Implementation of the Recovery Guide in inpatient mental health services in Sweden-A process evaluation study

Stories of taking part in Everyday Life Rehabilitation - A narrative inquiry of residents with serious mental illness and their recovery pathway

Context and purpose

Persons enduring serious mental illness (SMI) and living in supported housing facilities often receive inadequate care, which can negatively impact their health outcomes. To address these challenges, it is crucial to prioritize interventions that promote personal recovery and address the unique needs of this group. When developing effective, equitable, and relevant interventions, it is essential to consider the experiences of persons with an SMI. By incorporating their perspectives, we can enhance the understanding, and thereby, the design and implementation of activity- and recovery-oriented interventions that promote health, quality of life, and social connectedness in this vulnerable population. Thus, the aim of this study is to explore the stories of participants partaking in Everyday Life Rehabilitation and how they make sense of their engagements in everyday life activities and their recovery processes.

Methods

Applying a narrative analysis, this study explores the stories of seven individuals with an SMI residing in Swedish supported housing facilities, participating in the Everyday Life Rehabilitation (ELR) program during six months, and how they retrospectively make meaning of their engagement in everyday life activities and recovery processes.

Findings

The participants' stories about their rehabilitation and personal recovery pathways elucidate how the inherent power of the activity, as well as the support the participants received to get started and succeed, had a significant impact on their self-identity, confidence, motivation, mattering, life prospects, and vitality. The participants valued the transparent steps along the process, weekly meetings, the signals, beliefs, and feedback communicated throughout, and the persistent, adaptive, and yet supporting approach in their personal progress.

Significance

This study underscores the need for interventions that prioritize meaningful activities and are sensitive to the complexity of the personal recovery process, especially in supported housing facilities. Future research should further explore effective strategies and mechanisms to promote personal recovery and to reduce the stigma associated with SMI.

Legitimizing user knowledge in mental health services: Epistemic (in)justice and barriers to knowledge integration

Including the voices and knowledge of service users is essential for developing recovery-oriented and evidence-based mental health services. Recent studies have however, suggested that challenges remain to the legitimization of user knowledge in practice. To further explore such challenges, a co-production study was conducted by a team of researchers and representatives from user organizations in Sweden. The aim of the study was to explore the barriers and facilitators to the legitimacy of user knowledge, as a central factor in sustainably implementing user influence in mental health practice. A series of workshops, with representatives of mental health services and user organizations were conducted by the research team to explore these issues. The analysis built on the theoretical framework of epistemic injustice, and the underlying aspects, testimonial, hermeneutic and participation-based injustice, were utilized as a framework for a deductive analysis. Results suggest that this is a useful model for exploring the complex dynamics related to the legitimacy of user knowledge in mental health systems. The analysis suggests that the legitimacy of user knowledge is related to the representativeness of the knowledge base, the systematic formulation of this knowledge in applicable methods, access to resources and positions within the mental health system and participation in the process of integrating this knowledge-base in mental health contexts. Legitimizing user knowledge in practice additionally challenges mental health systems to support readiness for change in working environments and to address the power and role issues that these changes involve.