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Waks S, Morrisroe E, Reece J, Fossey E, Brophy L, Fletcher J. Consumers lived experiences and satisfaction with sub-acute mental health residential services. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1849-1859. [PMID: 38456931 DOI: 10.1007/s00127-024-02631-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Sub-acute recovery-oriented facilities offer short-term residential support for people living with mental illness. They are generally highly regarded by consumers, with emerging evidence indicating that these services may support recovery. The aim of the current study was to explore the relationship between personal recovery and consumers' satisfaction with sub-acute residential services, and consumers' views about service features that aid recovery. METHODS Consumers at 19 adult Prevention and Recovery Care Services in Victoria, Australia, were invited to complete measures containing sociodemographic information and measures on personal recovery and wellbeing. After going home, participants were invited to complete measures on service satisfaction and experience. RESULTS Total and intrapersonal scores on the personal recovery measure increased significantly between Time 1 and Time 2, indicating marked improvement. Personal recovery and satisfaction measures were moderately to strongly correlated. Thematically analysed open-ended responses revealed themes of feeling connected, finding meaning and purpose, and self-empowerment as important aspects of these services, with some recommendations for improvements. CONCLUSION Sub-acute residential mental health care may support individuals' personal recovery; consumer satisfaction indicates these services also offer an acceptable and supportive environment for the provision of recovery-oriented care. Further exploring consumers' experiences of sub-acute residential services is essential to understand their effectiveness, opportunities for improvement and intended impacts on personal recovery.
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Affiliation(s)
- S Waks
- Discipline of Clinical Psychology, Graduate Schools of Health, University of Technology Sydney, Chippendale, NSW, Australia
| | - E Morrisroe
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - J Reece
- Discipline of Psychological Science, Australian College of Applied Professions, Melbourne, VIC, Australia
| | - E Fossey
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - L Brophy
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
- The ALIVE National Centre for Mental Health Research Translation, The University of Melbourne, Melbourne, VIC, Australia.
- Social Work & Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - J Fletcher
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- The ALIVE National Centre for Mental Health Research Translation, The University of Melbourne, Melbourne, VIC, Australia
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Parker G. Journeying with a bipolar disorder: The quest plot. Australas Psychiatry 2024; 32:467-469. [PMID: 39079049 PMCID: PMC11459860 DOI: 10.1177/10398562241268261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2024]
Abstract
OBJECTIVE Many with a bipolar disorder embark on a quest, most commonly during elevated mood states, and sometimes driven by a prescient delusion. This essay draws a parallel with a prominent literary plot - the Quest. METHOD Reference to the literary plot is made and an exemplar provided, being based on the personal stories of several patients. RESULTS Parallels between the literary model and the current vignette are emphasized. CONCLUSION Manic prescience can sometimes be more than a delusion. The Quest is both a literary plot and at times may underlie manic behaviours and even illustrate its symbolic value.
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Affiliation(s)
- Gordon Parker
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
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3
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Cioffi CC, Flinn RE, Pasman E, Gannon K, Gold D, McCabe SE, Kepner W, Tillson M, Colditz JB, Smith DC, Bohler RM, O'Donnell JE, Hildebran C, Montgomery BW, Clingan S, Lofaro RJ. Beyond the 5-year recovery mark: Perspectives of researchers with lived and living experience on public engagement and discourse. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 133:104599. [PMID: 39341070 DOI: 10.1016/j.drugpo.2024.104599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 09/13/2024] [Accepted: 09/15/2024] [Indexed: 09/30/2024]
Abstract
There has been growing attention toward including people with lived and living experience (PWLLE) with substance use, substance use disorders, and recovery in public-facing activities. The goals of including PWLLE in sharing their perspectives often include demonstrating that recovery is possible, destigmatizing and humanizing people who have substance use experiences, and leveraging their lived experience to illuminate a particular topic or issue. Recently, the National Council for Mental Wellbeing issued a set of guidelines entitled, "Protecting Individuals with Lived Experience in Public Disclosure," which included a "Lived Experience Safeguard Scale." We offer the present commentary to bolster some of the ideas presented by the Council and to articulate suggested changes to this guidance, with the goal of reducing unintentional gatekeeping and stigma. Specifically, we offer that there are numerous problems with the recommendation to only invite people who have "five or more years of sustained recovery" to contribute to public discourse. The idea of perceived stability after five years of abstinence is not new to us or the field. We suggest that this idea excludes people who have experienced the present rapidly changing substance use landscape, people who have briefly returned to use, some young people, and people with living experience who also can valuably contribute to public discourse. We offer alternative guidelines to the National Council for Mental Wellbeing and others seeking to promote practices that are inclusive to the diversity of PWLLE.
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Affiliation(s)
- Camille C Cioffi
- University of Oregon, Oregon Research Institute, & Influents Innovations, USA.
| | - Ryan E Flinn
- College of Education & Human Development, University of North Dakota, USA.
| | - Emily Pasman
- University of Michigan, Center for the Study of Drugs, Alcohol, Smoking, and Health, USA.
| | | | - Dudi Gold
- Criminologist, Bar-Ilan University, Israel.
| | - Sean Esteban McCabe
- University of Michigan, Center for the Study of Drugs, Alcohol, Smoking, and Health, USA.
| | - Wayne Kepner
- University of California San Diego School of Medicine, USA.
| | | | | | | | - Robert M Bohler
- Jiann-Ping Hsu College of Public Health at Georgia Southern University, USA.
| | | | | | | | | | - Ryan J Lofaro
- Department of Public and Nonprofit Studies, Georgia Southern University, USA.
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4
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Settrisman R, Mishra AK. Journeys to functionality: A dimensional analysis of personal narratives of recovery from depression. J Eval Clin Pract 2024. [PMID: 39319511 DOI: 10.1111/jep.14144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 07/23/2024] [Accepted: 09/07/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Recovery from depression constitutes a long journey that is understood as a unique and multifaceted process encompassing various dimensions. To understand what constitutes recovery from depression and to develop greater insights into the unique dimensions of the recovery journey, the study of recovery memoirs is essential. METHOD This article performs a dimensional analysis on six Indian first-hand accounts of recovery from depression collected in Amrita Tripathi and Arpita Anand's Real Stories of Dealing with Depression to examine the journeys toward healing and the uniqueness of the recovery processes. Through the dimensional analysis, four core dimensions of recovery from depression-Problems, Social Supports, Position of Recovery and Functionality-are identified. The process of recovery, consisting of understanding the problems (causes) through sensed adversities (sensed effects), making use of received social supports to transform oneself, finding out the position of recovery, and lastly, functioning peacefully for living, corresponds to the four dimensions of recovery. Drawing on Herbert Blumer's theory of social interactionism, the article examines how different individuals interpret their experiences of depression in unique ways and develop distinctive recovery strategies. DISCUSSION The identified dimensions of recovery correspond to the need for unique approaches to recovery articulated by each of the narrators. The selected narratives reveal that the problems are unique, and for each of the unique problems, there has to be a distinctive support mechanism. The recovery narratives are centred around the unique problems wherein the individuals attempt to understand what happened to them and why it happened. CONCLUSION The article concludes by suggesting that healthcare practitioners can utilise the dimensions and the subdimensions as a lead to understand fully how their clients conceptualise their problems and try to understand how each client defines the recovery itself.
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Affiliation(s)
- Ryno Settrisman
- Department of Humanistic Studies, Indian Institute of Technology (BHU), Varanasi, India
| | - Ajit K Mishra
- Department of Humanistic Studies, Indian Institute of Technology (BHU), Varanasi, India
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Wolff B, Glasson EJ, Pestell CF. "Broken fragments or a breathtaking mosaic": A mixed methods study of self-reported attributes and aspirations of siblings of individuals with and without neurodevelopmental conditions. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024; 34:1005-1017. [PMID: 38824445 DOI: 10.1111/jora.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/15/2024] [Indexed: 06/03/2024]
Abstract
Siblings of individuals with neurodevelopmental conditions (NDCs) experience distinct challenges and have unique strengths compared to siblings of individuals without NDCs. The present study examined attributes and aspirations of siblings of individuals with and without neurodevelopmental conditions, and analyzed the association between qualitative responses and quantitative measures of growth mindset, positive and negative valence, and mental health diagnoses. A novel mixed methods thematic analysis was employed to explore the experiences of 166 siblings (75 NDC and 91 controls, aged 14-26, 66.27% female) completing an online survey as part of a larger study on sibling mental health. The overarching theme described The Process of Self-Actualization and Integration, reflecting the journey siblings undergo in seeking to understand themselves and others amidst psychological challenges. It encompassed three subthemes: Personal Growth and Identity Formation; Connection and Belonginess; and Societal Perspective and Global Consciousness. Qualitative responses were analyzed within a Research Domain Criteria (RDoC) framework, and associations between phenomenology and mental health diagnoses examined. NDC siblings had higher negative valence and lower positive valence embedded in their responses, and quantitatively lower self-reported growth mindset (i.e., beliefs about the capacity for personal growth), compared to control siblings, which correlated with self-reported mental health diagnoses. Findings suggest clinical practice may focus on optimizing self-identified strengths and offer opportunities for self-actualization of hopes and ambitions, while providing support for families to attenuate bioecological factors impacting mental health.
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Affiliation(s)
- Brittany Wolff
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Emma J Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
- Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Carmela F Pestell
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
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Gabrielsson S, Wolpher N, Zammata E, Fagerström L, Lindgren BM. When the time is right: Men's experiences of recovery in self-harm. Int J Ment Health Nurs 2024; 33:1110-1118. [PMID: 38459624 DOI: 10.1111/inm.13319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/30/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
Previous research has mainly focused on self-harm among women, defining what it is, what functions it has, how to manage and prevent self-harm, and how to recover from it. A recent review of the literature on self-harm among men concluded that research need to consider both clinical and personal aspects of recovery and pointed out the need to explore recovery from men's point of view. This study aimed to describe men's experiences of recovery in self-harm. Data were collected in Sweden in 2020 using semi-structured interviews. Eleven men who had recovered in self-harm were interviewed. Interviews were analysed using an abductive approach to qualitative content analysis. The analysis involved the application of an established framework for personal recovery in mental illness: connectedness, hope, identity, meaning, and empowerment (CHIME). The analysis identified one main theme: when the time is right, and five sub-themes: finding support in others; trusting that change is possible; getting to know yourself; reaching a new understanding; and developing new strategies to manage life. While the cessation of self-harm might both be a sign of and contribute to recovery, it is not the defining feature of recovery. Mental health professionals should be persistent in providing person-centred, recovery-oriented care for men who self-harm. The CHIME framework can be applied in the context of men's recovery in self-harm. This study is reported in accordance with the COREQ guidelines.
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Affiliation(s)
- Sebastian Gabrielsson
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Nicole Wolpher
- Self Harm and Eating Disorder Organization (SHEDO), Stockholm, Sweden
| | - Elias Zammata
- Self Harm and Eating Disorder Organization (SHEDO), Stockholm, Sweden
| | - Lisbeth Fagerström
- Faculty of Education and Welfare Studies, Åbo Academy University, Vaasa, Finland
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Bloemert H, Sizoo BB, Verhoeven EWM, Beekman A, van Meijel B. Recovery of adults with autism spectrum disorder during intensive inpatient treatment: a qualitative study. Front Psychiatry 2024; 15:1383138. [PMID: 38911701 PMCID: PMC11190818 DOI: 10.3389/fpsyt.2024.1383138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Although some adults with autism spectrum disorder (ASD) require intensive and specialized ASD treatment, there is little research on how these adults experience the recovery process. Recovery is defined as the significant improvement in general functioning compared to the situation prior to treatment. Methods This qualitative study describes the recovery process from the perspective of adults on the autism spectrum during intensive inpatient treatment. Semi-structured interviews (n = 15) were carried out and analyzed according to the principles of grounded theory. Results Our results indicate that, given the specific characteristics of autism, therapeutic interventions and goal-oriented work cannot be carried out successfully, and the recovery process cannot begin, if no good working relationship has been established, and if care is not organized in ways that a person on the autism spectrum finds clear and predictable.
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Affiliation(s)
- Hendrikje Bloemert
- Center for Developmental Disorders, Dimence Institute for Mental Health, Deventer, Netherlands
- Department of Nursing, Inholland University of Applied Sciences, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra (UMC; VUmc), Amsterdam, Netherlands
| | - Bram B. Sizoo
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | | | - Aartjan Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra (UMC; VUmc), Amsterdam, Netherlands
| | - Berno van Meijel
- Department of Nursing, Inholland University of Applied Sciences, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra (UMC; VUmc), Amsterdam, Netherlands
- Parnassia Psychiatric Institute, Parnassia Academy, The Hague, Netherlands
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8
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Lim E, Tate R, Sewell A, Higham K, Ferraz K, Harban K, Murdock J, Delahunty S. Consumers' Experiences of Comprehensive-Prepared Graduate Nurses and Their Nursing Care in Acute Mental Health Settings. Issues Ment Health Nurs 2024; 45:617-623. [PMID: 38593452 DOI: 10.1080/01612840.2024.2330571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Pre-registration nursing education has long moved away from preparing nurses with mental health specialisation to nurses with comprehensive knowledge and skills. However, the consumers' experiences of comprehensive-prepared nurses and their nursing care has not been widely explored. This paper reports on a study with consumers to explore their experiences with comprehensive-prepared graduate nurses and the nursing care that they provide in acute mental health settings. An exploratory qualitative study using semi-structured interviews was chosen as the research method. Purposeful sampling recruited 12 consumers and data saturation was achieved. Braun and Clarke's method of thematic analysis was used to analyse the collected data and three themes emerged. The themes are: (i) You got what it takes to be a mental health nurse, (ii) Slow down and spend quality time with us, and (iii) Read in between the lines when we share our negative lived experiences. The findings are useful for identifying strategies to develop evidence-based nursing education for comprehensive-prepared graduate nurses to improve the consumers' experiences of their nursing care.
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Affiliation(s)
- Eric Lim
- School of Nursing, Curtin University, Perth, Australia
| | - Rebecca Tate
- Service 5, Fremantle Hospital, Palmyra DC, Australia
| | - Amy Sewell
- Service 5, Fremantle Hospital, Palmyra DC, Australia
| | - Kezia Higham
- School of Nursing, Curtin University, Perth, Australia
| | - Kristina Ferraz
- Nursing Education, Fiona Stanley Fremantle Hospitals Group, Murdoch, Australia
| | - Kathryn Harban
- Nursing Education, Fremantle Hospital and Health Service, Palmyra DC, Australia
| | - Jane Murdock
- Service 5, Fremantle Hospital, Palmyra DC, Australia
| | - Sharon Delahunty
- Service 5, Fiona Stanley Fremantle Hospitals Group, Murdoch, Australia
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Melvin E, Green M, Keiller E, Parmar C, Bourne J. A systematic review of dramatherapy interventions used to support adults with psychosis. Schizophr Res 2024; 267:44-54. [PMID: 38518478 DOI: 10.1016/j.schres.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/10/2024] [Accepted: 02/17/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Psychiatric treatment of psychosis often comprises therapeutic and psychotropic combinations. Dramatherapy is often utilised in health services with this population, particularly when clients struggle to engage with talking therapies because of complex presentations, experience preverbal trauma, neurodiversity challenges and/or communication difficulties. Dramatherapy as a therapeutic intervention is recognised by health regulating bodies but as yet has not yet been systematically reviewed. AIMS To synthesise existing peer-reviewed empirical research literature and gather evidence regarding dramatherapy used to support adults with psychosis; To collate and understand the intervention methods of dramatherapy as a treatment to support adults experiencing psychosis; To assess the effect of dramatherapy on adults with psychosis, by collating qualitative and quantitative outcome measures, where reported in included research. METHODS Literature was sourced through database searches (CINAHL, EMBASE, COCHRANE, PsycINFO, PubMed, Scopus, and APA PsycNet) and hand searches. 8541 papers were screened, and 11 met inclusion criteria for synthesis. Findings related to aims were narratively synthesised, before being thematically analysed. RESULTS Participant characteristics of age, gender, ethnicity, and socio-economic background were heterogeneous. Participants across studies often had multiple diagnoses, and unknown complexities making recovery through standard treatment unachievable. Presentations included episodes of psychosis, schizophrenia, and dual-diagnoses of mental health challenges and intellectual difficulties. Positive effects found the use of dramatherapy include: New perspectives; Improved relationships; Ability to make choices with reduced anxiety; Understanding of self; Reduced psychotic symptoms. Quantitative data substantiated qualitative findings, and effect indicated changes in social functioning, behaviours, and symptoms following dramatherapy intervention. IMPLICATIONS Systematic findings will support practitioners to implement evidence-based practice and to improve treatment provision for adults with psychosis. Further methodologically sound research into the field is encouraged to advance understanding of dramatherapy interventions for adults with psychosis.
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Affiliation(s)
| | | | | | | | - Jane Bourne
- Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, United Kingdom.
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Deering K, Wagstaff C, Williams J, Bermingham I, Pawson C. Ontological insecurity of inattentiveness: Conceptualizing how risk management practices impact on patient recovery when admitted to an acute psychiatric hospital. Int J Ment Health Nurs 2024; 33:420-430. [PMID: 37882636 DOI: 10.1111/inm.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
Risk management which assesses and mitigates risks such as suicide and violence is under scrutiny, particularly within psychiatric inpatient settings. Restrictive practices, which result from risk assessment, such as observations, physical restraint and ward seclusion can impact negatively on patient recovery, hindering abilities to develop a meaningful life that emphasizes purpose, hope and autonomy, despite experiencing mental distress. Yet, less is known about the impact from the patient's perspective when first admitted to hospital, a period which among other reasons may come with increasing risk management practices owing to the clinical uncertainties about patient risks. In this grounded theory study, we explore the impact on recovery, interviewing 15 adult participants with patient experiences of being in an acute hospital. The main theme of the study, termed a core category with a grounded theory, was identified as "ontological insecurity of inattentiveness". This highlighted a staff inattentiveness with involving patients with risk management and explaining the purposes of the practice, which raised insecurities about what was happening to the patients when admitted to hospital. Four subcategories support the core category; discounting the patients' experiences to gain a meaningful grasp of risk management, ambiguity about risk management rules, particularly the reasons around their use, forebodingness to the hospital environment and, management from afar, with patients feeling scrutinized from observations without a voice to offer different views. It is hoped these findings will add to the field of patient involvement in psychiatric inpatient settings, proposing attempts to raise understanding and inclusivity of risk management, starting when first admitted to hospital.
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Affiliation(s)
- Kris Deering
- Nursing Academy, University of Exeter, Exeter, UK
| | - Chris Wagstaff
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Jo Williams
- School of Nursing and Midwifery, University of the West of England, Blackberry Hill, Bristol, UK
| | - Ivor Bermingham
- Service user and carer involvement coordinator, Southwest of England, England
| | - Chris Pawson
- Psychology Department, University of the West of England, Frenchay Campus, Bristol, UK
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11
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Ali Y, Rennick-Egglestone S, Llewellyn-Beardsley J, Ng F, Yeo C, Franklin D, Perez Vallejos E, Ben-Zeev D, Kotera Y, Slade M. Perception and appropriation of a web-based recovery narratives intervention: qualitative interview study. Front Digit Health 2024; 6:1297935. [PMID: 38419807 PMCID: PMC10899698 DOI: 10.3389/fdgth.2024.1297935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Mental health recovery narratives are widely available to the public, and can benefit people affected by mental health problems. The NEON Intervention is a novel web-based digital health intervention providing access to the NEON Collection of recovery narratives. The NEON Intervention was found to be effective and cost-effective in the NEON-O Trial for people with nonpsychosis mental health problems (ISRCTN63197153), and has also been evaluated in the NEON Trial for people with psychosis experience (ISRCTN11152837). We aimed to document NEON Intervention experiences, through an integrated process evaluation. Methods Analysis of interviews with a purposive sample of intervention arm participants who had completed trial participation. Results We interviewed 34 NEON Trial and 20 NEON-O Trial participants (mean age 40.4 years). Some users accessed narratives through the NEON Intervention almost daily, whilst others used it infrequently or not at all. Motivations for trial participation included: exploring the NEON Intervention as an alternative or addition to existing mental health provision; searching for answers about mental health experiences; developing their practice as a mental health professional (for a subset who were mental health professionals); claiming payment vouchers. High users (10 + narrative accesses) described three forms of appropriation: distracting from difficult mental health experiences; providing an emotional boost; sustaining a sense of having a social support network. Most participants valued the scale of the NEON Collection (n = 659 narratives), but some found it overwhelming. Many felt they could describe the characteristics of a desired narrative that would benefit their mental health. Finding a narrative meeting their desires enhanced engagement, but not finding one reduced engagement. Narratives in the NEON Collection were perceived as authentic if they acknowledged the difficult reality of mental health experiences, appeared to describe real world experiences, and described mental health experiences similar to those of the participant. Discussion We present recommendations for digital health interventions incorporating collections of digital narratives: (1) make the scale and diversity of the collection visible; (2) provide delivery mechanisms that afford appropriation; (3) enable contributors to produce authentic narratives; (4) enable learning by healthcare professionals; (5) consider use to address loneliness.
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Affiliation(s)
- Yasmin Ali
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Department of Architecture and Built Environment, Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - Donna Franklin
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Elvira Perez Vallejos
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| | - Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Center for Infectious Disease Education and Research, Osaka University, Osaka, Japan
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Faculty of Nursing and Health Sciences, Health, and Community Participation Division, Nord University, Namsos, Norway
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Slade M, Rennick-Egglestone S, Elliott RA, Newby C, Robinson C, Gavan SP, Paterson L, Ali Y, Yeo C, Glover T, Pollock K, Callard F, Priebe S, Thornicroft G, Repper J, Keppens J, Smuk M, Franklin D, Walcott R, Harrison J, Smith R, Robotham D, Bradstreet S, Gillard S, Cuijpers P, Farkas M, Zeev DB, Davidson L, Kotera Y, Roe J, Ng F, Llewellyn-Beardsley J. Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with non-psychotic mental health problems: a pragmatic randomized controlled trial. World Psychiatry 2024; 23:101-112. [PMID: 38214639 PMCID: PMC10785987 DOI: 10.1002/wps.21176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Narratives describing first-hand experiences of recovery from mental health problems are widely available. Emerging evidence suggests that engaging with mental health recovery narratives can benefit people experiencing mental health problems, but no randomized controlled trial has been conducted as yet. We developed the Narrative Experiences Online (NEON) Intervention, a web application providing self-guided and recommender systems access to a collection of recorded mental health recovery narratives (n=659). We investigated whether NEON Intervention access benefited adults experiencing non-psychotic mental health problems by conducting a pragmatic parallel-group randomized trial, with usual care as control condition. The primary endpoint was quality of life at week 52 assessed by the Manchester Short Assessment (MANSA). Secondary outcomes were psychological distress, hope, self-efficacy, and meaning in life at week 52. Between March 9, 2020 and March 26, 2021, we recruited 1,023 participants from across England (the target based on power analysis was 994), of whom 827 (80.8%) identified as White British, 811 (79.3%) were female, 586 (57.3%) were employed, and 272 (26.6%) were unemployed. Their mean age was 38.4±13.6 years. Mood and/or anxiety disorders (N=626, 61.2%) and stress-related disorders (N=152, 14.9%) were the most common mental health problems. At week 52, our intention-to-treat analysis found a significant baseline-adjusted difference of 0.13 (95% CI: 0.01-0.26, p=0.041) in the MANSA score between the intervention and control groups, corresponding to a mean change of 1.56 scale points per participant, which indicates that the intervention increased quality of life. We also detected a significant baseline-adjusted difference of 0.22 (95% CI: 0.05-0.40, p=0.014) between the groups in the score on the "presence of meaning" subscale of the Meaning in Life Questionnaire, corresponding to a mean change of 1.1 scale points per participant. We found an incremental gain of 0.0142 quality-adjusted life years (QALYs) (95% credible interval: 0.0059 to 0.0226) and a £178 incremental increase in cost (95% credible interval: -£154 to £455) per participant, generating an incremental cost-effectiveness ratio of £12,526 per QALY compared with usual care. This was lower than the £20,000 per QALY threshold used by the National Health Service in England, indicating that the intervention would be a cost-effective use of health service resources. In the subgroup analysis including participants who had used specialist mental health services at baseline, the intervention both reduced cost (-£98, 95% credible interval: -£606 to £309) and improved QALYs (0.0165, 95% credible interval: 0.0057 to 0.0273) per participant as compared to usual care. We conclude that the NEON Intervention is an effective and cost-effective new intervention for people experiencing non-psychotic mental health problems.
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Affiliation(s)
- Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, Namsos, Norway
| | | | - Rachel A Elliott
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Chris Newby
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Robinson
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Sean P Gavan
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Luke Paterson
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Yasmin Ali
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Department of Architecture and Built Environment, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | | | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Felicity Callard
- School of Geographical & Earth Sciences, University of Glasgow, Glasgow, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, East London NHS Foundation Trust, London, UK
| | - Graham Thornicroft
- Centre for Implementation Science and Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Jeroen Keppens
- Department of Informatics, King's College London, London, UK
| | - Melanie Smuk
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | | | - Rianna Walcott
- Black Communication and Technology Lab, Department of Communication, University of Maryland, College Park, MD, USA
| | | | - Roger Smith
- NEON Lived Experience Advisory Panel, Nottingham, UK
| | | | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Steve Gillard
- School of Health Sciences, City, University of London, London, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- International Institute for Psychotherapy, Babes¸-Bolyai University, Cluj-Napoca, Romania
| | - Marianne Farkas
- Center for Psychiatric Rehabilitation, College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Dror Ben Zeev
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Larry Davidson
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Center for Infectious Disease Education and Research, Osaka University, Osaka, Japan
| | - James Roe
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration East Midlands, University of Nottingham, Nottingham, UK
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
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13
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Ng F, Rennick-Egglestone S, Onwumere J, Newby C, Llewellyn-Beardsley J, Yeo C, Ali Y, Pollock K, Kotera Y, Pomberth S, Gavan SP, van der Krieke L, Robotham D, Gillard S, Thornicroft G, Slade M. Pragmatic, feasibility randomized controlled trial of a recorded mental health recovery narrative intervention: narrative experiences online intervention for informal carers (NEON-C). Front Psychiatry 2024; 14:1272396. [PMID: 38323025 PMCID: PMC10845336 DOI: 10.3389/fpsyt.2023.1272396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/14/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Informal carers of people with mental health problems often have unmet support needs. Mental health recovery narratives are increasingly accessible, but their relevance to and effect on informal carers have been minimally investigated. The Narrative Experiences Online (NEON) Intervention is a first-in-field intervention that provides informal carers with access to a diverse collection of recorded mental health recovery narratives. This trial aimed to examine the feasibility and acceptability of the NEON Intervention for informal carers. Methods This study involved a two-arm feasibility randomized controlled trial. Carers were randomly assigned to receiving versus not receiving the NEON Intervention. The feasibility aspects investigated included the acceptability of the intervention and of randomization, trial processes, engagement rates, recruitment procedures, attrition, sample size estimation, identification of candidate primary and secondary outcomes, and the feasibility of conducting a definitive trial. A qualitative process evaluation was conducted. Findings A total of 121 carers were eligible, of whom 54 were randomized (intervention: 27, control: 27). Twelve-month follow-up data were available for 36 carers. Carers accessed a mean of 25 narratives over a 12-month period, and the intervention group, compared with the control group, reported a small effect on hope and a moderate effect on the presence of meaning in life. Five modifications were recommended to improve the user experience, applicability, and trial processes. Discussion The NEON Intervention is feasible and acceptable. Significant refinement of the NEON Intervention and trial processes is required to personalize and ensure applicability to carers. Further feasibility testing is recommended prior to a definitive trial.
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Affiliation(s)
- Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, United Kingdom
| | - Christopher Newby
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Yasmin Ali
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Scott Pomberth
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Sean P. Gavan
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, United Kingdom
| | - Lian van der Krieke
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, Netherlands
| | | | - Steve Gillard
- School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Graham Thornicroft
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Health and Community Participation Division, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
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14
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Rose D, Beresford P. PPI in psychiatry and the problem of knowledge. BMC Psychiatry 2024; 24:52. [PMID: 38225641 PMCID: PMC10790510 DOI: 10.1186/s12888-023-05398-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/23/2023] [Indexed: 01/17/2024] Open
Abstract
This article begins by locating Patient and Public involvement ((PPI) historically and argues that 'mental health' was a special case. This movement held promise for service users in repositioning them as researchers as opposed to 'subjects'. We argue, however, that ultimately it failed and was reduced to involved publics 'tinkering at the edges'. In respect to this we reference institutions, hierarchies, organisations and the overall political climate. Ultimately, however, it failed at the level of knowledge itself in that t he underlying assumptions of conventional researchers, their aims and goals, clashed with those of the assumptions and aims of survivors. However, we argue that all is not lost, the mainstream itself is imploding and beneath the surface forms of distinctly survivor-led knowledge are emerging.
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Affiliation(s)
- Diana Rose
- CASS, ANU, ACT, Canberra, 0200, Australia.
| | - Peter Beresford
- University of East Anglia, Research Park Norwich, Norwich, NR4 7TJ, UK
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McCombie C, Ouzzane H, Schmidt U, Lawrence V. 'Physically it was fine, I'd eat what normal people do. But it's never like this in my head': A qualitative diary study of daily experiences of life in recovery from an eating disorder. EUROPEAN EATING DISORDERS REVIEW 2024; 32:46-55. [PMID: 37556406 PMCID: PMC10952333 DOI: 10.1002/erv.3018] [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] [Received: 04/06/2023] [Revised: 07/06/2023] [Accepted: 07/29/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE High eating disorder (ED) relapse rates stress the need for clearer understanding around how recovery is experienced and maintained. Recent research endorses the concept of recovery as a process rather than an endpoint. This study aimed to investigate daily experiences of living in recovery from an ED. METHOD Fourteen participants who self-identified as recovered from a formally diagnosed ED were recruited online. A qualitative diary app was used for data collection. Participants completed written or audio open-ended diary entries every other day for 2 weeks describing their experiences, thoughts, and feelings. Diaries were analysed using reflexive thematic analysis. RESULTS Four themes were developed. 'Ever-present eating disordered thoughts' highlights how pervasive these thoughts remain for participants. 'Impact of social discourses' unpacks the challenges of maintaining recovery while surrounded by unhelpful social discourses about food and body image. 'Recovery is precarious' highlights how a combination of stressors can build up to threaten recovery. 'Finding balance in recovery' illustrates the many ways participants try to manage their recovery each day. CONCLUSIONS The findings make it clear that living in recovery from an ED is a complex process that must be navigated daily. Recommendations for treatment and recovery support are discussed.
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Affiliation(s)
- Catherine McCombie
- Department of Health Services and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Hannah Ouzzane
- Department of Health Services and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Ulrike Schmidt
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Vanessa Lawrence
- Department of Health Services and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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16
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Quah ELY, Chua KZY, Lin CKR, Vijayan AV, Abdul Hamid NAB, Owyong JLJ, Satku N, Woong N, Lim C, Phua GLG, Ong EK, Fong W, Krishna LKR. The role of patients' stories in medicine: a systematic scoping review. BMC Palliat Care 2023; 22:199. [PMID: 38087237 PMCID: PMC10714554 DOI: 10.1186/s12904-023-01319-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Patients' stories provide Palliative Care physicians with a glimpse into the former's lives and their psycho-emotional, sociocultural, and contextual considerations. Yet, few physicians are trained to interpret and apply patients' stories in their practice. Inherent variability in how stories are transmitted and interpreted raises questions over their potential effects on care. Amidst a dearth of accounts in Palliative Care, we map current use of patient stories to guide the training, assessment, and oversight of this 'care influencing' practice in medicine. METHODS This systematic scoping review was guided by the Systematic Evidence-Based Approach (SEBA) to ensure a reproducible and structured approach. The themes and categories identified through the Split Approach's concurrent and independent thematic and directed content analyses provided a comprehensive sketch of the included articles. The Jigsaw Perspective combined the themes and categories identified. The last stage of SEBA compared these results with two recent reviews of storytelling to ensure consistency of the domains created that guided the discussion. RESULTS Ten thousand two hundred seven articles were reviewed, 963 full text articles were evaluated, and 199 articles were included. The four domains identified were study characteristics, benefits, approaches, and positive effects and concerns. CONCLUSION Stories support patient-centered, personalized, and holistic clinical care. However, variability in the stories, their interpretations and use in care decisions underscore the need for further study on the structuring, teaching, assessing, and delivery of this 'care influencing' practice.
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Affiliation(s)
- Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Casper Keegan Ronggui Lin
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore
- Division of Outpatient Pharmacy, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Andrew Vimal Vijayan
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Nur Amira Binte Abdul Hamid
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Jasmine Lerk Juan Owyong
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Neeta Satku
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore
| | - Natalie Woong
- Department of Internal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Road, Singapore, 574627, Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC C/O Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
- Health Data Science, University of Liverpool, Whelan Building The Quadrangle, Brownlow Hill, Liverpool, L69 3GB, UK.
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Llewellyn-Beardsley J, Rennick-Egglestone S, Callard F, Pollock K, Slade M, Edgley A. "Nothing's changed, baby": How the mental health narratives of people with multiple and complex needs disrupt the recovery framework. SSM - MENTAL HEALTH 2023; 3:100221. [PMID: 38045107 PMCID: PMC10316065 DOI: 10.1016/j.ssmmh.2023.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 12/05/2023] Open
Abstract
The dominant narrative in mental health policy and practice has shifted in the 21st century from one of chronic ill health to a 'recovery' orientation. Knowledge of recovery is based on narratives of people with lived experience of mental distress. However the narratives of people experiencing structural inequalities are under-represented in recovery research. Meanwhile, uses of recovery narratives have been critiqued by survivor-researchers as a co-option of lived experience to serve neoliberal agendas. To address these twin concerns, we undertook a performative narrative analysis of two 'recovery narratives' of people with multiple and complex needs, analysing their co-construction at immediate/micro and structural/macro levels. We found two contrasting responses to the invitation to tell a recovery story: a narrative of personal lack and a narrative of resistance. We demonstrate through reflexive worked examples how the genre of recovery narrative, focused on personal transformation, may function to occlude structural causes of mental distress and reinforce personal responsibility in the face of unchanging living conditions. We conclude that unacknowledged epistemological assumptions may contribute to co-constructing individualist accounts of recovery. A critical, reflexive approach, together with transparent researcher positionality, is imperative to avoid the epistemic injustice of a decontextualised form of recovery narrative.
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Affiliation(s)
- Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Felicity Callard
- School of Geographical and Earth Sciences, University of Glasgow, 8NN, University Avenue, Glasgow, G12 8QQ, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
- Nord University, Faculty of Nursing and Health Sciences, Health and Community Participation Division, Postbox 474, 7801, Namsos, Norway
| | - Alison Edgley
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
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Cea Madrid JC. Mad activisms in mental health: a integrative review. Salud Colect 2023; 19:e4627. [PMID: 38055370 DOI: 10.18294/sc.2023.4627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
The following text presents the results of a integrative review whose purpose was to identify and analyze the production of academic literature on mad activism in the field of mental health and its link with the notions of disability and neurodiversity. From searches conducted in May 2023 in the Web of Science, Scopus, and PubMed databases, 52 articles were selected, and thematic content analysis strategies were applied. The results account for various articulations between the concepts addressed, establishing a critical look at the biomedical model in mental health. In the forms of mad activism, the human rights approach, the fight against stigma and its influence on the reform processes of the mental health system become relevant. On the other hand, a framework of social justice, identity policies and practices of mutual support from the community are established. As a whole, they emphasize methodological innovations and an intersectional perspective on the production of knowledge. It is concluded that it is possible to situate madness as a field of constitution of a political actor and epistemic subject. Based on this, possible lines of research on mad activisms in Latin America are formulated.
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Affiliation(s)
- Juan Carlos Cea Madrid
- Psicólogo. Magíster en psicología, mención psicología comunitaria. Estudiante de Doctorado en Psicología. Universidad de Chile, Santiago, Chile.
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Reddy J, Black K, Bazemore K, Jordan K, Jackson JB, Knittel AK. Ethical inclusion: Risks and benefits of research from the perspective of perinatal people with opioid use disorders who have experienced incarceration. PLoS One 2023; 18:e0294604. [PMID: 37992010 PMCID: PMC10664874 DOI: 10.1371/journal.pone.0294604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/03/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Research ethics guidelines and emphasis on representation in research guide the inclusion of marginalized groups, including people with perinatal opioid use disorders (OUD) and people experiencing incarceration in the United States. However, insights from participants regarding the risks and benefits of participation are not adequately considered. The aim of this study was to examine the risks and benefits of research participation from the perspective of pregnant/postpartum people with OUD who have experienced incarceration. DESIGN We recruited people who had experience with perinatal incarceration and were either currently pregnant or postpartum, and at least 18 years old. All participants met the clinical criteria for OUD. Our study did not have exclusion criteria based on gender, race, or ethnicity. SETTING Participants were either currently incarcerated at the North Carolina Correctional Institute for Women in Raleigh, North Carolina, United States or had previously experienced perinatal incarceration and were recruited from a perinatal substance use disorder treatment program located in North Carolina. PARTICIPANTS Between 9/2021-4/2022, we completed 12 interviews with pregnant/postpartum people with OUD, approximately half who were currently incarcerated and half with a recent history of perinatal incarceration. INTERVENTION/MEASUREMENT Interviews were conducted via Webex phone or video. The interviews followed a scripted interview guide and lasted one hour on average. Interview transcripts were analyzed using the Rigorous and Accelerated Data Reduction technique to produce an overarching thematic framework. FINDINGS Our analysis identified benefits, including the personal advantage of self-expression, helping others and contributing to change, and financial incentives. Risks included stigma and breach of confidentiality, misunderstanding of the distinction between research and advocacy, and limited ability to share their whole experience. CONCLUSIONS Participant-identified benefits of research mirrored those from other marginalized populations, though participant-identified risks were novel and nuanced. Recruitment and consent should move beyond normative research ethics committees protocol language to consider the perspectives of participants.
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Affiliation(s)
- Julia Reddy
- Department of Maternal Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Kristel Black
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Keia Bazemore
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Kiva Jordan
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Jamie B. Jackson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
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Subhani M, Talat U, Knight H, Morling JR, Jones KA, Aithal GP, Ryder SD, Rennick-Egglestone S. Application and Extension of the Alcohol Recovery Narratives Conceptual Framework. QUALITATIVE HEALTH RESEARCH 2023; 33:1203-1217. [PMID: 37683106 PMCID: PMC10626984 DOI: 10.1177/10497323231197384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Recovery narratives are personal stories of health problems and recovery. A systematic review proposed a conceptual framework characterising alcohol misuse recovery narratives, consisting of eight principal dimensions, each with types and subtypes. The current study aims to apply and extend this preliminary conceptual framework. Semi-structured interviews were conducted to collect alcohol misuse recovery narratives from adult participants. A two-stage inductive and deductive thematic analysis approach was used to assess the relevance of the dimensions and types included in the preliminary conceptual framework and identify new components. The sample consisted of 11 participants from diverse socioeconomic backgrounds who had previously displayed varying degrees of alcohol misuse. All conceptual framework dimensions (genre, identity, recovery setting, drinking trajectories, drinking behaviours and traits, stages, spirituality and religion, and recovery experience) were present in the collected narratives. Three dimensions were extended by adding types and subtypes. Whilst the existing conceptual framework fitted the collected narratives, a new dimension describing the alcohol environment was required to fully characterise narratives. Types included in the alcohol environment dimension were policy and practice and social dynamics. The extended framework could guide the production of resources enabling clinicians to engage with narratives shared by their clients.
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Affiliation(s)
- Mohsan Subhani
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Usman Talat
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Holly Knight
- Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Joanne R. Morling
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Katy A. Jones
- School of Medicine, Applied Psychology, University of Nottingham, Nottingham, UK
| | - Guruprasad P. Aithal
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Stephen D. Ryder
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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McCarthy J, Higgins A, McCarthy B, Flynn AV, Gijbels H. Family members' perspectives of hope when supporting a relative experiencing mental health problems. Int J Ment Health Nurs 2023; 32:1405-1415. [PMID: 37332254 DOI: 10.1111/inm.13185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 06/20/2023]
Abstract
Current research views hope as a process that plays a positive role in the recovery of individuals with mental health problems. However, little attention has been given to the role of hope in the lives of their families. We aimed to address that gap. We deployed a qualitative descriptive design and carried out individual interviews with nine family members who supported a relative with mental health problems. A cross-comparison of the data generated three major themes: understandings of hope; factors that diminish hope and factors that nurture hope. The participants viewed hope as a positive and productive feeling or attitude that was life-affirming, and empowering. They also associated it with behaviours and dispositions such as attentiveness and empathy and the possibility of a return to a more stable and 'normal' life. The participants experienced hope as initially eroded when their relative was first diagnosed and institutionalized. Hope was further diminished due to the poor communication practices of some mental health professionals and the stress of the caring role itself. On the other hand, hope was nurtured through the support of other family members, friends, neighbours and peers. Acquiring knowledge and understanding about the relative's state of mental health nurtured hope and enabled the participants to have a more meaningful role in their recovery process. Practices of self-care such as independent activities and counselling also strengthened hope and some mental health professionals played a positive role in supporting these. Most striking about the reports of many of the participants was their assertion of their abiding love for their relative. Their account of their ability to see beyond the illness of their relative was an insight that we did not find in other accounts of the experiences of family members. We highlight the need for family members to have timely access to relevant information about their relatives' illness. We conclude that hope is relational at its core because of the interplay of intrapersonal, interpersonal and social factors that diminish or nurture it over time. Specifically, we propose that friends, neighbours and peer support groups as key actors in nurturing the hope of both family members and their relatives.
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Affiliation(s)
- Joan McCarthy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Bridie McCarthy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Angela V Flynn
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Harry Gijbels
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Curiale C, Lenzi M, Gaboardi M, Marino C, Ronconi L, Demita S, Cosentino R, Disperati F, Santinello M. Homeless people's recovery in Housing First and Traditional Services: The role of working alliance in Italian housing services. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2758-2773. [PMID: 37209420 DOI: 10.1002/jcop.23055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/25/2023] [Accepted: 04/29/2023] [Indexed: 05/22/2023]
Abstract
This study aims to investigate whether a working alliance could represent a potential mechanism that explains the effectiveness of housing services in terms of user recovery, comparing the Housing First (HF) model with Traditional Services (TS). This study included 59 homeless service users in Italy (29 = HF; 30 = TS). Recovery was assessed upon entering the study (T0) and after 10 months (T1). Results indicate that participants inserted in HF services were more likely to report stronger working alliances with social service providers at T0 that, in turn, was directly associated with higher levels of users' recovery at the beginning of the study and indirectly (through recovery at T0) with recovery at T1. Implications of the results are discussed with respect to research and practice on homeless services.
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Affiliation(s)
- Chiara Curiale
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Michela Lenzi
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Marta Gaboardi
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Claudia Marino
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Lucia Ronconi
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Silvia Demita
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Roberta Cosentino
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Francesca Disperati
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Massimo Santinello
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
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Jay EK, Patterson C, Fernandez R, Moxham L. Experiences of recovery among adults with a mental illness using visual art methods: A systematic review. J Psychiatr Ment Health Nurs 2023; 30:361-374. [PMID: 36305611 DOI: 10.1111/jpm.12882] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Arts-based research is an established and accepted research approach and systematic reviews have been published on this methodology. There are many possible data collection techniques and study designs within arts-based research, which have been implemented but not yet systematically reviewed. Rationales and challenges for arts-based research have covered participants' experiences of being in arts-based studies in health service research. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The main results of this systematic review are that mental health recovery concepts are effectively communicated by visual arts-based research and participation in these studies is progressive and connecting for mental health consumers. This paper adds new knowledge about participants' experiences specifically in visual arts-based studies, where the participants are mental health consumers. The results are significant because they support visual arts-based research in its development and popularity, both as a research approach and as an empowerment intervention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The results of this systematic review can enhance the fields of qualitative research methods and mental health nursing. Recommendations for professional development can be advanced from consumers' ideas and experiences of recovery reported in this review. Nurse scientists and consumer researchers can take into consideration visual arts-based data collection techniques for use as research and empowerment interventions with mental health consumer participants. ABSTRACT INTRODUCTION: Art creation has been found to be therapeutic to mental health consumers, making the prospect of art creation's conceivable benefits as a mental health research strategy worthy of consideration. AIM This systematic review aims to explore experiences of recovery among adults with a mental illness using visual art methods. METHOD Following a comprehensive database search, 14 suitable studies were identified. These involved adult participants with a formal mental health diagnosis, or who self-identify as having a mental illness. The studies employed arts-based methodologies with participant-created, visual art as their data. Articles underwent data extraction and quality appraisal with the JBI-QARI (Qualitative Assessment and Review Instrument). RESULTS Results were categorised and further aggregated into two synthesised findings according to Joanna Briggs Institute (JBI) guidelines. The synthesised findings are: (1) Creative artmaking enables the use of visual metaphors which can aid expression of feelings, externalisation of identity, and personal learning, and (2) Interpersonal and self-connectedness through inclusion in community, receiving support when needed, and progressing through loss, are beneficial for mental health recovery. DISCUSSION These findings are comparable to those already existing in the literature, and suggest that visual arts-based research methods are as dependable as other qualitative research methods. Additionally, this systematic review reveals that when conducting research studies, there are benefits for mental health consumer participants when visual arts-based methods are used. IMPLICATIONS FOR PRACTICE A visual arts-based research intervention can be concluded to have the effect of an empowerment intervention, as well as being a credible research method.
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Affiliation(s)
- Elissa-Kate Jay
- School of Nursing, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, New South Wales, Australia
| | - Christopher Patterson
- School of Nursing, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, New South Wales, Australia
| | - Ritin Fernandez
- Australia Centre for Research in Nursing and Health, St George Hospital, Kogarah, New South Wales, Australia
| | - Lorna Moxham
- School of Nursing, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, New South Wales, Australia
- Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, New South Wales, Australia
- JBI Centre of Excellence, University of Wollongong, Wollongong, New South Wales, Australia
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Kehoe M, Fossey E, Edan V, Chaffey L, Brophy L, Weller PJ, Shawyer F, Meadows G. Consumer Views and Experiences of Secondary-Care Services Following REFOCUS-PULSAR Staff Recovery-Oriented Practices Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105894. [PMID: 37239620 DOI: 10.3390/ijerph20105894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The use of recovery-oriented practice (ROP) can be challenging to implement in mental health services. This qualitative sub-study of the Principles Unite Local Services Assisting Recovery (PULSAR) project explored how consumers perceive their recovery following community mental health staff undertaking specific ROP training. METHODS Using a qualitative participatory methodology, 21 consumers (aged 18-63 years) participated in one-on-one interviews. A thematic analysis was applied. RESULTS Four main themes were extracted: (1) connection, (2) supportive relationships, (3) a better life, and (4) barriers. Connections to community and professional staff were important to support consumers in their recovery journey. Many consumers were seeking and striving towards a better life that was personal and individual to each of them, and how they made meaning around the idea of a better life. Barriers to recovery primarily focused on a lack of choice. A minor theme of 'uncertainty' suggested that consumers struggled to identify what their recovered future might entail. CONCLUSION Despite staff undertaking the ROP training, all participants struggled to identify language and aspects of recovery in their interaction with the service, suggesting a need for staff to promote open, collaborative conversations around recovery. A specifically targeted recovery resource might facilitate such conversation.
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Affiliation(s)
- Michelle Kehoe
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Peninsula Campus Building G, 47-49 Moorooduc Hwy, Frankston, VIC 3199, Australia
- Alfred Health, Adult Mental and Addiction Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Peninsula Campus Building G, 47-49 Moorooduc Hwy, Frankston, VIC 3199, Australia
| | - Vrinda Edan
- Centre for Mental Health Nursing, Department of Nursing, School of Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Lisa Chaffey
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Peninsula Campus Building G, 47-49 Moorooduc Hwy, Frankston, VIC 3199, Australia
| | - Lisa Brophy
- Social Work and Social Policy, Department of Community and Clinical Health School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
- The Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3000, Australia
| | | | - Frances Shawyer
- Southern Synergy, Monash Health, Dandenong, VIC 3175, Australia
| | - Graham Meadows
- The Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3000, Australia
- Southern Synergy, Monash Health, Dandenong, VIC 3175, Australia
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC 3168, Australia
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC 3168, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC 3168, Australia
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25
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Frounfelker RL, Mishra T, Holmes KB, Gautam B, Betancourt TS. Mental health among older Bhutanese with a refugee life experience: A mixed-methods latent class analysis study. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2023; 93:304-315. [PMID: 37155291 PMCID: PMC10330824 DOI: 10.1037/ort0000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
There are disparities in the mental health of refugee populations compared to individuals who have not experienced forced migration. It is important to identify individuals with a refugee life experience who are most in need of mental health care and prioritize their engagement in services. The objectives of this convergent mixed-methods study are to quantitatively identify the association between exposure to pre- and postresettlement traumas and stressors and mental health among older adults with a refugee life experience, qualitatively identify typologies of narratives of forced migration, and integrate findings to provide a more comprehensive understanding of the relationship between trauma and symptoms of posttraumatic stress disorder (PTSD). Study participants were Bhutanese with a refugee life experience living in a metropolitan area in New England (United States). We used quantitative surveys to identify exposures to traumas and symptoms of PTSD. We used latent class analysis to identify subgroups of trauma exposure and association with symptoms of PTSD. A subset of individuals participated in qualitative interviews. Narrative thematic analysis was used to explore typologies of life history narratives. Quantitatively, we identified four classes of patterns of trauma exposure throughout the refugee life trajectory. These classes were associated with current symptoms of PTSD. Qualitatively, we identified four narrative types that indicate participants interpreted and made sense of their life trajectories in a variety of ways. Integration of findings indicate that caution is needed in identifying individuals in need of mental health services and the best approach for interventions that promote psychosocial well-being. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Tej Mishra
- Washington, D.C. Department of Public Health
| | - Kieran B. Holmes
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Bhuwan Gautam
- Department of Public Health Sciences, Penn State College of Medicine
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Gamieldien F, Galvaan R, Myers B, Sorsdahl K. Mental Health Service Users and Their Caregivers Perspectives on Personal Recovery from Severe Mental Health Conditions in Cape Town, South Africa: A Qualitative Study. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2023; 11:201-219. [PMID: 38887754 PMCID: PMC11180021 DOI: 10.1007/s40737-023-00341-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/25/2023] [Indexed: 06/20/2024]
Abstract
Severe mental health conditions (SMHCs) significantly contribute to the global disease burden. In low-and-middle-income countries (LMICs) like South Africa, the long-term impact of SMHCs on individuals and their families is serious. However, mental health services focus on clinical recovery, with little attention given to the personal recovery needs of mental health service users (MHSUs) and their caregivers. The CHIME framework outlines five domains characterising personal recovery: connectedness, hope and optimism about the future, identity, meaning in life, and empowerment. This qualitative, descriptive study sought insights from male MHSUs and their caregivers on their perspectives of personal recovery from SMHCs. Four male MHSUs and three of their caregivers were purposively selected from Cape Flats communities in the Western Cape. Data were collected using visual participatory methods, including photovoice, life graphs, community maps, and photo-elicitation interviews with MHSUs. In addition, semi-structured interviews were held with caregivers. Data were thematically analysed, and two main themes emerged: Finding meaningful participation and affirming agency. These themes describe how diverse contextual, socioeconomic, political, demographic, cultural, and spiritual factors help and hinder personal recovery. MHSUs and their caregivers sought support from mental health non-profit organisations (MH-NPOs) because of stigmatising attitudes from their communities. MH-NPOs provided MHSUs with long-term relational support and opportunities to build their capacities which helped them access living, learning, working and socialising opportunities. Understanding the diverse needs of MHSUs and including MH-NPOs in scaling up community-based mental health services in LMICs will enable more accessible services that support personal recovery.
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Affiliation(s)
- Fadia Gamieldien
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
- Inclusive Practices Africa Research Unit, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Roshan Galvaan
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
- Inclusive Practices Africa Research Unit, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA Australia
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
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27
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Subandi MA, Nihayah M, Marchira CR, Tyas T, Marastuti A, Pratiwi R, Mediola F, Herdiyanto YK, Sari OK, Good MJD, Good BJ. The principles of recovery-oriented mental health services: A review of the guidelines from five different countries for developing a protocol to be implemented in Yogyakarta, Indonesia. PLoS One 2023; 18:e0276802. [PMID: 36862696 PMCID: PMC9980814 DOI: 10.1371/journal.pone.0276802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/13/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Recovery-oriented mental health service has become the focus of global change in mental health services. Most of North industrialized countries have adopted and implemented this paradigm in the last two decades. Only recently that some developing countries are trying to follow this step. In Indonesia's case, there has been little attention to developing a recovery orientation by mental health authorities. The aim of this article is to synthesize and analyze the recovery-oriented guidelines from five industrialized countries that we can use as a primary model for developing a protocol to be implemented in community health centre in Kulonprogo District, Yogyakarta, Indonesia. METHOD We used a narrative literature review by searching for guidelines from many different sources. We found 57 guidelines, but only 13 from five countries met the criteria, including five guidelines from Australia, one from Ireland, three from Canada, two from the UK, and two from the US. To analyze the data, we used an inductive thematic analysis to explore the themes of each principle as described by the guideline. RESULT The results of the thematic analysis revealed seven recovery principles, including (1) cultivating positive hope, (2) establishing partnerships and collaboration, (3) ensuring organizational commitment and evaluation, (4) recognizing the consumer's rights, (5) focusing on person-centeredness and empowerment, (6) recognizing an individual's uniqueness and social context, and (7) facilitating social support,. These seven principles are not independent, rather they are interrelated and overlap each other. CONCLUSION The principle of person-centeredness and empowerment is central to the recovery-oriented mental health system, while the principle of hope is also essential to embracing all the other principles. We will adjust and implement the result of the review in our project focusing on developing recovery-oriented mental health service in the community health center in Yogyakarta, Indonesia. We hope that this framework will be adopted by the central government in Indonesia and other developing countries.
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Affiliation(s)
- M. A. Subandi
- Faculty of Psychology, Gadjah Mada University, Yogyakarta, Indonesia
- * E-mail:
| | - Maryama Nihayah
- Faculty of Psychology, Gadjah Mada University, Yogyakarta, Indonesia
| | - Carla R. Marchira
- Department of Psychiatry, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Trihayuning Tyas
- Faculty of Psychology, Gadjah Mada University, Yogyakarta, Indonesia
| | - Ariana Marastuti
- Faculty of Psychology, Gadjah Mada University, Yogyakarta, Indonesia
| | - Ratri Pratiwi
- Faculty of Psychology, Mercu Buana University, Yogyakarta, Indonesia
| | | | - Yohanes K. Herdiyanto
- Department of Psychology, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Osi Kusuma Sari
- Directorate of Mental Health, Ministry of Health, Jakarta, Indonesia
| | - Mary-Jo D. Good
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Byron J. Good
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
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Abstract
Despite its seeming breadth and diversity, the bulk of the personal (mental health) recovery literature has remained strangely 'silent' about the impact of various socio-structural inequalities on the recovery process. Such an inadequacy of the empirical literature is not without consequences since the systematic omission or downplaying, at best, of the socio-structural conditions of living for persons with lived experience of mental health difficulties may inadvertently reinforce a reductionist view of recovery as an atomised, individualised phenomenon. Motivated by those limitations in extant scholarship, a critical literature review was conducted to identify and critique relevant research to problematise the notion of personal recovery in the context of socio-structural disadvantage such as poverty, homelessness, discrimination and inequalities. The review illuminates the scarcity of empirical research and the paucity of sociologically-informed theorisation regarding how recovery is shaped by the socio-structural conditions of living. Those inadequacies are especially pertinent to homelessness research, whereby empirical investigations of personal recovery have remained few and undertheorised. The gaps in the research and theorising about the relational, contextual and socio-structural embeddedness of recovery are distilled. The critical review concludes that personal recovery has remained underresearched, underproblematised and undertheorised, especially in the context of homelessness and other forms of socio-structural disadvantage. Understanding how exclusionary social arrangements affect individuals' recovery, and the coping strategies that they deploy to negotiate those, is likely to inform anti-oppressive interventions that could eventually remove the structural constraints to human emancipation and flourishing.
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Affiliation(s)
- Dimitar Karadzhov
- Dimitar Karadzhov, Centre for
Health Policy, University of Strathclyde, 16 Richmond Street, Glasgow,
G1 1XQ, UK.
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29
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Looi JC, Bastiampillai T, Allison S, Maguire PA. Considering patient narrative-based and medico-scientific epistemologies in framing psychiatric care. Australas Psychiatry 2023; 31:58-60. [PMID: 36112795 DOI: 10.1177/10398562221126427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Personal narratives of lived experience with psychiatric illness and distress remain central in the epistemology of mental illness. We provide a commentary on this potential bridging of patient narrative-based epistemology, and medico-scientific epistemology used by psychiatrists used for diagnosis, formulation, prognosis and treatment. CONCLUSION Discussion and planning of psychiatric care can be framed by understanding the narrative-based epistemology of a patient's illness as highlighted by five key questions to explore the patient's illness explanatory models. We propose five key questions for the psychiatrist's complementary consideration of medico-scientific epistemology that frame conceptual models of aetiology, pathophysiology, diagnosis, formulation, prognosis and treatment, which are embedded in the predominant socio-cultural environment. These questions assist in bridging patient narrative and medico-scientific explanatory models to facilitate more effective collaborative care planning.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, 2541Monash University, Clayton, VIC, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
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30
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Hare-Duke L, Charles A, Slade M, Rennick-Egglestone S, Dys A, Bijdevaate D. Systematic review and citation content analysis of the CHIME framework for mental health recovery processes: recommendations for developing influential conceptual frameworks. JOURNAL OF RECOVERY IN MENTAL HEALTH 2023; 6:38-44. [PMID: 36926313 PMCID: PMC7614322 DOI: 10.33137/jrmh.v6i1.38556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To identify design features of the CHIME conceptual framework of mental health recovery which are associated with high rates of citation. RESEARCH DESIGN AND METHODS Systematic review of all citations of the Connectedness, Hope, Identity, Meaning, and Empowerment (CHIME) framework of mental health recovery. Papers citing CHIME were screened and extracted from three citation databases. Citation content analysis was used to investigate associations between nine CHIME design features. Citations were investigated across six forms of visibility: all citations; Anglophone vs non-Anglophone; academic vs non-academic; academic discipline; professional group; and clinical population. RESULTS There were 915 eligible documents identified. Six CHIME framework design features met predefined thresholds for high levels of influence: (i) using a systematic review methodology for development, (ii) adopting a memorable acronym, (iii) having disaggregable components, and being unaligned to a (iv) particular discipline (i.e., transdisciplinary), (v) professional group, or (vi) diagnostic population. Documents from Anglophone countries were more likely to cite CHIME with reference to trans-professional (χ2=3.96, df=1, p=0.05) and ethnicity sub-group analysis (p=0.039) design features than non-Anglophone documents. Non-academic documents were more likely to cite the acronym design feature than academic papers (χ2=5.73, df=1, p=0.01). Public Health-related publications were more likely to cite CHIME within a trans-diagnostic framework (χ2=16.39, df=1, p<0.001) than other disciplines. CONCLUSIONS The influence and impact of conceptual frameworks for recovery are increased when the framework is underpinned by a systematic review, includes disaggregable components which can be summarized using a memorable acronym, and when the framework is transdisciplinary, trans-professional, and trans-diagnostic.
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Affiliation(s)
- Laurie Hare-Duke
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Nord University, Faculty of Nursing and Health Sciences, Health and Community Participation Devision, Namsos, Norway
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ada Dys
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Daan Bijdevaate
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
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Israel P, Ruud T, Weimand B. Carer involvement in the assessment of personal recovery: A naturalistic study of assertive community treatment in Norway. Front Psychiatry 2023; 14:1135135. [PMID: 37051169 PMCID: PMC10083239 DOI: 10.3389/fpsyt.2023.1135135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/22/2023] [Indexed: 04/14/2023] Open
Abstract
Background The user and carer movements have come a long way in becoming embedded in mainstream mental health services for individuals with serious mental illness. However, implementing recovery-oriented practice continues to be plagued by an individualistic clinical focus. The carers do not feel integrated despite policies and best intentions. The implementation of Assertive Community Treatment (ACT) provided an opportunity to involve the carers and compare their assessment of personal recovery with the users. Aims The aims of this study were to examine (i) how family carers and users differed in their assessment of personal recovery, (ii) whether familial and personal relationships influenced how carers assess personal recovery of users, and (iii) if the experience of family carers with the ACT team was associated with personal recovery. Methods The naturalistic, explorative study recruited 69 users and 36 family carers from 12 Norwegian ACT teams. The users and carers assessed the user's personal recovery. Family carers also reported their experience and satisfaction with the ACT teams. Analyses included independent and paired sample T-tests and correlation analysis. Results Family carers were significantly more conservative than the users' assessment of the intrapsychic and interpersonal subscales of personal recovery. The pattern held true whether the family carers were matched to the users or part of the total sample. Lastly, there was a significant negative correlation between the family carer's experience of cooperation with the ACT team and their assessment of the user's intrapersonal process of recovery. Conclusions The results of our study were consistent with previous research on carer involvement in MHS. However, it is the first study that engaged carers and assessed personal recovery of the users of ACT services. Discrepancy between carers and users is the rule. Clinicians are encouraged to embrace the discrepancy and diversity carers bring and learn the methodology of multi-informant assessments. There also is a need to address, update, and integrate the personal, familial, and relational aspects of recovery. Modification of recovery measures such as QPR and their creative use with carers has the potential to generate valuable third-party information and to involve them meaningfully in mental health services.
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Affiliation(s)
- Pravin Israel
- Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
- *Correspondence: Pravin Israel
| | - Torleif Ruud
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health, Department of Special Psychiatry, Akershus University Hospital, Lørenskog, Norway
| | - Bente Weimand
- Division of Mental Health, Department of Special Psychiatry, Akershus University Hospital, Lørenskog, Norway
- Department of Health, Social, and Welfare Studies, University of South-Eastern Norway, Kongsberg, Norway
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32
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Knittel AK, Ferguson EG, Jackson JB, Adimora AA. The influence of social relationships on PrEP attitudes among women with incarceration experience in the Southeastern USA. CULTURE, HEALTH & SEXUALITY 2023; 25:110-125. [PMID: 35015606 PMCID: PMC9271531 DOI: 10.1080/13691058.2021.2023760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
Women who have experienced incarceration face a disproportionately high risk of acquiring HIV. Despite efficacy of pre-exposure prophylaxis (PrEP) for HIV, very few women with incarceration histories are using PrEP. Our objective was to learn how sexual, drug-use and social relationships shape decisions about PrEP among women who have experienced incarceration. We used an inductive approach to analyse data from four focus groups undertaken with women who had previously experienced incarceration recruited from three community-based organisations. We identified public policy (medical distrust, lack of prevention in prisons and jails, and cost and coverage of PrEP); community (incarceration stigma, gossip as prevention); social and sexual network (positive peer and parenting relationships, distrust of sexual partners, and networks as a source of risk); and individual-level (active addiction or recovery, change after incarceration, and medical concerns) factors influencing the use of PrEP. Actions and interventions to improve PrEP uptake among women who have experienced incarceration must take account of the multilevel context of HIV prevention decisions.
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Affiliation(s)
- Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Ella G. Ferguson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jamie B. Jackson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Adaora A. Adimora
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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Krause KR, Edbrooke-Childs J, Bear HA, Calderón A, Wolpert M. What treatment outcomes matter most? A Q-study of outcome priority profiles among youth with lived experience of depression. Eur Child Adolesc Psychiatry 2023; 32:123-137. [PMID: 34273026 PMCID: PMC9908724 DOI: 10.1007/s00787-021-01839-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 06/28/2021] [Indexed: 12/16/2022]
Abstract
Interest in youth perspectives on what constitutes an important outcome in the treatment of depression has been growing, but limited attention has been given to heterogeneity in outcome priorities, and minority viewpoints. These are important to consider for person-centred outcome tracking in clinical practice, or when conducting clinical trials targeting specific populations. This study used Q-methodology to identify outcome priority profiles among youth with lived experience of service use for depression. A purposive sample of 28 youth (aged 16-21 years) rank-ordered 35 outcome statements by importance and completed brief semi-structured interviews eliciting their sorting rationales. By-person principal component analysis was used to identify outcome priority profiles based on all Q-sort configurations. Priority profiles were described and interpreted with reference to the qualitative interview data. Four distinct outcome priority profiles were identified: "Relieving distress and experiencing a happier emotional state"; "Learning to cope with cyclical distressing emotional states"; "Understanding and processing distressing emotional states"; and "Reduced interference of ongoing distressing emotional states with daily life". All four profiles prioritised improvements in mood and the ability to feel pleasure but differed in the level of importance assigned to learning coping skills, processing experiences, and the reduced interference of depression with life and identity. As part of a person-centered approach to care delivery, care providers should routinely engage young people in conversation and shared decision-making about the types of change they would like to prioritise and track during treatment, beyond a common core of consensus outcomes.
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Affiliation(s)
- Karolin Rose Krause
- Evidence Based Practice Unit (EBPU), Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK. .,Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT, UK. .,Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit (EBPU), Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH UK ,Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT UK
| | - Holly Alice Bear
- Evidence Based Practice Unit (EBPU), Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH UK ,Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT UK ,Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, M6J 1H4 UK
| | - Ana Calderón
- School of Psychology, Universidad Gabriela Mistral, Avda. Ricardo Lyon 1177, Providencia, Santiago, Chile
| | - Miranda Wolpert
- Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT UK ,Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE UK
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Levy-Fenner E, Colucci E, McDonough S. Lived Experiences of Mental Health Recovery in Persons of Culturally and Linguistically Diverse (CALD) Backgrounds within the Australian Context. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2022:1-26. [PMID: 36533215 PMCID: PMC9735058 DOI: 10.1007/s40737-022-00319-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/01/2022] [Indexed: 06/17/2023]
Abstract
Lived experience research related to mental health recovery is advancing, but there remains a lack of narrative material from the perspectives of people from under-represented, non-dominant cultural backgrounds in this domain. This study aimed to explore the lived experiences of mental health recovery in people of culturally and linguistically diverse (CALD) backgrounds in the Australian context. The current study involved a secondary analysis of audio and visual data collected during the digital storytelling project Finding our way in Melbourne, Australia. Thematic analysis was used to understand the lived experience narratives of nine participants in relation to mental health recovery. Five themes were identified through an iterative process of analysis, including Newfound opportunities and care, Family as key motivators and facilitators, Coping and generativity, Cultivating self-understanding and resilience, and Empowerment through social engagement. First person lived experience narratives offer deep insight into understanding the ways in which individuals of marginalised communities conceptualise and embody recovery. These findings further the literature and understanding on how to better serve the needs of people with mental health challenges from CALD communities through informed knowledge of what may be helpful to, and meaningful in, individuals' recoveries.
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Affiliation(s)
- E. Levy-Fenner
- Department of Psychology, Middlesex University, London, UK
| | - E. Colucci
- Department of Psychology, Middlesex University, London, UK
- Global and Cultural Mental Health Unit, The University of Melbourne, Melbourne, Australia
| | - S. McDonough
- Victorian Transcultural Mental Health, St. Vincent’s Hospital, Melbourne, Australia
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Australia
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Weetman C, Kiemle G, Lowe M, Balfour R. The Experience of Partner Relationships for Male Survivors of Childhood Sexual Abuse: A Qualitative Synthesis. TRAUMA, VIOLENCE & ABUSE 2022; 23:1478-1493. [PMID: 33729052 DOI: 10.1177/1524838021998311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Research has documented wide-ranging psychological impacts of childhood sexual abuse (CSA) for male survivors, but their experience of relationships is understudied. This qualitative review aimed to synthesize the qualitative literature concerning the experience of partner relationships for male CSA survivors. Electronic searches were conducted across PsycINFO, CINAHL, and PubMed, complemented by hand searches of references. Searches were limited to English-language peer-reviewed studies. Studies were included if they sampled adult male CSA survivors and reported qualitative data on their experience of partner relationships. Sixteen studies met the review criteria. Articles were quality-appraised using the Critical Appraisal Skills Programme qualitative checklist (2018), and narrative synthesis derived five themes: "sexual orientation confusion," "sexual intimacy difficulties," "the barrier of emotional intimacy," "navigating agency," and "healing and growth through love." Key findings were male CSA survivors can face considerable barriers to relational intimacy; however, romantic relationships also offer a space to heal and experience post-traumatic growth (PTG). Clinicians should be aware of the diffuse impacts CSA can have upon male survivors' intimate relationships. Helping survivors and their partners build a safe space in which to process CSA, reassert agency and relational boundaries, and express love and validation can support survivors toward PTG.
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Affiliation(s)
- Chloe Weetman
- Doctorate of Clinical Psychology Programme, 4591University of Liverpool, United Kingdom
| | - Gundi Kiemle
- Doctorate of Clinical Psychology Programme, 4591University of Liverpool, United Kingdom
| | - Michelle Lowe
- School of Education and Psychology, 1796University of Bolton, United Kingdom
| | - Robert Balfour
- Survivors West Yorkshire, University of Bradford, United Kingdom
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36
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Green B, García-Mieres H. Construing journeys to recovery from psychosis: A qualitative analysis of first-person accounts. Psychol Psychother 2022; 95:888-904. [PMID: 35670416 DOI: 10.1111/papt.12408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To perform a qualitative analysis of the factors that were construed as salient in facilitating the process of recovery in the narratives of people with psychosis who had their first-person accounts (FPAs) published in an academic journal. METHODS Computerized textual analysis was undertaken of 156 FPAs written by persons who had experienced psychosis and published in the Schizophrenia Bulletin between 1979 and 2020. Constructs were extracted from the FPAs and coded in terms of Mental health treatment and therapy, Self-management and Multiple factors; recovery processes (Connectedness, Hope, Identity, Meaning and Empowerment), Struggles and Turning points. RESULTS Psychosis impacted on individuals in profound and diverse ways. This was reflected in the different pathways to recovery included in the FPAs. Underlying the different pathways was the salience of re-engagement in the shared reality of others; development of a cohesive and positive self; empowerment through the use of self-management strategies, and making sense of experience through reconstruing what was meaningful. Personal constructs identified in the FPAs provided insight into both challenges faced and alternative avenues of movement that were perceived as available. CONCLUSIONS Processes that support individuals re-engaging with the shared reality of others are central to recovery. Supportive relationships and fostering open dialogue were consistent themes across the different pathways that recovery journeys took. Establishing a meaningful lifestyle and recovering a positive sense of identity were a key challenge following psychosis onset. Appreciation of experiences contained in FPAs has the potential to enhance the effectiveness and humanity of mental health care.
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Affiliation(s)
- Bob Green
- Independent Scholar, Formerly Statewide Forensic Mental Health Team, Queensland Forensic Mental Health Service, Brisbane, Qld, Australia
| | - Helena García-Mieres
- Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions M'ediques, Barcelona, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain.,Centro Investigación Biomédica en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Abstract
This perspective paper aims to present a personal viewpoint on the impact of psychiatric discourse on the principles of recovery in mental health care. Mental health services espouse these principles, yet psychiatric discourse remains the dominant model. A critical analysis will examine how psychiatry maintains this dominance. The aim is to examine how psychiatric discourse constructs both the nature of mental distress and its treatment, and how it maintains its power as the dominant authority and its relationship to recovery principles. The paper concludes that psychiatric discourse is the antithesis of recovery principles and that its authority is perpetuated through co-opting a medical explanatory model, claiming expertise in the ability to predict social risk, and maintaining a tightly controlled echo chamber. A way forward involves the dismantling of the hierarchical service delivery model based on psychiatric discourse and replacing it with a more horizontal service delivery model in which the lived experience of mental distress is central. Regular audit of services needs to prioritize recovery principles. The implications for mental health nursing are considered.
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Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Kotera Y, Rennick-Egglestone S, Ng F, Llewellyn-Beardsley J, Ali Y, Newby C, Fox C, Slade E, Bradstreet S, Harrison J, Franklin D, Todowede O, Slade M. Assessing diversity and inclusivity is the next frontier in mental health recovery narrative research and practice (Preprint). JMIR Ment Health 2022; 10:e44601. [PMID: 37067882 PMCID: PMC10152384 DOI: 10.2196/44601] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/24/2022] [Accepted: 01/01/2023] [Indexed: 01/02/2023] Open
Abstract
Demand for digital health interventions is increasing in many countries. The use of recorded mental health recovery narratives in digital health interventions is becoming more widespread in clinical practice. Mental health recovery narratives are first-person lived experience accounts of recovery from mental health problems, including struggles and successes over time. Helpful impacts of recorded mental health recovery narratives include connectedness with the narrative and validation of experiences. Possible harms include feeling disconnected and excluded from others. Diverse narrative collections from many types of narrators and describing multiple ways to recover are important to maximize the opportunity for service users to benefit through connection and to minimize the likelihood of harm. Mental health clinicians need to know whether narrative collections are sufficiently diverse to recommend to service users. However, no method exists for assessing the diversity and inclusivity of existing or new narrative collections. We argue that assessing diversity and inclusivity is the next frontier in mental health recovery narrative research and practice. This is important, but methodologically and ethically complex. In this viewpoint, we propose and evaluate one diversity and two inclusivity assessment methods. The diversity assessment method involves use of the Simpson Diversity Index. The two inclusivity assessment methods are based on comparator demographic rates and arbitrary thresholds, respectively. These methods were applied to four narrative collections as a case study. Refinements are needed regarding a narrative assessment tool in terms of its practicality and cultural adaptation.
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Affiliation(s)
- Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Yasmin Ali
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Chris Newby
- School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Fox
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Emily Slade
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Simon Bradstreet
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Julian Harrison
- Narrative Experiences Online Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Donna Franklin
- Narrative Experiences Online Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Olamide Todowede
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, Namsos, Norway
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Factors of Parental Preparation of Children with Mental Illnesses for Their Independent Living after Their Own Death. Healthcare (Basel) 2022; 10:healthcare10122360. [PMID: 36553884 PMCID: PMC9777822 DOI: 10.3390/healthcare10122360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
Families of children with mental illnesses are often concerned about living in the community after their parents' death. The cross-sectional study aimed to examine the association between how parents prepare adult children with mental illnesses to live independently after the death of the parent(s). The participants were 1112 members of 46 family support groups for mental illnesses in Tokyo, Japan. The age of the people with mental illness was 40s, and that of their parents was 70s. Logistic regression analysis showed that mothers' support in daily living, no income or pension for disabled people, staying at home during free time, and parental livelihood being the same as the person with mental illness were factors that were negatively associated with the independent living of people with mental illness. In contrast, parental participation in the family group and creating a system for securing regular living expenses of the person with mental illness were positively associated with independent living. The results suggest that parents need to promote their children's recovery and prepare them financially by forecasting their independent living after their own death.
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Baufeldt AL, Dawson DL. Mental Health Recovery Using the Individual Recovery Outcomes Counter (I.ROC) in a Community Rehabilitation Team: A Service Evaluation. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2022; 10:1-12. [PMID: 36407017 PMCID: PMC9668232 DOI: 10.1007/s40737-022-00315-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
There are many definitions of recovery in mental health. Community Rehabilitation Teams (CRTs) aim to support the mental health recovery of people. The Individual Recovery Outcomes Counter (I.ROC) is a way to measure recovery. To determine if being supported by a CRT helps mental health recovery for people transitioning from an inpatient service to the community. Individual reliable and clinically meaningful change indices were calculated for a total of 31 people. Two I.ROC questionnaires were completed by 31 people. Of these 31 people, 14 people had three completed I.ROC questionnaires. Of the 31 people, 17 showed a positive reliable change and three people made a clinically meaningful change. Of the 14 people, one had a positive reliable change, two had a negative reliable change, and no-one had a clinically meaningful change. The I.ROC shows the CRT to successfully support recovery in people with mental health difficulties.
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Affiliation(s)
| | - David L. Dawson
- College of Social Sciences, University of Lincoln, Lincoln, UK
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Bhattacharjee A, Williams JJ, Chou K, Tomlinson J, Meyerhoff J, Mariakakis A, Kornfield R. "I Kind of Bounce off It": Translating Mental Health Principles into Real Life Through Story-Based Text Messages. PROCEEDINGS OF THE ACM ON HUMAN-COMPUTER INTERACTION 2022; 6:398. [PMID: 36816014 PMCID: PMC9933887 DOI: 10.1145/3555123] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adopting new psychological strategies to improve mental wellness can be challenging since people are often unable to anticipate how new habits are applicable to their circumstances. Narrative-based interventions have the potential to alleviate this burden by illustrating psychological principles in an applied context. In this work, we explore how stories can be delivered via the ubiquitous and scalable medium of text messaging. Through formative work consisting of interviews and focus group discussions with 15 participants, we identified desirable elements of stories about mental health, including authenticity and relatability. We then deployed story-based text messages to 42 participants to explore challenges regarding both the stories' content (e.g., specific versus generalized) and format (e.g., story length). We observed that our stories helped participants reflect on and identify flaws in their thinking patterns. Our findings highlight design implications and opportunities for mental wellness interventions that utilize stories in text messaging services.
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Affiliation(s)
| | | | - Karrie Chou
- Rotman Commerce, University of Toronto, Canada
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Yamashita A, Yoshioka SI. Subjective recovery accounts of Japanese female patients suffering from alcohol use disorder. A phenomenological study. Perspect Psychiatr Care 2022; 58:2820-2827. [PMID: 35726722 DOI: 10.1111/ppc.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aimed to examine the subjective recovery accounts of Japanese female patients with alcohol use disorder (AUD) and the factors that affect their recovery. DESIGN AND METHODS This qualitative study used a phenomenological design. A focus group with 10 Japanese participants was conducted. FINDINGS Five theme clusters emerged: drinking to forget unpleasant feelings, fighting compulsive cravings with craving, unhealed wounds from past traumatic experiences, encounters with role models in self-help groups, and changing one's mindset to a proactive pursuit of happiness. PRACTICE IMPLICATIONS To support the recovery of women with AUD, psychiatric nurses should help them improve their family relationships, find recovery models, and proactively provide them with trauma-informed care.
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Affiliation(s)
- Ayako Yamashita
- School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Shin-Ichi Yoshioka
- School of Health Science, Faculty of Medicine, Tottori University, Yonago, Japan
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Llewellyn-Beardsley J, Rennick-Egglestone S, Pollock K, Ali Y, Watson E, Franklin D, Yeo C, Ng F, McGranahan R, Slade M, Edgley A. 'Maybe I Shouldn't Talk': The Role of Power in the Telling of Mental Health Recovery Stories. QUALITATIVE HEALTH RESEARCH 2022; 32:1828-1842. [PMID: 35979858 PMCID: PMC9511241 DOI: 10.1177/10497323221118239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Mental health 'recovery narratives' are increasingly used within teaching, learning and practice environments. The mainstreaming of their use has been critiqued by scholars and activists as a co-option of lived experience for organisational purposes. But how people report their experiences of telling their stories has not been investigated at scale. We present accounts from 71 people with lived experience of multiple inequalities of telling their stories in formal and informal settings. A reflexive thematic analysis was conducted within a critical constructivist approach. Our overarching finding was that questions of power were central to all accounts. Four themes were identified: (1) Challenging the status quo; (2) Risky consequences; (3) Producing 'acceptable' stories; (4) Untellable stories. We discuss how the concept of narrative power foregrounds inequalities in settings within which recovery stories are invited and co-constructed, and conclude that power imbalances complicate the seemingly benign act of telling stories of lived experience.
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Affiliation(s)
- Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | | | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Yasmin Ali
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Emma Watson
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Donna Franklin
- NEON Lived Experience Advisory Panel, University of Nottingham, Nottingham, UK
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | | | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Alison Edgley
- School of Health Sciences, University of Nottingham, Nottingham, UK
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44
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Koutná V, Blatný M, Jelínek M. Posttraumatic stress and growth in adolescent childhood cancer survivors: Links to quality of life. Front Psychol 2022; 13:992310. [PMID: 36160575 PMCID: PMC9505020 DOI: 10.3389/fpsyg.2022.992310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Pediatric cancer can be considered an event potentially leading to posttraumatic stress symptoms (PTSS) as well as posttraumatic growth (PTG). While clinically significant levels of PTSS are rare in childhood cancer survivors, PTG is common in this population. However, the relationship of PTG to overall adaptation and quality of life (QOL) in pediatric cancer patients is not clear. Therefore, our study aims to analyse the relationships of PTSS and PTG with QOL in childhood cancer survivors. In this study, 172 childhood cancer survivors completed measures of quality of life (Minneapolis-Manchester Quality of Life Scale; child and adolescent version), posttraumatic stress (UCLA PTSD Reaction Index for DMS-IV) and posttraumatic growth (Benefit Finding Scale for Children). Correlation analyses were carried out separately for the child (up to 13 years, N = 47) and adolescent (more than 13 years, N = 125) groups and each QOL dimension. In the adolescent group, the relationship of PTSS and PTG with QOL was further verified by regression analyses while controlling for age, gender, and time off treatment. In children, negative relationships between PTSS and QOL were found, but the relationships between QOL and PTG were not significant. In adolescents, significant relationships were found for all dimensions of QOL and PTSS and also for several dimensions of QOL and PTG. The relationships between PTSS and QOL dimensions were negative in both groups, and the relationships between PTG and QOL in the adolescent group were weakly positive. In adolescents, regression analyses controlling for age, gender and time off treatment were performed and confirmed a negative relationship of PTSS with all QOL dimensions except for social functioning. For PTG, regression analyses revealed a significant positive relationship with QOL dimensions of social functioning, outlook on life and intimate relations. While the relationship between PTSS and QOL is negative for almost all QOL dimensions in children and adolescents, the nature of the relationship between PTG and QOL appears to be more complex and changing over time. PTG in children may reflect different processes with different outcomes than PTG in adolescents.
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Affiliation(s)
- Veronika Koutná
- Institute of Psychology, Czech Academy of Sciences, Brno, Czechia
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
- *Correspondence: Veronika Koutná,
| | - Marek Blatný
- Institute of Psychology, Czech Academy of Sciences, Brno, Czechia
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Martin Jelínek
- Institute of Psychology, Czech Academy of Sciences, Brno, Czechia
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
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45
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Gamieldien F, Galvaan R, Myers B, Sorsdahl K. Service Providers Perspectives on Personal Recovery from Severe Mental Illness in Cape Town, South Africa: A Qualitative Study. Community Ment Health J 2022; 58:955-966. [PMID: 34671918 PMCID: PMC9187550 DOI: 10.1007/s10597-021-00904-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Abstract
Severe mental illnesses (SMI) contribute significantly to the global burden of disease. In low-and-middle-income countries (LMICs), the treatment gap impacts the clinical and personal recovery of people living with an SMI. The drive to reduce this treatment gap in LMICs makes it pertinent to understand service providers' views on recovery from SMI. Semi-structured interviews and focus groups with service providers from health services and non-profit organisations in the Western Cape Province, South Africa, were conducted in this qualitative study. Seventeen participants were purposively selected, and data were thematically analysed. Three major themes emerged: delineating recovery, available services supporting recovery from SMI, and facilitators and barriers to recovery at the service level. Health services favoured clinical over personal recovery. Participants thought that many service users' personal recovery from SMI was hindered by intersecting social, economic, cultural, and political inequalities that extended beyond the influence of the health sector.
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Affiliation(s)
- Fadia Gamieldien
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa. .,Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa.
| | - Roshan Galvaan
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Faculty of Health Sciences, Curtin enAble Institute, Curtin University, Perth, WA, Australia.,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa
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46
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Happell B, Sharrock J, Warner T, O'Donovan A, Hurley E, Gordon S. Changing 'the world for the better': motivations of mental health academics for supporting expert by experience roles in mental health education. J Ment Health 2022:1-8. [PMID: 35766312 DOI: 10.1080/09638237.2022.2091759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Despite demonstrating positive outcomes in education, academic positions for Experts by Experience in mental health have not been widely implemented. To date positions have been driven by individual champions (allies). Their motivation for this support has not yet been researched. AIMS To deepen understanding of motivations of mental health academics who have championed and supported implementation of EBE positions. METHODS A Qualitative exploratory, study was undertaken involving in-depth individual interviews with 16 academics with experience of actively supporting the implementation of Expert by Experience positions in academia. Data were analysed independently by two researchers using a structured thematic framework. RESULTS Motivations commonly arose from allies' own experiences of working with or exposure to Experts by Experience. Other motivating factors included: belief in the value of specific knowledge and expertise Experts by Experience contributed to mental health education; and, identifying the essential role Experts by Experience play in meeting policy expectations, and the broader philosophy of the university. CONCLUSIONS The motivations identified by allies in this study have implications for Expert by Experience roles. Deeper understanding of motivations to support these roles is essential to arguing for their value, and ultimately producing positive outcomes in the education of health professionals.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, and Hunter Institute of Medical Research, and Priority Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, Australia.,School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Julie Sharrock
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, Australia
| | - Terri Warner
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, Australia
| | - Aine O'Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Emma Hurley
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sarah Gordon
- Master of Culture, Health and Medicine (Advanced), Research Assistant, School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, Australia
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47
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Fusar-Poli P, Estradé A, Stanghellini G, Venables J, Onwumere J, Messas G, Gilardi L, Nelson B, Patel V, Bonoldi I, Aragona M, Cabrera A, Rico J, Hoque A, Otaiku J, Hunter N, Tamelini MG, Maschião LF, Puchivailo MC, Piedade VL, Kéri P, Kpodo L, Sunkel C, Bao J, Shiers D, Kuipers E, Arango C, Maj M. The lived experience of psychosis: a bottom-up review co-written by experts by experience and academics. World Psychiatry 2022; 21:168-188. [PMID: 35524616 PMCID: PMC9077608 DOI: 10.1002/wps.20959] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Psychosis is the most ineffable experience of mental disorder. We provide here the first co-written bottom-up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically-informed perspectives. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of psychosis as well as family members and carers, representing a global network of organizations. The material was complemented by semantic analyses and shared across all collaborators in a cloud-based system. The early phases of psychosis (i.e., premorbid and prodromal stages) were found to be characterized by core existential themes including loss of common sense, perplexity and lack of immersion in the world with compromised vital contact with reality, heightened salience and a feeling that something important is about to happen, perturbation of the sense of self, and need to hide the tumultuous inner experiences. The first episode stage was found to be denoted by some transitory relief associated with the onset of delusions, intense self-referentiality and permeated self-world boundaries, tumultuous internal noise, and dissolution of the sense of self with social withdrawal. Core lived experiences of the later stages (i.e., relapsing and chronic) involved grieving personal losses, feeling split, and struggling to accept the constant inner chaos, the new self, the diagnosis and an uncertain future. The experience of receiving psychiatric treatments, such as inpatient and outpatient care, social interventions, psychological treatments and medications, included both positive and negative aspects, and was determined by the hope of achieving recovery, understood as an enduring journey of reconstructing the sense of personhood and re-establishing the lost bonds with others towards meaningful goals. These findings can inform clinical practice, research and education. Psychosis is one of the most painful and upsetting existential experiences, so dizzyingly alien to our usual patterns of life and so unspeakably enigmatic and human.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley, London, UK
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Giovanni Stanghellini
- Department of Psychological, Territorial and Health Sciences, "G. d'Annunzio" University, Chieti, Italy
- Center for Studies on Phenomenology and Psychiatry, Medical Faculty, "D. Portales" University, Santiago, Chile
| | - Jemma Venables
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Juliana Onwumere
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Guilherme Messas
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | | | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Ana Cabrera
- Asociación Española de Apoyo en Psicosis, Madrid, Spain
| | - Joseba Rico
- Asociación Española de Apoyo en Psicosis, Madrid, Spain
| | - Arif Hoque
- Young Person's Mental Health Advisory Group (YPMHAG), King's College London, London, UK
| | - Jummy Otaiku
- Young Person's Mental Health Advisory Group (YPMHAG), King's College London, London, UK
| | - Nicholas Hunter
- NHS South London and Maudsley (SLaM) Recovery College, London, UK
| | - Melissa G Tamelini
- Institute of Psychiatry, Hospital das Clínicas de São Paulo, São Paulo, Brazil
| | - Luca F Maschião
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Mariana Cardoso Puchivailo
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- Department of Psychology, FAE University Center, Curitiba, Brazil
| | - Valter L Piedade
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Péter Kéri
- Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe), Brussels, Belgium
| | - Lily Kpodo
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Jianan Bao
- OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Forensic and Neurodevelopment Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health Trust, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- School of Medicine, Keele University, Staffordshire, UK
| | - Elizabeth Kuipers
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Tang JPS, Liu T, Lu S, Sing CY, Sze LCY, Lum TYS, Tse S. 'It was the deepest level of companionship': peer-to-peer experience of supporting community-dwelling older people with depression - a qualitative study. BMC Geriatr 2022; 22:443. [PMID: 35590279 PMCID: PMC9121547 DOI: 10.1186/s12877-022-03121-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an ample body of literature examining the experiences and outcomes of peer support services for mental health recovery in western countries. However, formal peer support is only recently adapted and piloted to alleviate depression among older people, and little is known about how the peer-to-peer model might be lived out in the older Chinese population. This qualitative study investigated peer supporters' (PS) perspectives of their roles and experiences of rendering formal peer support to community-dwelling older adults at risk of or living with depression in Hong Kong. METHODS The study adopted a qualitative design. Five semi-structured focus groups were conducted with 27 trained peer supporters between ages 54-74 (21 females and 6 males) who had provided peer-to-peer support to older adults at risk of or living with depression in the community for at least 12 months. Thematic analysis was employed to derive content and meanings from the focus group transcripts. RESULTS Participants' mean age was 61.9 years; two-thirds of them were retired and the rest still engaged in part-time or full-time employment. Four themes were identified in relations to the roles and experiences in rendering the peer support services: (1) peerness in health and age-related lived experiences; (2) companionship, social and emotional ties beyond formal support; (3) meaningful roles to facilitate older people's functional ability; and (4) hopes and actions against the undesirable outcomes of aging. Being a PS might provide meaningful roles for persons in transition to or living in late adulthood, and enable community-dwelling older adults with depression to maintain functional ability. On the other hand, defining the concept of 'peer' beyond the shared experience of mental distress, ensuring a healthy boundary between the peers and the service users, maintaining a careful balance between time-limited formal support and stable social ties, and providing self-management training and on-going support appear crucial. CONCLUSIONS This study of PS' perspectives and experiences offer insights into the age-specific dimension of the peer relationship. Despite the promising effects it might offer, careful implementation of peer support among older adults is warranted to safeguard against the ensuing loss of meaningful social ties and the potential emotional distress.
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Affiliation(s)
- Jessica P S Tang
- Department of Social Work and Social Administration, The University of Hong Kong, Room 520, 5/F., The Jockey Club Tower, Centennial Campus, Pokfulam Road, Hong Kong, China
| | - Tianyin Liu
- Department of Social Work and Social Administration, The University of Hong Kong, Room 520, 5/F., The Jockey Club Tower, Centennial Campus, Pokfulam Road, Hong Kong, China
| | - Shiyu Lu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - C Y Sing
- Department of Social Work and Social Administration, The University of Hong Kong, Room 520, 5/F., The Jockey Club Tower, Centennial Campus, Pokfulam Road, Hong Kong, China
| | - Lesley C Y Sze
- Department of Social Work and Social Administration, The University of Hong Kong, Room 520, 5/F., The Jockey Club Tower, Centennial Campus, Pokfulam Road, Hong Kong, China
| | - Terry Y S Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Room 520, 5/F., The Jockey Club Tower, Centennial Campus, Pokfulam Road, Hong Kong, China.,Sau Po Centre on Aging, The University of Hong Kong, Hong Kong, China
| | - Samson Tse
- Department of Social Work and Social Administration, The University of Hong Kong, Room 520, 5/F., The Jockey Club Tower, Centennial Campus, Pokfulam Road, Hong Kong, China.
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49
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Subhani M, Talat U, Knight H, Morling JR, Jones KA, Aithal GP, Ryder SD, Llewellyn-Beardsley J, Rennick-Egglestone S. Characteristics of alcohol recovery narratives: Systematic review and narrative synthesis. PLoS One 2022; 17:e0268034. [PMID: 35511789 PMCID: PMC9070949 DOI: 10.1371/journal.pone.0268034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Narratives of recovery from alcohol misuse have been analysed in a range of research studies. This paper aims to produce a conceptual framework describing the characteristics of alcohol misuse recovery narratives that are in the research literature, to inform the development of research, policy, and practice. METHODS Systematic review was conducted following PRISMA guidelines. Electronic searches of databases (Ovid MEDLINE, EMBASE, CINHAL, PsychInfo, AMED and SCOPUS), grey literature, and citation searches for included studies were conducted. Alcohol recovery narratives were defined as "first-person lived experience accounts, which includes elements of adversity, struggle, strength, success, and survival related to alcohol misuse, and refer to events or actions over a period of time". Frameworks were synthesised using a three-stage process. Sub-group analyses were conducted on studies presenting analyses of narratives with specific genders, ages, sexualities, ethnicities, and dual diagnosis. The review was prospectively registered (PROSPERO CRD42021235176). RESULTS 32 studies were included (29 qualitative, 3 mixed-methods, 1055 participants, age range 17-82years, 52.6% male, 46.4% female). Most were conducted in the United States (n = 15) and Europe (n = 11). No included studies analysed recovery narratives from lower income countries. Treatment settings included Alcoholic Anonymous (n = 12 studies), other formal treatment, and 'natural recovery'. Eight principle narrative dimensions were identified (genre, identity, recovery setting, drinking trajectory, drinking behaviours, stages, spirituality and religion, and recovery experience) each with types and subtypes. All dimensions were present in most subgroups. Shame was a prominent theme for female narrators, lack of sense of belonging and spirituality were prominent for LGBTQ+ narrators, and alienation and inequality were prominent for indigenous narrators. CONCLUSIONS Review provides characteristics of alcohol recovery narratives, with implications for both research and healthcare practice. It demonstrated knowledge gaps in relation to alcohol recovery narratives of people living in lower income countries, or those who recovered outside of mainstream services. PROTOCOL REGISTRATION Prospero registration number: CRD42020164185.
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Affiliation(s)
- Mohsan Subhani
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Usman Talat
- Alliant Manchester Business School, University of Manchester, Manchester, England
| | - Holly Knight
- Population and Lifespan Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Joanne R. Morling
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
- Population and Lifespan Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Katy A. Jones
- School of Medicine, Applied Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Guruprasad P. Aithal
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Stephen D. Ryder
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
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50
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Charles A, Hare-Duke L, Nudds H, Franklin D, Llewellyn-Beardsley J, Rennick-Egglestone S, Gust O, Ng F, Evans E, Knox E, Townsend E, Yeo C, Slade M. Typology of content warnings and trigger warnings: Systematic review. PLoS One 2022; 17:e0266722. [PMID: 35507551 PMCID: PMC9067675 DOI: 10.1371/journal.pone.0266722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 03/25/2022] [Indexed: 11/28/2022] Open
Abstract
Content and trigger warnings give information about the content of material prior to receiving it. Different typologies of content warnings have emerged across multiple sectors, including health, social media, education and entertainment. Benefits arising from their use are contested, with recent empirical evidence from educational sectors suggesting they may raise anxiety and reinforce the centrality of trauma experience to identity, whilst benefits relate to increased individual agency in making informed decisions about engaging with content. Research is hampered by the absence of a shared inter-sectoral typology of warnings. The aims of this systematic review are to develop a typology of content warnings and to identify the contexts in which content warnings are used. The review was pre-registered (ID: CRD42020197687, URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020197687) and used five sources: electronic databases covering multiple sectors (n = 19); table of contents from multi-sectoral journals (n = 5), traditional and social media websites (n = 53 spanning 36 countries); forward and backward citation tracking; and expert consultation (n = 15). In total, 6,254 documents were reviewed for eligibility and 136 documents from 32 countries were included. These were synthesised to develop the Narrative Experiences Online (NEON) content warning typology, which comprises 14 domains: Violence, Sex, Stigma, Disturbing content, Language, Risky behaviours, Mental health, Death, Parental guidance, Crime, Abuse, Socio-political, Flashing lights and Objects. Ten sectors were identified: Education, Audio-visual industries, Games and Apps, Media studies, Social sciences, Comic books, Social media, Music, Mental health, and Science and Technology. Presentation formats (n = 15) comprised: education materials, film, games, websites, television, books, social media, verbally, print media, apps, radio, music, research, DVD/video and policy document. The NEON content warning typology provides a framework for consistent warning use and specification of key contextual information (sector, presentation format, target audience) in future content warning research, allowing personalisation of content warnings and investigation of global sociopolitical trends over time.
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Affiliation(s)
- Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
| | - Laurie Hare-Duke
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Hannah Nudds
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Donna Franklin
- Narrative Experience Online Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Onni Gust
- Department of History, University of Nottingham, Nottingham, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Elizabeth Evans
- School of Cultures, Languages, and Area Studies, University of Nottingham, Nottingham, United Kingdom
| | - Emily Knox
- School of Information Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
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