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Purpose: Self-disgust appears to be a prominent feature in anorexia nervosa (AN), which might help explain why AN is often such a persistent disorder. Little is known about how this emotion can impact on recovering from this disorder. This study aims to develop our understanding of how people experience the emotion of self-disgust after physical recovery from AN. Design/methodology/approach: Twelve female participants who reported previously having had a clinical diagnosis of AN but had physically recovered according to their EDE-Q scores took part in a semi-structured interview to explore their experiences of recovery and the role self-disgust played within this. Interpretative phenomenological analysis was used to explore the data. Findings: Three themes were identified within the data to explain the experiences of self-disgust in those with AN: continued self-disgust following physical "Recovery", multiple manifestations of self-disgust in recovery and increasing self-disgust in recovery as a driver for relapse. Practical implications: Self-disgust was something each participant appeared to experience often, despite being physically recovered from AN. Disgust-based reactions to the self are enduring and highly resistant to change even whilst other aspects of the disorder become less potent. Self-disgust is multi-faceted and may trigger relapse as the signs of improvement and behaviours inherent in recovering were generally viewed as disgusting to the individuals. Originality/value: Self-disgust is an emotion that continues to affect people with AN despite physical recovery. The recovery process itself is not linear and self-disgust is enduring and may cause those affected to relapse. Considering this emotion within therapeutic intervention may encourage those with AN to accept their recovered self. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore the psychological and relational processes of a service user reflective group on a medium secure forensic ward. The group was conceptualised by the service as a component of the therapeutic offer contributing to the patients' journey towards recovery and this study aimed to explore whether the group was being experienced as beneficial, by service users and staff, in relation to recovery concepts. Design/methodology/approach: Qualitative data were collected using semi-structured interviews from 10 participants who had experience of an existing service user reflective group on a medium secure forensic ward. Participants in the study were patients who attended the group (6) and staff members who facilitated the group (4). The data collected were analysed using constructivist grounded theory methodology. Findings: Results formed a flexible, cyclical model based on five key categories: "Group Identity", "Linking Self with Others", "The Changing Self", "Living Visibly in a System" and "Moving On." Practical implications: Findings indicate that service user reflective groups in forensic inpatient settings can contribute to increased interpersonal effectiveness and personal recovery. Originality/value: The role of service user reflective groups in secure recovery has not been explored empirically to date, although they are a suggested intervention to enhance relational security and to aid therapeutic progress within a secure recovery framework. This study aimed to begin to address this gap in research and understanding. [ABSTRACT FROM AUTHOR]

Purpose: Eating disorders (EDs) remain a major health concern, and their incidence has further increased since the COVID-19 pandemic. Given the equally increasing demands on treatments and service provision and the high levels of relapse post-treatment, it is important that research explore novel and innovative interventions that can further support recovery for individuals with EDs. There is growing evidence that arts interventions are beneficial for recovery from EDs. This study aims to evaluate the feasibility of conducting a stand-up comedy course to support ED recovery. Design/methodology/approach: The study used a qualitative interview study design to evaluate the recovery benefits of participating in stand-up comedy workshops for a pilot group of people in recovery from EDs (n = 10). Findings: The comedy intervention was well-attended and had high acceptability and feasibility. For most individuals, participating in the course had a positive impact, including promoting personal recovery (PR) outcomes across all five elements of the CHIME framework. Unique assets of the course included providing participants with an opportunity to distance themselves from everyday worries of living with an ED; the opportunity to cognitively reframe situations by making them the object of humour; and providing a safe space to (re-)build a positive sense of self. Originality/value: This is the first study, to the best of the authors' knowledge, that evaluates stand-up comedy workshops for ED recovery and further demonstrates the potential of arts interventions and the relevance of PR frameworks in this field. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the roles of psychologists in seclusion in adult mental health services in Ireland, their perspectives on seclusion and its use in recovery-oriented practice and related professional practice issues. Design/methodology/approach: A qualitative hermeneutic phenomenological study was conducted from a social constructivist perspective. Semi-structured interviews with 17 psychologists were analysed using reflexive thematic analysis. Findings: Twenty-four themes were identified, which were clustered into four overarching themes. Participants viewed themselves and psychology in Ireland more broadly as peripheral to seclusion. They believed that seclusion possessed no inherent therapeutic value but viewed it as an uncomfortable and multi-faceted reality. Participants regarded seclusion and recovery as largely inconsistent and difficult to reconcile, and they perceived systemic factors, which had a pervasive negative impact on seclusion and recovery in practice. Practical implications: The findings highlight the perceived complexity of seclusion and its interface with recovery, and the need to conscientiously balance conflicting priorities that cannot be easily reconciled to ensure ethical practice. The findings suggest psychologists are well-suited to participate in local and national discussions on using seclusion in recovery-oriented practice. Originality/value: This study offers a unique insight into psychologists' perceptions of seclusion and considers the implications of these views. Participants' nuanced views suggest that psychologists can make valuable contributions to local and national discussions on these topics. [ABSTRACT FROM AUTHOR]

Purpose: In 2019, the world was hit by a life threatening severe acute respiratory syndrome causing a global pandemic; Coronavirus disease (COVID-19). In the UK, a nationwide "lockdown" of public isolation and reduced social contact followed. The experience of COVID-19 and the lockdown for forensic secure mental health patients is yet to be understood. This study aims to explore this phenomenon from the patients' perspective. Design/methodology/approach: A qualitative approach was taken. Semi-structured interviews were carried out with six patients from a low secure unit in the UK, between November 2020 and March 2021. Findings: Interpretive phenomenological analysis generated three superordinate themes from the data, providing insight into patients' experience: "treading water"; how they managed: "learning to swim"; and what was helpful during this time: "in the same boat". Practical implications: Further consideration should be given to creating a sense of safety in wards, along with ways to continue to address the power imbalance. Interestingly, social connection may be cultivated from within the hospital setting and would benefit from further research. Originality/value: To the best of the authors' knowledge, this is the first study to explore secure patients' experience of COVID-19 from the patients' perspective, within a population often neglected within recovery research. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to describe mental health professionals' experiences of changes in attitudes towards, and knowledge about, users of mental health-care recovery and decisional participation in clinical practice after an educational intervention. Design/methodology/approach: Users of mental health care want to participate in decisions regarding their own mental health care. Shared decision-making as a method is coherent with recovery orientation in mental health services and results in better-informed patients and fewer conflicts regarding decisions. A qualitative intervention study was designed to evaluate changes in attitudes and knowledge about mental health recovery in Sweden. Nine participants were interviewed, and the data were analysed by content analysis. Findings: Three categories were generated from the analysis: Increased theoretical knowledge, changing attitudes about practical approaches and the significance of social factors in recovery. Originality/value: When shared decision-making is to be implemented in mental health, professionals need to gain knowledge about recovery and need to adopt changed roles as health professionals. Educational interventions therefore seem necessary if such changes are to happen. [ABSTRACT FROM AUTHOR]

Purpose: Depression, physical health, well-being, sleep and physical activity are interlinked. Healthy levels of physical activity and effective night-time sleep can reduce depressive symptoms. In the context of their lives and symptoms of depression, this paper aims to understand participants' experiences of using a Fitbit, physical activity and sleep and the barriers and facilitators for healthy sleep and physical activity. Design/methodology/approach: Qualitative methods were used to conduct interviews with 19 patients (4 male; 15 female) diagnosed with treatment-resistant depression undergoing transcranial magnetic stimulation (TMS) treatment for depression. Reflexive thematic analysis was used. Findings: Healthy sleep and physical activity levels are interlinked and reduce depressive symptoms as well as improving well-being and physical health. A Fitbit is useful to enhance physical activity, self-awareness, motivation, healthier lifestyles and effective sleep. Barriers to healthy sleep and physical activity levels included depressive symptoms, environmental factors and anxieties. Facilitators for healthy sleep and physical activity levels included knowledge of the benefits, support from family and friends and applying sleep hygiene. Practical implications: There is a need to provide interventions using wearable activity trackers that build on the links between increased physical activity, improved sleep, enhanced well-being, better physical health and lower depressive symptoms. Originality/value: To the best of the authors' knowledge, this is the first time that patients undergoing TMS have had their experiences of sleep, activity and using a Fitbit investigated and reported. [ABSTRACT FROM AUTHOR]

Purpose: Dual Diagnosis Anonymous (DDA) is a peer-led programme developed in the USA, which aims to address mental and addictive disorders in an integrated manner. This study is part of a mixed-methods evaluation of the first DDA pilot in the UK, and the purpose of this study is to explore the impact and mechanism of change of the programme through the perspective of DDA attendees, facilitators and the funding commissioners. Design/methodology/approach: Six DDA members were interviewed three times over a period of 12 months, the facilitators were interviewed twice and the commissioner was interviewed once. The qualitative longitudinal data were analysed using a trajectory thematic analysis. Findings: DDA attendance was perceived to have had a positive impact on five main areas: acceptance of self, of others and from others; social functioning; self-development; recovery progression; and feeling of hope. The possibility of addressing both mental health and addiction at the same time was a key factor in the recovery process. The facilitators observed that DDA had contributed to integrate members into employment and education, while the commissioner stressed the importance of joint commissioning and sustainability. Originality/value: The longitudinal approach provided a unique insight into the recovery process of DDA members. Being able to address the mental health as well as the substance use problems was considered to be a fundamental strength of DDA in comparison to the single purpose peer-support fellowships. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have pointed the need for more research, which explores how peer provision brings about change associated with recovery. This study aims to test Leamy's framework, which consists of five recovery processes: connectedness, hope, identity, meaning and empowerment (also known as the CHIME framework) within the peer provision context. Design/methodology/approach: This mixed-methods study was completed in two stages. A total of 13 face-to-face interviews were conducted with peers and the transcripts were analysed thematically. A short online questionnaire was completed by 12 peers and analysed with both descriptive statistics and thematic analysis. Findings: The participants spoke about the value of peer providers (PPs) in building connectedness, fostering hope and optimism, growing identity, enhancing meaning and empowerment (CHIME). However, their connectedness was hindered by external circumstances and the intrapersonal capacities of their PP. Practical implications: The CHIME framework was useful in highlighting stages in which peers moved through their recovery and its corresponding PP involvement. PPs were also found to promote motivation, which was a key driver in their peers' recoveries. Further research is needed to test frameworks that account for wider systemic issues and the role PPs play in enhancing motivation. Originality/value: This study has identified the usefulness of the CHIME framework in describing peer provision. It contributes to our understanding of how peer provision can promote recovery in persons with mental health challenges. It lays the groundwork for future research into examining the role of peer provision in recovery and its distinctiveness from other forms of mental health support. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore the experiences of mentally disordered offenders (MDOs) conditionally discharged from secure hospitals on a restrictive Section of the Mental Health Act (Section 37/41). Design/methodology/approach: Data were derived from seven semi-structured interviews from three forensic community teams. Findings: Thematic analysis identified seven predominant themes: (1) the uncertainty of the discharge timeframe; (2) fear of jeopardising discharge; (3) progress; (4) engagement with community life; (5) barriers to social engagement; (6) evolving identity and (7) someone to turn to. Findings are discussed in relation to the recovery model and the good lives model. Practical implications: The findings highlight the importance of fostering trust between MDOs and their care teams to encourage help-seeking. They also suggest that resources should be sequenced appropriately throughout the discharge process, to match the "window of engagement" and maximize impact and effectiveness. Originality/value: This research gained rarely obtained first-hand perspectives from MDOs, with the findings contributing to a more effective evaluation of the discharge pathway. [ABSTRACT FROM AUTHOR]

Purpose: The onset of psychosis typically develops during adolescence, a crucial period for beginning the transition from family to independence and developing a stable sense of self. Recovery amongst adolescents experiencing early onset psychosis has not yet been investigated with reference to its influence on self-identity. The purpose of this paper is to explore the impact living with early onset psychosis has on self-identity for adolescents in recovery. Design/methodology/approach: A purposive sample of ten adolescents aged between 16 and 18 years from an Early Intervention Service in the Scottish National Health Service were recruited. All had experienced at least one episode of psychosis and were within three years of first contact with the service. Semi-structured interviews were adopted to capture adolescents' perspectives concerning their experiences of recovery from psychosis and the impact on self-identity. All interviews were audio-recorded, transcribed and thematically analysed. Findings: Qualitative analysis of adolescents' accounts revealed how recovery from psychosis involves working with individual explanatory frameworks concerning uncertain identities and status ambiguity, a decrease in referent points and unfavourable social comparisons (emphasising loss, grief and self-criticism). Research limitations/implications: Supporting adolescents experiencing early psychosis involves education, rebuilding relationships with self and others and providing access to psychotherapeutic interventions to aid self-identity development when needed. Originality/value: The originality of this paper lies in the importance of identity, recovery, human reconnection, advocacy and community reintegration for adolescents experiencing psychosis. Public mental health campaigns to tackle the stigma surrounding psychosis are essential to assisting adolescents in developing their sense of self through their recovery journeys. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to reach beyond existing research into the mental health benefits of arts-based or educational opportunities, to discover the particular impact on members' recovery processes of being part of a committed, long-term troupe or community – specifically focussing on specialist theatre companies. Design/methodology/approach: Following a literature review investigating the growing number of theatre troupes for mental health service users, qualitative research was conducted into one such company. In-depth qualitative interviews were conducted with six company members. Thematic analysis of interview transcripts was then cross-checked and enriched through a group interview with six other members. Findings: Two overarching themes emerged: the importance of "being known" within the company (key sub-themes included "intuitive democracy" and the "paradox of reliability"), and the ways in which individuals "branched out" from this secure basis into artistic, professional and voluntary roles, while remaining company members. Research limitations/implications: The findings from this small-scale study, while not necessarily generalisable to other long-term communities of care and learning with a "troupe" or "team" structure, would provide valuable starting points for a larger-scale investigation. Practical implications: If generalisable, institutions in the mental health and educational worlds should place more emphasis on developing and resourcing long-term models of support. Social implications: The specialist theatre company model contrasts with prevalent individualised, time-limited services for those experiencing mental ill health. Originality/value: The study provides compelling narrative evidence to amplify understanding of how "connectedness" is experienced within a troupe, and may enable individuals with mental illnesses to progress further in their recovery journey. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to focus on the findings of a review of the Learning Advice Service which provided mainstream learning opportunities and individual support to people using mental health services. The service was decommissioned after 15 years due to service reconfiguration and cost-cutting.Design/methodology/approach Semi-structured interviews were carried out with members of the Learning Advisor’s caseload by a researcher with no affiliation to the NHS or the Institute of Mental Health and no connection to the clients. The researcher also transcribed and analysed the interviews. This ensured that there could be no personal or positive bias. The clients faced significant mental health challenges and used the Learning Advice Service to facilitate and support their entry into mainstream learning.Findings The service enabled individuals facing significant mental health challenges to gain access to adult, community, distance and further and higher education facilitated by individual advice, guidance and support. They were able to broaden their sense of identity beyond that of someone using mental health services and to widen their social and educational base.Research limitations/implications Lack of funding within mental health services to continue this type of work limits research which would further explore the value of mainstream education in the recovery of people with a mental health diagnosis. While this cohort was small because of funding and staffing constraints, it would be possible to generalise to a larger scale, using flexible person-centred ways of working if the will, staffing and funding were made available. Further research is certainly indicated as current practice has moved away from mainstream inclusion to discrete provision with associated limitations.Practical implications The practical implications include the development of autonomy and the development of a sense of identity that is separate from a mental health diagnosis and where appropriate to gain qualifications and further the student’s knowledge.Social implications Social implications include broadening one’s experience, developing communication skills in a broad context, transferable skills, independence and strengthening one’s sense of identity separate from a mental health diagnosis.Originality/value Individuals from a variety of educational and other backgrounds who expressed an interest in pursuing education in mainstream facilities were encouraged and supported in doing so in flexible and individual ways. It appears to be more usual that people using mental health services are encouraged to learn in groups comprising other people using such services, frequently on mental health service premises with associated limitations. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to investigate the internal and social factors that persons with experience from severe mental illness and alcohol and other drugs problems, and who have received treatment for these problems, describe as important for initiating and maintaining a recovery process.Design/methodology/approach In total, 40 persons were interviewed and asked to describe factors they perceived as important for initiating and maintaining recovery. The software Nvivo was used to categorise data in internal and social factors with subcategories.Findings There is significant variation in how recovery emerged but involved in general having a proper social situation and finding meaning in life. Initially, the majority had a marginalised situation with need of assistance with housing, employment, financial and social support.Research limitations/implications The change process in the investigated group is interpreted as related to individual resources rather than belonging to a group defined as having “double trouble”.Practical implications The study implies that in addition to professional help to handle diagnosed problems, the group in focus also need support and interventions that address individual complex needs.Social implications Supporting activities/peer support seem to be important for those lacking support from family. At the same time, it is important to recognise the risk of being forced into a recovery identity which might lead to worsening the situation for those who do not fit into this.Originality/value By using the same design as in previous studies, comparisons with other groups are possible while still keeping the qualitative meaning of the investigated factors. [ABSTRACT FROM AUTHOR]

Purpose Arts and cultural activities have been illustrated to be beneficial for mental health service users. The purpose of this paper is to explore the benefits of museum visits and engage in arts activities for mental health service users.Design/methodology/approach Semi-structured interviews were conducted with 17 mental health service users in Denmark. A thematic approach was used to analyse the data and theoretical lens of sociological theories of institutional logics was employed to explore the findings.Findings These benefits are perceived to include empowerment and meaning in life, which are two of the core principles of recovery; arts engagement can, therefore, be a useful tool in recovery. The findings also show that the experience of visiting a museum was not always positive and depended upon the interaction with the museum educators.Originality/value The service users identified arts engagement as creating meaning in life and empowerment, which are two element in the conceptual framework, CHIME (an acronym for: Connectedness, Hope and optimism, Identity, Meaning in life and Empowerment), that describes the human process of recovery. The findings also highlighted that if museums want to engage positively with people with mental health problems and contribute to their recovery then the training of staff and the improvement of institutional approaches to support working with vulnerable people are essential. [ABSTRACT FROM AUTHOR]

Purpose Existing literature has examined what recovery means to people with co-occurring difficulties, but does little to examine experiences of recovery as a process. The purpose of this paper is to use a narrative approach to explore the process of recovery as an individual journey in a social context. It focuses on people who use alcohol in order to explore the impact of alcohol’s specific cultural meanings on the recovery journey.Design/methodology/approach Ten interviews with people with coexisting mental health and alcohol misuse difficulties were conducted, audio-recorded, and transcribed. The transcriptions were analysed using narrative analysis.Findings Most participants’ narratives shared a three-part structure, from a traumatic past, through an episode of change, to an ongoing recovery phase. Change and recovery were attributed to several factors including flexible and practical support from services, therapeutic relationships with key professionals, and peer support. Some participants redefined themselves and their alcohol use in relation to ideas of what it is to be “normal”.Research limitations/implications The research excluded people who recover outside of services, replicating a shortcoming of much research in this area.Practical implications The value placed on professionals having specialised therapeutic skills in working with trauma highlights the need for training in this area. The role for practical and material support underlines the importance of multi-agency working.Originality/value The narrative methodology enables the study to draw links between personal stories of recovery and wider social influences, allowing comment on the implications for services. Further, the experiences of people with coexisting mental health and alcohol misuse difficulties have rarely been studied apart from the dual diagnosis population in general, so this paper is able to investigate the specific challenges for this population. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide insights into the views and attitudes that psychiatrists have about recovery colleges (RCs).Design/methodology/approach Semi-structured interviews were conducted with ten psychiatrists from the Norfolk and Suffolk Foundation Trust.Findings Psychiatrists had a strong concept of the RC model, and were broadly positive about it, recognising many benefits. Various challenges were also acknowledged including how the RC model interacts with the medical model.Originality/value This is the first known study to explore solely the psychiatrists’ views of RCs, a group who are likely to be particularly influential within services. The sample was relatively unexposed to RCs, enabling insight into how the RC is perceived by those outside of its functioning as well as the state of wider organisational support, which is important for the success of RCs. [ABSTRACT FROM AUTHOR]

Purpose Borderline personality disorder (BPD) is a complex condition characterized by a number of psychosocial difficulties that typically involve considerable suffering for individuals with the condition. Recovery from BPD may involve specific processes such as work on how the self is perceived by the individual with BPD and his or her relationships which differ from those common to recovery from other mental health conditions. The details of the processes that may best promote changes within the self and relationships are yet to be established. The paper aims to discuss these issues.Design/methodology/approach In total, 17 consumers from a specialist BPD service were interviewed to identify factors they have experienced that contribute to recovery from BPD. Thematic analysis within a grounded theory framework was used to understand key themes within the interview data. The emphasis was on specific conditions of change rather than the more global goals for recovery suggested by recent models.Findings Key themes identified included five conditions of change: support from others; accepting the need for change; working on trauma without blaming oneself; curiosity about oneself; and reflecting on one’s behavior. To apply these conditions of change more broadly, clinicians working in the BPD field need to support processes that promote BPD-specific recovery identified by consumers rather than focusing exclusively on the more general recovery principles previously identified within the literature.Originality/value The specific factors identified by consumers as supporting recovery in BPD are significant because they involve specific skills or attitudes rather than aspirations or goals. These specific skills may be constructively supported in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore how those engaged in service user involvement (SUI) initiatives perceive involvement and recovery; whether involvement is related to their recovery process and, if so, how.Design/methodology/approach An exploratory qualitative method, social constructionist grounded theory, was adopted throughout the research process. Nine semi-structured interviews were undertaken with participants who self-defined as having current or previous mental health problems and who were engaged in SUI initiatives.Findings Most participants identified explicit links between their own experiences of SUI and recovery. These links represented a connection between the characteristics they perceived to be inherent to involvement and their personal definitions of recovery. In contrast, experiences of consultation and involvement as patient service users was limited and identified as an area for improvement. The core of the tentative grounded theory constructed suggests that individuals found in involvement elements which were concordant with and supported their own definitions of recovery and which were not apparent in their experiences as patients.Research limitations/implications The small sample and narrow constituency of participants limit the nature of the claims made by the study.Practical implications This study highlights the value of involvement in promoting recovery and indicates the merit of promoting meaningful involvement across the spectrum of the service user experience.Originality/value This study offers a unique contribution to the current literature, highlighting the links made between involvement and personal recovery. [ABSTRACT FROM AUTHOR]

Purpose Recovery is an important concept within mental healthcare policy. There is a growing expectation that clinicians adopt approaches that align with the recovery principles, despite significant disagreements about what recovery-oriented interventions might look like in practice. It is also unclear how recovery may be relevant to personality disorder. This paper aims to discuss these issues.Design/methodology/approach In total, 16 clinicians were interviewed at two mental health services in Melbourne, Australia. These clinicians had specialist training and experience in the treatment of borderline personality disorder (BPD) and provided insight regarding the meaning and relevance of the recovery paradigm in the context of BPD. Thematic analysis within a grounded theory approach was used to understand key themes identified from the interview data.Findings Thematic analysis suggested that clinicians understand recovery in three distinct ways: as moving towards a satisfying and meaningful life, as different ways of relating to oneself and as remission of symptoms and improved psychosocial functioning. Clinicians also identified ways in which recovery-related interventions in current use were problematic for individuals diagnosed with BPD. Different approaches that may better support recovery were discussed. This study suggests that practices supporting recovery in BPD may need to be tailored to individuals with BPD, with a focus on cultivating agency while acknowledging the creative nature of recovery.Originality/value Clinicians are in a strong position to observe recovery. Their insights suggest key refinements that will enhance the ways in which recovery in BPD is conceptualized and can be promoted. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore and describe experiences of recovery among people with co-occurring mental health and substance use conditions (co-occurring conditions) in a rural community in Norway.Design/methodology/approach In-depth individual interviews with eight persons with co-occurring conditions were conducted, audiotaped, transcribed and analysed using a phenomenological approach. This study is part of a research project investigating recovery orientation of services in a Norwegian district.Findings The analysis yielded four dimensions of recovery: feeling useful and accepted; coming to love oneself; mastering life; and emerging as a person. Insecure and inadequate housing and limited solutions to financial problems were described as major obstacles to recovery.Research limitations/implications Further research into the facilitation of recovery as defined by persons with concurrent disorders is needed, particularly regarding the facilitation of community participation.Practical implications This study supports an increased focus on societal and community factors in promoting recovery for persons with co-occurring conditions, as well as service designs that allow for an integration of social services and health care, and for collaboration among services.Social implications The results suggest that the community can aid recovery by accepting persons with co-occurring conditions as fellow citizens and welcoming their contributions.Originality/value The paper provides an enhanced understanding of how persons with co-occurring conditions may experience recovery. [ABSTRACT FROM AUTHOR]

Purpose – The perspectives of frontline clinical staff working with individuals in later life within an inpatient mental health setting, of their role in recovery, have not yet been explored. The purpose of this paper is to understand what recovery means within an inpatient mental health setting for older adults. The authors address clear implications for clinical practice. Design/methodology/approach – Semi-structured interviews were conducted with 11 multidisciplinary participants across two specialist older adult recovery units at an independent hospital in the UK. Thematic analysis was applied to the transcripts. Findings – Three main themes were identified: participants identified their normative task as the promotion of “moving on” (clinical recovery) and their existential task as personal recovery. The context in which recovery happens was highlighted as the third theme. These represented competing workplace goals of clinical and personal recovery. This highlights the need to give permission to personal recovery as the process that enables mental health recovery in older adults. Originality/value – Staff working in a inpatient mental health service for older adults discussed the meaning of recovery and their role in enabling recovery. This has implications for sustainable clinical practice in this setting. Recovery-orientated practice in this setting is required but the detail is not yet understood. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to present a qualitative analysis of the facilitators of recovery in in-patient psychiatric rehabilitation from the service users' perspective. Design/methodology/approach -- Interviews with 31 in-patients were coded and analysed thematically at an interpretive level using an inductive approach. Findings -- The dominant themes identified were hope, agency, relationships and opportunity. Totally, 20 subthemes were identified. Agency was more important to men than women and agency, hope and relationships were all more important to detained patients. Research limitations/implications -- Interview data were collected in writing rather than taped. The results may not be transferrable to patient populations with significantly different demographic or service factors. Practical implications -- Services need to target interventions at the areas identified by service users as important in their recovery. The findings suggest both environmental and relational aspects of care that may optimise recovery. Services also need to be able to measure the quality of the care they provide. A brief, culturally valid and psychometrically assessed instrument for measuring the recovery orientation of services is required. Originality/value -- As far as the authors are aware no qualitative work to date has examined the recovery experiences of psychiatric rehabilitation in-patient service users in order to understand what services require to do to enable recovery from their perspective. The conceptual framework identified in this paper can be used to develop a service user self-report measure of the recovery orientation of services. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to measure service user and staff views of the recovery orientation of three mental health rehabilitation units; two "open" and one "locked". It identified elements of recovery that were important to service users. It measured the units' performance on domains of recovery, attending to differences between staff members' and service users' perceptions and between the locked and open units. Design/methodology/approach -- A cross-sectional design was used. Staff and service users completed the "Developing Recovery Enhancing Environment Measure (DREEM)". Findings -- Findings revealed some differences between staff and service user views. Service users in the locked unit reported the organisational climate to be more recovery oriented on some domains than those in the open units. Service users' responses highlighted potential areas for service improvement. Research limitations/implications -- The sample was small but reflected the applied setting. Some service users were not invited to participate because of significant communication or cognitive difficulties and it is recognised that they may have had alternative views that remain unrepresented. Practical implications -- The DREEM provided valuable information about current practice and potential for service development. Both locked and open units can provide recovery-oriented environments. Services should be aware of discrepant views between staff and service users. Originality/value -- To the knowledge, this is the first study to use the DREEM to evaluate the recovery orientation of a locked recovery unit and to compare locked and unlocked units. [ABSTRACT FROM AUTHOR]

Purpose -- Recovery is a key organising principle underlying mental health services, but remains under-researched in primary care. The purpose of this paper is to explore what recovery from psychosis means from multiple perspectives, the role of primary care in fostering recovery, and interventions that might enhance its promotion in primary care. Design/methodology/approach -- A total of 20 patients who had experienced psychosis and 24 General Practitioners (GPs) with varying expressed interest in mental health participated in semi-structured interviews, and were invited to two subsequent mixed focus groups. Data were analysed using Framework Analysis. Findings -- Recovery was conceptualised by GPs without a specialist clinical interest in mental health as improvements in symptomatic outcomes, by GPs with a special interest as improvements in social or functional outcomes, and by patients as a process involving a "whole person" approach. Both GPs and patients highlighted benefits of primary care including continuity, accessibility, and the role primary care professionals can play in supporting patients' families, and helping patients expand social support networks. Despite feeling "fobbed off' at times, patients desired a shift in responsibility for psychosis from secondary to primary care. Practical implications -- Reflective peer supervision meetings for GPs and patient-led training might improve primary care's ability to provide a more recovery-focused environment. Originality/value -- This study provided original and valuable findings regarding how GPs viewed their own role in promoting recovery from psychosis. This study also provided original findings regarding how patients viewed the role of primary care in promoting recovery from psychosis. [ABSTRACT FROM AUTHOR]

Purpose -- The concept of recovery is well accepted internationally as a guiding vision for mental health services. The purpose of this paper is to highlight the challenges faced by in-home psychiatric support workers in implementing this vision in their work with clients with severe psychiatric disability. Design/methodology/approach -- The findings reported here are based on interviews with 27 support workers and ten managers of organisations providing support services. These were collected as part of evaluations of two supported housing programmes carried out between 2010 and 2011. Findings -- Challenges faced by support workers coalesced around two areas: first, balancing the need to provide care with the need to promote autonomy and second, developing an effective working relationship while working mainly within a clients' home. Practical implications -- These challenges for support workers highlight tensions within the recovery vision that are not easily resolved. To ensure high quality, recovery-oriented care services are provided, support workers need access to training courses that focus on challenging areas of this work and should be provided with regular professional supervision. Originality/value -- Existing literature on support workers has generally focused on the nature of the role and support worker interactions with other health workers. In this paper, the authors highlight difficulties faced by support workers in implementing the vision of recovery in their work. The paper provides important information for policy makers and managers who are designing service delivery systems that aim to promote recovery. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to describe the working of one of the first Recovery Colleges (RCs) and explore the defining characteristics. Design/methodology/approach – This study explores the ways in which an educational approach contributes to the process of recovery as observed in the Nottingham Recovery College (NRC). A mixed-method research design was adopted, combining interviews, observation and visual methods as well as analysis of quantitative data. The process contributed to the continuing development of “fidelity criteria”, or defining principles and key features, of the college. Findings – The NRC demonstrates the possibilities of offering an alternative approach within mental health services; one which is educationally rather than therapeutically informed. The design and operation of the college is informed by educational principles in the creation and execution of the curriculum. This is critically developed through processes of co-production and co-facilitation by those with professional and lived experience, supported by policy development, rigorous documentation and the creation of a supportive, but challenging culture and environment. Students are offered very real opportunities for involvement, progression and leadership within and beyond the college. Research limitations/implications – Whilst building on work on education in self-management, the RCs move beyond the transmission of information to create new relationships between mental health professionals and students (rather than “service users”) – and through this, the relationship between students and their “condition” appears to be transformed. Early evidence suggests the NRC also provides a model of interaction that is distinct in educational terms. Practical implications – There is significant interest nationally and internationally in the development and operation of RCs in England. RCs present a possibility of transformation in the lives of people with long-term mental health conditions, with outcomes such as greater confidence and hope for the future in addition to widening social networks and providing opportunities for progression. They are also important in the implementation of Recovery through organisational change and the remodelling of commissioning arrangements. Originality/value – This is the first paper to be presented for publication specifically on the NRC. There is currently little published research on RCs. These are unique (and varying) organisations which are creating considerable interest nationally and internationally. An exploration of their defining characteristics will feed into subsequent larger-scale research. [ABSTRACT FROM AUTHOR]

Purpose - Community day leaves are one aspect of the rehabilitation offered at a secure forensic mental health facility in Australia. This study aimed to investigate staff and patients' understanding of community day leaves and how recovery principles were embedded. Design/methodology/approach - Ten escorted community day leaves were observed and 21 semi-structured interviews with staff and patients were conducted. Using an ethnographic research approach, thematic analysis guided by a comparative method was used to reveal the similarities and differences between staff and patient perspectives of escorted leaves and how principles of recovery were practiced. Findings - Although staff and patients expressed their understanding differently, they had a similar overall understanding of the function of community day leaves, that being, to successfully reintegrate and practice daily living skills. Recovery principles practiced included developing a sense of connectedness to others, power over their own lives, the roles they value, and therefore, hope for themselves. However, how these were facilitated by staff and practiced by patients, varied. Practical implications - Community day leaves can have the potential therapeutic benefits of enhancing or hindering recovery due to the staff member's facilitation. This study revealed how important it is for staff members to utilise recovery principles to enhance rehabilitation goals and therapeutic benefits. Originality/value - This study has identified that community day leaves need to be shaped by recovery principles, leading towards successful community integration and goals and objectives need to be agreed upon by both staff and patients. [ABSTRACT FROM AUTHOR]

Purpose – In April 2010, Nottinghamshire Healthcare NHS trust won Regional Innovation Funding to recruit, train and employ six peer support workers in community mental health teams. At the time, practical examples of the employment of peer support workers were lacking in England. An earlier paper focuses on the lessons learned in this first year of peer support. The aim of this paper is to examine the nature and dynamics of peer support: what the peers did with clients and what difference this made. Design/methodology/approach – The project was evaluated using a simple evaluation model reflecting service structure, processes and outcomes, collected through qualitative methods: documentary analysis, semi-structured interviews and a focus group. Findings – The six peers worked with 83 clients over the six month period. They offered emotional, practical, social support, support specific to care and support specific to recovery. They felt that the shared knowledge that they too had experienced mental health challenges was critical in engaging with clients in a trusting relationship and in informing their work. Originality/value – In the absence of English service models for peer support workers, this paper provides some guidance for new peer support teams, and some evidence to support the helpful nature of peer support work. [ABSTRACT FROM AUTHOR]