Research into Recovery and Wellbeing

A website about the work of the recovery research team at the Institute of Mental Health

The University of Nottingham

April 2020


Recovery Research Network eBULLETIN


April 2020


RRN Meetings

The 23rd meeting of the Recovery Research Network (RRN) was due to be hosted by Camden and Islington NHS Foundation Trust.  Due to the current developments with regard to Covid-19, this event has been cancelled.


The coronavirus pandemic is having unprecedented effects both nationally and internationally.  During this time of social distancing and self-isolation, remaining connected to our networks is important.  Please can we encourage our readership to continue to submit material to e-bulletin using the detail below.  As ever, comments are welcome from the readership about articles included in the ebulletins.


Thank-you. Please stay safe, and our best wishes to you all.


Please submit material to either Shula Ramon or Tony Sparkes. Their contact details are:





Coronavirus and Mental Health

The impact of coronavirus and government measures to restrict its transmission means that we have to pay particular attention to our mental health and wellbeing.  Some advice about this is available herehere and here.  Information from the World Health Organisation is available here.


RRN Membership Profile

Anyone who has an interest in recovery research can join the RRN, just fill in the online form available at:


Please note that if you join the Network, the details you supply will be circulated to other members of the Network as part of the monthly e-bulletin, but will not be put on our website and will not be shared with any other organisation. If you would like to leave the RRN and have your details removed from our database, please email



A Call to PhD Students and their Supervisors

Please could we remind the readership that PhD students (and their supervisors) are particularly welcome to join the RRN.  The forum provides a unique opportunity to network and build research capacity. The network also provides a collegial environment to present doctoral work.


Recovery Research: We would like to learn from your experience of conducting recovery research.  Therefore, would readers kindly get in touch with the Network to let us know about the things that have helped and the things that have hindered during your experience of undertaking recovery research. Please send your comments to either Tony or Shula.


Conferences and Events 

In an attempt to restrict the spread of coronavirus, limitations upon the free movement of people are evident in many countries throughout the world.  As you will no doubt be aware, such measures have impacted upon national and international travel and hospitality.


Whilst it is almost certain that traditional face-face conferencing/events will not be taking place in their ‘traditional’ format, please check with the organisers.  It may be that alternative or innovative platforms are being utilised to deliver such events going forward.  


Papers and Publications 

In addition to peer-reviewed literature and work of a purely academic nature, the ebulletin also welcomes the submission of material that would include grey literatures (such as briefing papers, reports and so on) that attest to the broader impact of personal recovery.


i)  Gerino, E., Rollè, L., Sechi, C. and Brustia, P. (2017) Loneliness, resilience, mental health, and quality of life in old age: A structural equation model.  Frontiers in Psychology.  Nov 2017 Vol8  Article 2003.  Online:



Objectives: In the scientific literature on aging, a recent core issue has been the role of individuals’ internal and external resources, which are considered intrinsically connected, in contributing synergistically to physical and psychological quality of life (QoL). The current study investigates the way in which psychological factors—such as, loneliness, resilience, and mental states, in terms of depression and anxiety symptoms—affect the perceived QoL among elderly individuals.

Method: Data from 290 elderly Italian participants were used to study the mediation effects of both mental health and resilience to elucidate the relationship between loneliness and psychophysical QoL.

Results: The best model we obtained supports the mediation effect of both resilience and mental health between loneliness and mental and physical QoL. These results highlight that loneliness influences mental and physical QoL via two pathways, with the impact of loneliness mediated by mental health and resilience dimensions.

Conclusions: The findings suggest the importance of the support that elderly people receive from social relationships. In terms of clinical interventions, the reduction of loneliness could be an important factor in primary prevention or the recovery process. A way to reduce levels of mental distress could be represented by the increasing of resilience and self-efficacy and reduction of loneliness dissatisfaction. A high degree of resiliency contributes to increasing perceived life quality at the physical and psychological levels, and at the same time, reducing anxiety and depressive symptoms.


ii)  Waddingham, R. (2020) COVID-19: How can we support each other (and ourselves)?“  Psychosis.  Online:



The Chair of The National Hearing Voices Network (

prepared this document, on behalf of the HVN Board, to provide some sources of information and support for its members, and others, during the Covid-19 pandemic. At the request of the journal Editor (also a member of the HVN Board), the document is published here, verbatim, for Psychosis readers around the world. Although targeted at people in the UK who hear voices or see visions, much of the information is potentially also relevant for other people, including mental health professionals. Like HVN, neither the journal nor ISPS endorse or recommend specific mental health services or practitioners. We recognise that different things are helpful for different people. The document is published merely to increase the range of options for people to choose from if they feel the need for additional support or information. All at HVN, Psychosis and ISPS wish readers a safe passage though the current stormy waters, which, despite all the fears and losses, are providing us all with opportunities to take care of one another like many of us have never experienced before.


iii)  Hardy, K. V., Dickens, C. E., Roach, E. L., Harrison, V., Desai, A., Flynn, L, Noordsy, D. L., Dauberman, J. and Adelsheim, S. (2020) Lived experience perspectives on reducing the duration of untreated psychosis: the impact of stigma on accessing treatment.  Psychosis.  Online:



Introduction: Prolonged duration of untreated psychosis (DUP) has long-term deleterious effects on outcomes. Research has focused on identifying factors contributing to prolonged DUP and initiatives to reduce the time it takes individuals to access treatment. Stigma may contribute to extended DUP, but there has been little exploration of the experience of stigma and its impact on accessing care. 

Objectives: The aim of this study was to explore the impact of stigma on decisions to seek care from the perspective of individuals with lived experience of psychosis and their caregivers. 

Methods: A survey, developed by a group consisting of individuals with lived experience of psychosis, and distributed online, was designed to elicit quantitative and qualitative data relating to the experience of accessing care at the onset of psychosis. Qualitative data were analysed using Thematic Analysis.

Results: 193 respondents completed the survey. Qualitative analysis yielded themes including “perception of stigma” and “outcomes associated with stigma”.

Conclusions: There is a need to address stigma at the outset of treatment, and wider dissemination of information about psychosis is necessary. Future research should address cultural differences in individuals’ experiences of psychosis, as well as the role siblings play in the care of affected individuals.


iv)  Holmes, E. A., O’Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., Ballard, C., Christensen, H., Cohen Silver, R., Everall, I., Ford, T., John, A., Kabir, T., King, K., Madan, I., Michie, S., Przybylski, A. K., Shafran, R., Sweeney, A., Worthman, C. M., Yardley, L., Cowan, K., Cope, C., Hotopf, M. and Bullmore, E. (2020) Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry.  Online:



The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK’s world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.


v)  Hornstein, G. A., Robinson Putnam, E. and Branitsky, A.  (2020): How do hearing voices peer-support groups work? A three-phase model of transformation. Psychosis.  Online:



Despite decades of research and the development of many psychiatric medications, widespread suffering remains among people who hear voices. Hearing voices groups (HVGs) encourage an in-depth exploration of the meaning of voices and use peer support to develop coping strategies. Although HVGs continue to spread around the world, their effectiveness remains unknown and only a few studies have examined members’ experiences. To understand the mechanisms by which these groups operate, we recruited a diverse sample of 113 participants from across the US, who completed detailed qualitative questionnaires describing their voice-hearing histories, experiences in HVGs and changes in their lives outside the group. A subset also participated in follow-up interviews. A collaborative team of researchers and voice hearers used phenomenological, grounded theory and thematic analyses to identify a distinctive set of elements that make HVGs unique: in their style of interaction (non-judgmental, curious, reciprocal and unstructured dialogue among people regarded as equals, in a shared community); and in the content of meetings (welcoming multiple perspectives and exploring coping strategies in non-prescriptive ways, with a focus on expertise by experience). We propose a three-phase model to explain how these elements interact within HVGs to enable significant transformation to occur.


vi)  Empson, L. A. and Conus, P. (2020) Video ethnography: introducing a new tool from research to psychiatric practice?  Psychosis.  Online:



Ongoing progress in psychiatric research calls for interdisciplinary approaches and use of novel methodologies. After discussing theoretical advantages of the use of video ethnography in psychiatric research in the context of urbanicity/psychosis studies, the present article explores the representations of first line practitioners regarding its use in psychiatric research and, by extrapolation, in general practice based on qualitative analysis of case-managers feedbacks. Video ethnography was found sufficiently acceptable and tolerable tool within our research cohort. Both patients and case managers were positive about assets provided by this approach. Nevertheless, more research is warranted to supplement reported results and conceptualize further implementation of video ethnography as a research tool. Further developments in this area may profit to psychiatric care beneficiaries by enabling a user inclusive approach and enriching therapists' appreciation of the impact of psychotic symptoms on patient's daily life. While the use of video ethnography in psychiatric research and practice with patients suffering from psychosis remains scarce, ever changing attitudes of the society towards self-exposure and availability of non-professional video recording material may further shape both research and clinical practice.


vii)  Bowen, A. L., Maguire, T. and Newman-Taylor, K. (2020) Do recovery outcome measures improve clinical practice? A linguistic analysis of the impact of the Hope, Agency and Opportunity measure in community mental health teams. Perspectives in Public Health. 140(2)  102-107



Aims:  Recovery approaches are identified as the overarching framework for improving mental health services for people with severe and enduring conditions. These approaches prioritise living well with long-term conditions, as evidenced by personal recovery outcomes. There is little research demonstrating how to support busy mental health teams, work in this way. This study assessed the impact of introducing a brief measure of recovery, the Hope, Agency and Opportunity (HAO), on the attitudes and behaviours of staff working in community mental health teams, to test whether routine use of such measures facilitates recovery-based practice.

Methods:  Linguistic analysis assumes that language is indicative of wider attitudes and behaviours. Anonymised clinical notes recorded by community mental health team clinicians were analysed for recovery and non-recovery language, over 30 months. This covered periods before, during and after the introduction of the recovery measure. We used a single-case design (N = 1 community mental health team) and hypothesised that clinicians would use recovery-focused language more frequently, and non-recovery-focused language less frequently, following the introduction of the measure, and that these changes would be maintained at 18-month follow-up.

Results:  Visual inspection of the data indicated that recovery-focused language increased following the introduction of the HAO, though this was not maintained at follow-up. This pattern was not supported by statistical analyses. No clear pattern of change was found for non-recovery-focused language.

Conclusions:  The introduction of a brief measure of recovery may have influenced staff attitudes and behaviours temporarily. Any longer-term impact is likely to depend on ongoing commitment to the use of the measure, without which staff language, attitudes and behaviours return to previous levels.


viii)   NSPCC (2020) What children are saying to Childline about coronavirus.  NSPCC.  Online:


From the author’s webpage:

Our briefing provides an overview of the main concerns that children and young people have been talking to Childline counsellors about during the coronavirus pandemic (COVID-19). Gaining an insight into these worries can help adults think about what support needs to be put in place for young people at this time.  Between 21 January 2020 and 8 April 2020, Childline delivered 2,209 counselling sessions to children and young people who expressed concerns about coronavirus. Issues discussed included: mental health, family relationships, schoolwork and bullying


ix)  The following three items are blogs.  The first is written by Andy Bell, Deputy Chief Executive at the Centre for Mental Health (available here).   Andy starts by reminding us that both mental health problems and Covid-19 do not discriminate; at least rhetorically.  Whilst there may be some grain of truth in such statements, a much deeper analysis (re)confirms that social and structural inequalities serve to construct a different reality for many.  A reality that is discriminatory, affecting disproportionally more people, families and communities who are already disadvantaged, on many levels.  Moreover, Andy points to the distinct possibility of even further disadvantage and injustice as Covid-19 joins the plethora of factors that contribute to the intersectionalities between Covid-19 and poor mental health.  Whilst we are in this together he adds, the inequalities that divide us are as great as ever.


x)  The second blog is written by Barney Cullum (available here).  Writing out of Mental Health Today, Barney draws attention to the injustices that are experienced by some people who find themselves detained within medium-secure mental health hospitals in England and Wales.  His blog draws upon the experience of ‘Adam’, an interviewee, who talks about his much longer incarceration in a secure unit for pleading ‘not guilty’, than a much shorter prison sentence had he pleaded ‘guilty’.  The concept of diagnostic overshadowing is introduced, which concerns the lasting impact of a person’s diagnosis rather than what they actually did.  Barney’s blog captures a very real sense of the multi-layered ambivalence that runs in parallel to the indeterminate nature of Adam’s experience.


xi)  Writing out of the National Survivor User Network (NSUN), the third blog, authored by Diana Rose, considers the paradox that is inherent in the government’s strategy to ‘Shield’ those people it considers to be (more) vulnerable.  Grounded in, although not exclusive to, personal experience Diana grapples with the contradiction that on the one hand she is receiving special attention due to the vulnerabilities brought about by her ‘underlying health conditions’, whilst on the other hand, those same health conditions are not receiving any attention due to the impositions brought about by Covid-19.  An insightful and informative read, available here.


Other News / Resources

i)  MHPRU survey: Impact of COVID-19 on mental health services and mental health service users#COVIDMentalHealth


Out of University College London, Prof. Alan Simpson draws attention to an important survey targeting people who work in mental health care in the UK in any sector or any speciality.  The survey is intended to:


… help us better understand how the COVID-19 pandemic is impacting on mental health services and the people who use these services, and what is being done to manage these impacts, both in the NHS and the voluntary sector. We appreciate this is a very busy period for you but believe this survey can quickly inform the national response to the pandemic.


It is being carried out by the NIHR Mental Health Policy Research Unit (MHPRU) for England, whose core team is based at University College London and Kings’ College London. We are independent university-based researchers, including many researchers with lived experience, who will be feeding back results from the study rapidly to policy makers, including the Department of Health and Social Care and NHS England, to study participants and to the wider public. The survey is intended for people who work in mental health care in the UK in any sector or any speciality.


We are also keen to interview people about interesting developments and innovations – please see this section on the survey if you would like to be interviewed.


The survey should take around 20 minutes to complete and the responses you provide are confidential. Full details about the survey can be found here:


Finally, we would like to take this opportunity to thank you for all your hard work in continuing to provide mental health care during these very challenging times.


Please click on the link below to take part in the survey. Please forward this email to colleagues that may be interested. Or see us on Twitter: @MentalHealthPRU #COVIDMentalHealth


ii)  The British Association of Social Workers (BASW)  

As with several other professional associations connected to mental health work, BASW include updates and guidance concerning Covid-19 on their website.  Please see here


In addition to the above, BASW have also issued information and support for Approved Mental Health Professionals, AMHP leads and Principal Social Workers on the role of Approved Mental Health Professionals during the Covid-19 Pandemic.  This is an important resource and can be found here


iii)  MadCovid

On its ‘about’ page MadCovid states that:

MadCovid is a shared space for survivor / service user led projects and initiatives that started during the COVID-19 pandemic.


Please explore the above site to find a wealth of testimony and resources that intersect survivor / service user experience during the Covid-19 pandemic.



iv)  Centre for Mental Health

In its April 2020 update, the Centre for Mental Health (CMH) set out a range of useful links and information to support mental health equality through the Covid-19 pandemic. Please see the following link


CMH organise their work in this area across three domains, (1) supporting people and services, (2) a platform for lived experience and (3) research and analysis.  For more information, please see: Supporting mental health equality through the pandemic


v)  The Social Care Institute for Excellence (SCIE)

On their website, SCIE host a range of material that is relevant to social care provision at a time of Covid-19.  Please see the following link


vi)  Shula Ramon and Tony Sparkes co-produce the RRN monthly ebulletin. Please email if there is anything you would like included in the next issue, as we are keen to receive and advertise more news, articles and website references. Information can be posted to either Shula or Tony at the following: