Evidence-based Recovery Colleges: developing a typology based on organisational characteristics, fidelity and funding.

PURPOSE: Recovery Colleges (RCs) have been implemented across England with wide variation in organisational characteristics. The purpose of this study is to describe RCs across England in terms of organisational and student characteristics, fidelity and annual spending, to generate a RC typology based on characteristics and to explore the relationship between characteristics and fidelity. METHODS: All RC in England meeting criteria on recovery orientation, coproduction and adult learning were included. Managers completed a survey capturing characteristics, fidelity and budget. Hierarchical cluster analysis was conducted to identify common groupings and generate an RC typology. RESULTS: Participants comprised 63 (72%) of 88 RC in England. Fidelity scores were high (median 11, IQR 9-13). Both NHS and strengths-focussed RCs were associated with higher fidelity. The median annual budget was £200,000 (IQR £127,000-£300,000) per RC. The median cost per student was £518 (IQR £275-£840), cost per course designed was £5,556 (IQR £3,000-£9,416) and per course run was £1,510 (IQR £682-£3,030). The total annual budget across England for RCs is an estimated £17.6 m including £13.4 m from NHS budgets, with 11,000 courses delivered to 45,500 students. CONCLUSION: Although the majority of RCs had high levels of fidelity, there were sufficiently pronounced differences in other key characteristics to generate a typology of RCs. This typology might prove important for understanding student outcomes and how they are achieved and for commissioning decisions. Staffing and co-producing new courses are key drivers of spending. The estimated budget for RCs was less than 1% of NHS mental health spending.

The biological paradigm of psychosis in crisis: A Kuhnian analysis.

The philosophy of Thomas Kuhn proposes that scientific progress involves periods of crisis and revolution in which previous paradigms are discarded and replaced. Revolutions in how mental health problems are conceptualised have had a substantial impact on the work of mental health nurses. However, despite numerous revolutions within the field of mental health, the biological paradigm has remained largely dominant within western healthcare, especially in orientating the understanding and treatment of psychosis. This paper utilises concepts drawn from the philosophy of Thomas Kuhn to explore the impact of what Kuhn terms 'anomalies' within the dominant biological paradigm: the anomaly of the meaningful utterance, the anomaly of complex aetiology and taxonomy and the anomaly of pharmacological inefficacy in recovery. The paper argues that the biological paradigm for understanding psychosis is in crisis and explores the implications for mental health nursing.

Recovery Colleges Characterisation and Testing in England (RECOLLECT): rationale and protocol.

BACKGROUND: Recovery Colleges are a relatively recent initiative within mental health services. The first opened in 2009 in London and since then numbers have grown. They are based on principles of personal recovery in mental health, co-production between people with lived experience of mental health problems and professionals, and adult learning. Student eligibility criteria vary, but all serve people who use mental health services, with empirical evidence of benefit. Previously we developed a Recovery College fidelity measure and a preliminary change model identifying the mechanisms of action and outcomes for this group, which we refer to as service user students. The Recovery Colleges Characterisation and Testing (RECOLLECT) study is a five-year (2020-2025) programme of research in England. The aim of RECOLLECT is to determine Recovery Colleges' effectiveness and cost-effectiveness, and identify organisational influences on fidelity and improvements in mental health outcomes.  METHODS: RECOLLECT comprises i) a national survey of Recovery Colleges, ii) a prospective cohort study to establish the relationship between fidelity, mechanisms of action and psychosocial outcomes, iii) a prospective cohort study to investigate effectiveness and cost-effectiveness, iv) a retrospective cohort study to determine the relationship between Recovery College use and outcomes and mental health service use, and v) organisational case studies to establish the contextual and organisational factors influencing fidelity and outcomes. The programme has been developed with input from individuals who have lived experience of mental health problems. A Lived Experience Advisory Panel will provide input into all stages of the research. DISCUSSION: RECOLLECT will provide the first rigorous evidence on the effectiveness and cost effectiveness of Recovery Colleges in England, to inform their prioritising, commissioning, and running. The validated RECOLLECT multilevel change model will confirm the active components of Recovery Colleges. The fidelity measure and evidence about the fidelity-outcome relationship will provide an empirically-based approach to develop Recovery Colleges, to maximise benefits for students. Findings will be disseminated through the study website (researchintorecovery.com/recollect) and via national and international Recovery College networks to maximise impact, and will shape policy on how Recovery Colleges can help those with mental health problems lead empowered, meaningful and fulfilling lives.

Inpatient Institutional Care: The Forced Social Environment.

The landscape of mental health recovery is changing; there have been calls for a shift from the clinical expertise being the dominant voice within mental healthcare towards a more personalised and collaborative service that supports those in need of mental healthcare to define what recovery is for the individual. Within this new recovery movement, there has been a recognition of the importance of the social environment in which individuals are situated and the relationship of this to mental health and wellbeing. Included in this is the importance of an individual's role within society and the ways in which knowledge, such as experts by experience, can hold an important value. The argument then, is that social connectedness forms part of the recovery journey and that relationships can help us develop or re-connect with who we are in powerful ways. Such a view has only been strengthened by the recent and ongoing global COVID-19 pandemic. Within the UK, discussions of the importance of our wellbeing have become commonplace within the context of restricted social contact. With this heightened awareness of how the social contributes to wellbeing, it is important to consider the environments in which those in receipt of mental healthcare are situated. One of which is institutionalised care, where it is commonplace to restrict social contact. For example, by virtue of being within a locked environment, individuals' freedom of movement is often non-existent and thus contacts with those not residing or working within the institution is restricted. While such restrictions may be deemed necessary to protect the individual's mental health, such environments can be unintentionally toxic. Data are presented from an ethnography that was conducted within an inpatient forensic mental health hospital in the UK to highlight the problematic social environment which some individuals experience. Key interpersonal issues are presented, such as, trust, racism, the threat of physical violence and bullying that was experienced by staff and residents at the hospital. Consideration is given to the coping strategies enacted by residents and the pathologising of such behaviour. The consequences on interpersonal wellbeing are explored.

How Can Poetry Support the Understanding of Psychotic Experiences? - A Conceptual Review.

OBJECTIVE: The therapeutic application of poetry for those who have experienced psychosis remains under researched and potentially undervalued. This paper presents a conceptual review exploring the relationship between poetry and psychosis, based on a synthesis of existing literature. RESEARCH DESIGN AND METHODS: The review identified papers from a range of sources and disciplines. Initial searches were undertaken using databases CINAHL, PsycINFO and ASSIA; this search was then followed up with a library search for key texts and a further search for associated grey literature involving exploring blogs and conference presentations. The data was then synthesized based on methods from both narrative review and thematic analysis to generate a conceptual framework. RESULTS: The results reveal a conceptual framework comprised of three domains: i) psychotic language as meaningful poetics, ii) poetry as an expression of psychosis and iii) poetic exchange as therapeutic practice. The conceptual framework proposes that not only can psychosis be understood as meaningful poetics, but also that poetry may offer meaningful linguistic opportunities to aid the expression and narration of self and experiences. The potential for extending our understanding of the poetry in this way is analogous to forms of talking therapy, and this may be a base for extending understanding and communicative practice for a range of mental health professions. CONCLUSION: The conceptual framework suggests a novel understanding of psychosis in relation to poetry, moving away from traditional biomedical paradigms and placing importance upon individual narratives.

The ethics of reflective research in single case study inquiry.

TOPIC: Recent developments in policy change in the governance of research ethics in the UK are reviewed and discussed regarding how the changes in informed consent impacts on single case study research. CONCLUSIONS: Changes in the ethics of health research (particularly in the UK) and informed patient consent have potentially negative implications for case study research where overregulated research guidance may impinge on patient treatment. PRACTICE IMPLICATIONS: The psychotherapy milieu is a highly protective environment where case study research design has, historically, been effectively applied without compromising clients' interests and treatment. A distinction between "prospective" and "reflective" psychotherapy research is proposed that offers an ethical foothold, protecting patients and allowing scope for practitioners to continue to advance knowledge from their reflective practice.

Chess & schizophrenia: Murphy v Mr Endon, Beckett v Bion.

This paper reconvenes Samuel Beckett's psychotherapy with Wilfred Bion during 1934-1936 during which time Beckett's conceived and began writing this second novel, Murphy. Based on Beckett's visits to the Bethlem & Maudsley Hospital and his observation of the male nurses, the climax of Murphy is a chess match between Mr Endon (a male schizophrenic patient) and Murphy (a male psychiatric nurse). The precise notation of the Endon v Murphy chess match tells us that the Beckett intended it to be an exemplar of an anti-match, perhaps a metaphor for the tragedy of being locked into madness. It is also argued that the match offers us insight into Beckett's experience of the process of psychotherapy with Bion. Based on new information from Beckett's nephew and Bion's widow, hypotheses about the long term impact of the Bion-Beckett analysis are advanced as a mutual experience which shaped the lives and later literary output of both men, producing conjoined career writings which continue to offer us stark and sublime condensations of depression, psychosis, and the challenges of therapy and recovery.