Community Mental Health Journal, 56(2), 2020, pp.196-205.
Publisher:
Springer
... of recovery. Implications regarding intervention to support individuals to explore VHE are discussed.
(Publisher abstract)
This study aimed to explore how adults with lived experiences of voice hearing, who have participated in hearing voices groups based on approaches of the Hearing Voices Movement, understand their voice hearing experiences (VHE). A phenomenological approach guided the study design. In-depth semi-structured interviews were conducted with five participants who attended a hearing voices group. Participants experienced a journey of understanding VHE. The overarching theme ‘tension and recalibration’ permeated five themes: beliefs about voices; navigating the relationship with my voices; learning to live with my voices; rediscovering myself with my voices; and, influences to understanding my voices. This study highlights how voice hearers’ understanding can evolve over time and throughout phases of recovery. Implications regarding intervention to support individuals to explore VHE are discussed.
(Publisher abstract)
Subject terms:
schizophrenia, psychoses, service users, recovery;
Journal of Dual Diagnosis, 11(3/4), 2015, pp.179-183.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Objective: There is rapidly growing evidence of natural recovery from cannabis use in people with psychosis, but little is known about how it occurs. This qualitative study explores what factors influence the decision to cease cannabis use, maintain cessation, and prevent relapse.
Methods: Ten people with early psychosis and lifetime cannabis misuse, who had been abstinent for at least a month,
(Edited publisher abstract)
Objective: There is rapidly growing evidence of natural recovery from cannabis use in people with psychosis, but little is known about how it occurs. This qualitative study explores what factors influence the decision to cease cannabis use, maintain cessation, and prevent relapse.
Methods: Ten people with early psychosis and lifetime cannabis misuse, who had been abstinent for at least a month, were recruited from public adult mental health services. These six men and four women participated in a semi-structured qualitative interview assessing reasons for addressing cannabis use, effective change strategies, lapse contexts, and methods used to regain control. Interpretative phenomenological analysis was used to identify themes in their responses. Results: Participants had a mean age of 23 years (SD = 3.7), started using cannabis at age 13.7 (SD = 1.6), began daily use at 17 (SD = 3.1), and had abstained from cannabis for 7.9 months (SD = 5.4). Awareness of the negative impact of substance use across multiple domains and the presence of social support for cannabis cessation were seen as vital to sustained success, as was utilisation of a combination of coping strategies. The ability to address pressure from substance-using peers was commonly mentioned. Conclusions: Maximally effective treatment may need to focus on eliciting a range of benefits of cessation and control strategies and on maximising both support for change and resistance to peer pressure. Further research might focus on comparing perceived effective strategies between individuals who obtain sustained cessation versus those who relapse.
(Edited publisher abstract)
Subject terms:
drug misuse, psychoses, recovery, substance misuse;
Community Mental Health Journal, 54(6), 2018, pp.793-804.
Publisher:
Springer
There is a growing number of qualitative accounts regarding recovery from psychosis from a service user perspective. The aim of this study was to conduct a systematic review of these qualitative accounts. A thematic synthesis was utilised to synthesise and analyse seventeen studies included in the review. Studies were included if they used a qualitative methodology to explore service users’ experiences of recovery from psychosis as a primary research question. All included studies were subjected to a quality assessment. The analysis outlined three subordinate themes: the recovery journey, facilitators of recovery (e.g. faith and spirituality, personal agency and hope), and barriers to recovery (e.g. stigma and discrimination, negative effects of mental health services and medication). Recovery
(Publisher abstract)
There is a growing number of qualitative accounts regarding recovery from psychosis from a service user perspective. The aim of this study was to conduct a systematic review of these qualitative accounts. A thematic synthesis was utilised to synthesise and analyse seventeen studies included in the review. Studies were included if they used a qualitative methodology to explore service users’ experiences of recovery from psychosis as a primary research question. All included studies were subjected to a quality assessment. The analysis outlined three subordinate themes: the recovery journey, facilitators of recovery (e.g. faith and spirituality, personal agency and hope), and barriers to recovery (e.g. stigma and discrimination, negative effects of mental health services and medication). Recovery is an idiosyncratic process but includes key components which are important to people who experience psychosis. These should be explored within clinical practice.
(Publisher abstract)
Subject terms:
systematic reviews, psychoses, service users, user views, qualitative research, recovery, schizophrenia;
British Journal of Psychiatry, 207(6), 2015, pp.551-555.
Publisher:
Cambridge University Press
Background: Supporting recovery is the aim of national mental health policy in many countries. However, only one measure of recovery has been developed in England: the Questionnaire about the Process of Recovery (QPR), which measures recovery from the perspective of adult mental health service users with a psychosis diagnosis.
Aims: To independently evaluate the psychometric properties
(Publisher abstract)
Background: Supporting recovery is the aim of national mental health policy in many countries. However, only one measure of recovery has been developed in England: the Questionnaire about the Process of Recovery (QPR), which measures recovery from the perspective of adult mental health service users with a psychosis diagnosis.
Aims: To independently evaluate the psychometric properties of the 15- and 22-item versions of the QPR.
Method: Two samples were used: data-set 1 (n = 88) involved assessment of the QPR at baseline, 2 weeks and 3 months. Data-set 2 (n = 399; trial registration: ISRCTN02507940) involved assessment of the QPR at baseline and 1 year.
Results: For the 15-item version, internal consistency was 0.89, convergent validity was 0.73, test-retest reliability was 0.74 and sensitivity to change was 0.40. Confirmatory factor analysis showed the 15-item version offered a good fit. For the 22-item version, the interpersonal subscale was found to underperform and the intrapersonal subscale overlaps substantially with the 15-item version.
Conclusions: Both the 15-item and the intrapersonal subscale of the 22-item versions of the QPR demonstrated satisfactory psychometric properties. The 15-item version is slightly more robust and also less burdensome, so it can be recommended for use in research and clinical practice.
(Publisher abstract)
Subject terms:
evaluation, instruments, recovery, psychoses, mental health problems, service users;
Mental Health and Social Inclusion, 19(3), 2015, pp.107-113.
Publisher:
Emerald
Purpose: The purpose of this paper is to highlight what helps and what is difficult about cognitive behaviour therapy for psychosis (CBTp) in relation to recovery and social inclusion, how it can be adapted for a non-western culture, and how inclusion in communities in which people feel comfortable can help their recovery.
Design/methodology/approach: Three journal articles are described. of their recovery.
Findings: UK service users appreciated feeling equal to their therapist in CBTp, receiving an understandable explanation of their difficulties, and support for gradual steps towards activities they valued. However, it was difficult revisiting traumatic pasts to understand their difficulties, and UK mental health culture may hamper taking an active role in treatment. In Pakistan, CBTp can
(Edited publisher abstract)
Purpose: The purpose of this paper is to highlight what helps and what is difficult about cognitive behaviour therapy for psychosis (CBTp) in relation to recovery and social inclusion, how it can be adapted for a non-western culture, and how inclusion in communities in which people feel comfortable can help their recovery.
Design/methodology/approach: Three journal articles are described. The first summarises six small qualitative studies involving interviews with UK service users about what they found helpful and challenging about CBTp. The second article reports on a pilot trial of CBTp adapted for the culture in Pakistan, where families are seen as more involved in service users’ care. The third article describes USA-based participants’ engagement with different communities as part of their recovery.
Findings: UK service users appreciated feeling equal to their therapist in CBTp, receiving an understandable explanation of their difficulties, and support for gradual steps towards activities they valued. However, it was difficult revisiting traumatic pasts to understand their difficulties, and UK mental health culture may hamper taking an active role in treatment. In Pakistan, CBTp can be successfully adapted to include a key family member and local spiritual beliefs. In a USA context, service users developed competencies in community groups they valued, and these could be minority or service user communities where people felt comfortable and could make a contribution.
(Edited publisher abstract)
Subject terms:
cognitive behavioural therapy, psychoses, social inclusion, communities, recovery, multicultural approach;
Therapeutic Communities: the International Journal of Therapeutic Communities, 39(4), 2018, pp.149-161.
Publisher:
Emerald
Purpose: Too often people with complex mental health needs do not find their way out of the mental health system or find satisfactory solutions that enable them to live a full life. In 2015 the Mental Health Department (MHD) of Trieste established the Recovery House pilot project to address this concern. The paper aims to Investigate the project. Design/methodology/approach: The Recovery House was co-created with and for people between 18 and 35 years old with diagnoses of psychosis and other complex mental health conditions. An integral part of the pilot was the organization of the “Recovery Community,” inspired by the Assembly model embraced by Franco Basaglia. The Recovery Community met regularly to both support and learn from the Recovery House and aimed to create a democratic and reflective space where power relationships, self-determination, responsibility and ownership by all the stakeholders, including family members, could be explored together. Findings: Over a period of 31 months, four groups of people have successfully completed their residency at the Recovery House. In total, 89 percent of people who stayed at the Recovery House did so up to six months. After the period of staying at the Recovery House most of them moved to independent living or shared supported accommodation. Originality/value: This initiative sheds light on the fact that democratic values, approaches and structures can improve both service functioning and the recovery outcomes for people with complex health needs. Further, the Recovery House has had a significant effect on the culture and practice of the MHD
(Edited publisher abstract)
Purpose: Too often people with complex mental health needs do not find their way out of the mental health system or find satisfactory solutions that enable them to live a full life. In 2015 the Mental Health Department (MHD) of Trieste established the Recovery House pilot project to address this concern. The paper aims to Investigate the project. Design/methodology/approach: The Recovery House was co-created with and for people between 18 and 35 years old with diagnoses of psychosis and other complex mental health conditions. An integral part of the pilot was the organization of the “Recovery Community,” inspired by the Assembly model embraced by Franco Basaglia. The Recovery Community met regularly to both support and learn from the Recovery House and aimed to create a democratic and reflective space where power relationships, self-determination, responsibility and ownership by all the stakeholders, including family members, could be explored together. Findings: Over a period of 31 months, four groups of people have successfully completed their residency at the Recovery House. In total, 89 percent of people who stayed at the Recovery House did so up to six months. After the period of staying at the Recovery House most of them moved to independent living or shared supported accommodation. Originality/value: This initiative sheds light on the fact that democratic values, approaches and structures can improve both service functioning and the recovery outcomes for people with complex health needs. Further, the Recovery House has had a significant effect on the culture and practice of the MHD in adopting a comprehensive approach to emotional distress.
(Edited publisher abstract)
Subject terms:
recovery, recovery approach, mental health problems, co-production, communities, intervention, severe mental health problems, psychoses, young adults, user participation;
British Journal of Social Work, 48(6), 2018, pp.1754-1773.
Publisher:
Oxford University Press
This longitudinal study using the sampling frame of the second Australian prevalence study of psychosis aimed to identify predictors of the health and well-being of care-givers of people with psychosis and inform social work recovery-oriented practice. Ninety-eight carers were recruited at baseline and seventy-eight re-interviewed after one year. Correlational and regression analyses were conducted to identify relationships between carer and service user-related factors and predictors of carers’ health and well-being over time. Carers’ poor health and well-being were predicted by a combination of specific service user-related characteristics and care-giving factors. Carers’ assessment of the functioning of their relative/friend with psychosis at baseline had stronger relationships with their own health and well-being at follow-up than other factors. Carers’ care-giving burden was predicted by their educational levels and their relative/friend’s cognitive levels over time. To achieve improved health and well-being for carers, services need to consider potential deterioration of carers’ physical health over time, to facilitate appropriate referral of carers with physical health problems and provide psycho-social rehabilitation services to improve the functioning of people with psychosis. Findings provide some evidence to support social work recovery-oriented practice in working with people with psychosis and the routine inclusion of carers in such interventions.
(Publisher abstract)
This longitudinal study using the sampling frame of the second Australian prevalence study of psychosis aimed to identify predictors of the health and well-being of care-givers of people with psychosis and inform social work recovery-oriented practice. Ninety-eight carers were recruited at baseline and seventy-eight re-interviewed after one year. Correlational and regression analyses were conducted to identify relationships between carer and service user-related factors and predictors of carers’ health and well-being over time. Carers’ poor health and well-being were predicted by a combination of specific service user-related characteristics and care-giving factors. Carers’ assessment of the functioning of their relative/friend with psychosis at baseline had stronger relationships with their own health and well-being at follow-up than other factors. Carers’ care-giving burden was predicted by their educational levels and their relative/friend’s cognitive levels over time. To achieve improved health and well-being for carers, services need to consider potential deterioration of carers’ physical health over time, to facilitate appropriate referral of carers with physical health problems and provide psycho-social rehabilitation services to improve the functioning of people with psychosis. Findings provide some evidence to support social work recovery-oriented practice in working with people with psychosis and the routine inclusion of carers in such interventions.
(Publisher abstract)
Mental Health Review Journal, 20(4), 2015, pp.256-266.
Publisher:
Emerald
Purpose: When detaining and enforcing treatment, psychiatric services often assumed that the person is separate from their dysfunctional biology and removed from their social context. Coproduction is hindered by polarised views where one party holds power and others are not able to promote their views. But if biomedical models are abandoned, ethical grounding for mental health law would be lost. The purpose of this paper is to explore the experience of detaining and being detained, clarifying understandings of trust, illness, personhood and control.
Design/methodology/approach: A hermeneutic phenomenological approach was employed.
Findings: A social worker and man who suffers from psychosis report that their choices are limited by mental health law. They both experience themselves as passive. The man rejects society and withdraws to avoid stress; while the Social Worker just follows legal guidelines. Interaction in mental healthcare is experienced as lacking trust, involving threat, but sometimes negotiation is possible. Control over illness is associated with having a choice of treatments. Psychosis is not experienced as a separate illness process and control is exercised over the person rather than that illness. To enable coproduction, detention or enforced treatment should be grounded more firmly in morality or criminal justice. People who suffer psychosis could be understood and their views more often accepted.
Research limitations/implications: This was a small qualitative study designed to prompt discussion and inform further research and policy review.
(Edited publisher abstract)
Purpose: When detaining and enforcing treatment, psychiatric services often assumed that the person is separate from their dysfunctional biology and removed from their social context. Coproduction is hindered by polarised views where one party holds power and others are not able to promote their views. But if biomedical models are abandoned, ethical grounding for mental health law would be lost. The purpose of this paper is to explore the experience of detaining and being detained, clarifying understandings of trust, illness, personhood and control.
Design/methodology/approach: A hermeneutic phenomenological approach was employed.
Findings: A social worker and man who suffers from psychosis report that their choices are limited by mental health law. They both experience themselves as passive. The man rejects society and withdraws to avoid stress; while the Social Worker just follows legal guidelines. Interaction in mental healthcare is experienced as lacking trust, involving threat, but sometimes negotiation is possible. Control over illness is associated with having a choice of treatments. Psychosis is not experienced as a separate illness process and control is exercised over the person rather than that illness. To enable coproduction, detention or enforced treatment should be grounded more firmly in morality or criminal justice. People who suffer psychosis could be understood and their views more often accepted.
Research limitations/implications: This was a small qualitative study designed to prompt discussion and inform further research and policy review.
(Edited publisher abstract)
Subject terms:
co-production, decision making, recovery, mental health care, psychoses, compulsory detention, schizophrenia, social workers;
Methods: This qualitative analysis was conducted as part of an exploratory mixed-methods study of mental health recovery. Members of Kaiser Permanente Northwest in the United States (a group-model, not-for-profit, integrated health plan) who had serious mental illness diagnoses were interviewed four times over two years about factors affecting their mental health recovery. Interviews were of their mental health recovery. When asked at follow-up, 97% (n = 171) provided codeable answers about substances and mental health. Differing pathways to recovery were identified, including through formal treatment, self-help groups or peer support, 'natural' recovery (without the help of others), and continued but controlled use of alcohol. Three overarching themes were identified in participants' experiences of recovering from serious mental illnesses and substance-related problems: Learning about the effects of alcohol and drugs provided motivation and a foundation for sobriety; achieving sobriety helped people to initiate their mental health recovery processes; and achieving and maintaining sobriety built self-efficacy, self-confidence, improved functioning and a sense of personal growth. Non-judgmental support from clinicians adopting chronic disease approaches also facilitated recovery. Conclusions: Irrespective of how people achieved sobriety, quitting or severely limiting use of substances was important to initiating and continuing mental health recovery processes. Substance abuse treatment approaches that are flexible, reduce barriers to engagement, support learning about effects
(Edited publisher abstract)
Methods: This qualitative analysis was conducted as part of an exploratory mixed-methods study of mental health recovery. Members of Kaiser Permanente Northwest in the United States (a group-model, not-for-profit, integrated health plan) who had serious mental illness diagnoses were interviewed four times over two years about factors affecting their mental health recovery. Interviews were recorded, transcribed, and coded with inductively derived codes. Themes were identified by reviewing text coded 'alcohol or other drugs.' Results: Participants (N = 177) had diagnosed schizophrenia/schizoaffective disorder (n = 75, 42%), bipolar I/II disorder (n = 84, 48%), or affective psychosis (n = 18, 10%). At baseline, 63% (n = 112) spontaneously described addressing substance use as part of their mental health recovery. When asked at follow-up, 97% (n = 171) provided codeable answers about substances and mental health. Differing pathways to recovery were identified, including through formal treatment, self-help groups or peer support, 'natural' recovery (without the help of others), and continued but controlled use of alcohol. Three overarching themes were identified in participants' experiences of recovering from serious mental illnesses and substance-related problems: Learning about the effects of alcohol and drugs provided motivation and a foundation for sobriety; achieving sobriety helped people to initiate their mental health recovery processes; and achieving and maintaining sobriety built self-efficacy, self-confidence, improved functioning and a sense of personal growth. Non-judgmental support from clinicians adopting chronic disease approaches also facilitated recovery. Conclusions: Irrespective of how people achieved sobriety, quitting or severely limiting use of substances was important to initiating and continuing mental health recovery processes. Substance abuse treatment approaches that are flexible, reduce barriers to engagement, support learning about effects of substances on mental health and quality of life, and adopt a chronic disease model of addiction may increase engagement and success. Peer-based support like Alcoholics or Narcotics Anonymous can be helpful for people with serious mental illnesses, particularly when programs accept use of mental health medications.
(Edited publisher abstract)
Subject terms:
severe mental health problems, substance misuse, drug misuse, schizophrenia, recovery, psychoses, bipolar disorder, therapy and treatment, self-help groups, peer support;
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 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
(Publisher abstract)
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.
(Publisher abstract)
Subject terms:
psychoses, severe mental health problems, service users, mental health professionals, recovery, staff, attitudes, wellbeing, schizophrenia;