Experiences of recovery among adults with a mental illness using visual art methods: A systematic review

Addressing equity, diversity, and inclusion in JBI qualitative systematic reviews: a methodological scoping review

OBJECTIVE

The objective of this methodological scoping review was to investigate ways in which qualitative review teams are addressing equity, diversity, and inclusion (EDI) in the process of conducting and reporting qualitative systematic reviews that use JBI guidelines.

INTRODUCTION

To promote health equity, there is a need for evidence synthesis processes and practices to develop approaches that incorporate EDI. Some guidance is available to guide equity-focused review methods and reporting, but this is primarily oriented to quantitative systematic reviews. There is currently limited knowledge about how review teams are addressing EDI within qualitative evidence syntheses.

INCLUSION CRITERIA

This review included English-language qualitative systematic reviews, published in 2022, that used all the stjpg outlined in the JBI guidance for qualitative reviews.

METHODS

A 1-year sample of published reviews was identified from a search undertaken on March 17, 2023, of 2 health care databases: MEDLINE (Ovid) and CINAHL (EBSCOhost). Data extraction followed a framework approach, using an adapted pre-existing equity template. This included attention to i) the reporting of a range of characteristics associated with EDI, ii) search approaches, and iii) analytical approaches (including reflexivity, intersectionality, and knowledge user engagement). Data were analyzed using descriptive statistics and narrative summary.

RESULTS

Forty-three reviews met the inclusion criteria. The majority of the reviews (n = 30) framed their questions and aims in a generic/universal (rather than EDI-focused) way. Six reviews justified their population focus in terms of an EDI-related issue. Only 1 review included a knowledge user. The sociodemographic and other key characteristics of the samples in underpinning studies were poorly reported, making it hard to discern EDI-related issues or to undertake EDI-related analyses. Thirteen of the reviews included non-English-language evidence sources, and 31 reviews included gray literature sources. Ten reviews demonstrated an element of intersectional or otherwise critical approach within their analyses of categories and synthesized findings (whereby issues of power and/or representation were explicitly considered). Only 8 reviews included discussions of review team composition and reflexivity within the review process.

CONCLUSIONS

This EDI-focused methodological enquiry has highlighted some limitations within current qualitative evidence synthesis practice. Without closer attention to EDI, there is a danger that systematic reviews may simply serve to amplify, rather than illuminate, existing gaps, silences, and inequitable knowledge claims based on dominant representations. This review sets out a range of suggestions to help qualitative evidence synthesis teams to more systematically embed EDI within their methods and practices.

REVIEW REGISTRATION

Open Science Framework https://osf.io/wy5kv/.

Do Therapeutic Recreation Mental Health Clinical Placements Provide Educational Experiences to Pre-Registration Student Nurses?: A Mixed Methods Systematic Review

Clinical placements are a critical component in any pre-registration student nurse's skill development and play an influential role in career specialisation upon registration. However, students are reporting to feel anxious and under prepared attending clinical placements, especially within mental health settings. Such a concern was highlighted in the Australian Government's Productivity Commission into Mental Health (2020). With recommendations for clinical placements to occur in therapeutic recreation environments, allowing increased interactions between students and individuals with a lived experience. Hence, this mixed methods systematic review aims to explore the experiences of pre-registration student nurses completing their mental health clinical placement within a therapeutic recreation environment. Six databases were searched for the review; CINHAL, Medline, PsycINFO, Web of Science, Scopus and the ProQuest Dissertation and Theses database, yielding 10 214 articles. Data were imported to COVIDENCE for management and screening processes. Risk of bias was undertaken by two authors utilising the Joanna Briggs Institute's Critical Appraisal Checklist for qualitative and quasi-experimental studies and McGill's Mixed Methods Appraisal Tool 2018 Version for mixed methods studies. Data were extracted manually for the 13 included articles which met the review inclusion criteria. Following a thematic analysis of the extracted data, three themes emerged: an optimal learning environment, impact on stigmatising beliefs and influence on future career. Findings identified that therapeutic recreation environments pose numerous education benefits for pre-registration student nurses. It is apparent through an immersive mental health clinical placement; student nurses are able to increase their mental health understanding through the lens of those with lived experiences. Such environments challenge stigmatising beliefs held by students prior to clinical placements and can lead to an increased desire to pursue a career within the mental health speciality. This review offers an insight into the many benefits for pre-registration student nurses who complete their mental health clinical placements in therapeutic recreation environments, including reduced stigmatising beliefs, increased mental health knowledge and improved clinical confidence. Trial Registration: PROSPERO: CRD42023476280.

Personal Narratives From a Mental Health Community Art-Based Project: Insights From Collaborative Creation

Community arts interventions demonstrate positive effects on mental health recovery by fostering creativity, self-expression, and social interaction. This study explores the participation process in the Artistic Couples project, which provides collaborative spaces for artists with mental health conditions and local artists. We followed up six artistic couples participating in the project using a narrative-in-action process over 6 months in various community settings. Our aim was to understand the experiences of artists during their participation in Artistic Couples and to uncover the mental health benefits derived from their involvement. Coupled and individually semi-structured interviews and participant observation were employed. Data analysis was conducted using narrative analysis. The results of the collaborative process among participants are reflected in three primary areas: (1) Meeting, engagement, and connection; (2) Dialogue, teamwork, and creative process; and (3) Personal development and learning. The research findings suggest that participating in the Artistic Couples project facilitates self-expression, a sense of social connection, and improved artistic skills among participants, fostering mutual support and effective interpersonal communication. Moreover, participants reported experiences of learning and personal development. Consequently, the study advocates for creating new community spaces that encourage collaborative practices within mental health services. These spaces should promote free expression and facilitate discussions on personal matters, including mental health challenges.

Contributing to 'a sense of purpose' - Evaluating consumer recovery progress after attending a therapeutic-recreation intervention programme: A quantitative analysis

INTRODUCTION

The recommended objective for mental health plans and policies is the adoption of recovery approaches to mental healthcare. Mental health recovery is no longer defined by symptom resolution but as a journey towards a meaningful life from the consumer's own perspective. Recovery approaches focus on consumers' strengths, feelings of well-being and the achievement of personal goals. Designing recovery-oriented interventions is crucial for supporting people in their personal recovery journey.

AIM

This study sought to evaluate how attending a recovery-oriented intervention impacts the recovery of attending people living with serious mental illness.

METHODS

A quasi-experimental approach was utilised to examine changes in self-reported recovery progress in a purposive sample of consumers living with enduring mental illness (N = 105). Recovery progress was evaluated via the Recovery Assessment Scale - Domains and Stages (RAS-DS). Data were collected at entry and exit to a therapeutic recreation programme grounded in principles of recovery-oriented care and social contact theory. Pre-post scores were analysed via a repeated-measures multivariate analysis of variance (RM-MANOVA) per the four RAS-DS recovery domains.

RESULTS

After attending the therapeutic recreation programme, consumer recovery scores significantly increased in the functional, personal, and social recovery RAS-DS domains as measured by 'Doing Things I Value', 'Looking Forward', and 'Connecting and Belonging' (respectively). No changes were observed to consumers' clinical recovery progress, as assessed via the recovery domain 'Mastering my Illness'.

CONCLUSION

The results of this study demonstrate that therapeutic recreation camps can provide a recovery-based approach to mental healthcare, with positive effects on the three areas of: a purposeful life; connection and belonging; and optimism and hope. Recovery Camp has been previously identified by the Productivity Commission as having potential person-centred recovery benefits for mental health consumers. The results of this study now establish these benefits as evidence based and can be used to guide mental health practice and policy for the implementation of therapeutic recreation camps for mental health recovery.

A scoping review of the use of creative activities in stroke rehabilitation

OBJECTIVE

Clarifying the distinctions between art-based creative activities in the domains of occupational therapy and art therapy in the context of stroke rehabilitation, while also describing the effects of art-based creative activities on stroke rehabilitation.

DESIGN

Scoping review.

DATA SOURCE

A systematic search was performed in nine databases (Web of Science, PubMed, EMBASE, Cochrane Library, CINAHL and four Chinese database) from their inception to December 2023.

REVIEW METHODS

The study included randomized and non-randomized controlled trials involving art-based creative activities, as well as qualitative research providing detailed intervention measures. The study focused on stroke patients, with primary outcomes related to patients' physiological recovery, psychological well-being, ADL, etc. Data extraction included information on intervention strategies and study results.

RESULTS

Seventeen studies were included, extracting six similarities and differences in creative activity between two domains. Creative activities were observed to have positive impacts on daily living activities, limb motor function, fine motor ability, and emotional well-being in stroke patients.

CONCLUSION

Creative activities, whether in occupational therapy or art therapy, involve providing participants with tangible crafting materials for the creation of artistic works. Future stroke rehabilitation practices should tailor activities and intervention focus based on patients' rehabilitation needs, preferences, and cultural background. The current comprehensive analysis provides initial support for the potential positive role of creative activities in stroke rehabilitation, but further in-depth research is needed to confirm their effectiveness.

Behind the creative canvas: An innovative trauma-informed art-based educational approach using an immersive learning pedagogy

Trauma has been increasingly considered in mental health policies and strategies worldwide. However, the implementation of such initiatives into practice remains inconsistent resulting in a fragmented approach to trauma-informed care. One explanation for the current state of trauma services is the unpreparedness of mental health nurses in line with emerging traumagenic theoretical frameworks. We addressed this gap by implementing an innovative pedagogic project co-produced with people with lived experience of trauma. The aim of this qualitative study was to explore mental health nursing students' perspective on the usefulness of an art-based approach to learning about, and working with, trauma in a non-interactive virtual reality (VR) environment. Ten mental health nursing students have been conveniently selected to take part in a focus group. The thematic analysis revealed authenticity, the power of arts, and underutilisation of arts in mental health nursing as key themes following students' reflections and critical discussions. Recommendations to enhance trauma-informed nursing education and practice are made to support an approach that has the potential to instil positive changes in the way mental health nursing students perceive and work with trauma in their practice.

Creative therapy in health and disease: Inner vision

Can we better understand the unique mechanisms of de novo abilities in light of our current knowledge of the psychological and neuroscientific literature on creativity? This review outlines the state-of-the-art in the neuroscience of creativity and points out crucial aspects that still demand further exploration, such as brain plasticity. The progressive development of current neuroscience research on creativity presents a multitude of prospects and potentials for furnishing efficacious therapy in the context of health and illness. Therefore, we discuss directions for future studies, identifying a focus on pinpointing the neglected beneficial practices for creative therapy. We emphasize the neglected neuroscience perspective of creativity on health and disease and how creative therapy could offer limitless possibilities to improve our well-being and give hope to patients with neurodegenerative diseases to compensate for their brain injuries and cognitive impairments by expressing their hidden creativity.

The meaning of the recovery process and its stages for people attending a mental health day hospital: A qualitative study

INTRODUCTION

This study sought to explore the meaning of the recovery process and its stages from the perspective of people attending a mental health day hospital.

METHODS

A descriptive exploratory qualitative study was carried out. Semi-structured interviews were conducted with people attending a mental health day hospital. The data were analysed deductively by means of content analysis.

RESULTS

The participants described the recovery process as a process based on three pillars; the attitude towards recovery, hardship, and the effort required throughout the process. Regarding the stages of recovery, for the participants in the first stage of the process (Moratorium), the search for hope was the most important element. In the second stage (Awareness), the reestablishment of their identity, through the acceptance of the consequences derived from the mental health problem, together with being able to feel full and fulfilled, were the most outstanding elements. In the third stage (Preparation), participants highlighted the search for meaning in life, facing their fears and the process with an open mind. Finally, the last two stages (Rebuilding and Growth) were related to taking responsibility and empowerment for recovery.

CONCLUSIONS

The results of this study provide insight into the perception of the recovery process and its stages in people attending a mental health day hospital. These findings may contribute to aligning the nurse-patient perspective, helping nurses to understand the key elements of patients according to their stage of recovery, and thus be able to subsequently individualise interventions.

PATIENT AND PUBLIC CONTRIBUTION

This study was based on interviews with 15 patients receiving treatment at an adult mental health day hospital. This study would not have been possible without their participation.