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Mental health recovery has shifted from clinical conceptualizations to more personal ones. However, much of the lived experience literature has focused on people living with mental health conditions, and less attention has been placed on various mental health professionals, especially in Asian countries, where the personal recovery literature base is in its nascent stage. We sought to contribute to a growing body of work by exploring recovery from the lens of different mental health professionals in Singapore. Mental health professionals in Singapore were invited to participate in an online interview through social media. The recordings were transcribed verbatim and analyzed using a constructive grounded theory approach. Nineteen participants were interviewed. A single core category, "living in society once more", and three categories, "An ongoing process", "Regaining ability to function in society", and "A normality report card" were identified from our data. Recovery within the Singapore mental health professional perspective focuses on helping individuals return to society and function productively while considering existing societal norms such as the highly competitive and pragmatic culture in Singapore. Future research can explore in greater depth the impact of these factors on the recovery process. [ABSTRACT FROM AUTHOR]

Recovery is known to be enhanced by meaningful interactions between patients and mental health staff. However, nurses may become distanced from patients, and patients may spend most of their time in inpatient mental health care alone. This study aimed to explore how patients experience the intervention Daily Talks, a patient-driven innovation intended to enhance meaningful interactions between patients and staff. Fourteen in-depth interviews were performed with patients who participated in Daily Talks. The interviews were analysed using reflexive thematic analysis. The results of the participants' experiences of Daily Talks are presented in four themes: 1.Interpersonal and active interaction where individual factors matter 2.A patient-controlled space 3.A multi-use intervention and 4.A part of the daily healthcare structure. Participants stated that Daily Talks improved the relationship between patients and their nursing staff, and they stressed the importance of patients having control over both time and content in the Daily Talks. Daily Talks was used to vent emotions and thoughts, handle situations and create strategies, and become part of a helpful structure. The results support the value of Daily Talks, indicating that Daily Talks may facilitate helpful structures and meaningful relationships between patients and nursing staff. [ABSTRACT FROM AUTHOR]

Engagement in everyday activities has been identified as an important element in personal recovery from the experience of mental illness and a key priority for service-users. This study explored the role of everyday activities in recovery. This study used a photovoice participatory research. Twenty-one participants experiencing mental illness were recruited from a community-managed mental health service in Melbourne, Australia. Data collection included individual interviews and photovoice courses. The courses included group discussions and required participants to take photographs about their everyday activities that support recovery. A lived experience co-facilitator contributed to development and delivery of the course. The interviews and group discussions were transcribed verbatim and analysed using constant comparative methods. Recovery as a "journey of living well" was identified as the central theme that encompasses three interlinked categories: (1) living a life on hold; (2) choosing to recover; and (3) learning and navigating strategies. The findings suggest that recovery involves a range of experiences embedded in people's everyday lives. Recovery-oriented practice should provide opportunities for engagement in meaningful activities, to help consumers identify their potential and strategies to live well, and to adopt co-production at all levels. [ABSTRACT FROM AUTHOR]

Psychological recovery is typically measured in improving access to psychological therapies (IAPT) services as the reduction of symptoms on routine outcome measures (ROMs). However, conceptualisations of psychological recovery vary, and there are concerns that ROMs may not be suitable for measuring recovery from complex mental health difficulties. To gain insight into psychological recovery and measurement in clinical practice. A qualitative study at a step-4 IAPT service in the North of England. Eight clinicians contributed to focus groups, and 10 service users were later interviewed individually. Factors that informed four congruent and interacting themes of recovery were identified among participants as an ongoing personal process, of intra-therapeutic and extra-therapeutic factors impacting on recovery in helpful and unhelpful ways, and the need for idiographic long-term recovery measures. The functional and long-term nature of recovery and the socio-economic context for recovery were considered particularly crucial. The need for idiographic long-term recovery measures to support the ongoing process of recovery was reported in the majority of instances. Study findings mirrored existing recovery and outcome measurement literature, provided new evidence in relation to recovery from complex mental health difficulties, and made recommendations for future research and clinical practice. [ABSTRACT FROM AUTHOR]

A psychiatric advance directive (PAD) is designed to prevent involuntary mental health interventions by enabling people with serious mental illnesses to plan ahead for their own treatment during a future incapacitating crisis. This study implemented PAD facilitation in assertive community treatment (ACT) teams. We examined ACT clients' attitudes toward PAD facilitators, satisfaction with PAD facilitation, the short-term impact of PAD completion on subjective sense of empowerment and attitudes toward treatment, and whether the type of PAD facilitator made a difference. Participants were randomly assigned to be offered PAD facilitation by a peer support specialist or non-peer ACT team clinician, and interviewed at baseline (n = 145) and post-facilitation 1–2-month follow-up (n = 116), to assess perceived consumer-directedness of PAD facilitation, empowerment and various treatment attitudes. Mean scores before and after the intervention were compared for PAD-completers, non-completers, and those who completed a PAD with a peer vs. non-peer. The effect of PAD completion was assessed using logistic and linear regression analysis. There was no evidence of bias against peer-facilitators. There was a modest positive impact of PAD facilitation on treatment attitudes and empowerment. PAD facilitation by peer support specialists and others working in community mental health settings supports recovery. [ABSTRACT FROM AUTHOR]

Open Dialogue (OD) is a needs-based, service-user initiated approach to mental health service delivery that emphasises dialogue, and shared understanding between service users, and their support network. The aim of this study was to explore the lived experience of being part of an OD-informed mental health service in Ireland. Data were collected through semi-structured group interviews and analysed using thematic analysis. Three primary themes were identified across the data set namely: diversity across practice; unpacking the taken-for-granted and mental health as shared experiences. Participants experienced enhanced communication, improved relationships with mental health staff and developed shared understandings of mental health. This small-scale implementation demonstrates the received value for service users and their networks of an OD-informed approach within a traditional care pathway. As a relational and collaborative way of working, it requires a shift in clinical practice for mental health staff and service users that is experienced as a welcome change from treatment-as-usual (TAU). [ABSTRACT FROM AUTHOR]

Background: There is extensive literature documenting the nature of recovery in mental health in adult populations, but there is very little exploring its nature and meaning for young people. Aims: To gain a detailed understanding from the perspective of young people about the concept of recovery in young people's mental health. Method: Semi structured interviews were conducted with 23 young people. Interviews were transcribed verbatim and analysed using thematic analysis. Results: Themes emerging from the interviews included young people's dynamic conceptualisations of recovery, awareness of others views of recovery, polarised goals of recovery, and facilitators and barriers of recovery. Conclusions: To be relevant for young people, the mental health recovery model must incorporate individual needs, developmental considerations and fluctuations in goals. It must also be embedded within the young person's ecological system such as family, friends and school, and be focussed around an explicit and collaborative recovery discussion with the young person. [ABSTRACT FROM AUTHOR]

Background: The relationship between personal choice and mental health recovery in the context of supported housing has not been explored. Aims: To gain an understanding of how choice facilitates recovery processes in supported housing environments for those with serious mental illness (SMI). Method: Qualitative in-depth interviews were conducted with 24 tenants with SMI living in supported housing. Results: Choice while living in supported housing was a large contributor to wellbeing and mental health recovery. Tenants valued three domains of choice: (1) choosing to be responsible for one's life, (2) choosing how to organize one's social life and (3) choices that make them feel "at home". Conclusion: This is one of the first studies on choice and recovery for persons who have transitioned to supported housing. Findings reveal the need for research to move beyond focusing on choice of housing (e.g. housing type) and explore the scope and relevance of choice in housing. [ABSTRACT FROM AUTHOR]

Background: The recovery movement has become highly influential in research and services for people who experience psychosis. However, the precise meaning of recovery from psychosis is contested, and there are concerns that the language of the recovery movement may be co-opted to serve other priorities. Aims: To investigate carers' constructions of the meaning of recovery from psychosis. Method: A qualitative study, using synthetic discursive psychology to analyse transcripts of semi-structured interviews with seven carers recruited from an Early Intervention in Psychosis service, where recovery approaches were practised. Results: We found medical accounts of recovery to be highly influential used both frequently and as a key reference point, even when describing alternative, non-medical accounts of recovery. Such alternative accounts of recovery in the data were fragementary and participants tended to use such accounts to signal some kind of trouble or disruption. Conclusions: Explanations of the objectives of recovery approaches cannot escape comparison with a medical repertoire of recovery. Such explanations may benefit from illustration using personal accounts of recovery that contain concrete detail. Creating conditions of safe uncertainty around the meaning of recovery may be an important aim for clinicians and services. [ABSTRACT FROM AUTHOR]

Background: Developing recovery-oriented services, and ensuring genuine consumer participation in all aspects of services are central components of contemporary Australian mental health policy. However, attitudes of mental health professionals present a significant barrier. Given the positive impact of education on health professionals' attitudes, particularly when consumers are involved, further exploration of consumer involvement in education is required. Aims: To enhance understanding of the role consumers can play within mental health nursing education. Method: A qualitative exploratory project was undertaken involving individual interviews with mental health nurse academics and consumer educators. Results: Two main themes emerged from nurse participants: Recovery in action, consumer educators were able to demonstrate and describe their own recovery journey; and not representative, some participants believed consumer educators did not necessary reflect views and opinions of consumers more broadly. Two main themes for consumers were: the truth about recovery, consumer educators demonstrated recovery as an achievable goal; and not a real consumer, where health professionals to dismiss the consumer experience as unrepresentative and therefore not credible. Conclusions: Consumer participation can contribute positively to nurse education, however representativeness presents a major barrier, potentially enabling nurses to dismiss experiences of consumer academics and educators as exceptional rather than typical. [ABSTRACT FROM AUTHOR]

Background: Recovery processes in borderline personality disorder (BPD) are poorly understood. Aims: This study explored how recovery in BPD occurs through routine or specialist treatment, as perceived by service users (SUs) and therapists. Methods: SUs were recruited from two specialist BPD services, three community mental health teams, and one psychological therapies service. Semi-structured interviews were conducted with 48 SUs and 15 therapists. The "framework" approach was used to analyse the data. Results: The findings were organized into two domains of themes. The first domain described three parallel processes that constituted SUs' recovery journey: fighting ambivalence and committing to taking action; moving from shame to self-acceptance and compassion; and moving from distrust and defensiveness to opening up to others. The second domain described four therapeutic challenges that needed to be addressed to support this journey: balancing self-exploration and finding solutions; balancing structure and flexibility; confronting interpersonal difficulties and practicing new ways of relating; and balancing support and independence. Conclusions: Therapies facilitating the identified processes may promote recovery. The recovery processes and therapeutic challenges identified in this study could provide a framework to guide future research. [ABSTRACT FROM AUTHOR]

Background: The concept of recovery is contested throughout the existing literature and in mental health services. Little research exists that gives voice to service user perspectives of recovery. Aim: This paper explores how service users in two recovery oriented services run by the National Health Service in North West England talked about recovery and what it meant to them. Method: 14 service users accessing these services took part in semi-structured qualitative interviews focusing on the concept of recovery. Data were analysed using an interpretive phenomenological analysis approach. Results: Service users talked about recovery as a dynamic, day to day process as well as an outcome; specifically related to being discharged from inpatient settings. A number of factors including relationships and medication were cited to have the potential to make or break recovery. Conclusions: The study highlights the continued dominance of the biomedical model in mental health services. Service users appear to have internalised staff and services’ understanding of recovery perhaps unsurprisingly given the power differential in these relationships. Implications for clinical practice are explored. [ABSTRACT FROM AUTHOR]

Background: Recovery Colleges address mental health challenges using an educative approach underpinned by a collaborative recovery orientated philosophy. Research has been limited with no studies identified reporting research on the design and delivery of a specific course. Aims: To understand how Recovery College students and tutors experience the design and delivery of a mental health Recovery College course, specifically the “‘Building Resilience” course. Method: Thematic analysis of qualitative data related to the experience and process of collaboration in recovery college course design and delivery. Data included 13 qualitative individual interviews with course students and tutors and “naturally occurring” data generated through course preparation and delivery. Results: Findings drew attention to the centrality of: prior experience and design related to students, tutors and the course structure; co-delivery related to tutors and co-learner impacts; and to the course methods and environment. Conclusions: Commitment to collaboration in design and delivery of Recovery College courses can mobilise the diverse experiences and expertise of tutors and students. The environment and methods of learning have a significant impact and should be considered alongside content. Boundaries between people and areas of knowledge and experience that arise can be viewed as sources of creativity that can enrich courses. [ABSTRACT FROM AUTHOR]

Background: Community-managed mental health organisations are important vehicles for “place-based” recovery-oriented services in regional areas. However, the community-based sector is not well described in data collections and more research is needed to identify the specific contributions that such services can make to recovery. This situation has become more acute in Australia with the restructure of mental health services under the new National Disabilities Insurance Scheme (NDIS). Aims: The project aimed to understand more about what is effective in the service system; what impacts living in a regional location might have on a person’s lived and service system experience and what people find helpful and supportive in their recovery journeys. Method: A one-year qualitative study utilising photovoice and written narrative with group workshops, individual interviews and a capstone exhibition experience. Results: Research findings were consistent with recovery principles but also revealed elements not commonly emphasised in the recovery literature. Four main themes were distilled: belonging and being connected; survival, resilience and hope; living a contributing life and compassionate service provision. Conclusion: The effectiveness of recovery-oriented service delivery needs to be secured under the individualised funding structure of the new NDIS and expanded for the specific needs of people living in regional communities. [ABSTRACT FROM AUTHOR]

Background: Scarce information is available about how users experience treatment at mental health day hospitals, particularly in South America. Aims: To explore users’ perspectives about elements of day hospital treatment that facilitate or hinder the recovery process in a mental health facility in Buenos Aires, Argentina. Methods: Semi-structured individual interviews (n = 8) and focus groups (n = 4) were carried out with a convenience sample of users of a mental health day hospital program based on a formulation, testing and redevelopment of propositions approach. Results were analyzed through grounded theory techniques. Results: Categories indicating recovery were: starting to do things, being able to see themselves from a new perspective, mood improvement and changes in interpersonal relationships. Aspects facilitating recovery were: activities organized by the facility, the group approach, the care provided by facility workers and the physical environment. Hindering aspects were: heterogeneity of users in terms of age, severity, diagnosis and being underestimated by staff. Conclusions: Being active again was considered to be the main recovery indicator in this cultural context and participating in activities led by skilled facilitators was the most beneficial factor of the program according to the users. [ABSTRACT FROM AUTHOR]

Background: There is lack of long-term controlled studies evaluating treatment effects of antipsychotic medication. A complete investigation should include the service user perspective. Aims: To investigate experiences of clinically recovered service users of antipsychotic medications during and after a first episode of psychosis. Method: We used a thematic analytic approach within an interpretative-phenomenological framework. 20 clinically recovered service users were interviewed. Results: Themes: (1) Antipsychotic drugs reduce mental chaos during the acute phase, (2) Non-stigmatizing environments were perceived to increase chances of successful use, (3) Antipsychotic drugs beyond the acute phase – considered to compromise the contribution of individual effort in recovery, (4) Prolonged use – perceived to reduce likelihood of functional recovery, (5) Antipsychotic medication was considered as a supplement to trustful relationships. Conclusions: Acute phase antipsychotic treatment was mostly perceived as advantageous by this sample, who was in clinical recovery. However, costs were often seen as outweighing benefits beyond the acute stage. Findings clearly emphasize the need for a collaborative approach to be integrated across all phases of care. This study underscores the need to investigate sub-group differences with regard to long-term antipsychotic treatment. [ABSTRACT FROM AUTHOR]

Background: Forensic psychiatry is characterized by involuntary treatment and risk of violence. The concept of recovery is rarely in focus as the primary focus is on risk assessment, violence prevention and reducing coercion in care. Aim: To determine what resources forensic staff use to avoid or prevent violent situations, and to explore how these practices resemble the domains of recovery-oriented care. Method: Semi-structured interviews with staff who were identified by forensic patients as key workers in their recovery process. Interview texts were analyzed using interpretive content analysis. Results: Staff prevent violent situations using tacit knowledge and experience, and through a shared collegial responsibility. Staff safeguard patients, encourage patient participation, and provide staff consistency. Conclusions: The results have implications for forensic care as well as psychiatry regarding the process of making recovery a reality for patients in the forensic care setting. [ABSTRACT FROM AUTHOR]

Background: Sub-acute residential mental health services provide care for people who are not acutely unwell but require more support than generally available when living in the community. Little is known about how these services facilitate recovery and whether these facilitators differ for clients entering from the community (step-up) or from inpatient settings (step-down). Aim: To identify features of a sub-acute residential service that have assisted step-up and step-down clients in their recovery. Method: Semi-structured interviews were conducted with 16 step-up and 21 step-down clients. Interview transcripts were examined using an inductive, semantic content analysis approach. Results: Themes identified included the community context, personal support, the formal program offered and assistance in personal recovery processes, with the level of support for these themes differing for step-up and step-down clients. Conclusions: Step-up and step-down clients have differing needs to be addressed in a sub-acute service. These services can better meet the needs of clients if they are aware of the setting the client has come from and tailor their services accordingly. Step-up clients prefer support in developing social skills and illness management techniques; step-down clients prefer a less structured environment with assistance in living skills and personal processes of recovery. [ABSTRACT FROM AUTHOR]

Background: Australian mental health policy requires that mental health services facilitate meaningful and genuine consumer participation in all aspects of mental health services. Roles for practitioners who work from their own experience of significant mental health challenges and mental health service use have been implemented in many services to promote participation and the development of more consumer focused services. Aims: To enhance understanding of perspectives of individuals working in lived experience roles to more closely understand their experiences and opinions about these roles. Method: A grounded theory study interviews were conducted with 13 lived experience practitioners. Results: The medical model was a core category arising from this work. Participants described the medical model as a prevailing culture within mental health services from their personal and professional experiences. This culture imposed a major limitation on the implementation, effectiveness and development of lived experience roles and themselves as individuals. It was also seen as a major limitation to the progress of Recovery orientated reform. Conclusions: The development of Recovery oriented services requires a strong lived experience practitioner workforce, with appropriate resourcing and support available. The current medical model approach requires critique to facilitate reform and avoid tokenism. [ABSTRACT FROM AUTHOR]

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: In England, personal budgets are offered to eligible people with severe mental health problems to enable them to purchase what is helpful for their quality of life or recovery. However, in-depth insight into people's own perceptions of the outcomes is lacking. Aims: To investigate people's own reporting of outcomes from using personal budgets in relation to social care needs arising from severe mental health problems. Method: A convenience sample of 47 individuals receiving personal budgets was recruited from three English local authorities. In-depth semi-structured interviews were subject to thematic framework analysis. Results: Most participants identified positive outcomes across domains interconnected through individual life circumstances, with mental health and wellbeing, social participation and relationships, and confidence and skills most commonly reported. Some needed more support than others to identify goals and make use of the personal budget to take a more active part in the society. Conclusions: Personal budgets can enable people to achieve outcomes that are relevant to them in the context of their lives, particularly through enhancing their wellbeing and social participation. Consideration should be given to distinguishing those individuals potentially requiring more support for engagement from those who can engage more independently to identify and pursue their goals. [ABSTRACT FROM AUTHOR]

Background: Wellbeing is an important outcome in the context of recovery from mental illness. The views of mental health professionals on wellbeing may influence their approach to supporting recovery. Aims: This study aims to explore views held by mental health staff about factors influencing their own wellbeing and that of service users with psychosis. Methods: Semi-structured interviews were conducted with 14 mental health staff in South London who had worked with people with psychosis. Thematic analysis was used to analyse the data and comparisons were made between staff views of wellbeing for themselves and service users. Results: Staff participants held similar conceptualisations of wellbeing for themselves and for service users. However, they suggested a differential impact on wellbeing for a number of factors, such as balance, goals and achievement, and work. Staff employed a more deficit-based perspective on wellbeing for service users and a more strengths-based view for themselves. Conclusions: Staff stated a recovery orientation in principle, but struggled to focus on service user strengths in practice. A stronger emphasis in clinical practice on amplifying strengths to foster self-management is indicated, and staff may need support to achieve this emphasis, e.g. through specific interventions and involvement of peer support workers. [ABSTRACT FROM AUTHOR]

Background: Research on recovery from mental illness and the influence of compulsory psychiatric institutional care has revealed the complexity of this concept. There is also limited knowledge regarding the impact of gender-role expectations in these contexts, and how such expectations may influence both the care and individuals' recovery processes. Aim: To explore women's and men's perceptions of the impact of compulsory inpatient care on recovery from severe mental illness. Method: Grounded theory was used to analyse 30 first-person accounts of recovery from mental illness, elicited via interviews with individuals who had been compulsorily treated in hospital and diagnosed with a severe mental illness. Results: Inpatient care at an early stage was crucial for the informants' recovery. However, there was ambivalence in their perceptions of the impact of compulsory inpatient care. The narratives confirmed gender differences as well as gender stereotypes. Conclusions: The results have implications for recovery research, in that they emphasise the importance of understanding recovery as a gender-influenced process. [ABSTRACT FROM AUTHOR]

This paper explores an innovative approach to recovery training in which the medium of delivery – as much as the actual content of what was delivered – challenged the conventional construction of professional relationships. The training group comprised service users together with the practitioners who normally worked with them and would continue to do so. The paper examines the staff experiences of the training and the impact on their practice through qualitative interviews conducted 6 months post-training with a sample of four staff participants. The thematic analysis of the interviews demonstrated that this approach could be a powerful experience that brought about lasting changes in working relationships and professional identities. Particular themes that emerged included challenging power relationships and the value of the trainers disclosing their own lived experience and recovery narratives in creating a "safe space" for collaborative learning. This approach demonstrated the potential to be transformative for staff and their relationships with service users, although care may need to be exercised when offering it to staff with little prior exposure to recovery-oriented practice. [ABSTRACT FROM AUTHOR]

The concept of recovery has become central to international mental health policy and service planning. At present there, however, is no unified theory of mental health recovery available to guide clinical practice. The aim of this study was to develop a coherent theory of recovering from mental health problems from the point of view of those recovering in Ireland. The study was guided by classic grounded theory and based on individual interviews with 32 volunteers who had experienced mental health problems. The participants' main concern was identified as striving to reconnect with life. The core category of reconnecting with life had three interactive subcategories: (1) reconnecting with self through accepting oneself as a worthy human being capable of positive change; (2) reconnecting with others through accepting and validating interaction; (3) reconnecting with time, through getting a glimpse of positive future, coming to terms with the past, and actively shaping and executing one's present and future. The study shows that accepting, validating and the hope-instilling interaction can facilitate the process of reconnecting with life and is, therefore, crucial for recovery-oriented care. [ABSTRACT FROM AUTHOR]

The importance of having hope for recovery has been highlighted in numerous qualitative studies of recovery. It is identified as a vital part of this process, and guidelines suggest that service providers should therefore facilitate hope in their clinical work; however, they do not indicate how this guidance can be operationalised. To identify the sources of hope for recovery based on the accounts of people with experience of recovery; to ascertain how these accounts show service providers can facilitate such hope in their therapeutic work. Semi-structured interviews were conducted with eight people with experience of recovering from mental health problems. A grounded theory analysis was undertaken. A model conceptualising the role of hope in recovery was developed with three categories: "influence of others on hope", "personal hope" and "doing recovery". The model indicates a complex interaction between hope and recovery with an important role for social context and interpersonal relationships, including those with clinicians. Mental health service providers occupy a powerful position in relation to service users' hope, and must carefully consider how they communicate their own hopefulness about clients' recovery. Suggestions are made about facilitating hope for recovery. [ABSTRACT FROM AUTHOR]