The transformation from custodial to recovery-oriented care: a paradigm shift that needed to happen.

As custodial mental health services are beginning to adopt a recovery-oriented model of care, it is imperative that successes in the transformation to recovery are captured. The aim of this illustrative case study was to describe the organizational procedure that enabled the systematic transformation of a custodial mental health service to a service with a self-professed recovery orientation as its model of service delivery. One-to-one interviews with key stakeholders and a document analysis were completed to thoroughly describe the transformation of the service. Four major themes arose from the data: (a) "We had this whole paradigm shift that needed to happen;" (b) "Think recovery," the development of a manualized guide; (c) "Stepping out my recovery;" adaptation of the service guide to the secure care context; and (d) developing the culture. The "developing the culture" major theme was subcategorized to consist of (a) the right people, (b) education, (c) reflective learning, and (d) leadership. The themes provided insights to assist mental health nurses to understand the processes involved in systems transformation. However, the major successes of the service, although only recently evaluated, commenced over a decade ago and yet continue to evolve.

Recovery-oriented care in older-adult acute inpatient mental health settings in Australia: an exploratory study.

Recovery-oriented care acknowledges the unique journey that consumers lead with the aim of regaining control of their lives in order to live a good life. Recovery has become a dominant policy-directed model of many mental health care organizations, but in older-adult acute mental health inpatient settings, nurses do not have a clear description of how to be recovery-oriented. The aims of this study were to determine the extent to which elements of existing nursing practice resemble the domains of recovery-oriented care and provide a baseline understanding of practice in preparation for transformation to recovery-oriented mental health care provision. An exploratory, qualitative research design was used to meet the research aims. A purposive sample of mental health nurses (N = 12) participated in focus groups in three older-adult inpatient settings in Australia. A general inductive approach was used to analyze the qualitative data. The mental health nurses in this study readily discussed aspects of their current practice within the recovery domains. They described pragmatic ways to promote a culture of hope, collaborative partnerships, meaningful engagement, autonomy and self-determination, and community participation and citizenship. Nurses also discussed challenges and barriers to recovery-oriented care in older-adult acute mental health settings. This study identified a reasonable baseline understanding of practice in preparation for transformation to recovery-oriented older-adult mental healthcare provision. A concerted drive focused on recovery education is required to effectively embed a recovery-orientated paradigm into older-adult mental health settings.

Recovery-oriented care in acute inpatient mental health settings: an exploratory study.

Australian mental health nurses will need to care with consumers of mental health services, within the domains of recovery. However, in acute inpatient mental health settings, nurses are without a clear description of how to be recovery-oriented. The intent of this qualitative study was to ask nurses to reflect on and describe current practice within acute inpatient services that are not overtly recovery-oriented. Results show that nurses can identify recovery and articulate with pragmatic clarity how to care within a recovery-oriented paradigm. Pragmatic modes of care described by nurses support using "champions" to assist with eventual system transformation in the delivery of mental health services.

Recovery-oriented care in a secure mental health setting: "striving for a good life".

Recovery-oriented care acknowledges the unique journey of the consumer to regain control of his or her life in order to live a good life. Recovery has become a dominant policy-directed model of mental health service delivery. Even services that have traditionally been institutional and custodial have been challenged to embrace a recovery-oriented model. The aim of this qualitative study was to provide a description of service delivery in a secure in-patient mental health service, which has developed a self-professed recovery-oriented model of service delivery. An in-depth case study of the secure in-patient service using an exploratory research design was undertaken to meet the aim of this study. Qualitative data was gathered from interviews with consumers and staff (n = 15) and a focus group with carers (n = 5). Data were analyzed using a content analysis approach. Ethical approval for the study was obtained. The stakeholders readily described the secure service within recovery domains. They described a common vision; ways to promote hope and autonomy; examples of collaborative partnership which enhanced the goal of community integration; a focus on strength-based, holistic care; and the management of risk by taking calculated risks. Discrepancies in the perceptions of stakeholders were determined. This case study research provides a demonstrable example of recovery-in-action in one secure mental health service in Australia. It is intended to assist mental health services and clinicians seeking guidance in developing strategies for building and maintaining partnerships with consumers and carers in order for secure services to become truly recovery-oriented.

Carbon dynamics and budget in a Zoysia japonica grassland, central Japan.

The ecosystem carbon budget was estimated in a Japanese Zoysia japonica grassland. The green biomass started to grow in May and peaked from mid-July to September. Seasonal variations in soil CO(2) flux and root respiration were mediated by changes in soil temperature. Annual soil CO(2) flux was 1,121.4 and 1,213.6 g C m(-2) and root respiration was 471.0 and 544.3 g C m(-2) in 2007 and 2008, respectively. The root respiration contribution to soil CO(2) flux ranged from 33% to 71%. During the growing season, net primary production (NPP) was 747.5 and 770.1 g C m(-2) in 2007 and 2008, respectively. The biomass removed by livestock grazing (GL) was 122.1 and 102.7 g C m(-2), and the livestock returned 28.2 and 25.6 g C m(-2) as fecal input (FI) in 2007 and 2008, respectively. The decomposition of FI (DL, the dry weight loss due to decomposition) was very low, 1.5 and 1.4 g C m(-2), in 2007 and 2008. Based on the values of annual NPP, soil CO(2) flux, root respiration, GL, FI, and DL, the estimated carbon budget of the grassland was 1.7 and 22.3 g C m(-2) in 2007 and 2008, respectively. Thus, the carbon budget of this Z. japonica grassland ecosystem remained in equilibrium with the atmosphere under current grazing conditions over the 2 years of the study.