Sense of self in recovery from severe mental illness

Personal recovery and future self-continuity in individuals with schizophrenia

INTRODUCTION

Personal (or self-rated) recovery in schizophrenia represents an adaptive process of constructing meaning in life, finding hope, and establishing a positive identity. In this sense, recovery is linked to and dependent upon one's sense of future self. Although self-rated recovery has been explored in relation to various affective, social, and psychological factors, the relationship between personal recovery and future-self continuity has not been examined. Future self-continuity (or continuous identity) refers to the sense of connection between one's present and future self, as the same person now as in the future. Individuals, who cannot connect their present selves to future selves view their future self as a stranger and have a decreased sense of self-empowerment and feel less motivated to work towards future-oriented and personally meaningful treatment goals. We postulate that having good future self-continuity may be a prerequisite to success in recovery-oriented treatment programs. The current study explored the relationship between self-rated recovery and future self-continuity in individuals with schizophrenia.

METHOD

Forty participants with schizophrenia were recruited from two inpatient units and completed a battery of assessments including cognitive functioning, symptom severity, level of functioning as well as an assessment of personal recovery.

RESULTS

The results indicated that higher future self-continuity predicted better personal recovery in individuals with schizophrenia after controlling for key demographic variables, symptom severity, psychosocial and cognitive functioning ability.

CONCLUSION

Future self-continuity was the only significant psychological variable that predicted personal recovery in individuals with schizophrenia. Clinical implications and future directions are discussed.

The effectiveness of character strength intervention on severe mental illness in Hong Kong

The Character Strength Intervention is designed to cultivate and enhance positive traits and virtues in individuals. We sought to explore whether severely mentally ill adult participants who attended sixteen 40-min sessions of the intervention and treatment as usual (TAU) would report higher purpose in life, life satisfaction, recovery, and happiness composite scores than participants in TAU only. Thirty-nine participants received Intervention + TAU, and 50 received TAU-only. The participants filled in the evaluations at baseline, two mid-point assessments during the intervention, and one after the intervention. The ANCOVA models show a significant intervention effect on recovery and happiness at T3 but diminished at T4 after the intervention wrapped up. The intervention group has significantly less deterioration in recovery than the control group. No significant intervention effect emerged in purpose in life and life satisfaction. It should be noted that the intervention outcome is also negatively impacted by the baseline condition. The slope analysis indicates that for intervention recipients whose happiness scores are lower than 14.16, the predicted intervention outcome is even lower than that of the control group. Future severe mental illness interventions could consider incorporating CSI to enhance recovery and happiness while also being mindful of the baseline conditions to enhance intervention efficacy.

Recovery-Oriented Group Songwriting for Mental Health Confidence with Adults on an Acute Mental Health Unit: A Cluster-Randomized Effectiveness Study

Music therapy can address various clinical objectives related to recovery in acute mental health inpatient settings. However, there is a gap in the literature investigating if group-based songwriting can impact mental health confidence/self-efficacy. Therefore, the purpose of this study was to determine the effects of a single-session recovery-oriented group-based songwriting protocol on adults hospitalized in an acute care mental health unit as measured by mental health confidence. Over 48 sessions, 128 participants were cluster-randomized to songwriting or control conditions. The songwriting condition addressed motivations for and pathways to recovery. To avoid testing fatigue in this single-session study, songwriting participants received the intervention and then completed the Mental Health Confidence Scale (MHCS) while control participants completed the MHCS and then received a music intervention that did not address recovery. Results indicated significant between-group differences in optimism, coping, and advocacy subscales as well as total mental health confidence. In all measures, the songwriting group had more favorable mean scores than the control group. Effect sizes were in the small and medium ranges. Despite the temporal limitations associated with single-session treatment germane to acute mental health settings, results were statistically significant and clinically relevant. Implications for clinical practice, limitations, and suggestions for future research are provided.

The Poetic Wavelength-Tuning into the Meaningful Poetics of Psychosis

Despite the emerging evidence base to support the therapeutic potential of creative writing and poetry for a variety of mental health problems, the therapeutic potential of poetry for people who have experienced psychosis remains poorly understood. The paper argues that by considering psychosis as meaningful poetics, this epistemological shift has the potential to foster curious inquiry and increase opportunities for meaningful dialogue. The paper introduces and explores the concept of the 'poetic wavelength', building on the previously established notion of the psychotic wavelength, which proposes that others need to 'tune in' to what is being communicated through psychosis. The concept of the poetic wavelength suggests that the reading and writing of poetry may support this process of 'tuning in' both for those experiencing psychosis and those working therapeutically with them.

The Transtheoretical Model of Change and Recovery from a Suicidal Episode

OBJECTIVE

The Transtheoretical Model of Change (TTM) is an established model outlining five stages of change within a psychotherapeutic context: pre-contemplation, contemplation, preparation, action, and maintenance. Research shows that these models benefit patients and clinicians by enhancing their understanding of complex processes and identifying optimal therapeutic support for individuals at specific times. This study aimed to apply the TTM to personal recovery following a suicidal episode.

METHOD

A meta-synthesis was conducted on qualitative studies that outlined distinct phases or stages of recovery from a suicidal episode. The identified recovery stages were mapped onto corresponding TTM stages.

RESULTS

Recovery processes followed a pattern aligning with TTM stages, but the action, maintenance, and termination stages were not clearly distinguished in the context of personal recovery. A three-stage model was proposed instead: (1) precontemplation, where recovery is not seen as possible or meaningful; (2) contemplation, during which there is growing awareness and consideration of the possibility of recovery and change; and (3) active growth, which is characterized by ongoing progress and engagement in at least one personal recovery process.

CONCLUSIONS

The proposed three-stage model condenses the later TTM stages and may better reflect personal recovery from a suicidal episode. Applying the model in clinical settings could help with case conceptualization and inform recovery approaches to an individual's current stage. Future research should evaluate the benefits of incorporating stages of change into suicide-focused recovery interventions to develop more effective interventions.

Is personal recovery a transdiagnostic concept? Testing the fit of the CHIME framework using narrative experiences

BACKGROUND

Personal recovery is operationalized in the CHIME framework (connectedness, hope, identity, meaning in life, and empowerment) of recovery processes. CHIME was initially developed through analysis of experiences of people mainly with psychosis, but it might also be valid for investigating recovery in mood-related, autism and other diagnoses.

AIMS

To examine whether personal recovery is transdiagnostic by studying narrative experiences in several diagnostic groups.

METHODS

Thirty recovery narratives, retrieved from "Psychiatry Story Bank" (PSB) in the Netherlands, were analyzed by three coders using CHIME as a deductive framework. New codes were assigned using an inductive approach and member checks were performed after consensus was reached.

RESULTS

All five CHIME dimensions were richly reported in the narratives, independent of diagnosis. Seven new domains were identified, such as "acknowledgement by diagnosis" and "gaining self-insight". These new domains were evaluated to fit well as subdomains within the original CHIME framework. On average, 54.2% of all narrative content was classified as experienced difficulties.

CONCLUSIONS

Recovery stories from different diagnostic perspectives fit well into the CHIME framework, implying that personal recovery is a transdiagnostic concept. Difficulties should not be ignored in the context of personal recovery based on its substantial presence in the recovery narratives.

What to take up from the patient's talk? The clinician's responses to the patient's self-disclosure of their subjective experience in the psychiatric intake interview

During psychiatric diagnostic interviews, the clinician's question usually targets specific symptom descriptions based on diagnostic categories for ICD-10/DSM-5 (2, 3). While some patients merely answer questions, others go beyond to describe their subjective experiences in a manner that highlights the intensity and urgency of those experiences. By adopting conversation analysis as a method, this study examines diagnostic interviews conducted in an outpatient clinic in South Finland and identifies sequences that divulge patients' subjective experiences. From 10 audio-recorded diagnostic interviews, 40 segments were selected where patients replied to medically or factually oriented questions with their self-disclosures. The research focus was on the clinicians' responses to these disclosures. We present five sequential trajectories that the clinicians offered third-position utterances in response to their patients' self-disclosure of subjective experiences. These trajectories include the following: 1) the clinician transfers the topic to a new agenda question concerning a medical or factual theme; 2) the clinician presents a follow-up question that selects a topic from the patient's self-disclosure of a subjective experience that may orient either towards the medical/factual side or the experiential side of the patient's telling; 3) the clinician provides an expert interpretation of the patient's self-disclosure of his or her subjective experience from the clinician's expert perspective; 4) the clinician gives advice that orients mainly to a treatment recommendation or to another activity; and 5) the clinician presents a formulation that focusses on the core of their patient's self-disclosure of his or her subjective experience from the patient's perspective. In addition, we present what these responsive practices invoke from the patient in the next turn. We argue that an awareness of these strategies facilitates both the diagnosis and an appropriate therapeutic relationship during the psychiatric assessment interview. Finally, we discuss the clinical significance of our results regarding the patient's agency and the clinician's more conscious patient-centred orientation in the psychiatric assessment procedure.

[The psychosocial rehabilitation in addiction medicine]

OBJECTIVES

Addictive behaviors constitute complex behaviors that are usually related to social habits, such as substance use, gambling or gaming activities, or sexual or physical activity. They progressively overrun and stifle the routine habits of the concerned individuals, for example within their occupational or family spheres of life, as well as in their hobbies or in their main physiological functions, such as sleep or eating cycles. The rehabilitation approach of care integrates the objective of restoring the altered habits and functional rhythms, to optimize the clinical outcomes and improve quality of life of the concerned persons.

METHODS

Using a focused and narrative literature review, we aimed to explain what psychosocial rehabilitation consists in, and why this approach is particularly relevant for the addiction care, although to date it has remained insufficiently developed in the routine practice of many facilities.

RESULTS

The "rehab" approach, is first based on a structured and comprehensive assessment of the clinical and functional aspects of the patient, which secondarily allows to frame an individualized project of care that is closely built together with the patient. This project of care can integrate classical pharmacotherapeutic and psychotherapeutic tools, but it also emphasizes wider approaches for restoring some basic social and physiological functions of the concerned person, such as sleep, eating, social functioning, physical activity, or spiritual needs. Priorities among these different dimensions have to be defined by the concerned person.

CONCLUSIONS

The "rehab" approach is particularly relevant in addiction medicine. It represents a more global conception of care that conceives the recovery of social and physiological functioning as a core treatment objective for the concerned persons. The consequences for care organization are that many additional professionals should be integrated into the treatment schemes for addiction, including peer counselors, occupational therapists, physical activity coaches, or dieticians.

Perceptions and experiences of prenatal mental health: A qualitative study among pregnant women in Ghana

Prenatal mental health problems can have adverse effects on the health and wellbeing of the mother as well as her baby. However, the factors associated with its etiology, expression, and coping mechanisms in Ghana remain understudied. This qualitative study explored the perceptions and experiences of prenatal mental health problems among 21 pregnant women in Accra through semi-structured interviews. Interpretative Phenomenological Analysis led to three dominant themes; "conceptions of prenatal mental disorders" (sub-themes: awareness and constructions of prenatal mental health problems), "experiences of mental health problems" (sub-themes: symptoms of prenatal mental health problems and causal attributions of prenatal mental health problems) and "coping mechanisms of the pregnancy experience" (subthemes: faith, social support and work). The lack of knowledge of mental health disorders in this study and the expression of contextually relevant and culturally defined constructions and experiences of prenatal mental health problems, highlight the need for the development of culturally suitable interventions within the Ghanaian context.

Recovery journey of people with a lived experience of schizophrenia: a qualitative study of experiences

BACKGROUND

Mental health recovery involves an integration of clinical and psychosocial frameworks. The recovery journey of individuals diagnosed with schizophrenia and the factors that influence it have been extensively studied. Because the recovery journey is culturally influenced, we examined the recovery process expriences of individuals diagnosed with schizophrenia in China, focusing on the influence of a Confucian-dominated collectivist and family-centred culture.

METHODS

An Interpretive Phenomenological Analysis (IPA) study was conducted; data were gathered through in-depth interviews with 11 individuals with lived experience of schizophrenia.

RESULTS

Four themes were identified in this study: traumatic illness experiences, influence of the family, motives for recovery, and posttraumatic growth, comprising ten subthemes. "For the family" and "relying on oneself" are the main drivers of recovery for individuals with a Chinese cultural background. Some people believe that taking care of themselves is an important way to ease the burden on their families and treat them well. There is a link between 'for the family' and 'relying on oneself.

CONCLUSIONS

Individuals living with schizophrenia in China have undergone significant traumatic experiences and have profound interactions with their families. Post-traumatic growth reflects an increase in the individual's connection to others and individual agency. It also suggests that the individual is not receiving enough support outside of the family. The impact of individual agency and family relationships should be considered in services that promote recovery, and clinic staff should enhance support outside the home to the individuals.

Discrepancies between self and caregiver perceptions of agency in first-episode psychosis

Personal agency-a key element of recovery from psychotic disorders-is formed and maintained in large part through interactions with others. Interactions with caregivers are particularly important in first-episode psychosis (FEP), as these interactions form the foundations for lifelong caregiving relationships. The present study examined shared understandings of agency (operationalized as efficacy to manage symptoms and social behaviors) within families affected by FEP. Individuals with FEP (n = 46) completed the Self-Efficacy Scale for Schizophrenia (SESS) and measures of symptom severity, social functioning, social quality of life, stigma, and discrimination. Caregivers (n = 42) completed a caregiver version of the SESS assessing perceptions of their affected relative's self-efficacy. Self-rated efficacy was higher than caregiver-rated efficacy in all domains (positive symptoms, negative symptoms, and social behavior). Self- and caregiver-rated efficacy correlated only in the social behavior domain. Self-rated efficacy was most associated with lower depression and stigmatization, whereas caregiver-rated efficacy was most associated with better social functioning. Psychotic symptoms did not relate to self- or caregiver-rated efficacy. Individuals with FEP and caregivers have discrepant perceptions of personal agency, perhaps because they base perceptions of agency on different sources of information. These findings highlight specific targets for psychoeducation, social skills training, and assertiveness training to develop shared understandings of agency and facilitate functional recovery.

Attitudes of Italian mental health nurses towards mental illness and recovery: a cross-sectional study

Background

Mental health nurses' (MHNs) stigma and discrimination against people with mental illnesses are obstacles to recovery and the development of effective care and treatment. Although many authors have been interested in exploring stigma among general health professionals, paradoxically, less and non-generalizable evidence is available on this phenomenon among MHNs. Understanding the factors associated with stigma and its relationship to recovery attitudes among MHNs could allow for more accurate interventions and improve patient care outcomes.

Objective

This study conducted on a sample of Italian psychiatric nurses had the objective of analyzing the aptitude for recovery and the tendency towards stigma of these professionals towards mental illness.

Methodology

A cross-sectional web survey was conducted on a sample of Italian MHNs, who were administered two validated tools, the RAQ-7 (assessment of recovery aptitude) and the WHO-HC-15 (assessment of stigma) respectively.

Results

A total of 204 MHNs were interviewed. The analysis showed positive overall scores (high recovery aptitude and low stigma levels) among participating MHNs. The attitude to recovery appeared to be directly related to a lower tendency to stigma towards mental illness. It has been observed that MHNs with advanced levels of education appear to be more predisposed to recovery, as well as generally less stigmatizing. There is evidence that the setting in which care is provided, marital status and age can play a significant role in the tendency to stigmatization.

Conclusion

Our manuscript could assist nursing executives, leaders or educators in making decisions about managing and preventing stigma among MHNs.

Measuring recovery in Arabic countries: Translation of the self-efficacy for personal recovery scale

AIM

To translate the Self-Efficacy for Personal Recovery Scale (SEPRS) into Arabic and evaluate the psychometric properties of the Arabic version.

METHODS

An established translation methodology was employed, involving back-translation, comparison, forward-translation, comparison, and piloting. The pre-final version of the Arabic translated scale was tested for clarity with young people with a primary diagnosis of mental health problem. The final Arabic version and standardized measures of hope and loneliness were administered to 119 young people in two rounds.

RESULTS

Internal consistency was adequate (Cronbach's alpha = 0.87 in round 1, 0.91 in round 2). Consistent with the English version, a one-factor solution best fitted the data. The correlation between SEPRS and hope was R = 0.60 (round 1) and R = 0.61 (round 2), indicating convergent validity. The correlation between SEPRS and loneliness was R = -0.52 (round 1) and R = -0.60 (round 2). Correlation between test and retest was R = -0.998 indicated adequate test-retest reliability. Minimal floor and ceiling effects were detected.

CONCLUSION

The use of the Arabic SEPRS with Arabic-speaking samples is supported. Further research to investigate divergent validity is warranted.

Enhanced supported living for people with severe and persistent mental health problems: A qualitative investigation

Supported living has been shown to improve functioning and social inclusion in people with severe and persistent mental health problems, reduce hospitalisation and provide secure accommodation in a population where housing needs are often unmet. Conversely, living in supported accommodation has been depicted by some as depersonalising, marginalising and an ordeal to survive. Discussions regarding housing and support often lack a thorough consideration of individual experiences, with a reliance on quantitative surveys. The question remains how to assure that supported accommodations actually are supportive of the residents' ongoing recovery process. The present study sought to shed light on the experiences of residents in an enhanced supported living service in the United Kingdom. Semi-structured interviews were conducted with nine residents of the service between July 2020 and February 2021. Transcripts were analysed using thematic analysis and indicated three superordinate themes of experiences considered valuable to residents: (1) support from care staff which was readily available; (2), a sense of community and daily activity offered by the residence and on-site activities; and (3) the experience of supported living as a stepping-stone in an ongoing recovery process. Findings indicate the power of comprehensive care with supportive staff, peer-relations, autonomy and fostering hope in empowering individuals in their ongoing recovery.

Lifesaving turning points: First-person accounts of recovery after suicide attempt(s)

This study explores the recovery processes of persons who had attempted suicide. Semi-structured interviews were conducted with eight persons who had attempted suicide and the data were analyzed by means of systematic text condensation. The participants described lifesaving turning points, which were connected to meaningful relationships, taking control over one's own life, and establishing a new everyday life. Suicide prevention efforts must be adapted to individual needs. First-person knowledge is important if we are to understand what is seen as helpful and should be emphasized when implementing suicide prevention work.

Kintsugi-Identity change and reconstruction following an episode of psychosis: A systematic review and thematic synthesis

AIM

Research has shown that experiences of psychosis can have a significant impact on an individual's identity. Moreover, the way those who experience psychosis make sense of these changes appears to affect their recovery journey and hold clinical significance. However, this area of research is still very much developing, and there is a need for reviews, which look to synthesise and understand this process of identity change to guide clinicians working in this area as well as future research. This study looks to meet that gap and aims to synthesise qualitative literature exploring the lived experience of identity change amongst people who experience psychosis.

METHODS

A systematic review using thematic synthesis was carried out. The PRISMA and ENTREQ guidelines were followed in reporting the study.

RESULTS

Ninety-one papers were identified which met criteria for inclusion and 31 papers included in the synthesis at which point conceptual saturation was judged to have been reached. Five themes were created: psychosis as an obliteration of the old self; the futile fight against psychosis; mourning for who I was; the battle for self as a battle against disempowerment; and recovery as rebirth.

CONCLUSIONS

Results highlighted the substantive impact an experience of psychosis has on an individual's identity, the key role sense making around these identity changes plays in recovery and the crucial impact of clinicians on the sense-making process. The implications for theory, future research and clinical practice are discussed.

Conceptualizing mental health among diverse Americans

Purpose

A single conceptualization of mental health based on empirical research has yet to be adopted by researchers and practitioners. This paper aims to explore how diverse Americans define mental health. The aim of the study was to build a conceptualization of the term “mental health”, using qualitative and quantitative methods, on the basis of definitions provided by an ethnically diverse sample of lay-people and professionals.

Design/methodology/approach

Concept mapping methods, including multidimensional scaling and hierarchical cluster analysis, were applied to 146 statements generated by 125 participants of diverse American racial and ethnic groups. The resulting concept map was inspected visually, quantitatively and qualitatively.

Findings

Out of the 146 statements, 8 overarching themes emerged from multidimensional scaling and hierarchical cluster analysis. Themes include Well-being, balance, coping, adaptability, relational, self, lack of mental illness and physical. T-tests revealed statistically significant differences on ratings of importance for statements within the theme “Lack of Mental Illness” from those included in “Well-Being”, “Balance” and “Coping.” Statements included in the theme “Lack of Mental Illness” were rated least essential to the construct of mental health. The “Self” cluster appeared at the center of the data visualization, suggesting that Americans believe that self is essential to the construct in question.

Practical implications

This mixed-method study is consistent with prior evidence that mental health and mental illness might best be considered separate constructs (Westerhof and Keyes, 2010). A logical follow-up might examine why the concept of “Self” emerges centrally as it would help mental health practitioners and policymakers to focus their understanding of mental health to improve mental health interventions.

Originality/value

Understanding that the concept of “Self” is central to Americans’ conceptualizing of mental health may help mental health practitioners and policymakers to focus their efforts in delivering targeted mental health interventions.

[Acceptance, mourning of delusions and recovery]

Recovering from a mental disorder is a process by which the affected person will develop a new life project, based on the optimal use of personal and environmental resources. This involves adapting and managing certain symptoms better, in order to be able to rebuild oneself psychologically. This may be the case for delusions, which need to be distanced and accepted in order to develop this new life stage in. In this perspective, the notions of mourning for the self and mourning for delusional beliefs seem to be necessary steps in the reconstruction of a self that is favourable to recovery.

The Lost Social Context of Recovery Psychiatrization of a Social Process

From being a concept questioning the core of psychiatric knowledge and practice, recovery has been adopted as a guiding vison for mental health policy and practice by different local, national, and international organizations. The aim of this article is to contextualize the different understandings of recovery and its psychiatrization through the emergence of an individualizing and de-contextualized definition which have gained a dominant position. It ends with an attempt to formulate a new definition of recovery which integrates people in their social context. Research results from various follow-up studies showing the possibility of recovery from severe mental distress have stressed the importance of societal, social and relational factors as well of the person's own agency when facing their distress and reactions from their environment. These researches were published in the 1970s and 80s; a period of struggle for liberation from colonialism, of struggle by women and black people for their civil rights, and a time of de-institutionalization of services directed toward the poor, elderly, handicapped, prisoners, and people with mental health problems. Recovery research pointed at the central role of individuals in their recovery journey and it was understood as a personal process in a social context. However, with neo-liberal political agenda, the personal role of individuals and their own responsibility for their well-being was stressed, and contextual understandings and the role of social, material and cultural changes to promote recovery faded away. Thus, during recent decades recovery has been mostly defined as an individualistic journey of changing the persons and their perception of their situation, but not of changing this situation. Contextual aspects are almost absent. The most quoted definition accepts the limits posed by an illness-based model. This kind of definition might be a reason for the wide acceptance of a phenomenon that was initially experienced as a break with the bio-medical paradigm. Recently, this dominant individualized understanding of recovery has been criticized by service users, clinicians and researchers, making possible a redefinition of recovery as a social process in material and cultural contexts.

Implementation of an Expressive Writing Intervention for Adolescents during Inpatient Psychiatric Hospitalization

BACKGROUND:

Given the high rates of mental health concerns and communication difficulties for adolescents a treatment intervention to allow for effective expression may be therapeutic. One of the leading writing practices is Pennebaker’s Expressive Writing (EW) intervention. EW involves individuals writing about their feelings and thoughts regarding negative life experiences. Benefits of EW include a reduction of psychological symptoms and doctor visits, and better adjustment.

OBJECTIVE:

To examine the role of using EW and creative writing as a group intervention for youth admitted to an inpatient psychiatric hospital (IPH)

METHODS:

The current study evaluated participant engagement in a 3-day EW activity facilitated by nurses and graduate students on the IPH unit under the supervision of the IPH unit nurse manager and course instructor. Participants included 23 youth between 12- and 18-years-old

RESULTS:

Of the 23 participants 49.69% discussed vivid descriptions of illness, 24.5% discussed negative emotions, 20.25% included casual explanation, 5.52% discussed polarized view, and 16.56% discussed their desires, wishes, and goals. The response rate of clinician’s review of the EW content included 58% of clinician’s coding was on the patient’s current state, 24% was on causal explanations, and 18% was on treatment options.

CONCLUSION:

The current EW intervention facilitated by nursing staff and graduate students in an IPH was found to be engaged in by participants and provide an additional therapeutic resource to participants. EW may foster patient communication with staff about their functioning, mental health concerns, and treatment needs.

Telemedicine solutions for patients with mental disorders: a Delphi study and review of mobile applications in virtual stores

Mental disorders are a critical public health challenge since they profoundly affected people lifestyle. Mental healthcare treatments aim to promote a higher quality of life of the patients. These procedures include interventions for prolonged mental illness which can be supported by telemedicine technologies. This paper presents a comprehensive analysis of mobile applications selected to address the most critical needs of people with mental problems. Needs include areas of the patient's life, such as basic activities, behavioral changes, and daily life tasks. This work has two main objectives; (1) identify critical needs for patients with mental disorders and (2) identify and analyze apps that can meet the identified critical needs. A Delphi methodology survey was carried with a group of thirteen volunteers, including nurses, assistants, and psychiatrists who are working in Zamora and Valladolid, Spain. This survey has recommended different needs for patients with mental disorders and address objective 1. Google Play and Apple Store have been assessed to select the most relevant mobile applications that were recommended in the Delphi study to address the essential needs of these patients according to objective 2. The results of the Delphi survey show 24 different needs for patients with mental disorders. This study has analyzed 62 mobile applications which address the essential needs recommended in the Delphi study. The selected mobile applications represent 31 applications with feedback (50%); 15 informative applications (24%), and 16 independent applications (26%). On the one hand, applications with feedback request can address 13 recommended needs (54%). On the other hand, informative applications can address 7 needs (29%). Finally, the independent applications are only able to respond to 4 of the 24 recommend needs (17%). Mobile health applications present effective technologies to support the needs of patients with mental disorders. However, this study suggests a critical limitation of mobile applications for mental health since the majority of the applications require user activity. Therefore, future research initiatives on the design and development of mobile apps for people who have mental disorders should focus on independent applications.

Attachment as a framework to facilitate empowerment for people with severe mental illness

OBJECTIVES

Recovery and empowerment have evolved into key objectives in the treatment and care of people with severe mental illness (SMI), and interest has grown in the role of social relationships in recovery. This study is the first to explore whether attachment styles are related to levels of empowerment, and secondly, whether attachment anxiety and attachment avoidance are associated with lower empowerment levels, independently of quality and frequency of social contact.

DESIGN

We used a cross-sectional design.

METHODS

In a sample of 157 participants with SMI in outpatient care, associations between attachment (Revised Adult Attachment Scale), self-reported social functioning, and empowerment (Netherlands Empowerment List) were assessed.

RESULTS

Attachment anxiety and attachment avoidance were both associated with lower levels of empowerment. A stepwise multiple regression analysis showed that the prediction of empowerment was significantly improved by adding attachment anxiety and attachment avoidance to quality and frequency of social contact. Attachment anxiety, attachment avoidance, and quality of social contact were significant predictors; frequency of social contact was not.

CONCLUSIONS

Although our design does not allow causal conclusions, our results highlight the importance of interpersonal processes and behaviours as routes to improving empowerment for people with SMI. A promising approach might thus consist of securing attachment bonds with significant others so that the self and the other are perceived as reliable resources. Our findings also feature the importance of reciprocity and equality in social relationships. Taken together, our study emphasizes the value of social, contextualized interventions in recovery work for people with SMI.

PRACTITIONER POINTS

Working towards attachment safety in interpersonal relations may be important in recovery-oriented treatment and care for people with severe mental illness (SMI). Helping people with SMI to recognize and change how they tend to relate themselves to others may promote engagement and effectiveness of recovery-oriented treatment and care. Reciprocity and equality in social relationships as vital complements to the more one-sided nature of 'standing alongside' and offering support may be important requisites for empowerment.

Impact of the EU Blue Card programme on cultural participation and subjective well-being of migrants in Germany

The first aim of this study is to investigate the role of the EU Blue Card programme implemented in 2012 in Germany. In particular, we aim to explore the impact on the participation in cultural activities of first-generation non-European Union (EU) and non-European Economic Area (EEA) migrants, such as attendance to cinema, concerts and theatre. The second aim is to examine the impact of cultural activities on subjective well-being (SWB), measured by life satisfaction. We compare the cultural participation and life satisfaction between the treatment group that is the non-EU/EEA first-generation immigrants and the control group that consists, not only of natives and second-generation immigrants but also composes of EU/EEA first-generation immigrants who are not eligible to the programme. We will apply a sharp and a fuzzy regression discontinuity design (RDD) within a seemingly unrelated regression equations (SURE) system using the Ordered Probit method. The empirical analysis relies on data from the German Socio-Economic Panel (GSOEP) survey over the period 2015–2018. The results show that the treated subjects experience an increase in cultural participation activities and an improvement in their SWB, as a result of the EU Blue Card programme, compared to the control group. Participation in classical music performance, opera or theatre influences more the SWB compared to other cultural activities. Policies that promote labour market integration and participation in cultural activities will enable immigrants to integrate into the social norms of the host societies and improve their SWB.

Narrative identity in the psychosis spectrum: A systematic review and developmental model

Individuals with schizophrenia-spectrum disorders face profound challenges as they attempt to maintain identity through the course of illness. Narrative identity-the study of internalized, evolving life stories-provides a rich theoretical and empirical perspective on these challenges. Based on evidence from a systematic review of narrative identity in the psychosis spectrum (30 studies, combined N = 3859), we argue that the narrative identities of individuals with schizophrenia-spectrum disorders are distinguished by three features: disjointed structure, a focus on suffering, and detached narration. Psychotic disorders typically begin to emerge during adolescence and emerging adulthood, which are formative developmental stages for narrative identity, so it is particularly informative to understand identity disturbances from a developmental perspective. We propose a developmental model in which a focus on suffering emerges in childhood; disjointed structure emerges in middle and late adolescence; and detached narration emerges before or around the time of a first psychotic episode. Further research with imminent risk and early course psychosis populations would be needed to test these predictions. The disrupted life stories of individuals on the psychosis spectrum provide multiple rich avenues for further research to understand narrative self-disturbances.

Diversity, Complexity and Ordinality: Mental Health Services Outside the Institutions-Service Users' and Professionals' Experience-Based Practices and Knowledges, and New Public Management

In conjunction with the dismantling of psychiatric hospitals, social workers have been commissioned to help service users in their daily living in their homes and in the community. The consequences of these changes for experience-based knowledge and practices in their contexts remain relatively unknown. In this study, eighteen service users and the social workers they described as helpful for them were interviewed. The interviews were recorded, transcribed, and analyzed using Thematic Analysis. The following themes emerged: “Here, there and everywhere”, “Doing, being, becoming”, “Talking” and “Order, planning and improvisation” concerning the contradictions service users and professionals mentioned about their practices and the conditions imposed by managerial methods connected to New Public Management. Finally, “Spontaneous planned complexity” was chosen as our overarching theme to characterize the new knowledge and practices which have been developed. The displacement of the place for the encounter and the introduction of non-medicalized professions have allowed community-based practices and thus the co-creation and emergence of new knowledge about the service users as persons and the professionals as qualified professionals. The challenge remains for managers to have trust in their colleagues and not impose rigid rules, schematized methods, and repeated controls.

Social Identities of Persons With Schizophrenia and Social Functioning: Individual and Family Caregiver Perspectives

ABSTRACT

We apply social identity theory and self-categorization theory to examine the role of social identities in relation to the recovery of persons with schizophrenia. We assess whether illness-based and non-illness-based identities held by both those with schizophrenia and their caregivers explain additional variance in social functioning in persons with schizophrenia beyond the previously established predictors of negative symptoms and theory of mind. Sixty Mexican-origin adults diagnosed with schizophrenia and their family caregivers were obtained through an outpatient mental health clinic located in either Los Angeles, CA, or in Puebla, Mexico. A three-step hierarchical regression indicated that identity endorsements, from both the perspective of the person with schizophrenia and their caregiver, and negative symptomatology are significant independent predictors of social functioning. Specifically, greater endorsement of nonillness identities both for the person with schizophrenia and also their caregiver is associated with higher social functioning. Illness identity plays an important role in the path to recovery.

Recovery e os grupos de ajuda e suporte mútuos em saúde mental: análise de uma experiência

Para o artigo, é realizado um recorte dos resultados da pesquisa que originou a dissertação “’Nada sobre nós, sem nós’: Empoderamento e recovery em um estudo de um grupo de ajuda e suporte mútuos em saúde mental no município do Rio de Janeiro-RJ”, dando enfoque às experiências de usuários e usuárias de um grupo de ajuda e suporte mútuos em saúde mental, priorizando algumas de suas narrativas, associadas a seus processos de recovery. Considerando a realidade das práticas de saúde mental, seus limites e desafios, visa-se contribuir para os avanços no campo, priorizando as experiências brasileiras de protagonismo de usuários e usuárias de serviços, tal como os grupos de ajuda e suporte mútuos. Foi utilizado o método de pesquisa participante com os sete usuários e as cinco usuárias do grupo básico de facilitadores do programa. Para analisar os processos de recovery no dispositivo grupal em foco, é necessário contextualizá-los a partir da nossa realidade de reforma psiquiátrica. Como resultados, foram abordadas as questões mais gerais sobre o funcionamento do grupo, os temas e as questões da vida cotidiana, as questões relacionadas ao trabalho, a relação com os serviços de saúde mental e com evidências e indicadores de efetividade. A discussão dos desafios e efeitos do trabalho com o grupo para seus processos de protagonismo é importante para que possamos avançar nas políticas e práticas de saúde mental, considerando especificamente a relevância do processo de recovery no contexto brasileiro, dando visibilidade às práticas de protagonismo de usuários e usuárias de serviços.

Recovery e saúde mental: uma revisão da literatura latinoamericana

A abordagem Recovery emergiu nos anos 1970 nos Estados Unidos a partir dos movimentos em defesa dos direitos dos usuários dos serviços de saúde mental, ex-pacientes ou sobreviventes da psiquiatria. A partir da década de 2000 recovery vem orientando serviços de saúde mental em diversos países e muitos acreditam que possa contribuir com os processos de reforma do modelo de atenção em saúde mental em todo o mundo. No campo acadêmico, um número de publicações vem analisando as formas diversas de aplicação da abordagem em níveis nacionais e internacional. O objetivo desta revisão integrativa, realizada em 2019, foi analisar como a abordagem recovery vem sendo tratada na literatura científica na América Latina. A análise gerou categorias temáticas desvelando os principais assuntos abordados nestas publicações, entre eles discussões sobre terminologia, conceito de recovery, práticas, políticas e serviços orientados por recovery e possibilidades da incorporação da abordagem no contexto da Reforma Psiquiátrica Brasileira que, apesar dos obstáculos, ainda pode ser considerada como orientadora da Política Nacional de Saúde Mental no Brasil. A revisão aponta que o número de publicações sobre recovery na América Latina é escasso, comparado com o número de publicações nos Estados Unidos, Canadá, Hong Kong, Europa e Oceania, e são oriundas principalmente do Brasil. Percebe-se, ainda, que os autores brasileiros, em geral, entendem que recovery pode representar uma importante contribuição ao avanço da Reforma Psiquiátrica Brasileira e alguns defendem a necessidade de cautela sobre a incorporação da abordagem sem uma devida adaptação ao contexto social, cultural e econômico local. Também foi apontado que recovery tem sido aplicado em outros contextos sociais. 

Recovery e saúde mental: uma revisão da literatura latinoamericana

A abordagem Recovery emergiu nos anos 1970 nos Estados Unidos a partir dos movimentos em defesa dos direitos dos usuários dos serviços de saúde mental, ex-pacientes ou sobreviventes da psiquiatria. A partir da década de 2000 recovery vem orientando serviços de saúde mental em diversos países e muitos acreditam que possa contribuir com os processos de reforma do modelo de atenção em saúde mental em todo o mundo. No campo acadêmico, um número de publicações vem analisando as formas diversas de aplicação da abordagem em níveis nacionais e internacional. O objetivo desta revisão integrativa, realizada em 2019, foi analisar como a abordagem recovery vem sendo tratada na literatura científica na América Latina. A análise gerou categorias temáticas desvelando os principais assuntos abordados nestas publicações, entre eles discussões sobre terminologia, conceito de recovery, práticas, políticas e serviços orientados por recovery e possibilidades da incorporação da abordagem no contexto da Reforma Psiquiátrica Brasileira que, apesar dos obstáculos, ainda pode ser considerada como orientadora da Política Nacional de Saúde Mental no Brasil. A revisão aponta que o número de publicações sobre recovery na América Latina é escasso, comparado com o número de publicações nos Estados Unidos, Canadá, Hong Kong, Europa e Oceania, e são oriundas principalmente do Brasil. Percebe-se, ainda, que os autores brasileiros, em geral, entendem que recovery pode representar uma importante contribuição ao avanço da Reforma Psiquiátrica Brasileira e alguns defendem a necessidade de cautela sobre a incorporação da abordagem sem uma devida adaptação ao contexto social, cultural e econômico local. Também foi apontado que recovery tem sido aplicado em outros contextos sociais. 

Negotiating the Practical Meaning of Recovery in a Process of Implementation : An Empirical Investigation of How a Participatory-Inspired Research Approach to Implementation Might Facilitate a More Recovery-Oriented Practice: The Case of RENEW-DK

As implementation of recovery-oriented practices has proven difficult, this study investigates whether a participatory-inspired approach to implementing and adjusting a recovery-oriented model, RENEW-DK, might facilitate a more recovery-oriented practice among the professionals in public sector services. Ten narrative interviews with professionals was analyzed from a Science and Technology Studies perspective, and special attention was devoted to the concepts of distortion and stigmatization. Despite a one-year participatory process of model adjustment and implementation, professionals experienced RENEW-DK as a distortion and thus shaped their practice of RENEW-DK according to organizational requirements and professional beliefs instead of making their practice more recovery-oriented. The study calls attention to the need to acknowledge contradictions between intentions in general models and values in specific organizations with local norms and practices.

Stages of recovery in psychosis: Converging qualitative research and psychoanalysis

PURPOSE

The purpose of this study is to find common points of view between the results of qualitative studies researching stages of the recovery process in persons with psychosis and mental changes in a therapeutic relationship in psychoanalytically oriented psychotherapy.

CONCLUSIONS

Both concepts correspond one to another. The added psychoanalytical perspective highlights milestones in psychic change: attainment of mental differentiation; integration of self together with the transformation of psychotic grandiosity into decentration, which implies responsibility for illness and own life.

PRACTICE IMPLICATIONS

These conclusions highlight the importance of supporting relationships for people suffering from psychoses.

A Mixed-Method Analysis on the Impacts of a System-Driven Implementation of Multiple Child Evidence-Based Practices on Community Mental Health Providers

Initiatives to scale up evidence-based practices (EBPs) in routine care are likely to have myriad impacts on community providers, but these impacts have not yet been examined in depth. This is especially true within the context of simultaneous implementation of multiple evidence-based practices. The aim of this study was to characterize the multifaceted impacts on community mental health therapists within a system-driven implementation of multiple EBPs for youth and families. Semistructured interview and survey data were gathered from 60 therapists at 11 agencies contracted with the Los Angeles County Department of Mental Health to deliver EBPs within the Prevention and Early Intervention initiative. Therapists' accounts of impacts varied, and were either predominately negative, predominantly positive, or mixed-valence. Mixed-methods analyses using Kruskal-Wallis tests showed therapist valence groups varied on mean levels of self-reported burnout on surveys. Themes from qualitative data revealed several favorable (e.g., increased EBP knowledge, structure) and unfavorable (e.g., distress, feeling constrained by EBPs) impacts of county-contracted EBP implementation. These findings inform the development and implementation of future system-driven EBP initiatives that consider therapist perspective to optimize positive impacts and minimize negative impacts on therapists.

Beyond formalized plans: User involvement in support in daily living - users' and support workers' experiences

BACKGROUND

User involvement, based on respect and carried out through dialogue, has been shown to lead to increased self-respect, self-confidence and positive identity. In Sweden, the Social Service Act requires that interventions be designed and implemented together with the individual concerned. The basic criterion for social support is prolonged severe mental illness (usually at least 6 months), with no criteria for specific diagnosis or institutional history. The most common form of social support is 'support in daily living', a community care intervention for people aged 18 years or older who have their own homes and living arrangements.

AIM

This article aims to deepen our understanding of user involvement at the individual level in the provision of an ongoing social work intervention. What elements of user involvement can be found in users' and support workers' descriptions of helpful support in daily living?

METHOD

Qualitative interviews were conducted with 18 users, who had experienced support in daily living as helpful, and 16 interviews with the users' support workers.

RESULTS

Three major, interconnected themes emerged: Constant dialogue; Framing the flexibility, in relation to formalized intervention plans and regulations; The importance of 'small things', decisions concerning daily life.

CONCLUSION

Both users and support workers described user involvement at the individual, micro-level to be an integral part of helpful support in daily living. It was possible to create a space for dialogue and co-creation in which users were involved in formulating and deciding the contents of their support at an informal level, to influence their own everyday lives. While a formal framework of rules, restrictions and plans surrounds meetings between users and professionals, a facilitating factor may be the absence of too detailed plans and regulations, leaving trust to users and professionals and their capacity to manage most of the choices they have to make.

A Complexity Perspective on Narrative Identity Reconstruction in Mental Health Recovery

The issue of complex nonlinear change processes is one of the least understood aspects of recovery and one of the most difficult to apply in recovery-oriented health care. The purpose of this article is to explore the recovery stories of 17 mental health peer support workers to understand their narrative identity reconstruction in recovery using a complexity perspective. Using the Life Story Model of Identity (LSMI), a narrative thematic analysis of interviews suggests that self-mastery as part of personal agency is an important component of participants' narrative identity reconstruction. Self-mastery is particularly evident in redemptive story turning points (positive outcome follows negative experience). A complexity perspective suggests that participants realized their adaptive capacity in relation to self-mastery as part of recovery and that its use at story turning points critically influenced their recovery journey. Further exploring self-mastery as adaptive growth in narrative identity reconstruction appears to be a fruitful research direction.

Experiences of Recovery in EPAPSY's Community Residential Facilities and the Five CHIME Concepts: A Qualitative Inquiry

In the context of the reform of psychiatric services in Greece, the debate about the concept of recovery is still growing. Recovery is defined as a path through which individuals facing mental health challenges are enabled to regain and further develop significant relationships with family, friends, the community, and themselves and at the same time to cope with the detrimental effects of stigma through empowerment. The present qualitative study aims to explore the experiences of people living in EPAPSY's (Association for Regional Development and Mental Health) community residential facilities focusing mainly upon the key concepts of the CHIME (connectivity, hope, identity, meaning, and empowerment) conceptual framework of recovery. To this end, semi-structured interviews were conducted with seven participants living and receiving mental health care in a residential facility of EPAPSY. The participants' accounts were analyzed using thematic analysis in a deductive and inductive manner. The research findings highlighted, among others, the challenges the participants faced during their early years in family and school, the experience of the revolving door effect, and the perceived turn their life took when they were transferred to a community residential facility, thus opening a new chapter in their lives. Of the five CHIME concepts, all are present in the participants' accounts, with emphasis given to a meaningful present, a need to feel "normal" again, and a positive outlook for the future, both for themselves and their relationships, despite the persistence of certain difficulties.

Arts, mental distress, mental health functioning & life satisfaction: fixed-effects analyses of a nationally-representative panel study

BACKGROUND

Arts engagement within communities is ubiquitous across cultures globally and previous research has suggested its benefits for mental health and wellbeing. However, it remains unclear whether these benefits are driven by arts engagement itself or by important confounders such as socio-economic status (SES), childhood arts engagement, previous mental health, personality, or self-selection bias. The aim of this study is to use fixed effects models that account for unidentified time-constant confounding measures to examine the longitudinal association between arts (frequency of both arts participation and cultural attendance), mental distress, mental health functioning and life satisfaction.

METHODS

Data from 23,660 individuals (with a mean age of 47 years) included in the UK Understanding Society wave 2 (2010-2012) and wave 5 (2013-2015) were analyzed. Aside from controlling for all time-constant variables using fixed-effects models, we additionally adjusted for time-varying demographic factors (e.g. age and marital status), health behaviors and social support variables.

RESULTS

After controlling for all time-constant variables and identified time-varying confounders, frequent arts participation and cultural attendance were associated with lower levels of mental distress and higher levels of life satisfaction, with arts participation additionally associated with better mental health functioning. Health-related and social time-varying factors were shown partly but not wholly to explain the observed associations.

CONCLUSION

Arts engagement amongst the population as a whole may help enhance positive mental health and life satisfaction, and protect against mental distress. These results are independent of a wide range of time-constant confounding factors.

The subjective-agentic personality sector (SAPS): Introduction to the special issue on self, identity, and psychopathology

This special issue is predicated upon the premise that there exists a subjective-agentic personality sector (SAPS) that is crucially relevant to the understanding and treatment of psychopathology. SAPS is often overlooked by "trait" models in personality psychology. It is comprised of "hot" cognitions about one's self and identity as they unfold throughout the life span and are brought to bear on interpersonal relationships. There are four ways in which SAPS may be involved in psychopathology: (a) inherently, as a component of psychiatric disorders, (b) as a passive vulnerability dimension, namely by interacting with life stress, (c) as an active vulnerability dimension, that is, by propelling external situations that culminate in psychopathology, and (d) by constituting a central consequent of psychopathology (i.e., the scarring pattern, see below). In this Journal of Personality special issue, experts in personality and psychopathology demonstrate the centrality of SAPS in unipolar depression, anxiety disorders, bipolar spectrum disorder, eating disorders, posttraumatic stress disorder, complex trauma and borderline personality disorder, social anxiety disorder, suicidality in the context of mood disorders, and recovery from schizophrenia. A commentary by Dan McAdams, a leader in the study of self and identity, concludes this special issue.

'Recovery' in the Real World: Service User Experiences of Mental Health Service Use and Recommendations for Change 20 Years on from a First Episode Psychosis

Little is known about how recovery oriented policy and legislative changes influence service users’ perceptions of mental health care over time. Although the recovery approach is endorsed in many countries, qualitative research examining its impact on service use experiences has been lacking. This study aimed to explore this impact as well as experiences of service utilisation and suggestions for change with people diagnosed with a First Episode Psychosis between 1995 and 1999. Participants had used services during the 10 year period prior to, and 10 years post, policy and legislative shifts to the recovery approach. Semi-structured interviews were conducted with 10 participants who met criteria for ‘full functional recovery’ and 10 who did not. Data were analysed using Thematic Networks Analysis to develop Basic, Organising, and Global Themes. Over time, recovered participants perceived an improvement in service quality through the ‘humanising’ of treatment and non-recovered participants experienced their responsibility in recovery being recognised, but felt abandoned to the recovery approach. Findings suggest the importance of viewing service users as demonstrating personhood and having societal value; examining the personal meaning of psychotic experiences; and matching expectations with what services can feasibly provide. The implementation and the principal tenets of the recovery approach warrant further investigation.

Narrative Identity Reconstruction as Adaptive Growth During Mental Health Recovery: A Narrative Coaching Boardgame Approach

Objective

The purpose of this paper is to construct a conceptual framework for investigating the reconstruction of narrative identity in mental health recovery from a complexity perspective. This conceptual framework provides the foundation for developing a health boardgame to facilitate narrative identity reconstruction.

Methods

A selective integrative review of the theoretical and empirical literature relevant to narrative identity reconstruction in recovery was conducted. Sources included books, dissertations, internet resources, and professional journals.

Findings

The reviewed material provides a conceptual framework that offers an enriched understanding of narrative identity reconstruction in recovery as a process of adaptive growth. It identifies the Hero's Journey, the life story model of identity (LSMI), and intentional change theory (ITC) as particularly relevant in informing strategies for narrative identity reconstruction. The conceptual framework can be operationalized in a narrative coaching treatment approach using a boardgame.

Conclusion and Implications for Practice

In practice, mental health professionals could use the narrative coaching boardgame to facilitate people's adaptive change with a focus on building skills to reconstruct their preferred narrative identity and foster hope. Future research should explore what aspects of narrative identity and non-linear dynamic processes of change are most important in people's recovery narratives and in particular these processes can be assessed in response to the use of the boardgame.

Patient versus rater evaluation of symptom severity in treatment resistant schizophrenia receiving clozapine

Patient input as part of health care has taken on increased importance recently. To look at whether patients with treatment resistant schizophrenia (TRS) are able to provide a valid self-assessment of symptoms, the present study investigated patient versus rater evaluation of clinical symptoms. Ninety-three patients diagnosed with TRS and treated with clozapine were recruited. Both patients and raters completed the 7-point Clinical Global Impression - Schizophrenia Version (CGI-SCH) scale, thereby providing evaluations for positive, negative, depressive, and cognitive symptoms as well as overall illness severity. Patients rated their clinical symptoms significantly lower than raters. A positive correlation was found between patients and raters for all symptom domains, while the strength of correlation varied. Age, gender and years of education did not impact the relationship between patient and rater scores. The conclusion is that patients provided valid information in self-assessments of symptoms when compared to raters, and this was consistent over time. In addition, the greatest heterogeneity between rater and patient ratings occurred with regard to cognitive symptoms. Patient assessments may help further engage individuals in their care and permit clinicians to identify where discrepancies exist. Addressing these issues offers opportunities for improved therapeutic alliance, education, and shared decision-making within treatment.

Small Things, Micro-Affirmations and Helpful Professionals Everyday Recovery-Orientated Practices According to Persons with Mental Health Problems

The aim of this study is to present concrete descriptions of the content in the construction of helpful relationships with staff, according to users. Starting with the re-occurring concept of the meaning of "little things" in recovery studies, a literature review was done. A thematic analysis shows that small things play an important role in improving a person's sense of self. Small things seem to be an invisible but effective parts of a recovery-orientated practice, but they might be defined as unprofessional and their efficacy negated.

The Person with Schizophrenia as a Person

In the mental health field, the attention given to the subjective side of a person's experience is grossly inadequate. The best way to reflect the subjectivity of a person may be by means of the subjectivity of another. To take account of both subjective experience and objective measures in the course of mental disorders, a new concept is needed. This may be the person's story.

Beck Self-Esteem Scale-Short Form: Development and psychometric evaluation of a scale for the assessment of self-concept in schizophrenia

A requisite step for testing cognitive theories regarding the role of self-concept in schizophrenia is the development of measures that follow a cognitive conceptualization and better capture the multifaceted nature of this construct. The purpose of this study was to examine the psychometric properties a new self-concept measure, the Beck Self-Esteem Scale-Short Form (BSES-SF), based on a sample of 204 individuals with schizophrenia or schizoaffective disorder. We evaluated the BSES-SF's dimensionality, internal consistency reliability, and construct and divergent validity using confirmatory factor analysis, Cronbach's alpha, Pearson correlations, independent samples t-tests, and one-way analysis of variance. Findings indicate that the 10-item BSES-SF is a reliable and valid measure of self-concept that is appropriate for a broad group of individuals with schizophrenia spectrum disorders. Following cognitive theory, the scale demonstrated significant relationships with delusion severity, motivation, and depression, further signifying its utility for research and practice efforts that are designed to address psychopathology in schizophrenia.

Building trust and recovery capital: the professionals’ helpful practice

Purpose

The possibility of recovery for persons with co-occurring addiction and mental health problems has been contested. Though, recent studies show that recovery might happen, but without connection to specific treatment interventions. The purpose of this paper is to analyse professionals’ perceptions of their contribution to improvement.

Design/methodology/approach

In all, 15 experienced professionals were interviewed. The interviews were analysed using thematic analysis.

Findings

Recovery processes were dependent of the persons’ access to different forms of recovery capital (RC). Lack of RC was often associated with lack of trust in one’s self and others (identity and personal capital). Professionals had to be accepted as trustful agents through co-creating changes in the person’s life. Trusting a professional might be a basis for trusting one’s self as an agent in one’s recovery process and develop a social network (identity and relationship capital). Other aspects stressed by the professionals were to manage their own fragmentized organisations and societal shortcomings (economic capital).

Practical implications

Recovery has been described as a profoundly individual journey. However, it is also deeply social, involving other persons and contextual factors. Focusing on just one level might counteract the complex work behind double recovery.

Originality/value

Improvement was described as dependent on the presence of personal, inter-personal, organisational and societal factors. The findings give a deep and concrete understanding of the process constituting the development of a working alliance and its dependence on factors outside the direct relation between the staff member and the person.