Everyday life, culture, and recovery: carer experiences in care homes for individuals with severe mental illness

Qualitative Analysis of the Content Validity of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) in Schizophrenia: A Multi-Stakeholder Perspective

The US Food and Drug Agency (FDA) requires clinical trials targeting cognitive impairment associated with schizophrenia (CIAS) to demonstrate the functional relevance of cognitive improvements by employing a functional co-primary measure. Although quantitative evidence supports the suitability of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) for this purpose, FDA guidelines for qualification of clinical outcome assessments require evidence of content validity, defined as qualitative evidence that key stakeholders view the measure as relevant and important. To collect this important qualitative data, semi-structured interviews were conducted with outpatients with schizophrenia (n = 24), caregivers (n = 12), and professional peer support specialists (n = 12) to elicit their views about the definition and importance of functional independence, the importance of the functional domains assessed by the VRFCAT (meal planning, using transportation, handling money, shopping), and the relevance of the VRFCAT tasks to these domains. Qualitative thematic analyses revealed consistent themes across groups in defining functional independence, including performing instrumental self-care, financial, and social tasks; making decisions autonomously; and not depending on others to carry out daily activities. There were, however, notable differences in their views regarding the importance of and barriers to functional independence. All groups viewed the VRFCAT as assessing skill domains that are central to independent functioning and, with some minor differences, the VRFCAT tasks were viewed as relevant and meaningful examples of the domains. These qualitative results provide converging evidence that key stakeholders view the VRFCAT as a content-valid measure.

"I don't believe I'm going to recover from anything." Understanding recovery amongst people with severe mental illness attending community health services in Spain

PURPOSE

The concept of recovery has become the backbone of mental health services and professional practices. However, research aimed at analysing the conceptualisation of recovery of people diagnosed with severe mental illness (SMI) has an obvious Anglo-Saxon bias. Our objective was to analyse what a sample of 51 users of mental health services diagnosed with SMI in Spain understand by recovery.

METHOD

The participants were interviewed in depth about their concept of recovery, and their responses were thematically analysed by three observers.

RESULTS

Four categories of definitions of the concept of recovery were found in the analysis: Socio-Behavioural, Biomedical, Resistance, and Wellbeing-Growth. Inter-rater reliability scores ranged from 0.7 to 0.84 according to Krippendorff's alpha. While the Biomedical category essentially corresponded to the idea of clinical recovery, the Wellbeing-Growth category reproduced the concept of personal recovery (PR) that is dominant in the literature. The most frequent categories were Socio-Behavioural and Biomedical. Assimilation of the PR concept by participants was quite limited. The markedly relational character of the most frequent categories challenges the individualistic core of the classic definition of PR.

CONCLUSIONS

We advocate the need to make alternative recovery concepts and narratives visible to the mental health services' users and practitioners.IMPLICATIONS FOR REHABILITATIONThe concept of personal recovery is not common amongst mental health services' users as recovery is mainly understood in social and biomedical terms.Different conceptualizations of recovery can coexist in participants.Mental health services should consider alternative narratives to personal recovery.Mental health services should provide resources for creating community and sense of belonging as first strategies for promoting recovery.

Ethical Dilemmas of Participation of Service Users with Serious Mental Illness: A Thematic Synthesis

Mental health professionals are expected to stimulate the participation of service users with serious mental illness. This not only changes what is expected from service users and professionals, it also changes the values underlying their relationship. The value of autonomy becomes more important as a result. This raises potential ethical dilemmas. This paper reports the findings of a thematic synthesis of 28 papers on the views of service users, professionals and family members on the care relationship in inpatient, outpatient and community services for people with serious mental illness. It puts forward various perspectives on participation of service users, foregrounding differing values, which in turn can lead to ethical dilemmas for professionals. The key implications for mental health professionals and future research are discussed.

Does Employment Promote Recovery? Meanings from Work Experience in People Diagnosed with Serious Mental Illness

Employment has been highlighted as a determinant of health and as an essential milestone in the recovery process of people with serious mental illness. Different types of programs and public services have been designed to improve the employability of this population. However, there has not been much interest in the meanings attributed to these experiences and the negative aspects of work experience. In this research, we explored the meanings that participants attributed to their work experience and the impact of work on their recovery process. Research participants lived in Andalusia (Spain), a region in southern Europe with a high unemployment rate. Two versions of a semi-structured interview were designed: one for people who were working, and one for unemployed people. Participants' narratives were categorized according to grounded theory and the analyses were validated in group sessions. Apart from several positive effects for recovery, the analysis of the narratives about work experience outlined certain obstacles to recovery. For example, participants mentioned personal conflicts and stress, job insecurity and meaningless jobs. While valid, the idea that employment is beneficial for recovery must be qualified by the personal meanings attributed to these experiences, and the specific cultural and economic factors of each context.

Meaning in work and emerging work identities of housing support workers: A quest for a comprehensible plot

BACKGROUND

Work and employees are often marginalized in studies on community-based psychiatric care and support systems. This paper highlights the role of the worker at congregated supported housing for people with severe mental illness (SMI). Housing support workers (HSW) are a fairly new professional role and have developed as a result of major changes in Swedish mental health care and services. The development of new roles is not unproblematic and raises intriguing questions.

OBJECTIVE

The purpose of this article is to describe housing support workers' experiences of meaning in their work, and in addition illuminate how the work identity of HSWs can be negotiated and constructed.

METHODS

Four focus group interviews were conducted with a total of 25 participants. Additionally, three follow up sessions were conducted with the same participants. The material consists of employees from four different sites. The intepretation of the material was inspired by a constructionist approach.

RESULTS

The analysis generated three themes: to do a good job, everyday needs and the formal role. The work identity for HSWs is complex and not easily interpreted.

CONCLUSIONS

The experience of an unclear assignment affects the description of what is meaningful and important-the work identity and significant affiliations for HSWs. In the long run, this fragmented world can have negative implications for the HSW.

"Now he walks and walks, as if he didn't have a home where he could eat": food, healing, and hunger in Quechua narratives of madness

In the Quechua-speaking peasant communities of southern Peru, mental disorder is understood less as individualized pathology and more as a disturbance in family and social relationships. For many Andeans, food and feeding are ontologically fundamental to such relationships. This paper uses data from interviews and participant observation in a rural province of Cuzco to explore the significance of food and hunger in local discussions of madness. Carers' narratives, explanatory models, and theories of healing all draw heavily from idioms of food sharing and consumption in making sense of affliction, and these concepts structure understandings of madness that differ significantly from those assumed by formal mental health services. Greater awareness of the salience of these themes could strengthen the input of psychiatric and psychological care with this population and enhance knowledge of the alternative treatments that they use. Moreover, this case provides lessons for the global mental health movement on the importance of openness to the ways in which indigenous cultures may construct health, madness, and sociality. Such local meanings should be considered by mental health workers delivering services in order to provide care that can adjust to the alternative ontologies of sufferers and carers.