Taking the plunge: Service users’ experiences of hope within the mental health and substance use services

Exploring individuals' experiences of hope in mental health recovery: Having a sense of possibility

WHAT IS KNOWN ON THE SUBJECT?: Mental health recovery is acknowledged as a process of transformation and a way of living a meaningful life despite the presence of mental ill-health. Experiencing hope has been articulated as intrinsic to service users experience of a meaningful life. The social construction of mental illness and stigma are recognised as barriers to experiencing hope. Mental health professionals have responsibility to positively influence the experience of hope. WHAT THIS ARTICLE ADDS TO EXISTING KNOWLEDGE?: Individuals in mental health recovery experience hope as the embodiment of having a sense of possibility in life. Individuals' sense of possibility in life is underpinned by a belief and confidence that they will be ok. This belief is informed by 'feeling safe' and 'feeling connected'. This article generates an increased understanding of the dynamic relational processes that unpin hope generation. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Mental health stakeholders need to be more explicit in exploring 'hope' and uncovering its therapeutic potential. Mental health practitioners need skill in enabling individuals to feel safe and connected while understanding its role in cultivating hope. ABSTRACT: Introduction The experience of hope is widely acknowledged and empirically supported as a key catalyst of mental health recovery. Lived experience accounts of hope are critical in accessing data on what has been termed a nebulous concept. This article is the second presentation of data from this study and provides further context to improve understanding of hope and optimise its therapeutic potential. Aim To explore how individuals describe and make sense of their experience of hope in mental health recovery. Method A qualitative Interpretative Phenomenological Analysis (IPA) approach was used. Results This article explores the second of three experiential group themes: Hope as Having a sense of possibility 'I will be ok' which is informed by feeling safe and feeling connected. Discussion Having a sense of possibility is easier when basic needs are met and people feel connected to self, others and the universe. The use of creativity as a pathway to the imagination is positively experienced. The role of family, friends and healthcare professionals as hope reservoirs is critical. Finally, the framing of medication use emerged as significant. Implications for Practice It is important that all stakeholders appreciate the interpretation of hope and use the understanding and skill in harnessing its therapeutic potential.

Hope as experienced by people with acquired brain injury in a rehabilitation-or recovery process: a qualitative systematic review and thematic synthesis

Background

There has been an increasing interest in the concept of hope within the field of brain injury rehabilitation. Existing reviews have nevertheless focused on stroke, leaving out the broad population of people with acquired brain injury (ABI). Furthermore a majority of the included studies in those reviews excluded the subgroup of people with communication difficulties, thus primarily giving voice to a select group of people with ABI.

Methods

A qualitative systematic review was conducted with the purpose of systematically reviewing and thematically synthesise findings about hope as experienced by adults with ABI in a rehabilitation or recovery process. The search strategy included peer-reviewed qualitative studies published after 2000 in English or Scandinavian languages. Searches of EBSCO databases incorporating CINAHL, MEDLINE, and PsycINFO were conducted together with SocINDEX, Social Work Abstracts, Eric and Web of Science. Ten qualitative studies were included, and the Critical Appraisal Skills Program (CASP) was used for assessing the quality and relevance of the ten studies. Qualitative findings were synthesized using Thomas and Harden's methodology.

Results

Through a thematic synthesis eleven subthemes were identified relating to experiences of hope. These were grouped into four analytical themes: (1) hope a two folded phenomenon; (2) time and temporality; (3) progress, goals and visibility and (4) the alliance; a balancing act requiring good communication skills.

Conclusion

This review has shown that even though hope has both a positive and negative side to it, it is necessary as a driving force for people with ABI in terms of supporting them to keep going and not give up. Rehabilitation professionals are advised to embrace the ambiguity of hope, customizing the support of hope to each person with ABI. Attention is needed on how to make progress visible for persons with ABI during their rehabilitation process just as rehabilitation professionals should acknowledge the alliance with the person with ABI as a core component of rehabilitation. This requires a focus on professionals' communication skills if hope promoting relationships between professionals and persons with ABI are to be achieved.

Exploring individuals' experiences of hope in mental health recovery: An interpretative phenomenological analysis

WHAT IS KNOWN ON THE SUBJECT?: The delivery of mental health recovery orientated acre is a requirement of mental health professionals and an acknowledged desired outcome for individuals presenting with mental health issues. Hope has been recognized as one of 5 key processes of mental health recovery, and critically as the key catalyst of recovery. Mental health nurses are required to be competent in cultivating service user hope. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Novel exploration of how people described and made sense of the lived experience of hope in mental health recovery. Participants described hope as intrinsic to life in the context of its ability to cultivate desire and provide energy for life and living. Participants with experience of attempts to end life had a very clear concept of hope as missing at these times. Participants described the concept of hope as present but hidden to explain their survival through tortuous circumstances. The themes generated contribute to a greater understanding of the dynamic role and process of hope in mental health recovery. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Mental health practitioners need to be competent in understanding and cultivating hope as part of a person-centred approach, embedded in a therapeutic relationship. All stakeholders including service users, mental health nurses and educators need a more accessible reified dialogue of "hope" that harnesses its therapeutic potential. ABSTRACT: Introduction Mental health services have embraced the philosophy and practice of recovery. Research has confirmed hope as a micro-process of recovery. The lived experience of hope has received scant attention. This is required to improve understanding and optimize its therapeutic potential. Aim To explore how individuals describe and make sense of their experience of hope in mental health recovery. Method A qualitative interpretative phenomenological analysis (IPA) approach was used. The sample was accessed via email networks. Data were generated through semi-structured interviews and analysed using an IPA framework. Results Three superordinate themes emerged: "Without it we would wither up and die"-Hope as intrinsic to life; "I will be ok"-Having a sense of possibility and "Making it happen"-Moving forward. Individuals referenced hope by its absence when attempts were made to end life, and as present but hidden in tortuous circumstances. Discussion Individuals were more familiar with the concept of hopelessness, had a ready-to-hand vocabulary of "having no hope" and used this by default to inform what hope meant. Implications for Practice It is important that all stakeholders appreciate the context specific interpretation of hope and cultivate dialogue and understanding to harness its therapeutic potential.

How do Mental Health Services Foster Hope? Experience of People Accessing Services

Hope is essential to mental health recovery, yet little is known about how mental health services can foster hope. This paper addresses the question: How can mental health services influence the sense of hope experienced by people who access their services? Sixty-one people who accessed a new mental health service were interviewed about their experiences, including about how the service had influenced their sense of hope. Interviews were analysed using constant comparative analysis. The data revealed that hope increased when people perceived positive changes in themselves and their circumstances: developing new understandings and perspectives; having effective strategies to manage challenges; seeing progress or having plans; and having support. Changes were attributed to three major features of the service: accessibility; staff competence and wisdom; and caring interactions. The findings highlight that, while individual clinicians are important, other interactions with services and the wider service context are also critical for facilitating hope.

Experiences of Hope after Treatment of Hepatitis C Infection-A Qualitative Study

The aim of this study was to explore the experiences of hope people had after undergoing treatment for a hepatitis C virus infection (HCV). Between October 2019 and May 2020, 19 one-on-one interviews were conducted with people who inject drugs and had undergone HCV treatment. All participants had completed treatment and were documented as being virus-free. Data were audio recorded and then transcribed verbatim and analysed; a method inspired by reflexive thematic analysis. Those interviewed conveyed rich and nuanced descriptions of experiences of a life with HCV. Through the course of the analysis we developed four themes. The themes were formulated as metaphors aimed at capturing commonalities about how the participants seemed to "turn their gaze" after receiving HCV treatment: (1) turning their gaze backward; (2) turning their gaze inwards; (3) turning their gaze toward others and (4) turning their gaze forward. Participants' descriptions of their experiences relating to HCV were somewhat gloomy, and HCV treatment seemed to inspire hope and a brighter outlook on several areas of life.

'Not at all what I had expected': Discontinuing treatment with extended-release naltrexone (XR-NTX): A qualitative study

BACKGROUND

Extended-release naltrexone (XR-NTX), an opioid antagonist, has demonstrated equal treatment outcomes, in terms of safety, opioid use, and retention, to the recommended OMT medication buprenorphine. However, premature discontinuation of XR-NTX treatment is still common and poorly understood. Research on patient experiences of XR-NTX treatment is limited. We sought to explore participants' experiences with discontinuation of treatment with XR-NTX, particularly motivation for XR-NTX, experiences of initiation and treatment, and rationale for leaving treatment.

METHODS

We conducted qualitative, semi-structured interviews with participants from a clinical trial of XR-NTX. The study participants (N = 13) included seven women and six men with opioid dependence, who had received a minimum of one and maximum of four injections of XR-NTX. The study team analyzed transcribed interviews, employing thematic analysis with a critical realist approach.

FINDINGS

The research team identified three themes, and we present them as a chronological narrative: theme 1: Entering treatment - I thought I knew what I was going into; theme 2: Life with XR-NTX - I had something in me that I didn't want; and theme 3: Leaving treatment - I want to go somewhere in life. Patients' unfulfilled expectations of how XR-NTX would lead to a better life were central to decisions about discontinuation, including unexpected physical, emotional, or mental reactions as well as a lack of expected effects, notably some described an opioid effect from buprenorphine. A few participants ended treatment because they had reached their treatment goal, but most expressed disappointment about not achieving this goal. Some also expressed renewed acceptance of OMT. The participants' motivation for abstinence from illegal substances generally remained.

CONCLUSION

Our findings emphasize that a dynamic understanding of discontinuation of treatment is necessary to achieve a long-term approach to recovery: the field should understand discontinuation as a feature of typical treatment trajectories, and discontinuation can be followed by re-initiation of treatment.

Part I: Dynamics of Recovery: A Meta-Synthesis Exploring the Nature of Mental Health and Substance Abuse Recovery

Recovery-oriented care has become a leading vision across countries. To develop services and communities in more recovery-oriented directions, enhanced understandings of recovery in terms of personal and social contexts are important prerequisites. The aim of this study is to explore the nature and characteristics of the experiences of recovery. The method used is a form of qualitative meta-synthesis that integrates the findings from multiple qualitative studies published by one research group. Twenty-eight empirical papers with a focus on recovery as personal and contextual experiences were included in this meta-synthesis. Five meta-themes were developed: (a) being normal, (b) respecting and accepting oneself, (c) being in control, (d) recovery as intentional, and (e) recovery as material and social. The themes describe how recovery encompasses dynamics between personal experiences and contextual dimensions. This meta-synthesis consolidated an understanding of recovery as dynamics of the self and others, and as dynamics of the self and material resources. This understanding of recovery suggests the need to work not only with the person, but also with families, networks, social systems, and local communities, thus developing mental health and substance abuse services in more collaborative, open-ended, and context-sensitive directions.

Part II: Living Life: A Meta-Synthesis Exploring Recovery as Processual Experiences

Recovery, a prominent concern in mental health care worldwide, has been variously defined, requiring further clarification of the term as processual. Few studies have comprehensively addressed the nature of recovery processes. This study aims to explore the nature and characteristics of experiences of recovery as processual. The method used is a form of qualitative meta-synthesis that integrates the findings from 28 qualitative studies published during the past 15 years by one research group. Three meta-themes were developed: (a) recovery processes as step-wise, cyclical, and continuous, (b) recovery as everyday experiences, and (c) recovery as relational. These themes describe how recovery is intertwined with the way life in general unfolds in terms of human relationships, learning, coping, and ordinary everyday living. This meta-synthesis consolidates an understanding of recovery as fundamental processes of living in terms of being, doing, and accessing. These processes are contextualized in relation to mental health and/or substance abuse problems and highlight the need for support to facilitate the person's access to necessary personal, social, and material resources to live an ordinary life in recovery.

What role does employment play in dual recovery? A qualitative meta-synthesis of cross-cutting studies treating substance use treatment, psychiatry and unemployment services

Purpose

The role of employment in dual recovery from mental illness and substance use is scarcely addressed in previous studies and a deeper understanding of this issue is needed. The purpose of this paper is to cast further light on the conditions that either facilitate or block the road to employment for dually diagnosed people (DDP) and how these conditions could either promote or hinder recovery.

Design/methodology/approach

Drawing on the principles laid out by health researchers Sandelowski and Barroso (2007), the study is designed as a qualitative meta-synthesis comprising a systematic literature search, a critical assessment of the identified studies and an integrative synthesis of the articles’ findings.

Findings

The synthesis outlines that the findings from the seven identified studies show a recovery process in which unemployed, DDP are becoming employed people – or where there is an attempt to restore their status as working persons – and how this process is driven or hindered by personal, interpersonal and systemic facilitators or barriers.

Research limitations/implications

The synthesis adds nuances to the understanding of employment in dual recovery processes and suggests that unconnected means of, and goals for, intervention among these individuals and systems might reduce the chances of DDP obtaining and maintaining a job.

Originality/value

The paper calls for more advanced research and policy on the multiple – and often contradictory – aspects of gaining and maintaining employment as part of dually diagnosed persons’ recovery.

Experiences of Professional Helping Relations by Persons with Co-occurring Mental Health and Substance Use Disorders

Recovery in co-occurring mental health and substance use disorders often involves relationships with professional helpers, yet little is known about how these are experienced by service users. The aim of this study was to explore and describe behaviour and attributes of professional helpers that support recovery, as experienced by persons with co-occurring disorders. Within a collaborative approach, in-depth individual interviews with eight persons with lived experience of co-occurring disorders were analysed using systematic text condensation. The analysis yielded four categories of recovery-supporting behaviour and attributes of professional helpers and the ability to build trust cuts across all of them: Building trust through (a) hopefulness and loving concern, (b) commitment, (c) direct honesty and expectation and (d) action and courage. Services should allow for flexibility and continuity, and training should recognise the importance of establishing trust in order to reach out to this group.

You never know what’s around the next corner: exploring practitioners ' hope inspiring practices

Purpose

– Hope is regarded central to recovery in a broad range of health conditions including mental health and substance use problems. Still the phenomenon, along with its implications to research and practice, has gained limited attention. The purpose of this paper is to explore first-person accounts of how practitioners nurture and inspire hope.

Design/methodology/approach

– This qualitative study is part of a larger action research project. Data were collected using in-depth interviews with eight participants. The interviews were transcribed verbatim and analyzed applying thematic analysis.

Findings

– Hope was perceived as a central phenomenon to practitioners within mental health and substance use services. The following overarching themes were identified through thematic analysis: “Believing in oneself and others,” “Seeing and acknowledging opportunities” and “maneuvering towards hope.”

Research limitations/implications

– It seems that there is a need for extending knowledge in how practitioners may inspire hope. In addition there seems to be a need for developing more knowledge on how practitioners’ own hope may be nurtured within a system that is constantly undergoing change and new demands.

Practical implications

– Participants considered their own hope as a prerequisite in being able to hope on behalf of others and strategies for inspiring hope were presented on both an individual and system level. Working conditions and challenges within the service system in itself entailed challenges, which at times made nurturing hope difficult. Systems need to embrace flexibility and openness, allowing efforts aimed at inspiring hope to be made. In addition, practitioner’s own hope and the importance of nurturing it, needs to be acknowledged within services. Hope needs to be viewed as a joint venture, in context and in relation to others.

Originality/value

– The paper contributes to the knowledge base on hope inspiring practices within a field sometimes associated with challenges and despair. It points out some important preconditions in relation to the challenges practitioners might encounter, both on an individual level and in relation to the service system per se.