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Katayama M, Aijo R, Kitaoka K, Kawaguchi M. How nursing students' perceptions of people with psychiatric disabilities change when using the strengths model during practicums: A qualitative research study. NURSE EDUCATION TODAY 2024; 138:106190. [PMID: 38583345 DOI: 10.1016/j.nedt.2024.106190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/19/2024] [Accepted: 03/31/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The Strengths Model, a framework grounded in the belief that everyone has an inherent capability to cope with challenges, is designed to support the hopes and aspirations of people with psychiatric disabilities, guiding them toward their desired self-image. The model originally gained attention in the field of social welfare and has since become popular in the field of community mental health. There is an increasing demand for nurses to understand and implement this model in the support they provide. OBJECTIVES To clarify how implementation of the Strengths Model in nurse education impacts students' perceptions of their clients with psychiatric disabilities. DESIGN Qualitative descriptive study informed by Grounded Theory. SETTING Public university nursing practicum. PARTICIPANTS Sixteen fourth-year students undertaking a practicum using the Strengths Model. METHODS Semi-structured interviews. RESULTS The core concept identified was that people with psychiatric disabilities uncover their own inherent strengths. Students began their engagement by listening to clients' dreams and goals. Then, three processes were identified that led to the outcome of students seeing clients in terms of their limitations, while one process was identified that led to the alternate desirable outcome of students developing a sense of respect for clients. CONCLUSIONS These findings indicate that the process leading to students developing a sense of respect for clients with psychiatric disabilities involved three interrelated factors: students listening to clients' dreams and goals, both parties working together to discover the clients' dreams, and clients uncovering their own inherent strengths and then leveraging them. Incorporating the Strengths Model, which takes a person-centric approach to support the agency of people with psychiatric disabilities, into nurse education has the potential to foster healthcare professionals who respect people with psychiatric disabilities, see them on an equal footing, and consider themselves partners in facilitating the recovery journey.
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Affiliation(s)
- Miho Katayama
- Department of Nursing, Faculty of Health Sciences, Komatsu University, Mukaimotoorimachi He 14-1, Komatsu, City, Ishikawa Prefecture 923-0961, Japan.
| | - Ritsuko Aijo
- Department of Nursing, Faculty of Health Sciences, Komatsu University, Mukaimotoorimachi He 14-1, Komatsu, City, Ishikawa Prefecture 923-0961, Japan; Doctoral Course, Department of Neuroscience, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640, Japan
| | - Kazuyo Kitaoka
- Department of Nursing, Faculty of Health Sciences, Komatsu University, Mukaimotoorimachi He 14-1, Komatsu, City, Ishikawa Prefecture 923-0961, Japan
| | - Megumi Kawaguchi
- Faculty of Medical Sciences, Division of Nursing, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
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Khanthavudh C, Grealish A, Tzouvara V, Huang J, Leamy M. Implementation and evaluation of recovery-oriented practice interventions for people with mental illness in Asia: An integrative review. Int J Nurs Stud 2023; 147:104591. [PMID: 37708624 DOI: 10.1016/j.ijnurstu.2023.104591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Recovery is a process involving empowering individuals to take control of their lives and develop meaningful and purposeful life, regardless of whether their mental health symptoms persist. Recovery-oriented practice has been widely implemented, particularly in Anglophone countries, during the past two decades. Mental health recovery in Asia is also moving towards recovery-oriented practice. Little is known about how recovery-oriented interventions originating in the West have been implemented and evaluated in Asian contexts. OBJECTIVE This review aimed to identify 1) types of recovery-oriented practice interventions that have been implemented in Asia, 2) how they have been culturally adapted, 3) barriers and facilitators to implementation, and 4) how the interventions have been evaluated. DESIGN This is an integrative review. METHODS This integrative review followed Whittemore and Knafl's five-stage framework. Six electronic databases (e.g., PsycINFO, MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Library) were systematically searched from their inception to January 2022 to identify eligible studies published in English language. The key search terms included "mental illness", "recovery-oriented intervention", and "Asia". Studies reporting on implementation and evaluation of recovery-focused interventions in Asian settings were eligible. Quality assessment and narrative synthesis were subsequently undertaken. RESULTS Thirty-eight studies were included. Seven main types of recovery-oriented intervention were identified: (1) peer programmes; (2) illness management and recovery; (3) individual placement and support; (4) strength model case management; (5) clubhouse model; (6) wellness recovery action plan and (7) psychiatric advance directive, alongside several novel recovery programmes. Studies reported cultural adaptations for language, content, cultural norms, religious beliefs, family, and local context. Barriers to implementation included a poor understanding of recovery concepts and inadequate organisational resources. A range of clinical and personal recovery outcome measures were reported. CONCLUSIONS Recovery-oriented interventions are increasing in Asia, with nearly half of reviewed studies featuring cultural adaptations. However, research is geographically skewed, and more rigorously conducted studies are needed across a wider range of Asian countries. REGISTRATION This review was registered with the PROSPERO International prospective register of systematic reviews (CRD42022310049). TWEETABLE ABSTRACT Recovery-oriented practice interventions for people with mental illness are on the rise in Asia @chonmananNN.
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Affiliation(s)
- Chonmanan Khanthavudh
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom; Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Annmarie Grealish
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom; Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Vasiliki Tzouvara
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Jing Huang
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Mary Leamy
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
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Hsiao CY, Lu HL, Chiu CK, Tsai YF. Factors associated with attitudes of mental health nurses towards the importance of families in mental health nursing care. Int J Ment Health Nurs 2023; 32:1429-1438. [PMID: 37332262 DOI: 10.1111/inm.13187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
Family involvement in mental healthcare is a key ingredient in the recovery of patients with mental illness. Research on the attitudes of mental health nurses regarding family involvement in mental healthcare remains limited. This study aimed to examine factors that affect the attitudes of mental health nurses towards the importance of family involvement in mental health nursing care. A descriptive, correlational study with a cross-sectional design was conducted with 162 mental health nurses at two psychiatric hospitals in Taiwan. Descriptive statistics, independent t-tests, one-way analysis of variance, and stepwise multiple linear regression analyses were applied to analyse data. Mental health nurses generally demonstrated positive attitudes towards incorporating families into nursing care. Older age, more clinical experiences in mental healthcare, and workplace (such as working in chronic psychiatric inpatient wards) were found to be key factors for mental health nurses' attitudes. Particularly, greater competence in working with families and job satisfaction were the most significant factors associated with positive attitudes of mental health nurses towards involving families as important in nursing care. Insight into correlates of mental health nurses' attitudes towards the importance of focusing on families in care is pivotal for targeted interventions to improve nurses' attitudes towards families and, thus, implement family engagement in mental healthcare practices.
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Affiliation(s)
- Chiu-Yueh Hsiao
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan City, Taiwan, Republic of China
- Department of Psychiatry, Chang Gung Memorial Hospital, Tao-Yuan City, Taiwan, Republic of China
| | - Huei-Lan Lu
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan, Republic of China
| | - Chin-Kuai Chiu
- Taoyuan Psychiatric Center, Ministry of Health and Welfare, Tao-Yuan City, Taiwan, Republic of China
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan City, Taiwan, Republic of China
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan City, Taiwan, Republic of China
- Department of Psychiatry, Chang Gung Memorial Hospital in Keelung, Keelung City, Taiwan, Republic of China
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Kealeboga KM, Manyedi ME, Moloko-Phiri S. Nurses' Perceptions on How Recovery-Oriented Mental Health Care Can Be Developed and Implemented. Nurs Res Pract 2023; 2023:4504420. [PMID: 37664807 PMCID: PMC10470086 DOI: 10.1155/2023/4504420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/05/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023] Open
Abstract
Aim This study explored how nurses working in inpatient mental health units perceived the development and implementation of a recovery-oriented mental healthcare programme (ROMHCP). Background The recovery-oriented mental healthcare approach (ROMHCA) in mental health is regarded as the future of mental health services and has been implemented in different countries worldwide. However, regarding developing and implementing the recovery approach, Africa appears to have been left behind by the rest of the continents. Design The study used a qualitative approach to describe how a recovery-oriented mental healthcare approach could be developed. Methods Thirty nurses who worked in Botswana's four inpatient mental health facilities consented and voluntarily participated in the study. Data were collected from February to mid-March 2022 through online focus group discussions and analysed using thematic analysis. The COREQ checklist was used to report the findings. Results Two main themes emerged as follows: (i) developing and implementing a recovery-oriented mental healthcare programme is possible and (ii) certain elements are required to develop and implement ROMHCP. Conclusion The participants believed that people diagnosed with mental illness could recover from the illness and suggested how it could be achieved. They also contended that the programme's success would lie mainly with multisectoral support from policymakers, facilities, hospital personnel, patients, and the community. Clinical Relevance. ROMHCP has the potential to benefit people with mental illness in the country. In addition, it would allow nurses to improve their knowledge and skills in managing mental illnesses. Patient or Public Contribution. The patients and the general public did not contribute to the study's concept, design, and outcomes. However, the nurses working in mental health facilities volunteered to participate in the study.
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Affiliation(s)
- Kebope Mongie Kealeboga
- University of Botswana, Faculty of Health Sciences, School of Nursing Science, Gaborone, Botswana
- North-West University Faculty of Health Sciences, School of Nursing Science, Mafikeng, South Africa
| | - Mofatiki Eva Manyedi
- North-West University Faculty of Health Sciences, School of Nursing Science, Mafikeng, South Africa
| | - Salaminah Moloko-Phiri
- North-West University Faculty of Health Sciences, School of Nursing Science, Mafikeng, South Africa
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Ma M, Shi Z, Chen Y, Ma X. Recovery journey of people with a lived experience of schizophrenia: a qualitative study of experiences. BMC Psychiatry 2023; 23:468. [PMID: 37369995 DOI: 10.1186/s12888-023-04862-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 05/11/2023] [Indexed: 06/29/2023] Open
Abstract
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.
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Affiliation(s)
- Min Ma
- Wuhan Mental Health center, Wuhan Hospital for Psychotherapy, Rehabilitation Department, Wuhan, China
| | - Zhidao Shi
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Yanhong Chen
- China University of Geosciences Wuhan, Wuhan, China
| | - Xiquan Ma
- Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Åkerblom KB, Ness O. Peer Workers in Co-production and Co-creation in Mental Health and Substance Use Services: A Scoping Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:296-316. [PMID: 36396756 PMCID: PMC9931804 DOI: 10.1007/s10488-022-01242-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/19/2022]
Abstract
People with lived experience of mental health challenges are extensively employed as peer workers within mental health and substance use services worldwide. Research shows that peer workers benefit individuals using such services and can have essential roles in developing recovery-oriented services. However, understanding how peer workers' contributions, by their role, functions, and input can be better used remains a critical challenge. Research on public sector innovation has focused on relevant actors collaborating to tackle complex demands. Co-production and co-creation are concepts used to describe this collaboration. Co-production refers to the collaboration between providers and users at the point of service delivery, whereas co-creation refers to collaboration starting in the early service cycle phases (e.g., in commissioning or design), including solution implementation. We overviewed research literature describing peer workers' involvement in mental health and substance use services. The research question is as follows: How are peer workers involved in co-production and co-creation in mental health and substance use services, and what are the described outcomes? A literature search was performed in 10 different databases, and 13,178 articles were screened, of which 172 research articles describing peer workers' roles or activities were included. The findings show that peer workers are involved in co-production and function as providers of pre-determined services or, most often, as providers of peer support. However, they are rarely engaged as partners in co-creation. We conclude that the identified peer worker roles have different potential to generate input and affect service delivery and development.
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Affiliation(s)
| | - Ottar Ness
- Department of Education and Lifelong Learning, Norwegian University of Science and Technology, Trondheim, Norway
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Ong QS, Yang HZ, Kuek JHL, Goh YS. Implementation of peer-support services in Asia: A scoping review. J Psychiatr Ment Health Nurs 2022; 30:309-325. [PMID: 36263517 DOI: 10.1111/jpm.12879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Qin Soo Ong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Hui Zhu Yang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Jonathan Han Loong Kuek
- Susan Wakil School of Nursing, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yong Shian Goh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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Sofouli E, Wiltsey-Stirman S, Groleau D, Perreault M, Piat M. Identifying and Exploring Sustainability Determinants of Mental Health Recovery-Oriented Interventions: A Mixed Methods Study Protocol. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:249-261. [PMID: 36035969 PMCID: PMC9395767 DOI: 10.1007/s43477-022-00052-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
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.
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Kronkvist MB, Forsberg KA, Rämgård M, Sandlund M, Janarv T, Dahlqvist Jönsson P. User participation in decision-making – a qualitative intervention study on mental health professionals’ experiences. JOURNAL OF PUBLIC MENTAL HEALTH 2022. [DOI: 10.1108/jpmh-11-2021-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study was to describe mental health professionals’ experiences of changes in attitudes towards, and knowledge about, users of mental health-care recovery and decisional participation in clinical practice after an educational intervention.
Design/methodology/approach
Users of mental health care want to participate in decisions regarding their own mental health care. Shared decision-making as a method is coherent with recovery orientation in mental health services and results in better-informed patients and fewer conflicts regarding decisions. A qualitative intervention study was designed to evaluate changes in attitudes and knowledge about mental health recovery in Sweden. Nine participants were interviewed, and the data were analysed by content analysis.
Findings
Three categories were generated from the analysis: Increased theoretical knowledge, changing attitudes about practical approaches and the significance of social factors in recovery.
Originality/value
When shared decision-making is to be implemented in mental health, professionals need to gain knowledge about recovery and need to adopt changed roles as health professionals. Educational interventions therefore seem necessary if such changes are to happen.
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Klevan T, Jonassen R, Topor A, Borg M. Mutual learning: exploring collaboration, knowledge and roles in the development of recovery-oriented services. A hermeneutic-phenomenological study. Int J Qual Stud Health Well-being 2021; 16:2001898. [PMID: 34802400 PMCID: PMC8635568 DOI: 10.1080/17482631.2021.2001898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The concept of recovery is commonly described as multifaceted and contested in the field of mental health and substance abuse. The aim of this study is to explore how understandings of recovery and recovery orientation of services are developed through daily practices and collaboration between service users and professionals. Methods Eight pairs of participants were interviewed together, in accordance with the dyadic interview method. The dyads/pairs consisted of service users and professional helpers. A collaborative hermeneutic-phenomenological analysis was used to analyse data. Results Data were analysed into three overarching and entangled themes, exploring how recovery-oriented collaboration and knowledge encompasses (a) recovery as relational processes. These processes are entangled with (b) recovery as situated in time and place. Furthermore, relational processes and dimensions of time and place are situated in and supported or hindered by (c) recovery orientation as part of the municipal policies, understood as the regulations, frameworks and decisions guiding mental health and substance abuse services in the municipality. Conclusions The further development of recovery-oriented services should focus on facilitating open-ended and flexible ways of developing practices and relationships. This involves recognizing how relationships contribute to the development of knowledge and practices.
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Affiliation(s)
- Trude Klevan
- Center for Mental Health and Substance Abuse, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Reidun Jonassen
- Center for Mental Health and Substance Abuse, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Alain Topor
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
| | - Marit Borg
- Center for Mental Health and Substance Abuse, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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