI, explanatory factor analysis and confirmatory factor analysis was employed. Convergent validity was assessed by calculating Pearson’s correlation coefficients between the total RKI score and the scores for the other three scales. We also calculated Cronbach’s α coefficients for the total score and for each domain of RKI to assess internal consistency reliability. Results The participants’ mean age was 40.4 years and 30.4% were men. 20-item RKI did not provide any adequate or interpretable factor solutions at any number of factors by EFAs. Thus four items (#1, 4, 5, and 13) were subsequently eliminated in stages, then 16-item RKI was employed as a consequence for further analyses. EFA with four factor structures yielded marginally interpretable constitution. Each factor represented the knowledge regarding psychiatric symptoms and recovery; knowledge about the recovery process; the understanding of what is important for recovery; and the understanding of the challenges and responsibility in recovery, respectively. Subsequent CFA suggested good fit to the data. Good convergent validity and understandable internal consistency reliability were also observed. Conclusions The Japanese 16-item RKI revealed reasonable factorial validity, good convergent validity, and understandable internal consistency reliability among mental health professionals. Japanese cultural settings seemed to influence the four-factor structure in the present study. It can be used for future study in Japan, while future large-scale research is required to ensure robust verification.
Collapse
Affiliation(s)
- Rie Chiba
- Research Institute of Nursing Care for People and Community, University of Hyogo, 13-71 Kitaoji-cho, Akashi, Hyogo 673-8588 Japan
| | - Maki Umeda
- Department of Public Health Nursing, Graduate School of Nursing, St Luke's International University, 10-1, Akashi-cho, Chuo-ku, Tokyo, 104-0044 Japan
| | - Kyohei Goto
- Tokyo Musashino Hospital, 4-11-11, Komone, Itabashi-ku, Tokyo, 173-0037 Japan
| | - Yuki Miyamoto
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Sosei Yamaguchi
- Department of Psychiatric Rehabilitation, Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8553 Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| |
Collapse
|
16
|
Klevan T, Karlsson B, Ruud T. “At the extremities of life” – Service user experiences of helpful help in mental health crises. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2017. [DOI: 10.1080/15487768.2017.1302370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
17
|
Geyt GL, Awenat Y, Tai S, Haddock G. Personal Accounts of Discontinuing Neuroleptic Medication for Psychosis. QUALITATIVE HEALTH RESEARCH 2017; 27:559-572. [PMID: 26984364 DOI: 10.1177/1049732316634047] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We conducted this study to explore personal accounts of making choices about taking medication prescribed for the treatment of psychosis (neuroleptics). There are costs and benefits associated with continuing and discontinuing neuroleptics. Service users frequently discontinue neuroleptics; therefore, we specifically considered these decisions. We used a grounded theory approach to analyze transcripts from interviews with 12 participants. We present a preliminary grounded theory of the processes involved in making choices about neuroleptic medication. We identified three tasks as important in mediating participants' choices: (a) forming a personal theory of the need for, and acceptability of taking, neuroleptic medication; (b) negotiating the challenges of forming alliances with others; and (c) weaving a safety net to safeguard well-being. Progress in the tasks reflected a developmental trajectory of becoming an expert over time and was influenced by systemic factors. Our findings highlight the importance of developing resources for staff to facilitate service user choice.
Collapse
Affiliation(s)
- Gabrielle Le Geyt
- 1 University of Manchester, Manchester, UK
- 2 North Staffordshire Combined Healthcare NHS Trust, Newcastle, UK
| | | | - Sara Tai
- 1 University of Manchester, Manchester, UK
| | | |
Collapse
|
18
|
Eikmeier G, Kieser LD, Paap M, Utschakowski J, Lacroix A. [Reorganising a department of psychiatry according to recovery principles: A pilot study with mixed-method design]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 120:16-20. [PMID: 28284362 DOI: 10.1016/j.zefq.2016.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 11/26/2016] [Accepted: 11/29/2016] [Indexed: 11/25/2022]
Abstract
Considering the impact of mental disorders, control and evaluation of treatment programs are important topics. Here, we report on a pilot study composed of a qualitative and a quantitative part to monitor the recovery-oriented reorganisation of a psychiatric department. For this purpose 13 and 15, respectively, stakeholders of the change management were interviewed between 2012 (T1) and 2014 (T2). Moreover, patients and staff were asked to complete a German version of the Recovery Self Assessment (RSA) questionnaire. The main result of the first investigation (T1) was that nursing staff fostered the projected transformation, while physicians and psychologists focused on risk management and worried about losing their role. The patients' and staff's questionnaire ratings of the recovery orientation of the department were surprisingly positive. However, most of the staff members were not correctly informed about patients' rights to see their files. In the second investigation (T2), many of the interviewees were under the impression that either their participation had decreased and/or that the reorganisation, from their point of view, had already been completed. Nevertheless, staff assessed the recovery orientation of their work as significantly improved, while the patients' evaluation of the recovery orientation of the department was unchanged. Concerning single items of the RSA questionnaire, the support of occupational rehabilitation and aspects of participation were rated worst. Methodological problems and possible implications of the results are discussed.
Collapse
Affiliation(s)
- Gisbert Eikmeier
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Klinikum Bremerhaven Reinkenheide, gGmbH, Bremerhaven, Deutschland.
| | | | | | - Jörg Utschakowski
- Die Senatorin für Wissenschaft, Gesundheit und Verbraucherschutz, Bremen, Deutschland
| | - Angelika Lacroix
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Klinikum Bremerhaven Reinkenheide, gGmbH, Bremerhaven, Deutschland
| |
Collapse
|
19
|
Coffey M, Cohen R, Faulkner A, Hannigan B, Simpson A, Barlow S. Ordinary risks and accepted fictions: how contrasting and competing priorities work in risk assessment and mental health care planning. Health Expect 2016; 20:471-483. [PMID: 27312732 PMCID: PMC5433531 DOI: 10.1111/hex.12474] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 11/27/2022] Open
Abstract
Background Communication and information sharing are considered crucial to recovery‐focused mental health services. Effective mental health care planning and coordination includes assessment and management of risk and safety. Objective Using data from our cross‐national mixed‐method study of care planning and coordination, we examined what patients, family members and workers say about risk assessment and management and explored the contents of care plans. Design Thematic analysis of qualitative research interviews (n = 117) with patients, family members and workers, across four English and two Welsh National Health Service sites. Care plans were reviewed (n = 33) using a structured template. Findings Participants have contrasting priorities in relation to risk. Patients see benefit in discussions about risk, but cast the process as a worker priority that may lead to loss of liberty. Relationships with workers are key to family members and patients; however, worker claims of involving people in the care planning process do not extend to risk assessment and management procedures for fear of causing upset. Workers locate risk as coming from the person rather than social or environmental factors, are risk averse and appear to prioritize the procedural aspects of assessment. Conclusions Despite limitations, risk assessment is treated as legitimate work by professionals. Risk assessment practice operates as a type of fiction in which poor predictive ability and fear of consequences are accepted in the interests of normative certainty by all parties. As a consequence, risk adverse options are encouraged by workers and patients steered away from opportunities for ordinary risks thereby hindering the mobilization of their strengths and abilities.
Collapse
|
20
|
Stickley T, Higgins A, Meade O, Sitvast J, Doyle L, Ellilä H, Jormfeldt H, Keogh B, Lahti M, Skärsäter I, Vuokila-Oikkonen P, Kilkku N. From the rhetoric to the real: A critical review of how the concepts of recovery and social inclusion may inform mental health nurse advanced level curricula - The eMenthe project. NURSE EDUCATION TODAY 2016; 37:155-163. [PMID: 26687142 DOI: 10.1016/j.nedt.2015.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 09/29/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES This critical review addresses the question of how the concepts of recovery and social inclusion may inform mental health nurse education curricula at Master's level in order to bring about significant and positive change to practice. DESIGN This is a literature-based critical review incorporating a rapid review. It has been said that if done well, this approach can be highly relevant to health care studies and social interventions, and has substantial claims to be as rigorous and enlightening as other, more conventional approaches to literature (Rolfe, 2008). DATA SOURCES In this review, we have accessed contemporary literature directly related to the concepts of recovery and social inclusion in mental health. REVIEW METHODS We have firstly surveyed the international literature directly related to the concepts of recovery and social inclusion in mental health and used the concept of emotional intelligence to help consider educational outcomes in terms of the required knowledge, skills and attitudes needed to promote these values-based approaches in practice. RESULTS A number of themes have been identified that lend themselves to educational application. International frameworks exist that provide some basis for the developments of recovery and social inclusion approaches in mental health practice, however the review identifies specific areas for future development. CONCLUSIONS This is the first article that attempts to scope the knowledge, attitudes and skills required to deliver education for Master's level mental health nurses based upon the principles of recovery and social inclusion. Emotional intelligence theory may help to identify desired outcomes especially in terms of attitudinal development to promote the philosophy of recovery and social inclusive approaches in advanced practice. Whilst recovery is becoming enshrined in policy, there is a need in higher education to ensure that mental health nurse leaders are able to discern the difference between the rhetoric and the reality.
Collapse
Affiliation(s)
- Theodore Stickley
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Institute of Mental Health Building, Triumph Road, Innovation Park, Nottingham, NG7 2TU, United Kingdom.
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | - Oonagh Meade
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
| | - Jan Sitvast
- University of Applied Sciences HU, Bolognalaan 101, 3584CJ Utrecht, The Netherlands.
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | - Heikki Ellilä
- Dep. Health and Wellbeing, Turku University of Applied Sciences, Ruiskatu 2, 20720 Turku, Finland.
| | | | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin 2, Ireland.
| | - Mari Lahti
- University of Applied Science Turku, Ruiskatu 8, 20810 Turku, Finland.
| | | | | | - Nina Kilkku
- Tampere University of Applied Sciences, Kuntokatu 3, 33520 Tampere, Finland.
| |
Collapse
|
21
|
Le Boutillier C, Chevalier A, Lawrence V, Leamy M, Bird VJ, Macpherson R, Williams J, Slade M. Staff understanding of recovery-orientated mental health practice: a systematic review and narrative synthesis. Implement Sci 2015; 10:87. [PMID: 26059397 PMCID: PMC4464128 DOI: 10.1186/s13012-015-0275-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health policy is for staff to transform their practice towards a recovery orientation. Staff understanding of recovery-orientated practice will influence the implementation of this policy. The aim of this study was to conduct a systematic review and narrative synthesis of empirical studies identifying clinician and manager conceptualisations of recovery-orientated practice. METHODS A systematic review of empirical primary research was conducted. Data sources were online databases (n = 8), journal table of contents (n = 5), internet, expert consultation (n = 13), reference lists of included studies and references to included studies. Narrative synthesis was used to integrate the findings. RESULTS A total of 10,125 studies were screened, 245 full papers were retrieved, and 22 were included (participants, n = 1163). The following three conceptualisations of recovery-orientated practice were identified: clinical recovery, personal recovery and service-defined recovery. Service-defined recovery is a new conceptualisation which translates recovery into practice according to the goals and financial needs of the organisation. CONCLUSIONS Organisational priorities influence staff understanding of recovery support. This influence is leading to the emergence of an additional meaning of recovery. The impact of service-led approaches to operationalising recovery-orientated practice has not been evaluated. TRIAL REGISTRATION The protocol for the review was pre-registered (PROSPERO 2013: CRD42013005942 ).
Collapse
Affiliation(s)
- Clair Le Boutillier
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Agnes Chevalier
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Vanessa Lawrence
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Mary Leamy
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Victoria J Bird
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | | | - Julie Williams
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Mike Slade
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| |
Collapse
|
22
|
Leitan ND, Michalak EE, Berk L, Berk M, Murray G. Optimizing delivery of recovery-oriented online self-management strategies for bipolar disorder: a review. Bipolar Disord 2015; 17:115-27. [PMID: 25238632 DOI: 10.1111/bdi.12258] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 06/27/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Self-management is emerging as a viable alternative to difficult-to-access psychosocial treatments for bipolar disorder (BD), and has particular relevance to recovery-related goals around empowerment and personal meaning. This review examines data and theory on BD self-management from a recovery-oriented perspective, with a particular focus on optimizing low-intensity delivery of self-management tools via the web. METHODS A critical evaluation of various literatures was undertaken. Literatures on recovery, online platforms, and self-management in mental health and BD are reviewed. RESULTS The literature suggests that the self-management approach aligns with the recovery framework. However, studies have identified a number of potential barriers to the utilization of self-management programs for BD and it has been suggested that utilizing an online environment may be an effective way to surmount many of these barriers. CONCLUSIONS Online self-management programs for BD are rapidly developing, and in parallel the recovery perspective is becoming the dominant paradigm for mental health services worldwide, so research is urgently required to assess the efficacy and safety of optimization methods such as professional and/or peer support, tailoring and the development of 'online communities'.
Collapse
Affiliation(s)
- Nuwan D Leitan
- Faculty of Life and Social Sciences, Swinburne University of Technology, Hawthorn, Vic., Australia
| | | | | | | | | |
Collapse
|
23
|
Abstract
BACKGROUND Harm in mental health has traditionally been viewed as "unambiguous" and measured in terms of suicide, self-harm, self-neglect and violence. In order to develop an organisational patient safety strategy, one Trust engaged with service users, carers and senior clinicians and managers in order to understand how they define harm. AIM To explore the meaning of harm in a mental health and learning disabilities setting. METHOD This paper describes the outcome of service improvement work with service users, carers, senior clinicians and managers at one Trust to determine what harm meant to them. RESULTS Harm is a concept which is broader than elements currently seen within organisational patient safety metrics and clinical risk assessments. CONCLUSIONS Taking into account the diverse feedback received about what constitutes harm, a more inclusive definition emerges which could be incorporated into a new framework for risk management, balancing risk of harms across multiple dimensions. This approach has the potential to bring together consideration of the risk and recovery agendas.
Collapse
Affiliation(s)
- Michael J Sykes
- Tees, Esk and Wear Valleys NHS Foundation Trust, Mental Health Research Group , Stockton-on-Tees , UK and
| | | | | |
Collapse
|