Consumer-operated service program members' explanatory models of mental illness and recovery

Physicians' Explanatory Models of Pediatric Inflammatory Bowel Disease: A Qualitative Interview Study

Explanatory models are culturally informed representations of illness that convey understandings of the etiology and expected course of disease. Substantial research has explored lay explanatory models, but examining physicians' clinical explanatory models can also provide insight into patients' understandings of illness because physicians are a foundational source of authoritative knowledge that shapes lay concepts of illness and disease. This study characterized the explanatory models used by pediatric gastroenterologists when explaining inflammatory bowel disease (IBD) to children. We conducted semi-structured qualitative interviews with 20 pediatric gastroenterologists across the United States about their clinical communication and explanatory models. We identified two primary explanatory models used to describe immune dysregulation in pediatric IBD: the defense and protection model, which characterizes the immune system as an army that erroneously sees the body as "non-self" and attacks it; and the switch model, which conceptualizes treatment as activating a switch that turns off a faulty immune response. We also identified two models used by some physicians to describe inflammation: the scratch and scrape model, which compares IBD inflammation to scratches or scrapes on the skin; and the bonfire model, which compares inflammation to a fire in need of extinguishing. While the use of militaristic metaphors is pervasive in medicine, describing autoimmunity as a battle against the self may lead children to perceive their body as the enemy. This may be compounded by describing the immune system as "confused" while noting its ongoing protective function. Use of these explanatory models may nevertheless improve patient disease-related knowledge.

Narrative research on mental health recovery: two sister paradigms

BACKGROUND

Despite the breadth of narrative studies on individuals with severe mental illness, the suitability of narrative inquiry to exploring mental health recovery (MHR) has not been examined.

AIMS

(1) Examining the appropriateness of narrative inquiry to studying MHR; (2) assessing the extent to which narrative studies on MHR conform to the unique features of narrative research, as a distinctive form of qualitative inquiry.

METHODS

Review of empirical, theoretical and methodological literature on recovery and narrative inquiry.

RESULTS

Considering the perspectives of recovery and narrative as paradigms, the similarity between their ontology and epistemology is shown, evident in 10 common emphases: meaning, identity, change and development, agency, holism, culture, uniqueness, context, language and giving voice. The resemblance between these "sister" paradigms makes narrative methodology especially fruitful for accessing the experiences of individuals in recovery. Reviewing narrative studies on MHR suggests that, currently, narrative research's uniqueness, centered on the holistic principle, is blurred on the philosophical, methodological and textual levels.

CONCLUSIONS

Well-established narrative research has major implications for practice and policy in recovery-oriented mental health care. The narrative inquiry paradigm offers a possible path to enhancing the distinctive virtues of this research, realizing its potential in understanding and promoting MHR.

Recovery, non-profit organisations and mental health services: 'Hit and miss' or 'dump and run'?

BACKGROUND

The evolution of Recovery-oriented mental health services in Western nations across the globe has given rise to a growth in community-based psychosocial support services, to assist in meeting the diverse needs of consumers. This article reports findings of research that explored the perceptions of community workers who are employed by non-profit organisations and deliver psychosocial support services to support delivery of Recovery-oriented clinical mental health services.

AIMS

The focus of the research reported in this article includes the benefits and challenges encountered by the community workers when working with clinicians.

METHOD

The research was undertaken as part of a single-case embedded study, which evaluated the implementation of Recovery-oriented approaches to the delivery of clinical mental health services in a major urban centre located in south-eastern Australia.

RESULTS

Generally, community workers employed by the non-profit organisations perceived the implementation of Recovery-oriented clinical mental health services to be a positive step forward for consumers. Challenges to the delivery of Recovery-oriented services included issues arising from the many different understandings of what it means to experience mental health Recovery, the quality of communication between the community workers and clinicians and the clinicians' lack of understanding of the role of non-profit organisations and community workers.

CONCLUSION

The article concludes with recommendations to address the challenges involved, with a view to improving the partnerships between community workers and clinicians, and the Recovery journey of people with serious mental illness.

Understanding Universal Elements in Mental Health Recovery: A Cross-Examination of Peer Providers and a Non-Clinical Sample

In our study, we examined underlying human elements embedded in mental health recovery, by exploring shared positive change among peer providers with serious mental illnesses in recovery and a normative sample in spiritual growth following adversity. We conducted secondary analysis based on two independent qualitative study samples consisting of 31 American peer providers and 27 Israeli adults. We identified three shared and two distinct enablers of positive change: peer groups, significant mentor, self-transcendent experiences. Distinct enablers were having meaningful task/role (clinical sample) and deliberate choice to commit to change in face of uncertainty (non-clinical sample). Enablers facilitated positive processes of meaning making and enhancement of agency. Enablers provided opportunities to which the person responded and made use of--thus, enacting a positive reinforcement of change processes. The findings highlight the value of examining mental health recovery in a broad holistic perspective and have implications for practice.