Understanding recovery in the context of lived experience of personality disorders: a collaborative, qualitative research study.

BACKGROUND: Concepts of recovery increasingly inform the development and delivery of mental health services internationally. In the UK recent policy advocates the application of recovery concepts to the treatment of personality disorders. However diagnosis and understanding of personality disorders remains contested, challenging any assumption that mainstream recovery thinking can be directly translated into personality disorders services. METHODS: In a qualitative interview-based study understandings of recovery were explored in extended, in-depth interviews with six people purposively sampled from a specialist personality disorders' service in the UK. An interpretive, collaborative approach to research was adopted in which university-, clinical- and service user (consumer) researchers were jointly involved in carrying out interviews and analysing interview data. RESULTS: Findings suggested that recovery cannot be conceptualised separately from an understanding of the lived experience of personality disorders. This experience was characterised by a complexity of ambiguous, interrelating and conflicting feelings, thoughts and actions as individuals tried to cope with tensions between internally and externally experienced worlds. Our analysis was suggestive of a process of recovering or, for some, discovering a sense of self that can safely coexist in both worlds. CONCLUSIONS: We conclude that key facilitators of recovery - positive personal relationships and wider social interaction - are also where the core vulnerabilities of individuals with lived experience of personaility disorders can lie. There is a role for personality disorders services in providing a safe space in which to develop positive relationships. Through discursive practice within the research team understandings of recovery were co-produced that responded to the lived experience of personality disorders and were of applied relevance to practitioners.

Initial predictors of outcome in an early intervention in psychosis service.

AIMS: The aims of this study were to determine medium-term outcomes of a cohort of early intervention service users after discharge from the service. Additionally, to establish whether characteristics can be easily identified in the early stages of treatment to predict outcome, aid discharge planning and focus interventions. METHODS: One hundred fifty-five early intervention service users were followed-up for a mean of 4.6 years from the start of early intervention treatment. Patients were divided into good and poor outcome groups and these groups were compared on gender, duration of untreated psychosis, age at first presentation to mental health services, hospital admissions in the first year and time spent on the waiting list. RESULTS: A third of the patients had a good outcome, with a discharge to primary care and no subsequent return to mental health services. Good outcome was associated with a later age of first contact with mental health services and fewer hospital admissions in the first year of treatment. CONCLUSIONS: We would suggest that clinicians working in this and similar services could use these two factors as early as one year into treatment to begin to consider discharge planning, or conversely to focus resources most appropriately on those likely to benefit most or those who have the greatest predicted need. This study supports an optimist view of prognosis for a significant proportion of first-episode psychosis patients.