Search

This paper builds on a previous article describing an innovative approach to enhance the service user and practitioner's experience of novel collaborative approach to service improvement. It aims to explore the impact of this through the voices of service users as collaborators and co-authors. The Recovery and Collaborative Care Planning Café (RCCPC) designed with World Café principles, created a safe space to foster inquiry and learning about recovery between service users, carers, and practitioners in an NHS Trust. An important part of the method was in changing conversations towards recovery and living well with conditions applying CHIME concepts (Connectedness, Hope, Identity, Meaning, and Empowerment). Story is a qualitative method known as a well-established effective means of engaging others in sharing experiences and perspectives. Through the stories of service users' experiences participating in the RCCP Cafe, it was clear that they felt that CHIME concepts had a positive impact on the way that their conversations evolved. Accounts of how these conversations had resulted in personal growth and increased connectedness emerged. [ABSTRACT FROM AUTHOR]

Mental health 'recovery narratives' are increasingly used within teaching, learning and practice environments. The mainstreaming of their use has been critiqued by scholars and activists as a co-option of lived experience for organisational purposes. But how people report their experiences of telling their stories has not been investigated at scale. We present accounts from 71 people with lived experience of multiple inequalities of telling their stories in formal and informal settings. A reflexive thematic analysis was conducted within a critical constructivist approach. Our overarching finding was that questions of power were central to all accounts. Four themes were identified: (1) Challenging the status quo; (2) Risky consequences; (3) Producing 'acceptable' stories; (4) Untellable stories. We discuss how the concept of narrative power foregrounds inequalities in settings within which recovery stories are invited and co-constructed, and conclude that power imbalances complicate the seemingly benign act of telling stories of lived experience. [ABSTRACT FROM AUTHOR]

This paper addresses the complex issue of the embodiment of grief. It explores how a theoretical shift to the body has influenced scholarly literature about grief and bereavement. Despite this shift, we argue that bodily interpretations and experiences are undertheorised in western psychological literature on bereavement. Specifically, we argue that linear stage models of grief have encouraged the view that grief needs 'working through' in the mind, and not necessarily the body. We draw on empirical data from interviews with bereaved people undertaken in England to illustrate aspects of the embodied experience of grief that differ from how psychological grief theories conceive of the bereaved person's body. Findings highlight the role of the bereaved person's body in managing grief and how the absence and continuing presence of the deceased person is managed through embodied practices. We conclude that understanding grief as an embodied experience can enable the development of grief theories that better capture the complex negotiation between the psychological processes of grief and the materiality of bodies. [ABSTRACT FROM AUTHOR]

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

In England, implementation and adoption of recovery-orientated (RO) practice has been slow and uneven. This qualitative study explored the barriers and enablers to the implementation and adoption of RO practice in community mental health provider organizations. Thirteen registered managers took part in semi-structured interviews. Four themes were identified: RO practice is not an entirely alien concept; RO practice is a labor intensive and skilled activity; Families need to be on onboard with RO support; and Limited community capacity for RO support. The most salient barriers and/or enablers were: staff training, public misconceptions of mental illness, and joint-working with families. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn about the Recovery Star and how its use can empower patients to develop their skills and self-reliance • To understand the benefits and constraints associated with using the Recovery Star in mental health inpatient services • To consider methods you could implement in your area of practice to support frequent and appropriate use of the Recovery Star The Recovery Star is a collaborative tool used by staff to support the recovery of adults who are using mental health services, including inpatient rehabilitation services. However, staff experiences of completing this tool with patients have seldom been reported. Therefore, a service evaluation was undertaken to explore staff perspectives about the useful elements and barriers associated with using the Recovery Star, to determine whether staff believe it is an appropriate tool to use in inpatient rehabilitation services, and to understand the reasons for the tool's underuse. Semi-structured interviews were conducted with nine staff members who worked across four wards in an inpatient rehabilitation service in Leicester, England. Four main themes were identified through a thematic analysis of the interview transcripts: it is a helpful tool; it is patient-dependent; it is underused due to constraints such as lack of time; and wider issues affecting its use. Subthemes for each of these themes were also identified. Staff reported that the Recovery Star is an appropriate tool to use in mental health rehabilitation services, although they recognised some barriers to its use and amendments required to ensure the tool is used more often. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Religion plays important role in recovery from mental illness.Religion can have both positive and negative effects on recovery. What does this paper add to existing knowledge?: It is conceivable for Black African service users (BASUs) to engage with the mainstream mental health services at the onset of their symptoms.BASUs see mental illness and recovery through the lens of religion. They mostly use Pentecostalism and traditional African healing systems to aid their recovery.The mainstream mental health system and the traditional African healing system exist in harmony for BASUs who are open to simultaneously access both services. What are the implications for practice?: There is a need to recognize that most Black Africans have unique ways of practising their Christianity. Thus, broad changes are needed in the services to support religious coping tailored to the individual persons in their recovery journey.There is a need for service providers and healthcare professionals to integrate Pentecostalism and traditional African healing systems into the recovery processes. It should equally be recognized that such changes could trigger confusion, dilemmas and paradoxes.Service providers and healthcare professionals must build partnership and collaborative working with cultural practitioners and the clergy from the Black African communities to facilitate recovery and address any misunderstandings. Introduction: Religion is an important impetus for recovery. However, there has been little work examining the role of religion in recovery for Black African service users (BASUs) in England. Aim: The aim of this study was to explore how religion influences recovery from mental illness for BASUs in England. Method: Twelve Black African service users were purposively selected and interviewed using face‐to‐face semi‐structured interviews. Data were analysed using interpretative phenomenological analysis (IPA). Results: The study generates fascinating insights that BASUs views about mental illness and recovery are influenced by Pentecostalism and traditional African healing systems. Discussion: The participants' perceptions of their mental illness experiences and recovery which are characterized by the pragmatism of Pentecostalism and cultural beliefs are consistent with what is reported in the literature. Implications for practice: The findings of the study show that broad changes are needed to accommodate the religious coping of BASUs in their recovery journey. [ABSTRACT FROM AUTHOR]

Social capital, and more particularly the social networks that define its existence, is said to benefit health and well‐being. In individuals recovering from alcohol and drug addiction, social capital accruing from social networks support treatment, recovery and maintenance. Therefore, the concept of social capital is important for public health practitioners working in recovery interventions. This qualitative study seeks to explore what practitioners perceive as the importance of social capital and how they apply the concept in interventions to support individuals recovering from drug and alcohol addiction. Eight public health practitioners involved in drug and substance abuse interventions in West Yorkshire, England, were interviewed. The results of the interview were then deductively coded using two priori themes of perceived impact of social capital on health outcomes and application of social capital theory in recovery interventions. The findings reveal that practitioners understand the impact of social capital as the effects of social networks on recovery and apply the concept in their interventions. However, the nature of interventions created based on similarities in condition (alcohol and substance addiction) and intended outcome (recovery) create bonding social capital with mixed outcomes. This paper argues that the wider benefits to service users are unintentionally inhibited by the overwhelming downsides of bonding social capital. For instance, closed support groups comprised of individuals with high similarities further exclude the already socioeconomically deprived service users from integrating and accessing resources outside their groups. [ABSTRACT FROM AUTHOR]

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

Background: Social capital has becomean influential concept in debating and understanding the modernworld. Within the drug and alcohol sector, the concept of 'recovery capital'has gained tractionwith researchers suggesting that people who have access to such capital are better placed to overcome their substance use-related problems than those who do not (Cloud and Granfield, 2008), leading to requests for interventions that focus on building social capital networks (Neale & Stevenson, 2015). While accepting that the concept of social capital has enormous potential for addressing the problems associated with drug use, this paper also considers its 'dark side'. Methods: Data were drawn from semi-structured interviews with 180 participants including 135 people who use drugs and 45 people who formerly used drugs. Results: High levels of trust, acquired through the establishment of dense social networks, are required to initiate recovery. However, these 'strong bonds'may also lead to the emergence of what is perceived by others as an exclusive social network that limits membership to those who qualify and abide by the 'rules'of the recovery community, particularly around continuous abstinence. Conclusions: Depending on the nature of the networks and the types of links participants have into them being socially connected can both inhibit and encourage recovery. Therefore, the successful application of social capital within the drugs and alcohol field requires a consideration of not only the presence or absence of social connections but their nature, the value they produce, and the social contexts within which they are developed. [ABSTRACT FROM AUTHOR]

There is evidence that poor sleep mitigates recovery from substance dependence and increases risk of relapse. However, to date research literature is located within biomedical, clinical and psychological paradigms. To complement the extant work, this article offers a sociological exploration of sleep in the context of recovery from dependence on alcohol and/or other drugs. Drawing on qualitative data generated through interviews with 28 men and women living in residential rehabilitation settings in England, we provide a detailed exploration of sleep practices focusing on how these are enacted throughout the night. We offer the concept of 'sleepfulness' to suggest that sleep should not be understood simply as being other than awake; rather it involves a myriad of associations between diverse actants - human and non-human - that come to 'fill up', enable and assemble sleep. Together these empirical insights and conceptualisations disturb the ontology of sleep and point to the fulsome dimensions of the category. [ABSTRACT FROM AUTHOR]

Previous research has highlighted that acute care provision can lead to a loss of confidence, control, and independent functioning in older adult patients. In addition, it is recognized that interactions between patients and health care staff are central to the prevention of functional decline in patients. In this study, we aimed to affect the staff–patient relationship by implementing a coaching intervention in an older adult acute care setting. Here, we report on staff experiences of this coaching approach. Data were collected from 16 members of staff via semi-structured interviews, which were analyzed using thematic analysis. Four themes were identified: Putting a Label on It, Stepping Back and Listening, Identifying the Opportunities, and Working as Team. Our findings show that a coaching approach can be successful in getting staff to reconsider their interactions with patients and to focus on strategies that foster the independence and autonomy of older adult patients. [ABSTRACT FROM AUTHOR]

While there is substantial common ground between the ideas of self-directed support and recovery, there are also significant differences in how these ideas have been implemented in policy and practice. This paper develops an 'ideal type' model of how personal budgets may need to be set up for people with mental health difficulties if they are to be effective as a mechanism that can enable recovery. Aspects of this 'ideal type' model are then examined in relation to the reported experiences of people accessing personal budgets from a national study of the implementation of personal budgets in mental health in England. In-depth qualitative interviews were undertaken across three local authority areas with fifty-three people with serious mental health difficulties who had accessed personal budgets in 2012-13. Our findings suggest that personal budgets can support recovery thinking and processes, and can be used to mobilise relevant resources to make this possible. Key to achieving this can be co-productive and/or peer-supported processes of assessment and planning. In addition, resource allocation may need to be flexible to take account of fluctuating levels of mental distress, and budgets should be linked to recovery goals rather than assuming long-term care needs. [ABSTRACT FROM AUTHOR]

Background: CHIME (connectedness, hope and optimism about the future, identity, meaning in life and empowerment) is a framework for conceptualising personal recovery from mental illness. To date, there has been limited research on its cross-cultural applicability. Aims: To apply CHIME to two culturally diverse groups’ conceptualisation of recovery from depression. Method: Qualitative interviews with 30 Anglo-Australians and 28 Indian-Australians living with depression in Melbourne, Australia. Data were thematically analysed. Results: Both groups valued connectedness but experienced stigma and struggled to broker family support. Identity, hope and optimism for the future were associated with positive thinking, being ‘cured’ and discontinuing treatment. Spirituality gave Indian participants meaning in life; Anglos derived meaning from the illness experience itself. Feeling empowered, for both groups, was related to improved socio-economic status and being ‘settled’ (e.g. having gainful employment, a home and family). Conclusions: CHIME was applicable in both groups, but culture mediated how cross-cutting issues (e.g. stigma) and sub-components of CHIME were operationalised. Recovery was also influenced by participant’s socio-economic context. Research, policy and practice implications are discussed. [ABSTRACT FROM AUTHOR]

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

Recovery has been associated with a transition in social networks and peer influences in terms of moving away from using peers and engaging in social networks, including those in recovery. This article uses a quantitative data approach to compare a group of individuals who described themselves as in recovery from alcohol and other drug (AOD) problems with a group from the same city involved in alcohol and drug treatment. The measures used included social network involvement and an assessment of recovery capital. Those in recovery had more people in recovery in their social networks, fewer people in active use in their networks, and were much more likely to be involved in formal recovery support groups. They also reported higher quality of life, lower depression and anxiety, and higher levels of personal and social capital. The groups hardly overlapped at all in their functioning, and one of the major challenges of a recovery model will be reconciling the positive recovery networks and cultures of recovery with the narrower and less recovery focused world of many users of structured treatment services. Understanding the mechanisms for the transition from using to recovery communities is essential to understanding a core component of the recovery journey. [ABSTRACT FROM PUBLISHER]

This article draws on data from a Stroke Association–funded longitudinal study in South East England (2003–2006) that explored the experiences and recovery of 43 stroke survivors under 60 years. Participants were invited to take part in four interviews over an 18-month period and to complete a diary for 1 week each month during this period. Here, we chart their shifting attitudes towards the process of their recovery. We bring a focus to how this transformed their views on the possible futures before them. We underline how hope was experienced as a deeply paradoxical and risk-laden notion. With energies concentrated upon the effort to live positively in the here and now, the very idea of hope for the future was met as an unwelcome distraction and in some cases even as a source of distress. [ABSTRACT FROM PUBLISHER]

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

Aim To explore how our understanding of care practice is shaped by the extent of our engagement with staff and patient experience. Background In spite of the fact that service users desire good spiritual care and that government guidelines recognize its importance, frontline staff in psychiatric settings often find current spiritual assessment tools hard to use and the concept of spirituality difficult to comprehend. Method A database search was conducted, the grey literature analysed, spirituality assessment tools were explored, and an approach based on user experience was considered. Key issues Each of these four perspectives resulted in different perceptions of care. Conclusions By engaging patient and staff experience, we begin to see spiritual care very differently. There may be rich opportunities for research into the lived experience of the support systems that service users create for each other on wards when they experience staff as inaccessible. Implications for nursing management Deeper engagement with patients and staff and their concerns is likely to result in breakthroughs in both the understanding and the practice of spiritual care as well as potentially other areas of nursing care. [ABSTRACT FROM AUTHOR]

Care planning should be a collaboration between the service user, caregivers and the relevant professionals. It is based on recovery principles, where clients identify their goals and how to work to reach them, rather than concentrating on illness, symptoms and problems. Mental health nursing students were taught the theory but observed that, in their clinical placements, this approach was often not followed in practice. These issues were explored in two teaching sessions with six students. Subsequent focus groups were recorded, transcribed and analysed, yielding four main themes: care planning custom and practice, collaboration, organisational culture and student assumptions about their mentors. Participants detailed how care planning might not be person-centred in practice. It was suggested that this might be due to clinical customs, strains and restrictions, lack of collaboration between service users and the multidisciplinary team, and inept organisational culture. The main challenge for services has been how to manage risk as well as the person-centred approach, and the ‘competing dilemmas associated with care-versus-control issues’. [ABSTRACT FROM AUTHOR]

Background: There is little consensus at policy or treatment level as to what defines ‘recovery’ in the alcohol addiction field. Aim: From interviewing a cohort of eight severely alcohol‐dependent people who fulfilled all categories of DSM‐IV and ICD 10 diagnostic criteria and had achieved long‐term recovery (LTR) of between 8 and 48 years, and who are long‐term AA members, a definition of recovery that is inclusive, and achievable, was sought from their lived experiences. Methodology: Interpretative Phenomenological Analysis was used. Findings: This research uncovers the processes involved in long‐term recovery, and identifies them as: sober; maintaining sobriety; and recovery. It suggests a move away from the acute model of cure by brief, time‐limited therapy, towards a model of sustained, on‐going and life‐long recovery management, combined with pro‐social aid resources. Individuals need to observe, and hear, the success narratives of others, and the therapeutic conditions of empathy, unconditional positive regard and congruence need to be strongly experienced by the individual. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this project was to explore the added value of participation in an Arts on Prescription (AoP) programme to aid the process of recovery in people with common but chronic mental health problems that have already undergone a psychological ‘talking’-based therapy. Methods. The study utilized qualitative in-depth interviews with 15 clients with persistent anxiety and depression who had attended an ‘AoP’ service and had previously received psychological therapy. Results and discussion. Attending AoP aided the process of recovery, which was perceived by participants as ‘returning to normality’ through enjoying life again, returning to previous activities, setting goals and stopping dwelling on the past. Most were positive about the benefits they had previously gained from talking therapies. However, these alone were not perceived as having been sufficient to achieve recovery. The AoP offered some specific opportunities in this regard, mediated by the therapeutic and effect of absorption in an activity, the specific creative potential of art, and the social aspects of attending the programme. Conclusions. For some people who experience persistent or relapsing common mental health problems, participation in an arts-based programme provides ‘added value’ in aiding recovery in ways not facilitated by talking therapies alone. [ABSTRACT FROM PUBLISHER]