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The aim was to explore the utility of Keyes’ concept of mental health in a substance addiction context. Mental health is considered the presence of emotional wellbeing in conjunction with high levels of social and psychological functioning. Using Keyes' measure, the frequency of languishing and flourishing is compared between clients who became abstinent and those continuing to use substances following treatment. It was hypothesised that there would be a significant interaction between substance use and levels of mental health over time. Participants were 794 individuals (79.5% male) attending residential substance abuse treatment provided by The Australian Salvation Army. The current sample was drawn from a larger longitudinal study evaluating routine client outcomes. At entry to treatment there were higher rates of languishing compared to population estimates, yet greater rates of flourishing at all time points compared to community normative data. There was a significant interaction between continuous mental health and substance use status. Mental health was rated significantly higher by individuals who were abstinent than those who had used substances at 3-month post-discharge follow-up. The comorbidity of mental illness and substance misuse has previously been investigated, but this is the first study to investigate the prevalence of mental health. While participants who remained abstinent achieved the highest levels of flourishing, at follow-up there were lower rates of languishing than found in a general community sample. Additionally, results suggested that improved mental health was a consequence of reduced severity of alcohol and other drug abuse, and followed reductions in cravings. [ABSTRACT FROM AUTHOR]

Background: Project Access UK was designed to provide real-world observations on the status of medication-assisted treatment (MAT) of opioid dependence. Methods: 544 respondents from three groups (physicians, patients in MAT and out-of-treatment users) were interviewed or completed questionnaires. Results: Patient reasons for seeking treatment included ending their dependence and improving their health and well-being. Patients and users reported a mean of 4.0 versus 2.7 prior MAT episodes, but patient awareness of the main treatment options varied from 94% for methadone to 46% for buprenorphine–naloxone. Among patients, 49% requested a specific medication (mostly methadone) and 78% of requests were granted. Forty percent of patients were not currently receiving psychosocial or key- working support. Daily supervised dosing was most commonly cited as a condition of staying in treatment with the biggest impact on daily life (36%). Among patients, 56% continued to use illicit drugs on top of their MAT and few (7%) were in employment. The majority of patients (56%) and users (51%) had been in prison (an average of 6.8 times). Conclusion: Patients are motivated to recover. However, the full range of evidence-based interventions are not fully utilised and many patients cycle repeatedly through periods of treatment, relapse and imprisonment. [ABSTRACT FROM PUBLISHER]

Background We examined possible associations between different red blood cell (RBC) transfusion strategies, overall quality of life (OQoL), and recovery of activities of daily living (ADL) in operated frail elderly hip fracture patients, and the possibility that OQoL was related to ADL recovery. Methods A prospective, assessor-blinded, randomized controlled trial was carried out among 157 elderly residents (≥65 years) from nursing homes and sheltered housing facilities with Mini-Mental State Examination scores ≥5 points. Patients were assigned to either a restrictive RBC transfusion strategy [hemoglobin (Hb) < 9.7 g/dL, 6 mmol/L] or a liberal strategy (Hb < 11.3 g/dL, 7 mmol/L) during the first 30 days after surgery. An interview-based questionnaire, the depression list (DL) assessing OQoL, and the modified Barthel Index (MBI) assessing ADL performance, were conducted on day 30 and 1 year after hip fracture surgery. Sum-scores of DL, MBI, and their changes from day 30 until 1 year (expressing recovery) were compared between RBC transfusion groups. Possible associations between changes of DL and MBI sum-scores were tested for across total patient population. Results There was no association between OQoL and RBC transfusion strategies on day 30 or at 1 year. The DL sum-score changes were similar for both groups, (ie, 1.06 points) [95% confidence interval (CI) -0.62, 2.76)] P = .21. The MBI sum-scores increased at 1 year following the liberal transfusion strategy (ie, by 6.86 points) (95% CI 0.41, 13.3) P = .03. Recoveries of OQoL and ADL were associated: β = -0.06 (95% CI -0.11, -0.01) P = .02. Conclusions According to our Hb threshold criteria, OQoL and RBC transfusion strategies for frail elderly hip fracture patients are not associated. However, for survivors with less severe dementia, ADL recovery after 1 year is greater following a liberal transfusion strategy than a restrictive strategy. OQoL progress and ADL recovery were associated. [ABSTRACT FROM AUTHOR]

Objectives. Evidence suggests social relationships may be important facilitators for recovery from functional impairment, but the extant literature is limited in its measurement of social relationships including an over emphasis on filial social support and a paucity of nationally representative data. Methods. Using data from Waves 4-9 (1998-2008) of the Health and Retirement Study (HRS), this research examines the association between social relationships and recovery from severe mobility limitation (i.e., difficulty walking one block or across the room) among older Americans. Using a more nuanced measure of recovery that includes complete and partial recovery, a series of discrete-time event history models with multiple competing recovery outcomes were estimated using multinomial logistic regression. Results. Providing instrumental support to peers increased the odds of complete and partial recovery from severe mobility limitation, net of numerous social, and health factors. Having relatives living nearby decreased the odds of complete recovery, while being engaged in one’s neighborhood increased the odds of partial recovery. The influence of partner status on partial and complete recovery varied by gender, whereby partnered men were more likely to experience recovery relative to partnered women. The effect of neighborhood engagement on partial recovery also varied by gender. Disengaged women were the least likely to experience partial recovery compared with any other group. Discussion. The rehabilitative potential of social relationships has important policy implications. Interventions aimed at encouraging older adults with mobility limitation to be engaged in their neighborhoods and/or provide instrumental support to peers may improve functional health outcomes. [ABSTRACT FROM AUTHOR]

The physical impacts of a disaster are usually the most obvious impacts, and they are easily measured. However, there is not sufficient in-depth understanding of social issues arising after disasters. This qualitative study explored three main concepts regarding social issues after an earthquake in an Iranian context: social vulnerability, social uncertainty and confusion, and ignorance of local social capital. Negligence of social issues after disasters leads to delays in returning back to normal life. Policymakers are encouraged to take a comprehensive plan into account which considers these issues and facilitates the process of returning to normal life after earthquakes. [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]

Aim To explore the challenges and caring activities of spouses of intensive care unit survivors during the first year of patient recovery. Background Every year, millions of people globally are discharged from an intensive care unit after critical illness to continue treatment, care and rehabilitation in general hospital wards, rehabilitation facilities and at home. Consequently, millions of spouses become informal caregivers. Little is known, however, about the concrete challenges spouses face in post-intensive care unit everyday life. Design Explorative, qualitative grounded theory study. Methods Participants were spouses of intensive care unit survivors. The study was undertaken in Denmark in 2009-2010. Data consisted of 35 semi-structured dyad interviews at 3 and 12 months post-intensive care unit discharge, two group interviews with patients and two with spouses. Findings 'Shifting their role from spouse to caregiver and back' was identified as the core category of the study. The role shifts progressed in a dynamic process involving four elements: (1) committing to caregiving; (2) acquiring caregiving skills; (3) negotiating level of caregiving and (4) gradually leaving the caregiver role. Post- ICU caregiving comprised five patient dimensions: observing, assisting, coaching, advocating and managing activities. Conclusions Spouses play a vital and multifaceted role in post-intensive care unit recovery. The findings can inform healthcare professionals in their efforts to prepare intensive care unit patients' families for the time following intensive care unit and hospital discharge. Hospital staff, rehabilitation experts and primary care professionals must acknowledge spouses' important contribution from intensive care unit admission throughout recovery. [ABSTRACT FROM AUTHOR]

This qualitative study explored the recovery experience of six women who have survived intimate partner violence. Interviews were used as an instrument to elicit the individual stories of each of these women. Qualitative analysis revealed two types of themes: process and supports. The process themes include (a) spirituality, (b) facing death, (c) future relationships and (d) hope and encouragement. The support themes include (a) professional help (effective and ineffective) and (b) informal supports (family/friends/other survivors). Implications for helping professionals include the call for increased understanding of the recovery process and the need to abandon preset agendas when working with survivors. [ABSTRACT FROM PUBLISHER]

Understanding how a self-help program with a positive psychology focus and professional leaders influences change is important to guide support programs. We used a qualitative, explanatory, organizational case study including method and source triangulation to describe and explain leadership mechanisms supporting recovery. Horizontal leadership processes included overcoming stigma and becoming a helper, and vertical processes included internalized willingness to lead, vision formation, pride and professionalization, continuity and accessibility, and flexible leadership. Resource-focused and professionally led self-help is likely compatible and complementary to 12-step programs, as it integrates peer support and collaborative leadership with the best of professional programs, including sober leadership. [ABSTRACT FROM AUTHOR]

This article examines how the personal experiences of mental distress of people involved in the British service user/survivor movement were shaped or transformed by this involvement, and the impact of involvement on their recovery journeys. The analysis was based on 12 in-depth interviews with service users/survivors who are, or were once, involved with the service user/survivor movement. Three large themes were identified regarding the ways in which social movement involvement affected the personal experience of mental distress: (a) making sense and reframing mental distress, (b) the social experience of involvement and (c) identity and identity reconstruction. We discuss how some features of the service user/survivor movement, such as self-help, user involvement, the centrality of experience to collective action, and the range of political positions adopted by activists can affect experience and recovery in different forms. As an exploratory study that looks into a complex topic, our findings illuminate the ways of surviving, recovering and experiencing mental distress in the context of a significant social movement. [ABSTRACT FROM AUTHOR]

This exploratory research brief presents a single case study of the resiliency of “Mary B.” She grew up in an Old Order Amish family where isolation, secrecy, and patriarchy masked repeated sexual assaults by her older brothers that began at age 7. By the age of 20, Mary alleged she had been raped on more than 200 separate occasions by members of her Amish family. After years of pleading with her mother and church officials to intervene, she sought therapy outside the Amish community. This led to three of her brothers being incarcerated. Her family disowned her and she was banned from the Amish community, leaving with an 8th grade education and little more than the clothes she was wearing. In less than 2 years, Mary had moved to a new town, completed her GED, obtained a car and driving license, maintained a small home, and worked as a certified nursing assistant. She consented to tape recorded interviews and completed several quantitative diagnostic measures. Scores on the diagnostic measures placed her within the normal range on self-esteem, competency, depression, stress, social support, and life skills. Analysis of interviews revealed Mary rebounded from her past by reframing her experiences. Themes identified within the interviews supported 6 of the 7 types of resiliencies (insight, independence, initiative, relationships, humor, and morality) outlined in the therapeutic Challenge Model. [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 study examined whether increases in purpose in life (PIL) over 2.5 years were associated withDiagnostic and Statistical Manual of Mental Disorders (4th ed.)remission among 364 individuals with alcohol dependence. Remission from alcohol dependence at final follow-up was associated with significantly greater increases in PIL over time, compared to those without remission or with partial remission. The strong relationship between increases in PIL and remitted status at final follow-up indicates the importance of existential issues to recovery, and the value of incorporating these concerns into treatment and further investigating their role in initiating and supporting recovery. [ABSTRACT FROM PUBLISHER]

Objectives This study sought to explore the links between recovery stages, symptoms, function, and narrative development among individuals with a recent onset of psychosis. Design A qualitative longitudinal study was conducted including quantitative data at baseline. Methods Forty-seven participants were administered the Indiana Psychiatric Illness Interview three times over 9 months and content analysis was performed. Participants also completed the Social Functioning Scale, the Brief Psychiatric Rating Scale - Expanded, the California Verbal Learning Test, and the Trailing Making Test at baseline. Descriptive discriminant analysis was performed. Results Results suggested that participants were mostly in the first two stages of recovery (moratorium, awareness) and that being in the awareness, rather than moratorium, stage was associated, to a different extent, with richer narrative development, better levels of psychosocial function, less negative and positive symptoms, and more years of education. Furthermore, recovery appeared to be a stable process over the assessment period. Conclusions Recovery is a complex concept including objective and subjective aspects. In the recovery path of persons recently diagnosed with psychosis, social engagement, narrative development, and occupational functioning seem to be particularly important aspects. This study is a first step, and future research is needed with larger and more diverse participant pools, and assessments conducted over longer periods of time. Practitioner points As greater level of social engagement was the most robust predictor of membership in the awareness versus moratorium stage, treatment of early psychosis should include interventions targeting social relations and social skills., As greater narrative development was the second most robust predictor, enhancing it via psychotherapy could be a pertinent clinical goal. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the perceived influence of family on recovery from severe mental illness. 54 semi-structured interviews were conducted with a diverse sample of people with severe mental illness living in Montreal. Results indicated that family both facilitated and impeded recovery processes. Specifically, family facilitated recovery through providing (a) moral support, (b) practical support and (c) motivation to recover. However family impeded recovery through (a) acting as a stressor, (b) displaying stigma and lack of understanding, and (c) forcing hospitalization. The study indicates the importance of family psychoeducation in promoting recovery. [ABSTRACT FROM AUTHOR]

Aim To describe experiences of recovery from bulimia nervosa among young adult women. Background Most studies into recovery from eating disorders focus on anorexia nervosa, although some include both anorexia and bulimia nervosa. Recovery has been described as beginning with renewed self-esteem. Design Qualitative interview study. Methods Fourteen women were invited to participate; five women, between 23-26 years of age, who assessed themselves as healthy for at least 2 years agreed to take part in narrative interviews. Tape-recorded interviews lasting 45-60 minutes (median 49 minutes) were conducted from February-April 2010 and transcribed verbatim. Data were analysed using qualitative content analysis. Findings The interviews revealed four themes in recovery from bulimia nervosa: feeling stuck in bulimia nervosa, getting ready to change, breaking free of bulimia nervosa and grasping a new reality, each comprising two or more subthemes. The process of recovery was not linear, but rather went back and forth between progress and relapse. The women expressed strong ambivalence about leaving the illness behind. An important part of their recovery was their ability to accept themselves. It was essential for their recovery to be supported in developing a unique explanation of the cause of their illness. Conclusion Women's ability to recover from bulimia nervosa and take control over their lives is based on their self-efficacy. Effective care should therefore strive to strengthen women's beliefs in their own abilities, to instil hope for recovery and thus to bolster their self-efficacy. [ABSTRACT FROM AUTHOR]

Aim To explore the narratives created by non-injured family members in relation to themselves and their family in the first year after head injury. Background A head injury is a potentially devastating injury. The family responds to this injury by supporting the individual and their recovery. While the perspective of individual family members has been well documented, there is growing interest in how the family as a whole makes sense of their experiences and how these experiences change over time. Design Longitudinal narrative case study using unstructured in-depth interviews. Methods Data were collected during an 18-month period (August 2009-December 2010). Nine non-injured family members from three families were recruited from an acute neurosurgical ward and individual narrative interviews were held at one, three and 12 months postinjury where participants were asked to talk about their experience of head injury. Analysis was completed on three levels: the individual; the family and between family cases with the aim of identifying a range of interwoven narrative threads. Findings Five interwoven narratives were identified: trauma, recovery, autobiographical, suffering and family. The narrative approach emphasized that the year posthead injury was a turbulent time for families, who were active agents in the process of change. Conclusion This study has shown the importance of listening to people's stories and understanding their journeys irrespective of the injured person's outcome. Change postinjury is not limited to the injured person: family members need help to understand that they too are changing as a result of their experiences. [ABSTRACT FROM AUTHOR]

This paper presents the findings from Phase II of our multiphase, community-based research project that examined in-depth insights into the meanings of leisure and active living in the recovery experiences of culturally diverse, community-dwelling adults with mental illness. A series of three face-to-face, semistructured interviews were conducted once each week for 3 weeks with each individual who was purposefully selected from a pool of Phase I study participants. This case-study subsample (n = 23; 14 women and 9 men) included seven White, six Black, six Hispanic American, and four Asian American participants, aged between 23 and 78 years. The findings suggested that actively engaged leisure would act as a mechanism (i.e., “leisure space”) for “movement from” stress and tension and “movement to” something enjoyable and meaningful (e.g., a source of fulfillment, social connections, the reaffirmation of self-worth, hope for the future, altruism). [ABSTRACT FROM AUTHOR]

Background Family members play a crucial role in supporting the recovery of loved ones with psychosis. The journey of recovery is not only traversed by the person experiencing the mental illness but also by their family. Interventions to support these families have traditionally either focused on psychoeducation or addressed problematic interactions or expressed emotion. Family programmes have far less frequently emphasized supporting family members' adjustment to the challenges posed by their relative's disorder or their recovery from associated distress. The study compared a control condition that received only a psychoeducational booklet (Information) and a condition also receiving a correspondence-based interactive recovery-oriented intervention (Connections). The Connections group was expected to show greater improvements in recovery knowledge, well-being, experiences of caregiving, hopefulness and distress. Method A randomized controlled trial was conducted to evaluate the effectiveness of two correspondence-based family interventions delivered to 81 carers of relatives with psychosis. Results Intent-to-treat analyses showed no differential outcomes between conditions, but an analysis of participants who substantially completed their allocated treatment showed that carers receiving Connections had significantly more improvements in well-being, positive experiences of caregiving and distress. Conclusions Correspondence interventions that support carer's recovery may result in more positive mental health for those who complete key elements of the programme compared with information alone. However, many carers do not complete a correspondence programme and this may limit its impact. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message A focus on recovery-oriented interventions holds relevance for carers as well as their loved ones with mental illness., To our knowledge, this is the first randomized controlled trial of a recovery-focused intervention for carers., Carers may receive positive mental health benefits from recovery-focused correspondence programmes to the extent that they can be encouraged to remain engaged with such programmes. [ABSTRACT FROM AUTHOR]

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]

People with severe mental health problems such as psychosis have access to less social capital, defined as resources within social networks, than members of the general population. However, a lack of theoretically and empirically informed models hampers the development of social interventions which seek to enhance an individual's social networks. This paper reports the findings of a qualitative study, which used ethnographic field methods in six sites in England to investigate how workers helped people recovering from psychosis to enhance their social networks. This study drew upon practice wisdom and lived experience to provide data for intervention modelling. Data were collected from 73 practitioners and 51 people who used their services in two phases. Data were selected and coded using a grounded theory approach to depict the key themes that appeared to underpin the generation of social capital within networks. Findings are presented in four over-arching themes - worker skills, attitudes and roles; connecting people processes; role of the agency; and barriers to network development. The sub-themes which were identified included worker attitudes; person-centred approach; equality of worker-individual relationship; goal setting; creating new networks and relationships; engagement through activities; practical support; existing relationships; the individual taking responsibility; identifying and overcoming barriers; and moving on. Themes were consistent with recovery models used within mental health services and will provide the basis for the development of an intervention model to enhance individuals' access to social capital within networks. [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]

This article offers an analysis of the impact of recovery-oriented treatment discourses and practices on tenant-staff relationships in the context of the Pinewood Apartments, a Texas-based permanent supported housing community. Drawing on 6 months of ethnographic research and personal experience of working as a caregiver at Pinewood, I demonstrate how tenant-staff relationships were compromised by service providers’ negative evaluations of certain tenants in the context of emotionally charged service interactions. These negative evaluations, I argue, stem from deeply held ideas about valuable citizenship that are embedded in the philosophy and practices of recovery, which emphasizes client choice, self-sufficiency, and autonomy. It should be noted, though, that negative evaluations were not necessarily definitive; both tenants and service providers at times exhibited sympathy and forgiveness for each other. [ABSTRACT FROM AUTHOR]

The article discusses a study which looked at experience of recovery from first-episode psychosis in schizophrenia among various patients. Topics mentioned include the use of interpretative phenomenological analysis in data analysis, the role of patient support and having to care for another as contributors to patient recovery, and the increasing view of patients with schizophrenia as active agents in their own treatment.

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 masculinities shape the experiences of men and their partners after survival from out-of-hospital cardiac arrest. Background Survivors of out-of-hospital cardiac arrest report depression, dependence on others for daily functioning, decreased participation in society and significant decreases in quality of life. There is growing evidence that masculine gender identities play a central role in the recovery experiences of men and their families following other major cardiac events. However, to date, there has been no examination of how masculinities shape men's experiences of recovery following out-of-hospital cardiac arrest. Design Interview study guided by an interpretive description approach. Data were subjected to thematic analysis. Method A purposive sample of seven male sudden cardiac arrest survivors and 6 female partners was recruited in 2010 from a secondary care centre in British Columbia, Canada. Results Three themes were prominent in the experiences of the participants: (1) Support and self-reliance; (2) Dealing with emotional (in) vulnerability; and (3) No longer a 'He-man'. Conclusion Masculinities played a role in men's experiences of recovery and adaptation following out-of-hospital cardiac arrest. Hegemonic masculinity partly explained men's experiences, notably their reluctance to seek professional support and reactions to changes in lifestyle. However, the study also suggests that the popular stereotype of men being 'strong and silent' in the face of ill-health may only be a part of a more complex story. Nurses would benefit from taking into consideration the potential influence of male gender identities on men's recovery postcardiac arrest. [ABSTRACT FROM AUTHOR]

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Recovery is a widely discussed concept in the field of research, treatment, and public policy regarding serious mental illness, and mainly schizophrenia. Aim of our study was to assess the relationship between personal recovery and prediction variables, as psychopathology, neurocognition, clinical and cognitive insight, and social functioning in inpatients affected by schizophrenia, with a special interest on cognitive insight. We assessed 76 inpatients affected by schizophrenia at their hospital discharge. Instruments included the Beck Cognitive Insight Scale, the Insight Scale and the Recovery Assessment Scale to assess the cognitive and clinical insight, and personal recovery. The neurocognitive assessment was represented by a single factor score produced by a principal components analysis of a neurocognitive test battery. Social functioning was measured also. Low self-reflectiveness of cognitive insight represented the best predictors of personal recovery. The relationship between cognitive insight and recovery found in this study may contribute to develop tailored interventions, taking into account the personal sense of recovery, despite the psychopathological evaluation. [ABSTRACT FROM AUTHOR]

Disbelief exits that individuals who have a mental health condition are able to recover and fully function in life. This study analyzed 1,437 adults from the 2006 General Social Survey. Structural equation modeling (1) examined the relationship between respondents' level of prejudicial attitudes and social distance (i.e., stigma) toward individuals who have a mental health condition and their belief in the potential of recovery (2) tested whether previous contact with an individual who received treatment was a mediator. Findings indicated that the belief in recovery led to lower levels of social distance. Prejudicial attitudes were found to be a predictor of one's level of social distance. Previous contact was not a mediator however; males, minorities and those with less education were less likely to have had previous contact. Results indicated a need to emphasize the probability of recovering from a mental health condition when developing target-specific stigma reducing strategies. [ABSTRACT FROM AUTHOR]

One of the key aspects of recovery from substance dependence is making a transition from a social network supportive of substance use to one that supports recovery. This study assessed this transition in social identity in an adult therapeutic community (TC) at baseline and 2 weeks into treatment. Where residents increased identification with the TC, and reduced social identification with using groups, retention in treatment improved. As retention is a proxy measure of positive outcomes, this pilot suggests that facilitating residents' positive identification with the community in the first weeks of treatment may be central to retaining residents and improving treatment outcomes. [ABSTRACT FROM AUTHOR]

This study explored how young adult people living with chronic inflammatory bowel disease (IBD) experienced that knowledge about their body symptoms and their food intake could promote recovery from their diagnosed disease. A hermeneutic approach was used to analyze interviews with patients living with IBD outside hospital. Thirteen young adults 18 to 45 years of age, with IBD, resided in their home environment and were engaged in different study and work activities. Two main themes emerged from the analysis of the interviews: (1) confidence with symptoms of disease as a source to recovery and (2) nutritional recovery in different stages of IBD. The course of the disease may be turned toward regeneration using a balanced diet in a long-term management perspective. Development of a tailored diet will provide energy and act as a catalyst to enhance the adaptive immune system in the body. Embodied knowledge and recovery from IBD within the individual patient requires understanding, clinical support, and the skills of the IBD nurse, dietitian, and doctor in an interdisciplinary team collaboration. [ABSTRACT FROM AUTHOR]

Older people often have companion animals, and the significance of animals in human lives should be considered by nurses—particularly in relation to older people’s health, which can be affected by diseases. The incidence of stroke increases with age and disabilities as a result of stroke are common. This study aimed to explore older people’s experiences of living with companion animals after stroke, and their life situation with the animals in relation to the physical, psychological and social aspects of recovery after stroke. The study was performed using individual interviews approximately 2 years after stroke with 17 participants (10 women and 7 men) aged 62–88 years. An overarching theme arising from the content analysis was contribution to a meaningful life. This theme was generated from four categories: motivation for physical and psychosocial recovery after stroke; someone to care for who cares for you; animals as family members; and providers of safety and protection. The main conclusion was that companion animals are experienced as physical and psychosocial contributors to recovery and a meaningful life after stroke. [ABSTRACT FROM AUTHOR]

Service users were interviewed as part of a multi-method evaluation of an alcohol and drug social work service in Scotland. This paper explores service user interviews that were conducted in the evaluation, addressing the following questions: What did the service users feel about the service itself? Leading on from this, what did they see as helpful in facilitating their recovery in general? The research will be contextualised in Scotland’s culture of problematic drug and alcohol use, Scottish drug and alcohol policy and the emerging recovery-orientated approach. The methodology of the evaluation will be explained and findings from the service user interviews will be outlined under the headings: therapeutic relationships, outreach, timeframe, and holistic approach and joint working. The paper demonstrates the importance of service user accounts not only for providing general feedback on social work services, but also for giving specific insight into what is helpful for individuals seeking to recover from substance use problems. [ABSTRACT FROM AUTHOR]

Question: In the 6 months after total knee arthroplasty (TKA), what is the pattern of pain resolution and functional recovery in people without diabetes, with diabetes that does not impact on routine activities, and with diabetes that does impact on routine activities? Is diabetes that impacts on routine activities an independent predictor of slower resolution of pain and functional recovery after TKA? Design: Community-based prospective observational study. Participants: A consecutive cohort of 405 people undergoing primary TKA, of whom 60 (15%) had diabetes. Participants with diabetes were also asked preoperatively whether diabetes impacted on their routine activities. Participants were categorised into three groups: no diabetes (n = 345), diabetes with no impact on activities (n = 41), and diabetes that impacted activities (n = 19). Outcome measures: Pain and function were measured using the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index within the month before surgery and 1, 3 and 6 months after surgery. Demographic, medical and surgical factors were also measured, along with depression, social support and health-related quality of life. Results: No baseline differences in pain and function were seen among the three groups ( p > 0.05). Adjusting for age, gender and contralateral joint involvement across the 6 postoperative months, participants with diabetes that impacted on routine activities had pain scores that were 8.3 points higher (indicating greater pain) and function scores that were 5.4 points higher (indicating lower function) than participants without diabetes. Participants with diabetes that doesn’t impact on routine activities had similar recovery to those without diabetes. Conclusion: People undergoing TKA who report preoperatively that diabetes impacts on their routine activities have less recovery over 6 months than those without diabetes or those with diabetes that does not impact on routine activities. Physiotherapists could institute closer monitoring within the hospital and community settings for people undergoing TKA who perceive that diabetes impacts on their routine activities. [Amusat N, Beaupre L, Jhangri GS, Pohar SL, Simpson S, Warren S, Jones CA (2014) Diabetes that impacts on routine activities predicts slower recovery after total knee arthroplasty: an observational study. Journal of Physiotherapy 60: 217–223] [ABSTRACT FROM AUTHOR]

The delivery of psychiatric rehabilitation interventions has been recognised as fundamental to facilitate recovery of people with severe mental illness. Although Portugal has developed a plan to restructure mental health services between 2007 and 2016, multiple barriers are hindering its effective implementation. We aim to describe a Portuguese psychiatric rehabilitation institution and analyse barriers in the mental health paradigm change. With our experience, we intend to help countries that are planning or passing through a change of paradigm in mental health care to anticipate and avoid similar obstacles. Sources used were research literature, government policy documents and legislation,in locoexperience and experiential knowledge. The case study was carried out using interactive (participant observation and non-structured interviews) and non-interactive techniques (document analysis, namely the target institution reports, projects and dossiers). Barriers found include not complying with the most recent available evidence and the use of outdated and non-evidence and values-based models. Moreover, a deficient monitoring and evaluation of services' quality, resistance to change, lack of appropriate training of professionals, lack of involvement of users in their care planning and funding issues are also contributors for the perpetuation of this scenario. [ABSTRACT FROM PUBLISHER]

The use of peer support for persons with mental illness has been gaining force. While research has demonstrated the benefits of peer support, few studies have investigated the qualitative characteristics of how peer support aids persons recovering from mental illness. Therefore, this study sought to clarify the characteristics that constitute peer support and its contribution to recovery. We conducted ethnographic fieldwork and semi-structured interviews with nine peer advocates at a consumer-run organization in New York City, and identified three themes that describe how peer support influences recovery: transforming experience into expertise, understanding the mechanics of peer support, and launching peers towards their own recovery. Peer support plays a critical role in helping clients move beyond their patient role to an empowered sense of personhood. Additionally, the value of peer support highlights current deficiencies within the mental health system and how a bolder shift towards recovery might repair them. [ABSTRACT FROM AUTHOR]

Natural disasters are increasingly becoming a common occurrence; but there remains a paucity of information about how families as a unit recover from disasters in general and from wildfires in particular. The work presented here investigates family recovery after a devastating wildfire in a rural community in Alberta, Canada. The goal is to examine the experience of families, parents and children, in the aftermath of the wildfire including the evacuation and recovery. The study was conducted within a research program that is focusing on understanding the links between disaster recovery and community resilience. We interviewed 27 parents and 26 children representing 19 families and conducted extensive community fieldwork. Data analysis included an inductive coding process. Findings indicate commonalities among affected families. In particular, six main themes related to family recovery were generated: different life goals and priorities, new routines, changes in attitudes, changes in interactions within the family unit and with the community, as well as new values and perceptions. Results also indicate parents' and children's recovery is marked by their own experiences and particular needs. The discussion of these findings highlights the important role of parents in family recovery, but also the necessity of examining the family unit and the changes it undergoes in re-establishing family routines while acknowledging children's concerns about protecting their parents. The study enhances our theoretical understanding of the social impacts of wildfires and is useful for those involved in disaster planning and recovery in preparation for future wildfire events. [ABSTRACT FROM AUTHOR]

Incorporating individuals’ understandings and explanations of mental illness into service delivery offers benefits relating to increased service relevance and meaning. Existing research delineates explanatory models of mental illness held by individuals in home, outpatient, and hospital-based contexts; research on models held by those in peer-support contexts is notably absent. In this article, I describe themes identified within and across explanatory models of mental illness and recovery held by mental health consumers (N = 24) at one peer center, referred to as a consumer-operated service center (COSP). Participants held explanatory models inclusive of both developmental stressors and biomedical causes, consistent with a stress–diathesis model (although no participant explicitly referenced such). Explicit incorporation of stress–diathesis constructs into programming at this COSP offers the potential of increasing service meaning and relevance. Identifying and incorporating shared meanings across individuals’ understandings of mental illness likewise can increase relevance and meaning for particular subgroups of service users. [ABSTRACT FROM PUBLISHER]

Objective. In a previous multisite comparative study of spiritual and religious coping (S/R) among outpatients with schizophrenia; S/R were adaptive for 80% of patients; harmful for 13%; and marginal for 7%. This importance was underestimated by clinicians. We created an interfaith therapeutic group to address such topics. The aim of the study is to assess patients' wish to address S/R issues in their psychiatric care. Method. Psychiatrists asked consecutive outpatients about their wish; with who they shared S/R concerns; and their interest to enroll in the 'Spiritual and Recovery Group'. Results. Among the 147 patients included less than half shared their spiritual concerns with other people. A quarter wished to address S/R issues in their care; 24/147 already shared those issues with a religious professional; half of them wished also to share them with their psychiatrist. Among the 21 patients who participated in an in-depth spiritual assessment 16 patients were directed to the S/R group and 5 patients were directed to groups addressing other therapeutic objectives. Conclusion. For one patient out of ten, S/R issues were of a clinical significance warranting integration into psychiatric treatment. This study shows that patients' views are in accordance with former research, putting forward psychiatrists' stance on this issue. [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]

BackgroundStudies of the long-term course and outcome of psychoses tend to focus on cohorts of prevalent cases. Such studies bias samples towards those with poor outcomes, which may distort our understanding of prognosis. Long-term follow-up studies of epidemiologically robust first-episode samples are rare.MethodAESOP-10 is a 10-year follow-up study of 557 individuals with a first episode of psychosis initially identified in two areas in the UK (South East London and Nottingham). Detailed information was collated on course and outcome in three domains (clinical, social and service use) from case records, informants and follow-up interviews.ResultsAt follow-up, of 532 incident cases identified, at baseline 37 (7%) had died, 29 (6%) had emigrated and eight (2%) were excluded. Of the remaining 458, 412 (90%) were traced and some information on follow-up was collated for 387 (85%). Most cases (265, 77%) experienced at least one period of sustained remission; at follow-up, 141 (46%) had been symptom free for at least 2 years. A majority (208, 72%) of cases had been employed for less than 25% of the follow-up period. The median number of hospital admissions, including at first presentation, was 2 [interquartile range (IQR) 1–4]; a majority (299, 88%) were admitted a least once and a minority (21, 6%) had 10 or more admissions. Overall, outcomes were worse for those with a non-affective diagnosis, for men and for those from South East London.ConclusionsSustained periods of symptom remission are usual following first presentation to mental health services for psychosis, including for those with a non-affective disorder; almost half recover. [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]

Internationally, the alcohol and other drug (AOD) field has an increasing focus on recovery-oriented care, however there has been little research addressing the impacts in Australia. This study explores the attitudes of AOD clinicians toward recovery-oriented care in Victoria. Data was collected from 50 AOD clinicians and managers across six AOD services. Data collection included completion of a structured questionnaire addressing recovery attitudes and beliefs and semistructured group interviews. Although participants agreed with the broad concept of recovery, there was disagreement over the appropriateness ofrecoveryas a term. The findings support that the development of a set of guiding recovery principles would be more useful than a simple definition. [ABSTRACT FROM AUTHOR]

There is increasing recognition that cultivating compassion for oneself and others can act as an antidote to feelings of threat, shame, humiliation and paranoia. This study aimed to explore the further development of a narrative-based measure of compassion. We hypothesised that greater compassion would be associated with lower levels of positive symptoms, negative symptoms, cognitive disorganisation, excitement and emotional distress. Participants were 29 individuals with psychosis. Greater narrative compassion was associated with less negative symptoms, less cognitive disorganisation and less excitement. We found no correlations between narrative compassion and the Self-Compassion Scale. Notwithstanding the methodological problems of our study, our findings have important implications for developing an attachment-based understanding of compassion and the use of compassion to support recovery from complex mental health problems such as psychosis. [ABSTRACT FROM AUTHOR]

Background: Having access to information and communication technologies (ICTs) is a prerequisite to meaningful participation in society. Objectives: This paper seeks to: i. explore the engagement of homeless drug users (HDUs) with ICTs and ii. discuss the findings with reference to recovery from drug dependence. Methods: The study design was qualitative and longitudinal, involving data collected in 2012-13 via 52 semi-structured interviews with 30 homeless drug users (25 men; five women). Participants were recruited from 17 hostels in two English cities. Interview data were analyzed using Framework. Results: HDUs had access to ICTs, used ICTs, and wanted to engage with them more. Experiences of digital exclusion were a function of participants' inability to afford ICTs, the relatively cheap and poor quality technology available to them, limited knowledge about ICTs, and lack of support in using them. That HDUs were often unable to take full advantage of technology because they had nobody to explain what their devices could do or to show them how they worked was ironic given that using ICTs to (re)establish and maintain relationships were functions of technology that HDUs particularly liked. Conclusions: The physical, human, cultural, and social capital of HDUs influenced their access to, and use of, ICTs. Equally, ICTs were themselves an important recovery resource. Services and others should endeavor to provide HDUs with easy access to good quality technology, as well as offers of support and education so that all individuals have the knowledge and confidence to make optimum use of the technology that is available to them. [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]

In Sweden, the duration of treatment is increasing for patients admitted to forensic psychiatric care. To reduce the length of stay, it is important for the forensic rehabilitation and recovery process to be effective and safe. Not much is known about how the process of recovery and transition begins and how it is described by the forensic patients. The purpose of this study was to explore how forensic patients with a history of high risk for violence experienced the turn towards recovery. A qualitative content analysis was used to analyse interviews with 10 patients who had decreased their assessed risk for violence on the risk assessment instrument HCR-20 and who were successfully managed a lower level of security. Three themes were identified: (i) the high-risk phase: facing intense negative emotions and feelings (ii) the turning point phase: reflecting on and approaching oneself and life in a new way (iii) the recovery phase: recognising, accepting and maturing. In the high-risk phase, chaotic and overwhelming feelings were experienced. The turning point phase was experienced as a sensitive stage, and it was marked by being forced to find a new, constructive way of being. The recovery phase was characterised by recognising personal circumstances in life, including accepting the need for structure, a feeling of maturity and a sense of responsibility for their own life. In order to ensure a successful recovery, the forensic nursing staff needs to recognise and support processes related to treatment motivation and turning points. Recommendations for best nursing practice are given accordingly. [ABSTRACT FROM AUTHOR]

Background: African Americans (AAs) who experience a first time stroke are younger and have double the stroke rate and more poststroke complications than other Americans. Objective: To assess perceived poststroke care barriers among younger AA men and their care partners (CPs) in order to inform the development of acceptable and effective improvements in poststroke care for this high-risk group. Methods: Ten community-dwelling AA stroke survivors and 7 of their CPs participated in focus groups and advisory board meetings. Survivors had stroke or transient ischemic attack within 1 year and a Barthel Index score &nvgt;60. In focus groups, using a semi-structured interview guide, survivors and CPs identified self-perceived barriers and facilitators to poststroke care. Thematic analysis of session transcripts and the constant comparative method were used to generate themes. Results: Survivor age ranged from 34 to 64 years. Mean Barthel score was 95.5. CPs, all AA women, ranged in age from 49 to 61 years. Five CPs were wives, 1 was a fiancée, and 1 was a niece. Participants cited multiple personal, social, and societal stroke recovery challenges. Although hypertension and smoking risks were acknowledged, stress, depression, posttraumatic stress disorder, anger/frustration, personal identity change, and difficulty communicating unique needs as AA men were more frequently noted. Facilitators included family support, stress reduction, and dietary changes. Conclusions: Younger AA men and their CPs perceive multiple poststroke care barriers. Biological risk reduction education may not capture all salient aspects of health management for AA stroke survivors. Leveraging family and community strengths, addressing psychological health, and directly engaging patients with health care teams may improve care management. [ABSTRACT FROM AUTHOR]

The last decade has seen new forms of peer support emerge from a “new addiction recovery advocacy movement.” One structure for organizing these services is the recovery community center (RCC), which combines the social fellowship of AA with the service mission of a drop-in center, while offering new services like recovery coaching. The backbone of the RCC is its volunteers from the recovery community, who instill hope, role model recovery, and dispel stigma. We describe this model and provide data from two RCCs. These data suggest that RCCs may serve as hubs of recovery-oriented systems of care, serving as the impetus for more rigorous research to be conducted on the role and effectiveness of this emerging form of service delivery. [ABSTRACT FROM AUTHOR]