The role of peer support in recovery among clients with mental illness attending the psychiatric service in a tertiary hospital in Malaysia: a qualitative study.

BACKGROUND: The understanding that mental health recovery is a personal and subjective experience informs mental health policies in many countries. However, most of the populations in these studies are from the West, limiting their applicability in Asia. Peer support in mental health refers to helping and mentoring people who have overcome similar obstacles. Despite being proven to be effective in promoting recovery, little is known about its use in Malaysian psychiatric patients. This study aims to explore the participants' perspectives on their concept of recovery and how the peer support group (PSG) aid them to achieve recovery. METHODOLOGY: This study was conducted on clients with mental illness who attended the PSG provided by the Community Psychiatry and Psychosocial Intervention Unit in National University Malaysia Medical Centre. A qualitative generic inductive approach was employed in this thematic exploratory study. Purposive sampling was the method used to collect the data for this thematic exploratory study. In-depth interviews of 11 study participants were audio recorded and transcribed verbatim. Data were analyzed using Braun and Clarke (2006) descriptive thematic analysis method. RESULTS: The findings of this study highlighted six key themes; three pertaining to the participants' perspectives on the meaning of recovery (1. Gaining self-reliance and social inclusion, 2. Personal growth and improved life circumstances in recovery, and 3. Symptoms improvement) and another three pertaining to how the peer support group aids recovery (1. Empowerment and growth through peer support, 2. Promoting well-being, 3. Social connection and support). CONCLUSION: The findings of this study provide valuable insights into the perspectives of psychiatry clinic patients enrolled in PSG on the concept of recovery and the role of such groups in their recovery journey. The findings demonstrated that the PSG complemented the participants' perspectives on recovery, reinforcing the notion that a comprehensive and person-centered approach to mental health services is essential for successful and sustained recovery outcomes.

A Constructivist Grounded Theory Study on Mental Health Recovery from a Lived Experience Perspective in Singapore.

More contemporary personal recovery conceptualisation of mental health recovery emphasize the need to consider the perspectives of people who experience mental ill-health. Most lived experience research has been done in Western cultures with relatively few studies in Asian ones, creating a gap that needs to be addressed due to differences in cultural worldviews. This study explores the notion of recovery from the lens of people experiencing mental health challenges in Singapore. We adopted a constructivist grounded theory perspective to evaluate qualitative data from 21 participants. The core category which best represented what recovery meant was "reconciling and living with experiences of mental ill-health". Our findings suggest that a variety of societal aspects greatly influence perceptions of mental health recovery in Singapore, as participants often shared their desire to live a meaningful life within society but could only do so if they found a way to manage their symptoms more effectively.

A Missed Opportunity to Cultivate Positive Attitudes about Mental Health Recovery among Undergraduate Nursing Students - A Quasi-Experimental Controlled Study.

INTRODUCTION: Mental health recovery is a critical concept that needs to be thoroughly understood and supported by nurses. Undergraduate nurse educators have the opportunity to clarify misconceptions and cultivate positive recovery attitudes. AIM: To assess the impact of an undergraduate nursing course on attitudes toward mental health recovery and the relationship between recovery attitudes and prejudice toward those who experience a mental illness. METHODS: A quasi-experimental pretest-posttest, nonequivalent-control group study was conducted using a sample of undergraduate nursing students in New York City (N = 126). The intervention group was assigned to an undergraduate mental health nursing course and the control group to a pediatric/maternal health nursing course. Attitudes toward mental health recovery and prejudice were measured at the beginning and end of the semester. Two-way mixed analyses of variance were used to determine the differences in students' attitudes. Pearson product-moment correlation analyses were used to assess the relationship between prejudice toward people who experience a mental illness and attitudes toward recovery. RESULTS: The mental health nursing course had no measurable impact on students' recovery attitudes. However, there was a moderate-to-strong inverse relationship between recovery attitudes and prejudice toward those who experience a general mental illness (r = -0.54), depression (r = -0.60), or schizophrenia (r = -0.43). CONCLUSIONS: Curriculum reform is needed to optimize the impact of undergraduate education on students' attitudes. Possible changes include a more holistic approach to mental health that does not over accentuate the biomedical model, the use of nontraditional clinical sites that provide students an opportunity to interact with those further along in their recovery, and the inclusion of those in recovery in curriculum development. As there was a moderate-to-strong inverse relationship between recovery attitudes and prejudice, educational interventions that positively impact one may also impact the other. Further research is needed to investigate if the relationship is causal.

Supporting self-determination in mental health recovery: Strategies employed by occupational therapists.

INTRODUCTION: Self-determination is a core component of mental health recovery and a predictor of positive outcomes. The literature calls for occupational therapists to lead practice change to greater recovery-orientation, including facilitating people's self-determination. However, systemic challenges thwart translation of policy into practice and therapists report a lack of confidence in implementing recovery-oriented principles. This study aimed to understand the strategies that mental health occupational therapists employ to support people's self-determination. METHODS: Data were collected through an international on-line questionnaire principally comprising two open-ended questions designed to elicit deep reflective personal accounts. Participants were asked about an experience in which they supported a person's self-determination and the factors that either facilitated or hindered this experience. Qualitative data were analysed using inductive thematic analysis, guided by constant comparative methods. FINDINGS: Thirty-four therapists, predominantly from Australia (n = 30), participated. Therapists described supporting self-determination as a multifaceted process that involved: (1) working on myself, (2) working with the person, and (3) working with others. They emphasised that the combined use of various strategies across these three areas of work was important to support people's self-determination. Further, awareness of and addressing issues of power in their practice was key. CONCLUSION: This study supports the translation of recovery-oriented principles into practice by revealing the nuanced strategies implemented by occupational therapists striving to support self-determination. Participants employed diverse strategies to empower people to take the 'driver's seat' in their mental health recovery journey. Insights from this study will support other occupational therapists to actualise recovery-oriented principles and better support self-determination in their practice. To effectively implement self-determination strategies, therapists must reflect on and address existing power differentials within mental health services, particularly between themselves and the people they support.

Exploring gender impact on collaborative care planning: insights from a community mental health service study in Italy.

INTRODUCTION: Personal recovery is associated with socio-demographic and clinical factors, and gender seems to influence the recovery process. This study aimed to investigate: i) differences in the recovery goals of men and women users of a community mental health service in Italy; ii) any differences by gender in recovery over six months using the Mental Health Recovery Star (MHRS). METHODS: Service users and staff completed the MHRS together at recruitment and six months later to agree the recovery goals they wished to focus on. Socio-demographic and clinical characteristics and ratings of symptoms (BPRS), needs (CAN), functioning (FPS), and functional autonomy (MPR) were collected at recruitment and six months follow-up. Comparisons between men and women were made using t-tests. RESULTS: Ten women and 15 men completed the MHRS with 19 mental health professionals. Other than gender, men and women had similar socio-demographic, and clinical characteristics at recruitment. Women tended to choose recovery goals that focused on relationships whereas men tended to focus on work related goals. At follow-up, both men and women showed improvement in their recovery (MHRS) and women were less likely to focus on relationship related goals, perhaps because some had found romantic partners. There were also gains for both men and women in engagement with work related activities. Ratings of functional autonomy (MPR) improved for both men and women, and men also showed improvement in symptoms (BPRS) and functioning (FPS). CONCLUSIONS: Our findings suggest that collaborative care planning tools such as the MHRS can assist in identifying individualized recovery goals for men and women with severe mental health problems as part of their rehabilitation.

'Trials and Tribulations': The Ambivalent Influence of Temporary Accommodation on Mental Health Recovery in Chronically Homeless Adults.

Relatively few studies have explicitly examined whether and how shelter-type, temporary or emergency accommodation shapes homeless clients' personal (mental health) recovery. A transatlantic phenomenological qualitative study was conducted to examine the influence of those services on personal recovery. Eighteen chronically homeless adults with a history of serious mental illness were recruited from several temporary accommodation services in New York City (NYC), U.S., and Glasgow, Scotland. Participants completed repeat in-depth interviews and a novel one-week multimedia mobile phone diary. The interpretative phenomenological analysis (IPA) produced three overarching group experiential themes: 'everything was just starting to fall into place'; 'caught in a trap'; and 'trials and tribulations'. Collectively, the findings underscore the duality of influence of temporary accommodation on recovery. Those ambiguous spaces confronted participants with existential uncertainty, volatility and chronic boredom, but also proffered opportunities for envisioning and enacting recovery. Embarking on recovery while residing in temporary accommodation is possible, even for those enduring chronic life adversity. However, it is contingent upon enabling socio-material, affective and relational resources. Implications are discussed for theorising recovery as a contextually embedded, relational phenomenon, and for providing recovery-oriented support across the housing continuum.

Exploring the Efficacy of an Online Training Programme to Introduce Mental Health Recovery to Carers.

Family carers often support people with mental ill-health, however, there is a dearth of research on the importance of recovery to mental health carers. This article describes the delivery and qualitative evaluation of an online training programme on recovery to a group of eleven carers. The participants considered their understanding of the meaning of recovery, differentiating between its personal and clinical nature. They highlighted the importance of carer involvement in the service users' professional support, alongside the need for carers to participate more widely in service development. Finally, the participants found the training useful in enabling them to recognise their own needs in a caring journey, particularly valuing its delivery by a service user and carer trainer. This study is limited by the small number of participants in this programme; however, this series of connected studies suggests its potential to be rolled out more widely, possibly embedded in Recovery Colleges.

Nursing Students' Perceptions Toward Recovery in Mental Health: A Descriptive Qualitative Study.

BACKGROUND: Recovery in mental health remains inconclusive where the two most prevailing definitions "clinical" and "personal" remain. In nursing schools, students are predominantly taught straightforward concepts of clinical recovery, which result in only a perfunctory and rudimentary understanding of recovery among the undergraduates. AIMS: To explore the perceptions of nursing undergraduates on recovery for people experiencing mental health conditions. METHOD: A descriptive qualitative study was conducted on 14 nursing undergraduates from Years 1 to 4 of the study. Participants were recruited through convenience sampling, and the required sample size was determined by data saturation. Semistructured questions were used during the individual face-to-face interviews from October and December 2019. Recordings were transcribed verbatim; the transcripts were then subjected to thematic analysis. RESULTS: Three themes were identified to support the research questions: (1) semantics of major terms used in mental health care-where participants provided the description of terminologies used; (2) the meaning of recovery-where participants explained their views on "recovery"; and (3) sources of conceptualization-where participants explained their conceptual understanding on mental health conditions and recovery. CONCLUSION: The findings suggest that the need for a more holistic approach encompassing personal recovery should be included in the nursing curriculum. This is necessary to promote enabling support in the recovery of people experiencing mental health conditions beyond medical interventions.

Co-design and evaluation of a multidisciplinary teaching resource on mental health recovery involving people with lived experience.

BACKGROUND: Students from a range of health disciplines need to learn from people with lived experience of mental distress and recovery to develop recovery capabilities for mental health practice. AIMS: The aims of this study are to describe the co-design of a teaching resource, to explore the experience of people with lived experience during the resource development, and to evaluate the outcome of the resource on student recovery capabilities. METHOD: Using a sequential mixed method, a project group consisting of six people with lived experience and 10 academics from five health disciplines was convened to co-develop teaching resources. People with lived experience met independently without researchers on several occasions to decide on the key topics and met with the research team monthly. The teaching resource was used in mental health subjects for two health professional programmes, and the Capabilities for Recovery-Oriented Practice Questionnaire (CROP-Q) was used before and after to measure any change in student recovery capabilities. Scores were compared using the Wilcoxon signed rank test. The people with lived experience were also interviewed about their experience of being involved in constructing the teaching resources. Interviews were audiotaped, transcribed, and analysed thematically. RESULTS: The finished resource consisted of 28 short videos and suggested teaching plans. Occupational therapy and nursing student scores on the CROP-Q prior to using the educational resource (n = 33) were 68 (median) and post scores (n = 28) were 74 (median), indicating a statistically significant improvement in recovery capability (P = 0.04). Lived experience interview themes were (i) the importance of lived experience in education; (ii) personal benefits of participating; (iii) co-design experience; and (iv) creating the resource. CONCLUSION: Co-design of teaching resources with people with lived experience was pivotal to the success and quality of the final product, and people with lived experience described personal benefits of participating in resource development. More evidence to demonstrate the use of the CROP-Q in teaching and practice is needed.

A Testimony of Christian Drug Rehabilitation: Transformed by the Power of God.

ABSTRACT: Drug addiction is at crisis level in the United States. Nurses caring for persons affected by substance use disorder (SUD) have a resource in Mr. Ming Ho Liu's testimony on Good TV (Taiwan)-translated and summarized in this article-of his addiction experiences and successful treatment at Operation Dawn, a Christian drug rehabilitation center. Recovery from SUD is possible by God's power. In Mr. Liu's case, his recovery was accomplished without medication.

The phenotype of recovery VI: The association between life-history strategies, delay discounting, and maladaptive health and financial behaviors among individuals in recovery from alcohol use disorders.

BACKGROUND: The life-history theory is a well-established framework that predicts behaviors and explains how and why organisms allocate effort and resources to different life goals. Delay discounting (DD) is associated with risky behaviors and has been suggested as a candidate behavioral marker of addiction. Thus, we investigated the relationship between DD, life-history strategies, and engagement in risky behaviors among individuals in recovery from alcohol use disorder (AUD). METHODS: Data from 110 individuals in recovery from addiction from The International Quit & Recovery Registry, an ongoing online registry designed to understand recovery phenotype, were included in the analysis. The association between life-history strategies, DD, engagement in risky behaviors, and remission status were assessed. RESULTS: Life-history strategy scores were significantly associated with DD rates and finance, health, and personal development behaviors after controlling for age, sex, race, ethnicity, years of education, marital status, smoking status, and history of other substance use. Remission status was significantly associated with life-history strategy, DD, drug use, fitness, health, and safe driving after controlling for age, sex, race, years of education, marital status, and smoking status. In addition, a mediation analysis using Hayes' methods revealed that the discounting rates partially mediated the association between remission status and life-history strategy scores. CONCLUSIONS: Life-history strategies and remission status are both significantly associated with DD and various health and finance behaviors among individuals in recovery from AUD. This finding supports the characterizations of DD as a candidate behavioral marker of addiction that could help differentiate subgroups needing special attention or specific interventions to improve the outcomes of their recovery. Future longitudinal studies are warranted to understand the relationships between changes in life-history strategies, DD, maladaptive health behaviors, and remission status over time.

Posttraumatic growth and recovery among a sample of Egyptian mental health service users: a phenomenological study.

BACKGROUND: Delivery of recovery-oriented mental health practice is fundamental to personal recovery. Yet, there is lack of service users' accounts on what constitutes mental health recovery in Egypt. OBJECTIVES: The aim of this study was to explore mental health recovery meaning informed by people with personal experience of recovery. METHODS: A phenomenological research design was used. Semi-structured qualitative interviews were conducted with 17 adult community-dwelling individuals who identified as recovered/recovering from mental health issues. An inductive thematic analysis approach was used to analyses participants' responses. RESULTS: Participants predominately reported personal and functional definitions of mental health recovery. Posttraumatic growth was the strongest theme comprising: relation to others, spirituality, new possibilities, identity & strengths, and appreciation of life. Themes of acceptance and forgiveness, functional and clinical recovery, and finding hope were also identified. CONCLUSIONS: This is the first study to explore mental health recovery meaning among a sample of people with lived experience of mental health issues in Egypt. Findings suggest that developing and implementing psychosocial interventions to support posttraumatic growth among people with mental health issues is a priority.

'Maybe I Shouldn't Talk': The Role of Power in the Telling of Mental Health Recovery Stories.

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

Individualized Intervention to Support Mental Health Recovery Through Implementation of Digital Tools into Clinical Care: Feasibility Study.

Myriad digital tools exist to support mental health but there are multiple barriers to using these tools in routine care. This study aimed to assess the feasibility of an intervention incorporating a support role to help the clinical team identify and use technology to promote recovery. The technology specialist intervention is 3 months in duration and comprises four stages: goal setting, researching and evaluating tools, demonstrating and selecting tools, and ongoing support. We implemented the intervention in a community mental health center and a dual diagnosis treatment program, working with eight clients and their case managers. Clients and case managers willingly engaged with the technology specialist and found the intervention beneficial. Integration and collaboration with the care team facilitated implementation of the technology specialist in these real-world settings. Clients reported that the intervention made it easy to try a digital tool. Six of the eight participants stated that they made substantial progress toward their goals. The technology specialist is a promising new role for mental health care delivery to augment traditional services and enhance individualized recovery.

Supporting Mental Health Recovery, Citizenship, and Social Justice.

Individuals with serious mental illness (SMI) have historically experienced stigma and marginalization. Mental health providers are well positioned to engage in social justice agendas geared at supporting the civil rights of those with SMI, and ultimately helping open doors to the full rights of participation in the community. By engaging and partnering in a mental health recovery and strengths-based orientation, leaders in these settings have the capacity to influence micro-, meso, and macro-systems. This can shed light on mechanisms to build on the strengths, capabilities, and hopes of individuals to live lives of meaning as they so define, with equal access to resources and rights, within communities of their choice. The article articulates an integrated application of these concepts for embracing and utilizing the concepts of mental health recovery, citizenship, and social justice in public mental health. Additionally, specific examples and practical applications are offered within the context of an inpatient setting and a community setting.

A Pilot Remote Drama Therapy Program Using the Co-active Therapeutic Theater Model in People with Serious Mental Illness.

The impact of drama therapy on mental health recovery remains poorly understood. We examined the effects of a pilot remote drama therapy program for community members living with serious mental illness. The entire intervention was delivered remotely. Participants with serious mental illness completed a 12-week drama therapy program which included an online performance open to the public. Four quantitative scales were administered pre- and post-program. A focus group was conducted 1 week after the performance. Six participants completed the program and crafted a public performance themed around hope. No significant differences were identified in the quantitative measures. Five themes were identified in the post-performance focus group. Drama therapy presents an opportunity for individuals with serious mental illness to process and share their journeys with their diagnoses and re-create a healthy sense of self with increased community awareness.

A critical analysis of the Tidal Model of Mental Health Recovery.

The purpose of this paper is to critically analyze the Tidal Model of Mental Health Recovery. This examination consolidates the existing knowledge used in developing and implementing this model in order to add clarity and explores how its theory relates to practice, research, and educational activities. This paper follows Chinn and Kramer's theory analysis framework, which includes the following criteria: clarity, simplicity, generalizability, importance, and accessibility. While the Tidal Model theory meets the criterion of clarity, simplicity is impeded due to the complexity of its concepts. That being said, Barker's theory is applicable across different psychiatric nursing settings because it is general and accessible. To enhance simplicity and make this a more actionable mid-range theory, an illustration is offered to demonstrate how the theory could be utilized and empiricized with a potential population of women who use substances. It is concluded that the Tidal Model appeals not only to mental health practice, but as the literature indicates, it also supports everyone who needs shelter where they feel safe at some point in their lives.

A scoping review of gamification for mental health in children: Uncovering its key features and impact.

Mental health conditions in children and adolescents have wide-ranging effects, limiting opportunities for future productive lives. While there has been an upsurge of interest in using games for learning, gamification to optimize health outcomes is worth reviewing when this approach to address mental health conditions is in its infancy. A literature search was conducted with two hundred and fifteen articles involving participants up to 19 years of age with diagnosable mental health conditions, involving the concept of game design elements to motivate health in the context of comparing gamification and non-gamification approaches were retrieved after employing Boolean operators and pre-determined search strategies. Literature of participants with addiction to alcohol or substance use and organic brain issues were excluded as their mental health recovery differed regardless of gamification impact. Findings, extracted from 8 included articles following rigorous screening and critical appraisal, showed that gamification to relieve mental health symptoms were conducted via mobile devices or computers. Key features of the games involved applications or video where players with mental health conditions took on roles in a virtual world with narratives. Real-life knowledge and skills to manage the symptoms of mental health conditions were learned in the process as players leveled up in the game. Only one study utilized gamification platforms that could detect breathing changes but it was shown to be only helpful towards relief of anxiety symptoms. Nevertheless, the potential for gamification for mental health outcomes remains promising.

The significant mediators between depression and mental health recovery among community-dwelling people with a diagnosed mental disorder.

To investigate the mediating roles of community integration and positive thinking on the relationship between depression and mental health recovery among community dwelling people with mental disorders in South Korea. A cross-sectional, descriptive study was utilized. Data were collected from 167 community-dwelling people with mental disorders who did not use the day program at community mental health centers. Data were collected from November 20, 2018, to February 15, 2019. Both community integration and positive thinking were found to mediate the effects of depression on mental health recovery. The mediating effect of positive thinking was significantly greater than that of community integration. This study added evidence for a significant multiple mediating effect of community integration and positive thinking on the relationship between depression and mental health recovery in community-dwelling people with mental disorders. Although the consumer-centered recovery paradigm of people with mental health difficulties is of global importance, little research has been conducted on mental health recovery among community-dwelling people with mental disorders who do not use the day program at community mental health centers. It was found that community integration and positive thinking mediated the effects of depression on mental health recovery, with positive thinking mediating this relationship the most. Thus, these results suggest a specific direction of community mental health services to promote mental health recovery for people with mental disorders who do not have access to community mental health services.