Developing and Sustaining Recovery-Orientation in Mental Health Practice: Experiences of Occupational Therapists

Supports that help me to live well in the community: experiences of people living with schizophrenia

INTRODUCTION

People with schizophrenia are more likely to be hospitalised than any other psychiatric diagnosis. Occupational therapists working in mental health are often required to assess and recommend supports that will assist people with schizophrenia to live successfully in the community. There is little research exploring consumer perspectives regarding the support they find useful to stay out of the hospital. The aim of this study was to explore what supports people living with schizophrenia identify as helping them to live in the community and stay out of the hospital.

METHOD

Qualitative data were collected via semi-structured interviews with adult consumers (N = 18) diagnosed with schizophrenia. Data were thematically analysed using constant comparative analysis methods. Inductive analysis was followed by a deductive phase of analysis.

FINDINGS

Participants highlighted personal-, occupational- and environmental-focused supports. Person-focused supports addressed cognitive and psychological needs. Occupation-focused supports included assisting people to manage daily life with a mental illness; engage in social activities; and engage in meaningful activities. Environment-focused supports included access to financial security; accommodation security; and community of choice. In addition to types of support, participants highlighted the importance of quality of support including the need for flexible; timely; and non-judgemental support.

CONCLUSION

These results emphasise the multifaceted nature of support required by people living with schizophrenia to stay out of the hospital. Both type and quality of support are important. People in this study were able to clearly articulate the types and qualities of support that were important to them. Occupational therapists may benefit from greater collaboration with consumers during assessments of support needs and the development of recommendations. Further exploration of how occupational therapists identify people's multifaceted support needs is required.

A mixed-method evaluation of peer-led education about attitudes towards consumers' recovery among Mental Health Nurses working in acute inpatient psychiatric units

Despite integrating the recovery model of care in mental health, mental health professionals still have pessimistic attitudes towards the recovery of people with mental illness. Positive attitudes towards recovery are essential components to integrate recovery-oriented practices in all areas of mental health. Evidence shows that education and training are effective while emphasising the importance of consumer-based interventions to enhance recovery attitudes. This study aimed to evaluate the effectiveness of peer-led education about recovery attitudes towards people with mental illness among Mental Health Nurses working in acute inpatient settings. The methodology used was a sequential explanatory mixed method with pre- and post-test design involving three phases. Phase 1: survey (n = 103), phase 2: post-test survey immediate (n = 17) and follow-up (n = 11) and phase 3: in-depth interviews (n = 12). The results show that Mental Health Nurses have positive recovery attitudes with some room for improvement. Most participants agreed with all items of the Recovery Attitudes Questionnaire. However, the participants had various views on the relationship between faith and recovery. The peer-led education significantly improved RAQ items 1, 2, 3, 4 and 6 statistically. Furthermore, peer-led education effectively enhanced recovery attitudes immediately after the intervention and helped to maintain sustainable attitudes 3 months later. A qualitative exploration of recovery attitudes revealed three main themes: participants' reflections, recovery hurdles and interpersonal relationships.

Supporting self-determination in mental health recovery: Strategies employed by occupational therapists

INTRODUCTION

Self-determination is a core component of mental health recovery and a predictor of positive outcomes. The literature calls for occupational therapists to lead practice change to greater recovery-orientation, including facilitating people's self-determination. However, systemic challenges thwart translation of policy into practice and therapists report a lack of confidence in implementing recovery-oriented principles. This study aimed to understand the strategies that mental health occupational therapists employ to support people's self-determination.

METHODS

Data were collected through an international on-line questionnaire principally comprising two open-ended questions designed to elicit deep reflective personal accounts. Participants were asked about an experience in which they supported a person's self-determination and the factors that either facilitated or hindered this experience. Qualitative data were analysed using inductive thematic analysis, guided by constant comparative methods.

FINDINGS

Thirty-four therapists, predominantly from Australia (n = 30), participated. Therapists described supporting self-determination as a multifaceted process that involved: (1) working on myself, (2) working with the person, and (3) working with others. They emphasised that the combined use of various strategies across these three areas of work was important to support people's self-determination. Further, awareness of and addressing issues of power in their practice was key.

CONCLUSION

This study supports the translation of recovery-oriented principles into practice by revealing the nuanced strategies implemented by occupational therapists striving to support self-determination. Participants employed diverse strategies to empower people to take the 'driver's seat' in their mental health recovery journey. Insights from this study will support other occupational therapists to actualise recovery-oriented principles and better support self-determination in their practice. To effectively implement self-determination strategies, therapists must reflect on and address existing power differentials within mental health services, particularly between themselves and the people they support.

How do Mental Health Services Foster Hope? Experience of People Accessing Services

Hope is essential to mental health recovery, yet little is known about how mental health services can foster hope. This paper addresses the question: How can mental health services influence the sense of hope experienced by people who access their services? Sixty-one people who accessed a new mental health service were interviewed about their experiences, including about how the service had influenced their sense of hope. Interviews were analysed using constant comparative analysis. The data revealed that hope increased when people perceived positive changes in themselves and their circumstances: developing new understandings and perspectives; having effective strategies to manage challenges; seeing progress or having plans; and having support. Changes were attributed to three major features of the service: accessibility; staff competence and wisdom; and caring interactions. The findings highlight that, while individual clinicians are important, other interactions with services and the wider service context are also critical for facilitating hope.

Implementation of peer-support services in Asia: A scoping review

WHAT IS KNOWN ON THE SUBJECT

Peer-support services was started in the 1970s psychiatric survivor movement in the United States of America (USA) due to the lack of transitional support for deinstitutionalized psychiatric patients. Delivered by peer-support workers (PSWs) with lived experiences of mental health conditions, peer-support workers use their experiential knowledge to help others with similar conditions. The paradigm shifts in mental health recovery has led to an increase in interest on peer-support services among the Asia countries. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The diversity political and cultural differences in Asia makes it a unique for people to understand the mental health ecosystem that exist within. This review is timely as it provides the insights into the current state of peer-support services for mental health consumers in Asia and the future research on them. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: First, this review provided a broad overview on the current types of peer-support services and their implementation in Asia. Second, emphasized the importance and value of peer-support services for individuals with mental health conditions in their journey towards recovery. Third, important to build a more positive image for peer-support workers by assigning more clarity to their roles and systematizing training to hone their skills in providing peer support.

ABSTRACT

Introduction The increasing recognition and need for recovery-oriented services led to the heightened interests of peer-support services globally, including Asia. However, little is known about the peer-support services in Asia as compared to the West, where peer-support services primarily originated from and are well established. Aim To examine available evidence on the implementation of peer-support services for such consumers in Asia. Method This scoping review was based on the Arksey & O'Malley's framework. A comprehensive search was performed across seven electronic databases. The grey literature was also searched through Open Grey and ProQuest Dissertation and Theses, alongside hand searching of the reference of the studies. Articles searched was from January 2000 to December 2021. Results Three main themes were identified to provide an overview on peer-support services for mental health consumers in Asia: the delivery of such services in Asia; Asian consumers' perceptions of them; and factors affecting their implementation. Discussion Given their relative novelty in Asia, findings from this review represent useful insights for organizations and policy administrators when formulating such services. Implications for Practice Future research should also focus on evaluating the effectiveness of such services in Asia and comparing their outcomes with other regions.

Identifying and Exploring Sustainability Determinants of Mental Health Recovery-Oriented Interventions: A Mixed Methods Study Protocol

Mental health recovery is the new paradigm in the mental health service delivery system worldwide. Recovery-oriented services go beyond traditional clinical care that is centered on symptom remission, aiming to help people: restore social connections with other individuals and the community; develop hope and optimism for the future; reconstruct an identity beyond that of a “mental patient”; discover meaning in life; and feel empowered to gain control over treatment (CHIME framework). Over the last ten years, several efforts at implementation of recovery-oriented interventions have been documented in the scientific literature. However, little attention has been given to their sustainability, even though it is reported that not all health interventions can fully sustain their activities beyond the initial implementation phase. The aim of this mixed methods case study is to better understand the factors that determine the sustainability of two recovery-oriented interventions (peer support and recovery training) after their roll-out in four organizations in Canada that provide community housing for adults with mental health challenges. Qualitative and quantitative data will be collected from managers, service providers, and implementation team members that oversaw the implementation process along with organizational documents. Data collection and analysis will be guided by the Consolidated Framework for Sustainability Constructs in Healthcare, the Framework for Reporting Adaptations and Modifications, and the Program Sustainability Assessment Tool. Findings will expand our current evidence base on the intersection of sustainability and mental health recovery interventions that remains under-explored.

The significant mediators between depression and mental health recovery among community-dwelling people with a diagnosed mental disorder

To investigate the mediating roles of community integration and positive thinking on the relationship between depression and mental health recovery among community dwelling people with mental disorders in South Korea. A cross-sectional, descriptive study was utilized. Data were collected from 167 community-dwelling people with mental disorders who did not use the day program at community mental health centers. Data were collected from November 20, 2018, to February 15, 2019. Both community integration and positive thinking were found to mediate the effects of depression on mental health recovery. The mediating effect of positive thinking was significantly greater than that of community integration. This study added evidence for a significant multiple mediating effect of community integration and positive thinking on the relationship between depression and mental health recovery in community-dwelling people with mental disorders. Although the consumer-centered recovery paradigm of people with mental health difficulties is of global importance, little research has been conducted on mental health recovery among community-dwelling people with mental disorders who do not use the day program at community mental health centers. It was found that community integration and positive thinking mediated the effects of depression on mental health recovery, with positive thinking mediating this relationship the most. Thus, these results suggest a specific direction of community mental health services to promote mental health recovery for people with mental disorders who do not have access to community mental health services.

A scoping review: Treatment attitudes and adherence for adults with schizophrenia

AIM AND OBJECTIVES

This scoping review presents an exploration of literature on the relationship between treatment attitudes and adherence in adults experiencing schizophrenia.

BACKGROUND

Strategies to address adherence and improve treatment outcomes are described in literature. However, adherence remains a challenge for people experiencing mental illness in practice. Transformational frameworks, evidence-based practice and patient-centred approaches have been established and implemented but non-adherence incidence rates continue to rise among people with schizophrenia. Moreover, the relationship between treatment attitudes and adherence in adults diagnosed with schizophrenia remains unclear.

DESIGN

A scoping review using the framework offered by Implementation Science, 5, 2010, 1. The PRISMA-ScR checklist was used to ensure integrity of the review.

METHODS

Four databases PsychINFO, Medline, Cochrane and CINAHL databases were searched for literature along with the reference lists of eligible sources. Original research, peer-reviewed articles published between 2010 and 2020 in English language were included. Articles were included if study participants were adults with a diagnosis of schizophrenia or related psychosis. Methodological quality was evaluated using a quality assessment checklist, the Critical Appraisal Skills Programme tool.

RESULTS

Ten articles were included in the study. Five main themes about treatment adherence emerged from the literature: (i) severity of symptoms, (ii) side effects, (iii) beliefs and attitudes, (iv) insight and (v) support and relationships.

CONCLUSIONS

This scoping review concluded that attitude influenced adherence to medication in people with schizophrenia. The five main themes reported directly influenced attitude, impacting on treatment adherence in people experiencing schizophrenia. This review makes recommendations for a person-centred and recovery framework that aims to improve adherence.

RELEVANCE TO CLINICAL PRACTICE

Nurses in all healthcare settings could use evidence-based strategies to enhance treatment adherence in people with a range of physical and mental health conditions.

Effect of recovery-based interventions on recovery knowledge and attitudes of mental health professionals, regarding recovery-oriented practice: A quantitative narrative review

Mental health recovery is an enabling process encouraging consumers to live a productive life, notwithstanding the presence of debilitating symptoms of illness. The recovery model has been integrated into all areas of mental health. However, literature shows that mental health professionals are not equipped to provide recovery-oriented care to consumers. Researchers have recommended recovery-based interventions to develop knowledge, attitudes, and skills to promote recovery-oriented practice in mental health, yet there is a paucity of research regarding the effect of recovery-oriented interventions on the knowledge and attitudes of mental health professionals to improve recovery-oriented practice. Therefore, the purpose of the current review is to understand the effectiveness of interventions on recovery knowledge and attitudes of mental health professionals regarding recovery-oriented practice. The papers were identified through the Population Intervention Comparison and Outcome strategy. The heterogeneity of the selected papers led to a narrative review instead of a systematic review with meta-analysis. The analysis suggested that recovery-based interventions are effective in enhancing the recovery knowledge and attitudes of mental health professionals. Recovery-based interventions have the potential to reduce the use of physical restraints and improve work satisfaction among mental health professionals. The limitations of the studies were the heterogeneity of the selected populations and the absence of strong methodologies to assess the effect of the interventions. Therefore, future investigations should be focused on the effect of interventions on a homogeneous group using randomized controlled trials.

Identifying occupational therapy outcome measures supportive of recovery-orientated mental health services in Ireland

Purpose

No occupational therapy outcome measures have been designed specifically for recovery-orientated services.This paper aims to identify occupational therapy outcome measures relevant to mental health practice and assess them against recovery principles adopted by Irish Mental Health Services.

Design/methodology/approach

A narrative review methodology was used to appraise outcome measures against CHIME recovery principles.

Findings

A systematic search across 13 databases identified eight well-established outcome measures commonly used within occupational therapy mental health literature. The included outcome measures were appraised using a recovery alignment tool.

Practical implications

All outcome measures connected to some recovery processes. Those using semi-structured interview formats and notably the Canadian Occupational Performance Measure (COPM) had the strongest alignment to recovery processes.

Originality/value

This is the first known review which provides some validation that the included outcome measures support recovery processes, yet the measures rely heavily on therapist’s skills for processes to be facilitated. It recommends that ways to better support the process of partnership in occupational therapy mental health outcome measures be explored and further research be undertaken.

Igniting and Maintaining Hope: The Voices of People Living with Mental Illness

The study objective was to identify the types of experiences that consumers identify as igniting and maintaining hope, and those most frequently reported. Data were collected through an anonymous online survey. Two open-ended questions elicited reflective personal accounts regarding hope-promoting experiences. Using an interpretive content analysis design, data were coded inductively using constant comparative analysis. Numbers of participants reporting each type of experience were calculated to identify patterns of hopeful experiences. Findings from 72 participants highlighted a diversity of hope-promoting experiences and sources. Fifteen experiences were identified, forming two broad categories: interactions and experiences involving others, and personal or internal experiences, insights and actions. Findings suggest that consumers play an active role in igniting and maintaining their own hope. Peer workers and health workers can support this by being cognizant of the quality of their interactions with consumers and by facilitating connections with others, particularly families, friends and peers.

Mental health recovery among hospitalized patients with mental disorder: Associations with anger expression mode and meaning in life

This study aimed to investigate the effect of anger expression mode and meaning in life on mental health recovery among hospitalized patients with mental disorder in South Korea. Data were collected from 141 such patients using the Korean version of anger expression mode, meaning in life, and mental health recovery. Date were as analyzed using stepwise multiple regression analysis. Significant predictors of mental health recovery included presence of meaning, search for meaning, and anger control. The regression model explained 48.2% of mental health recovery. Interventions for fostering meaning in life and beneficial anger expression techniques may increase mental health recovery in this clinical population.

The relationship between community integration and mental health recovery in people with mental health issues living in the community: A quantitative study

WHAT IS KNOWN ON THE SUBJECT?: Mental health treatments have become patient-centred. Evaluating recovery in people with mental health difficulties living in the community can help to develop better client-centred services. Community integration is critical to recovery in patients with mental health difficulties. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This is the first study to use a single integrated measure of mental health recovery to evaluate the effect of community integration. Physical community integration was the easiest goal for most to reach. Developing independence/self-actualization was harder. In mental health recovery, most people were able to overcome stuckness. Developing abilities for basic functioning was harder. Participating in mental health centre day programmes promoted mental health recovery in people with mental health difficulties living in the community. Independence/self-actualization, psychological integration and social support improved mental health recovery in people with mental health difficulties living in the community. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a need to develop and actively promote programmes that attract people with mental health difficulties living in the community so that they will actively use mental health centre services. Offering systematic social skills training and occupational rehabilitation therapy to people with mental health difficulties living in the community may help them function independently. Mental health service programmes should provide volunteer opportunities for people with mental health difficulties living in the community to facilitate a sense of belonging. Mental health nurses should serve as a social support resource for people with mental health difficulties living in the community by providing education to family and friends on how to support patients' recovery, and invigorating integration projects such as "making healthy friends." Abstract Introduction Although community integration of people with mental health difficulties and a consumer-centred recovery paradigm are of global importance, little research has been conducted on community integration factors that directly affect mental health recovery. Aim This study investigated the relationship between community integration and mental health recovery in people with mental health difficulties living in the community in South Korea. Method Data were collected from 155 people with mental health difficulties living in the community, using the Self-Reporting Scale of Community Integration and the Mental Health Recovery Measure (Korean version), and analysed using hierarchical regression analysis. Results Among the community integration subscales, independence/self-actualization, psychological integration and social support were significant factors in mental health recovery, explaining 47.3% of the variance. Discussion An effective intervention strategy for mental health recovery of people with mental health difficulties living in the community may reinforce community integration by carefully considering independence/self-actualization, psychological integration and social support. Implications for practice Mental health nurses should provide intervention to people with mental health difficulties living in the community to help them develop strategies for functioning independently, experiencing a sense of achievement and developing a sense belonging in the community.

A Review of Strategies for Enhancing Clarity and Reader Accessibility of Qualitative Research Results

Objective. To characterize elements of the results section of qualitative research reports that make findings more accessible to readers. Methods. Two analytical methods were used for this review. First, published reviews and textbooks written by experts outlining how to evaluate qualitative research were retrieved and reviewed to identify common elements that enhance clarity of the results section. In the second analysis, the authors analyzed the results sections of a subset of qualitative studies to identify, from a reader's point of view, aspects that enhanced and detracted from communication of the results. Findings. Four elements improve accessibility of the results section for readers of qualitative research reports. Content, the first element, describes what information the reader should look for in the results section. Style of results, the second element, identifies wording choices that improve reader accessibility and understanding. Narrative flow, the third element, describes a results section that flows smoothly and logically. Structural cohesiveness, the final element, outlines effective organization of the results section. Results. While authors take several approaches to the presentation of results in qualitative research reports, some strategies appear to be more common and effective than others. The efficient presentation of results can impact a reader's assessment of the quality and credibility of a study. Identified content and stylistic elements should be considered by authors hoping to make the results of their qualitative research more accessible and comprehensible to readers.

Thriving in an expanding service landscape: Experiences of occupational therapists working in generic mental health roles within non-government organisations in Australia

INTRODUCTION

Occupational therapists are an integral part of Australian mental health services. Recent changes in the mental health sector mean that increasing numbers of occupational therapists now work in generic, non-profession-specific roles in non-government organisations. Previous research has identified a range of challenges faced by occupational therapists in generic roles, including reduced satisfaction and loss of professional identity. An exploration of potentially positive aspects and strategies that assist occupational therapists to succeed and flourish within generic roles is lacking. The aim of this study was to explore what assists occupational therapists to thrive within generic roles in Australia's non-government mental health sector.

METHODS

Semi-structured, in-depth interviews were conducted with 12 occupational therapists working in generic mental health roles across three non-government organisations spanning three Australian states. Data were analysed thematically using constant comparative analysis.

RESULTS

Thriving was supported in three domains. First, occupational therapists facilitated their own thriving by keeping their occupational therapy lens, and managing ambiguity. Second, workplaces were supportive when their values aligned with occupational therapy core values, they recognised and valued the occupational therapy contribution, and their roles allowed opportunities for therapists to use their profession-specific skills. Third, the broader occupational therapy profession assisted thriving through preparation, validation and ongoing inclusion.

CONCLUSION

Despite some challenges, occupational therapists can and do thrive in generic non-government mental health roles. The preliminary framework of thriving provides valuable insights for those developing university curricula, those providing continuing professional development opportunities and for individual occupational therapists entering this expanding area of practice. Findings also provide insights into how individuals, academic curricula and the profession can respond and adapt to systemic transformations occurring in mental health service delivery.

Factors Associated with Changes in Community Ability and Recovery After Psychiatric Rehabilitation: A Retrospective Study

One of the key goals of psychiatric rehabilitation is to return individuals with mental illnesses back into the community via restoration of the necessary skills. This retrospective study seeks to evaluate the factors associated with improvement in community functioning after a period of outpatient rehabilitation. 223 individuals enrolled into three broad rehabilitation groups-clinical, vocational and creative therapies/individual sessions-were included in this study. The Multnomah Community Ability Scale (MCAS) and Milestones of Recovery Scale (MORS) were used to evaluate each individual before and after the rehabilitation programme. Across all three groups, there were significant improvements in MCAS scores and MORS ratings. In multivariate models, clinical rehabilitation group was superior to creative therapies/individual sessions in predicting MORS change. The study also revealed a close relationship between recovery gains and improvement in community ability.