1
|
Ali Y, Rennick-Egglestone S, Llewellyn-Beardsley J, Ng F, Yeo C, Franklin D, Perez Vallejos E, Ben-Zeev D, Kotera Y, Slade M. Perception and appropriation of a web-based recovery narratives intervention: qualitative interview study. Front Digit Health 2024; 6:1297935. [PMID: 38419807 PMCID: PMC10899698 DOI: 10.3389/fdgth.2024.1297935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Mental health recovery narratives are widely available to the public, and can benefit people affected by mental health problems. The NEON Intervention is a novel web-based digital health intervention providing access to the NEON Collection of recovery narratives. The NEON Intervention was found to be effective and cost-effective in the NEON-O Trial for people with nonpsychosis mental health problems (ISRCTN63197153), and has also been evaluated in the NEON Trial for people with psychosis experience (ISRCTN11152837). We aimed to document NEON Intervention experiences, through an integrated process evaluation. Methods Analysis of interviews with a purposive sample of intervention arm participants who had completed trial participation. Results We interviewed 34 NEON Trial and 20 NEON-O Trial participants (mean age 40.4 years). Some users accessed narratives through the NEON Intervention almost daily, whilst others used it infrequently or not at all. Motivations for trial participation included: exploring the NEON Intervention as an alternative or addition to existing mental health provision; searching for answers about mental health experiences; developing their practice as a mental health professional (for a subset who were mental health professionals); claiming payment vouchers. High users (10 + narrative accesses) described three forms of appropriation: distracting from difficult mental health experiences; providing an emotional boost; sustaining a sense of having a social support network. Most participants valued the scale of the NEON Collection (n = 659 narratives), but some found it overwhelming. Many felt they could describe the characteristics of a desired narrative that would benefit their mental health. Finding a narrative meeting their desires enhanced engagement, but not finding one reduced engagement. Narratives in the NEON Collection were perceived as authentic if they acknowledged the difficult reality of mental health experiences, appeared to describe real world experiences, and described mental health experiences similar to those of the participant. Discussion We present recommendations for digital health interventions incorporating collections of digital narratives: (1) make the scale and diversity of the collection visible; (2) provide delivery mechanisms that afford appropriation; (3) enable contributors to produce authentic narratives; (4) enable learning by healthcare professionals; (5) consider use to address loneliness.
Collapse
Affiliation(s)
- Yasmin Ali
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Department of Architecture and Built Environment, Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - Donna Franklin
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Elvira Perez Vallejos
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| | - Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Center for Infectious Disease Education and Research, Osaka University, Osaka, Japan
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Faculty of Nursing and Health Sciences, Health, and Community Participation Division, Nord University, Namsos, Norway
| |
Collapse
|
2
|
Slade M, Rennick-Egglestone S, Elliott RA, Newby C, Robinson C, Gavan SP, Paterson L, Ali Y, Yeo C, Glover T, Pollock K, Callard F, Priebe S, Thornicroft G, Repper J, Keppens J, Smuk M, Franklin D, Walcott R, Harrison J, Smith R, Robotham D, Bradstreet S, Gillard S, Cuijpers P, Farkas M, Zeev DB, Davidson L, Kotera Y, Roe J, Ng F, Llewellyn-Beardsley J. Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with non-psychotic mental health problems: a pragmatic randomized controlled trial. World Psychiatry 2024; 23:101-112. [PMID: 38214639 PMCID: PMC10785987 DOI: 10.1002/wps.21176] [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] [Indexed: 01/13/2024] Open
Abstract
Narratives describing first-hand experiences of recovery from mental health problems are widely available. Emerging evidence suggests that engaging with mental health recovery narratives can benefit people experiencing mental health problems, but no randomized controlled trial has been conducted as yet. We developed the Narrative Experiences Online (NEON) Intervention, a web application providing self-guided and recommender systems access to a collection of recorded mental health recovery narratives (n=659). We investigated whether NEON Intervention access benefited adults experiencing non-psychotic mental health problems by conducting a pragmatic parallel-group randomized trial, with usual care as control condition. The primary endpoint was quality of life at week 52 assessed by the Manchester Short Assessment (MANSA). Secondary outcomes were psychological distress, hope, self-efficacy, and meaning in life at week 52. Between March 9, 2020 and March 26, 2021, we recruited 1,023 participants from across England (the target based on power analysis was 994), of whom 827 (80.8%) identified as White British, 811 (79.3%) were female, 586 (57.3%) were employed, and 272 (26.6%) were unemployed. Their mean age was 38.4±13.6 years. Mood and/or anxiety disorders (N=626, 61.2%) and stress-related disorders (N=152, 14.9%) were the most common mental health problems. At week 52, our intention-to-treat analysis found a significant baseline-adjusted difference of 0.13 (95% CI: 0.01-0.26, p=0.041) in the MANSA score between the intervention and control groups, corresponding to a mean change of 1.56 scale points per participant, which indicates that the intervention increased quality of life. We also detected a significant baseline-adjusted difference of 0.22 (95% CI: 0.05-0.40, p=0.014) between the groups in the score on the "presence of meaning" subscale of the Meaning in Life Questionnaire, corresponding to a mean change of 1.1 scale points per participant. We found an incremental gain of 0.0142 quality-adjusted life years (QALYs) (95% credible interval: 0.0059 to 0.0226) and a £178 incremental increase in cost (95% credible interval: -£154 to £455) per participant, generating an incremental cost-effectiveness ratio of £12,526 per QALY compared with usual care. This was lower than the £20,000 per QALY threshold used by the National Health Service in England, indicating that the intervention would be a cost-effective use of health service resources. In the subgroup analysis including participants who had used specialist mental health services at baseline, the intervention both reduced cost (-£98, 95% credible interval: -£606 to £309) and improved QALYs (0.0165, 95% credible interval: 0.0057 to 0.0273) per participant as compared to usual care. We conclude that the NEON Intervention is an effective and cost-effective new intervention for people experiencing non-psychotic mental health problems.
Collapse
Affiliation(s)
- Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, Namsos, Norway
| | | | - Rachel A Elliott
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Chris Newby
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Robinson
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Sean P Gavan
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Luke Paterson
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Yasmin Ali
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Department of Architecture and Built Environment, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | | | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Felicity Callard
- School of Geographical & Earth Sciences, University of Glasgow, Glasgow, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, East London NHS Foundation Trust, London, UK
| | - Graham Thornicroft
- Centre for Implementation Science and Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Jeroen Keppens
- Department of Informatics, King's College London, London, UK
| | - Melanie Smuk
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | | | - Rianna Walcott
- Black Communication and Technology Lab, Department of Communication, University of Maryland, College Park, MD, USA
| | | | - Roger Smith
- NEON Lived Experience Advisory Panel, Nottingham, UK
| | | | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Steve Gillard
- School of Health Sciences, City, University of London, London, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- International Institute for Psychotherapy, Babes¸-Bolyai University, Cluj-Napoca, Romania
| | - Marianne Farkas
- Center for Psychiatric Rehabilitation, College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Dror Ben Zeev
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Larry Davidson
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Center for Infectious Disease Education and Research, Osaka University, Osaka, Japan
| | - James Roe
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration East Midlands, University of Nottingham, Nottingham, UK
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| |
Collapse
|
3
|
Subhani M, Talat U, Knight H, Morling JR, Jones KA, Aithal GP, Ryder SD, Rennick-Egglestone S. Application and Extension of the Alcohol Recovery Narratives Conceptual Framework. QUALITATIVE HEALTH RESEARCH 2023; 33:1203-1217. [PMID: 37683106 PMCID: PMC10626984 DOI: 10.1177/10497323231197384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Recovery narratives are personal stories of health problems and recovery. A systematic review proposed a conceptual framework characterising alcohol misuse recovery narratives, consisting of eight principal dimensions, each with types and subtypes. The current study aims to apply and extend this preliminary conceptual framework. Semi-structured interviews were conducted to collect alcohol misuse recovery narratives from adult participants. A two-stage inductive and deductive thematic analysis approach was used to assess the relevance of the dimensions and types included in the preliminary conceptual framework and identify new components. The sample consisted of 11 participants from diverse socioeconomic backgrounds who had previously displayed varying degrees of alcohol misuse. All conceptual framework dimensions (genre, identity, recovery setting, drinking trajectories, drinking behaviours and traits, stages, spirituality and religion, and recovery experience) were present in the collected narratives. Three dimensions were extended by adding types and subtypes. Whilst the existing conceptual framework fitted the collected narratives, a new dimension describing the alcohol environment was required to fully characterise narratives. Types included in the alcohol environment dimension were policy and practice and social dynamics. The extended framework could guide the production of resources enabling clinicians to engage with narratives shared by their clients.
Collapse
Affiliation(s)
- Mohsan Subhani
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Usman Talat
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Holly Knight
- Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Joanne R. Morling
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Katy A. Jones
- School of Medicine, Applied Psychology, University of Nottingham, Nottingham, UK
| | - Guruprasad P. Aithal
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Stephen D. Ryder
- Nottingham Digestive Diseases Biomedical Research Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | | |
Collapse
|
4
|
Rennick-Egglestone S, Subhani M, Knight H, Jones KA, Hutton C, Jackson T, Hutton M, Wragg A, Morling JR, Sprange K, Ryder SD. Transient Elastography and Video Recovery Narrative Access to Support Recovery From Alcohol Misuse: Development of a Novel Intervention for Use in Community Alcohol Treatment Services. JMIR Form Res 2023; 7:e47109. [PMID: 37792440 PMCID: PMC10585443 DOI: 10.2196/47109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Mortality from alcohol-related liver disease has risen significantly for 3 decades. Transient elastography (TE) is a noninvasive test providing a numerical marker of liver disease. Preliminary evidence suggests that TE can reduce alcohol consumption. The KLIFAD (does knowledge of liver fibrosis affect high-risk drinking behavior?) study has developed a complex intervention wherein people receiving alcohol treatment are provided with access to TE, accompanied by scripted feedback tailored to their disease state, and access to video narratives describing alcohol misuse recovery after receiving TE. Recovery narratives are included due to preliminary evidence from mental health studies which suggest that access to digital narratives describing recovery from mental health problems can help people affected by mental health problems, including through mechanisms with the potential to be transferable to an alcohol treatment setting, for example, by increasing hope for the future, enabling learning from the experience of others, or promoting help-seeking behaviors. OBJECTIVE We aimed to develop the KLIFAD intervention to the point that it could be delivered in a feasibility trial and to produce knowledge relevant to clinicians and researchers developing interventions making use of biomarkers of disease. METHODS In research activity 1, standardized scripted feedback was developed by this study, and then iterated through focus groups with people who had experienced alcohol misuse and TE, and key alcohol workers with experience in delivering TE. We report critical design considerations identified through focus groups, in the form of sensitizing concepts. In research activity 2, a video production guide was coproduced to help produce impactful video-based recovery narratives, and a patient and public involvement (PPI) panel was consulted for recommendations on how best to integrate recovery narratives into an alcohol treatment setting. We report PPI recommendations and an overview of video form and content. RESULTS Through research activity 1, we learnt that patient feedback has not been standardized in prior use of TE, that receiving a numeric marker can provide an objective target that motivates and rewards recovery, and that key alcohol workers regularly tailor information to their clients. Through research activity 2, we developed a video production guide asking narrators what recovery means to them, what helped their recovery, and what they have learned about recovery. We produced 10 recovery narratives and collected PPI recommendations on maximizing impact and safety. These led to the production of unplanned videos presenting caregiver and clinician perspectives, and a choice to limit narrative availability to alcohol treatment settings, where support is available around distressing content. These choices have been evaluated through a feasibility randomized controlled trial [ISRCTN16922410]. CONCLUSIONS Providing an objective target that motivates and rewards recovery is a candidate change mechanism for complex interventions integrating biomarkers of disease. Recovery narratives can contain distressing content; intervention developers should attend to safe usage. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2021-054954.
Collapse
Affiliation(s)
- Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Mohsan Subhani
- Nottingham Digestive Diseases Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Holly Knight
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Katy A Jones
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Clare Hutton
- KLIFAD Study PPI Panel, Nottingham, United Kingdom
| | | | | | - Andrew Wragg
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Joanne R Morling
- Nottingham Digestive Diseases Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kirsty Sprange
- Nottingham Clinical Trials Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Stephen D Ryder
- Nottingham Digestive Diseases Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
5
|
Amsalem D, Jankowski SE, Pagdon S, Valeri L, Yang LH, Markowitz JC, Neria Y, Pescosolido BA, Dixon LB, Martin A. Selfie Videos to Reduce Stigma and Increase Treatment Seeking Among Youths: Two Noninferiority Randomized Controlled Trials. Psychiatr Serv 2023; 74:229-236. [PMID: 36254455 DOI: 10.1176/appi.ps.20220168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Confronting stigma early in life could enhance treatment seeking. In two randomized controlled trials (RCTs), one focused on psychosis and the other on adolescent depression, the efficacy and equivalence of brief social contact-based videos were evaluated and compared with a control condition. The outcomes of interest were changes in illness-related stigma and treatment-seeking intention. The hypotheses were that the intervention videos would show greater efficacy than control conditions and that traditional and selfie videos would demonstrate similar efficacy. METHODS Young adults (study 1, N=895) and adolescents (study 2, N=637) were randomly assigned to view intervention videos (in traditional or selfie styles) or to a control condition. In short videos (58-102 seconds), young presenters humanized their illness by emotionally describing their struggles and discussing themes of recovery and hope. RESULTS Repeated-measures analyses of variance and paired t tests showed significant differences in stigma and treatment seeking between the intervention and control groups and similar efficacy of the traditional and selfie videos. Cohen's d effect sizes ranged from 0.31 to 0.76 for changes in stigma from baseline to 30-day follow-up in study 1 and from 0.13 to 0.47 for changes from baseline to postintervention in study 2. CONCLUSIONS The RCTs demonstrated the efficacy of brief videos, both traditional and selfie, in reducing illness-related stigma among young adults and adolescents and in increasing treatment-seeking intention among adolescents. Future studies should explore the effects of brief videos presented by social media influencers on mental health stigma and treatment engagement.
Collapse
Affiliation(s)
- Doron Amsalem
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Samantha E Jankowski
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Shannon Pagdon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Linda Valeri
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Lawrence H Yang
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - John C Markowitz
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Yuval Neria
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Bernice A Pescosolido
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| | - Andrés Martin
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Amsalem, Jankowski, Pagdon, Markowitz, Neria, Dixon); Department of Biostatistics (Valeri) and Department of Epidemiology (Yang), Columbia University Mailman School of Public Health, New York City; Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City (Yang); Department of Sociology, Indiana University, Bloomington (Pescosolido); Child Study Center and Simulated Participant Program, Yale School of Medicine, New Haven, Connecticut (Martin)
| |
Collapse
|
6
|
Kotera Y, Rennick-Egglestone S, Ng F, Llewellyn-Beardsley J, Ali Y, Newby C, Fox C, Slade E, Bradstreet S, Harrison J, Franklin D, Todowede O, Slade M. Assessing diversity and inclusivity is the next frontier in mental health recovery narrative research and practice (Preprint). JMIR Ment Health 2022; 10:e44601. [PMID: 37067882 PMCID: PMC10152384 DOI: 10.2196/44601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/24/2022] [Accepted: 01/01/2023] [Indexed: 01/02/2023] Open
Abstract
Demand for digital health interventions is increasing in many countries. The use of recorded mental health recovery narratives in digital health interventions is becoming more widespread in clinical practice. Mental health recovery narratives are first-person lived experience accounts of recovery from mental health problems, including struggles and successes over time. Helpful impacts of recorded mental health recovery narratives include connectedness with the narrative and validation of experiences. Possible harms include feeling disconnected and excluded from others. Diverse narrative collections from many types of narrators and describing multiple ways to recover are important to maximize the opportunity for service users to benefit through connection and to minimize the likelihood of harm. Mental health clinicians need to know whether narrative collections are sufficiently diverse to recommend to service users. However, no method exists for assessing the diversity and inclusivity of existing or new narrative collections. We argue that assessing diversity and inclusivity is the next frontier in mental health recovery narrative research and practice. This is important, but methodologically and ethically complex. In this viewpoint, we propose and evaluate one diversity and two inclusivity assessment methods. The diversity assessment method involves use of the Simpson Diversity Index. The two inclusivity assessment methods are based on comparator demographic rates and arbitrary thresholds, respectively. These methods were applied to four narrative collections as a case study. Refinements are needed regarding a narrative assessment tool in terms of its practicality and cultural adaptation.
Collapse
Affiliation(s)
- Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Yasmin Ali
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Chris Newby
- School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Fox
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Emily Slade
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Simon Bradstreet
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Julian Harrison
- Narrative Experiences Online Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Donna Franklin
- Narrative Experiences Online Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Olamide Todowede
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, Namsos, Norway
| |
Collapse
|
7
|
Llewellyn-Beardsley J, Rennick-Egglestone S, Pollock K, Ali Y, Watson E, Franklin D, Yeo C, Ng F, McGranahan R, Slade M, Edgley A. 'Maybe I Shouldn't Talk': The Role of Power in the Telling of Mental Health Recovery Stories. QUALITATIVE HEALTH RESEARCH 2022; 32:1828-1842. [PMID: 35979858 PMCID: PMC9511241 DOI: 10.1177/10497323221118239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Mental health 'recovery narratives' are increasingly used within teaching, learning and practice environments. The mainstreaming of their use has been critiqued by scholars and activists as a co-option of lived experience for organisational purposes. But how people report their experiences of telling their stories has not been investigated at scale. We present accounts from 71 people with lived experience of multiple inequalities of telling their stories in formal and informal settings. A reflexive thematic analysis was conducted within a critical constructivist approach. Our overarching finding was that questions of power were central to all accounts. Four themes were identified: (1) Challenging the status quo; (2) Risky consequences; (3) Producing 'acceptable' stories; (4) Untellable stories. We discuss how the concept of narrative power foregrounds inequalities in settings within which recovery stories are invited and co-constructed, and conclude that power imbalances complicate the seemingly benign act of telling stories of lived experience.
Collapse
Affiliation(s)
- Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | | | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Yasmin Ali
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Emma Watson
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Donna Franklin
- NEON Lived Experience Advisory Panel, University of Nottingham, Nottingham, UK
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | | | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Alison Edgley
- School of Health Sciences, University of Nottingham, Nottingham, UK
| |
Collapse
|
8
|
Characteristics of alcohol recovery narratives: Systematic review and narrative synthesis. PLoS One 2022; 17:e0268034. [PMID: 35511789 PMCID: PMC9070949 DOI: 10.1371/journal.pone.0268034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Narratives of recovery from alcohol misuse have been analysed in a range of research studies. This paper aims to produce a conceptual framework describing the characteristics of alcohol misuse recovery narratives that are in the research literature, to inform the development of research, policy, and practice. METHODS Systematic review was conducted following PRISMA guidelines. Electronic searches of databases (Ovid MEDLINE, EMBASE, CINHAL, PsychInfo, AMED and SCOPUS), grey literature, and citation searches for included studies were conducted. Alcohol recovery narratives were defined as "first-person lived experience accounts, which includes elements of adversity, struggle, strength, success, and survival related to alcohol misuse, and refer to events or actions over a period of time". Frameworks were synthesised using a three-stage process. Sub-group analyses were conducted on studies presenting analyses of narratives with specific genders, ages, sexualities, ethnicities, and dual diagnosis. The review was prospectively registered (PROSPERO CRD42021235176). RESULTS 32 studies were included (29 qualitative, 3 mixed-methods, 1055 participants, age range 17-82years, 52.6% male, 46.4% female). Most were conducted in the United States (n = 15) and Europe (n = 11). No included studies analysed recovery narratives from lower income countries. Treatment settings included Alcoholic Anonymous (n = 12 studies), other formal treatment, and 'natural recovery'. Eight principle narrative dimensions were identified (genre, identity, recovery setting, drinking trajectory, drinking behaviours, stages, spirituality and religion, and recovery experience) each with types and subtypes. All dimensions were present in most subgroups. Shame was a prominent theme for female narrators, lack of sense of belonging and spirituality were prominent for LGBTQ+ narrators, and alienation and inequality were prominent for indigenous narrators. CONCLUSIONS Review provides characteristics of alcohol recovery narratives, with implications for both research and healthcare practice. It demonstrated knowledge gaps in relation to alcohol recovery narratives of people living in lower income countries, or those who recovered outside of mainstream services. PROTOCOL REGISTRATION Prospero registration number: CRD42020164185.
Collapse
|
9
|
Rennick-Egglestone S, Elliott R, Newby C, Robinson C, Slade M. Impact of receiving recorded mental health recovery narratives on quality of life in people experiencing non-psychosis mental health problems (NEON-O Trial): updated randomised controlled trial protocol. Trials 2022; 23:90. [PMID: 35093141 PMCID: PMC8800358 DOI: 10.1186/s13063-022-06027-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health recovery narratives are first-person lived experience accounts of recovery from mental health problems, which refer to events or actions over a period of time, and which include elements of adversity or struggle, and also self-defined or observable strengths, successes, or survival. Recorded recovery narratives are those presented in invariant form, including text, audio, or video. In a previous publication, we presented a protocol for three pragmatic trials of the Narrative Experiences Online (NEON) Intervention, a web application recommending recorded recovery narratives to participants. The aim of the definitive NEON Trial was to understand whether the NEON Intervention benefitted people with experience of psychosis. The aim of the smaller NEON-O and NEON-C trials was to evaluate the feasibility of conducting definitive trials of the NEON Intervention with people (1) experiencing non-psychosis mental health problems and (2) who informally care for others experiencing mental health problems. An open recruitment strategy with a 60-week recruitment period was developed. Recruitment for the NEON Trial and NEON-O Trial targeted mental health service users and people not using mental health services. The NEON Trial recruited to time and target. The NEON-O Trial achieved its target in 10 weeks. Analysis considered by a Programme Steering Committee after the target was achieved demonstrated a definitive result could be obtained if the trial was adapted for recruitment to continue. The UK Health Research Authority approved all needed amendments following ethical review. PURPOSE OF THIS ARTICLE To describe the decision-making process for amending the NEON-O Trial and to describe amendments made to the NEON-O Trial to enable a definitive result. The article describes amendments to the aims, objectives, design, power calculation, recruitment rate, process evaluation design, and informed consent documents. The extended NEON-O Trial adopts analysis principles previously specified for the NEON Trial. The article provides a model for other studies adapting feasibility trials into definitive trials. TRIAL REGISTRATION All trials prospectively registered. NEON Trial: ISRCTN11152837 . Registered on 13th August 2018. NEON-C Trial: ISRCTN76355273 . Registered on 9th January 2020. NEON-O Trial: ISRCTN63197153 . Registered on 9th January 2020. The NEON-O Trial ISRCTN was updated when amendments were approved. Amendment details: NOSA2, 30th October 2020.
Collapse
Affiliation(s)
- Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Rachel Elliott
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Chris Newby
- School of Medicine, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Clare Robinson
- Centre for Primary Care & Public Health, Pragmatic Clinical Trials Unit, Queen Mary University of London, 58 Turner St, London, E1 2AB UK
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| |
Collapse
|
10
|
Paterson L, Rennick-Egglestone S, Gavan SP, Slade M, Ng F, Llewellyn-Beardsley J, Bond C, Grundy A, Nicholson J, Quadri D, Bailey S, Elliott RA. Development and delivery cost of digital health technologies for mental health: Application to the Narrative Experiences Online Intervention. Front Psychiatry 2022; 13:1028156. [PMID: 36419974 PMCID: PMC9676659 DOI: 10.3389/fpsyt.2022.1028156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The increasing development and use of digital health interventions requires good quality costing information to inform development and commissioning choices about resource allocation decisions. The Narrative Experiences Online (NEON) Intervention is a web-application that delivers recorded mental health recovery narratives to its users. Two randomized controlled trials are testing the NEON Intervention in people with experience of psychosis (NEON) and people experiencing non-psychosis mental health problems (NEON-O). AIM This study describes and estimates the cost components and total cost of developing and delivering the NEON Intervention. MATERIALS AND METHODS Total costs for the NEON Trial (739 participants) and NEON-O Trial (1,024 participants) were estimated by: identifying resource use categories involved in intervention development and delivery; accurate measurement or estimation of resource use; and a valuation of resource use to generate overall costs, using relevant unit costs. Resource use categories were identified through consultation with literature, costing reporting standards and iterative consultation with health researchers involved in NEON Intervention development and delivery. Sensitivity analysis was used to test assumptions made. RESULTS The total cost of developing the NEON Intervention was £182,851. The largest cost components were software development (27%); Lived Experience Advisory Panel workshops (23%); coding the narratives (9%); and researchers' time to source narratives (9%). The total cost of NEON Intervention delivery during the NEON Trial was £118,663 (£349 per NEON Intervention user). In the NEON-O Trial, the total delivery cost of the NEON Intervention was £123,444 (£241 per NEON Intervention user). The largest cost components include updating the narrative collection (50%); advertising (19%); administration (14%); and software maintenance (11%). Uncertainty in the cost of administration had the largest effect on delivery cost estimates. CONCLUSION Our work shows that developing and delivering a digital health intervention requires expertise and time commitment from a range of personnel. Teams developing digital narrative interventions need to allocate substantial resources to curating narrative collections. IMPLICATIONS FOR PRACTICE This study identifies the development and delivery resource use categories of a digital health intervention to promote the consistent reporting of costs and informs future decision-making about the costs of delivering the NEON Intervention at scale. TRIAL REGISTRATION NEON Trial: ISRCTN11152837, registered 13 August 2018, http://www.isrctn.com/ISRCTN11152837. NEON-O Trial: ISRCTN63197153, registered 9 January 2020, http://www.isrctn.com/ISRCTN63197153.
Collapse
Affiliation(s)
- Luke Paterson
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Sean P Gavan
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.,Health and Community Participation Division, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Carmel Bond
- Nottingham University Business School, The University of Nottingham, Nottingham, United Kingdom
| | - Andrew Grundy
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Joe Nicholson
- School of Humanities, The University of Nottingham, Nottingham, United Kingdom
| | - Dania Quadri
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Sylvia Bailey
- Narrative Experiences Online Intervention (NEON) Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Rachel A Elliott
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
11
|
Slade M, Rennick-Egglestone S, Llewellyn-Beardsley J, Yeo C, Roe J, Bailey S, Smith RA, Booth S, Harrison J, Bhogal A, Penas Morán P, Hui A, Quadri D, Robinson C, Smuk M, Farkas M, Davidson L, van der Krieke L, Slade E, Bond C, Nicholson J, Grundy A, Charles A, Hare-Duke L, Pollock K, Ng F. Recorded Mental Health Recovery Narratives as a Resource for People Affected by Mental Health Problems: Development of the Narrative Experiences Online (NEON) Intervention. JMIR Form Res 2021; 5:e24417. [PMID: 34042595 PMCID: PMC8193481 DOI: 10.2196/24417] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The internet enables sharing of narratives about health concerns on a substantial scale, and some digital health narratives have been integrated into digital health interventions. Narratives describing recovery from health problems are a focus of research, including those presented in recorded (eg, invariant) form. No clinical trial has been conducted on a web-based intervention providing access to a collection of Recorded Recovery Narratives (RRNs). OBJECTIVE This study presents knowledge produced through the development of the Narrative Experiences Online (NEON) Intervention, a web-based intervention incorporating the algorithmic recommendation of RRNs. METHODS Knowledge was gathered through knowledge integration (KI) activities. KI1 synthesized previous studies to produce the NEON Impact Model describing how accessing RRNs produces health-related outcomes. KI2 developed curation principles for the NEON Collection of RRNs through consultation with the NEON Lived Experience Advisory Panel and the curation of a preliminary collection. KI3 identified harm minimization strategies for the NEON Intervention through consultation with the NEON International Advisory Board and Lived Experience Advisory Panel. The NEON Intervention was finalized through 2 research studies (RS). In RS1, mental health service users (N=40) rated the immediate impact of randomly presented narratives to validate narrative feedback questions used to inform the recommendation algorithm. In RS2, mental health service users (n=25) were interviewed about their immediate response to a prototype of the NEON Intervention and trial procedures and then were interviewed again after 1 month of use. The usability and acceptability of the prototype and trial procedures were evaluated and refinements were made. RESULTS KI1 produced the NEON Impact Model, which identifies moderators (recipient and context), mechanisms of connection (reflection, comparison, learning, and empathy), processes (identification of change from narrative structure or content and internalization of observed change), and outcomes (helpful and unhelpful). KI2 identified 22 curation principles, including a mission to build a large, heterogeneous collection to maximize opportunities for connection. KI3 identified seven harm minimization strategies, including content warnings, proactive and reactive blocking of narratives, and providing resources for the self-management of emotional distress. RS1 found variation in the impact of narratives on different participants, indicating that participant-level feedback on individual narratives is needed to inform a recommender system. The order of presentation did not predict narrative feedback. RS2 identified amendments to web-based trial procedures and the NEON Intervention. Participants accessed some narratives multiple times, use reduced over the 4-week period, and narrative feedback was provided for 31.8% (105/330) of narrative accesses. CONCLUSIONS RRNs can be integrated into web-based interventions. Evaluating the NEON Intervention in a clinical trial is feasible. The mixed methods design for developing the NEON Intervention can guide its extension to other clinical populations, the design of other web-based mental health interventions, and the development of narrative-based interventions in mental health.
Collapse
Affiliation(s)
- Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - James Roe
- National Institute for Health Research, ARC East Midlands, University of Nottingham, Nottingham, United Kingdom
| | - Sylvia Bailey
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
| | | | - Susie Booth
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Julian Harrison
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Adaresh Bhogal
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Patricia Penas Morán
- Department of Personality, Assessment and Psychological Treatment, University of Deusto, Bilbao, Spain
| | - Ada Hui
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Dania Quadri
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Clare Robinson
- Centre for Primary Care & Public Health, Pragmatic Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Melanie Smuk
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marianne Farkas
- College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Larry Davidson
- Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Lian van der Krieke
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, Netherlands
| | - Emily Slade
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Carmel Bond
- Nottingham University Business School, University of Nottingham, Nottingham, United Kingdom
| | - Joe Nicholson
- School of Humanities, University of Nottingham, Nottingham, United Kingdom
| | - Andrew Grundy
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Laurie Hare-Duke
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
12
|
Nakanishi M, Kurokawa G, Niimura J, Nishida A, Shepherd G, Yamasaki S. System-level barriers to personal recovery in mental health: qualitative analysis of co-productive narrative dialogues between users and professionals. BJPsych Open 2021; 7:e25. [PMID: 33407961 PMCID: PMC8058814 DOI: 10.1192/bjo.2020.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND No co-productive narrative synthesis of system-level facilitators and barriers to personal recovery in mental illness has been undertaken. AIMS To clarify system-level facilitators and barriers to personal recovery of people with mental illness. METHOD Qualitative study guided by thematic analysis. Data were collected through one focus group, which involved seven service users and three professionals. This group had 11 meetings, each lasting 2 h at a local research institute, between July 2016 to January 2018. RESULTS The analysis yielded three themes: barriers inhibiting positive interaction within personal relationship networks, roots of barriers from mental health systems and the social cultural context, and possible solutions to address the roots. Barriers were acknowledged as those related to sense of safety, locus of control within oneself and reunion with self. The roots of barriers were recognised within mental health services, including system without trauma sensitivity, lack of advocacy support and limited access to psychosocial approaches. Roots from social cultural context were also found. There were no narratives relating to facilitators. A possible solution was to address the roots from systems. Social cultural change was called for that makes personalised goals most valued, with an inclusive design that overcomes stigma, to achieve an open and accepting community. CONCLUSIONS The analysis yielded system-level barriers specific to each recovery process. Roots of barriers that need transformation to facilitate personal recovery were identified within mental health services. Social interventions should be further explored to translate the suggested social cultural changes into action.
Collapse
Affiliation(s)
- Miharu Nakanishi
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Japan
| | - George Kurokawa
- Peer Staff Department, Sudachikai Social Welfare Corporation, Japan
| | - Junko Niimura
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Japan
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Japan
| | - Geoff Shepherd
- Program Director, Implementing Recovery through Organisational Change (ImROC), UK
| | - Syudo Yamasaki
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Japan
| |
Collapse
|
13
|
Yeo C, Rennick-Egglestone S, Armstrong V, Borg M, Charles A, Duke LH, Llewellyn-Beardsley J, Ng F, Pollock K, Pomberth S, Walcott R, Slade M. The Influence of Curator Goals on Collections of Lived Experience Narratives: A Qualitative Study. JOURNAL OF RECOVERY IN MENTAL HEALTH 2021; 4:16-28. [PMID: 34988285 PMCID: PMC7612150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to investigate how curator goals influence the design of curation processes for collections of mental health lived experience narratives. The objectives were (1) to characterize the goals of a range of curators of existing collections, and (2) to identify specific working practices impacted by these goals. RESEARCH DESIGN AND METHODS Thirty semi-structured interviews were conducted with a purposive sample of curators of collections of lived experience narratives. Thematic analysis was conducted. Goals and impacts on working practice were tabulated, and narrative summaries were constructed to describe the relation between the two. RESULTS Curators interviewed were from seven countries (Brazil, Canada, Hong Kong, India, Italy, UK, USA), and 60% had lived experience of mental health service usage. Participants discussed eight goals that inspired their work: fighting stigma, campaigning for change in service provision, educating about mental health and recovery, supporting others in their recovery journey, critiquing psychiatry, influencing policy, marketing health services, and reframing mental illness. These goals influenced how decisions were made about inclusion of narratives, editing of narrative content, withdrawal rights, and anonymization. CONCLUSIONS Our work will support the development of curatorship as a professional practice by shaping training for curators, helping curators reflect on the outcomes they would like to achieve, and helping individuals planning a collection to reflect on their motivations. We argue that transparency is an essential orientation for curators. Transparency allows narrators to make an informed choice about donating a narrative. It allows policy makers to understand the influences on a collection and hence treat it as a source of collective evidence.
Collapse
|
14
|
Roe J, Brown S, Yeo C, Rennick-Egglestone S, Repper J, Ng F, Llewelyn-Beardsley J, Hui A, Cuijpers P, Thornicroft G, Manley D, Pollock K, Slade M. Opportunities, Enablers, and Barriers to the Use of Recorded Recovery Narratives in Clinical Settings. Front Psychiatry 2020; 11:589731. [PMID: 33192738 PMCID: PMC7661955 DOI: 10.3389/fpsyt.2020.589731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Recorded Recovery Narratives (RRNs) describing first-person lived experience accounts of recovery from mental health problems are becoming more available. Little is known about how RRNs can be used in clinical practice and clinical education. Aims: The aim of this paper is to enable implementation planning for RRN interventions by identifying determinants of uptake. The objective was to identify opportunities, barriers, and enablers to the uptake of RRN interventions in clinical practice and education. Method: Three phases of focus groups were conducted with multi-professional mental health clinicians. Phase 1 (4 groups, n = 25) investigated current and possible uses of RRNs, Phase 2 (2 groups, n = 15) investigated a specific intervention delivering recovery narratives. Phase 3 (2 groups, n = 12) investigated clinical education uses. Thematic analysis was conducted. Results: RRNs can reinforce the effectiveness of existing clinical practices, by reducing communication barriers and normalizing mental health problems. They can also extend clinical practice (increase hope and connection, help when stuck). Clinical considerations are the relationship with care pathways, choice of staff and stage of recovery. In educational use there were opportunities to access lived experience perspectives, train non-clinical staff and facilitate attitudinal change. Barriers and enablers related to design (ability to use online resources, accessibility of language, ability to individualize choice of narrative), risk (triggering content, staff skills to respond to negative effects), trust in online resource (evidence base, maintenance), and technology (cost of use, technology requirements). Conclusions: RRNs can both improve and extend existing clinical practice and be an important educational resource. RRNs can improve engagement and hope, and address internalized stigma. Beneficially incorporating RRNs into clinical practice and education may require new staff skills and improved technological resources in healthcare settings. Future work could focus on the use of peer support workers views on RRN use and how to avoid unnecessary and unhelpful distress. Trial Registration Number: Work in this paper has informed three clinical trials: ISRCTN11152837; ISRCTN63197153; ISRCTN76355273.
Collapse
Affiliation(s)
- James Roe
- National Institute for Health Research, Applied Research Collaboration (ARC) East Midlands, University of Nottingham, Nottingham, United Kingdom
| | - Susan Brown
- Mindtech MedTech Cooperative, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Julie Repper
- Implementing Recovery Through Organisational Change (ImROC), Nottingham, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewelyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ada Hui
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - David Manley
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
15
|
Yeo C, Hare-Duke L, Rennick-Egglestone S, Bradstreet S, Callard F, Hui A, Llewellyn-Beardsley J, Longden E, McDonough T, McGranahan R, Ng F, Pollock K, Roe J, Slade M. The VOICES Typology of Curatorial Decisions in Narrative Collections of the Lived Experiences of Mental Health Service Use, Recovery, or Madness: Qualitative Study. JMIR Ment Health 2020; 7:e16290. [PMID: 32945771 PMCID: PMC7532459 DOI: 10.2196/16290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Collections of lived experience narratives are increasingly used in health research and medical practice. However, there is limited research with respect to the decision-making processes involved in curating narrative collections and the work that curators do as they build and publish collections. OBJECTIVE This study aims to develop a typology of curatorial decisions involved in curating narrative collections presenting lived experiences of mental health service use, recovery, or madness and to document approaches selected by curators in relation to identified curatorial decisions. METHODS A preliminary typology was developed by synthesizing the results of a systematic review with insights gained through an iterative consultation with an experienced curator of multiple recovery narrative collections. The preliminary typology informed the topic guide for semistructured interviews with a maximum variation sample of 30 curators from 7 different countries. All participants had the experience of curating narrative collections of the lived experiences of mental health service use, recovery, or madness. A multidisciplinary team conducted thematic analysis through constant comparison. RESULTS The final typology identified 6 themes, collectively referred to as VOICES, which stands for values and motivations, organization, inclusion and exclusion, control and collaboration, ethics and legal, and safety and well-being. A total of 26 subthemes related to curation decisions were identified. CONCLUSIONS The VOICES typology identifies the key decisions to consider when curating narrative collections about the lived experiences of mental health service use, recovery, or madness. It might be used as a theoretical basis for a good practice resource to support curators in their efforts to balance the challenges and sometimes conflicting imperatives involved in collecting, organizing, and sharing narratives. Future research might seek to document the use of such a tool by curators and hence examine how best to use VOICES to support decision making.
Collapse
Affiliation(s)
- Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Laurie Hare-Duke
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Felicity Callard
- School of Geographical & Earth Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ada Hui
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Eleanor Longden
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Tracy McDonough
- Department of Psychology, Mount St. Joseph University, Cincinnati, OH, United States
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - James Roe
- National Institute for Health Research, ARC East Midlands, University of Nottingham, Nottingham, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
16
|
Rennick-Egglestone S, Elliott R, Smuk M, Robinson C, Bailey S, Smith R, Keppens J, Hussain H, Pollock K, Cuijpers P, Llewellyn-Beardsley J, Ng F, Yeo C, Roe J, Hui A, van der Krieke L, Walcott R, Slade M. Impact of receiving recorded mental health recovery narratives on quality of life in people experiencing psychosis, people experiencing other mental health problems and for informal carers: Narrative Experiences Online (NEON) study protocol for three randomised controlled trials. Trials 2020; 21:661. [PMID: 32690105 PMCID: PMC7370499 DOI: 10.1186/s13063-020-04428-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/17/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Mental health recovery narratives have been defined as first-person lived experience accounts of recovery from mental health problems which refer to events or actions over a period of time and which include elements of adversity or struggle, and also self-defined strengths, successes or survival. They are readily available in invariant recorded form, including text, audio or video. Previous studies have provided evidence that receiving recorded recovery narratives can provide benefits to recipients. This protocol describes three pragmatic trials that will be conducted by the Narrative Experiences Online (NEON) study using the NEON Intervention, a web application that delivers recorded recovery narratives to its users. The aim of the NEON Trial is to understand whether receiving online recorded recovery narratives through the NEON Intervention benefits people with experience of psychosis. The aim of the NEON-O and NEON-C trials is to evaluate the feasibility of conducting a definitive trial on the use of the NEON Intervention with people experiencing non-psychosis mental health problems and those who care for others experiencing mental health problems respectively. METHODS The NEON Trial will recruit 683 participants with experience of psychosis. The NEON-O Trial will recruit at least 100 participants with experience of non-psychosis mental health problems. The NEON-C Trial will recruit at least 100 participants with experience of caring for others who have experienced mental health problems. In all three trials, participants will be randomly allocated into one of two arms. Intervention arm participants will receive treatment as usual plus immediate access to the NEON Intervention for 1 year. Control arm participants will receive treatment as usual plus access to the NEON Intervention after 1 year. All participants will complete demographics and outcome measures at baseline, 1 week, 12 weeks and 52 weeks. For the NEON Trial, the primary outcome measure is the Manchester Short Assessment of Quality of Life at 52 weeks, and secondary outcome measures are the CORE-10, Herth Hope Index, Mental Health Confidence Scale and Meaning in Life Questionnaire. A cost-effectiveness analysis will be conducted using data collected through the EQ-5D-5 L and the Client Service Receipt Inventory. DISCUSSION NEON Trial analyses will establish both effectiveness and cost-effectiveness of the NEON Intervention for people with experience of psychosis, and hence inform future clinical recommendations for this population. TRIAL REGISTRATION All trials were prospectively registered with ISRCTN. NEON Trial: ISRCTN11152837 . Registered on 13 August 2018. NEON-C Trial: ISRCTN76355273 . Registered on 9 January 2020. NEON-O Trial: ISRCTN63197153 . Registered on 9 January 2020.
Collapse
Affiliation(s)
- Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.
| | - Rachel Elliott
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Melanie Smuk
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Clare Robinson
- Centre for Primary Care & Public Health, Pragmatic Clinical Trials Unit, Queen Mary University of London, 58 Turner St, London, E1 2AB, UK
| | - Sylvia Bailey
- NEON Lived Experience Advisory Panel, Nottingham, UK
| | - Roger Smith
- NEON Lived Experience Advisory Panel, Nottingham, UK
| | - Jeroen Keppens
- Department of Informatics, King's College London, Bush House, 30 Aldwych, London, WC2B 4BG, UK
| | - Hannah Hussain
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Kristian Pollock
- School of Health Sciences, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - James Roe
- National Institute for Health Research, ARC East Midlands, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Ada Hui
- School of Health Sciences, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Lian van der Krieke
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
| | - Rianna Walcott
- Department of Digital Humanities, King's College London, Strand, London, WC2R 2LS, UK
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| |
Collapse
|
17
|
Rennick-Egglestone S, Ramsay A, McGranahan R, Llewellyn-Beardsley J, Hui A, Pollock K, Repper J, Yeo C, Ng F, Roe J, Gillard S, Thornicroft G, Booth S, Slade M. The impact of mental health recovery narratives on recipients experiencing mental health problems: Qualitative analysis and change model. PLoS One 2019; 14:e0226201. [PMID: 31834902 PMCID: PMC6910821 DOI: 10.1371/journal.pone.0226201] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/21/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mental health recovery narratives are stories of recovery from mental health problems. Narratives may impact in helpful and harmful ways on those who receive them. The objective of this paper is to develop a change model identifying the range of possible impacts and how they occur. METHOD Semi-structured interviews were conducted with adults with experience of mental health problems and recovery (n = 77). Participants were asked to share a mental health recovery narrative and to describe the impact of other people's recovery narratives on their own recovery. A change model was generated through iterative thematic analysis of transcripts. RESULTS Change is initiated when a recipient develops a connection to a narrator or to the events descripted in their narrative. Change is mediated by the recipient recognising experiences shared with the narrator, noticing the achievements or difficulties of the narrator, learning how recovery happens, or experiencing emotional release. Helpful outcomes of receiving recovery narratives are connectedness, validation, hope, empowerment, appreciation, reference shift and stigma reduction. Harmful outcomes are a sense of inadequacy, disconnection, pessimism and burden. Impact is positively moderated by the perceived authenticity of the narrative, and can be reduced if the recipient is experiencing a crisis. CONCLUSIONS Interventions that incorporate the use of recovery narratives, such as peer support, anti-stigma campaigns and bibliotherapy, can use the change model to maximise benefit and minimise harms from narratives. Interventions should incorporate a diverse range of narratives available through different mediums to enable a range of recipients to connect with and benefit from this material. Service providers using recovery narratives should preserve authenticity so as to maximise impact, for example by avoiding excessive editing.
Collapse
Affiliation(s)
- Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Amy Ramsay
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ada Hui
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Julie Repper
- Implementing Recovery for Organisational Change (ImROC), Nottingham, United Kingdom
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - James Roe
- National Institute for Health Research CLAHRC East Midlands, Institute of Mental Health, University of Nottingham, United Kingdom
| | - Steve Gillard
- Population Health Research Institute, St. George's University of London, London, United Kingdom
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Susie Booth
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|