Discrepancy between experience and importance of recovery components in the symptomatic and recovery perceptions of people with severe mental disorders.

BACKGROUND: Personal recovery has become an increasingly important approach in the care of people with severe mental disorders and consequently in the orientation of mental health services. The objective of this study was to assess the personal recovery process in people using mental health services, and to clarify the role of variables such as symptomatology, self-stigma, sociodemographic and treatment. METHODS: Standardised measures of personal recovery process, clinical recovery, and internalized stigma were completed by a sample of 312 participants in a Severe Mental Disorder program. RESULTS: Users valued most the recovery elements of: improving general health and wellness; having professionals who care; hope; and sense of meaning in life. Significant discrepancies between perceived experience and relative importance assigned to each of the components of the REE were observed. Regression modeling (χ2 = 6.72, p = .394; GFI = .99, SRMR = .03) identified how positive discrepancies were associated with a higher presence of recovery markers (ß = .12, p = .05), which in turn were negatively related to the derived symptomatology index (ß = -.33, p < .001). Furthermore, the relationship between clinical and personal recovery was mediated by internalized stigma. CONCLUSIONS: An improvement in psychiatric services should be focused on recovery aspects that have the greatest discrepancy between importance and experience, in particular social roles, basic needs and hope. Personal and clinical recovery are correlated, but the relationship between them is mediated by internalized stigma, indicating the need for clinical interventions to target self-stigma.

Scoping review protocol on non-pharmacological interventions for interpersonal and self-directed violence in adults with severe mental illness.

INTRODUCTION: Violence committed by people with mental illness has implications for mental health policy and clinical practice. Several strategies to reduce the risk of aggressive and violent behaviour have been proposed, and these include non-pharmacological interventions. There is, however, a need to identify which of these interventions are effective, and as a first step, we will conduct a scoping review to identify non-pharmacological interventions for self-directed or interpersonal violence in adults with severe mental illness across different conditions and settings. METHODS AND ANALYSIS: This is a scoping review protocol. The review will include any randomised controlled trials (RCTs) and cluster RCTs that assess the efficacy of interventions on self-directed or interpersonal violence with no restrictions on the control treatment in people with severe mental illness in any setting. No restrictions will be applied in terms of language or date of publication. To identify studies, a search will be performed in the following databases: Embase, MEDLINE (via PubMed), PsycINFO, CINAHL, LILACS, SciELO, Cochrane Library, Web of Science, Scopus, ProQuest, Epistemonikos and databases of clinical trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement will be followed for reporting the findings, including the use of a PRISMA flow diagram. A standardised form will be used to extract data from studies. The findings will be classified using conceptual categories that will be specified in detail and a descriptive summary of the main results will be created. Moreover, it will be assessed whether the studies identified have been included in systematic reviews or meta-analyses and the results will be used to generate a conceptual map. ETHICS AND DISSEMINATION: No patients or other participants will be involved in this study. We will prepare a manuscript for publication in a peer-reviewed journal and the results will be presented at mental health conferences.

Psychometric Adequacy of Recovery Enhancing Environment (REE) Measure: CHIME Framework as a Theory Base for a Recovery Measure.

PURPOSE: The aim of this study was to assess to what extent the recovery elements of the Recovery Enhancing Environment (REE) instrument measured the dimensions proposed by the CHIME framework, (Connectedness, Hope and optimism about future, Identity, Meaning in life and Empowerment dimensions), so as to evaluate personal recovery in people with severe mental illness. METHODS: Two processes were conducted. Firstly, five experts matched the elements of recovery evaluated by the REE items with the CHIME domains and subdomains. Then, the resulting structure from those experts agreement was analyzed with different confirmatory factor analyses (CFA) using responses to the recovery elements dimension of the REE of 312 mental health service users. RESULTS: The percentage of agreements and the kappa coefficients were adequate taking into account the CHIME dimensions (κ = 0.57 to 0.69, total κ = 0.74); however, lower agreement was found at the subdimensions level. Some indexes of the CFA were acceptable for a second order factor analysis [χ 2 (242)= 346.03, p < 0.001, CFI= 0.931, RMSEA= 0.037 (0.028 to 0.046)] and the most adequate solution was obtained from the bi-factorial structure (χ 2 (223)=233.19, p=0.306, CFI= 0.993, RMSEA= 0.012 [0.000 to 0.027]). CONCLUSIONS: Despite the subjective and complex nature of the personal recovery construct, the REE measure can be a valid instrument to verify the existing CHIME conceptual framework, since two of the models tested have resulted in adequate indexes and were also congruent with the theoretical framework and the statistical solution. Thus, REE can be used to obtain a global index of Personal Recovery dimension, and the five indicators proposed by the CHIME framework.

Evidence of psychometric adequacy of the Spanish Adaptation of REE: Recovery Enhancing Environment.

INTRODUCTION: In this study we present the process and results of the Spanish adaptation and validation of REE (Recovery Enhancing Environment), an instrument designed to assess the personal process of recovery and the recovery orientation of mental health services. METHODOLOGY: The Spanish REE version has been completed by a representative sample of the Severe Mental Disorder (SMD) program users in the Mental Health Services of Biscay (n=312). RESULTS: The validity evidence of each section (importance of recovery elements, experience of recovery elements, organizational climate and recovery markers) of the REE has shown unidimensionality of the scale, with suitable indexes in the factorial analyses and Cronbach alphas greater than .90 for each dimension. Moreover, significant correlations have been found between REE and its dimensions, and with other instruments that measure severity, functionality and quality of life. CONCLUSIONS: The adequacy of the psychometric properties of the REE make it an interesting instrument to assess the different indicators related to the recovery model, especially if the scarcity of available instruments is taken into account.

Evidencias de adecuación psicométrica de la adaptación española del REE: Cuestionario de Evaluación del Desarrollo de Entornos Favorables para la Recuperación / Evidence of psychometric adequacy of the Spanish Adaptation of REE: Recovery Enhancing Environment

INTRODUCCIÓN: En el presente estudio se presentan el proceso y los resultados de la adaptación al castellano y la validación de REE (Recovery Enhancement Environment), una herramienta diseñada para evaluar tanto el proceso personal como la orientación de los servicios asistenciales hacia la recuperación. METODOLOGÍA: La versión española de REE fue completada por una muestra representativa de usuarios atendidos en el programa Trastorno Mental Grave (TMG) de la Red de Salud Mental de Bizkaia (n = 312). RESULTADOS: Las evidencias de validez de cada una de las secciones (importancia de los componentes de recuperación, experiencia de los componentes de recuperación, clima organizacional y marcadores de recuperación) del REE han mostrado unidimensionalidad con índices adecuados en los análisis factoriales, siendo las puntuaciones de consistencia interna de cada una de las dimensiones superiores a 0,90. Asimismo, se han encontrado correlaciones significativas entre el REE y sus dimensiones, y con otros instrumentos que evalúan gravedad, funcionalidad y calidad de vida. CONCLUSIONES: La adecuación del comportamiento de las evidencias psicométricas del REE lo convierten en un instrumento de interés para la evaluación de diferentes indicadores en relación al modelo de recuperación, más aún dada la escasez de herramientas disponibles

INTRODUCTION: In this study we present the process and results of the Spanish adaptation and validation of REE (Recovery Enhancing Environment), an instrument designed to assess the personal process of recovery and the recovery orientation of mental health services. METHODOLOGY: The Spanish REE version has been completed by a representative sample of the Severe Mental Dis-order (SMD) program users in the Mental Health Services of Biscay (n = 312). RESULTS: The validity evidence of each section (importance of recovery elements, experience of recovery elements, organizational climate and recovery markers) of the REE has shown unidimensionality of the scale, with suitable indexes in the factorial analyses and Cronbach alphas greater than .90 for each dimension. Moreover, significant correlations have been found between REE and its dimensions, and with other instruments that measure severity, functionality and quality of life. CONCLUSIONS: The adequacy of the psychometric proper-ties of the REE make it an interesting instrument to assess the different indicators related to the recovery model, especially if the scarcity of available instruments is taken into account

Patrón de uso de clozapina en España. Variabilidad e infraprescripción / Pattern of use of clozapine in Spain. Variability and under-prescription

Introducción: Los datos internacionales disponibles sobre uso de clozapina recogen en general una baja prescripción, infradosificación y retraso en el inicio del tratamiento, y han originado diversas iniciativas para mejorar su uso y disminuir la llamativa variabilidad. No disponemos de estudios que valoren estos aspectos en población española, por lo que nos hemos planteado una primera y modesta aproximación a través de 4 muestras territoriales. Nuestra hipótesis es que, al igual que las referencias comentadas, en nuestro país el consumo de clozapina podría ser bajo y variable. Nuestro objetivo, en caso de confirmarse la hipótesis, sería iniciar una reflexión sobre posibles estrategias a plantear. Material y métodos: Los autores han accedido a datos de consumo de clozapina en Cataluña, Castilla y León, País Vasco y un Área de Madrid (el Área de Gestión Clínica PSM del Hospital 12 de Octubre). Resultados: Los pacientes con diagnóstico de esquizofrenia en tratamiento en los territorios estudiados oscilan en torno al 0,3%; los tratamientos con clozapina/10.000 habitantes entre el 33% y 57%; y los pacientes diagnosticados como esquizofrenia en tratamiento con clozapina suponen entre el 13,7% y 18,6% de los tratados. El coeficiente de variación entre centros y prescriptores es frecuentemente superior al 50%. Conclusiones: Aunque por debajo de las cifras indicadas por la literatura, los datos globales de prescripción de clozapina en los territorios que hemos estudiado no son tan bajos como los recogidos en otros trabajos internacionales, y se sitúan en el rango de países de nuestro entorno. Sin embargo, la variabilidad en la prescripción es muy importante, aparentemente no justificada; y aumenta a medida que analizamos zonas menores, hasta una gran heterogeneidad de la prescripción individual

Introduction: International studies on clozapine use usually show lower than expected prescription proportions, under-dosing and delayed initiation of treatment, which has led to a number of initiatives aimed at improving its use and reducing the striking variability observed among practitioners. There are no similar studies on the Spanish population. Therefore we planned initial data collection from 4 territorial samples. We hypothesized that clozapine prescription would also be low and variable in our country. If this hypothesis were confirmed, a reflection on possible strategies would be necessary. Material and methods: We accessed data on clozapine prescription in Catalonia, Castile and Leon, the Basque Country and the Clinical Management Area of the Hospital 12 de Octubre (Madrid). Results: Patients diagnosed with schizophrenia under treatment in these territories comprise around .3% of their total population; treatment with clozapine ranges between 33.0 and 57.0 per 10000 inhabitants; patients diagnosed with schizophrenia on current treatment with clozapine range between 13.7% and 18.6% of the total number of patients with this diagnosis. The coefficient of variation between centres and prescribers is often higher than 50%. Conclusions: Although below the figures suggested as desirable in the literature, global prescribing data for clozapine in the areas we studied are not as low as the data collected in other international studies, and are in the range of countries in our environment. However, the variability in prescription is large and apparently not justified; this heterogeneity increases as we focus on smaller areas, and there is great heterogeneity at the level of individual prescription

Pattern of use of clozapine in Spain. Variability and under-prescription. / Patrón de uso de clozapina en España. Variabilidad e infraprescripción.

INTRODUCTION: International studies on clozapine use usually show lower than expected prescription proportions, under-dosing and delayed initiation of treatment, which has led to a number of initiatives aimed at improving its use and reducing the striking variability observed among practitioners. There are no similar studies on the Spanish population. Therefore we planned initial data collection from 4 territorial samples. We hypothesized that clozapine prescription would also be low and variable in our country. If this hypothesis were confirmed, a reflection on possible strategies would be necessary. MATERIAL AND METHODS: We accessed data on clozapine prescription in Catalonia, Castile and Leon, the Basque Country and the Clinical Management Area of the Hospital 12 de Octubre (Madrid). RESULTS: Patients diagnosed with schizophrenia under treatment in these territories comprise around .3% of their total population; treatment with clozapine ranges between 33.0 and 57.0 per 10000 inhabitants; patients diagnosed with schizophrenia on current treatment with clozapine range between 13.7% and 18.6% of the total number of patients with this diagnosis. The coefficient of variation between centres and prescribers is often higher than 50%. CONCLUSIONS: Although below the figures suggested as desirable in the literature, global prescribing data for clozapine in the areas we studied are not as low as the data collected in other international studies, and are in the range of countries in our environment. However, the variability in prescription is large and apparently not justified; this heterogeneity increases as we focus on smaller areas, and there is great heterogeneity at the level of individual prescription.

Reflexiones en torno al modelo de recuperación / Reflections on the recovery model

El objetivo de este artículo es aportar algunas reflexiones críticas sobre el modelo de recuperación en salud mental, su implementación en los servicios asistenciales y su posible impacto en las personas afectadas y en los profesionales. En un momento en el que la recuperación se ha convertido en el centro de la retórica de todos los planes y estrategias de salud mental, no es fácil definir de forma operativa cómo se traslada lo esencial del modelo a la práctica asistencial rutinaria en los servicios públicos de salud mental, ni qué consecuencias se derivarían de adoptar dicho enfoque. Teniendo en cuenta especialmente que el modelo de recuperación parece amparar muy diversas concepciones, desde las más ortodoxas y compatibles con la práctica asistencial habitual a las más críticas con la misma, es necesario definir en qué acciones específicas se traduce la adopción de este modelo en la organización de los servicios, cómo se evalúa su impacto y qué posibles efectos conlleva para los usuarios, los profesionales y la sociedad en general (AU)

This paper tries to offer some critical reflections on the recovery model in mental health, its deployment in care services and its impact on patients and mental health professionals. At a time when recovery has become the center of the rhetoric of all mental health plans and strategies, it is not easy to define in an operative way how the essential elements of the model have to be transferred to routine care practices in mental health public services, nor to assess the consequences that would result from adopting this approach. Taking into account that the recovery model seems to support very different conceptions, from the most orthodox and common care practices to the most critical ones, it is necessary to define what specific actions have to be implemented for the adoption of this model in the organization of services, how to assess their impact, and what potential effects they entail for users, professionals and society (AU)