The experiences and meanings of recovery for Swazi women living with "schizophrenia"

Personal recovery after mental illness from a cultural perspective: A scoping review

BACKGROUND

Although personal recovery has become a well-known concept in most Western countries, it remains under-recognised in non-Western countries.

AIMS

This scoping review aimed to investigate how culture impacts the conceptualisation of personal recovery by evaluating how well the personal recovery framework CHIME (Connectedness, Hope, Identity, Meaning and Empowerment) fits amongst individuals from non-Western ethnic origin.

METHOD

A scoping review with systematic searches was conducted. Studies were included in the scoping review if they examined personal recovery among individuals from non-Western cultures. Articles were excluded if the target population had no experience with mental illness or had an ethnic Western origin. The review used the CHIME framework in a 'best-fit' framework synthesis, to understand how culture impacted the understanding and experience of recovery. A comprehensive search of five databases (PsycInfo, ProQuest, EMBASE, MEDLINE and CINAHL) resulted in the inclusion of 76 studies out of the 1,641 studies identified. The search was conducted in February 2023 and updated the same month in 2024.

RESULTS

The 76 studies demonstrated that the CHIME framework is applicable in non-Western cultures, with few adjustments to the subcategories. Generally, there was a greater emphasis on connectedness with others across all categories of CHIME, and religion was more frequently used as source to achieve the components of CHIME more often in non-Western cultures. Socio-structural factors influenced how personal recovery can be experienced, and important factors such as welfare benefits impacts recovery.

CONCLUSION

Special attention should be given to the importance of relationships, especially family, in achieving recovery and religion should be recognised as a crucial element to experiencing connectedness, hope, identity, meaning and empowerment. To enhance the CHIME framework, integrating the sub-components shared responsibility and shared control would be beneficial. Socio-structural factors should be considered when using the CHIME framework.

Mental health recovery in a collectivist society: Saudi consumers, carers and nurses' shared perspectives

In 2019, the World Health Organization urged a global shift towards recovery-focused practices in mental health care. In Western nations, this transition often prioritised individualism over collectivism. In contrast, collectivist societies prioritise recovery through community and social support. This study explored mental health recovery from the perspectives of consumers, carers and registered nurses in a mainly collectivist society (Saudi Arabia) using a qualitative exploratory descriptive design. Sixteen consumers, ten carers and eight registered nurses participated in online semi-structured interviews. Inductive thematic analysis was employed to analyse English-translated versions of the 34 interviews. Consolidated criteria for reporting qualitative studies 32-item checklist were used. The study found that recovery was perceived as a process of transforming towards living a meaningful life of goals and values supported by trusted people who share moments of comfort and empowerment. A unique finding was the 'bond of recovery' a collectivist value that aid consumers' community integration in society. Saudi consumers' experiences of recovery were similar to consumers' movement narratives of recovery. Future research should establish a recovery-focused educational program that incorporates our findings into a recovery-oriented approach. This will facilitate providing a collaborative care between consumers, carers and nurses that centres around consumers' recovery goals and values.

Intersectoral and multisectoral approaches to enable recovery for people with severe mental illness in low- and middle-income countries: A scoping review

The needs of people with severe mental illness are complex and require a range of services embedded in well-coordinated systems of care to enable recovery, promote well-being and optimise social integration. The concept of recovery is strongly rooted in the centrality of multi and intersectoral systems of care, and, while multi and -intersectoral dimensions of mental health systems have been highlighted in analyses focusing on high-income regions, little has been elaborated in terms of these approaches in the recovery of people with severe mental illness (SMI) in low- and middle-income countries (LMICs). The aim of this review was to identify and describe multi and intersectoral approaches underpinning community-based SMI recovery interventions in LMICs. A scoping review was carried out following the following steps: (1) Objectives for the review were developed and refined; (2) A systematic search of databases (EbscoHost, PubMed, Google Scholar) and previous reviews were undertaken from 2012 to 2022, where relevant papers were identified; (3) Papers with a focus on SMI and recovery, a specific description of an intervention, located in LMICs, with explicit linkages between sectors, and published in English, were selected for inclusion; (4) Data were extracted and charted and (5) Findings were analysed and reported thematically. Thirty-six papers were included for analysis, from 18 countries, including qualitative studies, trials, desktop and secondary data reviews and case studies. Examples of multi- and intersectoral action included collaboration between healthcare and community support systems, collaboration in providing supported housing and supportive community spaces for recovery, and linkages between biomedical and social spheres of care. Barriers included the dominance of mental health professions in delivering care, community-based stigmatising attitudes towards SMI. Multi- and intersectoral collaboration for SMI recovery requires investments in financing, education and coordination by a governing body.

Exploring lived experience of recovery processes in those with psychosis: a systematic review with thematic synthesis of qualitative evidence

The purpose of the study was to conduct a systematic review of literature which explores lived experiences of the manifestation, appearance of meaning, and interpretation of the recovery process in schizophrenia and determined that there needs treatment shift that is centred on personal recovery processes. The focus of this review is to examine the current recovery research of the lived experience in schizophrenia. Recovery is an idiosyncratic and debated process that emerges from the perspectives of people who experience schizophrenia. Recovery literature is gained from qualitative accounts and synthesising these accounts provides an overview of the evidence base for recovery. A search of Medline, Emcare, Cinahl and Scopus databases discovered 11 studies that were published between 2016 and 2020 that met the scope of the review. Studies were included if they used qualitative methodology to explore how individuals with schizophrenia experience the process of recovery. Studies were subjected to quality assessment using the Critical Appraisal Skills Program (CASP) Qualitative Research Checklist. Several themes were identified during the qualitative analysis. These themes were linked by a common thread. This “meta-theme” is “connection.” Connection with individual sense of self and connecting with the social world. Connecting with self enhance the capacity of those with schizophrenia to be able to connect interpersonally and intersubjectively with the social world, which is seen to lead to recovery. The reviewed literature supported the theoretical approach that the person with schizophrenia needed to regain their lost self before taking further steps in the recovery process. Further research of schizophrenia as a self – disorder being phenomenologically designed would further highlight the necessity of this for the recovery process. Such research would illuminate recovery being about who you are and not about how sane or normal you are.

Service Providers Perspectives on Personal Recovery from Severe Mental Illness in Cape Town, South Africa: A Qualitative Study

Severe mental illnesses (SMI) contribute significantly to the global burden of disease. In low-and-middle-income countries (LMICs), the treatment gap impacts the clinical and personal recovery of people living with an SMI. The drive to reduce this treatment gap in LMICs makes it pertinent to understand service providers' views on recovery from SMI. Semi-structured interviews and focus groups with service providers from health services and non-profit organisations in the Western Cape Province, South Africa, were conducted in this qualitative study. Seventeen participants were purposively selected, and data were thematically analysed. Three major themes emerged: delineating recovery, available services supporting recovery from SMI, and facilitators and barriers to recovery at the service level. Health services favoured clinical over personal recovery. Participants thought that many service users' personal recovery from SMI was hindered by intersecting social, economic, cultural, and political inequalities that extended beyond the influence of the health sector.

The experience of psychosis and recovery from consumers' perspectives: An integrative literature review

WHAT IS KNOWN ON THE SUBJECT?: Since the first decade of this century, few qualitative studies and literature reviews have reported consumers' experiences of psychosis and recovery. The findings from these studies need further exploration. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: New insights into consumers' experiences of psychosis were generated. Additionally, understanding of consumers' conceptions and experiences of recovery were reported. Consumers' insights into the enablers and barriers to recovery that they encountered were also identified. Gaps in the literature remain, particularly those related to the effects of gender and culture on consumers' experiences of and recovery from psychosis. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses' understanding of consumers' perspectives and experiences of psychosis is vital to enhancing the quality of mental health nursing when caring for people living with psychosis. To support user-based recovery, mental health nurses need to incorporate person-centred approaches and reduce their preferencing of medical understandings of recovery.

ABSTRACT

INTRODUCTION: Psychosis is a distressing disorder. Consumers' perspectives about their experiences of psychosis and recovery are essential aspects of mental health nursing.

AIMS

To review contemporary evidence related to consumers' experiences of and recovery from psychosis.

METHOD

An integrative review was the method used; six databases were systematically searched. Of the 157 articles screened, 14 met the inclusion criteria and were assessed for quality using Joanna Briggs Institute Appraisal tools. Data were compared, classified and integrated.

RESULTS

Findings revealed that consumers' experiences of psychosis included issues with self-expression and language, psychosocial problems and stigma. Also, consumers' experiences associated with their recovery were reported, and this included their perspectives on the enablers and barriers that they encountered.

DISCUSSION

Consumer's experiences of and recovery from psychosis provide an essential basis for managing and working with people experiencing psychosis. Further research identifying the potential effects of gender and culture into consumers' lived experiences is required.

IMPLICATIONS FOR PRACTICE

Exploring the experience of someone with psychosis will help nurses to understand the impacts of this condition. This understanding can guide nurses to apply recovery-oriented practices. Specific aspects of psychosis experience, including gender and culture, should inform nurses' practices towards recovery.

Experiences and perceptions of people living with schizophrenia in Japan: A qualitative study

This descriptive study used a qualitative inductive approach to investigate the subjective experiences and perceptions of people with schizophrenia living in the community during times of difficulty and how they coped. We conducted semi-structured interviews with nine community-dwelling people with schizophrenia and used the KJ method developed by Kawakita Jiro to structure the data obtained. We identified 10 symbols with his method: bewilderment at the onset; helplessness and longing for death; solitude linked to death; precarious daily life; relationships at risk; fear of being stigmatized; pillars of emotional support; will to overcome; hope to never give up; and living with the illness. The results suggest that community mental health nurses should provide support so their patients can continue to have pillars of emotional support and the will to overcome difficulties, as well as continue to use their coping methods, even when experiencing many difficulties. It is important that nurses understand and share in their patients' difficult experiences and hopes when providing support toward their recovery.

Recovery From Severe Mental Health Problems: A Systematic Review of Service User and Informal Caregiver Perspectives

Introduction: The recovery approach aims to have users' perspectives at the heart of service development and research; it is a holistic perspective that considers social needs, personal growth and inclusion. In the last decade recovery-oriented research and practice has increased greatly, however, a comprehensive model of recovery considering exclusively the perspectives of people with lived experience has not been devised. Aims: This review aimed to develop a framework and contextualize service users' and informal caregivers' understanding of recovery from severe mental health problems. Methods: We systematically searched 6 databases including key terms related to knowledge, experience and narratives AND mental health AND personal recovery. The search was supplemented with reference sourcing through gray literature, reference tracking and expert consultation. Data analysis consisted of a qualitative meta-synthesis using constant comparative methods. Results: Sixty-two studies were analyzed. A pattern emerged regarding the recovery paradigms that the studies used to frame their findings. The resulting recovery framework included the domains Social recovery; Prosperity (Legal, political, and economic recovery); Individual Recovery; and Clinical Recovery Experience (SPICE). Service users' definitions of recovery tended to prioritize social aspects, particularly being accepted and connecting with others, while caregivers focused instead on clinical definitions of recovery such as symptom remission. Both groups emphasized individual aspects such as becoming self-sufficient and achieving personal goals, which was strongly linked with having economic means for independence. Conclusions: The recovery model provided by this review offers a template for further research in the field and a guide for policy and practice. Predominant definitions of recovery currently reflect understandings of mental health which focus on an individual perspective, while this review found an important emphasis on socio-political aspects. At the same time, only a small number of studies took place in low-income countries, focused on minoritized populations, or included caregivers' perspectives. These are important gaps in the literature that require further attention. Systematic Review Registration: The review protocol was registered on PROSPERO (CRD42017076450); https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=76450.

Exploration of recovery of people living with severe mental illness (SMI) in low/middle-income countries (LMICs): a scoping review

OBJECTIVE

To examine the literature on how recovery of people with severe mental illness (SMI) is conceptualised in low/middle-income countries (LMICs), and in particular what factors are thought to facilitate recovery.

DESIGN

Scoping review.

DATA SOURCES AND ELIGIBILITY

We searched 14 electronic databases, hand searched citations and consulted with experts during the period May-December 2019. Eligible studies were independently screened for inclusion and exclusion by two reviewers. Unresolved discrepancies were referred to a third reviewer.

DATA EXTRACTION AND SYNTHESIS

All bibliographical data and study characteristics were extracted using a data charting form. Selected studies were analysed through a thematic analysis emerging from extracted data.

RESULTS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram offers a summary of the results: 4201 titles, 1530 abstracts and 109 full-text articles were screened. Ten articles were selected for inclusion: two from Turkey, two from India, and one each from China, Swaziland, Indonesia, Egypt, South Africa and Vietnam. Although most studies used qualitative methods, data collection and sampling methods were heterogeneous. One study reported on service provider perspectives while the rest provided perspectives from a combination of service users and caregivers. Three themes emerged from the data analysis. First, studies frame recovery as a personal journey occurring along a continuum. Second, there was an emphasis on social relationships as a facilitator of recovery. Third, spirituality emerged as both a facilitator and an indicator of recovery. These themes were not mutually exclusive and some overlap exists.

CONCLUSION

Although there were commonalities with how high-income countries describe recovery, we also found differences in conceptualisation. These differences in how recovery was understood reflect the importance of framing the personal recovery concept in relation to local needs and contextual issues found in LMICs. This review highlighted the current sparse evidence base and the need to better understand recovery from SMI in LMICs.