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BACKGROUND: Individual Placement and Support (IPS) is an evidence-based vocational rehabilitation program that helps people with severe mental problems to obtain and maintain paid jobs. Turnover of IPS employment specialists is a scarcely studied subject that can undermine the effectiveness and implementation of the intervention. OBJECTIVE: This study aimed to explore and describe the experiential factors and processes that shape IPS employment specialists' decisions to quit. METHODS: Braun and Clarke thematic analysis was used to analyze interviews of former IPS employment specialists, who worked during the early implementation phase in Northern Norway. RESULTS: A number of negative and positive experiential factors and processes were found to shape IPS employment specialists' decisions to quit their jobs. A single theme captured our findings 'The decision to quit for IPS employment specialists is a gradual process consisting of draining factors outweighing nourishing factors'. CONCLUSION: To retain IPS employment specialists in the early implementation phase, it is not enough to rely on hiring well-fitting individuals. Instead, prospectively developing interorganizational contexts, timely identifying and addressing work environment problems, while nurturing the strengths of individual workers can be helpful in decreasing turnover rates of IPS employment specialists. [ABSTRACT FROM AUTHOR]

We explore the implementation and development of individual placement and support (IPS) in Norway. IPS is an evidence‐based practice for supporting people experiencing mental illness to obtain and maintain competitive employment. Implementation of IPS into routine practice has been challenged by different paradigms in vocational rehabilitation, health and welfare policies. Data were mainly collected through individual and joint interviews of IPS experts and key stakeholders involved in the implementation of IPS. Data were analysed using thematic analysis. Three themes were derived from the analysis, representing different phases in the implementation process: (1) seeking a way to meet unmet need in work and mental health practice, (2) gathering knowledge and national evidence, and (3) embedding IPS into routine practice. The study demonstrates how health and welfare policy gradually developed IPS from vocational rehabilitation to a mainstreamed welfare employment scheme. This development may secure the future of IPS in Norway. However, the implications for practice in the longer term are unknown. Our study provides insight into how implementation of an evidence‐based practice both influences and is influenced by national policymaking. [ABSTRACT FROM AUTHOR]

Mental health lived experience narratives are first-person accounts of people with experience of mental health problems. They have been published in journals, books and online, and used in healthcare interventions and anti-stigma campaigns. There are concerns about their potential misuse. A four-language systematic review was conducted of published literature characterizing uses and misuses of mental health lived experience narratives within healthcare and community settings. 6531 documents in four languages (English, Danish, Swedish, Norwegian) were screened and 78 documents from 11 countries were included. Twenty-seven uses were identified in five categories: political, societal, community, service level and individual. Eleven misuses were found, categorized as relating to the narrative (narratives may be co-opted, narratives may be used against the author, narratives may be used for different purpose than authorial intent, narratives may be reinterpreted by others, narratives may become patient porn, narratives may lack diversity), relating to the narrator (narrator may be subject to unethical editing practises, narrator may be subject to coercion, narrator may be harmed) and relating to the audience (audience may be triggered, audience may misunderstand). Four open questions were identified: does including a researcher's personal mental health narrative reduce the credibility of their research?: should the confidentiality of narrators be protected?; who should profit from narratives?; how reliable are narratives as evidence?) [ABSTRACT FROM AUTHOR]

Background: For decades there has been a continuous increase in the number of people receiving welfare benefits for being outside the work force due to mental illness. There is sufficient evidence for the efficacy of Individual Placement and Support (IPS) for gaining and maintaining competitive employment. Yet, IPS is still not implemented as routine practice in public community mental health services. Knowledge about implementation challenges as experienced by the practitioners is limited. This study seeks to explore the experiences of the front-line workers, known as employment specialists, in the early implementation phase. Methods: Qualitative data were collected through field notes and five focus group interviews. The study participants were 45 IPS employment specialists located at 14 different sites in Northern Norway. Transcripts and field notes were analysed by thematic analyses. Results: While employment specialists are key to the implementation process, implementing IPS requires more than creating and filling the role of the employment specialist. It requires adjustments in multiple organisations. The new employment specialist then is a pioneer of service development. Some employment specialists found this a difficult challenge, and one that did not correspond to their expectations going into this role. Others appreciated the pioneering role. IPS implementation also challenged the delegation of roles and responsibilities between sectors, and related legal frameworks related to confidentiality and access. The facilitating role of human relationships emphasised the importance of social support which is an important factor in a healthy work environment. Rural areas with long distances and close- knit societies may cause challenges for implementation. Conclusion: The study provides increased understanding on what happens in the early implementation phase of IPS from the employment specialists' perspective. Results from this study can contribute to increased focus on job satisfaction, turnover and recruitment of employment specialists, factors which have previously been shown to influence the success of IPS. The greatest challenge for making "IPS efficacy in trials" become "IPS effectiveness in the real world" is implementation, and this study has highlighted some of the implementation issues. [ABSTRACT FROM AUTHOR]

The concept of recovery is commonly described as multifaceted and contested in the field of mental health and substance abuse. The aim of this study is to explore how understandings of recovery and recovery orientation of services are developed through daily practices and collaboration between service users and professionals. Eight pairs of participants were interviewed together, in accordance with the dyadic interview method. The dyads/pairs consisted of service users and professional helpers. A collaborative hermeneutic-phenomenological analysis was used to analyse data. Data were analysed into three overarching and entangled themes, exploring how recovery-oriented collaboration and knowledge encompasses (a) recovery as relational processes. These processes are entangled with (b) recovery as situated in time and place. Furthermore, relational processes and dimensions of time and place are situated in and supported or hindered by (c) recovery orientation as part of the municipal policies, understood as the regulations, frameworks and decisions guiding mental health and substance abuse services in the municipality. The further development of recovery-oriented services should focus on facilitating open-ended and flexible ways of developing practices and relationships. This involves recognizing how relationships contribute to the development of knowledge and practices. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate how curator goals influence the design of curation processes for collections of mental health lived experience narratives. The objectives were (1) to characterize the goals of a range of curators of existing collections, and (2) to identify specific working practices impacted by these goals. Research Design and Methods: Thirty semi-structured interviews were conducted with a purposive sample of curators of collections of lived experience narratives. Thematic analysis was conducted. Goals and impacts on working practice were tabulated, and narrative summaries were constructed to describe the relation between the two. Results: Curators interviewed were from seven countries (Brazil, Canada, Hong Kong, India, Italy, UK, USA), and 60% had lived experience of mental health service usage. Participants discussed eight goals that inspired their work: fighting stigma, campaigning for change in service provision, educating about mental health and recovery, supporting others in their recovery journey, critiquing psychiatry, influencing policy, marketing health services, and reframing mental illness. These goals influenced how decisions were made about inclusion of narratives, editing of narrative content, withdrawal rights, and anonymization. Conclusions: Our work will support the development of curatorship as a professional practice by shaping training for curators, helping curators reflect on the outcomes they would like to achieve, and helping individuals planning a collection to reflect on their motivations. We argue that transparency is an essential orientation for curators. Transparency allows narrators to make an informed choice about donating a narrative. It allows policy makers to understand the influences on a collection and hence treat it as a source of collective evidence. [ABSTRACT FROM AUTHOR]

We are three researchers within the field of mental health. For the past 3 years, we have collaborated with colleagues in Greece on evaluating the pilot project Refugee Outreach Mental Health Team. Part of our role has been to evaluate how refugees and asylum seekers experience the treatment and support offered by the team. The findings from the evaluation have been presented in a published research report and we have thereby "completed our task." However, following the completion of the formal obligations, we have continued to dwell on the less outspoken dialogues and inner voices. Not only those of the participants, but also the ones of the researchers that are present before, during and after research interviews. Inspired by relational autoethnography, we share some "other stories" about how the research processes touched us deeply and how it has left traces in our minds and bodies long after the project completion. We reflect on how relational processes of polyphonic meaning-making can be used to develop deeper insights and knowledge as well as a call for action. We suggest that the sharing of other stories can provide new knowledge and new understandings of how knowledge can be developed. Our hope is also that it may serve troubling or evocative purposes, and encourage the development of dialogues by invoking inner and outer voices. Perhaps, it may even call for solidarity in others and ourselves. [ABSTRACT FROM AUTHOR]

The method dyadic interviews involves interviewing a pair of participants, focusing explicitly on the interaction between them and how it develops data. Dyadic interviews with persons who are involved in ongoing, working relationships can be a feasible means of exploring research topics that are related to collaboration and collaborative practices. The concept of recovery is considered highly relevant to different kinds of relationship-based practices, involving a person and context centered shift within the field of mental health. What is referred to as recovery-oriented practices, is best understood as developed through collaboration. This involves a shift in the understanding of who beholds the expert knowledge and what knowledge "is," acknowledging the importance of including different types and sources of knowledge when new knowledge is to be developed. In this paper we explore how dyadic interviews with pairs consisting of mental health service users and professionals can facilitate co-created knowledge about recovery as collaborative practices through collaboration. We argue that dyadic interviews can enable development of dialogic and collaborative knowledge, potentially blurring and challenging boundaries between knowledge-bases and roles. [ABSTRACT FROM AUTHOR]

Background: Collaboration has become a cornerstone for healthcare practice in recent decades resulting in the efforts at international and national levels to integrate the concept into healthcare practice and services. However, there is a paucity of research delineating strategies for professionals to apply in collaborative practice with clients in general as well as in mental health and substance abuse (MHSA) care. Methods: The method applied in this paper is a form of qualitative meta-synthesis referring to the integration of findings from multiple qualitative studies within a program of research by the same investigators. Eighteen empirical papers with the focus on community MHSA practice and recovery-orientation with relevance to the service user–professional relationship in MHSA practice were included in this meta-synthesis. Results: Three types of processes of collaboration specified by meta-themes were identified. The meta-themes of the interactive-dialogical process type include (a) maintaining human relationship, (b) walking alongside, (c) information sharing, (d) seizing the present moment, (e) taking the perspective of the other, and (f) aligning/scaffolding. The meta-themes of the negotiated-participatory engagement type include (a) feedback-informing process, (b) putting differences to work, (c) negotiated partnering, (d) accommodating user participation, and (e) addressing the tension between help and control. The meta-themes of the negotiated supportive process type are (a) helping in context, (b) coordinating, (c) pulling together, (d) advocating, and (e) availing. These meta-themes are strategies for collaboration applicable in MHSA practice. Conclusions: This meta-synthesis of collaborative processes found in community mental health practice points to the possibility of developing a set of repertoires of practice for service user/professional collaboration, especially in community MHSA practice. [ABSTRACT FROM AUTHOR]

Background: Various models for collaborative practice in mental health care incorporating the perspectives of service-user participation and collaboration in the care have been developed. However, the emphasis in these practice models has not been on identifying specific features of "how" collaboration and service-user participation can occur and be nurtured. This suggests a need for a collaborative practice model that specifies essential strategies operationalizing the tenets of service-user participation and collaboration applicable in mental health and substance abuse (MHSA) care. Methods: A double helix approach of coalescing theoretical ideas and empirical findings to develop a practice model that is applicable in MHSA practice. A theoretical analysis is carried out to identify the critical, foundational elements for collaborative practice in MHSA practice, and has identified the philosophical-theoretical orientations of Habermas' theory of communicative action, Bakhtin's dialogicality, and the philosophy of personhood as the foundational features of collaboration. This base is juxtaposed with the results of a qualitative meta-analysis of 18 empirical articles on collaboration in MHSA to advance a collaborative practice model specifically in the domain of service user/professional collaboration. Results: "The collaborative, dialogue-based clinical practice model" (CDCP Model) for community mental health care is proposed, within the structure of four main components. The first specifies the framework for practice that includes person-centered care, recovery-orientation, and a pluralistic orientation and the second identifies the domains of collaboration as service user/professional collaboration, inter-professional collaboration, and service sector collaboration. The third identifies self-understanding, mutual understanding, and shared decision-making as the essential principles of collaboration. The fourth specifies interactive-dialogic processes, negotiated-participatory engagement processes, and negotiated-supportive processes as the essential strategies of collaboration applicable in service user/professional collaboration which were extracted in the empirical work. An illustration of the CDCP Model in a clinical case is given. Conclusions: The CDCP Model presented fills the gap that exists in the field of community MHSA practice regarding how to operationalize systematically the tenets of person-centeredness, recovery-oriented, and pluralism-oriented practice in terms of user/professional collaboration. [ABSTRACT FROM AUTHOR]

Participation in friluftsliv has gained increased attention along with the growing concern regarding the extended prominence of mental health challenges. The objective of this study was to conduct a systematic review of various forms of friluftsliv as part of recovery processes for people experiencing eating disorders. Following the PRISMA guidelines, we systematically searched in five databases and 5,994 hits were retrieved. Screening of abstracts according to the inclusion and exclusion criteria identified 13 full-text studies as eligible. The most prominent findings were improved body image and enhanced self-esteem following participation in friluftsliv. However, more high-quality research is necessary for an increased understanding of if, and how, friluftsliv can contribute in the recovery processes and reduction of factors associated with eating disorders. [ABSTRACT FROM AUTHOR]

Research on the topic of not talking about psychosocial hardships describes the presence of 'house rules' against illness-talk in common areas in 'meeting places' ('day centres') in community mental health care. The aim of this article was to explore the complexity of not talking about psychosocial hardships ('silence') in meeting places in Norwegian community mental health care. The research team consisted of first-hand and academic knowers of community mental health care (participatory research team). We performed two series of focus group discussions with service users and staff of meeting places. The focus group interviews were analysed within a discourse analytic framework, and five discursive constructions were identified: (1) biomedical colonization of illness-talk, (2) restricted access for biomedical psychiatry and problem-talk in the common spaces of meeting places, (3) censorship of service users' civil and human rights to freedom of speech, (4) protection from exploitation and burdens and (5) silent knowledge of the peer community. Based on the analysis, we suggest that not talking about illness (silence) entails a complexity ranging from under-privileging implications to promoting the interests of people who 'use' meeting places. For instance, restricting biomedical psychiatry may imply the unintended implication of further silencing service users, while silently shared understandings of hardships among peers may imply resistance against demands to speak to legitimize one's situation. The discussion illuminates dilemmas related to silence that require critical reflexive discussions and continuous negotiations among service users, staff and policymakers in community mental health care. [ABSTRACT FROM AUTHOR]

This study, the third in a series of 3, draws on a broader Norwegian research project exploring the phenomenon of support for young persons with mental health issues. The aim was to explore and explicate the sense of "nourishing communion," as a somewhat neglected aspect of support. Fourteen Norwegian young adults, aged 18–25, were interviewed about their experiences of support. Data was analyzed using van Manen's hermeneutic-phenomenological approach to open up possible meanings of how nourishing communion is concretely lived. Analysis was supplemented by in-depth reflexive dialogues between Mona Sommer and Linda Finlay, which fostered a nourishing communion akin to the processes and dimensions of our phenomenon of interest. Findings highlight 5 intertwined existential themes: (a) trusting the other to hold vulnerability safely; (b) flourishing in mutual participation; (c) acceptance in a felt togetherness; (d) feeling found and received; and (e) feeling an attuned resonance. The notion of "nourishing communion" as a significant but neglected element of support challenges current practice, suggesting the need for a different approach to collaboration with young persons and their networks. From the perspectives both of individual professional engagement and of policy making, there is a need for further exploration of how young persons might be supported to create and maintain a broader range of nourishing relationships. [ABSTRACT FROM AUTHOR]

This study explores how young adults with co-occurring substance abuse and mental health issues experience the challenges of belonging to their local communities. The data were generated through qualitative in-depth interviews with seven young adult service users, six of whom were interviewed twice. The qualitative data analysis resulted in three overarching themes: the need to accept one's own life and the structures surrounding it; being caught between conflicting social worlds; and moral fumbling in choices and actions. Using an empirical study, we suggest that a process of 'communal invalidation' operates through which young adults in the community are socially defined as inadequate. This invalidation serves as a formidable barrier to their recovery. [ABSTRACT FROM AUTHOR]

This study contributes to the existing literature on peer support and complexities in peer support practices by exploring and describing service users' perspectives on challenges in developing helpful relationships with peer support workers. Twenty-six service users with mental health and/or substance problems who had collaborated with one or more peer support workers on five or more occasions voluntarily participated across five focus groups. Interviews with these participants were tape-recorded and transcribed verbatim. Data were analyzed using the Braun-Clark approach to thematic analysis, resulting in two major themes: (a) embrace the difference and (b) harness the contextual factors. The findings suggest that peer support by sharing lived experiences does not always result in helpful relationships that promote recovery. How and when aspects of lived experience are shared appears to play an important role in characterizing relationships as helpful or not. [ABSTRACT FROM AUTHOR]

This article provides an overview over current knowledge regarding helpful support to promote participation in education and work among people with mental health problems. Based on 14 studies gleaned from a systematic review, three overarching themes were identified through thematic analysis:supportive interpersonal relationships, integrating mental health and everyday life issues with education/employment support, andperson-centered support. The findings call for a deeper understanding of support in the context of mental health and participation in education and work among people with mental health problems. [ABSTRACT FROM PUBLISHER]

Background: People who struggle with mental health problems can provide valuable insight into understanding and improving the coordination of mental health and welfare services. The aims of the study were to explore service users' experiences and perceptions of continuity of care within and across services relevant to personal recovery, to elicit which dimensions of continuity of care are most essential to service users, and to generate ideas for improving service users' experiences of continuity of care.Methods: In the context of a hermeneutic-phenomenological approach, ten service users at a community mental health centre were interviewed about their experiences of continuity of care in and across services. Eight of these were re-interviewed two years later. A collaborative research approach was adopted. Data were analysed by means of a data-driven stepwise approach in line with thematic analysis.Results: Following the analysis five themes representing experiences of continuity of care were developed. Each theme ranged from poor to good experiences of continuity of care: Relationship - from experiencing frequent setbacks and anxiety due to breaks in relationships, to feeling safe in an ongoing personal relationship; Timeliness - from experiencing frustrating waiting times with worsening of problems, to getting help when needed; Mutuality - from having a one-sided struggle, to a situation in which both professionals and service users take initiatives; Choice - from not having the opportunity to make practical arrangements within the context of one's everyday life, to having an array of support options to choose from; Knowledge - from feeling confused and insecure because one does not know what is happening, to feeling safe because one is informed about what is going to happen. Participants provided a range of suggestions for improving experiences of continuity of care.Conclusions: A discrepancy between aspects of continuity that are essential for service users and their experiences of actual practice was revealed. The valid evidence generated in the present collaborative study therefore offers knowledge to policy makers, professionals and service users that may be of help in their future efforts in orienting primary care, mental health, addiction and welfare services towards recovery. [ABSTRACT FROM AUTHOR]

Background: There is a large and diverse literature on the concept of hope in health care. This literature covers a broad spectrum of perspectives, from philosophical, conceptual, and theoretical analysis through to attempts at measuring the concept of hope with differing health care users. Aims: To explore the concept of hope through the secondary analysis of existing data sets, with the intention of understanding hope in the context of person-centeredness. Research Question: What is the experience of hope among service users and informal carers in different health care contexts? Method: Secondary analysis of data derived from three research studies. Findings: We identified four key themes that together illustrate what we describe as a kaleidoscope of hope, reinforcing the view that there is no one presentation of hope and that practitioners must engage authentically with service users to determine the most effective and appropriate intervention strategies. Conclusions: Hope is not a singular phenomenon, and in the context of person-centered practice there is a need for practitioners to engage authentically with service users and listen carefully to what may bring hope for them. [ABSTRACT FROM AUTHOR]

User involvement in therapy includes some form of feedback from the clients. The feedback guides the therapist and the clients toward a best possible result through a best possible therapy process. In recent years many different procedures for collecting feedback have been developed. In a previous study presented in this journal we explored the expectations therapists had before including the comprehensive clinical feedback procedure, Systemic Therapy Inventory of Change ( STIC), in their clinical practices. Our aim with this present study is to explore couples' and family therapists' experiences with STIC from the perspective of user involvement. We found that the term 'using STIC' represented many different variations both between therapists and between the families each therapist worked with. Likewise user involvement, combined with a feedback procedure like STIC, was also a many faceted area. We discuss how therapists' experiences may relate to the different aspects of user involvement in therapy. [ABSTRACT FROM AUTHOR]

Background Focus on service users' needs, coping and empowerment, user involvement, and comprehensiveness are supposed to be key elements of the Community Mental Health Centres in Norway. Taking a user-oriented approach means acknowledging the individual's own expectations, aims and hopes. However, studies that have investigated service users' expectations of treatment and support at Community Mental Health Centres are hard to find. Objective The aim of the study was therefore to explore service users' expectations at the start of treatment at a Community Mental Health Centre. Method Within a collaborative framework, taking a hermeneutic-phenomenological approach, ten service users participated in in-depth interviews about their expectations, hopes and aims for treatment and recovery. The participants sought help due to various mental health issues that had interfered with their lives and created disability and suffering. A data-driven stepwise approach in line with thematic analysis was used. The study was approved by the Norwegian Social Science Data Services. Results The following four main themes representing participants' expectations at the start of treatment were elicited: hope for recovery, developing understanding, finding tools for coping and receiving counselling and practical assistance. Participants' expectations about treatment were tightly interwoven with their personal aims and hopes for their future life, and expectations were often related to practical and financial problems, the solution of which being deemed necessary to gain a safe basis for recovery in the long run. Limitations The transferability of the results may be limited by the small number of participants. Conclusions The study emphasises how important it is that service users' personal aims and expectations guide the collaborative treatment process. In addition to providing treatment aimed at improving symptoms, Community Mental Health Centres should take a more comprehensive approach than today by providing more support with family issues, social life, education, work and financial issues. [ABSTRACT FROM AUTHOR]

Studies have shown that service users report their encounter with peer supporters as positive. However, little is known about service users' experiences with developing a relationship, working together and collaborate, with peer supporter workers. The aim of this study was therefore, to explore and describe service users' experiences with peer support relationships, support and collaboration. Twenty-six service users with mental health problems and/or substance abuse voluntarily participated in the study. Data was collected through five focus groups interviews in different areas in Norway. The data was analyzed using a hermeneutic content analysis and resulted in three master themes. Overall, these findings reveal that service users deem their relationship and collaboration with peer supporter workers as positive. Furthermore, these findings offer a critical evaluation of peer support, by highlighting challenges related to peer support relationships and collaboration. [ABSTRACT FROM AUTHOR]

Many countries have sought reforms aimed at maximizing the potential of service users to regain as much control as possible over care decisions and through the trajectory of care. There is a robust research literature suggesting that at the core of these services are collaborative relationships in which providers respect the perspectives of the persons being served and the partnerships in which they are involved. Although the significance of collaboration is established in the mental health field in this way, what it actually means to collaborate in practice, to be partners or to be mutually involved in a partnership with young adult service users, has been given less attention. In this article, the authors explore and describe the experiences of a cohort of these young adults, paying particular attention to their perspectives on collaborative practices with practitioners. Qualitative interviews were conducted with seven young adult service users age 20 to 30. Using thematic analysis, the authors identified four overarching themes that characterized their experiences of collaborating with practitioners in mental health and addiction care: (1) don’t fix me or judge me, (2) someone to sort issues out with, (3) not giving up, and (4) practical help. These findings inform the development and delivery of services to maximize positive outcomes for young adult service users with cooccurring mental health and substance use problems. [ABSTRACT FROM PUBLISHER]

Purpose The importance of collaboration in the mental health field is a well established theoretical principle, but there has so far been less attention to its practical implications from a parents’ perspective. The purpose of this paper is to describe parents’ experiences of collaboration with mental health practitioners.Design/methodology/approach This was a qualitative study based on thematic analysis of multi-stage focus group discussions with ten parents of young adults with co-occurring mental health and substance use problems.Findings The authors identified three major themes related to family member’s experiences of collaborative practices: negotiating partnerships, incomprehensible services and being the young adult’s advocate.Research limitations/implications A potential limitation of this study is that the parents who agreed to take part in this study were all part of the population who really want to be involved in their relative’s care; other family members who did not take part may have different feelings. It would be interesting to interview the siblings and partners of young adults with mental health and substance abuse problems. A last limitation is that only family parents participated in these focus group discussions; it would be interesting to invite service users and practitioners to elicit information about similarities and differences in their experiences of collaborative practices.Practical implications This study emphasises that parents should be seen as unique individuals as well as families. Parents are persons in different contexts. This creates different needs in their collaboration with the professionals. Parents want to be invited to contribute with their experiences and knowledge, being a collaborative partner in the service provision, and not a burden for their young adults, or to the professionals.Social implications This study emphasises that it may be important to understand the complex situations of each family parent, supporting their loved ones and at the same time living lives of their own. Families are in demanding and stressful situations often over many years. They want to be invited to contribute with their experiences and knowledge, being a collaborative partner in the service provision, and not a burden for their young adults, or to the professionals.Originality/value The importance of collaboration is well established in in the mental health field. However, there has been less attention to what collaboration with parents might involve in practice. This paper describes the collaborative experiences of parents of young adults (18-28 years) with co-occurring mental health and substance use problems. [ABSTRACT FROM AUTHOR]

Background: Recovery can be understood as a subjective process guided by personal expectations, goals and hopes. The aim of the study was to explore how persons using a Community Mental Health Centre (CMHC) experienced that their expectations for treatment, and goals and hopes for recovery were supported by the health professionals during treatment. Methods: Employing a hermeneutic-phenomenological approach, eight service users were interviewed about their expectations for treatment and their goals and hopes for recovery at the start of their contact with health professionals at a CMHC. Two years later, they were re-interviewed about their experiences of treatment and support from the health professionals in their work towards these goals and hopes. A collaborative approach was adopted. A co-researcher with lived experience took part in all stages of the study. Data were analysed by means of a data-driven stepwise approach in line with thematic analysis. Results: Five themes reflecting how participants experienced support from health professionals at the CMHC in their work towards their recovery goals were elicited, as follows: developing an understanding of oneself and one's mental health problems; learning how to change feelings and behaviours; being 'pushed' into social arenas; finding helpful medication; and counselling in family, practical and financial issues. The participants' expectations about counselling with regard to longer-term family, practical, and financial challenges were insufficiently met by the CMHC. In the experience of the service users, recovery occurred within the context of their everyday life with or without the support of their professional helpers. Conclusions: To facilitate recovery, health professionals should acknowledge the service user's personal goals and hopes and take a more comprehensive and longer-term approach to his or her needs and desires. Acknowledging and facilitating recovery goals by offering counselling with regard to family, practical and financial issues seems particularly important. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explore and describe service users’ subjective experiences of mental health crisis. The main research question is: How do people with severe mental health problems experience and understand mental health crisis? Based on a hermeneutic-phenomenological methodology, in-depth interviews with seven participants have been carried out to encourage reflections on mental health crisis experiences. The findings reveal the crisis as being complex and multifaceted, which contains two dimensions in experiencing crisis—an existential dimension (personal) and a contextual (social) dimension. Three main themes identified through the analysis, “Feeling out of control,” “Emotional darkness,” and “Loneliness and seeking togetherness”. Mental health crisis is experienced as chaos, losing control, loss of energy, and feelings of hopelessness. During mental health crisis, one’s social life can be difficult and involve many paradoxes and daily challenges. However, the participants revealed an understanding of a need for help, as mental health crisis emerges as a continuity of struggles in complex situations. There is a need for more comprehensive and broader perspectives of mental health crisis as a phenomenon, especially from the person’s perspective. Conceptualizing mental health crisis experiences from the person-perspective offers an opportunity for understanding this as an integral part of people’s lives. The nature of mental health crisis explicitly captured and understood in light of the complexity of personal lives is critical in developing recovery-oriented mental health care. [ABSTRACT FROM PUBLISHER]

In this article, we suggest that collaboration can be specified as a set of processes built around turntaking as the key process, with the processes of negotiation for common goals and putting differences to work as the two-dimensional focus in collaborative practice. Turntaking connects therapeutic work to establishing relationships instead of focusing on motivational states. Common goals connect collaborative practice to the therapeutic alliance. Putting difference at the centre places collaborative practice within a dialogical perspective. We specify dialogue as the overarching perspective in this article, differentiating two different types of conversation within the concept: dialogical and dialectical as the processes of change. The dialectical leads to an agreement of goals and perspectives, while the dialogical is oriented to accepting differences in goals and perspectives. These are connected to two different paths to change within the present moment. The first describes a process of moving along in present moments that turn into now-moments and are resolved in a moment of meeting. This could be seen as a description of dialectical conversations at a micro level. The second path to change occurs during quieter moments of therapeutic processes when participants are engaged in an intersubjective quest to negotiate the best fit between one's own intentions and those of the other. The therapist's skills to realise this include the use of service user feedback and following the lead of the family. [ABSTRACT FROM AUTHOR]

In previous research, meeting places have been favourably addressed by service users, but they have also been contested as exclusionary. In this participatory explorative study, we sought to perform a contextual analysis of meeting places in Norway based on a discourse analysis of three focus group discussions with 15 staff members. We asked the following question: how do meeting-place employees discuss their concrete and abstract encounters with service users and their experiences? We focused on service user involvement, which was largely analysed as neoliberal consultation and responsibilisation. Service users were positioned as resisting responsibility trickling down and defending staffed meeting places. Social democratic discourse was identified in the gaps of neoliberal discourse, which is noteworthy given that Norway is a social democracy. This relates to global concerns about displacements of democracy. We suggest that meeting places appear to hold the potential for staff and service users to collaborate more democratically. [ABSTRACT FROM PUBLISHER]

Background: Self-help strategies and various contextual factors support recovery. However, more in-depth knowledge is needed about how self-help strategies and supportive environments facilitate the recovery process. Aims: To explore what individuals who have recently been referred to a specialist Community Mental Health Center experience as helpful and what they do to help themselves. Method: Ten service users participated in in-depth interviews within a collaborative-reflexive framework. A hermeneutic-phenomenological approach was used. Results: Participants described a variety of helpful strategies and environmental supports. Four relevant main themes were identified: helpful activities, helpful people and places, self-instruction and learning about mental problems and medication and self-medication. Conclusions: The process of recovery is initiated before people become users of mental health services. This study confirms that recovery takes place within the person's daily life context and involves the interplay of contextual factors, such as family, friends, good places, work and other meaningful activities. The coping strategies reported may represent an important focus for attention and clinical intervention. [ABSTRACT FROM AUTHOR]

Background: The care situation for persons experiencing severe mental illness is often complex and demands good coordination, communication, and interpersonal relationships among those involved from the primary and specialized mental health care systems. For 15 years, professional care providers from different service levels within the same geographical areas in Norway have been trained together in a 2-year local onsite training program with the aim of increasing skills, joint understanding, and collaboration in their work with individuals experiencing severe mental illness. Methods: The key aspects of competence addressed by the training program were measured at baseline, after 1 year, and at the end of the training period. Professional education and experience were also rated at baseline. Data were collected between 1999 and 2005 and were analyzed by estimating a linear mixed model. Results: Results showed a significant increase in participants' experienced competence in all training goals, especially for the understanding of psychosis and relationship building. There was no significant variance at the program level, indicating consistent implementation of local programs. Conclusions: This prospective study indicates that the training program was successful in increasing perceived competence in the areas addressed, and training staff from different service levels together probably contributed to more collaboration. This training model still operates in Norway. [ABSTRACT FROM AUTHOR]

Little information exists on the specific reflective processes that precede therapists' choice of including or not including a structured feedback procedure in their established practice. In the present study, we aim to describe and explore experienced couple and family therapists' expectations for how the comprehensive therapy feedback procedure Systemic Therapy Inventory of Change might influence their practices. Through a thematic analysis of six focus group interviews, two main themes were elicited. The first main theme involved values embedded in current practice, with the following subthemes: (1) balance between the therapist's expert knowledge and the client's experience-based knowledge; and (2) making time to build alliances. The second main theme concerned the presumed influence on current practice, with the following subthemes: (1) 'Systemic Therapy Inventory of Change will disturb the therapist's capacity to stay present'; (2) 'Systemic Therapy Inventory of Change will shape conversations'; and (3) 'Systemic Therapy Inventory of Change will contribute to increased qualitative depth'. We discuss these results in relation to the notion of Systemic Therapy Invention of Change as a 'third party in the room'. We also discuss the results in relation to implications for collaborative practices, and for client and therapist autonomy. [ABSTRACT FROM AUTHOR]

Background: Person-centred practice is now firmly embedded in the nursing and healthcare discourse. While there is a growing body of development and research activity in the field, there is increased recognition of the need for further advances in the body of existing knowledge. This is reflected in the different approaches to person-centredness being adopted by healthcare systems internationally. Aims: To provide an overview of person-centredness and ways in which person-centred practice has been adopted in healthcare systems internationally. Methods: A summary review of the evidence underpinning the concepts and theory of personcentredness, incorporating an overview of national strategic frameworks that influence the development of person-centred practice in different countries. Findings: While there have been considerable advances in the development of person-centredness, there is a lot of work to be done in the adoption of more consistent approaches to its development and evaluation. In particular, a shared discourse and measurement tools are needed. Internationally, person-centredness is gaining momentum and many countries have strategic frameworks in place to direct its development and implementation. Conclusions: Significant developments in the theory and practice of person-centredness in nursing and healthcare have taken place. However, as evidenced by the accounts of in-country developments, internationally there is a need to develop more strategic multiprofessional approaches to the development/implementation and evaluation of person-centred practices. Implications for practice: • National developments in person-centred healthcare need to reflect the diversity of strategic approaches internationally • While a common language of person-centredness is emerging, there is a need for clarity over how this is operationalised in everyday practice situations [ABSTRACT FROM AUTHOR]

Background: During the past three decades, the concepts of recovery and person-centredness have become familiar in mental health policy, practice and research, as well as in the voicing of service users’ experiences of moving from mental distress and processes towards wellbeing and citizenship. Recovery, like person-centredness, is about a person retaining and keeping control over their life situation and being assisted in making informed decisions, and about supporting real partnerships between persons, families and services. Aim: The aim of the article is to discuss the roots and developments of recovery and personcentredness, highlight some key strategies of these practice developments and show how the concepts and practices can nurture each other. What this article adds to the topic: The roots of recovery are based in service user and activist organisations, and in disability movements, while the roots of person-centeredness can be traced back to Carl Rogers’ work from the early 1940s, and also to humanistic-existentialist oriented models of care in the 1960 and 1970s. The two concepts are interdependent in that they presuppose each other. The key aspects of recovery can be summed up as: • Recovery as a spontaneous, natural event • Recovery as consequence of active treatment • Recovery despite symptoms and functional impairments Recovery is a personal, social and a spiritual process. Person-centredness is regarded as an essential component in good-quality care, and is understood as conveying a holistic approach characterised by respect for individuals and their unique experiences and needs. Implications for practice: To make recovery and person-centredness influential in practice, four strategies are outlined: • Realising the radical change involved in placing the person at the centre • Acknowledging mental health problems as both personal and social • Recognising and using knowledge embedded in the lived experience of service users, family members and practitioners • Paying genuine attention to the spiritual process of recovery [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Although the importance of collaboration is well established as a principle in research and in theory, what it actually means for practitioners to collaborate in practice, to be partners in a collaborative relationship, has thus far been given less attention. The aim of this study was to identify key characteristics of the ways in which mental health practitioners collaborate with service users and their families in practice. Methods This was a qualitative study that used multi-staged focus group discussions with ten mental health care and social work practitioners in community mental health and substance use care. Thematic analysis was applied to identify common characteristics. Results We identified three major themes related to practitioners' experiences of collaborative practices: (1) walking alongside through negotiated dialogues, (2) maintaining human relationships, and (3) maneuvering relationships and services. Conclusions It appears that even with the rich knowledgebase that has developed on the merits of collaborative relationships, it continues to be challenging for practitioners to reorient their practice accordingly. The findings of this study indicate that the practitioners focus on two types of processes as characterizing collaborative practice: one focusing on conversations among practitioners and service users and their families and the other focusing on management and control among health care providers, service sectors, and service users (i.e., inter/intra-system collaboration). [ABSTRACT FROM AUTHOR]

Hope is a central concept in nursing and other fields of health care. However, there is no consensus about the concept of hope. We argue that seeking consensus is futile given the multifaceted and multidimensional nature of the concept, but instead we encourage in-depth studies of the assumptions behind talk about hope in specific contexts. Our approach to the 'science of hope' is inspired by philosophical pragmatism. We argue that hope is a concept that opens different rooms for action in different contexts and that accordingly, all hope interventions are contextually sensitive. Careful attention to how the relative positions and power of nurses and patients influence what can be inferred from their different ways of talking about hope may make hopeful conversations more meaningful in health care relationships. [ABSTRACT FROM AUTHOR]

Purpose – The co-occurrence of mental health and substance use problems is prevalent, and has been problematic both in terms of its complexity for the person and of the challenges it poses to health care practitioners. Recovery in co-occurring mental health and substance use problems is viewed as with multiple challenges embedded in it. As most of the existing literature on recovery tends to treat recovery in mental health and substance use problems separately, it is critical to assess the nature of our current understanding of what has been described as “complex” or “dual” recovery. The purpose of this paper is to identify and discuss what persons with co-occurring mental health and substance use problems describe as facilitators and barriers in their recovery process as revealed in the literature. Design/methodology/approach – The method used for this study was a small-scale review of the literature gleaned from a wider general view. Searches were conducted in CINAHL, Psych info, Medline, Embase, SweMed+, and NORART. Findings – Three overarching themes were identified as facilitators of dual recovery: first, meaningful everyday life; second, focus on strengths and future orientation; and third, re-establishing a social life and supportive relationships. Two overarching themes were identified as barriers to dual recovery: first, lack of tailored help and second, complex systems and uncoordinated services. Originality/value – The recovery literature mostly focuses on recovery in mental health and substance use problems separately, with less attention being paid in the first-person literature to what helps and what hinders dual recovery. [ABSTRACT FROM AUTHOR]

Background: The perspective of mental health recovery is increasingly shaping mental health care policies. Current texts in music therapy identify the importance of this critical and user-oriented perspective, but the relevance and implications for music therapy need to be outlined. Objective: This study explores service users' experiences of music therapy in mental health care, and the potential role of music therapy in the development of recovery-oriented service provision. Methods: We conducted a qualitative meta-synthesis of studies examining service users' experiences in music therapy; included were 14 studies with a total of 113 participants. Both first-hand account of participants and the researchers' representations of such statements were taken into account in the analysis. Findings: A taxonomy of four areas of users' experiences was identified: "having a good time;" "being together;" "feeling;" and "being someone." These core categories point towards music therapy as an arena that can be used by persons with mental health problems in their personal and social recovery process. Music therapy can contribute to the quality of mental health care by providing an arena for stimulation and development of strengths and resources that may contribute to growth of positive identity and hope for people with mental illness. Conclusions: The findings from this meta-synthesis indicate that the provision of music therapy closely resembles recognized benefits of a recovery-oriented practice. Awareness of users' self-determination and the development of a strength-based and contextual approach to music therapy that fosters mutual empowering relationships are recommended. [ABSTRACT FROM AUTHOR]

Being in recovery from bipolar disorder involves work-related concerns. The specific aims of this study are to: 1) understand the role of work in recovery from bipolar disorders, and 2) understand how people with such disorders deal with work-related challenges. These topics are examined from the stance of the recovery process, in which work-related activities were explored. Semi-structured, qualitative interviews were conducted with persons who had experienced recovery from bipolar disorder. Analysis was performed through thematic and phenomenological analysis, with hermeneutic phenomenology and reflexive methodology as a framework. The findings are presented through the following themes: 1) many types of work – finding meaning and a focus; 2) helpful roles and contexts – to be much more than a person with an illness; 3) making work possible – the role of supportive relationships and supportive medications, and 4) the costs of working too much – finding a meaningful and healthy balance. [ABSTRACT FROM PUBLISHER]

Background: Crisis resolution and home treatment (CRHT) is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the first paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on describing the characteristics of the patients at admission. Methods: The study was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, were the complete registration of patients of this team in the period from February 2008 to July 2009. Results: Although diverse in their characteristics, the patients were over represented by females, young to middle aged, and people on public support. The patients were mostly referred to the team by self/family members and primary care physicians. At admission, depression was the most prevalent symptom, the overall intensity level of mental health problems was low, and most of the patients had long-standing mental health problems. Conclusions: Self/family referral seems to be a critical route to receive services by CRTH teams as shown in our study, suggesting a need to examine policies that disallow this form of referral in some communities. The findings from our study show that the patients of the CRHT team, while mostly having long-standing mental health problems and had been receiving healthcare for them, did not have severe mental health problems at admission, although could have been in crises. There is a need for further studies to examine how people with severe mental health problems obtain services in time of crises, and to address the need to gain a greater understanding of the role of CRHT. [ABSTRACT FROM AUTHOR]

The key epistemological assumption in participatory research is the belief that knowledge is embedded in the lives and experiences of individuals and that knowledge is developed only through a cooperative process between researchers and experiencing individuals. There are various notions about the nature and processes of participation in this type of research. This paper focuses on specific processes that are used for a "genuine" participation by experiencing individuals as research participants. It also identifies processes that are critical for researchers to engage with, in order to become pro-participatory in their approaches to qualitative research. The paper draws on a particular project as an exemplar-"The Crisis Resolution and Home Treatment Project." This project uses various participatory research processes to elicit and include voices of health-care professionals, service users, and family members. The main objective of the research project is to develop knowledge for new forms of community-based practices for people experiencing mental health crisis. We present the participatory research methodology applied in this research, and discuss two sets of processes used to enhance "participation" in research-one set to encourage and elicit participation by research participants; and the other set to engage researchers in reflection within the participatory research process. This will mitigate the paucity of literature regarding the processes and approaches necessary to make participatory research truly "participatory" both for research participants and researchers. [ABSTRACT FROM AUTHOR]

Background: Crisis resolution and home treatment (CRHT) is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the second paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on the provision of professional services by the team. Methods: The project was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, constituted the complete registration of patients of this team in the period from February 2008 to July 2009. Results: The average length of service by the team was about 15 days, and those with depression as the major symptom had the longest mean length of stay on the team. The team was engaged in providing a variety of services including individual treatments involving multiple professionals, group treatment meetings, and coordination activities involving external service sectors. While the type of professionals providing individual treatment was not associated with the severity level of clinical problems, those receiving various group treatment meetings had more serious level of clinical symptoms than those not receiving group treatment meetings. In addition coordination activities involving healthcare professionals and social services in the community were in line with the patients' clinical and social needs. The results of the study show that the team functioned effectively in addressing the general guidelines for the functioning of CRHT teams. [ABSTRACT FROM AUTHOR]

Background: Crisis resolution and home treatment (CRHT) is an emerging mode of delivering acute mental healthcare in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the third paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on the changes in morbidity and clinical problems from admission to discharge and the length of service. Methods: The study was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, were the complete registration of patients of this team in the period from February 2008 to July 2009. Results: The findings indicate that the patients´ mental health status improved from admission to discharge, although many patients were discharged with the same mental health symptoms as those present at admission. However, one third of the patients were discharged with no clinically significant mental health problems. The majority of the patients of the CRHT team on the other hand seemed to be those with long-standing mental health problems, who were likely to be in need of continuing mental health care even after the resolution of mental health crises. There is a need for a coordinated system of community-based mental health services for patients with long-standing mental health problems, within which CRHT teams can play a pivotal role in making connections between the crisis-care and the recovery-oriented care. The mean length of service was around 15 days with variations by the clinical problem types, with the patients in the psychosis group having the shortest duration and the patients in the depression group having the longest duration. [ABSTRACT FROM AUTHOR]

Background: As Norway moves toward the provision of home-based crisis response, knowledge is needed about understandings of mental health crisis and effective ways of addressing crises within the home. Objective: To elicit and learn from service users' experiences about the subjective meanings of crisis and what kind of help will be most effective in resolving mental health crises. Theoretical: A phenomenological-hermeneutic cooperative inquiry method was used to elicit and analyse focus group responses from mental health service users who had experienced crises. Results: Findings clustered into three themes: (1) Crisis as multifaceted and varied experiences; (2) losing the skills and structure of everyday life; and (3) complexities involved in family support. Conclusion: Several aspects of crises require an expansion of the biomedical model of acute intervention to include consideration of the personal and familial meaning of the crisis, attention to the home context, and activities of daily living that are disrupted by the crisis, and ways for the person and the family to share in and learn from resolution of the crisis. [ABSTRACT FROM AUTHOR]

Most people with mental health problems want a paid job, but experience difficulties in obtaining one. In-depth knowledge from service users is needed about what supports their work capacity and potentials. This qualitative study aimed to explore the occupational history of people with severe mental-health problems and experiences of being candidates in a transitional employment course. Two in-depth interviews with five candidates of this course were conducted. Four themes were developed: 'all it takes to have a life', 'being on the right track', 'asking for feedback', and 'candidates - for what'? The participants in this study experienced this course as a possibility for exploring themselves, their everyday lives and work potentials. However, they perceived some of the program's philosophy as unhelpful which highlights the significance of listening to the service users' preferences. These findings suggest that further standardization of vocational-rehabilitation programs in mental health may be counter-productive. [ABSTRACT FROM AUTHOR]