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Objective: This article examines the relationship between inpatient mental health units' adherence to recovery-oriented care and 30-day patient readmission. Method: The sample included patients admitted to one of 34 Veterans Health Administration inpatient mental health units. Recovery-oriented care was assessed using interviews and site visits. Patient characteristics and readmission data were derived from administrative data. Findings: Overall recovery orientation was not associated with readmission. Exploratory analyses found higher scores on a subsample of items pertaining to inpatient therapeutic programming were associated with lower patient readmissions. Additionally, patients with more prior service use and substance abuse or personality disorders were more likely to be readmitted. Conclusions and Implications for Practice: A growing body of literature supports the association between psychotherapeutic services in inpatient units and better patient outcomes. However, further research is needed to examine this association. More work is needed to develop appropriate psychotherapy services for the inpatient setting and support their implementation. Impact and Implications: While this study did not find an overall association between recovery-oriented inpatient mental health services and patient readmission, it did show an association between the provision of therapeutic services and readmissions. These findings support the importance of developing therapeutic models appropriate for acute inpatient settings as well as supporting their provision. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the mediating roles of self-esteem and self-efficacy on the relationship between family social networks and personal recovery among Chinese people with mental illness in Hong Kong. Methods: One hundred and twenty-five Chinese adults with mental illness from community mental health centers in Hong Kong were recruited for this study. Data were collected using a structured questionnaire. Results: Study results indicated that a large family network size was indirectly related to high levels of personal recovery through high self-efficacy. High perceived family support was directly related to high levels of personal recovery. In addition, high family criticalness was related to low levels of personal recovery directly and indirectly through low self-esteem. Conclusions and Implications for Practice: These findings suggest that using a family approach to enhance individuals' self-esteem and self-efficacy might promote personal recovery among people with mental illness in the Chinese context. Impact and Implications: This study found that family network size is indirectly related to personal recovery, via the effect of self-efficacy. Self-esteem mediates the relationship between family criticalness and personal recovery. Study findings underscore the importance of incorporating strategies to enhance self-esteem and self-efficacy into family interventions aiming to promote personal recovery among people with mental illness in the Chinese context. [ABSTRACT FROM AUTHOR]

Objectives: Although recovery for people with serious mental illness (SMI) has received considerable attention, there is a research gap on the related topics of well-being and happiness—subjects that have been widely studied in the general population. The objective of this study was to explore the experiences of happiness, well-being, and recovery from the perspectives of persons with SMI, and to examine similarities and differences among these constructs. Method: This qualitative study used semistructured interviews with a purposive sample of 30 adults with SMI to explore experiences of happiness, well-being, and recovery. Reflexive thematic analysis was applied to generate themes related to each concept. Results: Happiness was facilitated through relationships with natural and professional supports, engaging in meaningful activities that conferred a sense of accomplishment, using coping skills to reduce distress, engaging in recreational activities, and meeting basic material needs. Well-being was promoted through self-care activities and enhanced through relationships with professional supports. However, nearly one-fourth of participants expressed uncertainty about what well-being meant to them. Recovery was characterized as a process of overcoming illness or adversity through which personal control over symptoms and stressors is increased; recovery is also facilitated by supportive professional relationships. Conclusions and Implications for Practice: Most factors relating to the happiness of people with SMI are also factors that have been identified in theory and research as facilitating the happiness of the general population. Findings suggest that happiness should be considered an important new area of research, policy, and practice in the fields of psychiatric rehabilitation. Impact and Implications: Happiness, well-being, and recovery are important and fulfilling experiences for persons with serious mental illness. However, it is unclear how these concepts overlap or diverge from one another. Our findings suggest significant similarities but also important distinctions between happiness and recovery and that promoting happiness should be a priority area for mental health professionals, policymakers, and researchers. [ABSTRACT FROM AUTHOR]

Objective: Spirituality is part of recovery for many people with lived experience of mental health issues, including those who become peer specialists and utilize their own recovery experiences to facilitate the recovery of others. This research explores how peer specialists view spirituality in their work with their peers and the factors that impact conversations in this area. Method: Eleven peer specialists participated in individual qualitative interviews. Inquiries were made about their own experiences of spirituality and how these were used to support others. Additional questions probed factors that facilitated or served as barriers to their ability to engage in such conversations. Data were subjected to thematic analysis. Results: Peer specialists experienced well-being, hope, and self-acceptance through spirituality. Use of spirituality in peer support was influenced by their personal spiritual journey, specifically because they understood its value to recovery. Barriers to use included fear of rejection and lack of formal support. The number one facilitator was their personal experience, but they suggested the need for training and guidelines as important future facilitators. Conclusions and Implications for Practice: Results indicate that at least some peer specialists are thinking about the role of spirituality in their work but express some struggles with such activities. There appears a need for guidelines on how to use spirituality in peer support, better definitions of the competencies peer specialists need, and more attention to training and supervision in this area—possibly to maximize the benefit of the lived experience that many peer specialists bring to their work. Impact and Implications: This qualitative study investigated mental health peer specialists' experiences of using spirituality in their work, including facilitators and barriers to having spiritually oriented conversations with peers. Findings indicate that peer specialists find value in using spirituality in their work but need additional support, especially through training and encouragement from organizational leadership, to increase confidence and skills in this area. [ABSTRACT FROM AUTHOR]

Background: Recovery-oriented, strengths-based intervention engages service users' strengths and resources to support their recovery process. This model was developed in an American context and has been applied in Hong Kong. It is important to formulate an understanding of strengths better fit to Hong Kong Chinese. Aims: This exploratory qualitative study examined Hong Kong Chinese service users' views on strengths and preferred translation for the word strengths, along with its cultural nuances. Method: Twenty-six people with serious mental illnesses were individually interviewed at a mental health center in Hong Kong, based on a photo-elicitation technique and reflection on Chinese terms related to strengths. Analysis of data employed the constant comparative method. Results: Participants reported that social factors, such as support by helping professionals and engagement in family roles, as well as spiritual beliefs and practices, are important for recovery. These insights and their preferred translations of strengths generate a culturally nuanced understanding of strengths. Conclusions & Implications for Practice: The strengths model applied in Hong Kong can be enhanced by a more culturally nuanced perspective, for example, including the importance of family-based identity and filial piety, beliefs related to harmony and fate, and practices such as a temple or church attendance. Impact and Implications: This study investigates how Hong Kong Chinese people view strengths in facilitating recovery from mental illnesses. The term "strengths" in recovery was deemed synonymous with the terms ability (néng lì; 能力) and expertise (zhuān cháng; 專長) in Chinese. This study sheds light on how Chinese conceptualizations of "strengths" in recovery may be applied in interventions. [ABSTRACT FROM AUTHOR]

Objective: Understanding factors that promote and hinder the recovery process for people living with serious mental illness remains of critical importance. We examine factors, including limited literacy, associated with mental health recovery among public mental health service users. Method: This study uses data from a mixed-methods, service-user informed project focused on the impact of limited literacy in the lives of people with serious mental illness. Data from structured interviews evaluate perceptions of recovery as assessed with the Recovery Assessment Scale (RAS). Regression models examine factors related to recovery controlling for sociodemographic factors, literacy, neurocognition, mental health status, perceived social support, and stigma. Results: Despite bivariate relationships between RAS and limited literacy, the full models suggest that other factors account for this relationship. These include mental health status, higher social support, higher self-reported community status, and higher stigma consciousness, as well as race for some models. Conclusions and Implications for Practice: Our findings that social support and perceptions of community status are associated with higher scores on the RAS echo prior work demonstrating the importance of social connection and context in mental health recovery. Though literacy was not a predictor of recovery, further research should examine the relationship between literacy and recovery given the deep literature on literacy on health outcomes. In order to better support people in the recovery process it is important that more research is done to examine the complex relationship between stigma consciousness and recovery as well as understand the racial disparities that exist within the recovery subscales. Impact and Implications: Limited literacy was not significantly associated with recovery attitudes; however, individual and social level factors, mental health status, social support, perception of community status, and stigma consciousness were found to positively impact one's recovery attitudes. These factors need to be understood so they can be leveraged to help people move toward recovery. [ABSTRACT FROM AUTHOR]

Objective: The overall aim of the present paper is to elicit the subjective perceptions and experiences of people with Severe Mental Illness (SMI) involved in a Participatory Video project, with a focus on self-reported impact on recovery. There are 2 subobjectives, namely (a) to document which specific aspects (if any) of Participatory Video project participation are reported to positively influence recovery; and (b) to assess the impact of project involvement on specific dimensions of recovery. Method: In this project, 3 workgroups of people with Severe Mental Illness met approximately twice per week over a 2-year period to make and disseminate educational videos about mental illness. Workgroup participants (n = 20) took part in an in-depth semistructured qualitative interview at project end to understand their experience in the project, especially impact on recovery. Data was analyzed using thematic analysis techniques. Results: At completion, participants had made 26 videos and organized 49 community screenings reaching over 1,500 people. Participants reported that regular involvement in this project fostered their recovery in a variety of ways, imparting multiple psychosocial benefits, which are summarized in 5 themes: (a) skill-acquisition, (b) platform and voice, (c) connectedness, (d) a meaningful focus, and (e) personal development. Conclusions and Implications for Practice: Participatory Video is a powerful group intervention which positively benefits workgroup participants. Importantly, results overlap with other research indicating that grassroots-produced mental health themed videos can educate viewers and reduce public stigma. As such, psychiatric rehabilitation organizations should consider initiating similar projects in their own locales. Impact and Implications: Participatory Video is an innovative group program where marginalized people get together to produce documentary-type videos about their lives, which are then screened at community venues. This study found that regular involvement in a successful Participatory Video program helped foster the recovery of participants with severe mental illness. This suggests that Participatory Video is a recovery-oriented intervention, which could be initiated by mental health services and peer support organizations elsewhere. [ABSTRACT FROM AUTHOR]

Objective: A site visit protocol was developed to assess recovery promotion in the organizational climate and culture of programs for veterans with serious mental illnesses. Method: The protocol was pilot-tested in 4 programs: 2 that had scored high on the pilot version of a staff survey measure of program-level recovery promotion and 2 that had scored low. Two-person teams conducted onsite visits and assigned global and organizational domain ratings. Interrater agreement was assessed by examining adjacent agreement and computing weighted kappa. Results: The on-site protocol had good interrater agreement and discriminated between sites that scored high and low on the staff survey. Conclusions and Implications for Practice: This site visit protocol and procedure shows promise for evaluating recovery promotion in milieu-based programs. After further refinement of this tool, adaptations could be developed for accreditation protocols or for program self-assessment and quality improvement efforts. [ABSTRACT FROM AUTHOR]

Objective: Despite the increase in arts-based programs in community rehabilitation services in many countries, little is known about how these programs are perceived by health professionals who can refer individuals with mental health conditions to community-based psychiatric rehabilitation services. This study examined how senior professionals with key positions in the public health system perceive the integration of the arts in community-based psychiatric rehabilitation services in Israel. Method: Semi-structured interviews were conducted with 10 professionals. Results: The thematic analysis revealed 2 main themes. The first reflected "the perceived position of arts-based programs among other rehabilitation services," and had 2 subthemes: arts as a legitimate supplemental service, and arts as a motivating rehabilitation. The second theme reflected "the unique contribution of the arts to recovery processes," and had 3 subthemes: art-making facilitates self-expression and communication and bypasses resistance, art-making facilitates socialization, and art-making shapes and enhances personal identity. Conclusions and Implications for Practice. Because most of the professionals were exposed to the creative arts in their workplace, they valued their contribution to the rehabilitation process. Thus, direct contact can provide more information, more accurate perceptions, and a better understanding of the benefits of arts-based services, which may in turn encourage service managers and policymakers to include these services. [ABSTRACT FROM AUTHOR]

Objective: This study examines the role of mattering to others as an intrapersonal construct that may mediate the relationship between social support and 2 separate criterion variables: recovery and internalized stigma associated with living with a serious mental health condition. Adults living with serious mental health disorders, such as schizophrenia, face numerous social challenges that may leave them feeling isolated, stigmatized, and that they do not matter to others, thus thwarting the potential for recovery. Theorists and researchers conceptualize the sense of mattering to others as the perception that 1 is valued, recognized by others along with the feelings that others are concerned about our well-being. Method: Clubhouse members (N = 119) completed 1-hr, in-depth personal interviews assessing perceived social support, experiences of mental health recovery, and stigma associated with living with a mental health condition as well as a sense of mattering to others. Results: Mediation analyses revealed the significant effects of mattering to others as explaining the relationship between social support and recovery as well as the relationship between social support and internalized stigma. Conclusions and Implications for Practice: The findings illuminate our understanding as to how social support interventions can enhance recovery and reduce stigma associated with living with a psychiatric condition by attention to perceptions of whether one is valued and recognized by others. Mattering to others among consumers of social and health care interventions can serve to engage individuals who may withdraw from supports or internalize negative self-stereotypes based on internalized stigma. [ABSTRACT FROM AUTHOR]

Objective: Recovery from mental illness is influenced by one's social location along multiple dimensions of identity, such as race, class, gender, age, and ability, and by how these social locations are expressed through structural and institutional barriers. This project was developed using an intersectional policy analysis framework designed to promote equity across identity locations--called the multistrand method--to examine the potential use of self-directed care financing approaches in the Canadian mental health system. Method: A panel of 16 diverse stakeholders came together 4 times at structured 6-hr meetings to examine the evidence for self-directed care and explore its application in the Canadian context. Telephone interviews with evidence panel members were conducted to assess their perceptions of the group process and outcomes. Results: Our analysis revealed ways that intersecting strand locations might differentially influence the degree of choice and recovery experienced by self-directed care participants. Individualized resource allocation, draining financial resources from ethnically specific services, unevenness in acceptance of the recovery orientation, and paucity of service options in different geographical regions were identified as contexts in which self-directed care policies could promote inequity. However, greater peer involvement in the model's implementation, use of indigenous community supports, purchase of material goods by economically disenfranchised persons, and access to services from ethnically diverse clinicians in the private sector were identified as equity-promoting model features. Conclusion and Implications for Practice: By couching their analysis at the level of unique socially-situated perspectives, the group developed detailed policy recommendations and insights into both the potential and limitations of self-directed care. The knowledge gained from our project can be used to develop uniquely Canadian self-directed care models tailored to promote recovery through empowerment and self-determination across intersecting identity strand locations. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the impact of a mental illness self-management intervention, called Wellness Recovery Action Planning (WRAP), on the use of and need for mental health services over time compared with nutrition and wellness education. Method: Participants were recruited from outpatient community mental health settings in Chicago, Illinois. Using a single-blind, randomized controlled trial design, 143 individuals were assigned to WRAP or to a nutrition education course and assessed at baseline and at 2-month and 8-month follow-up. The WRAP intervention was delivered by peers in recovery from serious mental illness who were certified WRAP educators over nine weekly sessions lasting 2.5 hrs. The nutrition education curriculum was taught by trained non-peer educators using the same schedule. Mixed-effects random regression analysis tested for differences between the two interventions in (a) self-reported use of 19 clinical, rehabilitation, peer, emergent, and ancillary services; and (b) self-reported need for these services. Results: Results of mixed-effects random regression analysis indicated that, compared with controls, WRAP participants reported significantly greater reduction over time in service utilization (total, individual, and group), and service need (total and group services). Participants in both interventions improved significantly over time in symptoms and recovery outcomes. Discussion: Training in mental illness self-management reduced the self-reported need for and use of formal mental health services over time. This confirms the importance of WRAP in an era of dwindling behavioral health service availability and access. [ABSTRACT FROM AUTHOR]

Objective: Peer providers experience unique recovery and growth processes. This study examines the relationship of these processes with multiple occupational characteristics related so peer work. Outcomes are examined using positive psychology concepts: psychological well-being, posttraumatic growth, and generatively, as well as established recovery and empowerment measures. Method: Thirty peer providers employed in s variety of mental-health agencies participated in the study and completed standardized measures of recovery and growth processes. Multiple past and present occupational characteristics were identified and coded based on a semistructured interview and a background questionnaire. Results: Multivariate analyses revealed a significant association between participants' generatively and past participation in peer-support/self-help groups, as well as past work in a helping profession. No associations were found between the characteristics of participants' present peer jobs and the examined recovery and growth processes. Conclusions and implications for Practice: The present findings have implications for the expansion of the peer-provider workforce, They suggest that encouraging and enabling peer-support groups and peer-run organizations may have positive impact on the generatively of peer providers, and may draw generative individuals to thin emerging occupational modality of mental- health recovery oriented service. Study findings underscore the need for future research on recovery processes from the perspective of positive psychology and highlight the value of peer exposure as a catalyst of recovery and growth. [ABSTRACT FROM AUTHOR]

Objective: With the use of a qualitative approach, this study focuses on service providers' experiences and perspectives on recovery-oriented reform. Methods: Nine focus groups were conducted with a sample of 68 service providers recruited from three Canadian sites. Results: Three major themes were identified: 1) positive attitudes towards recovery-oriented reform; 2) skepticism towards recovery-oriented reform; and 3) challenges associated with implementing recovery-oriented practice. These challenges pertained to conceptual uncertainty and consistency around the meanings of recovery; application of recovery-oriented practice with certain populations and in certain contexts; bureaucratization of recovery-oriented tools; limited leadership support; and, societal stigma and social exclusion of persons with mental illnesses. Conclusions and Implications for Practice: The findings point towards challenges that might arise as system planners move ahead in their efforts toward implementing recovery within the mental health system. In this regard, we offer several recommendations for the planning of organizational and educational practices that support the implementation of recovery-oriented practice. [ABSTRACT FROM AUTHOR]

Objective: The aim of this research was to assess the relevance and impact of Wellness Recovery Action Planning (WRAP) in group settings, as a tool for self-management and wellness planning by individuals with mental-health problems. This paper reports on the impact on participants who trained as facilitators and delivered WRAP training to others within the organizations studied. Method: Eight WRAP facilitators took part in interviews and focus groups. Results: The WRAP facilitators reported a positive impact on their well-bring, from learning more about recovery, developing improved self-awareness, to integrating a WRAP approach into daily life. Conclusions and Implications for Practice: Delivering `WRAP training to groups can make a positive contribution to the well-being of facilitators themselves. Involving people with lived experience in the delivery of WRAP groups in this setting further promoted the recovery journey of facilitators. [ABSTRACT FROM AUTHOR]

Objective: This study investigated what women identifying as lesbian, gay, bisexual, uansgender, and/or queer (LGBTQ) think about mental health "recovery." Method We used a grounded theory analysis of 13 pailicipant interviews. Results: Three novel critiques emerged, including rejection of mental health "leeovely" based on participants' identities as "mad," sexual assault survivors, and/or LGBTQ. Conclusions and Implications for Practice: While a medicalized interpretation of "recovery" may not work for some women, alternative understandings, such as using "recovery" to heal from discrimination and demand systemic changes, have liberatory potential. It is essential that supporters discern and utilize each woman's chosen language. [ABSTRACT FROM AUTHOR]