Mental Health Service Users and Their Caregivers Perspectives on Personal Recovery from Severe Mental Health Conditions in Cape Town, South Africa: A Qualitative Study.

Severe mental health conditions (SMHCs) significantly contribute to the global disease burden. In low-and-middle-income countries (LMICs) like South Africa, the long-term impact of SMHCs on individuals and their families is serious. However, mental health services focus on clinical recovery, with little attention given to the personal recovery needs of mental health service users (MHSUs) and their caregivers. The CHIME framework outlines five domains characterising personal recovery: connectedness, hope and optimism about the future, identity, meaning in life, and empowerment. This qualitative, descriptive study sought insights from male MHSUs and their caregivers on their perspectives of personal recovery from SMHCs. Four male MHSUs and three of their caregivers were purposively selected from Cape Flats communities in the Western Cape. Data were collected using visual participatory methods, including photovoice, life graphs, community maps, and photo-elicitation interviews with MHSUs. In addition, semi-structured interviews were held with caregivers. Data were thematically analysed, and two main themes emerged: Finding meaningful participation and affirming agency. These themes describe how diverse contextual, socioeconomic, political, demographic, cultural, and spiritual factors help and hinder personal recovery. MHSUs and their caregivers sought support from mental health non-profit organisations (MH-NPOs) because of stigmatising attitudes from their communities. MH-NPOs provided MHSUs with long-term relational support and opportunities to build their capacities which helped them access living, learning, working and socialising opportunities. Understanding the diverse needs of MHSUs and including MH-NPOs in scaling up community-based mental health services in LMICs will enable more accessible services that support personal recovery.

International community of practice: learning from experiences of community development and social occupational therapy / Comunidade internacional de práticas: aprendendo com experiências de desenvolvimento comunitário e de terapia ocupacional social

Abstract Introduction Increasingly, occupational therapists and scientists across the globe are calling for a shift away from individualised western medical approaches, to working with communities and collectives, and in the social field. This signals the growing motivation to engage in socially responsive and transformative practices that address political structures and oppressive colonial systems. Objective The purpose of our Community of Practice (CoP) was to explore and describe the epistemologies, vocabularies, and understandings that underpin community development and social occupational therapy within diverse global contexts to advance theoretical perspectives and practices. Method As a CoP of occupational therapy and science scholars situated in four countries (Australia, Brazil, Canada, and South Africa), we met virtually bi-monthly from March 2020 to January 2023. Scholarly work involved critical narrative literature reviews, reflexive presentations, group dialogues, and individual and collective reflections and analyses. Results Individual narratives, four thematic threads, and a selection of vocabularies and epistemologies are presented. The thematic threads were: Connecting and making space for decolonial praxis, Questioning the disconnect between occupational therapy practice and contexts, Examining vocabularies that shape contextually relevant practice, and Engaging a reflexive stance to work towards equity, justice and social rights. Conclusions Generating knowledge that supports ways of knowing, being and doing reflective of multiple languages, sciences, and contexts will strengthen occupational therapy. Maintaining the pluriversal and resisting 'one size fits all' approaches to human occupation/everyday life is essential. This paper offers practitioners a catalyst for initiating decolonising praxis for learning across global contexts.

Resumo Introdução De modo crescente, terapeutas ocupacionais mundialmente estão discutindo mudanças das abordagens médicas ocidentais individualizadas para o trabalho com comunidades, coletivos e no campo social. Isto sinaliza uma motivação crescente para se engajar em práticas socialmente responsivas e transformadoras que abordem estruturas políticas e sistemas coloniais opressores. Objetivo Explorar e descrever epistemologias, vocabulários e entendimentos que sustentam a teoria de desenvolvimento de comunidades e da terapia ocupacional social, em diversos contextos globais para avançar em perspectivas teóricas e práticas. Método A partir de uma Comunidade de Prática de terapeutas ocupacionais e acadêmicos situados em quatro países (Austrália, Brasil, Canadá e África do Sul), nos reunimos virtualmente bimestralmente de março de 2020 até janeiro de 2023. Nosso trabalho envolveu revisões narrativas críticas da literatura, apresentações reflexivas, diálogos em grupo e reflexões e análises individuais e coletivas. Resultados Foram escolhidos quatro fios temáticos e uma seleção de vocabulários e epistemologias: Conectando e abrindo espaço para a práxis decolonial, Questionando a desconexão entre a prática da terapia ocupacional e os contextos, Examinando vocabulários que moldam a prática contextualmente relevante e Engajando uma postura reflexiva para trabalhar em direção à equidade, justiça e direitos sociais. Conclusões A geração de conhecimento reflexivo que sustente formas de saber, ser e fazer requer múltiplas linguagens, ciências e contextos que fortalecem a terapia ocupacional. É essencial manter a pluriversalidade e resistir a abordagens únicas para trabalhar com a ocupação humana/vida cotidiana. Este artigo oferece um catalisador para iniciar uma práxis descolonizadora de aprendizado em contextos globais.

Service Providers Perspectives on Personal Recovery from Severe Mental Illness in Cape Town, South Africa: A Qualitative Study.

Severe mental illnesses (SMI) contribute significantly to the global burden of disease. In low-and-middle-income countries (LMICs), the treatment gap impacts the clinical and personal recovery of people living with an SMI. The drive to reduce this treatment gap in LMICs makes it pertinent to understand service providers' views on recovery from SMI. Semi-structured interviews and focus groups with service providers from health services and non-profit organisations in the Western Cape Province, South Africa, were conducted in this qualitative study. Seventeen participants were purposively selected, and data were thematically analysed. Three major themes emerged: delineating recovery, available services supporting recovery from SMI, and facilitators and barriers to recovery at the service level. Health services favoured clinical over personal recovery. Participants thought that many service users' personal recovery from SMI was hindered by intersecting social, economic, cultural, and political inequalities that extended beyond the influence of the health sector.

Pedagogies within occupational therapy curriculum: centering a decolonial praxis in community development practice / Pedagogias dentro do currículo de terapia ocupacional: centrando uma práxis decolonial na prática de desenvolvimento comunitário

Abstract Introduction Critical occupational therapy aims to promote occupational justice through addressing the social determinants of health and the socio-political structures that affect peoples' occupational engagement. Objective This paper reports on two objectives from a case study, namely: To describe the teaching and learning practices in South Africa, University of Cape Town Occupational Therapy, Community Development Practice curriculum, and the pedagogy informing it. Method Multiple methods were used as data in the construction of the case. These included the review of curriculum documents and a focus group discussion with academics who teach on the programme. These academics also wrote reflective journal entries which were included in our analysis. Data was analysed using a critical interpretive synthesis. Results An overarching theme emerged, namely "Modelling a development processes in a teaching and learning alliance". This theme identified our key pedagogical approach, illustrating how a decolonial praxis that involves consciously resisting coloniality in the design and implementation of the curriculum occurred. This was made possible through pedagogical actions embedded in the approach and reflected in three categories: "Partnering to bring our critically reflexive and authentic selves"; "The labour of working with individual and systemic processes of struggle" and "Being committed to facing uncertainty together". Conclusion Our interpretation of our pedagogical approach within the curriculum demonstrates how decolonial pedagogies open up pathways that promote the kind of dialogic and transformative learning that is important for critical occupational therapy. These decolonial pedagogies hold significance for addressing health inequities and developing a justice-oriented profession.

Resumo Introdução A terapia ocupacional crítica visa promover a justiça ocupacional, abordando os determinantes sociais da saúde e as estruturas sociopolíticas que afetam o envolvimento ocupacional das pessoas. Objetivo Descrever e examinar a pedagogia aplicada ao currículo de Práticas de Desenvolvimento Comunitário, na Universidade da Cidade do Cabo (UCT), África do Sul. Método foram usados múltiplos métodos para a construção do caso. Isso incluiu a revisão de documentos e artefatos associados e uma discussão de grupo focal com acadêmicos que ensinam no programa. Esses acadêmicos também escreveram diários reflexivos que foram incluídas em nossa análise. Os dados foram analisados ​​por meio de uma síntese interpretativa crítica. Resultados Um tema abrangente emergiu, a saber: "Modelagem de processos de desenvolvimento em uma aliança de ensino e aprendizagem". Este tema identificou nossa abordagem pedagógica chave, ilustrando como uma práxis decolonial, abrangendo ações pedagógicas particulares, facilitou mudanças em direção à terapia ocupacional crítica. Essas ações pedagógicas foram refletidas em três categorias: "Parcerias para trazer nosso eu criticamente reflexivo e autêntico"; "O trabalho de desenvolver processos individuais e sistêmicos de luta" e "comprometer-se a enfrentar juntos as incertezas". Conclusão Nossa interpretação sobre a nossa abordagem pedagógica dentro do currículo demonstra como as pedagogias decoloniais abrem caminhos que promovem o tipo de aprendizagem dialógica que é importante para a terapia ocupacional crítica. Essas pedagogias decoloniais são importantes para o desenvolvimento de uma profissão voltada para a justiça.

Exploration of recovery of people living with severe mental illness (SMI) in low/middle-income countries (LMICs): a scoping review.

OBJECTIVE: To examine the literature on how recovery of people with severe mental illness (SMI) is conceptualised in low/middle-income countries (LMICs), and in particular what factors are thought to facilitate recovery. DESIGN: Scoping review. DATA SOURCES AND ELIGIBILITY: We searched 14 electronic databases, hand searched citations and consulted with experts during the period May-December 2019. Eligible studies were independently screened for inclusion and exclusion by two reviewers. Unresolved discrepancies were referred to a third reviewer. DATA EXTRACTION AND SYNTHESIS: All bibliographical data and study characteristics were extracted using a data charting form. Selected studies were analysed through a thematic analysis emerging from extracted data. RESULTS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram offers a summary of the results: 4201 titles, 1530 abstracts and 109 full-text articles were screened. Ten articles were selected for inclusion: two from Turkey, two from India, and one each from China, Swaziland, Indonesia, Egypt, South Africa and Vietnam. Although most studies used qualitative methods, data collection and sampling methods were heterogeneous. One study reported on service provider perspectives while the rest provided perspectives from a combination of service users and caregivers. Three themes emerged from the data analysis. First, studies frame recovery as a personal journey occurring along a continuum. Second, there was an emphasis on social relationships as a facilitator of recovery. Third, spirituality emerged as both a facilitator and an indicator of recovery. These themes were not mutually exclusive and some overlap exists. CONCLUSION: Although there were commonalities with how high-income countries describe recovery, we also found differences in conceptualisation. These differences in how recovery was understood reflect the importance of framing the personal recovery concept in relation to local needs and contextual issues found in LMICs. This review highlighted the current sparse evidence base and the need to better understand recovery from SMI in LMICs.

Occupational justice and social inclusion among people living with HIV and people with mental illness: a scoping review.

OBJECTIVE: To explore ways in which occupational justice and social inclusion are conceptualised, defined and operationalised in highly stigmatised and chronic conditions of mental illness and HIV. DESIGN: This scoping review protocol followed Arksey and O'Malley's (2005) Scoping Review Framework. DATA SOURCES AND ELIGIBILITY: The following databases were searched for the period January 1997 to January 2019: Medline via PubMed, Scopus, Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, SocINDEX and grey literature.Eligible articles were primary studies, reviews or theoretical papers which conceptualised, defined and/or operationalised social inclusion or occupational justice in mental illness or HIV. STUDY APPRAISAL AND SYNTHESIS: We undertook a three-part article screening process. Screening and data extraction were undertaken independently by two researchers. Arksey's framework and thematic analysis informed the collation and synthesis of included papers. RESULTS: From 3352 records, we reviewed 139 full articles and retained 27 for this scoping review. Definitions of social inclusion and occupational justice in the domains of mental illness and HIV were heterogeneous and lacked definitional clarity. The two concepts were conceptualised as either processes or personal experiences, with key features of community participation, respect for human rights and establishment and maintenance of healthy relationships. Conceptual commonalities between social inclusion and occupational justice were premised on social justice. CONCLUSIONS: To address lack of clarity, we propose further and concurrent exploration of these concepts, specifically with reference to persons with comorbid mental health disorders such as substance use disorders and HIV living in low-income countries. This should reflect contextual realities influencing community participation, respect for human rights and meaningful occupational participation. From this broadened understanding, quantitative measures should be applied to improve the standardisation of measurements for occupational justice and social inclusion in policy, research and practice.

Exploration of recovery of people living with severe mental illness (SMI) in low-income and middle-income countries (LMIC): a scoping review protocol.

INTRODUCTION: The construct of recovery was conceptualised in high-income countries and its applicability in low-income and middle- income countries is underexplored. A scoping review is proposed to synthesise knowledge, review conceptual overlap and map key elements of recovery from severe mental illness in low-income and middle-income countries. We aim to appraise the literature so as to inform future recovery-oriented services that consider the cultural and contextual influences on recovery from severe mental illness. METHODS AND ANALYSIS: The following electronic databases: MEDLINE via PubMed, SCOPUS (which included contents of Embase), PsycINFO, CINAHL, Africa-Wide Information, PsycARTICLES, Health source: Nursing/Academic Edition, Academic Search Premier and SocINDEX all via the EBSCOHOST platform, the Latin American and Caribbean Health Sciences Literature, the Cochrane Centre Register of Controlled Trials) and grey literature sources will be searched between May and December 2019. Eligible studies will be independently screened for inclusion and exclusion by two reviewers using a checklist developed for this purpose. Studies published between January 1993 and November 2019 that focus on recovery from severe mental illness in a low-income and middle-income country will be included. Findings will be compared and discrepancies will be discussed. Unresolved discrepancies will be referred to a third reviewer. All bibliographic data and study characteristics will be extracted and thematically analysed using a tool developed through an iterative process by the research team. Indicators will be classified according to a predefined conceptual framework and categorised and described using qualitative content analysis. ETHICS AND DISSEMINATION: The review aims to synthesise information from available publications, hence it does not require ethical approval. The results will be disseminated through publications, conference presentations and future workshops with stakeholders involved within the recovery paradigm of mental health policy and practice. The scoping review title is registered with the Joanna Briggs Institute.

"It is not what I planned for my life". Occupations of live-in domestic workers / "Não foi isso que planejei para minha vida". Ocupações de empregadas domésticas que moram no local de trabalho

Abstract Introduction In Brazil, nearly 20% of women in the country are domestic workers. Domestic work has a restrictive nature that can lead to occupational deprivation and occupational marginalization. This may be the case of live-in domestic workers in Brazil. Objective Our research question was: What are Brazilian domestic workers' experiences in participating in their occupations in everyday life? Method A qualitative phenomenological was carried out and thought purposive sampling 5 participants were selected in the Plano Piloto region, Brasilia, DF, Brazil. Data was collected through face-face interviews and analyzed using Systematic Text Condensation. Results The data analysis yielded one theme and two categories. The theme, Grappling with being a domestic worker, described the domestic workers ongoing confrontations and tensions experienced in their daily lives. This experience of wresting with the influence of being a domestic worker was constituted through two categories, namely a sense of 'Belonging to the labor role' and 'Exceptionalism: a employers' negotiation tactic'. Conclusion Our work contributes to a critical perspective of occupation. We focus on how historical, social and political factors contribute to creating oppressive environments that influences domestic workers as people who are part of a marginalized group. This occurs in the way that their occupations are constructed in their doing in every-day life.

Resumo Introdução No Brasil, aproximadamente 20% das mulheres são trabalhadores domésticas. O trabalho doméstico tem uma natureza restritiva, que pode resultar em privação ocupacional e marginalização ocupacional. Esse é possivelmente o caso das trabalhadoras domésticas brasileiras que moram no local de trabalho. Objetivo Identificar quais são as experiências cotidianas de participação em ocupações destas mulheres. Método Um estudo qualitativo, de abordagem fenomenológica foi desenvolvido, 5 participantes foram selecionadas no Plano Piloto, em Brasília, DF, Brasil. A coleta de dados foi realizada por entrevistas e analisadas usando Systematic Text Condensation. Resultados A análise dos dados levou a um tema e duas categorias. O tema 'agarrada em ser empregada doméstica' descreve as constantes confrontações e tensões vividas em suas vidas cotidianas. Essas experiências de lutas em ser empregada doméstica constituem as duas categorias: (i) 'pertencendo ao papel de trabalhadora' e (ii) 'exceções, uma tática de negociação de empregadores'. Conclusão Nosso trabalho contribui para uma perspectiva crítica da ocupação. Nosso foco em como fatores históricos, sociais e políticos contribuem para criação de ambientes opressivos que resultam em um processo de marginalização da condição de empregada doméstica.

Occupational justice and social inclusion in mental illness and HIV: a scoping review protocol.

INTRODUCTION: Mental illness and HIV remain prevalent as chronic and stigmatised conditions and a global public health concern. Disability-adjusted life-years due to comorbid neuropsychiatric conditions and HIV are rising. Occupational justice and social inclusion emphasise the importance of equity and the utility of resources and opportunities for all to engage in diverse, healthy and meaningful activities. However, succinct conceptualisation of social inclusion and occupational justice, including the relationship between these concepts is still limited. This hampers their effective utilisation in research and practice. Here, we present our scoping review protocol to appraise literature to describe and explain the state of conceptualisation of occupational justice and social inclusion in relation to mental illness and HIV. We are aiming to review the definitions, current utilisation and relationships between occupational justice and social inclusion to inform further theorisation and practice application. METHODS AND ANALYSIS: This scoping review protocol follows existing guidelines for scoping reviews in occupational therapy with particular attention on Arksey and O'Malley's (2005) scoping review framework. We iteratively developed a search strategy and carried out our search using the following databases: PubMed, Scopus, Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo and SocINDEX. To enhance the comprehensiveness of our search and capture all relevant information, we will also search a variety of grey literature sources. Two reviewers will independently screen eligible studies for inclusion. Bibliographic data, abstract content and aspects of the study design and findings will be extracted and thematically analysed. ETHICS AND DISSEMINATION: As secondary analysis, this scoping review does not require ethics approval. Results will summarise and disseminate existing research related to occupational justice and social inclusion in mental health and HIV/AIDS care, describing the conceptualisation, relationships between concepts and identifying gaps for further research and practical application. We will disseminate the results through peer-reviewed journals and conferences, targeting clinicians, academics, researchers and policy makers.

Recovery From Substance Abuse Among Zimbabwean Men: An Occupational Transition.

Substance abuse is a rising global problem, associated with medical, psychiatric, family, occupational, legal, political, financial, and spiritual problems. Recovery is an important area of consideration in occupational therapy's quest to promoting health and well-being. This narrative inquiry explored the journey of recovery from substance abuse among young adult Zimbabwean men. Three men were purposively selected to participate in in-depth narrative interviews about their occupations during recovery. Data were analyzed using a narrative analysis. Explanatory stories and three superordinate themes illustrated how substance abuse was associated with both positive and negative outcomes. The recovery process emerged as an ongoing occupational transition, influenced by occupational identity and involving changes in occupational participation. Recovery from substance abuse can be conceptualized as an occupational transition. Ongoing participation in "healthy" and meaningful occupations is key factor in this process. Construction of a positive occupational identity is also central.