Family Recovery Interventions with Families of Mental Health Service Users: A Systematic Review of the Literature

Examining the existing knowledge base for enablers of family recovery in mental health: a protocol for a scoping review of national and international literature

INTRODUCTION

Recovery-oriented services in mental health are becoming an accepted approach across much of the globe. While the development of recovery-oriented approaches has focused mainly on people accessing mental health services, families of those accessing services also need to be included under the discussions of mental health recovery within mental health service provision. It is important that service providers understand what support families require in order to facilitate their recovery journeys. To that end, this review will seek to ascertain what evidence exists on the enablers of family recovery from national and international literature.

METHOD AND ANALYSIS

This proposed scoping review aims to investigate the family recovery enablers within a mental health context. A Preferred Reporting Items for Systematic Reviews and Meta-Analysis compliant scoping review is proposed, based on Arksey and O'Malley's framework. Search terms are stated and a variety of databases (CINAHL, JSTOR, Ovid SP, PsycINFO, PubMed, RCNi, Science Direct, Web of Science and Wiley Online Library) and repositories (Google, Google Scholar and ResearchGate) will be consulted to examine papers based on a predetermined inclusion/exclusion criteria. The search range is from 1 January 2012 to 31 December 2022.

ETHICS AND DISSEMINATION

As this paper presents a protocol for a scoping review of the literature into family enablers in mental health, no ethical approval is required. The preprint protocol was added to OSF Registries on 29 October 2021 where it is freely available. The registry will be updated once this paper has been published. The resulting scoping review will be distributed through peer-reviewed publication in a high impact journal.

Interaction between the Participation in and the Impact on Mental Health Service Users and Their Relatives of a Multicomponent Empowerment-Based Psychosocial Intervention

Relatives play an important role in the recovery journey of mental health service users. Interventions directed either at service users or their relatives may influence the other person as well. The project 'Activa't per la salut mental' (Get active for mental health) consisted of a series of four interventions addressed at people diagnosed with mental disorders and their relatives to help them in their recovery process, increasing their agency and quality of life. The main objective of the present study is to evaluate the interaction of the participation of service users on their relatives' outcomes and vice versa. The impact of the project was evaluated within a randomised controlled trial. The treatment group had access to all the circuit interventions, while the control group received treatment as usual and could only access one of the interventions. All participants were evaluated at baseline, six months, and twelve months after the end of the first intervention. Service users were evaluated with the Stages of Recovery Instrument, and relatives with the Family Burden Interview Schedule II and the Duke-UNC-11 questionnaires. The interaction of participation and impact between service users and their relatives was analysed by means of correlational analyses within the intervention group (n = 111, service users mean age = 40.6, 40% women; relatives mean age = 56.7, 72% women). Service users' baseline characteristics (being in a relationship, educational level, employment, and younger age) influenced in the level of participation of relatives and vice versa (lower educational level). The results also indicated correlations between participation and outcomes at various points as well as the evolution of service users' recovery and the care burden of relatives. Service users' participation levels interacted with the decrease of relatives' frequency of burden and the first steps of their own recovery journey (moratorium, awareness, and preparation) while relative's participation just interacted with the evolution of two stages of service users' recovery levels (preparation and growth). These results can be extremely helpful in fostering interactive benefits in future projects addressing the wellbeing of mental health service users and their relatives. Future studies could use specific designs to explore the directionality of the causality of these effects.

Self-Report Measures Assessing Aspects of Personal Recovery in Relatives and Other Informal Carers of Those With Psychosis: A Systematic Review

Background

Providing long-term care for a family member with psychosis can cause significant distress for informal carers due to the trauma of seeing their loved one in crisis, dealing with the difficult symptoms of psychosis and the burden of providing care. An important aspect of carers' adjustment can be construed as their personal recovery in relation to having a relative affected by psychosis. Self-report measures are increasingly used to assess personal recovery in service users, but less is known about the utility of such tools for carers.

Aims

This review aimed to identify all self-report measures assessing aspects of carers' personal recovery, and to quality appraise them.

Methods

Academic Search Ultimate, CINAHL, MEDLINE, PsychINFO and PubMed were searched for articles that reported the development of self-report measures created for carers of those with psychosis. Studies were appraised using the Consensus-based Standards for the Selection of health status Measurement INstruments (COSMIN) checklist. A Levels of Evidence synthesis provided overall quality scores for each measure.

Results

The search identified 3,154 articles for initial screening. From a total of 322 full text articles, 95 self-report measures were identified with a final 10 measures included for the quality assessment showing varying levels of psychometric rigor.

Conclusions

The results show that no single self-report measure is currently available for use to comprehensively assess personal recovery for carers, highlighting the need for further research in this area and the development of a new measure.

The Evidence Base for Wellness Recovery Action Planning (WRAP): A Protocol for a Systematic Literature Review and Meta-Analysis

Wellness Recovery Action Planning (WRAP) is a structured recovery education program used internationally for anyone who wishes to create a positive change in their life. It was developed by Mary Ellen Copeland and Jane Winterling in the late 90s, resulting from a search of programs or initiatives that could support their wellness. Since then, many studies have been conducted into the efficacy of the program for those with a mental health/addiction challenge. However, to date, there has been little to no synthesis of the evidence base for WRAP outside of the Copeland Center’s internal reviews. The proposed systematic review and meta-analysis aims to investigate the evidence base for Wellness Recovery Action Planning within a mental health context. To do this, a PRISMA 2020 compliant review is proposed using the PRISMA-P statement as a guide to demonstrate the methodology to be undertaken. It outlines the inclusion/exclusion criteria, search terms, and databases while informing the readership of timescales to complete such actions. Finally, this protocol also addresses issues of bias and quality within included studies. This proposed literature review and meta-analysis will synthesize and examine the evidence base for WRAP using a systematic review methodology. It is hoped that this proposed review will identify gaps in the current literature regarding the program, and provide recommendations that will support the reviewers in their further studies while also strengthening the argument for a whole system evaluation of WRAP within an Irish context.

Co-Production within Child and Adolescent Mental Health: A Systematic Review

Background: Mental health services are currently experiencing much systemic and organisational change. Many countries have adopted a recovery approach to service provision through the development of national policies and frameworks. Within an Irish context, co-production has been identified as one of the four pillars required for services to become recovery orientated. However, there is a paucity of literature relating to the concept within child and adolescent mental health services. This paper aims to synthesise the peer-reviewed evidence on co-production within such services. Methods: A PRISMA compliant systematic review was undertaken. This includes how the reviewer retrieved, shortlisted, and selected studies for inclusion in the review. It outlines the inclusion/exclusion criteria and how these were further developed through the PICO framework. Finally, the methods also outline how the reviewer assessed bias and quality, as well as the process of data synthesis. Results: Two studies were included in this review, both focusing on co-production, but in different contexts within child and adolescent mental health. Two themes were identified: ‘road less travelled’ and ‘co-producing equality’. These themes and the associated sub-themes describe how co-production works in these services. Discussion: These results highlight the paucity of quality literature in co-production within child and adolescent mental health. Both studies scored poorly in terms of quality. Resulting from this review, a number of actions relating to the therapeutic environment need to be taken into account for co-production to be further implemented. Other: The reviewer has not received any funding for this paper. A protocol was not created or registered for this review.