Recovery-Oriented Intersectoral Care in Mental Health: As Perceived by Healthcare Professionals and Users

This study aimed to explore how mental health professionals and users perceive recovery-oriented intersectoral care when comparing mental health hospitals and community mental healthcare. Methodological design: Five audio-recorded focus group interviews of nurses, other health professionals and users were explored using manifest and latent content analysis. Ethical issues and approval: The study was designed in accordance with the ethical principles of the Helsinki Declaration and Danish law. Each study participant in the two intersectoral sectors gave their informed consent after verbal and written information was provided. Findings: From the health professionals’ perspective, the main theme informed by subthemes and categories was formulated: ‘Recovery-oriented intersectoral care requires more coordination and desire for collaboration’. Two subthemes were subsequently formulated: ‘The users´ perspective of the centre’ and ‘Need for a common agenda and understanding of recovery-oriented intersectoral care’. From the users´ perspective, the main theme was formulated as: ‘Recovery-oriented intersectoral care in tension between medical- and holistically oriented care’. This theme was informed by two subthemes: ‘The users´ perspective is not in focus’ and ‘A trusting relationship and a holistic approach brings coherence’. Conclusions: This study reveals that health professionals want to work in a recovery-oriented manner in intersectoral care, but several challenges appear which make achieving this aim difficult. A common understanding of recovery and how it should be carried out in intersectoral care does not exist. Care decisions are primarily made paternalistically, where the users’ and relatives’ voices are ignored. In an attempt to create coherence across sectors, intersectoral network meetings have been established with health professionals from both sectors. However, the meetings are characterised by a lack of a clear purpose regarding the meeting structure and content, and users are only minimally involved. Our results can contribute to dealing with the challenges of incorporating recovery-oriented intersectoral care as an ideology in all psychiatric and municipal contexts and is, therefore, important for health professionals and users.

The association of recovery orientation and stigmatizing beliefs

BACKGROUND

Although mental health advocates and providers have promoted both recovery-oriented care and the de-stigmatization of mental illness, no studies have examined the interrelation of these two specific constructs.

AIMS

This study aimed to evaluate this association, with the hypothesis that stronger perception of programmatic recovery orientation would be associated with less stigmatizing beliefs towards mental illness.

METHOD

Veterans (N = 122) and mental health clinicians (N = 98) at a large Veterans Affairs Medical Center completed an assessment of recovery orientation and a measure of beliefs about mental illness.

RESULTS

Stronger endorsement of programmatic recovery orientation was associated with less stigmatizing attitudes in both groups. Each of the five factors on the recovery measure was significantly and negatively associated with each of the four factors on the stigma measure.

CONCLUSIONS

Perspectives of recovery orientation and stigma are significantly, but negatively, associated. Future research should investigate the direction of causality behind these observed relationships, as this will provide the opportunity to identify potential interventions to increase recovery-oriented mental health care and reduce stigmatization.

Recovery-Oriented Cross-Sectoral Network Meetings between Mental Health Hospital Professionals and Community Mental Health Professionals: A Critical Discourse Analysis

Aims and objectives: In the medical field, we lack knowledge on how interprofessional collaboration across sectors is carried out. This paper explores how healthcare professionals and users perceive recovery-oriented cross-sectoral discharge network meetings between mental health hospital professionals and community mental health professionals and which discourses manifest themselves within the field of mental healthcare. Method: Ten professionals from a mental health hospital and eight community mental health professionals participated. In addition, five users with experience in mental health services in both sectors participated. Fairclough’s discourse analysis framework was used to explore their experiences. The study was designed following the ethical principles of the Helsinki Declaration and Danish law. Each study participant in the two intersectoral sectors gave their informed consent after verbal and written information was provided. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline to secure accurate and complete reporting of the study). Results: The healthcare professionals in both sectors are governed by steering tools, legislation and a strong biomedical tradition to solve illness-related problems, such that users must be offered treatment and support to achieve self-care as soon as possible. This can be seen as a reflection of, and a driving force in, a change in the wider social practice that Fairclough terms the ‘marketisation of discourse’—a social development in late modernity, whereby market discourse colonises the discursive practices of public institutions. The user of psychiatric and social services experiences a structured system that does not offer the necessary time for deep conversations. Users do not consider recovery as something that is only seen in relation to the efforts of the professionals, as recovery largely takes place independently of professionals. Recovery depends on users’ internal resources and a strong network that can support them on the journey. Conclusion: Healthcare professionals perceive recovery-oriented cross-sectoral discharge network meetings to reflect paternalistic and biomedical discourses. Users want to be seen more as whole persons and did not experience sufficient involvement in the intersectoral care. Relevance to clinical practice: Healthcare professionals need to be supported to seek clarity in the understanding and operationalisation of a recovery-oriented approach, if the agenda is to be truly adopted and strengthened.

Development of the Everyday Life Rehabilitation model for persons with long-term and complex mental health needs: Preliminary process findings on usefulness and implementation aspects in sheltered and supported housing facilities

This paper describes the initial phases of the design and development of the Everyday Life Rehabilitation (ELR) intervention, and it presents preliminary findings on usefulness and implementation aspects derived from an ongoing larger trial exploring the effect, cost-effectiveness, and usefulness of ELR. ELR is a model designed to meet the absence of meaningful activities and challenges with integrated, activity- and recovery-oriented rehabilitation in sheltered and supported housing facilities for persons with extensive psychiatric disabilities. The aim of the present study was to examine early experiences of implementing the ELR model from the perspectives of managers, housing staff, and occupational therapists. The paper will sum up preliminary findings based on process data included in an internal pilot prior to a full-scale pragmatic clustered RCT. Four Swedish municipalities with 19 housing facility units were involved and provided process data for the study. Thematic analysis were applied. The informants perceived the methodology to be well suited to the target group and context and to contribute to positive changes in participants' lives. The web-based training was also experienced as relevant and easily accessible to staff, as well as elements of collegial learning and feedback. However, they reported that their municipalities lacked basic conditions for making the whole concept work in such a short time. The ELR is overall perceived as useful, but experiences also make complex difficulties visible regarding integrated, coordinated rehabilitation and organizational readiness. Based on findings, a recommendation on basic prerequisites will be added to the ELR guidance for leadership and management.

CLINICAL TRIAL REGISTRATION

[ClinicalTrials.gov, 24 September 2021], identifier [NCT05056415].

Development of a scale to evaluate nurses' recovery orientation in the dementia care

WHAT IS KNOWN ON THE SUBJECT?: Much research has been conducted on the relationship between recovery orientation and people diagnosed with mental illnesses such as schizophrenia and mood disorders. A recovery-oriented approach by mental health professionals can reduce hospital stays and medical costs for people diagnosed with mental illness. There are similarities and differences between recovery-oriented approaches for individuals diagnosed with dementia and those diagnosed with mental illness. This reflects the characteristics of irreversible dementia. Although dementia courses at recovery colleges are increasing, dementia recovery is in its infancy and course content varies. The core of the recovery framework for individuals diagnosed with dementia is 'Continue to be me'. Recovery-oriented approaches and programmes have been developed by mental health workers for older adults, including those with dementia, but there are no outcome measures that reflect the characteristics of dementia care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We developed a scale to assess nurses' recovery orientation in dementia care, which has been found to be reliable, and although some validity issues remain, it is the first scale to objectively assess recovery orientation in dementia care. The emphasis is on helping people diagnosed with dementia maintain their identity, which is not adequately covered by existing measures of recovery. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The ability to objectively assess recovery orientation in dementia care allows us to identify areas of inadequacy. It can be used to reduce variation in the content of recovery college courses and as an indicator for evaluating training in recovery-oriented approaches to dementia care.

ABSTRACT

INTRODUCTION: Programmes regarding recovery-oriented approaches for older people, including those with dementia, have been developed, but there are no clear indicators, and the process is still in its infancy.

PURPOSE

We developed a scale to assess nurses' recovery orientation in dementia care.

METHODS

A draft of a 28-item scale was developed based on interviews with 10 nurses, skilled in dementia care with a Japanese mental health perspective, and a literature review. A self-administered questionnaire was developed for nurses working in a dementia ward, and an exploratory factor analysis was conducted. A confirmatory factor analysis was conducted to test for convergent and discriminant validity. The Recovery Attitude Questionnaire was used to examine criterion-related validity.

RESULTS

An exploratory factor analysis produced a 19-item scale and identified five factors (KMO value: 0.854). The Cronbach's alpha for the overall scale was .856, with each subfactor showing a range of .742-.792, validating its reliability.

DISCUSSION

The results of confirmatory factor analysis supported the five-factor construct. Reliability was verified, but some issues remained in convergent and discriminant validity.

IMPLICATIONS FOR PRACTICE

This scale can be used to objectively assess nurses' recovery orientation in dementia care and as a measure of training in recovery-oriented approaches.

The Effects of Australia's First Residential Peer-Support Suicide Prevention and Recovery Centre (SPARC)

Aim: This paper reports preliminary evidence of the impacts of Australia's first residential peer-support service for people at risk of suicide. Methods: Psychological distress was measured preintervention, postintervention, and after 3 months and analyzed using paired t tests. Interviews were held postintervention and were analyzed using thematic analysis. Results: Psychological distress significantly improved from preintervention to postintervention (n = 16, d = 1.77) and at follow-up (n = 5, d = 1.12). Interviews (n = 10) indicated that participants experienced improvements in mental well-being and feelings of connectedness, respite, and confidence to engage with other services. The peer-support workers were key. Some participants felt that the location was too remote, too little information was given, and a longer stay would have been preferable. Limitations: The study did not include a control group, the sample was relatively small, and participants may have been subject to socially desirable answers. Conclusions: These findings indicate that residential peer-support services potentially offer a valuable alternative to conventional inpatient treatment for people at risk of suicide.

Recovery-supportive interventions for people with substance use disorders: a scoping review

Background

Recovery-supportive interventions and strategies for people with substance use disorders are a cornerstone of the emergent recovery paradigm. As compared to other services, such approaches have been shown to be holistically focused and improve outcomes (e.g. substance use, supportive relationships, social functioning, and well-being). Even so, a comprehensive overview of the nature, extent, and range of research on the topic is lacking.

Methods

A scoping review of the literature was conducted to characterize the main topics on recovery-supportive interventions. A systematic search was conducted in three databases: Scopus, Web of Science, and PubMed from January 2000 to July 2023 using the PRISMA-ScR. Twenty-five studies published between 2005-2022 met the inclusion criteria.

Results

Most studies emanated from the United States, and we found a peak in publication frequency between 2018-2022 (n = 13) relative to other years. The most prominent lines of inquiry appear to concern recovery-oriented policies; principles of recovery-oriented services (challenges encountered when implementing recovery-oriented practices, relationships with service providers characterized by trust, and service user-service provider collaboration), and recovery capital (particularly recovery-supportive networks, employment, and housing). Seventeen studies addressed co-occurring disorders, and eight addressed substance use recovery.

Conclusion

To advance the field, more context-specific studies are required on supporting peer professionals, (including enabling cooperation with service users, and hiring experts by experience as staff), and training of professionals (e.g., nurses, psychologists, social workers, physicians) in the principles of recovery.