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Objective: Psychotherapy as a practice in the field of psychiatric rehabilitation is increasingly seen as a means to promote recovery from serious mental illness (SMI). While mostly informed by mental health theory and research, art might offer profound and enduring insights to inform psychotherapy with people with SMI. In this article, we argue that jazz, a form of art which entails both structure and improvising, may enrich and broaden clinicians' abilities to facilitate meaning-making with clients to promote recovery. Method: Through the literature review and theoretical synthesis, we explore how jazz may be a space where specific processes can be observed and accordingly guide psychotherapy focused on subjective forms of recovery. Results: We argue that jazz offers a space to see how timing, risk-taking, the ability to be simultaneously inside and outside an activity, and support for the process of tension and release can inform and inspire the process of improvisation within psychotherapy. Conclusion and Implications for Practice: Jazz offers a creative framework which can help clinicians observe and facilitate recovery processes in psychotherapy. The perspective of jazz in the therapeutic arena of psychiatric rehabilitation emphasizes the potential of the arts and humanities to continue to enrich our understanding and guide our teaching and training. Impact and Implications: The present article offers a unique framework for exploring how jazz music enables clinicians to observe and adjust recovery-oriented processes within psychotherapy for people with serious mental illness. Specifically, we suggest that the improvisational nature of jazz illuminates how certain elements in psychotherapy such as timing, risk-taking, the ability to be simultaneously inside and outside an activity and the process of tension and release enrich the understanding, conceptualization and process of people with serious mental illness making their own meaning of experience and directing their own recovery. [ABSTRACT FROM AUTHOR]

Objective: Psychotic experiences, such as hearing voices that others do not hear, being afraid of threats that others do not perceive, or believing in ideas that others find implausible can be confusing for those who face them and challenging to relate to for those who do not, leading to alienation and social exclusion. The objective of this article is to discuss how immersion in theater can enhance our understanding of human nature and facilitate a social environment that supports the recovery of individuals with psychosis. Methods: Drawing on theories of the psychology of art and narrative psychology, this conceptual article discusses a theatrical production, a play, titled "Voices," created by a person with lived experience of voice hearing. We apply Semenov's model of art as a social psychological system as a guiding framework to focus on the roles of the art product, artist–author, artist–performer, and recipient. Results: Theater is a uniquely reciprocal art form where actors and spectators share emotional, intellectual, and cathartic experiences, which could foster interpersonal connection, personal growth, and empathy. This article brings new perspective on how theater can elucidate psychotic experiences, encourage dialogue about these experiences, and facilitate social integration and recovery of individuals living with psychosis. Conclusion and Implications for Practice: Theater can promote social change, making space for a wider range of perspectives in society. Engaging individuals with lived experiences of psychosis in theatrical productions could lead to new insights about and acceptance of psychotic experiences, both for these individuals and for society at large. Impact and Implications: Drawing on theories of the psychology of art and narrative psychology, the authors discuss a theatrical play, titled "Voices," created by a person with lived experience of voice hearing. This article offers a novel perspective on the transformative power of theater in understanding psychotic experiences, fostering dialogue to explore these experiences, and contributing to social inclusion and rehabilitation of individuals living with psychosis. [ABSTRACT FROM AUTHOR]

Objective: To illustrate the value of reading fiction as a group supervision practice focused on supporting recovery-oriented psychotherapy for individuals experiencing serious mental illness (SMI). Method: Detailed practical description of the practice and conceptual analysis of the proposed value of using fiction as a group supervision method. Findings: Authors suggest that the supervisory practice is a novel component of clinical supervision, and offers value in its ability to promote reflective practice, to establish intersubjectivity among peers and supervisory relationships, and may serve for some to counter risks of clinician burnout. Conclusions and Implications for Practice: Participating in a book club that reads fiction as an adjunctive experience to supervision can promote recovery-oriented psychotherapy in four key ways: including its promotion of reflection on self, patients, and the experience of therapy for psychosis, its promotion of reflection on recovery and barriers to recovery, its ability to offer an experiential model of intersubjectivity, and its value in supporting peer consultation and helping offset clinician burnout. Impact and Implications: Reading fiction as a component of group supervision offers value to clinicians practicing psychotherapy with individuals experiencing serious mental illness. This study offers a conceptual analysis highlighting key benefits of this supervisory practice that could be developed and implemented in other settings interested in cultivating and supporting recovery-oriented mental health service provision. [ABSTRACT FROM AUTHOR]

Objectives: Mental health care has been identified as a major source of mental illness stigmatization. Detailed information about these stigmatization experiences is thus needed to reduce stigma in mental health practices. The study aimed to (a) identify the most relevant stigmatizing situations in mental health care encountered by users with schizophrenia and their families; (b) characterize the relative importance of these situations in terms of frequency, experienced stigmatization, and associated suffering; and (c) identify contextual and individual factors associated with these experiences. Method: An online survey was conducted in France among users and family members to characterize situations of stigmatization in mental health care and identify associated factors. The survey content was first developed from a participative perspective, through a focus group including users. Results: A total of 235 participants were included in the survey: 59 participants with schizophrenia diagnosis, 96 with other psychiatric diagnoses, and 80 family members. The results revealed 15 relevant situations with different levels of frequency, stigmatization, and suffering. Participants with a diagnosis of schizophrenia experienced more situations of stigmatization, with a higher frequency. Moreover, contextual factors were strongly associated with experienced stigmatization, including recovery-oriented practices (negatively associated) and measures without consent (positively associated). Conclusions and Implications for Practice: These situations, as well as associated contextual factors, could be targeted to reduce stigmatization and related suffering in mental health practices. Results strongly underscore the potential of recovery-oriented practice as an instrument to fight stigma in mental health care. Impact and Implications: This study describes 15 concrete situations of stigma experienced in mental health services by users with a schizophrenia diagnosis and their relatives (e.g., discrediting somatic complaint, pessimism, stereotype of dangerousness, violent practices, infantilization, lack of collaboration, lack of social inclusion, lack of respect in intimacy, lack of information and explanations). In addition, this study focused on factors associated with less experienced stigma, such as recovery-oriented practices. [ABSTRACT FROM AUTHOR]

Objective: Recovery Colleges support recovery for adults with mental health problems, through coproduction and education principles. This study aimed to determine whether students at three Recovery Colleges in England were representative of mental health service users. Methods: Gender, age, ethnicity, diagnosis, involuntary detention, and inpatient admission were extracted from clinical records. Data for all service user students enrolled, and those who had attended 70% of a Recovery College course were compared to mental health services caseloads, using chi-square goodness-of-fit tests. Results: Clinical records were identified for 1,788 students. Significant differences were identified for gender, age, and diagnosis (p <.001). In some Colleges, more students had recent inpatient admissions or involuntary detentions. Conclusions and Implications for Practice: Service user students were largely representative of mental health service users, although some groups were underrepresented. Further research is needed to understand why, so that Recovery Colleges can continue to address inequalities. Impact and Implications: This is the first multisite investigation into the characteristics of Recovery College students. It found that students are largely representative of people using mental health services, at different stages of their recovery. However, Colleges and mental health services could work on improving access for male, younger and older service users, and individuals with certain mental health diagnoses. [ABSTRACT FROM AUTHOR]

William (Bill) A. Anthony was a pioneer in the field of psychosocial/psychiatric rehabilitation and recovery. He established the Center for Psychiatric Rehabilitation at Boston University and served as the editor/coeditor of the Psychosocial Rehabilitation Journal (later Psychiatric Rehabilitation Journal). He helped to clarify ideas, principles, policies, and practices that promoted the right and ability of people living with psychiatric disabilities and mental health challenges to aspire to and achieve their own vision of a meaningful life. This introductory article briefly overviews Bill's contributions to psychiatric rehabilitation and recovery of people with mental health challenges and his influence on recent work in this field, a sample of which is presented in the current special section dedicated to him. To conclude, the article overviews this special section, which reports on studies in the United States and elsewhere, addressing supported education, recovery colleges, photovoice to promote community integration, and policy developments in Israel. Impact and Implications: This article summarizes the seminal impact of Bill Anthony's body of work on the field of psychiatric rehabilitation and recovery. Additionally, it traces the broad implications of his vision and contributions to the field, to the four articles presented in the special section, as examples of current work that will lead to future developments built upon his legacy. [ABSTRACT FROM AUTHOR]

Objective: Previous research has established the impact of psychiatric symptoms on social functioning, while there is a paucity of research examining how social functioning relates to personal recovery, an individual's self-assessment of their mental health recovery. This study examined the mediating effect of social engagement, interpersonal communication, and satisfaction with support in the relationship between distinct psychiatric symptom clusters and perceived mental health recovery. Methods: In a cross-sectional study, both patient self-report and provider assessment data were collected for 250 patients with serious mental illness (SMI) across four mental health service sites. Parallel mediation analytic models were used. Results: Interpersonal communication partially mediated the relationship between positive and negative symptom clusters and personal recovery. Satisfaction with social supports partially mediated the relationship between excited symptoms and personal recovery. Both interpersonal communication and satisfaction with social supports partially mediated the relationship between general psychological distress and depressive symptoms and personal recovery. Collectively, social functioning mediators explained nearly half of the relationship between general psychological distress and excited symptoms and personal recovery and nearly all of the relationship between positive symptoms and personal recovery. Conclusions and Implications for Practice: Clinical providers working with persons with SMI should regularly assess social functioning in addition to assessing psychiatric symptoms and personal recovery factors and should incorporate social skills education into SMI group and individual treatments. Social functioning as a target of treatment may be especially beneficial for patients who are dissatisfied with other interventions or feel they have experienced the maximum benefit from treatment and are seeking additional methods to support personal recovery. Impact and Implications: Social functioning such as interpersonal behavior and satisfaction with support partially mediated the impact of psychological symptom presentation on patient-perceived mental health recovery. Clinicians should regularly assess social functioning and incorporate evidence-based practices that serve to enhance interpersonal functioning into treatment for individuals with SMI. [ABSTRACT FROM AUTHOR]

Objective: Engagement in arts and cultural activities is valued and yields positive outcomes but may be understudied in populations with serious mental illness (SMI). Our aims are to evaluate the extent to which individuals with SMI deem participation areas related to arts and culture (e.g., going to a theater) to be important, and if important, how often they are being done and if it is enough in comparison to a nonSMI sample. Methods: We conducted analyses using a sample of 1,120 individuals with SMI from nine research studies between 2008 and 2016 and a sample of 300 individuals without SMI that were part of the Truven Health Analytics PULSE survey. All participants completed a survey containing questions related community participation. Analyses were conducted using independent samples t tests, followed by analysis of variances, and chi-square tests. Results: The results indicate that adults with SMI are as, or more interested in arts and cultural activities as adults in the general population, but do not participate in those areas as much as they would like in comparison. We also found that, as with the general population, participation in these areas is positively associated with quality of life and to a lesser degree, recovery. Conclusions and Implications for Practice: Engagement in arts and culture activities may be an overlooked compared to other areas of participation, such as employment. Psychiatric rehabilitation practitioners may need to pay greater attention to areas related to art appreciation, rather than just art production. Impact and Implications: We found that individuals with serious mental illness (SMI) deem arts and cultural activities to be just as important as individuals without SMI, but they are less likely to engage in them. Engagement in this area is positively associated with quality of life and recovery for individuals with SMI, indicating that psychiatric rehabilitation practitioners may need to pay greater attention to include these activities in their programs. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study was to gain insight into how practitioners in mental health care support people with severe psychiatric disabilities in setting and pursuing personal goals that are meaningful to them. Method: We conducted focus groups with 36 mental health practitioners in Norway and interpreted the data by using reflexive thematic analysis. Results: Four themes emerged from the analysis: (a) active collaboration to understand what is meaningful to the individual, (b) being nonjudgmental during the process of goal setting, (c) helping individuals break goals into smaller goals and steps, and (d) allowing time for the process of trying to achieve goals. Conclusions and Implications for Practice: Although goal setting is central to the Illness Management and Recovery program, practitioners perceive the work as quite demanding. To succeed, practitioners need to acknowledge goal setting as a long-lasting and shared process, not as a means to an end. As people with severe psychiatric disability often need help in goal setting, practitioners should play an important role in supporting them in setting goals, making plans for achieving them, and taking actual steps in that direction. Impact and Implications: Goal setting is a shared process where true collaboration is needed. Practitioners should monitor an individual's ambitions and goals even when they face increasing demands to treat individuals quickly, cheaply, and efficiently. If practitioners let financial and administrative priorities dictate their clinical practice, there is a risk that they will become less responsive to individuals' ambitions, rush to set goals too quickly, and not really attend to where individuals are. [ABSTRACT FROM AUTHOR]

Objective: Stigma jeopardizes recovery and successful implementation of mental health services (MHS) globally. Despite cultural variation in how stigma manifests, few studies have examined how culture fundamentally impacts the concept of "personhood" in Latin America. Chile has expanded MHS, providing universal coverage for evaluation and treatment of first episode psychosis (FEP). We applied the "what matters most" (WMM) framework of stigma to identify culturally salient factors that shape or protect against stigma in urban Chile, identifying potential implications for MHS and recovery. Methods: In-depth interviews (n = 48) were conducted with MHS users with psychotic disorders (n = 18), their family members (n = 15), and community members (n = 15), from two urban regions in Chile. Interviews were coded and analyzed to identify WMM, how WMM shapes stigma, and how MHS can influence achieving WMM. Results: Traditional values emphasizing physical/social appearance, gender roles, family, and social connectedness are highly valued. Socioeconomic transitions have engendered capitalistic variations on traditional values, with increasing emphasis on professional careers for men and women, individualism, and independence. Psychotic disorders interfere with fulfillment of both traditional and capitalist values, thereby reinforcing stigma. However, MHS are seen as partially effective in enabling fulfillment of some goals, including employment, appearance, and independence, while often remaining insufficient in enabling capacity to achieve marriage and having a family. Conclusions and Implications for Practice: MHS that facilitate recovery by engaging users in services, such as pharmacotherapy, education/vocational rehabilitation, and family-centered care aligned with cultural values can mitigate stigma and facilitate recovery by enabling users to fulfill WMM. Impact and Implications: Both traditional and capitalist values influence users of mental health services in urban Chile. Mental illness shapes stigma by interfering with widely valued goals of maintaining a good appearance, marriage and family formation, social connectedness, and independence. Mental health services have both positive and negative impacts on users' achievement of these goals. Future mental health services development can reduce stigma by aligning services with lived values. [ABSTRACT FROM AUTHOR]

Objective: People with serious mental illnesses (SMIs) are at high risk for suicidal ideation and behavior, and yet few suicide prevention interventions have been customized for this group. We describe the outcomes of a pilot trial of Mobile SafeTy And Recovery Therapy (mSTART), a four-session suicide-focused cognitive behavioral intervention for SMI, designed for the transition from acute to outpatient care and augmented with ecological momentary intervention to reinforce intervention content. Methods: The primary objective of this pilot trial was to evaluate the feasibility, acceptability, and preliminary effectiveness of START. Seventy-eight people with SMI and elevated suicidal ideation were randomized to either: (a) mSTART or (b) START alone (i.e., without mobile augmentation). Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of mobile intervention), and 24 weeks. The primary outcome of the study was change in suicidal ideation severity. Secondary outcomes included psychiatric symptoms, coping self-efficacy, and hopelessness. Results: A total of 27% of randomized persons were lost to follow-up after baseline, and engagement with mobile augmentation was variable. There was clinically significant improvement (d = 0.86) in suicidal ideation severity scores sustained over 24 weeks, with similar effects seen for secondary outcomes. Preliminary comparison indicated a medium effect size (d = 0.48) advantage at 24 weeks of mobile augmentation in suicidal ideation severity scores. Treatment credibility and satisfaction scores were high. Conclusions and Implications for Practice: START, regardless of mobile augmentation, was associated with sustained improvement in suicidal ideation severity and secondary outcomes in people with SMI at-risk for suicide in this pilot trial. Impact and Implications: This pilot study tested a new brief intervention designed to target suicide ideation in at-risk people with SMIs, focusing on the gap period between urgent and ongoing care. We found that the intervention, which included both in-person and mobile technology components, was feasible, acceptable, and linked with sustained improvement in suicide ideation. Although a pilot study, this research suggests that brief suicide-specific interventions adapted for people with SMIs could be helpful in bridging acute to outpatient care. [ABSTRACT FROM AUTHOR]

Objectives: This pilot study evaluated the feasibility and potential impacts of delivering the Psychosocial Rehabilitation (PSR) Toolkit for people with serious mental illness within a health care setting in Kenya. Method: This study used a convergent mixed-methods design. Participants were people with serious mental illness (n = 23), each with an accompanying family member, who were outpatients of a hospital or satellite clinic in semirural Kenya. The intervention consisted of 14 weekly group sessions of PSR cofacilitated by health care professionals and peers with mental illness. Quantitative data were collected from patients and family members using validated outcome measures before and after the intervention. Qualitative data were collected from focus groups with patients and family members, and individual interviews with facilitators, after the intervention. Results: Quantitative findings indicated that patients experienced moderate improvement in illness management and, in contrast to qualitative findings, family members experienced moderate worsening in attitudes toward recovery. Qualitative findings revealed positive outcomes for both patients and family members, as reflected in greater feelings of hope and mobilization to reduce stigma. Factors that facilitated participation included: helpful and accessible learning materials; committed and involved stakeholders; and flexible solutions to promote continued involvement. Conclusions and Implications for Practice: This pilot study found that delivery of the Psychosocial Rehabilitation Toolkit was feasible within a health care setting in Kenya and associated with overall positive outcomes among patients with serious mental illness. Further research on its effectiveness on a larger scale and using culturally validated measures is needed. Impact and Implications: This pilot study examined the feasibility and potential impacts of a psychosocial rehabilitation program for people with serious mental illness within a health care setting in Kenya. The program provided a more engaged and inclusive approach to mental health services, through which patients experienced a sense of possibility for their future lives and stakeholders became advocates for mental health recovery within their communities. Study findings also indicated improvements in recovery and increased connections with community among patients, and discussion of opportunities for improving mental health service delivery among stakeholders. [ABSTRACT FROM AUTHOR]

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: Serious mental illnesses (SMI) often occur during early adulthood, just as young people are developing important aspects of their identity that can affect their recovery. Positive ethnic identity development is associated with stress coping and psychological well-being in young people. But, there is limited research to indicate how individual experiences of belonging and attachment to one's ethnic group influence personal recovery processes among young adults living with SMI. Method: Young adults living with SMI (95% identified as ethnic/racial minorities) were recruited from four outpatient psychiatric rehabilitation programs (N = 83). Multivariate regressions were used to examine relationships between predictors (demographics, psychiatric symptomatology, ethnic identity) and the dependent variables (perceived stress and personal recovery). Results: A stronger, more developed ethnic identity and fewer depressive symptoms were associated with higher ratings of personal recovery. Increases in psychiatric symptoms predicted increased perceived stress. Post hoc analyses showed that Black, Latino/a, and multiracial study participants' ethnic identity ratings were similar to those of same ethnic/racial group of young adults without SMI. Conclusions and Implications for Practice: Ethnic identity development could be a significant psychosocial factor shaping mental health recovery among minority young people living with SMI. Several factors associated with psychological well-being among ethnic and racial minority youth may account for this, including adaptive coping, social support, and a buffering effect against racism. Our findings indicate that assessing and developing a young person's ethnic identity-related strengths and resources as a means for improving the personalization of recovery services and enhancing the quality of care. Impact and Implications: This study is one of the first to examine the relationship between ethnic identity and important psychological outcomes of stress and personal recovery among young adults with SMI. Results show that young adults with a sense of attachment and belonging to their ethnic groups report significantly higher personal recovery, suggesting that ethnic identity could play an important role in reducing mental health disparities among minority young adults with SMI. [ABSTRACT FROM AUTHOR]

Objective: Evidence concerning strengths model of case management (SMCM) remains mixed. This study aimed to test the hypotheses that higher fidelity to SMCM is associated with improved quality of life (QoL), hope, community participation, community functioning, more days of competitive employment and of independent living, and fewer days of hospitalization. Methods: SMCM was implemented over a 3-year period, at seven sites in the Canadian provinces of Newfoundland and Labrador, Québec, and Ontario. Independent assessors visited 14 teams at the seven sites to evaluate fidelity at baseline and 6, 12, 18, 24, and 36 months later. Participants (N = 311) answered standardized questionnaires at 4.5-month intervals up to 18 months. Fidelity assessments were interpolated so they could be associated with questionnaire responses. Linear mixed-effects models and generalized linear models were estimated. Results: Fidelity increased significantly, with all sites except one achieving or approaching good fidelity within 36 months. Fidelity was not significantly associated with any of the outcome measures, although all estimated directions of relationships were consistent with our hypotheses. Conclusions and Implications for Practice: In a pragmatic study of real-world implementation of the strengths model at seven sites, no statistically significant relationships between fidelity and outcomes were found. Low variation in fidelity across individuals, modest sample size, and limited ability to detect change over 18 months, may have contributed to these null findings. Impact and Implications: Implementation of strengths model of case management (SMCM) was largely successful at seven sites in three Canadian provinces, but higher fidelity was not significantly associated with improved client outcomes. The sample size of 311 may have been insufficient. Given mixed findings from previous studies, and the compatibility of SMCM with a recovery orientation, further research, with strong designs and large sample sizes, is needed. [ABSTRACT FROM AUTHOR]

Objective: Practitioner attitudes regarding the nature of psychosis and prospects of recovery are important targets in supervision and training of practitioners who work therapeutically with this population. The 19-item Psychosis Attitudes Scale (PAS) was developed as a way to monitor changes in psychosis-related attitudes among practitioners being trained in an Evidence Based Treatment (EBT) for psychosis. This study reports the development and underlying factor structure of the PAS. Method: Three hundred twenty-five community mental health clinicians completed the PAS following a Cognitive Behavioral Therapy for psychosis (CBTp) multiday workshop training. We conducted an exploratory factor analysis to investigate the underlying structure of the initial set of items. Results: Our analyses suggest that the PAS taps into four attitude groupings, which can be conceptualized as perceived confidence in working with individuals with psychosis (Factor 1), a recovery orientation (Factor 2), expectations of fulfillment (Factor 3), and a stress-vulnerability orientation (Factor 4). Conclusions and Implications for Practice: Factors 1 and 3 appear to tap into general themes relevant to training practitioners in an evidence-based psychotherapeutic intervention for psychosis. Factors 2 and 4 are consistent with guiding principles of high-fidelity CBTp. At the individual level, practitioner attitudes have implications for training retention and treatment delivery. At the organizational level, the collective attitudes of staff in a given setting may serve as an indicator of readiness for EBT for psychosis implementation. Impact and Implications: The Psychosis Attitudes Scale (PAS) appears to tap into practitioner's self-confidence in working with individuals with psychosis, recovery orientation, expectations of professional fulfillment, and adoption of a stress-vulnerability framework for conceptualizing psychosis risk. As these themes are relevant to competent delivery of Cognitive Behavioral Therapy for psychosis (CBTp), the PAS appears to have utility as a process measure for training and supervising practitioners who work therapeutically with individuals with psychosis. [ABSTRACT FROM AUTHOR]

Objective: The narrative enhancement and cognitive therapy (NECT) intervention aims to reduce self-stigma among people with severe mental illness. Based on previous studies that showed the intervention's beneficial outcomes, we conducted an uncontrolled pilot study of NECT in the Netherlands to assess both feasibility in delivering NECT and outcomes of the intervention for self-stigma, hope, recovery, and self-concept clarity. Methods: Feasibility was assessed through uptake and implementation data that included an assessment of enhancing and impeding factors according to surveys with NECT facilitators, and interviews with participants. Outcomes of NECT were studied through scales that assess self-stigma, self-concept clarity, hope, personal recovery, and quality of life. Results: Forty-one participants from five treatment sites participated in the pilot study, among whom 78% were considered "exposed" (i.e., attended at least six sessions). The analysis of enhancing and impeding factors indicated that support from the organization, sense of ownership, expectations of outcomes, and content of the intervention were reported as important in the implementation process. Participants reported decreases in self-stigma and increases in hope during the intervention. Conclusions and Implications for Practice: Assessments of feasibility provided valuable insights regarding ways to improve implementation of the intervention (such as increasing facilitators' sense of ownership of the intervention). Outcomes of NECT showed a decrease in self-stigma and improvement of hope among participants in this pilot study, supporting the previously found positive effects of the intervention. Impact and Implications: In this pilot study, NECT was found to be feasible and effective in reducing stigma and increasing hope among people with serious mental illness. The study highlights important factors related to feasibility including facilitators' and contextual factors. Results support the effectiveness of NECT. Accordingly, this pilot study gives important implications for policy makers, mental health clinicians, and peer workers in the Netherlands to further dissemination of NECT. [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]

Objective: Given the paucity of functional recovery measures for young people with psychosis, we developed and conducted psychometric testing of the Functional Outcomes Interview (FOI) and the Roles and Aspirations Among Youth scale (RAY; a much-needed patient-reported outcome measure). Method: Both measures were developed in English, Tamil, and French through discussions with professionals, participants, and families at early psychosis programs in Canada and India. The FOI assesses the number and tenure of functional roles and allows the nuanced assessment of each role in terms of performance, need for support, and quality of social contacts. The roles include work, school, household responsibilities, parenting/caregiving, and efforts to return to work/school. The RAY is a self-report of current roles and future aspirations. Test–retest reliability, internal consistency, factorial validity, and concurrent validity for the RAY; and inter-rater reliability (IRR), internal consistency, and concurrent validity for the FOI were assessed. Results: The RAY had adequate internal consistency and temporal stability and was unidimensional in factor analysis. The FOI had acceptable IRR and internal consistency, as evinced by comparable performance ratings across functional roles. Significant associations between our novel measures and well-established measures of functioning and negative symptoms indicate concurrent validity. Conclusions and Implications for Practice: The FOI and RAY were designed to be youth friendly, assess aspirations, and acknowledge individuals as desiring and holding multiple roles. They thus represent a significant advancement in assessing functional recovery in first-episode psychosis. Having been tested in two distinct settings, these measures show promise for wider deployment across geo-cultural contexts. Impact and Implications: This study advances the assessment of functional recovery in first-episode psychosis through its development and testing of measures that capture a wide spectrum of functional roles (work, school, household responsibilities, parenting/caregiving, efforts to return to work/school) and unique dimensions such as aspirations. Their youth friendliness will facilitate their broad uptake in the field as will the fact that they were tested in two culturally and economically distinct settings and three languages. [ABSTRACT FROM AUTHOR]

Objective: The experience of personal recovery from mental health has been theorized to occur through several pathways. CHIME is a seminal theoretical framework of personal recovery that is widely endorsed by the existing literature. Few studies have examined the utility of the CHIME framework with those experiencing acute challenges in their engagement in the recovery process. The purpose of the present study was to examine part of the CHIME framework for individuals with schizophrenia spectrum diagnoses in the period immediately following hospitalization. Specifically, the impact of social support and community integration on personal recovery was examined. Methods: The present study involved a secondary analysis of a Phase 2 clinical trial. Assessment measures were administered to participants 1-month (n = 82) and 6-months (n = 72) postdischarge from a psychiatric hospital. Hierarchical regression and mediation analyses were conducted to assess the relationship between social support, community integration, and 1-month and 6-month personal recovery. Results: Hierarchical regression analysis indicated that community integration and social support significantly predicted personal recovery. Mediation analyses indicated social support partially accounts for the relationship between community integration and personal recovery at 1- and 6-months postdischarge, providing evidence for social support as a mechanism of personal recovery during this time. Conclusion and Implications for Practice: This quantitative investigation of CHIME highlights the mechanism of social support for individuals who are experiencing acute challenges in their recovery. These findings point to the need for interventions that enhance community integration and social support postdischarge. Impact and Implications: The results of the present study suggest that social support is a significant mediator in the relationship between community integration and personal recovery for those who have recently been discharged from inpatient psychiatric hospital. These results can be used to inform the development of recovery-promoting interventions for individual's postdischarge. [ABSTRACT FROM AUTHOR]

Objective: Our objective is to provide preliminary evidence of the English translation of the Integrative Hope Scale (IHS). Hope is a critical concept for recovery. Synthesizing from other hope models, Schrank and colleagues developed the IHS. Although translated into five languages, no known studies assess the IHS's English translation within a clinical sample. Additionally, no known studies investigate the IHS's relationships with mental health measures in a mixed-diagnostic clinical sample. Method: To address these gaps in the literature, we used confirmatory factor analyses, alpha, and omega reliability coefficients, and correlational analyses to assess the IHS within a suburban, mixed-diagnostic intensive outpatient community mental health sample (n = 125) in the midwestern United States. Results: While poorest fit was found within the one-factor model, the four-factor oblique, higher-order, and bifactor models showed improved fit. Reliability for the total score was good, with subscales ranging from acceptable to good. Significant relationships were found for the IHS in expected directions with measures of hope and depression at a large effect size and anxiety and stress at a moderate effect size. Conclusions and Implications for Practice: This study provides preliminary evidence that the IHS may have the potential to serve as a central measure of hope. Given hope's role within recovery and given its relationships with mental health measures shown in this mixed-diagnostic clinical sample, the IHS should continue to be investigated by researchers, clinicians, and clients, especially in recovery-focused programs. Impact and Implications: This study provides psychometric support for the Integrative Hope Scale's (IHS) English translation among individuals who meet criteria for a variety of mental health diagnoses using confirmatory factor analysis, alpha and omega calculations, and correlational analyses. The IHS conceptualizes hope as containing internal and external elements; its public-domain status provides a free tool to assess hope within community mental health settings. [ABSTRACT FROM AUTHOR]

Objective: The literature on the experience of mental health providers (MHPs) working with people with serious mental illness (SMI) in community-based mental health programs related to sex, sexuality, and intimacy is scarce. The purpose of the present study was to explore the situations, thoughts, feelings, dilemmas, and challenges experienced by MHPs around these issues. Method: Semistructured interviews were conducted with 13 MHPs working with people with SMI in six different community mental health programs in Israel. Results: Four main themes emerged: (a) lack of professional training and skill sets to discuss clients' sexuality and intimacy issues, (b) ambivalence regarding the status and appropriateness of sexual relationships and intimacy as recovery-related goals, (c) discomfort discussing sexuality as a barrier to shared decision making and person-centered care, and (d) distinct programmatic and structural barriers to discussing and addressing needs and preferences related to sexuality and intimacy. Discussion: The study highlights challenges experienced by MHPs working with people with SMI when confronted with sexual activities, relationships, and intimacy issues raised by service users. The development and implementation of trainings and resources designed to bolster MHPs' skill sets addressing sexuality and intimacy should be a priority for the field of psychiatric rehabilitation. Conclusions and Implications for Practice: MHPs who work with people with SMI in community-based settings often experience complex thoughts, feelings, dilemmas, and challenges related to clients' desire for or involvement in intimate and sexual relationships. Our study indicates a need to develop and implement stronger training and supervision to support MHPs to respond effectively to these complex situations and associated challenges. Impact and Implications: Mental health providers (MHPs) who work with people with serious mental illness (SMI) in community-based settings often experience complex thoughts, feelings, dilemmas, and challenges related to clients' desire for or involvement in intimate and sexual relationships. Our study indicates a need to develop and implement stronger training and supervision to support MHP to respond effectively to these complex situations and associated challenges. [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: Medication is particularly important to advocates within the mental health recovery movement and this movement is founded upon a resistance to coercive treatment. Given this history, we explored the perspectives of providers and service users engaged in the recovery-oriented practice Person-Centered Care Planning (PCCP) to understand (a). How providers trained in PCCP understand the role of psychiatric medication and (b). How service users receiving services from providers trained in PCCP understand and experience the role of psychiatric medication in treatment. Method: This study comprises data from the qualitative phase of an NIMH-funded randomized trial of PCCP, an evidence-based recovery-oriented practice. Data were collected from 22 focus groups of providers and service users across seven community mental health centers. Interviews were analyzed using thematic analysis. Results: Qualitative themes from the provider focus groups included "promoting adherence" and "medication as a precondition." Providers expressed that service users need to be adherent to medication and their symptoms managed before recovery-oriented practices could be pursued. Service user themes included "we were cattle" and medication as "my saving grace." While many experienced medication as helpful, they found providers' focus on adherence to be inflexible and, at times, coercive. Conclusion and Implications for Practice: These results suggest that even within agencies actively implementing recovery-oriented practices, there are aspects of treatment, namely medication management, that are more impervious to recovery principles. Agency level trainings in PCCP and other recovery-oriented practices would benefit from the inclusion of all staff, including psychiatrists and other prescribers. Impact and Implications: Even within agencies actively implementing recovery-oriented practices, there are aspects of treatment, namely medication management, that are more impervious to recovery principles. To ensure recovery transformation efforts truly change mental health service delivery, psychiatrists need to attend recovery trainings and the importance of service user choice surrounding all aspects of treatment needs to be tackled head on. [ABSTRACT FROM AUTHOR]

Objective: People with lived experience of mental illness or distress can help others recover through peer or mutual support. One way they may help others recover is by fostering generativity, which refers to one's concern for and contributions toward the betterment of others, including future generations (e.g., through caregiving, engaging in civics). Generativity may add purpose to one's life, benefit society, and improve areas which persons with lived experience feel are important for their recovery. Despite its importance, the state of knowledge on experiences and facilitators of generativity, as well as the impact that engaging in generativity has on the lives of persons engaged in peer or mutual support, is unclear. Method: A librarian-assisted scoping review of the literature was conducted in five steps: identifying the research question and relevance; selecting studies; charting data; and coding and summarizing the results. Results: Out of 11,862 articles that were screened, only 18 met eligibility criteria. Most studies were conducted in the United States and included White/Caucasian participants. Our synthesis produced themes related to generative actions, which included helping others, changing organizations and systems, and sharing personal stories. Themes describing facilitators of generativity included individual-level and organizational-level factors. One theme reflecting the positive psychosocial impact of engaging in generativity was produced. Conclusions and Implications for Practice: Findings from this study point to several knowledge gaps to be investigated in future research and can facilitate the implementation of peer support initiatives aimed at fostering generativity, which may in turn promote recovery. Impact and Implications: This review revealed that peer and mutual support for persons with mental health challenges may help foster generativity (e.g., the contributions people make to other people), which may in turn support recovery. This review also identified several knowledge gaps that should be addressed in future research. The findings point to gaps in knowledge on a concept that can help persons more fully recover from their challenges. [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: This article reports on a qualitative study examining the experiences of peer support specialists (PSS) supervised by nonpeer supervisors (NPS) in adult community mental health settings. Method: Potential participants completed a demographic survey designed to address inclusionary criteria. From those eligible, a random number generator selected participants to be interviewed using a semistructured interview guide. The critical incident technique was used to elicit memorable experiences of supervision. Data were analyzed thematically. Twenty interviews were completed before saturation was reached. Results: Thematic analysis revealed eight major themes including supervisor attitudes, role integration, trauma-informed supervisory techniques, facilitative/supportive environment, perspective-taking, mutual learning, opportunities for peer networking, and the desire for a supervisor who was a more experienced peer support worker. Conclusions and Implications for Practice: PSS are integrating into a mental health service system transitioning from a medical model to a recovery-oriented model of care. NPS are the necessary guides who assist the PSS in navigating a system not yet aligned with peer values. If the mental health system is going to successfully become recovery oriented, NPS need a unique skill set to support those with lived experience whose recovery can help point the way. Impact and Implications: Peer support specialists (PSS) continue to enter the mental health workforce in increasing numbers. This study found that when nonpeer supervisors (NPS) employed peer-informed supervisory techniques. Supervision was experienced as helpful. If the mental health system is going to successfully become recovery oriented, then NPS need a unique skill set to support those with lived experience whose recovery can help point the way. [ABSTRACT FROM AUTHOR]

Objective: The inclusion of peer-delivered services in organizations providing behavioral health care has significantly increased in recent years, and substantial resources are being directed toward implementing recovery-oriented mental health services using peer-provided programs. Previous research found that participants in such programs have improved recovery outcomes. While there are demonstrated positive associations between recovery outcomes and peer-provided services, there is limited research on the effectiveness of specific peer-provided interventions. Veteran X is a peer-led program developed in the Department of Veterans Affairs in which participants serve as a recovery team for a fictitious Veteran who faces numerous social and mental health issues. This study compared the effectiveness of the Veteran X program with treatment as usual on measures of recovery wellbeing, symptoms and functioning, and risk and protective factors for substance use disorders. Methods: Participants were recruited (N = 80) over a period of ten months, and had self-selected into treatment as usual (TAU, N = 37), or treatment as usual plus Veteran X (N = 43). Results: No baseline differences were found on the pretest measures. Both groups improved on all measures after 60 days of participation, however Veteran X participants improved significantly more than TAU participants on the measures of recovery wellbeing and symptoms and functioning. Conclusions and Implications for Practice: The results of this study appear to support the positive contribution of the Veteran X program in improving recovery wellbeing and symptoms and functioning among participating veterans. Impact and Implications: Veteran X is an innovative approach to peer-led services in which participants serve as a recovery team for a fictitious Veteran with social and mental health concerns. Results of this study suggest that Veteran X is associated with gains in recovery wellbeing, symptoms and functioning, and may be a useful adjunct to traditional mental health treatment. [ABSTRACT FROM AUTHOR]

Objective: The current article describes efforts to develop and test a measure of recovery-oriented inpatient care. Method: The Recovery-oriented Acute INpatient (RAIN) scale was based on prior literature and current Veterans Health Administration (VHA) policy and resources and further revised based on data collection from 34 VHA acute inpatient units. Results: A final scale of 23, behaviorally anchored items demonstrated a four-factor structure including the following factors: inpatient treatment planning, outpatient treatment planning, group programming, and milieu. While several items require additional revision to address psychometric concerns, the scale demonstrated adequate model fit and was consistent with prior literature on recovery-oriented inpatient care. Conclusions and Implementations for Practice: The RAIN scale represents an important tool for future implementation and empirical study of recovery-oriented inpatient care. Impact and Implications: This study focused on developing a scale to measure recovery-oriented inpatient mental health care. The study found a 23-item scale matched prior literature and included four general areas of recovery-oriented inpatient care: inpatient treatment planning, outpatient treatment planning, group programming, and milieu. This scale can be used to improve the recovery orientation of inpatient programming. [ABSTRACT FROM AUTHOR]

Objective: Individuals with severe mental illness often face (anticipated) discrimination and (criminal) victimization, which have severe consequences for their social participation. The aim of the present study is to assess the effectiveness of a new intervention to manage and prevent revictimization, and to support safe participation by recognizing and acknowledging the impact of their victimization experiences. Method: A multicenter cluster randomized controlled trial was performed by following clients from four intervention teams and four teams providing care as usual. The primary outcomes were social participation, victimization, and discrimination. The secondary outcomes were acknowledgment of difficulties, self-efficacy and empowerment, quality of life, and psychosocial functioning. Data were collected at baseline, and after 10- and 20-month follow-ups. The data were analyzed according to the intention-to-treat principle using linear mixed models and generalized estimating equations. In total, 400 clients were included in the analyses: 216 in the intervention group and 184 in the control group. Results: For experienced discrimination and acknowledgment of difficulties and recovery support, we found small but significant time by condition interactions after 20 months. Both experienced and anticipated discrimination, and self-efficacy increased slightly in both groups. No significant differences were found for other outcome measures. Conclusions and Implications for Practice: The intervention had no effect on victimization and participation, but there were indications that it was successful in moderating experienced discrimination. The clients also felt significantly more acknowledged and supported in their recovery process. Further development of the intervention is needed, and future research should focus on improving implementation. Impact and Implications: Our study offers insights into how to reduce the uncertainty around discussing victimization that hampers participation, by assessing an intervention to support mental health practitioners to initiate the conversation on victimization with individuals with mental illness. This intervention had no effects on participation and victimization. It was found to successfully moderate experienced discrimination. Clients felt that their victimization experiences were acknowledged and that they were supported in their recovery process. [ABSTRACT FROM AUTHOR]

Objective: This study systematically reviews the systematic review (SR) evidence on mental health recovery from the perspective of adults with mental illness. Methods: Web of Science, ProQuest Dissertations & Theses, CINAHL, PubMed, PsycINFO, Scopus, and the libraries of the Cochrane Collaboration, Campbell Collaboration, and Joanna Briggs Institute were searched to identify eligible SRs including qualitative primary research. Two reviewers independently conducted data extraction and quality assessment. Overlap of primary studies was calculated. A framework for recovery was generated using reflexive thematic analysis. Results: An ecological model of recovery that included elements of psychological well-being was generated from 25 studies bridging personal/clinical, individual/social, and process/outcome conceptualizations of recovery. The first theme was a definition of recovery as a transformation from a negative identity state marked by despair, brokenness, and helplessness to a positive state of psychological well-being. This transformation was contingent upon four additional themes that included: (a) social and environmental conditions supporting access to basic resources and safety; (b) development of a sense of autonomy and personal responsibility; (c) roles and relationships that facilitated the personal experience of belonging and meaning; and (d) enlightenment defined as acceptance of the illness as a part of oneself and insight into how to promote well-being. Conclusions and Implications for Practice: Professionals working in recovery-oriented systems must consider how the subjective self-representations of persons with mental illness and objective social relationships interact to impact recovery. We close by discussing interventions that may promote the personal and social conditions of recovery. Impact and Implications: Evidence from systematic reviews of persons with mental illness supports an ecological model of mental health recovery. Clinicians and peers serving persons with mental illness must assess how structural, interpersonal, and intrapersonal factors inhibit or amplify the subjective experience of recovery. Wellness and recovery-oriented services play an important role in supporting positive psychological growth. [ABSTRACT FROM AUTHOR]

Objective: The primary purpose of the study was to explore and identify how components of recovery are associated with occupational performance and health among peer support specialists. Methods: One hundred and twenty-one peer support specialists were recruited from statewide peer certification training programs and the International Association of Peer Supporters. Study respondents completed a survey package including demographic questions and psychometrically sound self-report measures. Two hierarchical multivariable linear regression models were conducted to evaluate whether the recovery components of the process of recovery, social support for recovery, and work self-determination (i.e., work autonomy, work competence, and work relatedness) were associated with indicators of occupational performance (i.e., work engagement) and health (i.e., job satisfaction). Results: Work autonomy was associated with the occupational performance indicator, while the process of recovery and social support for recovery were the only recovery components associated with the indicator for occupational health. Conclusions and Implications for Practice: Findings support the importance of work self-determination and social support and recovery for occupational performance and health among peer support specialists. Mental health and rehabilitation professionals should address these key components of recovery when working with and supporting the work well-being of peer support specialists. Impact and Implications: Our findings indicated key components of recovery are linked to work well-being among peer support specialists. Despite the promotion of recovery among service users, there has been limited focus on the recovery process experienced by peer support specialists employed in mental health systems. These findings underscore the need for service providers, employers, and supervisors of peer support specialists to address both recovery and work well-being among peer support specialists. [ABSTRACT FROM AUTHOR]

Objective: Mental illness and addiction are prevalent during emerging adulthood and are associated with poorer functioning and quality of life. Research supports early intervention for enhancing recovery, though emerging adults frequently disengage from services, reducing effectiveness of early care. Research on self-determination theory shows healthcare climates that support psychological needs for autonomy, competence, and relatedness foster sustained engagement in treatment and health-promoting behaviors. The present study hypothesized that more need satisfying (and less frustrating) psychiatric hospital experiences would relate to various indicators of recovery among emerging adults. Methods: One-hundred four emerging adults from an acute psychiatric inpatient unit completed an adapted questionnaire measuring need satisfaction in the hospital and surveys of treatment attitudes, illness identity, and wellness during the 3rd week of their hospital stay. Six-month postdischarge service utilization data were obtained through electronic health databases. Results: A more need satisfying hospital experience was associated with greater autonomous motivation for treatment, more positive attitudes toward medications and services, more adaptive illness identification, and greater well-being. Greater need frustration was related to less autonomous and more controlled motivation for treatment, less positive attitudes toward medications and services, less adaptive illness identification, and lower well-being. While neither need satisfaction nor frustration related to subsequent visits to the emergency department or rehospitalization, a need frustrating hospital experience related to fewer attended community appointments during the 6 months following discharge. Conclusions and Implications for Practice: Hospital experiences that satisfy (and do not frustrate) the psychological needs of emerging adults may promote recovery and treatment engagement. Impact and Implications: When the psychiatric hospital environment promotes feelings of personal choice, effectiveness, and connection, emerging adults with serious mental illness report greater recovery and show higher community service use. The results are relevant to healthcare providers, policy makers, and consumers of psychiatric inpatient services, by illustrating the importance of a need-supportive hospital experience for effective early intervention. [ABSTRACT FROM AUTHOR]

Objective: Understandings of recovery in low- and middle-income countries, such as South Africa, are still emerging. This study explored recovery understandings by service users, carers, and service providers in South Africa. Method: Thirty-seven in-depth, semistructured interviews and three focus groups with service users, carers, and service providers from three public tertiary psychiatric hospitals in the Western Cape province of South Africa were conducted in 2018 and 2019. Data were transcribed and analyzed, using atlas.ti and reflexive thematic analysis, to generate themes. Results: Seven themes, with further subthemes, were generated: (a) relationship with others, (b) moving positively forward, (c) relationship with self, (d) relating to the world, (e) (re-)gaining of strengths, (f) awareness of difficulties, and (g) clinical understanding to support personal recovery. From the themes, a definition of recovery for the South African context was developed. Conclusion and Implications for Practice: The identified themes were not mutually exclusive—overlap is inevitable when describing personal recovery. These results and definition are informing the second phase of the overall study—developing a measure of personal mental health recovery for the South African context. The results can contribute to the wider clinical, academic and governmental comprehension of recovery, assist in the obtaining or retaining of funding for local recovery initiatives, and hopefully be useful for service users to understand their own process of recovery better and to be able to move along in that process. We recommend replicating the study and investigating recovery-conducive environments in South Africa with service users. Impact and Implications: Seven themes were generated and a definition of recovery formulated for the South African context. The results can contribute to the wider clinical, academic, and governmental comprehension of recovery; assist in the obtaining or retaining of funding for local recovery initiatives; and hopefully be useful for service users to understand their own process of recovery better and to be able to move along in that process. [ABSTRACT FROM AUTHOR]

Objective: A peer respite is a voluntary, short-term, overnight program that provides community-based mutual support to people experiencing a mental health crisis. This qualitative study of guest experiences at 1 peer respite examines its role in fostering recovery and wellbeing. Method: Conventional content analysis of interviews with 20 peer respite guests resulted in a thematic framework containing 7 "clusters" of themes with related subthemes. Results: The following themes emerged from the analysis and include both positive and negative experiences: belongingness, confidence and hope, crisis self-management, experiencing mutual support, freedom and responsibility, linking to community, and conflict and confrontation. Some guests endorsed the peer respite as a temporary break from stressful life situations, a homelike space for mutual support and community, and a preferred alternative to traditional crisis services. Others struggled with the unstructured environment and expectations for shared responsibility and self-reliance. Conclusions and Implications for Practice: Peer respites strengthen self-reliance and social connectedness and offer a viable alternative to traditional crisis services for some people some of the time. The results suggest potential "key ingredients" for peer respites, including a homelike environment, voluntary and self-determined supports, and peer support staff who possess the capacity for developing healing and genuine connections with guests while also promoting shared responsibility and self-reliance. Future research should further develop this theory of change and establish peer respite fidelity criteria based on program elements that seem to contribute to positive outcomes. Impact and Implications: Findings suggest "key ingredients" for peer respites: A homelike environment, voluntary and self-determined supports, and peer staff who possess the capacity for developing healing and genuine connections with guests while also promoting shared responsibility and self-reliance. This work contributes to a theory of change for peer respites: By providing a "break" from stressful life situations alongside mutual support, peer respites offer a viable alternative to traditional crisis services. [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: This study examined the types of goals set, the degree to which goals were achieved, and the factors influencing goal attainment for participants in a Recovery College, a recovery-based mental health education program that uses peer learning advisors to facilitate individual student learning plans. Method: Students of the Recovery College set baseline goals that were rated in terms of importance and difficulty in line with the Goal Attainment Scale (GAS) framework and reviewed at follow-up points. Goals were reviewed to determine areas of priority and an analysis of goal attainment was conducted using multinomial logit regression analysis. Results: Sixty-four students recorded their goals. The most common goal areas identified related to education, socialization, physical health, mental health, and employment. Seventy percent of goals were fully or partially achieved with goals rated as having a lower difficulty more likely to be achieved. Conclusion and Implications for Practice: Recovery College is a program model that can effectively support personal goal achievement, a recommended indicator of personal recovery and program success. The GAS proved to be a useful instrument for measuring goal setting and attainment in students' recovery journeys and peer learning advisors were effective in facilitating this process. The setting and achievement of physical health goals is of clinical significance. This study builds on limited published evidence demonstrating the important role that Recovery Colleges play in supporting participants to identify and achieve their personal goals. Further, it highlights the contribution that peer workers can make to this process, in keeping with the coproduction philosophy of the Recovery College model. [ABSTRACT FROM AUTHOR]

Objective: The Wellness Recovery Action Plan (WRAP) is a structured approach to illness self-management that is widely used within mental health services. This systematic review identifies, appraises, and meta-analyzes quantitative evidence from experimental or quasi-experimental comparison group designs for effects of WRAP on measures reflecting personal recovery and clinical symptomatology. Method: A systematic strategy was used to search 6 electronic reference databases (Medline, CINAHL, EMBASE, PsycINFO, PsycARTICLES, The Cochrane Library) using full-text, keywords, and Medical Subject Headings (MeSh)/Thesaurus headings terms. Unpublished research was identified using the same strategy in the EThOS database. Controlled trials of WRAP were selected and assessed for quality. Meta-analyses were applied to quantitative data to establish the effects of WRAP on outcomes of interest. Results: Of 253 studies initially identified, 5 quantitative studies (reported in 6 papers) reporting controlled trials were included in the review. Meta-analyses revealed that, relative to inactive control conditions, WRAP was (a) superior for promoting self-perceived recovery outcomes (demonstrating a small-but-significant pooled effect), but (b) not superior for reducing clinical symptomatology—although restriction to randomized-controlled trials revealed 1 small effect favoring WRAP for reducing depression. Conclusions and Implications for Practice: Participation in WRAP has positive outcomes for participants, quantifiable using comprehensive measures of self-perceived recovery. Improvements were not sustained over time. Future research could explore this, as well as potential effects of follow-up WRAP sessions. The results support a move to broader measurement of outcomes within mental health, away from a reliance on clinical outcome measures. Recommendations for further research are made. The current article pooled data from studies into the effectiveness of the Wellness Recovery Action Plan in adult mental health settings. The findings provide support for a broader conceptualization of outcomes than clinical symptom measurement: demonstrating significant growth in self-identified personal recovery in the absence of significant symptom reduction. [ABSTRACT FROM AUTHOR]

Objective: Mental health self-direction, also known as self-directed care, involves an individual budget controlled by the participant with support from a specially trained recovery coach. The model under study here, implemented in a Medicaid behavioral health managed care context, allowed individuals to intentionally reduce mental health service use and apply cost savings as "Freedom Funds" to purchase a range of goods and services that are not typically considered mental health services to support recovery. This pre-post study examined mental health service utilization and cost before and after participating in self-direction. Methods: The study involved Medicaid claims data for 45 self-directing participants over a 3-year period. Bivariate statistics were computed to identify meaningful pre-post differences in service utilization and standardized monthly costs. Results: Median standardized monthly mental health clinical outpatient costs were significantly lower after self-direction participation compared to before. Participants spent a mean of $182 per month in Freedom Funds to purchase a range of nonclinical goods and services to work toward recovery goals. Total service costs—including Freedom Funds used during self-direction—did not differ significantly before and after program participation. Conclusions and Implications for Practice: Findings from this modest pre-post examination of self-direction suggest that mental health self-direction can result in more person-driven, individualized services without increasing costs. More research is needed to examine the cost-effectiveness of self-direction and to understand how program design and implementation factors influence the relationship between self-direction and service costs. Self-direction supports individuals to set and reach recovery goals by accessing a range of goods and services using an individualized budget. This study adds to the modest literature examining cost implications of mental health self-direction and demonstrates that self-direction was implemented in a cost-neutral fashion in a Medicaid managed care context. Future studies should further explore whether and how mental health self-direction can support recovery without substantially increasing service costs. [ABSTRACT FROM AUTHOR]

Objective: Recovery from severe mental illnesses (SMI) has been described as an outcome (end state where persons are symptom free) or as a process (despite symptoms, people can pursue life goals). Less clear is whether recovery as a process has credibility in the substance use disorders (SUD) community. We examined how public perceptions and expectations of outcome and process between SMI and SUD differed. A severity effect within SMI and SUD categories was also examined. Method: Participants (N = 195) read definitions of SMI and SUD and completed an online survey of their agreement on: perceptions of recovery from SMI and SUD as outcome and process, and expectations of recovery as outcome and process. Participants were then given more and less severe SMI (i.e., schizophrenia vs. depression) and SUD (opiate vs. alcohol use) definitions. They then responded to recovery items SMI and SUD conditions with low and high severity. Results: For SMI, perceptions and expectations of recovery as process were endorsed more than outcome. Severity effect led to greater increases in perceptions and expectations about recovery as process. Specifically, differences between outcome and process for schizophrenia were significantly larger than for depression. For SUD, expectations of process were significantly lower than outcome ratings. One negative interaction was found for SUD expectations; difference scores for opiate users were smaller than for alcohol. Conclusions and Implications for Practice: We discussed implications for interventions that enhance recovery for people with SMI and SUD. This study shows that recovery as a process (symptom management) is more endorsed for persons with severe mental illnesses (SMI) whereas recovery as an outcome (symptom free) is more endorsed for people with substance use disorders (SUD). Distinction between process and outcome perspectives across two communities will shape individuals' recovery experience and inform good treatment practices. [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: Our goal was to develop and pilot a methodology that could reliably identify therapeutic homework tasks that are coherent with the goals of individuals receiving mental health recovery support. Method: The content of goals and therapeutic homework tasks of 66 clients were classified using the Camberwell Assessment of Need Goal-Action Plan (CAN-GAP) taxonomy. Goal-homework pairs were considered coherent if the content of the homework and goal were both independently assigned the same content domain. Results: The content of the goals and homework tasks were found to be highly coherent, with a 75% match in categories. Conclusions and Implications for Practice: It is possible to simply, and reliably, determine whether the content of goals and homework tasks are coherent. Lower coherence would require support workers to spend more time making the connection between homework and goals more explicit. Future research should determine whether higher coherence leads to greater goal attainment. [ABSTRACT FROM AUTHOR]

Objective: Recovery, defined as a personal process of living with mental illness, has become a prominent concept in mental health care. We aimed to map the state of the art of conceptualizing recovery, its promoting and impeding factors, recovery-oriented practice, and the assessment of recovery. Method: A scoping review of systematic reviews and meta-analyses was performed. Systematic searches were conducted, supplemented with hand-searching in reference lists. Results: Of 228 articles that were identified and 33 that were reviewed, a total of 25 were included. This review showed that the CHIME conceptual framework for personal recovery is widely endorsed, containing the elements of connectedness, hope and optimism, identity, meaning in life, and empowerment. Although personal recovery first and foremost starts from individual preferences, the CHIME framework should be adapted according to culture and unique population characteristics. "Difficulties and trauma" should be added, and the person's choice, risk taking, and coping with challenges should be emphasized. Barriers to recovery are stigma and negative effects of mental health services and medication. Facilitators of recovery include spirituality, personal agency, and social support. Recovery-focused interventions, in which peer providers are involved, enhance recovery, hope, and empowerment. For assessing recovery outcomes, multiple instruments are accepted as methodologically sound. Conclusions: Personal recovery is conceptualized as complementary to clinical recovery and represents processes rather than outcomes. Additional work is needed to bridge the gap between the concept of recovery-oriented practice and routinely provided interventions. A broad framework of recovery is needed, and more research is needed into the working mechanisms of personal recovery processes. [ABSTRACT FROM AUTHOR]

Objective: This study examined the psychometric properties of a Chinese language version of the Recovery-Promoting Relationship Scale (RPRS) scale in a sample of persons with severe mental illness in Taiwan. Method: Five hundred ninety-two participants from 32 community psychiatric rehabilitation centers in Taiwan agreed to participate in this study. Principal component factor analysis with oblique rotation was performed. Internal consistency and external construct validity were also examined. Results: The results revealed a 2-factor solution that differed from the structure of the original RPRS. The first factor (F1) comprised 7 items in the Core Relationship Index and 7 items in the Recovery-Promotion Strategies Index of the original RPRS. The second factor (F2) comprised 8 items in the Recovery- Promotion Strategies Index and 1 item (I5) in the Core Relationship Index of the original RPRS. The reliability of F1 and F2 was 0.961 and 0.941, respectively. The entire scale and subscales all had a significant and moderate correlation with recovery and service use. Conclusions and implications for practice: This study provides initial psychometric support for a Chinese language version of the RPRS. Additionally, the use of core interpersonal skills was correlated with recovery-promoting strategies. The findings support the use of the RPRS as a guide to promote recovery-oriented services in Taiwan. [ABSTRACT FROM AUTHOR]

Objective: A growing body of literature indicates that mobile health (mHealth) interventions that utilize smartphones for illness management are feasible, acceptable, and clinically promising. In this study, we examine how individuals with serious mental illness use a mHealth intervention--FOCUS--to selfmanage their illnesses. Additionally, we explored participant perceptions of the intervention's impact on their subjective illness experience. Method: We analyzed qualitative data from 30 individuals with serious mental illness who participated in 1 of 2 community-based, 3-month trials of FOCUS. In Study 1, weekly calls were conducted by a mHealth specialist to facilitate and enhance intervention use. In Study 2, researchers conducted qualitative interviews to gather detailed perspectives of intervention use. Data were sampled from the weekly call notes and qualitative interviews and analyzed using a thematic and collaborative approach. Results: Thematic analyses revealed 6 recurring themes. Three themes emerged in regard to participants' ongoing daily use of FOCUS: "back-up" support, symptom management, and self-awareness. Another 3 themes emerged related to the intervention's impact on participants' recovery processes: acceptance of symptoms, motivation and supporting positive outlook. Conclusions and Implications for Practice: This qualitative study offers insight into how individuals with serious mental illness made use of a mHealth intervention designed to support illness self-management. Our findings suggest that individuals may benefit differently from mHealth interventions depending on where they are in the recovery process. As mHealth interventions become increasingly popular in clinical settings, it is important to understand consumers' short-term and long-term benefits from these interventions. [ABSTRACT FROM AUTHOR]