1
|
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. Qual Health Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
2
|
McGranahan R, Jakaite Z, Edwards A, Rennick-Egglestone S, Slade M, Priebe S. Living with Psychosis without Mental Health Services: A Narrative Interview Study. BMJ Open 2021; 11:e045661. [PMID: 34281919 PMCID: PMC8291296 DOI: 10.1136/bmjopen-2020-045661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Little research has looked at how people who do not use mental health services experience psychosis. Thus, the present study aimed to explore the experiences and views of people with psychosis who have neither sought nor received support from mental health services for at least 5 years. DESIGN A narrative interview study. Thematic analysis was used to analyse the data. SETTING England. PARTICIPANTS Twenty-eight participants with self-defined psychotic experiences were asked to provide a free narrative about their experiences. RESULTS Five themes were identified: (1) Perceiving psychosis as positive; (2) Making sense of psychotic experiences as a more active psychological process to find explanations and meaning; (3) Finding sources of strength, mainly in relationships and the environment, but outside of services; (4) Negative past experiences of mental health services, leading to disengagement and (5) Positive past experiences with individual clinicians, as an appreciation of individuals despite negative views of services as a whole. CONCLUSIONS Perceiving psychosis as something positive, a process of making sense of psychotic experiences and the ability to find external sources of strength all underpin-in addition to negative experiences with services-a choice to live with psychosis outside of services. Future research may explore to what extent these perceptions, psychological processes and abilities can be facilitated and strengthened, in order to support those people with psychosis who do not seek treatment and possibly also some of those who are in treatment.
Collapse
Affiliation(s)
- Rose McGranahan
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - Zivile Jakaite
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - Alice Edwards
- Newham Centre for Mental Health, East London NHS Foundation Trust, London, UK
| | | | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| |
Collapse
|
3
|
Hui A, Rennick-Egglestone S, Franklin D, Walcott R, Llewellyn-Beardsley J, Ng F, Roe J, Yeo C, Deakin E, Brydges S, Penas Moran P, McGranahan R, Pollock K, Thornicroft G, Slade M. Institutional injustice: Implications for system transformation emerging from the mental health recovery narratives of people experiencing marginalisation. PLoS One 2021; 16:e0250367. [PMID: 33861807 PMCID: PMC8051813 DOI: 10.1371/journal.pone.0250367] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/06/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Institutional injustice refers to structures that create disparities in resources, opportunities and representation. Marginalised people experience institutional injustice, inequalities and discrimination through intersecting personal characteristics and social circumstances. This study aimed to investigate sources of institutional injustice and their effects on marginalised people with experience of mental health problems. METHODS Semi-structured interviews were conducted with 77 individuals from marginalised groups with experience of mental health problems, including psychosis, Black, Asian and minority ethnic (BAME) populations, complex needs and lived experience as a work requirement. These were analysed inductively enabling sensitising concepts to emerge. FINDINGS Three processes of institutional injustice were identified: not being believed because of social status and personal backgrounds; not being heard where narratives did not align with dominant discourses, and not being acknowledged where aspects of identity were disregarded. Harmful outcomes included disengagement from formal institutions through fear and mistrust, tensions and reduced affiliation with informal institutions when trying to consolidate new ways of being, and damaging impacts on mental health and wellbeing through multiple oppression. CONCLUSIONS Institutional injustice perpetuates health inequalities and marginalised status. Master status, arising from dominant discourses and heuristic bias, overshadow the narratives and experiences of marginalised people. Cultural competency has the potential to improve heuristic availability through social understandings of narrative and experience, whilst coproduction and narrative development through approaches such as communities of practice might offer meaningful avenues for authentic expression.
Collapse
Affiliation(s)
- Ada Hui
- 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
| | - Donna Franklin
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Rianna Walcott
- Department of Digital Humanities, King’s College London, London, 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
| | - James Roe
- National Institute for Health Research, ARC East Midlands, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Emilia Deakin
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Brydges
- School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
| | - Patricia Penas Moran
- Department of Personality, Assessment and Psychological Treatment, University of Deusto, Bilbo, Spain
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Graham Thornicroft
- Centre for Global Mental Health and 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
| |
Collapse
|
4
|
Yeo C, Hare-Duke L, Rennick-Egglestone S, Bradstreet S, Callard F, Hui A, Llewellyn-Beardsley J, Longden E, McDonough T, McGranahan R, Ng F, Pollock K, Roe J, Slade M. The VOICES Typology of Curatorial Decisions in Narrative Collections of the Lived Experiences of Mental Health Service Use, Recovery, or Madness: Qualitative Study. JMIR Ment Health 2020; 7:e16290. [PMID: 32945771 PMCID: PMC7532459 DOI: 10.2196/16290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Collections of lived experience narratives are increasingly used in health research and medical practice. However, there is limited research with respect to the decision-making processes involved in curating narrative collections and the work that curators do as they build and publish collections. OBJECTIVE This study aims to develop a typology of curatorial decisions involved in curating narrative collections presenting lived experiences of mental health service use, recovery, or madness and to document approaches selected by curators in relation to identified curatorial decisions. METHODS A preliminary typology was developed by synthesizing the results of a systematic review with insights gained through an iterative consultation with an experienced curator of multiple recovery narrative collections. The preliminary typology informed the topic guide for semistructured interviews with a maximum variation sample of 30 curators from 7 different countries. All participants had the experience of curating narrative collections of the lived experiences of mental health service use, recovery, or madness. A multidisciplinary team conducted thematic analysis through constant comparison. RESULTS The final typology identified 6 themes, collectively referred to as VOICES, which stands for values and motivations, organization, inclusion and exclusion, control and collaboration, ethics and legal, and safety and well-being. A total of 26 subthemes related to curation decisions were identified. CONCLUSIONS The VOICES typology identifies the key decisions to consider when curating narrative collections about the lived experiences of mental health service use, recovery, or madness. It might be used as a theoretical basis for a good practice resource to support curators in their efforts to balance the challenges and sometimes conflicting imperatives involved in collecting, organizing, and sharing narratives. Future research might seek to document the use of such a tool by curators and hence examine how best to use VOICES to support decision making.
Collapse
Affiliation(s)
- Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Laurie Hare-Duke
- 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
| | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Felicity Callard
- School of Geographical & Earth Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ada Hui
- 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
| | - Eleanor Longden
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Tracy McDonough
- Department of Psychology, Mount St. Joseph University, Cincinnati, OH, United States
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Fiona Ng
- 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
| | - James Roe
- National Institute for Health Research, ARC East Midlands, University of Nottingham, Nottingham, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
5
|
Killaspy H, Priebe S, McPherson P, Zenasni Z, Greenberg L, McCrone P, Dowling S, Harrison I, Krotofil J, Dalton-Locke C, McGranahan R, Arbuthnott M, Curtis S, Leavey G, Shepherd G, Eldridge S, King M. Predictors of moving on from mental health supported accommodation in England: national cohort study. Br J Psychiatry 2020; 216:331-337. [PMID: 31046864 DOI: 10.1192/bjp.2019.101] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Around 60 000 people in England live in mental health supported accommodation. There are three main types: residential care, supported housing and floating outreach. Supported housing and floating outreach aim to support service users in moving on to more independent accommodation within 2 years, but there has been little research investigating their effectiveness. AIMS A 30-month prospective cohort study investigating outcomes for users of mental health supported accommodation. METHOD We used random sampling, accounting for relevant geographical variation factors, to recruit 87 services (22 residential care, 35 supported housing and 30 floating outreach) and 619 service users (residential care 159, supported housing 251, floating outreach 209) across England. We contacted services every 3 months to investigate the proportion of service users who successfully moved on to more independent accommodation. Multilevel modelling was used to estimate how much of the outcome and cost variations were due to service type and quality, after accounting for service-user characteristics. RESULTS Overall 243/586 participants successfully moved on (residential care 15/146, supported housing 96/244, floating outreach 132/196). This was most likely for floating outreach service users (versus residential care: odds ratio 7.96, 95% CI 2.92-21.69, P < 0.001; versus supported housing: odds ratio 2.74, 95% CI 1.01-7.41, P < 0.001) and was associated with reduced costs of care and two aspects of service quality: promotion of human rights and recovery-based practice. CONCLUSIONS Most people do not move on from supported accommodation within the expected time frame. Greater focus on human rights and recovery-based practice may increase service effectiveness.
Collapse
Affiliation(s)
- Helen Killaspy
- Professor of Rehabilitation Psychiatry, Division of Psychiatry, University College London, UK
| | - Stefan Priebe
- Professor of Social and Community Psychiatry, Unit for Social and Community Psychiatry, Queen Mary University of London, Newham Centre for Mental Health, UK
| | - Peter McPherson
- Research Associate, Division of Psychiatry, University College London, UK
| | - Zohra Zenasni
- Statistician, Pragmatic Clinical Trials Unit, Queen Mary University London, Blizard Institute, Barts and The London School of Medicine and Dentistry, UK
| | - Lauren Greenberg
- Statistician, Pragmatic Clinical Trials Unit, Queen Mary University London, Blizard Institute, Barts and The London School of Medicine and Dentistry, UK
| | - Paul McCrone
- Professor of Health Economics, King's Health Economics, King's College London, UK
| | - Sarah Dowling
- Project Manager, Division of Psychiatry, University College London, UK
| | - Isobel Harrison
- Research Associate, Division of Psychiatry, University College London, UK
| | - Joanna Krotofil
- Research Associate, Division of Psychiatry, University College London, UK
| | | | - Rose McGranahan
- Research Assistant, Unit for Social and Community Psychiatry, Queen Mary University of London, Newham Centre for Mental Health, UK
| | - Maurice Arbuthnott
- Service User Representative, North London Service-User Research Forum, Division of Psychiatry, University College London, UK
| | - Sarah Curtis
- Professor Emerita, Department of Geography, Durham University, UK
| | - Gerard Leavey
- Director, Bamford Centre for Mental Health and Wellbeing, University of Ulster, Northern Ireland
| | | | - Sandra Eldridge
- Professor of Biostatistics, Pragmatic Clinical Trials Unit, Queen Mary University London, Blizard Institute, Barts and The London School of Medicine and Dentistry, UK
| | - Michael King
- Professorial Research Associate, Division of Psychiatry, University College London, UK
| |
Collapse
|
6
|
Sabitova A, McGranahan R, Altamore F, Jovanovic N, Windle E, Priebe S. Indicators Associated With Job Morale Among Physicians and Dentists in Low-Income and Middle-Income Countries: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e1913202. [PMID: 31922555 PMCID: PMC6991249 DOI: 10.1001/jamanetworkopen.2019.13202] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Improving health care in low- and middle-income countries (LMICs) requires a workforce with positive job morale. However, the level of job morale in this population remains unclear. OBJECTIVE To analyze studies measuring the job morale of physicians and dentists working in LMICs, using levels of job burnout, job satisfaction, and job motivation as indicators of job morale. DATA SOURCES A comprehensive search of Scopus, PubMed, PsycINFO, EMBASE, Web of Science, and the Cochrane Library, from database inception to October 30, 2018, and gray literature was performed. STUDY SELECTION Studies were eligible if at least 50% of the sample were qualified physicians and/or dentists working in public health care settings in LMICs. Three indicators of job morale in this population were used: job burnout, job satisfaction, and job motivation. Of 12 324 records reviewed, 79 studies were included in the systematic review and 59 were eligible for the meta-analysis. DATA EXTRACTION AND SYNTHESIS Data were extracted independently by several investigators in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Random-effects meta-analyses, planned subgroup analyses, and metaregression were performed. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess bias. MAIN OUTCOMES AND MEASURES Levels of job burnout, job satisfaction, and job motivation as indicators of job morale. RESULTS Overall, 12 324 records were identified. Of them, 80 records, representing 79 studies and involving 45 714 participants across 37 LMICs, met the inclusion criteria for the review; however, only 3 were from low-income countries. In 21 studies with 9092 participants working mainly in middle-income countries, 32% (95% CI, 27%-38%; I2 = 95.32%; P < .001) reported job burnout, and in 20 studies with 14 113 participants, 60% (95% CI, 53%-67%; I2 = 98.21%; P < .001) were satisfied with their job overall. Sufficient data were not available for a meta-analysis of job motivation. CONCLUSIONS AND RELEVANCE The findings suggest that, among physicians and dentists working mainly in middle-income countries, more than half reported having positive job morale. Positive job morale among physicians and dentists may help with recruitment and retention and thus support programs for improving health care in LMICs.
Collapse
Affiliation(s)
- Alina Sabitova
- Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Development, Queen Mary University of London, London, United Kingdom
- Department of Public Health, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Rose McGranahan
- Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Development, Queen Mary University of London, London, United Kingdom
| | - Francesco Altamore
- Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Development, Queen Mary University of London, London, United Kingdom
- Department of Biomedical, Metabolic, and Neuronal Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Nikolina Jovanovic
- Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Development, Queen Mary University of London, London, United Kingdom
| | - Emma Windle
- Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Development, Queen Mary University of London, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Development, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
7
|
Rennick-Egglestone S, Ramsay A, McGranahan R, Llewellyn-Beardsley J, Hui A, Pollock K, Repper J, Yeo C, Ng F, Roe J, Gillard S, Thornicroft G, Booth S, Slade M. The impact of mental health recovery narratives on recipients experiencing mental health problems: Qualitative analysis and change model. PLoS One 2019; 14:e0226201. [PMID: 31834902 PMCID: PMC6910821 DOI: 10.1371/journal.pone.0226201] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/21/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mental health recovery narratives are stories of recovery from mental health problems. Narratives may impact in helpful and harmful ways on those who receive them. The objective of this paper is to develop a change model identifying the range of possible impacts and how they occur. METHOD Semi-structured interviews were conducted with adults with experience of mental health problems and recovery (n = 77). Participants were asked to share a mental health recovery narrative and to describe the impact of other people's recovery narratives on their own recovery. A change model was generated through iterative thematic analysis of transcripts. RESULTS Change is initiated when a recipient develops a connection to a narrator or to the events descripted in their narrative. Change is mediated by the recipient recognising experiences shared with the narrator, noticing the achievements or difficulties of the narrator, learning how recovery happens, or experiencing emotional release. Helpful outcomes of receiving recovery narratives are connectedness, validation, hope, empowerment, appreciation, reference shift and stigma reduction. Harmful outcomes are a sense of inadequacy, disconnection, pessimism and burden. Impact is positively moderated by the perceived authenticity of the narrative, and can be reduced if the recipient is experiencing a crisis. CONCLUSIONS Interventions that incorporate the use of recovery narratives, such as peer support, anti-stigma campaigns and bibliotherapy, can use the change model to maximise benefit and minimise harms from narratives. Interventions should incorporate a diverse range of narratives available through different mediums to enable a range of recipients to connect with and benefit from this material. Service providers using recovery narratives should preserve authenticity so as to maximise impact, for example by avoiding excessive editing.
Collapse
Affiliation(s)
- Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Amy Ramsay
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ada Hui
- 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
| | - Julie Repper
- Implementing Recovery for Organisational Change (ImROC), Nottingham, United Kingdom
| | - Caroline Yeo
- 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
| | - James Roe
- National Institute for Health Research CLAHRC East Midlands, Institute of Mental Health, University of Nottingham, United Kingdom
| | - Steve Gillard
- Population Health Research Institute, St. George's University of London, London, United Kingdom
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Susie Booth
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
8
|
McGranahan R, Rennick-Egglestone S, Ramsay A, Llewellyn-Beardsley J, Bradstreet S, Callard F, Priebe S, Slade M. Curation of Mental Health Recovery Narrative Collections: Systematic Review and Qualitative Synthesis. JMIR Ment Health 2019; 6:e14233. [PMID: 31588912 PMCID: PMC6915799 DOI: 10.2196/14233] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Mental health recovery narratives are first-person lived experience accounts of recovery from mental health problems, which refer to events or actions over a period. They are readily available either individually or in collections of recovery narratives published in books, health service booklets, or on the Web. Collections of recovery narratives have been used in a range of mental health interventions, and organizations or individuals who curate collections can therefore influence how mental health problems are seen and understood. No systematic review has been conducted of research into curatorial decision making. OBJECTIVE This study aimed to produce a conceptual framework identifying and categorizing decisions made in the curation of mental health recovery narrative collections. METHODS A conceptual framework was produced through a systematic review and qualitative evidence synthesis. Research articles were identified through searching bibliographic databases (n=13), indexes of specific journals (n=3), and gray literature repositories (n=4). Informal documents presenting knowledge about curation were identified from editorial chapters of electronically available books (n=50), public documents provided by Web-based collections (n=50), and prefaces of health service booklets identified through expert consultation (n=3). Narrative summaries of included research articles were produced. A qualitative evidence synthesis was conducted on all included documents through an inductive thematic analysis. Subgroup analyses were conducted to identify differences in curatorial concerns between Web-based and printed collections. RESULTS A total of 5410 documents were screened, and 23 documents were included. These comprised 1 research publication and 22 informal documents. Moreover, 9 higher level themes were identified, which considered: the intended purpose and audience of the collection; how to support safety of narrators, recipients, and third parties; the processes of collecting, selecting, organizing, and presenting recovery narratives; ethical and legal issues around collections; and the societal positioning of the collection. Web-based collections placed more emphasis on providing benefits for narrators and providing safety for recipients. Printed collections placed more emphasis on the ordering of narrative within printed material and the political context. CONCLUSIONS Only 1 research article was identified despite extensive searches, and hence this review has revealed a lack of peer-reviewed empirical research regarding the curation of recovery narrative collections. The conceptual framework can be used as a preliminary version of reporting guidelines for use when reporting on health care interventions that make use of narrative collections. It provides a theory base to inform the development of new narrative collections for use in complex mental health interventions. Collections can serve as a mechanism for supporting collective rather than individual discourses around mental health.
Collapse
Affiliation(s)
- Rose McGranahan
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | | | - Amy Ramsay
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Felicity Callard
- Department of Psychosocial Studies, Birkbeck Institute for Social Research, Birkbeck University of London, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, Nottingham, United Kingdom
| |
Collapse
|
9
|
Rennick-Egglestone S, Morgan K, Llewellyn-Beardsley J, Ramsay A, McGranahan R, Gillard S, Hui A, Ng F, Schneider J, Booth S, Pinfold V, Davidson L, Franklin D, Bradstreet S, Arbour S, Slade M. Mental Health Recovery Narratives and Their Impact on Recipients: Systematic Review and Narrative Synthesis. Can J Psychiatry 2019; 64:669-679. [PMID: 31046432 PMCID: PMC6783672 DOI: 10.1177/0706743719846108] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mental health recovery narratives are often shared in peer support work and antistigma campaigns. Internet technology provides access to an almost unlimited number of narratives, and yet little is known about how they affect recipients. The aim of this study was to develop a conceptual framework characterizing the impact of recovery narratives on recipients. METHOD A systematic review of evidence about the impact of mental health recovery narratives was conducted. Searches used electronic databases (n = 9), reference tracking, hand-searching of selected journals (n = 2), grey literature searching, and expert consultation (n = 7). A conceptual framework was generated through a thematic analysis of included articles, augmented by consultation with a Lived Experience Advisory Panel. RESULTS In total, 8137 articles were screened. Five articles were included. Forms of impact were connectedness, understanding of recovery, reduction in stigma, validation of personal experience, affective responses, and behavioural responses. Impact was moderated by characteristics of the recipient, context, and narrative. Increases in eating disorder behaviours were identified as a harmful response specific to recipients with eating disorders. CONCLUSIONS Mental health recovery narratives can promote recovery. Recovery narratives might be useful for clients with limited access to peers and in online interventions targeted at reducing social isolation in rural or remote locations, but support is needed for the processing of the strong emotions that can arise. Caution is needed for use with specific clinical populations. Protocol registration: Prospero-CRD42018090923.
Collapse
Affiliation(s)
| | - Kate Morgan
- 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
| | - Amy Ramsay
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Steve Gillard
- Population Health Research Institute, St. George's University of London, London, UK
| | - Ada Hui
- 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
| | - Justine Schneider
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Susie Booth
- NEON Lived Experience Advisory Panel, Nottingham, UK
| | | | - Larry Davidson
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Simone Arbour
- Ontario Shores Centre for Mental Health Science, Ontario
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| |
Collapse
|
10
|
Slade M, Rennick-Egglestone S, Blackie L, Llewellyn-Beardsley J, Franklin D, Hui A, Thornicroft G, McGranahan R, Pollock K, Priebe S, Ramsay A, Roe D, Deakin E. Post-traumatic growth in mental health recovery: qualitative study of narratives. BMJ Open 2019; 9:e029342. [PMID: 31256037 PMCID: PMC6609070 DOI: 10.1136/bmjopen-2019-029342] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/12/2019] [Accepted: 05/31/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Post-traumatic growth, defined as positive psychological change experienced as a result of the struggle with challenging life circumstances, is under-researched in people with mental health problems. The aim of this study was to develop a conceptual framework for post-traumatic growth in the context of recovery for people with psychosis and other severe mental health problems. DESIGN Qualitative thematic analysis of cross-sectional semi-structured interviews about personal experiences of mental health recovery. SETTING England. PARTICIPANTS Participants were adults aged over 18 and: (1) living with psychosis and not using mental health services (n=21); (2) using mental health services and from black and minority ethnic communities (n=21); (3) underserved, operationalised as lesbian, gay, bisexual and transgender community or complex needs or rural community (n=19); or (4) employed in peer roles using their lived experience with others (n=16). The 77 participants comprised 42 (55%) female and 44 (57%) white British. RESULTS Components of post-traumatic growth were present in 64 (83%) of recovery narratives. Six superordinate categories were identified, consistent with a view that post-traumatic growth involves learning about oneself (self-discovery) leading to a new sense of who one is (sense of self) and appreciation of life (life perspective). Observable positively valued changes comprise a greater focus on self-management (well-being) and more importance being attached to relationships (relationships) and spiritual or religious engagement (spirituality). Categories are non-ordered and individuals may start from any point in this process. CONCLUSIONS Post-traumatic growth is often part of mental health recovery. Changes are compatible with research about growth following trauma, but with more emphasis on self-discovery, integration of illness-related experiences and active self-management of well-being. Trauma-related growth may be a preferable term for participants who identify as having experienced trauma. Trauma-informed mental healthcare could use the six identified categories as a basis for new approaches to supporting recovery. TRIAL REGISTRATION NUMBER ISRCTN11152837.
Collapse
Affiliation(s)
- Mike Slade
- Institute of Mental Health, University of Nottingham School of Health Sciences, Nottingham, UK
| | | | - Laura Blackie
- Department of Psychology, University of Nottingham, Nottingham, UK
| | - Joy Llewellyn-Beardsley
- Institute of Mental Health, University of Nottingham School of Health Sciences, Nottingham, UK
| | - Donna Franklin
- Institute of Mental Health, NEON Lived Experience Advisory Panel, Nottingham, UK
| | - Ada Hui
- Institute of Mental Health, University of Nottingham School of Health Sciences, Nottingham, UK
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Stefan Priebe
- Unit of Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Amy Ramsay
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - David Roe
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Emilia Deakin
- Institute of Mental Health, University of Nottingham School of Health Sciences, Nottingham, UK
| |
Collapse
|
11
|
Llewellyn-Beardsley J, Rennick-Egglestone S, Callard F, Crawford P, Farkas M, Hui A, Manley D, McGranahan R, Pollock K, Ramsay A, Sælør KT, Wright N, Slade M. Characteristics of mental health recovery narratives: Systematic review and narrative synthesis. PLoS One 2019; 14:e0214678. [PMID: 30921432 PMCID: PMC6438542 DOI: 10.1371/journal.pone.0214678] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Narratives of recovery from mental health distress have played a central role in the establishment of the recovery paradigm within mental health policy and practice. As use of recovery narratives increases within services, it is critical to understand how they have been characterised, and what may be missing from their characterisation thus far. The aim of this review was to synthesise published typologies in order to develop a conceptual framework characterising mental health recovery narratives. METHOD A systematic review was conducted of published literature on the characteristics of mental health recovery narratives. Narrative synthesis involved identifying characteristics and organising them into dimensions and types; and subgroup analysis based on study quality, narrator involvement in analysis, diagnosis of psychosis and experience of trauma. The synthesis was informed by consultation with a Lived Experience Advisory Panel and an academic panel. The review protocol was pre-registered (Prospero CRD42018090188). RESULTS 8951 titles, 366 abstracts and 121 full-text articles published January 2000-July 2018 were screened, of which 45 studies analysing 629 recovery narratives were included. A conceptual framework of mental health recovery narratives was developed, comprising nine dimensions (Genre; Positioning; Emotional Tone; Relationship with Recovery; Trajectory; Use of Turning Points; Narrative Sequence; Protagonists; and Use of Metaphors), each containing between two and six types. Subgroup analysis indicated all dimensions were present across most subgroups, with Turning Points particularly evident in trauma-related studies. CONCLUSIONS Recovery narratives are diverse and multidimensional. They may be non-linear and reject coherence. To a greater extent than illness narratives, they incorporate social, political and rights aspects. Approaches to supporting development of recovery narratives should expand rather than reduce available choices. Research into the narratives of more diverse populations is needed. The review supports trauma-informed approaches, and highlights the need to understand and support post-traumatic growth for people experiencing mental health issues.
Collapse
Affiliation(s)
- 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
| | - Felicity Callard
- Department of Psychosocial Studies, Birkbeck University, London, United Kingdom
| | - Paul Crawford
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Marianne Farkas
- College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, United States of America
| | - Ada Hui
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - David Manley
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, United Kingdom
| | - Amy Ramsay
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Knut Tore Sælør
- Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, Center for Mental Health and Substance Abuse, University of South Eastern Norway, Kongsberg, Norway
| | - Nicola Wright
- 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
| |
Collapse
|
12
|
Killaspy H, Priebe S, McPherson P, Zenasni Z, McCrone P, Dowling S, Harrison I, Krotofil J, Dalton-Locke C, McGranahan R, Arbuthnott M, Curtis S, Leavey G, MacPherson R, Eldridge S, King M. Feasibility Randomised Trial Comparing Two Forms of Mental Health Supported Accommodation (Supported Housing and Floating Outreach); a Component of the QuEST (Quality and Effectiveness of Supported Tenancies) Study. Front Psychiatry 2019; 10:258. [PMID: 31065244 PMCID: PMC6489479 DOI: 10.3389/fpsyt.2019.00258] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Mental health supported accommodation services are implemented across England, usually organised into a 'step-down' care pathway that requires the individual to repeatedly move as they gain skills and confidence for more independent living. There have been no trials comparing the effectiveness of different types of supported accommodation, but two widely used models (supported housing and floating outreach) have been found to provide similar support. We aimed to assess the feasibility of conducting a large-scale trial comparing these two models. Methods: Individually randomised, parallel group feasibility trial in three regions of England (North London, East London, and Cheltenham and Gloucestershire). We aimed to recruit 60 participants in 15 months, referred to supported accommodation, randomly allocated on an equal basis to receive either a local supported housing or floating outreach service. We assessed referrals to the trial, participants recruited, attrition, time from recruitment to moving into either type of supported accommodation, and feasibility of masking. We conducted a process evaluation to examine our results further. Results: We screened 1,432 potential participants, of whom 17 consented to participate, with 8 agreeing to randomisation (of whom 1 was lost to attrition) and 9 participating in naturalistic follow-up. Our process evaluation indicated that the main obstacle to recruitment was staff and service user preferences for certain types of supported accommodation or for specific services. Staff also felt that randomisation compromised their professional judgement. Conclusions: Our results do not support investment in a large-scale trial in England at this time. Trial registration: UK CRN Portfolio database, Trial ID: ISRCTN19689576. Trial funding: National Institute of Health Research (RP-PG-0707-10093).
Collapse
Affiliation(s)
- Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Peter McPherson
- Division of Psychiatry, University College London, London, United Kingdom
| | - Zohra Zenasni
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Paul McCrone
- King's Health Economics, King's College London, London, United Kingdom
| | - Sarah Dowling
- Division of Psychiatry, University College London, London, United Kingdom
| | - Isobel Harrison
- Division of Psychiatry, University College London, London, United Kingdom
| | - Joanna Krotofil
- Division of Psychiatry, University College London, London, United Kingdom
| | | | - Rose McGranahan
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Maurice Arbuthnott
- North London Service User Research Forum, Division of Psychiatry, University College London, London, United Kingdom
| | - Sarah Curtis
- Department of Geography, Durham University, Durham, United Kingdom
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, University of Ulster, Londonderry, United Kingdom
| | - Rob MacPherson
- 2Gether NHS Foundation Trust, Gloucester, United Kingdom
| | - Sandra Eldridge
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Michael King
- Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
13
|
McGranahan R, Hansson L, Priebe S. Psychopathological Symptoms and Satisfaction with Mental Health in Patients with Schizophrenia. Psychopathology 2018; 51:192-197. [PMID: 29566391 DOI: 10.1159/000487399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/30/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The patient's view of their mental health is a central aspect in research and practice. Yet, little is known about which psychopathological symptoms are linked with patients' satisfaction with their mental health. We aimed to identify these symptoms in patients with schizophrenia. METHODS An individual patient data meta-analysis was conducted with data from 2,488 patients from 8 independent studies. Satisfaction with mental health was rated on a 7-point scale, and symptoms were observer-rated using identical items from the Brief Psychiatric Rating Scale and the Positive and Negative Symptom Scale. Mixed multilevel univariate followed by multivariate regression models were used to identify symptoms associated with satisfaction with mental health. RESULTS In univariate regressions, all subscales - not age and gender - were associated with mental health satisfaction. In the multivariate regression, only affective and negative symptoms were significantly associated with a lower satisfaction with mental health, explaining 22.5% of the variance. CONCLUSIONS Observer-rated psychopathological symptoms are linked to patients' mental health satisfaction. In addition to affective symptoms - which are commonly negatively linked with satisfaction ratings - a higher level of negative symptoms makes patients less satisfied with their mental health, whilst positive and other symptoms do not influence mental health satisfaction.
Collapse
Affiliation(s)
- Rose McGranahan
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
| | - Lars Hansson
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
| |
Collapse
|