Whole systems approaches to diet and healthy weight: A scoping review of reviews.

BACKGROUND: Obesity is a global epidemic affecting all age groups, populations, and income levels across continents, though is known to disproportionately affect socioeconomically disadvantaged populations. The causes of obesity are complex, informed by diet and weight practices, but shaped by social, commercial, and environmental factors and government policy. Consequently, a Whole System Approach (WSA)-which considers the many causes of obesity and shifts the focus away from individuals as points of intervention and puts an emphasis on understanding and improving the system in which people live-is required. This scoping review of reviews aims to: determine how WSAs to diet and healthy weight have been implemented and evaluated nationally and internationally; to determine what models or theories have been used to implement WSAs; describe how WSAs have been evaluated; determine if WSAs are effective; and to identify the contribution of the public and/or service users in the development of WSAs. METHOD: Systematic searches were carried out using CINAHL, Scopus, PsycINFO (ProQuest), the Cochrane Library, and MEDLINE. Included review papers were those that focused on the application of a whole system approach to diet and/or healthy weight, and/or reported the theory/model used to implement or simulate this approach. Databases were searched from 1995 to March 2022 using a combination of text and Medical Subject Headings (MeSH terms). In addition, reference sections of identified articles were examined for additional relevant articles. Covidence software was used to screen titles and abstracts from the electronic databases and resolve conflicts. RESULTS: A total of 20,308 articles were initially retrieved; after duplicate removal 7,690 unique title and abstracts were reviewed, and 110 articles were selected for full text review. On completion of full text review, 8 review articles were included for data extraction. These included: one umbrella review, four systematic reviews, a rapid review, and two literature reviews (one of which was on strategic reports written for government and public health policy). Evaluations of WSA were mainly process evaluations although health outcomes were assessed in some studies. Several conceptual frameworks or mathematical modelling approaches have been applied to WSAs for diet, healthy weight, and obesity to inform their planning or delivery, and to understand/map the associated systems. Common mathematical approaches include agent based or System Dynamic Modelling. Underlying both conceptual and mathematical models is an understanding how the elements of the complex systems impact each other to affect diet, healthy weight, and obesity. WSA implementations have reported some success in positively impacting health outcomes including reducing Body Mass Index, reducing sugary food intake, and increasing physical activity. Public and user involvement in WSA was not widely reported. CONCLUSION: The application of WSA to diet and healthy weight shows promise, yet the research is lagging behind their implementation. Further robust evidence for using WSA to address diet and healthy weight are required, including incorporating process and outcome evaluations (perhaps using established approaches such as Systems Dynamic Modelling). Furthermore, the analysis of epidemiological data alongside longitudinal process and outcome evaluation regarding the implementation of a WSA is required.

Feasibility of Recovery Assessment Scale - Domains and Stages (RAS-DS) for everyday mental health practice.

Introduction: Routine use of self-rated measures of mental health recovery can support recovery-oriented practice. However, to be widely adopted, outcome measures must be feasible. This study examined the feasibility of Recovery Assessment Scale - Domains and Stages (RAS-DS) from the perspectives of mental health workers. Method: Mental health workers who had previously sought permission to use RAS-DS (n=58) completed an online survey that explored three aspects of feasibility: practicality, acceptability and applicability. Results: The highest-rated feasibility items related to applicability, or usefulness in practice, with over 90% of participants reporting that RAS-DS helps "promote discussion" and covers areas that are "meaningful to consumers". Acceptability items indicated that the purpose of RAS-DS is clear but length was an issue for some participants. At a practical level, RAS-DS was seen as easy to access but training was seen by many as necessary to ensure optimal use. Conclusion: Results suggest potential usefulness of RAS-DS as a routine outcome measure and identify aspects that can be addressed to further enhance feasibility including provision of training materials and opportunities, wide-reaching promotion of its use as a collaborative tool, and further investigation of issues around instrument length.

Preferences for telehealth: A qualitative study with people accessing a new mental health service.

Objectives: To examine preferences for telehealth versus in-person services for people who sought mental health support from an unfamiliar service during the COVID-19 pandemic and to identify the factors that influenced these preferences. Methods: Data are drawn from semi-structured interviews with 45 participants (32 people who accessed mental health services, 7 informal support people, and 6 people who accessed services themselves as well as identifying as informal supports). Data relating to experiences of telehealth, comparisons with in-person services and preferences were coded inductively and analysed using qualitative content analysis. Results: Just over half of the participants in our sample preferred telehealth or at least regarded it as a suitable option. Those who preferred telehealth were more likely to have had direct experience, particularly via videoconferencing, as part of their access to this new mental health service. Reasons for preferring in-person services included belief in the superiority of interpersonal communication in these settings, compatibility with personal communication style and discomfort with technology. Those preferring telehealth cited its convenience, elimination of the need to travel for services, the comfort and safety afforded by accessing services at home and the ability to communicate more openly. Conclusions: Hybrid models of care which harness the unique benefits of both in-person and remote service modalities appear to have a legitimate place in models of mental health care outside of pandemic situations. These results illuminate the potential of telehealth services when engaging with people seeking mental health help for the first time and in situations where existing relationships with service providers have not yet been established.

Occupations and balance during the transition to motherhood with a lifetime chronic illness: A scoping review examining cystic fibrosis, asthma, and Type-1 diabetes.

INTRODUCTION: Throughout the transition to motherhood, changes are experienced across a woman's physical, mental, social, and occupational self. Maternal chronic illness adds the complexity of increased healthcare needs and navigating a high-risk, medicalised pregnancy, birth, and post-natal period. Literature concerning motherhood transitions in chronic illness generally focusses on the mother's medical health and pregnancy outcomes; little is known about the impacts on women's occupations, balance, and quality of life. Understanding these issues may help support women in a more tailored and holistic way. OBJECTIVE: This scoping review aims to gather, analyse, and synthesise existing empirical research on occupational engagement and occupational balance as they impact on wellbeing and quality of life in women with a lifetime chronic illness before and during pregnancy and in early motherhood. METHOD: The review follows the nine-stage framework described in the Joanna Briggs Institute Manual for Evidence Synthesis (2020). Five databases were searched: Embase, Medline, PsycINFO, CINAHL, Scopus, and OT Seeker. Data were extracted and examined via content analysis, described in narrative synthesis, summarised into a conceptual framework, and tabulated. FINDINGS: A total of 8,655 papers were discovered on initial search. Following title and abstract screening, 220 full-text studies were assessed for eligibility, and 46 papers were finally included. Analysis generated four major themes: The Disrupted Transition Journey; Adaptation, Compromise and Choice; Outcomes; and Drawing on What's Available. The themes were conceptualised into a framework to explain how women sought to balance motherhood and illness-related occupations. Adequate access to information, social support, expert care, and financial resources improved both quality of life and healthcare compliance. CONCLUSION: Findings of this scoping review deepen the understanding of occupational balance during the transition to motherhood in the context of lifetime chronic illness. Healthcare providers and supportive family and friends can use this knowledge to adapt their approach to assisting women with chronic illness on the motherhood journey. These findings may also inform further inquiry into the scope of occupational therapy practice with this population.

Staff perceptions of factors affecting the use of RAS-DS to support collaborative mental health practice.

BACKGROUND: The Recovery Assessment Scale: Domains and Stages (RAS-DS) was designed to be both a recovery outcome measure and a tool to enhance service-user control over their recovery journey. While extensively and globally used in mental health services for the former purpose, routine use for the latter purpose is yet to be realised. The aim of this study was to identify barriers, facilitators and additional supports needed for RAS-DS to be used to support service user participation, goal setting and recovery action planning. METHODS: An online survey was conducted of mental health workers who had engaged with RAS-DS, including fixed choice and open-ended questions. Data were analysed using descriptive statistics and interpretive content analysis respectively. RESULTS: The 65 respondents reported more frequent use of RAS-DS as an outcome measure than as a collaboration tool and more than half reported difficulties in using it in this way. Factors that they described as influencing the use of RAS-DS as a tool for collaboration and support included: previous experiences with RAS-DS; organisational supports and policies; awareness of the RAS-DS amongst colleagues; RAS-DS related training and support; staff time and capacity; the format of RAS-DS; service user population or context; and respondents' own active efforts. CONCLUSIONS: Extending the use of RAS-DS, an already widely used tool, to routinely support recovery-oriented practice has both efficiency and service user empowerment benefits. However further work is needed to enable this including: provision of co-designed, accessible training resources; a user platform including built in guidance; and strategies to promote management understanding and valuing of the enhanced recovery-orientation opportunities inherent in RAS-DS use.

How do Mental Health Services Foster Hope? Experience of People Accessing Services.

Hope is essential to mental health recovery, yet little is known about how mental health services can foster hope. This paper addresses the question: How can mental health services influence the sense of hope experienced by people who access their services? Sixty-one people who accessed a new mental health service were interviewed about their experiences, including about how the service had influenced their sense of hope. Interviews were analysed using constant comparative analysis. The data revealed that hope increased when people perceived positive changes in themselves and their circumstances: developing new understandings and perspectives; having effective strategies to manage challenges; seeing progress or having plans; and having support. Changes were attributed to three major features of the service: accessibility; staff competence and wisdom; and caring interactions. The findings highlight that, while individual clinicians are important, other interactions with services and the wider service context are also critical for facilitating hope.

Predicting Housing Related Delayed Discharge from Mental Health Inpatient Units: A Case Control Study.

The aims of this study were to identify factors that a) predict whether people experience housing related discharge delay (HRDD) from a mental health inpatient unit; and b) predict the length of HRDD for people affected. By identifying the groups most affected by HRDD, clinicians and policy makers can prioritise and address barriers to timely discharge at both an individual and systemic level. A case control study using a detailed medical record review was conducted in one Australian mental health service. Demographic, clinical, contextual and systemic variables were collected for patients with HRDD in one calendar year (n = 55) and a random comparison sample (n = 55). Logistical and multiple regression analyses were conducted to identify variables that predict HRDD and length of HRDD. A model that correctly predicted 92% of HRDD and 78% of non-HRDD cases using five variables was developed. These variables were: diagnosis of schizophrenia or other psychotic disorder, physical comorbidity, having a history of violence or aggressive behaviour, being employed and being involved as a defendant in the justice system. The first three variables increased the likelihood of HRDD, while the second two reduced the likelihood of HRDD. For people who experienced HRDD, the only variable that predicted length of delay was staff reported difficulty finding appropriate support services. This model can be used to rapidly identify patients who might be at risk of HRDD and commence coordinated actions to secure appropriate housing and supports to facilitate timely discharge, thereby addressing a current practice gap. These findings highlight the intersection between health, housing and disability services in the lives of people with serious mental illness, and the need for a whole of government approach to investment and integration to address systemic barriers to suitable housing and supports.

'I'm institutionalised there's not much I can do': Lived experience of housing related delayed discharge.

INTRODUCTION: Delayed discharge from inpatient mental health units is the continued hospitalisation of consumers after being assessed as ready to be discharged. This is common in adult inpatient mental health services and is usually due to a lack of appropriate housing for discharge. Research indicates a range of possible negative impacts, but no studies have explored consumers' perspectives on this issue. This study explores consumers' perspectives of the experience of housing related delayed discharge (HRDD). METHOD: Using a grounded theory approach, in-depth interviews were conducted with 10 consumers. All consumers were experiencing HRDD from inpatient mental health units in one Sydney local health district. The data were analysed using constant comparative analysis. FINDINGS: A lack of choice and control was the central theme that characterised participants' experiences. The combined experience of being delayed in hospital and being homeless led to a lack of choice and control over the basics in life, how consumers spent their time and with whom, and their futures. This lack of autonomy was shaped by the features of the hospital and participants' personal circumstance. The hospital features included rules and routines, physical and social environments, resources, and support from staff. Personal circumstances included individual situations, social networks, and support from community organisations. Participants described a variety of impacts, including reduced mental and physical well-being, and anticipated difficulty transitioning back into the community. CONCLUSION: This study is the first of its kind and provides consumer perspectives on the impacts of HRDD on their well-being and recovery. The inability to participate in meaningful and necessary occupations is an occupational injustice and implies the need for occupational therapists to advocate for both the prevention of HRDD through government investment in affordable and readily available housing and the mitigation of its effects through modified hospital environments and practices.

Mental Health Peer Worker Perspectives on Resources Developed from Lived Experience Research Findings: A Delphi Study.

Lived experience research is potentially useful for assisting the recovery journeys of people experiencing mental health challenges, when presented in user-friendly formats. Consumer peer workers are ideally placed to introduce such resources to the people they work with. This study sought to explore the perspectives of expert consumer peer workers on the potential use of lived experience research resources in peer work practice. In particular: (1) what research topics would be most useful; and (2) what considerations are important for developing user-friendly and useful resources using findings from this research. A hybrid Delphi study was conducted. Eighteen expert peer workers participated in online group interviews, which included a semi-structured discussion and modified nominal group technique. These were followed by two rounds of surveys, which focused on prioritising the identified topics. Participants identified 47 topics suitable for lived experience research resources, 42 of which reached consensus as useful for consumers. A priority list of topics for use in peer work was identified through examination and grouping of peer worker rankings of the usefulness of resources for their work with consumers. The highest priority topics were as follows: developing and maintaining social networks; how peer workers can support consumers in their recovery journey; having choice with medications and participating in the decision-making process; and knowing your rights and responsibilities. Participants noted, however, that the usefulness of each topic ultimately depended on individual consumer's needs. They highlighted that a variety of formats and presentation were required to reach diverse consumer groups.

'Doing' dating: A cross-sectional survey of young adults (18-35 years) in Australia and Hong Kong.

INTRODUCTION: Dating is an occupation through which people form intimate relationships with others. Despite the importance of intimate relationships for wellbeing, there is limited information available in occupational therapy literature about the activities involved in dating and little guidance for practitioners who wish to support clients from diverse backgrounds who experience difficulties with dating. To address this gap, this study sought to explore dating among young adults (18-35 years) and compare dating activities between two contexts: Australia and Hong Kong. METHODS: Data were collected using an e-survey designed for this study and refined using cognitive interviewing (n = 12). It included questions about dating initiation and activities. Study design and reporting was guided by the Checklist for Reporting Results of Internet E-Surveys. Data were analysed using descriptive statistics and between group comparisons. Reponses to open ended questions were subjected to interpretative content analysis and quantified. RESULTS: In total, 2208 young adults aged 18-35 who had at least one dating experience and resided in either Australia or Hong Kong completed the survey. Participants met their dates most commonly through school, friends, dating apps, and work. The most frequent ways to ask a person on a date were by suggesting 'hanging out' or going out for food, drink or to the movies. Most participants reported that organising a date required extended negotiation between the parties. Differences were found between participants from Hong Kong and Australia. CONCLUSIONS: This is the first study of contemporary dating from an occupational perspective and provides an understanding of dating activities in two different cultural contexts.

How Do People Perceive and Adapt to Any Consequences of Electro Convulsive Therapy on Their Daily Lives?

Great controversy surrounds the use of electroconvulsive therapy or ECT. However, it continues to be used internationally. While research on short term effects of ECT abound, there is limited knowledge about long term impacts of ECT on individuals, especially from the lived experience perspective. The aim of this qualitative study was to gain an in-depth understanding of longer-term lived experiences of ECT and how people navigate any impacts on their daily lives. Twenty-three people participated in semi-structured interviews. Data collection and analysis involved an iterative process. Data were coded into four categories: (1) My ECT experience included physical mechanics, decision making, clinic experiences, post ECT support and attitudes and support of others); (2) Direct impacts of ECT on me encompassed both cognitive and emotional impacts; (3) Impacts on my life comprised daily activities, relationships, ongoing health care; and My strategies incorporated fixing or working around the problem, reframing, using support networks, protecting myself and taking control. Insights gleaned through lived experiences have important implications for other service users, direct service providers and those striving for system reforms that embrace more recovery orientated and trauma informed practices.

The parenting occupations and purposes conceptual framework: A scoping review of 'doing' parenting.

INTRODUCTION: Parenting is a valued, common and challenging adult role. Many parents, including some living with disability or difficult social circumstances, experience barriers to fulfilling their parenting roles. Yet, occupational therapy involvement in parenting is rarely documented. Current understandings about 'doing' parenting lack cohesion and are dispersed in occupational therapy literature. This study aims to map and synthesise occupational therapy literature on 'doing' parenting to describe the state of the existing knowledge base, and develop a conceptual framework of parenting occupations as portrayed in occupational therapy literature. METHODS: A scoping review was conducted. Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science were searched on 28 October 2019 and updated on 18 February 2021. Journal articles and book chapters were screened for eligibility. Included texts' publication characteristics, methodological characteristics, and areas of focus were summarised. Interpretive content analysis was conducted. RESULTS: From 5945 unique records, 105 texts were included. These discussed general parenting, parents with disabilities, and parenting in challenging social situations. Most texts focussed on mothers caring for young children in Western cultural contexts. The analysis culminated in the development of a conceptual framework: the Parenting Occupations and Purposes (POP) Framework. This comprises 10 interrelated areas of parenting occupations, which are performed for the purposes of addressing the child's basic, developmental and social needs. Parenting occupations were also found to be influenced by additional, underlying occupations that build parenting capacity - Continuous Parental Development (CPD) occupations. CONCLUSION: These findings provide an overview of current occupational therapy conceptualisations of parenting. Unlike most of the existing literature on parenting, the POP Framework is parent-centric rather than child-centric. More research on parenting occupations is needed, especially with more diverse representation (fathers, ages of children, parental disability and sociocultural background). Further research is required to examine the POP Framework's usefulness in guiding research and practice, particularly among parents with diverse characteristics.

Making Lived-Experience Research Accessible: A Design Thinking Approach to Co-Creating Knowledge Translation Resources Based on Evidence.

Mental health lived-experience research illuminates the perspectives and experiences of people who live with mental illness. However, little is known about how useful people with lived experience of mental illness/distress might find lived-experience research, nor what the best formats are to bring it to their attention. This paper describes the STELLER study (Supporting the Translation into Everyday Life of Lived-Experience Research), which explores the translation of lived-experience research in the lives of people living with mental illness. Our aim was to use a design thinking approach to develop a range of user-friendly formats to disseminate lived-experience research. A staged design thinking approach was used to develop a translation strategy for lived-experience research. We explored empathy via consumer consultation to understand their perspectives on lived-experience research, refined the design aim, research questions and generated ideas with consumers and mental health professionals, identified the evidence based on lived experience-authored journal articles, worked with design students and peer workers to create a suite of resources and developed prototypes tailored to individual settings and clients. Participatory design thinking strategies are essential to identify the best ways to translate evidence-based lived-experience research via accessible, lay-friendly resources targeted to individuals impacted by mental illness. This study is the first to investigate the feasibility and usefulness of bringing the findings of lived-experience research to individuals impacted by mental illness/distress. It provides evidence about a potentially important source of information that can be used to facilitate their recovery.

COVID-19 and Psychosocial Support Services: Experiences of People Living with Enduring Mental Health Conditions.

This paper uses secondary analysis to understand how COVID-19 shaped people's experiences with psychosocial support services in Australia. Data are drawn from questionnaires (n = 66) and semi-structured interviews (n = 62), conducted for a national service evaluation, with 121 people living with enduring mental health conditions and using psychosocial support services. Data relating to COVID-19 were inductively coded and analysed using constant comparative analysis. Most people's experiences included tele-support. While some people described minimal disruption to their support, many reported reduced engagement. People's wellbeing and engagement were influenced by: their location, living situation and pre-COVID lifestyles; physical health conditions; access to, comfort with, and support worker facilitation of technology; pre-COVID relationships with support workers; and communication from the organisation. The findings can help services prepare for future pandemics, adjust their services for a 'COVID-normal' world, and consider how learnings from COVID-19 could be incorporated into a flexible suite of service delivery options.

Lived experience research as a resource for recovery: a mixed methods study.

BACKGROUND: Lived experience research is conducted by people who have experience of mental health issues and is therefore better placed than more traditional research to illuminate participants' experiences. Findings that focus on identifying enablers of recovery from a lived experience perspective have the potential to assist people in their recovery process. However, this lived experience research is often difficult to find, access and interpret. We co-produced user-friendly and engaging resources to disseminate findings from six lived experience research studies. This paper seeks to answer the research questions: a) Did exposure to lived experience research increase hopefulness for participants?; and b) How else did interacting with lived experience research resources influence participants' lives? METHODS: Thirty-eight participants were introduced to four resources of their choosing by peer workers over a four-week period. The helpfulness of resources was evaluated using mixed methods, including a quasi-experimental analysis of change in hope, an anonymous survey and in-depth interviews. RESULTS: Findings indicated that the resources promoted hope, but that increases in hopefulness may not be seen immediately. Other impacts include that the resources: encouraged helpful activities; provided a positive experience; increased valued knowledge; encouraged people to reflect on their journey and think constructively about mental health issues; helped people to feel less alone; and assisted people to explain their situation to others. CONCLUSIONS: The research suggests the potential usefulness of lived experience research resources, presented in user-friendly formats, in the lives of people who experience mental health issues and implies a need to nurture this type of research.

Parent strategies to support young people experiencing mental health problems in Australia: What is most helpful?

Parents are a critical resource in supporting young people who live with mental health problems. Qualitative research has identified that parents use a wide range of strategies to provide support. However, parents report being unsure which strategies are likely to be helpful, so often struggle in this role. Presently, little empirical evidence exists to assist parents to decide which strategies are likely to be most helpful. This study aimed to explore the parent-perceived helpfulness of parental strategies to support young people living with mental health problems. Data were collected from February to July of 2018, using a cross-sectional, online, anonymous, self-report survey of participants who identified as parenting a young person (15-24 years) diagnosed with a mental health problem (n = 70). Overall, the strategies perceived as most helpful were practical assistance and personal interactions aimed at promoting positive thoughts and feelings and obtaining appropriate treatment. Least helpful strategies tended to be control-type strategies, aimed at behaviour change. Overall, there was good alignment between strategies' helpfulness and frequency of use, however, there were exceptions. These exceptions are likely reflections of the specific context of particular situations as well as parental uncertainty regarding alternative strategies. Generally, perceptions of strategies' helpfulness were unrelated to parent or child characteristics. However, helpfulness of strategies was associated with parents' satisfaction with their relationship with the young person. Parents' collective experience-based perceptions about the helpfulness of strategies used to support young people experiencing mental health problems can be harnessed to inform mental health practitioners' advice to parents and contribute to better mental health outcomes for young people.

Igniting and Maintaining Hope: The Voices of People Living with Mental Illness.

The study objective was to identify the types of experiences that consumers identify as igniting and maintaining hope, and those most frequently reported. Data were collected through an anonymous online survey. Two open-ended questions elicited reflective personal accounts regarding hope-promoting experiences. Using an interpretive content analysis design, data were coded inductively using constant comparative analysis. Numbers of participants reporting each type of experience were calculated to identify patterns of hopeful experiences. Findings from 72 participants highlighted a diversity of hope-promoting experiences and sources. Fifteen experiences were identified, forming two broad categories: interactions and experiences involving others, and personal or internal experiences, insights and actions. Findings suggest that consumers play an active role in igniting and maintaining their own hope. Peer workers and health workers can support this by being cognizant of the quality of their interactions with consumers and by facilitating connections with others, particularly families, friends and peers.

Thriving in an expanding service landscape: Experiences of occupational therapists working in generic mental health roles within non-government organisations in Australia.

INTRODUCTION: Occupational therapists are an integral part of Australian mental health services. Recent changes in the mental health sector mean that increasing numbers of occupational therapists now work in generic, non-profession-specific roles in non-government organisations. Previous research has identified a range of challenges faced by occupational therapists in generic roles, including reduced satisfaction and loss of professional identity. An exploration of potentially positive aspects and strategies that assist occupational therapists to succeed and flourish within generic roles is lacking. The aim of this study was to explore what assists occupational therapists to thrive within generic roles in Australia's non-government mental health sector. METHODS: Semi-structured, in-depth interviews were conducted with 12 occupational therapists working in generic mental health roles across three non-government organisations spanning three Australian states. Data were analysed thematically using constant comparative analysis. RESULTS: Thriving was supported in three domains. First, occupational therapists facilitated their own thriving by keeping their occupational therapy lens, and managing ambiguity. Second, workplaces were supportive when their values aligned with occupational therapy core values, they recognised and valued the occupational therapy contribution, and their roles allowed opportunities for therapists to use their profession-specific skills. Third, the broader occupational therapy profession assisted thriving through preparation, validation and ongoing inclusion. CONCLUSION: Despite some challenges, occupational therapists can and do thrive in generic non-government mental health roles. The preliminary framework of thriving provides valuable insights for those developing university curricula, those providing continuing professional development opportunities and for individual occupational therapists entering this expanding area of practice. Findings also provide insights into how individuals, academic curricula and the profession can respond and adapt to systemic transformations occurring in mental health service delivery.

What roles do male partners play in the mothering experiences of women living with mental illness? A qualitative secondary analysis.

BACKGROUND: Mothers who live with mental illness face diverse challenges. Research suggests that partner support or otherwise is likely to have a crucial influence on mothers' abilities to manage these challenges, yet little is known about how this plays out. In this study, we aimed to explore the roles played by male partners in the mothering experiences of women living with mental illness. METHODS: We conducted a qualitative secondary analysis using interview data collected from 18 participants in two previous qualitative studies. Both studies focused on the mothering experiences of women who lived with mental illness. In both studies, the importance of male partners was striking. The data were analyzed using constant comparative analysis. RESULTS: The roles of partners in women's experiences of mothering were multiple and dynamic, with each male partner playing a unique combination of roles. These included: facilitator; teammate; unfulfilled potential; distraction; dismantler, and threat to child. Roles were influenced by: mothers' interpretations; partners' behaviors, characteristics and circumstances; the family's living and custody arrangements; mothers' active management strategies; and a range of external controls and supports. CONCLUSIONS: Health professionals need to consider the complex roles partners play. This crucial aspect of mothers' social environments can be optimized by directly supporting and enabling partners themselves, and by supporting mothers to actively shape their partners' roles.

Family Inclusion in Mental Health Service Planning and Delivery: Consumers' Perspectives.

Family inclusion in treatment planning and delivery for people living with mental illness is advocated in government policy but is yet to be widely translated into practice. While external barriers have been identified, including concerns about consumers' best interests, little is known about consumers' own views. This study explores consumers' experiences and perspectives of including family in treatment. Semi-structured interviews were conducted with 13 adult consumers who could identify supportive family members. Data were analysed using constant comparative analysis. The findings indicated that the outcomes reported from family inclusion depended on who, how, how much and when family were included, and the degree of choice consumers had regarding these features For consumers to have real choice around these features, family inclusion needed to be accessible, families needed to be willing, and all parties needed to agree upon a consumer-centred purpose. Findings can aid health professionals to facilitate consumer choice.