'ALL ABOUT MY IDEAL MENTAL HEALTH SERVICE': Users, family members and experts by experience discussing a co-designed service.

INTRODUCTION: Many studies have investigated patients' understandings of how to optimise mental health services. However, only a few studies in the Italian context have involved experts by experience (EbEs), who can be ex-users, family members of ex-users or current service collaborators. Their role is crucial in implementing collaborative service quality assessment projects. METHOD: The study investigated the experience of 35 EbEs,  users, and family members who carried out a 9-month fortnightly project aimed at imagining an 'ideal service'. The facilitators of the discussion groups (two EbEs) were interviewed; written reports of each meeting were produced with relevant comments, notes and specific suggestions; and content analysis was applied. RESULTS: The most important result concerns the effectiveness of the project management method and group leadership carried out by the two EbEs. This approach allowed for complete autonomy of the work, without professional gaze or power imbalance. Also, the ideas and specific contents focused on by the two groups offer strategies to facilitate users' entry and reception in health care centres, to reduce the stigma of mental illness, to improve the centres' physical environment, to improve organisational aspects, to keep family members actively involved and to network mental health services with other territorial services. CONCLUSIONS: EbEs have proven to be key figures in ensuring equity of role in the service co-design process. This also concerns a context, the Italian one, where their role has not yet been recognised and legalised. Their contribution and ideas to improve services could be fundamental not only in mental health centres, but also in other health facilities, and could concern the entire service delivery process rather than being limited to quality assurance, according to a virtuous circle based on active participation and transformation of the role of users. PATIENT OR PUBLIC CONTRIBUTION: This work resulted from close collaboration between the two EbEs who conducted the groups, users and family members, the university, and the psychiatrist in charge of the service. All of them contributed to the research. The EbEs, researchers and psychiatrist participated in the interpretation of the data and are the co-authors of this paper.

Caring for People with Rare Diseases: A Systematic Review of the Challenges of, and Strategies for Dealing with, COVID-19.

The COVID-19 pandemic took a toll on everyone's lives, and patients with rare diseases (RDs) had to pay an even higher price. In this systematic review, we explored the impact of the COVID-19 pandemic on individuals with RDs from a psychological perspective. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we retrieved articles from the Google Scholar, Scopus, and PubMed databases focusing on 'COVID-19,' 'psychology,' and 'rare diseases.' Seventeen primary articles were identified (mainly from continental Europe). The results revealed the psychological effects of the pandemic on rare disease patients, including increased anxiety, stress, and depressive moods. This review also highlighted the increased vulnerability and reduced quality of life of rare disease patients during the pandemic, as well as the importance of telecare and psychological support as critical interventions for improving their well-being. There is an urgent need for multidisciplinary research and stronger healthcare systems to meet the unique challenges of rare disease patients, who represent 3.5-5.9% of the global population.

(Re)constructing identity following acquired brain injury: The complex journey of recovery after stroke.

INTRODUCTION: People with poststroke acquired brain injury (ABI) face a complex and often troubled identity reconstruction journey. The literature is rich with studies related to the psychological and neuropsychological components involved in rehabilitation, but it is lacking with respect to the investigation of the existential dimensions and the challenges associated with finding new senses and meanings for one's identity and future perspectives, body and interpersonal relationships. METHODS: The aim of this study is to investigate the narrative processes of identity reconstruction after brain damage. Through a qualitative approach, 30 autobiographical narratives about self, body and the relationships with others were collected and analyzed. Semistructured interviews were used for the data collection. Narrative and positioning analysis were applied. RESULTS: Four main positionings emerged: sanctioning a radical break with one's previous life; assuming a sense of salvation and compulsory as well as irreversible adaptation to the limitations associated with one's condition; feeling different and disabled; and considering new possibilities and active constructions of self-being in relationship with others. These results underline the narrative processes of construction of the injury and the identity and delineate possible resources and instruments to improve the clinical practice for health practitioners. They are also valuable for other professionals who deal with neurological services and rehabilitation, such as psychological counselling and support for persons who have experienced ABI and their families. PATIENT OR PUBLIC CONTRIBUTION: This work resulted from a close collaboration between two universities and a hospital neurological rehabilitation department in the Veneto Region (Northern Italy). Three associations of people with stroke and their families living in the same area contributed to designing the research on the basis of the needs expressed by their members with the aim to identify strategies and devices to be implemented in the public service to improve the care pathway. They also participated in the interpretation of the data.

Grounding co-writing: An analysis of the theoretical basis of a new approach in mental health care.

This contribution aims to highlight the theoretical and epistemological premises of the co-writing experience, a practice where a clinician and a patient are mutually engaged in jointly or collaboratively writing a narrative related to the patient's experience. Unlike a typical set of therapeutic techniques, co-writing is based on sharing perspectives and meanings about the experience of crisis, recovery, and the therapeutic process. The paper identifies and briefly describes four non-clinical epistemological paradigms on which it is grounded: ethnography, values-based practice, narrative care, and phenomenology. Although they differ in several ways, at the same time, they seem to share some common features that the paper investigates and comments. For clinicians, nurses, researchers and Mental Health Service managers, attention to the users and to the improvement of their active roles represents not only a strategy for the empowerment of results, but also the access door to a different perspective which relies on a renewed conceptualization of the mental disease nature that may lead to overcoming the epistemic asymmetry between the 'expert' and the 'other' in favor of intersubjective dialogue.

Is falling in love within the mental health system a problem? How to turn it into a chance for the care relationship.

WHAT IS KNOWN ABOUT THE SUBJECT?: In the context of health and social care, situations at the limit or beyond the role of the professional, such as falling in love and physical attraction between a client and a nurse, are very common events. In residential contexts, the construction of the professional relationship is made more complex than in other care contexts since sharing daily life, routine, constant contact and isolation contribute to making relationships more intense from an emotional point of view. Moreover, the same elements that promote the therapeutic process (interpersonal closeness, self-disclosure, trust) are also sources of role ambivalence and possible emotional misunderstandings. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: In contrast to what is usually proposed in the literature for the management of similar situations, such as supervision by experts external to the team, this paper proposes a strategy of supervision between peers (called in literature "intervision") and of taking charge of the situation by the entire team and the group of service users. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: The story here presented offers a key example that may be of interest not only to residential centres for substance users but also to all residential mental health communities. It shows not only that one can fall in love, but that this event can generate new opportunities for the therapeutic pathway. The risks associated with not addressing these situations are discussed. These include the restriction of the feeling of falling in love within the canons of error; the attribution of what happened to personal characteristics and the assumption of guilt for such occurrences. ABSTRACT: INTRODUCTION: The care pathway within a mental health service can create situations of strong emotional impact, including physical attraction and falling in love. This may evolve in moments of impasse for the staff and sometimes compromise the success of therapeutic treatment. AIM/QUESTION: This article offers some evidence about how intervene in a situation such as a client falling in love with a nurse, avoiding transforming it into a problem. The fear of the nurse, maybe already inclined to blame themselves for what has happened, when he/she asks for supervision, is to feel judged also by the supervisor. This story teaches that to refer to figures from outside the team, as would usually be the case with supervision, may be replaced by enhancing the role composition already available in the residential community as a resource. METHOD: The story was listened and enhanced thankyou to an exchange between M. and the community manager. From the analysis of the narratives co-produced by M., the former substance user, and the community manager, the elements that made it possible to transform a feeling of falling in love into an interaction of extended trust emerged. RESULTS AND DISCUSSION: The non-judgmental and confidential context, but above all the training in interpersonal exchange, facilitated the client sharing very intimate and private experiences, which are usually hidden or denied. This made it possible to make the community responsible for the individual's experiences and to overcome the role impasse and the related identity dilemma. IMPLICATIONS FOR PRACTICE: Neither nurses nor clients should be held accountable or blamed when these episodes occur. The strongest resource is sharing in the group and putting one's own experiences into play. Following the M. story, a targeted confrontation between team members and clients is an accessible and effective resource to respond to situations of strong emotional impact, falling in love being just one example; however, it can be effectively activated only through a collective taking charge of the individual's difficulties has already been implemented.

What is therapeutic? Analysis of the narratives available on the websites of Italian addiction rehab centres to present the therapeutic programme.

In recent years, the use of the adjective "therapeutic" has expanded to encompass a great variety of experiences, blurring the line between what is effectively therapeutic and what is not. Proceeding from the idea that a word's meaning is linked to its use in a particular linguistic game, we will analyse the etymons "therapy" and "psychotherapy" and the change in their meanings over time. This background will guide us in the qualitative analysis of the so-called "therapeutic activities" available on the websites of 14 Italian therapeutic communities for treating addiction. Four main master narratives emerge from our investigation. These are characterised by biomedical assumptions, pedagogical principles, religious precepts, and moral values, respectively. Activities are considered therapeutic per se rather than based on theoretical assumptions regarding change. In the light of our results, the adjective "therapeutic" has become a domain of common sense, which poses the threat of undue reification of the linguistic game that expresses it.

Implications of Involuntary Psychiatric Admission: Health, Social, and Clinical Effects on Patients.

ABSTRACT: Involuntary psychiatric admission is an increasing, widespread practice adopted throughout the world; however, its legal regulation and practice are still under debate, and it is subject to criticism from the human rights point of view. Only a few studies have strictly focused on the outcomes and subsequent treatment implications of this practice. To perform a scoping review of the literature on involuntary psychiatric admission and systematize and summarize its outcomes and implications for adult psychiatric inpatients.Four overarching issues emerged from the studies: a) symptomatological repercussions, b) impacts on treatment before discharge, c) impacts on treatment after discharge, and d) implications on patients' attitudes, behavior, and functioning. The overall evidence suggested correlations between involuntary psychiatric admission and several implications: length of stay, aggressive behavior, occurrence of psychopathologies, uses of coercive measures, psychiatric service activations after discharge, emotive reactions, and quality of life. The proposal presented here is the major involvement of the patient and of all the other actors involved during the entire treatment process to promote a shift from a delegation perspective to a negotiation perspective in the management of involuntary psychiatric admission.

Mental health practitioners' narratives about gender transition and the role of diagnosis: A qualitative study in the Italian context.

In many European Countries, a diagnosis is needed to access the gender transition process, which has sparked debate about whether gender variance should be equated with a psychodiagnosis. This study explores mental health practitioners' perspectives about the implications of using the diagnosis for gatekeeping purposes. Semi-structured interviews were conducted with 11 Italian mental health specialists. The personal positions and interpretative repertoires emerging from the interviews centred on three thematic areas: the diagnosis, the practitioner's role, and the clinical relationship. In relation to the development of health promotion policies, findings underscore the importance of exercising reflexivity, adhering to theory and national and/or international guidelines, and analysing people's needs to ensure that the clinical setting is an affirmative space, especially for non-binary people.

When the non-sharing of therapeutic goals becomes the problem: The story of a consumer and his addiction to methadone.

WHAT IS KNOWN ON THE SUBJECT?: It is well known that psychotropic drugs, besides having beneficial effects, may become a source of addiction. Drug therapy involving methadone is traditionally considered an essential medicine in the treatment for heroin dependence since it significantly reduces drug injecting and death rates associated with opioid dependence. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper investigates a paradoxical situation: the use of methadone therapy to maintain a condition of addiction rather than to overcome it. The story is told jointly by the head of a rehab centre and a young man who has developed a methadone addiction and kept it hidden for years from the operators of the addiction centre, who supplied him with the substance. WHAT ARE THE IMPLICATIONS FOR MENTAL-HEALTH NURSING?: The young man's story offers a key example which can be of interest not only for addiction centres but also for all mental-health services that supply drugs as therapy. This study examines what happens when a person taken over by a service pursues goals that are in contrast to the service mission. Specific communication strategies have to be implemented to update and negotiate goals in continuity with the personal live project of the service user. This story is a warning to not rely on consolidated operational practices, ignoring the investigation of personal meanings and aims of those who experience them. ABSTRACT: Introduction Mental health services typically follow standardized intervention protocols and systematic operating practices. Aim/Question This paper explores what happens when a service relies exclusively on fixed practices rather than on the negotiation of objectives and the differentiation of procedures according to the needs of the user. Method The analysis of the narratives produced in first person by Oliver, a former substance user, emphasizes the need of constructing a therapeutic plan in close cooperation, promoting an user active role and strengthening his affiliation in the change process. Results and Discussion In this specific case, the involvement of the user meant the identification of the peculiar meanings he attributed to the "substance of use," which paradoxically coincided with the "therapeutic substance" (methadone). Implications for Practice Oliver's story is an effective mirror for rethinking staff conduct when it assumes that the drug is therapeutic in itself, regardless of the way the person experiences and means it, it also offers a description of the interactive ways in which the relationship between a young person and service staff proved to be effectively therapeutic.

The Impact of Relational and Organizational-Environmental Aspects in Hospital Blood Collection: Clinical and Health Indications and New Training Needs.

This study deals with people who underwent a blood test and consequently suffered a fainting episode in the past. This phenomenon affects many people and if not adequately dealt with, it can lead to a perception of the blood test as a serious and traumatic event, which could limit its use as a preventive diagnostic tool. These experiences have been explored by research mainly on the basis of the physiological mechanisms involved in fainting, with a few studies considering the actual lived experience related to the blood test. This study explored how this experience is lived and managed, capturing aspects that could facilitate blood tests and the procedures associated with them, thus it focused on people with vasovagal syncope and was articulated through the semi-structured interview methodology. Among the significant results is the importance of the relational aspects implemented by health staff, the differing organisation of the blood test procedure, the need to make the hospital environment less aseptic and more humanistic, effective actions to counter the anxieties relating to the administration of the blood test and the importance of including the blood test with an inter-disciplinarity perspective.

It's the way you treat me that makes me angry, it's not a question of madness: Good and bad practice in dealing with violence in the mental health services.

WHAT IS KNOWN ON THE SUBJECT: The first access to a mental health service is sometimes marked by aggressive behaviours and anger. Forced hospitalization is frequently an occasion for resistance and hostility to the service, which should not be mistaken for psychotic symptoms. If this situation is not dealt with effectively, it can jeopardize the quality of the relationship with staff and compliance with the treatment programme. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: The narrator presents his experience in undergoing voluntary psychiatric treatment, casting light on nurses' good and bad practices: those that increased resistance, and those that helped de-escalate the uncontrolled reaction at the time of access, as well as during the recovery period. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING: Practitioners should be able to put in place listening techniques and ways of personalizing the relationship with the patient. When such measures become part of the patient's meaning system, the vicious circle of misunderstood anger that creates more anger may be interrupted and the patient can invest in relationships of trust. ABSTRACT: Aggression is often a reason for psychiatric hospitalization and may lead to prolonged hospital stays, and at worst to compulsory treatments. The relationship between mental illness and aggressive behaviour is a source for debate in the literature, while research data suggest that violent behaviour is impacted not only by the mental state of the patient, but also by environmental and relational conditions, hence the importance of an increased awareness of operating methods on the part of psychiatric staff. Alex's story is an effective mirror for rethinking staff conduct and offers many practical suggestions for understanding a patient's point of view in critical episodes and for deescalating relational tension.

Illness Experiences and Attitudes towards Medication in Online Communities for People with Fibromyalgia.

Fibromyalgia is a chronic disabling syndrome, and the legitimacy of its diagnosis is still debated. Internet and online communities may become a relevant resource for affected people. This present study aims to understand the role of online communities relating to fibromyalgia syndrome (FMS) patients' illness experiences and their attitudes towards medication. A qualitative content analysis based on the grounded theory approach was conducted on 19 conversations from an online forum, and 14 online interviews. Illness experience, lack of reference points, online communities, personal role and attitude towards medication were the five categories identified, with the search for recognition as the core category. The study highlighted that online communities represent a resource that allows users to express and share their needs, especially in terms of legitimacy and recognition.

The Effectiveness of Psychoeducational Support Groups for Women With Breast Cancer and Their Caregivers: A Mixed Methods Study.

Background: Previous studies on the effectiveness of psychological interventions in oncology mainly used quantitative measures and no study was conducted with regard to both caregivers and patients. Aim: This study evaluates the effectiveness of psychoeducational support groups, both for women with breast cancer, and for their informal caregivers through the use of quantitative and qualitative measures. Methods: A longitudinal design was used comparing two psychoeducational support groups with other two groups in a standard care control condition. Participants were 28 women with a diagnosis of breast cancer in the care of a hospital in Northern Italy, and 21 family caregivers. The quantitative data were collected by Cognitive Behavioral Assessment for Outcome Evaluation (CBA-OE) and the qualitative data through the use of semi-structured interviews. Results: The statistical analysis showed a significant change attributable to the psychological intervention that proves the effectiveness of such an intervention in the patients' and caregivers' group. The qualitative analysis allowed us to interpret the behavioral and psychological profile emerging from CBA-OE, by considering the subjective experience of the treatment groups. The group experience offered affective, relational and informative support, and allowed participants to create a network and to feel understood and reassured. Conclusion: The results suggest the usefulness of psychoeducational support groups for women with breast cancer and for their caregivers. The value of this kind of intervention is not only at an individual level but also at a systems level, and family involvement ensures the best positive outcomes.

Self-writing as a tool for change: the effectiveness of a psychotherapy using diary.

There is an abundance of literature investigating the relationship between self-writing and well-being in cases of trauma or life-changing events, but no such research has assessed the value of keeping a daily diary in promoting small changes, describing an individual's identity in its slow, but realistic evolution. This study examined how the use of diary as a narration tool contributed to improving a patient's awareness of his personal emotions and feelings during a course of psychotherapy. It investigated the changes occurring in the prevailing writing style of a 200-page diary written by a patient suffering from hypochondria over a period of two and a half years. Sentences relating to the need for change, to the self, to suffering and to the function attributed to the self-writing activity were analyzed on the basis of specific criteria deriving from dialogical self theory, which conceptualizes ways to adopt new identity positions during the course of change. Respondent validation identified a good correspondence between the findings of the textual analysis and the writer's own point of view. Results showed an improvement in awareness of moods and feelings. Identity positions became more integrated and writing more enjoyable. These findings demonstrate the potential of innovative use of diary writing as a longitudinal tool for consolidating strategies for change and as an additional means for assessing psychotherapy efficacy. Writing a diary proved effective both in supporting the patient's personal reflections and changes and in making it easier for him to share his thoughts with the therapist.