Research circles as a method for implementing new services in the public health and welfare system.

BACKGROUND: Co-creation has become a guiding principle in public service innovation, but more knowledge is still needed on overcoming barriers and increasing the effectiveness of co-creation processes. This study explores the research circle method as a concrete methodology for co-creation, and its application within two cases involving the implementation of new services for drug death-bereaved persons in Norway based on new research-based knowledge. METHOD: The study followed an action research design. The field notes and audio recordings were analysed using reflexive thematic analysis. RESULTS: The analysis identified two key dimensions experienced as important for the implementation of the new services when research circles were used as a method for co-creation: 1) the inclusion of participants from different contexts and 2) support structures for service interventions. DISCUSSION: Research circles are discussed as an important support structure for promoting public value co-creation that can contribute to increasing stakeholders' capacity for implementing services in the public system, especially when the focus is on the perspectives and interests of stakeholders, such as practitioners and management in public health and welfare services. However, the discussion also points to barriers relating to the co-creation process that need to be considered when planning research circle-based interventions.

How older adults recovering from substance use problems experience mattering.

AIM: Mattering (to feel valued and add value to self and others) is a fundamental human experience and mechanism in recovery. In this paper, we concern ourselves with the recovery of older adults with substance problems. This population is on the rise in many Western countries. To offer mattering enhancing programs for this group, more knowledge about later life mattering in service-assisted recovery processes is needed. This study aims to explore experiences of mattering in older adults receiving services to recover from substance use problems. METHODS: A collaborative and deductive reflexive thematic approach was applied in analysing 23 interviews with participants using substance use services. Participants were recovering from different substance use problems: alcohol, medication and illegal substances. The participants were recruited from three different Norwegian social contexts: two urban and one medium size municipality. The age of the sample ranged from 65-80 years, with approximately equal numbers for those aged 60-69 (12 participants) and 70-80 (11 participants). Seven participants were women and 16 men. RESULTS: Three main themes were identified in the analysis: "relational experiences of mattering and not mattering", "service-related experiences of mattering and not mattering" and "recovery and psychological sense of community as interrelated phenomena to experiences of mattering". The findings illustrate various nuanced experiences of mattering and not mattering in later life recovery processes. CONCLUSIONS: Overall, the participants' mattering experiences rested on fair, healthy and positive community relationships and fair and attentive services, where participants could feel valued and also have a chance to add value to others. Experiences of not mattering were precipitated by lack of support, disrespect, devaluation and loss of relationships, and also by being ignored and not receiving fair treatment and help by professionals. Importantly, reciprocal and enhancing relations between mattering, recovery and relational PSOC seem to exist and to be significant for the older adults' access to substance use services. Several practical implications are suggested to promote the therapeutic and preventive potentials of later life mattering in recovery.

'Living needs a landscape': A qualitative study about the role of enabling landscapes for people with mental health and substance abuse problems.

The deinstitutionalization of mental health institutions has enabled service users to live in the community and search for what Duff coins 'enabling places.' These places were explored through walking interviews, in which service-users led the way. This analysis revealed features which made places promote liveable lives: places help people explore, places help people stand out, places give people responsibilities, and places dare people. An adverse feature was also identified: places define people by their problems. Overall, we suggest that 'living needs a landscape' to capture how a diversity of places form an 'enabling landscape'. This suggests a shift of focus in research and treatment, from internal to external landscapes.

A qualitative study of children's experiences with school-based divorce groups led by teachers in Denmark.

New interventions are offered to children of divorced parents in Danish schools. Establishing conversation groups can be seen as part of this overall effort to increase pupils' well-being. This new practice leads to new professional challenges when teachers facilitate group processes and call for in-depth studies of children's own perspectives on their participation in these interventions. This article is based on ethnographic fieldwork and asks the following research question: 'How do children make sense of the professionals' double role as both group leader and teacher when facilitating the conversation-groups in schools?' The study draws on 23 interviews with children and observations in four conversation groups in Denmark. Theory of social representations is used as an analytical tool to explore the dilemmas of school interventions for children of divorced parents. The analysis presents three dominant themes: the group leader's problematic double role, balancing the duty of confidentiality and trusting the group members. The analysis shows that children struggle to express feelings about their home situation in the school context. The importance of balancing the duty of confidentiality as a group leader is clearly reflected as a key factor, seen from the perspective of the child.

Experiences of the Quality of the Interplay between Home-Living Young Adults with Serious Mental Illness and Their Social Environments.

The purpose of this study is to explore the experiences of the interplay between home-living young adults in the community with a serious mental illness (SMI) and their social environment and how this experience influence their mental health and well-being in light of the theory of salutogenesis. In a qualitative study, nine young adults with SMI were interviewed. The interviews were transcribed and subjected to reflexive thematic analysis. The following three overarching themes characterized these young adults' experiences of such interplay: (1) a sense of shame and feeling less valued in society, (2) challenges in engagement and maintaining relationships, and (3) the significance of social support in one's family. Accordingly, the young adults experienced both the presence of good, constructive interplay with their social environment and deficits in this reciprocal feedback loop. Overall, this study illuminates the need for more tolerant health-promoting public attitudes to ensure that individuals with a SMI might experience better interplay by feeling that they are valued members of a nurturing society and that they can contribute to their local community. Participation in society should not be limited by one's illness or expectations of being recovered before one can fully participate in society. Experiencing social support and inclusion in society is essential to strengthen self-identity and fight against stigma, thus promoting a sense of coherence, health and well-being.

Managers as peer workers' allies: A qualitative study of managers' perceptions and actions to involve peer workers in Norwegian mental health and substance use services.

BACKGROUND: Citizens with experience and knowledge about what it is like to use mental health and substance use services are increasingly employed within similar services as peer workers. Peer workers are portrayed as achieving societal obligations and help ensure that the outputs from service provision are more effective. Even though peer workers have worked in mental health and substance use services for a while, few studies have focused on exploring managers' experiences and perspectives about involving peer workers. This knowledge is needed because these managers can enable and hinder equitable involvement and collaboration with peer workers. METHODS: A qualitative explorative study was chosen to explore the following research question: How do managers in Norwegian mental health and substance use services experience, relate to, and embrace peer workers as assets in these services? A researcher (Ph.D. student) and a coresearcher (peer worker) conducted four online focus groups with a strategic selection of 17 Norwegian mental health and substance use services managers who had some experience with the involvement of peer workers in their organizations. RESULTS: The results identified using systematic text condensation are as follows: [1] Peer workers boost the ongoing shift toward increased service user involvement. [2] Peer workers are highly valued in the service transformation process. [3] Managers involve peer workers as partners in co-creation. The results show that managers connect with peer workers and facilitate their involvement in collaborative activities across the service cycle. Peer workers' proximity to service users and bridging capacity is highlighted as the reasons for their involvement. Thus, peer workers are involved in co-defining challenges, co-designing potential solutions, co-delivering those service solutions, and, sometimes, co-assessing service solutions to rethink and improve services. As such, peer workers are considered partners in co-creation. CONCLUSION: As managers involve peer workers, they increasingly discover peer workers' value, and because peer workers are involved, they increase their skills and capacity for collaboration. This research strengthens the knowledge base of the perceived value of peer workers' roles, bringing in new perspectives from management about utilizing and evaluating peer worker roles.

Experiences with physical activity, health and well-being among young adults with serious mental illness.

PURPOSE: To explore how young adults with serious mental illness (SMI) experience physical activity and how these experiences influence their perceived health and well-being. METHODS: Nine young adults with SMI who had participated in an aerobic high-intensity interval training program were interviewed in depth. The interviews were transcribed and subjected to reflexive thematic analysis. RESULTS: The results indicated that people with SMI mainly experience physical activity as a meaningful activity that contributes to an increased sense of well-being and better health. However, to overcome various barriers, it is crucial to experience social support and encouragement. The following three main themes were identified through reflexive thematic analysis: (1) positive changes in focus and an increase in well-being occur through physical activity; (2) increased mental strength results from physical activity; and (3) a lack of support and feelings of safety prevent physical activity. CONCLUSIONS: This study shows that adapted physical activity is an important resistance resource that can promote stronger self-identity, increased mental well-being and social engagement and thus contribute to an improved ability to manage stressors. Furthermore, the findings reveal that to engage in physical activity and promote sustainable life changes, it is important for individuals to choose a physical activity based on personal interest and meaning.

Mattering, wellness, and fairness: Psychosocial goods for the common good.

Whereas the behavioral and health sciences have been mainly concerned with the private good, there is an urgent need to understand and foster the collective good. Without a coherent framework for the common good, it will be extremely difficult to prevent and manage crises such as pandemics, illness, climate change, poverty, discrimination, injustice, and inequality, all of which affects marginalized populations disproportionally. While frameworks for personal well-being abound in psychology, psychiatry, counseling, and social work, conceptualizations of collective well-being are scarce. Our search for foundations of the common good resulted in the identification of three psychosocial goods: mattering, wellness, and fairness. There are several reasons for choosing them, including the fact that they concurrently advance personal, relational, and collective value. In addition, they represent basic human motivations, have considerable explanatory power, exist at multiple ecological levels, and have significant transformative potential. The complementary nature of the three goods is illustrated in an interactional model. Based on empirical evidence, we suggest that conditions of justice lead to experiences of mattering, which, in turn, enhance wellness. Challenges and opportunities afforded by the model at the intrapersonal, interpersonal, occupational, communal, national, and global levels are presented. The proposed psychosocial goods are used to formulate a culture for the common good in which we balance the right with the responsibility to feel valued and add value, to self and others, in order to promote not just wellness but also fairness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reconnecting with relational values in highly conflicted separating couples: A narrative therapy-informed relational interviewing teamwork-based supervision approach.

This article outlines a new supervision practice of narrative therapy-informed reflecting team-based relational interviewing for a high-conflict stuck case of a separated middle-aged couple. The article demonstrates the supervision method consisting in five parts. First, the supervisor interviews the couples' relationship while the team watches from behind the one-way mirror. Second, the team responds to the interview while the couple and the supervisor witness their conversation. The couple is then invited to respond back to the team. Furthermore, there is a meta-conversation about the supervision in collaboration with the couple. The intervention ends with therapeutic letter writing to the relationship. The couple showed a meaningful shift in their positioning towards a more relational awareness and found valuable ways for continuing their therapy. The theoretical elements of the approach underpinning practice to tackle high conflict are considered through the illustration of the case.

Peer Workers in Co-production and Co-creation in Mental Health and Substance Use Services: A Scoping Review.

People with lived experience of mental health challenges are extensively employed as peer workers within mental health and substance use services worldwide. Research shows that peer workers benefit individuals using such services and can have essential roles in developing recovery-oriented services. However, understanding how peer workers' contributions, by their role, functions, and input can be better used remains a critical challenge. Research on public sector innovation has focused on relevant actors collaborating to tackle complex demands. Co-production and co-creation are concepts used to describe this collaboration. Co-production refers to the collaboration between providers and users at the point of service delivery, whereas co-creation refers to collaboration starting in the early service cycle phases (e.g., in commissioning or design), including solution implementation. We overviewed research literature describing peer workers' involvement in mental health and substance use services. The research question is as follows: How are peer workers involved in co-production and co-creation in mental health and substance use services, and what are the described outcomes? A literature search was performed in 10 different databases, and 13,178 articles were screened, of which 172 research articles describing peer workers' roles or activities were included. The findings show that peer workers are involved in co-production and function as providers of pre-determined services or, most often, as providers of peer support. However, they are rarely engaged as partners in co-creation. We conclude that the identified peer worker roles have different potential to generate input and affect service delivery and development.

From public health to public good: Toward universal wellbeing.

We aim to consolidate recent trends in public health into a reconceptualization of the field as public good. We build on several strands of theory, research and action to formulate a more impactful future for the field. Our argument comprises three main parts. In the first part, we describe the central components of the proposed public good: conditions of justice, experiences of mattering, and outcomes of subjective and objective wellbeing. In the second section, we identify continua of practices that paint a trajectory from traditional public health to ecological and participatory public health, to universal wellbeing framed as a public good. The continua are defined in terms of assumptions, practices and roles. Among others, these continua pertain to capabilities, scope of the field, ecological focus, timing of intervention, role of citizen, role of professional, role of settings and role of government. Finally, the third section introduces a series of strategies and recommendations to make the narrative of universal wellbeing as public good a reality.

Picturing healthcare: a photovoice study of how healthcare is experienced by service users in a mental-health low threshold service.

BACKGROUND: A recent policy change dictates that all mental healthcare in Norway must be referred and documented in the medical record of the service users. This has not been the case within low threshold mental health services, which is services without referrals, social arenas where healthcare professionals are available and where service users themselves can choose to attend based on their self-reported needs. This challenges the idea of "healthcare" being a medical term as opposed to experienced and expressed by the service user. A new healthcare understanding that includes the service users' voices are thus needed, and the aim of this study is to explore how service users within low threshold services, understand, describe, and experience healthcare. METHODS: The present study has used the photovoice approach to explore how four service users perceive and experience healthcare in a low threshold context. The chosen photovoice method enabled service users to reflect upon and communicate their experiences first visually by individual pictures and thereafter reflective texts emerged through seven workshops. A qualitative thematic analysis was performed based on the pictures, notes and audiotaped material from the workshops. RESULTS: The analysis found three main themes showing how healthcare is experienced: availability of people, availability of places and availability of activities. This is illustrated through the following sub-themes: First, common community, good relations and fellowship, second, flexible and easily accessible support, which includes the opportunity to spend time and to try things out in a safe environment, and third, facilitation and motivation for participation and activity, given the opportunity to have a meaningful role and be seen as a resourceful human being. CONCLUSIONS: A new understanding of healthcare is needed in the context of recovery-oriented low threshold services, as today`s largely medical understanding of healthcare is challenging to connect to a relational, recovery-oriented understanding of healthcare. As healthcare are to be documented in service users medical record, further research should explore how to document healthcare based on a new or extended, relational understanding of healthcare.

In what ways do emerging adults with substance use problems experience their communities as influencing their personal recovery processes?

Applying the multiple psychological sense of community concept (MPSOC), this study explored how emerging adults with substance use problems experience the influences of various senses of community and communities on their personal recovery processes. Semi-structured interviews with 21 emerging adults from different urban contexts in Norway were analysed using a collaborative, seven-step, deductive, and reflexive thematic approach. MPSOC is shown to be a key concept for achieving a broad, in-depth understanding of emerging adults' senses of community and personal experiences of community influences on recovery processes from substance use. Positive and negative senses of community in geographical, relational, substance use-related and ideal communities influence the potentials and challenges in emerging adults' recovery processes. Supportive and motivating community relationships, meaningful activities with peers, and distance from recovery-impeding communities were identified as important recovery components. To promote recovery and prevent substance use in emerging adults, community approaches and tools applied in substance use treatment have to take into account and utilise multidimensional and age group-specific aspects of belonging.

"A mismatch between what is happening on the inside and going on, on the outside": a qualitative study of therapists' perspectives on student mental health.

BACKGROUND: Although a growing number of studies indicates a high prevalence of reported mental health problems in students and that the problems are growing in number and severity, less is known about the experiences of students facing mental health problems and personnel who interact with students that seek help for these problems. The aim of this study is to examine the perspectives of therapists working with students seeking therapy for mental health problems. METHODS: A qualitative study of 15 therapists' perspectives. Data are collected with in-depth, semistructured and open-ended interviews, and analyzed using a reflexive thematic analysis. RESULTS: We developed four themes that summarize how the therapists viewed and understood the students' experiences of mental health problems: (1) an agonizing mismatch between the inside and the outside, (2) conflicting needs for closeness and distance, (3) no room for pain, and (4) a major potential for ripple effects. CONCLUSIONS: We relate our findings to the existing theory and research, and we discuss the implications for clinical practice and the limitations of the study. We argue that our findings demonstrate the need to provide students room to explore and make meaning of their difficulties and pain related to mental health problems, in addition to offer some symptom-reducing tools and techniques that can enhance performance and academic achievements. More research is needed to understand what student mental health problems might be related to and what students need.

Part II: Living Life: A Meta-Synthesis Exploring Recovery as Processual Experiences.

Recovery, a prominent concern in mental health care worldwide, has been variously defined, requiring further clarification of the term as processual. Few studies have comprehensively addressed the nature of recovery processes. This study aims to explore the nature and characteristics of experiences of recovery as processual. The method used is a form of qualitative meta-synthesis that integrates the findings from 28 qualitative studies published during the past 15 years by one research group. Three meta-themes were developed: (a) recovery processes as step-wise, cyclical, and continuous, (b) recovery as everyday experiences, and (c) recovery as relational. These themes describe how recovery is intertwined with the way life in general unfolds in terms of human relationships, learning, coping, and ordinary everyday living. This meta-synthesis consolidates an understanding of recovery as fundamental processes of living in terms of being, doing, and accessing. These processes are contextualized in relation to mental health and/or substance abuse problems and highlight the need for support to facilitate the person's access to necessary personal, social, and material resources to live an ordinary life in recovery.

Peer support workers in co-production and co-creation in public mental health and addiction services: Protocol for a scoping review.

Worldwide, there is a growing interest to employ people with lived experiences in health and social services. Particularly in mental health and addiction services, individuals with lived experience of mental health problems enter the workplace as peer support workers (PSW´s). Their aim in the services is to bring in the perspective of service users in interactive processes at the micro and macro levels. The services´ ability to exploit the knowledge from PSW´s lived experiences will influence both the content and quality of the services, its effectiveness and its capacity to innovate and change. The concepts of co-production and co-creation are used to describe these interactive processes in the services in the literature. While co-production is aimed at improving individual services, co-creation seeks to develop service systems. This scoping review aims to provide an overview of the research status of PSW´s different involvement, in co-production and co-creation, in public mental health and addiction services. Studies describing PSW´s involvement in co-production and co-creation will be contrasted and compared. Knowledge about PSW´s involvement in co-production and co-creation is vital for understanding and further developing these interactive processes with PSW´s. The studies reviewed will describe PSW´s different types of involvement in co-production and co-creation in public mental health and addiction services or across organizational and institutional boundaries. The research question is: How are peer support workers involved in co-production and co-creation in public mental health and addiction services, and what are the described outcomes? Literature searches are conducted in Medline, PsycINFO, Embase, Oria, WorldCat, Google Scholar, Scopus, Academic Search Elite, Cinahl, and Web of Science, from the inception of each database to January 4, 2021. Expected results are that PSW´s are often described as a frontline worker who spends most of their working hours in a joint effort to co-produce with service users. Fewer studies describe PSW´s involved in interactive processes to re-design or transform public services systems. It is anticipated that this scoping review will increase the knowledge of the services' abilities to exploit PSW´s expertise and inform policy and research.

"The troublesome other and I": Parallel stories of separated parents in prolonged conflicts.

This qualitative study aims to explore how noncohabiting parenting couples in prolonged conflict construct the other parent and themselves. Ten parents from five parent couples were interviewed. A dyadic analytical design was used, where parent's stories of conflict were analyzed in parallel with their co-parent. Drawing on positioning theory, self-identity as parents emerged as implicit counter positions in storylines, which construct the co-parent as "the troublesome other." Two typologies of conflicted storylines were prominent in the findings: storylines of violations of trust, positioning the co-parents in relation to traumatic events in the past and, storylines of who is bad, positioning the co-parent as either a disloyal co-parent or a dysfunctional parent. The findings indicate that prolonged conflicts made it impossible to find available positions for cooperation. We argue that family therapists should aid each household toward promoting child and family resilience rather than continued efforts to solve chronic conflicts.

Development of salutogenic coping skills: experiences with daily challenges among young adults suffering from serious mental illness.

PURPOSE: The purpose of this study is to explore experiences with daily challenges and the development of salutogenic copings skills among young adults with serious mental illness. METHODS: Nine young adults with serious mental illness were interviewed. The interviews were transcribed and subjected to reflexive thematic analysis. RESULTS: Two main themes were identified through the analysis: "The influence of symptoms in everyday life and challenges with participating in the community" and "Making the small things matter." The findings show that different life experiences, or on-going challenges, often can affect or interfere their lives on a daily basis, and that previous experiences with psychosis can contribute to the development of salutogenic coping skills. CONCLUSIONS: This study shows the importance of increased knowledge and awareness of different life experiences and challenges among people with serious mental illness such as schizophrenia spectrum disorders. It is significant to strengthen the ability to identify and use appropriate resistance resources to promote salutogenic coping skills and thus better health. Furthermore, it is important to be aware that the development of salutogenic coping skills must be personalized to cultural contexts and society as well as supported by local communities, families and services.

Relational welfare: a socially just response to co-creating health and wellbeing for all.

AIMS: Contemporary approaches to pursuing public value and the vision of health and wellbeing for all have evolved notably in the past few decades, with distinct approaches termed 'co-creation' and 'health promotion' gaining traction. This article explores a critique of ongoing paradigmatic shifts in public health and the public sector, focusing on cross-fertilisation between co-creation and the promotion of health and wellbeing. Drawing on Nancy Fraser's claims for social justice through redistribution, recognition and representation to achieve participatory parity, we discuss a need for transformative change to achieve societal goals of creating health and wellbeing for all, leaving no one behind. CONCLUSIONS: Health promotion and co-creation converge in a quest for active citizenship through participation, as well as embracing a whole-of-government and whole-of-society approach. However, inequity in such processes, as well as health and wellbeing outcomes, are still persistent and contradictory to health promotion aims. This article argues that radically attending to human relationships and our dependency on other humans as a 'collective' need to be placed at the core of future-forming social construction of public and democratic institutions to allow the ongoing cross-fertilisation between health promotion and co-creation to work. Responding to this calls for transformation, the article presents a framework for developing a relational approach to welfare. The framework advocates for 'relational welfare', which captures the intersection of the welfare state, democracy and human relationships attending to social justice, capabilities and health and wellbeing for all as key public values in societal development.