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Recovery Research Network (RRN)

2022 RRN Emails

January 2022

Recovery Research Network eBULLETIN

January 2022

RRN Meetings
Due to the ongoing developments with regards to Covid-19 both nationally and internationally, RRN in-person meetings continue to be suspended at the present time. However, the current suspension arrangements are under constant review by the RRN Collective and it is possible that a webinar-style meeting may provide an interim measure to coalesce our membership prior to the resumption of face-face networking when it becomes safe to do so. More information about this possibility will be circulated in due course.

The national and international responses to Covid-19 are under constant review, and particularly so following the identification of a variant of concern named Omicron by the World Health Organisation in late November. We would encourage our readers to keep safe and follow relevant guidance as appropriate.

Please can we urge our readership to continue to submit material to the e-bulletin using the detail below. As ever, comments are welcome from the readership about articles included in the e-bulletins.

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:

Shula:     s.ramon@herts.ac.uk
Tony:      a.sparkes@bradford.ac.uk

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. There is a considerable amount of advice and information available online. We continue to include examples at the end of the e-bulletin.

RRN Membership Profile
Anyone who has an interest in recovery research can join the RRN, just fill in the online form available at:
https://www.researchintorecovery.com/events/rrn/join/

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, Events and Calls for Papers
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 likely that face-face conferencing/events will not be taking place in their ‘traditional’ format, it may be that alternative or innovative platforms are being utilised to deliver such events going forward.

i) International Shared Decision Making Conference 2022.
The 11th International Shared Decision Making Conference takes place June 20-22 2022 with a pre-conference June 19. The venue for the conference is Comwell Kolding (Denmark) – just next to the site of Lillebaelt University Hospital – Kolding site.

Conference registration for the above event opened on Monday 1st November 2021. For further details, please see here
https://www.isdm2022.com

ii) 14th European Network on Mental Health Services Evaluation

https://targetconferences.com EMNESH2022.com
ENMESH2022.com/program-at-a-glance:
Focus on: Collectivism and Individualism in Mental Health

June 27-29, 2022, Tel Aviv, Israel.

iii) Dr Stefan Rennick-Egglestone draws attention to the following Special Issue:
Special Issue of Perspectives in Public Health on “Recovery outside of mental health services”

Recovery Research Network members Dr Stefan Rennick-Egglestone and Dr Theo Stickley will co-edit a special issue of the journal Perspectives in Public Health, to be published in May 2023, with submission due by end of September 2022.

The theme for the special issue is “Recovery outside of mental health services: what can public health contribute?”. The editors would particularly like to hear about practice and research that focuses on increasing wellbeing as it relates to mental health, and which is not necessarily situated in statutory mental health services. They welcome contributions covering the entire age-span from childhood through to end-of-life, both national and international, and they can include articles that draw on the author’s experience of mental health problems to make recommendations for public health policy and practice.

Details of the special issue will be published on the journal website https://journals.sagepub.com/home/rsh soon, or contact Stefan Rennick-Egglestone through stefan.egglestone@nottingham.ac.uk

Papers and Publications
In addition to peer-reviewed literature and work of a purely academic nature, the e-bulletin 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) Vergallo, G. M. and Gulino, M. (2022) Physical restraint in psychiatric care: soon to fall out of use? Psychiatry and Clinical Psychopharmacology 31(4) 468-473
https://doi.org/10.5152/pcp.2021.21237

Abstract
International directives all recommend that using restraints on psychiatric patients should be avoided, yet scientific literature shows that such practices are still largely in use. This article aims to lay out strategies that could be put in place in order to gradually discard the use of restraints, particularly through a “restraint-free” approach, nursing, logistic–environmental pathways, and locally centered health care provision. All such tools have proven valuable for the purpose of safeguarding the health of psychiatric patients. Hence, the failure to put in place such measures may lead to litigation and lawsuits against physicians and particularly health care facilities. Undoubtedly, the ability to effectively implement such methods largely depends on the financial resources available, which in countries such as Italy are poorer than in others. Still, the risk of being sued and held professionally liable may constitute a factor in raising awareness among operators, facilities, and public health care management, leading to the implementation of policy changes aimed at minimizing the use of restraints.

RRN e-bulleting Editor’s note: we would have considered that the human rights aspect is at least as important, if not more than the motivation to stop the use of restraints due to fear of being sued? Furthermore, the use of restraint creates justified antagonism in service users, and de-motivates them to collaborate with their service providers.

ii) Skar Fröding, R., Clausen, H., Benth, J. S., Ruud, T., Slade, M. and Heiervang, K. S. (2022) Associations between personal recovery and service user-rated versus clinician-rated clinical recovery, a cross-sectional study. BMC Psychiatry 22:42
https://doi.org/10.1186/s12888-022-03691-y

Abstract
Background: This study examined the relationship between service user-rated personal recovery and clinician-rated and service user-rated clinical recovery. The relationships between different subdomains of clinical recovery and personal recovery were also assessed.
Methods: In total, 318 mental health service users with a psychosis diagnosis and their clinicians from 39 sites across Norway completed standardized questionnaires regarding personal recovery, clinical symptoms and psychosocial functioning. Regression models were used to investigate the relationship between personal and clinical recovery.
Results: Overall, clinical recovery was positively associated with personal recovery, when rated both by service users and by clinicians. Personal recovery was associated with lower levels of depression, self-harm and problems with relationships when rated by the service users. Among the subdomains rated by the clinicians, personal recovery was associated with fewer problems with relationships and higher aggressiveness.
Conclusions: These findings suggest that affective symptoms are associated with personal recovery, indicating the need for greater focus on depression treatment among people with psychosis. Improving social connections is of importance for personal recovery, and might be an area where clinicians and service users can meet and find agreement on important treatment goals.

iii) Charles, A.., Korde, P., Newby, C. et al. (2022) Proportionate translation of study materials and measures in a multinational global health trial: methodology development and implementation. BMJ Open 2022;12:e058083
https://doi.org/10.1136/bmjopen-2021-058083

Abstract
Objectives: Current translation guidelines do not include sufficiently flexible translation approaches for different study materials. We aimed to develop a proportionate methodology to inform translation of all types of study materials in global health trials.
Design: The design included three stages: (1) categorisation of study materials, (2) integration of existing translation frameworks and (3) methodology implementation [in different countries] (Germany, India, Israel, Tanzania and Uganda), and refinement.
Participants: The study population comprised 27 mental health service users and 27 mental health workers who were fluent in the local language in stage 7 (pretesting), and 54 bilingual mental health service users, aged 18 years or over, and able to give consent as judged by a clinician for step 9 (psychometric evaluation).
Setting: The study took place in preparation for the Using Peer Support in Developing Empowering Mental Health Services (UPSIDES) randomised controlled trial (ISRCTN26008944).
Primary outcome measure: The primary outcome measure was the Social Inclusion Scale (SIS). Results: The typology identifies four categories of study materials: local text, study-generated text, secondary measures and primary measure. The UPSIDES Proportionate Translation Methodology comprises ten steps: preparation, forward translation, reconciliation, back translation, review, harmonisation, pretesting, finalisation, psychometric evaluation and dissemination. The translated primary outcome measure for the UPSIDES Trial (SIS) demonstrated adequate content validity (49.3 vs 48.5, p=0.08), convergent validity and internal consistency (0.73), with minimal floor/ceiling effects.
Conclusion: This methodology can be recommended for translating, cross-culturally adapting and validating all study materials, including standardised measures, in future multisite global trials. The methodology is particularly applicable to multi-national studies involving sites with differing resource levels. The robustness of the psychometric findings is limited by the sample sizes for each site. However, making this limitation explicit is preferable to the typical practice of not reporting adequate details about measure translation and validation.

iv) Stuen, H. K., Landheim, A., Rugkåsa, J. and Wynn, R. (2018) Responsibilities with conflicting priorities: a qualitative study of ACT providers’ experiences with community treatment orders.
BMC Health Services Research 18:290
https://doi.org/10.1186/s12913-018-3097-7

Abstract
Background: Patients with severe mental illness may be subjected to Community Treatment Orders (CTOs) in order to secure that the patients adhere to treatment. Few studies have investigated the use of CTOs within an Assertive Community Treatment (ACT) setting, and little is known about how the tension between the patients’ autonomy and the clinicians’ responsibility to act in the patients’ best interest are resolved in practice. The aim of this study was to explore the service providers’ experiences with CTOs within an ACT setting.
Methods: The study was based on reviews of case files of 15 patients, eight individual qualitative in depth interviews and four focus group interviews with service providers involved in ACT and decisions related to CTOs. A modified grounded theory approach was used to analyse the data.
Results: The main theme ‘responsibility with conflicting priorities’ emerged from data analysis. The balance between coercive approaches and the emphasis on promoting patient autonomy was seen as problematic. The participants saw few alternatives to CTOs as long-term measures to secure ongoing treatment for some of the patients. However, participants perceived the ACT model’s comprehensive scope as an opportunity to build rapport with patients and thereby better meet their needs. The team approach, the ACT providers’ commitment to establish supportive relationships and the frequent meetings with patients in their home environment were highlighted. The ACT approach gave them insight into patients’ everyday lives and, in some cases a greater sense of security when considering whether to take patients off CTOs.
Conclusions: Many of the participants viewed CTOs as helpful in securing long-term treatment for patients. CTO decision-making was described as challenging and complex and presented the providers with many dilemmas. The ACT approach was considered as helpful in that it afforded comprehensive, patient-centered support and opportunities to build rapport.

v) Dreyer, R. P., Pavlo, A. J., Horne, A., Dunn, R., Danvers, K., Brush, J., Slade, M. and Davidson, L. (2021) Conceptual framework for personal recovery in patients with acute myocardial infarction. Journal of the American Heart Foundation. 10:e022354.
https://doi.org/10.1161/JAHA.121.022354

Abstract
Background: Although there has been movement in cardiology to advance patient-centered approaches to postacute myocardial infarction (AMI) care, work remains to be done in aligning patient preferences with clinical care. Our objective was to characterize patients’ experience of AMI and treatment to develop a new conceptual framework of patient-centered recovery in cardiology.
Methods and results: We conducted in-depth interviews with people who previously experienced an AMI (2016–2019). The interview focused on participants’ experiences of their recovery, which were audio-recorded, transcribed verbatim, and analyzed using a phenomenological framework. The overarching theme described by the 42 participants was feeling like a “different person” after the AMI. This shift manifested itself in both losses and gains, each of which posed new challenges to everyday life. The experience appeared to be an active process requiring people to take responsibility for their health. In terms of loss, participants describe how the AMI threatened their sense of safety and security and led to social isolation, fragility, uncertainty about the future, and difficulty expressing emotions accompanied this new fear. A conceptual framework describing the relationship between AMI, identity change, and functioning was developed.
Conclusions: Participants experienced the AMI as an unexpected disruption in their lives that had far-reaching effects on their daily functioning, and were resolved in numerous ways. The conceptual framework may assist in providing a theoretical basis for future interventions in cardiology that not only engage and retain patients in care but also improve long-term adherence to secondary prevention and other aspects of self-care.

vi) Griffiths, C., Walker, K. and Leathlean, C. (2022) Wearable physical activity and sleep tracker based healthy lifestyle intervention in Early Intervention Psychosis (EIP) Service: patient experiences. Open Journal of Psychiatry 12, 115-127
https://doi.org/10.4236/ojpsych.2022.121010

Abstract
Background: Physical activity, sleep, mental health, physical health, wellbeing, quality of life, cognition, and functioning in people who experience psychosis are interconnected factors. People experiencing psychosis are more likely to have low levels of physical activity, high levels of sedation, and sleep problems.
Intervention: An eight-week intervention; including the provision of a Fitbit and its software apps, sleep hygiene and physical activity guidance information, as well as three discussion and feedback sessions with a clinician.
Participants: Out of a sample of 31 using an early intervention psychosis (EIP) service who took part in the intervention, fifteen participants consented to be interviewed—9 (60%) males and 6 (40%) females, age range: 19 – 51 years, average age: 29 years.
Method: In-depth interviews investigating patient experience of the intervention and its impact on sleep, exercise, and wellbeing were undertaken. Thematic analysis was applied to analyse the qualitative data and content analysis was used to analyse questions with a yes/no response.
Results: Most of the participants actively used the Fitbit and its software apps to gain information, feedback, and set goals to make changes to their lifestyle and daily routines to improve quality of sleep, level of physical activity, and exercise.
Conclusion: The intervention was reported to be beneficial, and it is relatively easy and low cost to implement and therefore could be offered by all EIP services. Furthermore, there is potential value for application in services for other psychiatric disorders, where there is often a need to promote healthy lifestyle, physical activity, and effective sleep.

vii) Chu, M. H., Lau, B., Leung, J., Chan, C. S., Tang, B., Lau, C., Newby, Chiu, R., Lo, W. T., Schrank, B. and Slade, M. (2022) Positive psychotherapy for psychosis in Hong Kong: A randomized controlled trial. Schizophrenia Research 240 175-183
https://doi.org/10.1016/j.schres.2021.12.044

Abstract
Recovery-oriented practice has been advocated in mental health services in Hong Kong since 2009. Well-being has become an important area of focus for mental health services. Positive psychotherapy for Psychosis (PPP) is a well-being-focused intervention for use in psychosis, with preliminary evidence from a randomized controlled trial in the United Kingdom of impact on well-being and symptomatology. The aim of this study was to test the effectiveness of PPP on the well-being of people with psychosis in Hong Kong.
The study was a randomized controlled trial with two-arm parallel groups. Both groups received treatments as usual, and in addition the intervention group received a 13-session intervention based on a Cantonese Chinese translation of the PPP manual. Intention-to-treat analysis was used. The trial was registered (ANZCTR:ACTRN12620000464965).
A total of 154 participants (78 intervention, 76 control) were recruited. As compared to control group, intervention group participants showed significant changes over time on the primary outcome of well-being assessed using the Chinese Short Warwick-Edinburgh Mental Well-being Scale (p = 0.001) and on secondary outcomes of hope (Agency subscale: p = 0.029) and self-efficacy (p = 0.001).
Positive Psychotherapy for Psychosis was found to be an effective treatment in improving the well-being and other mental health outcomes for people with psychosis. It can be recommended for use in mental health services to promote recovery.

viii) Rennick-Egglestone, S., Elliott, R., Newby, C., Robinson, C. and Slade, M. (2022) 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. 23:90
https://doi.org/10.1186/s13063-022-06027-z

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

ix) Yeo, C., Rennick-Egglestone, S. and Armstrong, V. et al (2022) Uses and misuses of recorded mental health lived experience narratives in healthcare and community settings: systematic review. Schizophrenia Bulletin 48:1 134-144
https://doi.org/10.1093/schbul/sbab097

Abstract
Mental health lived experience narratives are first-person accounts of people with experience of mental health problems. They have been published in journals, books and online, and used in healthcare interventions and anti-stigma campaigns. There are concerns about their potential misuse. A four-language systematic review was conducted of published literature characterizing uses and misuses of mental health lived experience narratives within healthcare and community settings. 6531 documents in four languages (English, Danish, Swedish, Norwegian) were screened and 78 documents from 11 countries were included. Twenty-seven uses were identified in five categories: political, societal, community, service level and individual. Eleven misuses were found, categorized as relating to the narrative (narratives may be co-opted, narratives may be used against the author, narratives may be used for different purpose than authorial intent, narratives may be reinterpreted by others, narratives may become patient porn, narratives may lack diversity), relating to the narrator (narrator may be subject to unethical editing practises, narrator may be subject to coercion, narrator may be harmed) and relating to the audience (audience may be triggered, audience may misunderstand). Four open questions were identified: does including a researcher’s personal mental health narrative reduce the credibility of their research?: should the confidentiality of narrators be protected?; who should profit from narratives?; how reliable are narratives as evidence?)

x). Roe, D., Slade, M. and Jones, N. (2022) The utility of patient reported outcome measures in mental health. World Psychiatry 21:1. 56-57
https://doi.org/10.1002/wps.20924

Abstract
For decades, clinician-rated outcome measures have been the central source of data informing clinical practice and policy. Patient reported outcome measures (PROMs) more directly assess the lived experiences of service users, capturing their perspectives on their health status and essential subjective constructs such as goal attainment, quality of life and social inclusion. Patient reported experience measures (PREMs) assess their experiences of using health services, including communication, responsiveness and recovery orientation. Here we argue for the systematic implementation of co-developed, user-selected PROMs and PREMs; identify implementation challenges; and propose future priorities.

xi) Piat, M., Wainwright, M., Cherkas, D. et al. (2021) Identifying and understanding the contextual factors that shaped mid-implementation outcomes during the COVID-19 pandemic in organizations implementing mental health recovery innovations into services. Implementation Science Communications 2:101
https://doi.org/10.1186/s43058-021-00206-w

Abstract
Background: Seven housing and health services organizations were guided through a process of translating Chapter Six of the Canadian Guidelines for Recovery-Oriented Practice into a recovery-oriented innovation and plan for its implementation. At the time of the COVID-19 outbreak and lockdown measures, six of the seven organizations had begun implementing their chosen innovation (peer workers, wellness recovery action planning facilitator training, staff training and a family support group). This mid-implementation study used the Consolidated Framework for Implementation Research (CFIR) to identify contextual factors that influenced organizations to continue or postpone implementation of recovery-oriented innovations in the early months of the COVID-19 pandemic.
Methods: Twenty-seven semi-structured 45-min interviews were conducted between May and June 2020 (21 implementation team members and six providers of the innovation (trainers, facilitators, peer workers). Interview guides and analysis were based on the CFIR. Content analysis combined deductive and inductive approaches. Summaries of coded data were given ratings based on strength and valence of the construct’s impact on implementation. Ratings were visualized by mid-implementation outcome and recovery innovation to identify constructs which appear to distinguish between sites with a more or less favourable mid-implementation outcomes.
Results: Four mid-implementation outcomes were observed at this snapshot in time (from most to least positive): continued implementation with adaptation (one site), postponement with adaptation and estimated relaunch date (four sites), indefinite postponement with no decision on relaunch date (one site), and no implementation of innovation yet (one site). Two constructs had either a negative influence (external policies and incentives—renamed COVID-19-related external policy for this study) or a positive influence (leadership engagement), regardless of implementation outcome. Four factors appeared to distinguish between more or less positive mid-implementation outcome: adaptability, implementation climate and relative priority, available resources, and formally appointed internal implementation leaders (renamed “engaging implementation teams during the COVID-19 pandemic” for this study).
Conclusions: The COVID-19 pandemic is an unprecedented outer setting factor. Studies that use the CFIR at the mid-implementation stage are rare, as are studies focusing on the outer setting. Through robust qualitative analysis, we identify the key factors that shaped the course of implementation of recovery innovations over this turbulent time.

xii) Piat, M., Wainwright, M., Sofouli, E. et al. (2021) Factors influencing the implementation of mental health recovery into services: a systematic mixed studies review. Systematic Reviews 10:134
https://doi.org/10.1186/s13643-021-01646-0

Abstract
Background: Countries around the world have committed in policy to transforming their mental health services towards a recovery orientation. How has mental health recovery been implemented into services for adults, and what factors influence the implementation of recovery-oriented services?
Methods: This systematic mixed studies review followed a convergent qualitative synthesis design and used the best-fit framework synthesis method. Librarians ran searches in Ovid- MEDLINE, Ovid-EMBASE, Ovid-PsycInfo, EBSCO- CINAHL Plus with Full Text, ProQuest Dissertations and Theses, Cochrane Library, and Scopus. Two reviewers independently screened studies for inclusion or exclusion using DistillerSR. Qualitative, quantitative, and mixed methods peer-reviewed studies published since 1998 were included if they reported a new effort to transform adult mental health services towards a recovery orientation, and reported findings related to implementation experience, process, or factors. Data was extracted in NVivo12 to the 38 constructs of the Consolidated Framework for Implementation Research (CFIR). The synthesis included a within-case and a cross-case thematic analysis of data coded to each CFIR construct. Cases were types of recovery-oriented innovations.
Results: Seventy studies met our inclusion criteria. These were grouped into seven types of recovery-oriented innovations (cases) for within-case and cross-case synthesis. Themes illustrating common implementation factors across innovations are presented by CFIR domain: Intervention Characteristics (flexibility, relationship building, lived experience); Inner Setting (traditional biomedical vs. recovery-oriented approach, the importance of organizational and policy commitment to recovery-transformation, staff turnover, lack of resources to support personal recovery goals, information gaps about new roles and procedures, interpersonal relationships), Characteristics of Individuals (variability in knowledge about recovery, characteristics of recovery-oriented service providers); Process (the importance of planning, early and continuous engagement with stakeholders). Very little data from included studies was extracted to the outer setting domain, and therefore, we present only some initial observations and note that further research on outer setting implementation factors is needed.

xiii) Piat, M., Wainwright, M., Sofouli, E. et al. (2021) The CFIR card game: A new approach for working with implementation teams to identify challenges and strategies. Implementation Science Communications. 2:1
https://doi.org/10.1186/s43058-020-00099-1

Abstract
Background: The Consolidated Framework for Implementation Research (CFIR) and the ERIC compilation of implementation strategies are key resources for identifying implementation barriers and strategies. However, their respective density and complexity make their application to implementation planning outside of academia challenging. We developed the CFIR Card Game as a way of working with multi-stakeholder implementation teams that were implementing mental health recovery into their services, to identify barriers and strategies to overcome them. The aim of this descriptive evaluation is to describe how the game was prepared, played, used and received by teams and researchers and their perception of the clarity of the CFIR constructs.
Methods: We used the new CFIR-ERIC Matching Tool v.1 to design the game. We produced a deck of cards with each of the CFIR-ERIC Matching Tool barrier narratives representing all 39 CFIR constructs. Teams played the game at the pre-implementation stage at a time when they were actively engaged in a planning process for implementing their selected recovery-oriented innovation. The teams placed each card in either the YES or NO column of the board in response to whether they anticipated experiencing this barrier in their setting. Teams were also asked about the clarity of the barrier narratives and were provided with plain language versions if unclear. Researchers completed a reflection form following the game, and participants completed an open-added questionnaire that included questions specific to the CFIR Card Game. We applied a descriptive coding approach to analysis.
Results: Four descriptive themes emerged from this analysis: (1) the CFIR Card Game as a useful and engaging process, (2) difficulties understanding CFIR construct barrier narratives, (3) strengths of the game’s design and structure and room for improvement and (4) mediating factors: facilitator preparation and multi-stakeholder dynamics. Quantitative findings regarding the clarity of the barrier narratives were integrated with qualitative data under theme 2. Only seven of the 39 original barrier narratives were judged to be clear by all teams.
Conclusions: The CFIR Card Game can be used to enhance implementation planning. Plain language versions of CFIR construct barrier narratives are needed. Our plain language versions require further testing and refining.

Other News / Resources

i)  Prof. Shula Ramon draws attention to the online MSc Mental Health Recovery and Social Inclusion Programme at the University of Hertfordshire.  

In addition to the above link a promotional video can be found here:
VideoMHRSI –

ii) Coronavirus and Mental Health (information)

The following links are intended to illustrate the range of information and advice that is currently available with regard to Covid-19. It is neither exhaustive, nor is it arranged in any particular order. Apologies for any obvious omissions.

World Health organisation
Gov.uk
Social Care Institute for Excellence
Centre for Mental Health
Mental health Foundation
Mind
Rethink
Carers UK
National Service User Network
British Psychological Society
British Association of Social Workers
Royal College of Psychiatrists
Royal College of Nursing
Royal College of Occupational Therapists

iii) Shula Ramon and Tony Sparkes co-produce the RRN monthly e-bulletin. 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:

Shula:     s.ramon@herts.ac.uk
Tony:      a.sparkes@bradford.ac.uk

February 2022

Recovery Research Network eBULLETIN

February 2022

RRN Meetings
Due to the ongoing developments with regards to Covid-19 both nationally and internationally, RRN in-person meetings continue to be suspended at the present time. Nationally however, the current move towards the easing of restrictions represents an optimistic turn to the possibility of resuming face-to-face meetings. The current arrangements are under constant review by the RRN Collective and more information about this possibility will be circulated in due course. In the meantime, we would encourage our readers to keep safe and follow relevant guidance as appropriate.

Please can we urge our readership to continue to submit material to the e-bulletin using the detail below. As ever, comments are welcome from the readership about articles included in the e-bulletins.

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:
Shula: s.ramon@herts.ac.uk
Tony: a.sparkes@bradford.ac.uk

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. There is a considerable amount of advice and information available online. We continue to include examples at the end of the e-bulletin.

RRN Membership Profile
Anyone who has an interest in recovery research can join the RRN, just fill in the online form available at:
https://www.researchintorecovery.com/events/rrn/join/

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, Events and Calls for Papers
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 likely that face-face conferencing/events will not be taking place in their ‘traditional’ format, it may be that alternative or innovative platforms are being utilised to deliver such events going forward.

i) International Shared Decision Making Conference 2022.
The 11th International Shared Decision Making Conference takes place June 20-22 2022 with a pre-conference June 19. The venue for the conference is Comwell Kolding (Denmark) – just next to the site of Lillebaelt University Hospital – Kolding site.

Conference registration for the above event opened on Monday 1st November 2021. For further details, please see here
https://www.isdm2022.com

ii) 14th European Network on Mental Health Services Evaluation

https://targetconferences.com EMNESH2022.com
ENMESH2022.com/program-at-a-glance:
Focus on: Collectivism and Individualism in Mental Health

June 27-29, 2022, Tel Aviv, Israel.

iii) Dr Stefan Rennick-Egglestone draws attention to the following Special Issue:
Special Issue of Perspectives in Public Health on “Recovery outside of mental health services”

Recovery Research Network members Dr Stefan Rennick-Egglestone and Dr Theo Stickley will co-edit a special issue of the journal Perspectives in Public Health, to be published in May 2023, with submission due by end of September 2022.

The theme for the special issue is “Recovery outside of mental health services: what can public health contribute?”. The editors would particularly like to hear about practice and research that focuses on increasing wellbeing as it relates to mental health, and which is not necessarily situated in statutory mental health services. They welcome contributions covering the entire age-span from childhood through to end-of-life, both national and international, and they can include articles that draw on the author’s experience of mental health problems to make recommendations for public health policy and practice.

Details of the special issue will be published on the journal website https://journals.sagepub.com/home/rsh soon, or contact Stefan Rennick-Egglestone through stefan.egglestone@nottingham.ac.uk

Papers and Publications
In addition to peer-reviewed literature and work of a purely academic nature, the e-bulletin 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) Ramon, S., Zisman-IIani, Y. and Quirk, A. (ed) (2022) Shared decision making in mental health: international perspective on implementation. Frontiers in Psychiatry.

This E-book includes a summary editorial and twelve articles on updated developments in implementing shared decision making in mental health with different service users groups, a range of providers, tools, and countries.

The e-book and all individual articles are also available for download on the Research Topic homepage. The homepage also contains a detailed overview of this research topic, the opening paragraph is reproduced below:

The application of shared decision making (SDM) to mental health issues and services is a recent development. An increased range of different styles of SDM in mental health exists, reflecting varieties concerning the power differential of clinicians vs. service users, and the place allocated to experiential knowledge vs. scientific knowledge. Yet, current evidence highlights that compulsory interventions are still very common in the context of mental illnesses compared with physical-somatic illnesses; and in some situations the threat of compulsion is overt or barely concealed. Although more decision-making aids exist, these tools are not always equally validated, and their application does not necessarily ensure that the principles of SDM are either applied in practice or contributes to SDM and health outcomes.

ii) Stone, M., Kokanovic, R., Callard, F. and Broom, A. F. (2020) Estranged relations: coercion and care in narratives of supported decision-making in mental healthcare. Medical Humanities 46(1) 62-72.

Abstract
Supported decision-making has become popular among policymakers and mental health advocates as a means of reducing coercion in mental healthcare. Nevertheless, users of psychiatric services often seem equivocal about the value of supported decision-making initiatives. In this paper we explore why such initiatives might be rejected or ignored by the would-be beneficiaries, and we reflect on broader implications for care and coercion. We take a critical medical humanities approach, particularly through the lens of entanglement. We analyse the narratives of 29 people diagnosed with mental illness, and 29 self-identified carers speaking of their experiences of an Australian mental healthcare system and of their views of supported decision-making. As a scaffolding for our critique we consider two supported decision-making instruments in the 2014 Victorian Mental Health Act: the advance statement and the nominated person. These instruments presuppose that patients and carers endorse a particular set of relationships between the agentic self and illness, as well as between patient, carer and the healthcare system. Our participant narratives instead conveyed ’entangled’ relations, which we explore in three sections. In the first we show how ideas about fault and illness often coexisted, which corresponded with shifting views on the need for more versus less agency for patients. In the second section, we illustrate how family carers struggled to embody the supported decision-making ideal of the independent yet altruistic nominated person, and in the final section we suggest that both care and coercion were narrated as existing across informal/formal care divisions. We conclude by reflecting on how these dynamic relations complicate supported decision-making projects, and prompt a rethink of how care and coercion unfold in contemporary mental healthcare.

iii) Knight, F., Kokanović, R., Ridge, D., Brophy, L., Hill, N., Johnston-Ataata, K. and Herrman, H. (2018) Supported decision-making: The expectations held by people with experience of mental illness. Qualitative Health Research. 28(6) 1002 – 1015

Abstract
Supported decision-making (SDM) is a principle guiding mental health service provision, which aims to improve people’s ability to make informed decisions about their care. Understanding diverse individual needs is vital to its success. Based on 29 narrative interviews with people diagnosed with mental illness in Australia, we examine how participants reflected on their own experiences of SDM. We find that participants’ conceptualization of mental health expertise, their own experiences and sense of agency, and their varying needs for dependence and independence influenced their relationships with mental health practitioners. These factors in turn shaped their expectations about SDM. Four narrative positions emerged: the “Inward Expert,” the “Outward Entrustor,” the “Self-Aware Observer,” and the “Social Integrator.” These positionings influenced the type or style of support that participants expected and considered most useful. Our findings are relevant to developing effective approaches to SDM that take into account service users’ needs and preferences.

iv) Kusdemir, S., Oudshoorn, A. and Ndayisenga, J. P. (2022) A critical analysis of the Tidal Model of Mental Health Recovery. Archives of Psychiatric Nursing. 36. 34 – 40.

Abstract
The purpose of this paper is to critically analyze the Tidal Model of Mental Health Recovery. This examination consolidates the existing knowledge used in developing and implementing this model in order to add clarity and explores how its theory relates to practice, research, and educational activities. This paper follows Chinn and Kramer’s theory analysis framework, which includes the following criteria: clarity, simplicity, generalizability, importance, and accessibility. While the Tidal Model theory meets the criterion of clarity, simplicity is impeded due to the complexity of its concepts. That being said, Barker’s theory is applicable across different psychiatric nursing settings because it is general and accessible. To enhance simplicity and make this a more actionable midrange theory, an illustration is offered to demonstrate how the theory could be utilized and empiricized with a potential population of women who use substances. It is concluded that the Tidal Model appeals not only to mental health practice, but as the literature indicates, it also supports everyone who needs shelter where they feel safe at some point in their lives

v) Carr, E. R. and Ponce, A. N. (2022) Supporting mental health recovery, citizenship, and Social Justice. Community Mental Health Journal 58:11–19. Online:
https://doi.org/10.1007/s10597-021-00900-y

Abstract
Individuals with serious mental illness (SMI) have historically experienced stigma and marginalization. Mental health providers are well positioned to engage in social justice agendas geared at supporting the civil rights of those with SMI, and ultimately helping open doors to the full rights of participation in the community. By engaging and partnering in a mental health recovery and strengths-based orientation, leaders in these settings have the capacity to influence micro-, meso, and macro-systems. This can shed light on mechanisms to build on the strengths, capabilities, and hopes of individuals to live lives of meaning as they so define, with equal access to resources and rights, within communities of their choice. The article articulates an integrated application of these concepts for embracing and utilizing the concepts of mental health recovery, citizenship, and social justice in public mental health. Additionally, specific examples and practical applications are offered within the context of an inpatient setting and a community setting.

vi) Senneseth, M., Pollak, C., Urheim, R., Logan, C. and Palmstierna, T. (2022) Personal recovery and its challenges in forensic mental health: systematic review and thematic synthesis of the qualitative literature. BJPsych Open 8, e17, 1–15.
Https://doi.org/10.1192/bjo.2021.1068

Abstract
Background: There has been a call for a framework to guide recovery-oriented practices in forensic mental health services.
Aims: This study aims to examine personal recovery and its challenges in forensic mental health settings in relation to the established framework for personal recovery in mental illness: connected- ness, hope, identity, meaning and empowerment (CHIME).
Method: This study is an updated and expanded systematic review and thematic synthesis of the qualitative literature. A systematic search of six electronic databases (Web of Science, Medline, PsycINFO, CINAHL, EMBASE and SocIndex) was carried out in January 2019, using the terms [Recover*] AND [Forensic OR Secure] AND [Patient* OR Offend* OR Service User*]. Only studies that included service user’s own perceptions and were published from 2014 onward were included in the review. Data were examined with thematic synthesis and subsequently ana- lysed in relation to the CHIME framework.
Results: Twenty-one studies were included in the review. Findings suggest that some adjustments to the original CHIME framework are needed for it to be more relevant to forensic populations, and
that an additional recovery process regarding feeling safe and being secure (safety and security) could be added to CHIME, providing the CHIME-Secure framework (CHIME-S). Specific challenges and barriers for forensic recovery were identified and found to represent the opposite of the recovery processes defined by CHIME (e.g. hopelessness).
Conclusions: We present the CHIME-S as a framework for the personal recovery processes of forensic mental health service users. The CHIME-S may guide the recovery-oriented work of forensic mental health services.

 

Other News / Resources

i) Prof. Mike Slade has announced an exciting job opportunity to co-ordinate the RECOLLECT Programme – for further details about the post and the RECOLLECT Programme, a link is provided below:
https://jobs.kcl.ac.uk/gb/en/job/040529/Post-Doctoral-Research-Associate-Research-Fellow

Please note the closing date of 3.3.22

ii) Prof. Shula Ramon draws attention to the online MSc Mental Health Recovery and Social Inclusion Programme at the University of Hertfordshire.

An informative short video on the Programme is available here:
https://www.youtube.com/watch?v=urg9l3Zw1rQ

 

iii) Coronavirus and Mental Health (information)

The following links are intended to illustrate the range of information and advice that is currently available with regard to Covid-19. It is neither exhaustive, nor is it arranged in any particular order. Apologies for any obvious omissions.

World Health organisation
Gov.uk
Social Care Institute for Excellence
Centre for Mental Health
Mental health Foundation
Mind
Rethink
Carers UK
National Service User Network
British Psychological Society
British Association of Social Workers
Royal College of Psychiatrists
Royal College of Nursing
Royal College of Occupational Therapists

iii) Shula Ramon and Tony Sparkes co-produce the RRN monthly e-bulletin. 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:

Shula:     s.ramon@herts.ac.uk
Tony:      a.sparkes@bradford.ac.uk

March 2022

Recovery Research Network eBULLETIN

March 2022

RRN Meetings
Due to the ongoing developments with regards to Covid-19 both nationally and internationally, RRN in-person meetings continue to be suspended at the present time. Nationally however, the current move towards the easing of restrictions represents an optimistic turn to the possibility of resuming face-to-face meetings. The current arrangements are under constant review by the RRN Collective and more information about this possibility will be circulated in due course. In the meantime, we would encourage our readers to keep safe and follow relevant guidance as appropriate.

Please can we urge our readership to continue to submit material to the e-bulletin using the detail below. As ever, comments are welcome from the readership about articles included in the e-bulletins.

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:
Shula: s.ramon@herts.ac.uk
Tony: a.sparkes@bradford.ac.uk

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. There is a considerable amount of advice and information available online. We continue to include examples at the end of the e-bulletin.

RRN Membership Profile
Anyone who has an interest in recovery research can join the RRN, just fill in the online form available at:
https://www.researchintorecovery.com/events/rrn/join/

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, Events and Calls for Papers
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 likely that face-face conferencing/events will not be taking place in their ‘traditional’ format, it may be that alternative or innovative platforms are being utilised to deliver such events going forward.

i) The World Health Organisation invite you to the Global Launch of the WHO QualityRights e-training to advance mental health, eliminate stigma and promote community inclusion, on Tuesday 12 April 2022, 15.00 to 16.30 CEST.

There is global consensus that prevailing attitudes and practices need to be transformed on a massive scale to advance mental health. However, in countries across the world, whether low, medium or high-income, the collective response has been inadequate. A sea change in mental health is needed. Stigma and discrimination need to be replaced with hope, acceptance and inclusion in the community. In addition, services, policies and laws in the area of mental health need to reflect a person-centered, rights-based, holistic approach.

We are pleased to collaborate with WHO for the launch and rollout of its innovative QualityRights e-training programme to transform attitudes and practices in mental health will be launched globally reaching all people in all countries. The e-training is a key tool for tackling stigma and discrimination and promoting mental health, recovery and community inclusion. It offers the opportunity for hundreds of thousands of people to also learn how to look after their own mental health, how to support others and how to build responsive mental health services. In doing so, the world will be on a better path to achieving good mental health outcomes. This global launch and rollout has an ambitious target – 1 million learners to have completed the e-training by the end of 2024.

Join us on 12 April at 15.00 CEST to learn more about the QualityRights e-training and its strategic rollout over the next 3 years. You will hear from high level policy-makers and thought leaders in governments, UN agencies, humanitarian agencies and civil society about their plans to implement the e-training. Through personal testimonies you will also hear how the programme has already positively impacted the personal and professional lives of those who have completed it.

The launch event will include interpretation in Arabic, Chinese, French, Russian and Spanish. International signing and captioning will also be available.

Please register now for the 12 April launch event here:
https://who.zoom.us/webinar/register/WN_swLxocnvRwOwCDcgWjacmQ

ii) International Shared Decision Making Conference 2022.
The 11th International Shared Decision Making Conference takes place June 20-22 2022 with a pre-conference June 19. The venue for the conference is Comwell Kolding (Denmark) – just next to the site of Lillebaelt University Hospital – Kolding site.

Conference registration for the above event opened on Monday 1st November 2021. For further details, please see here
https://www.isdm2022.com

iii) 14th European Network on Mental Health Services Evaluation

https://targetconferences.com EMNESH2022.com
ENMESH2022.com/program-at-a-glance:
Focus on: Collectivism and Individualism in Mental Health

June 27-29, 2022, Tel Aviv, Israel.

iv) Dr Stefan Rennick-Egglestone draws attention to the following Special Issue:
Special Issue of Perspectives in Public Health on “Recovery outside of mental health services”

Recovery Research Network members Dr Stefan Rennick-Egglestone and Dr Theo Stickley will co-edit a special issue of the journal Perspectives in Public Health, to be published in May 2023, with submission due by end of September 2022.

The theme for the special issue is “Recovery outside of mental health services: what can public health contribute?”. The editors would particularly like to hear about practice and research that focuses on increasing wellbeing as it relates to mental health, and which is not necessarily situated in statutory mental health services. They welcome contributions covering the entire age-span from childhood through to end-of-life, both national and international, and they can include articles that draw on the author’s experience of mental health problems to make recommendations for public health policy and practice.

Details of the special issue will be published on the journal website https://journals.sagepub.com/home/rsh soon, or contact Stefan Rennick-Egglestone through stefan.egglestone@nottingham.ac.uk

Papers and Publications
In addition to peer-reviewed literature and work of a purely academic nature, the e-bulletin 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) Ng, F., Newby, C., Robinson, C., Llewellyn-Beardsley, J., Yeo, C., Roe, J., Rennick-Egglestone, S., Smith, R., Booth, S., Bailey, S., Castelein, S., Callard, F., Arbour, S. and Slade, M. (2022) How do recorded mental health recovery narratives create connection and improve hopefulness. Journal of Mental Health 31(2) 273-280
https://doi.org/10.1080/09638237.2021.2022627

Abstract
Background: Mental health recovery narratives are an active ingredient of recovery-oriented interventions such as peer support. Recovery narratives can create connection and hope, but there is limited evidence on the predictors of impact.
Aims: The aim of this study was to identify characteristics of the narrator, narrative content and participant which predict the short-term impact of recovery narratives on participants.
Method: Independent studies were conducted in an experimental (n¼40) and a clinical setting
(n¼13). In both studies, participants with mental health problems received recorded recovery narratives and rated impact on hopefulness and connection. Predictive characteristics were identified using multi-level modelling.
Results: The experimental study found that narratives portraying a narrator as living well with mental health problems that is intermediate between no and full recovery, generated higher self-rated levels of hopefulness. Participants from ethnic minority backgrounds had lower levels of connection with narrators compared to participants from a white background, potentially due to reduced visibility of a narrator’s diversity characteristics.
Conclusions: Narratives describing partial but not complete recovery and matching on ethnicity may lead to a higher impact. Having access to narratives portraying a range of narrator characteristics to maximise the possibility of a beneficial impact on connection and hopefulness

ii) Williams, L. and Armitage, C. (2022) Assessing the Value of a Novel “Recovery and Collaborative Care Planning Café” Initiative for Co-designing Improvements Through a Shared Learning Experience with Service Users, Carers, and Practitioners. Journal of Recovery in Mental Health. 5(2) 5-10. Online:
https://jps.library.utoronto.ca/index.php/rmh/article/view/37968

Abstract
Objective: This paper ascertains the value of a novel approach to creating a participative social learning space with service users, carers, and practitioners to develop recovery-oriented conversations and the experience of collaborative care planning.
Methods: A participatory method “World Café” was utilized with taught masterclasses on recovery principles. Evidenced-based practice was a central feature drawn from service user research. The Model for Improvement: Plan-Do-Study-Act (PDSA) framed the sessions to generate and test ideas.
Results: Service user and carer attendance was low at the start, although this increased after testing ideas using PDSA cycles to improve this. Shared learning grew over time, which led to ideas to create improved participation in care planning. Conversations also developed towards becoming more recovery oriented after participants incorporated a framing set of recovery concepts into the sessions.
Conclusions: The café design proved it was possible to both create a social learning space and change conversations leading to a greater focus on recovery through using CHIME (a conceptual framework incorporating connectedness, hope, identity, meaning, and empowerment). The café successfully

iii) Roe, D., Slade, M. and Jones, N. (2022) The utility of patient-reported outcome measures in mental health. World Psychiatry 21(1) 56-57.
https://doi.org/10.1002/wps.20924

Summary
in a short perspective piece for World Psychiatry, Roe et al discuss the usefulness of patient reported outcome measures (PROMs), and patient reported experience measures (PREMs). The authors make a cogent case for the systematic implementation of co-developed measures, particularly those that emerge out of substantive involvement from people with lived experience. The routine use of such measures are supported by ethical, clinical and institutional justifications. Going forward, the authors conclude by asserting that PROMs/PREMs may be better utilised if they are co-developed, offer enhanced levels of service user choice, capitalise upon the increasing use of mental health apps, and more fully embrace cultural and geopolitical differences.

iv) Griffiths, C., Maravic da Silva, K., Leathlean, C., Jiang, H., Ang, C. S. and Searle, R. (2022) Investigation of physical activity, sleep, and mental health recovery in treatment resistant depression (TRD) patients receiving repetitive transcranial magnetic stimulation (rTMS) treatment. Journal of Affective Disorders Reports. Online:
https://doi.org/10.1016/j.jadr.2022.100337

Abstract
Background: Repetitive transcranial magnetic stimulation (rTMS) is effective in treating depression; however, the effect on physical activity, sleep and recovery is unclear. This study investigated rTMS effect on physical activity and sleep through providing patients with a Fitbit and software apps; and reports the impact of rTMS on depression, anxiety and mental health recovery.
Methods: Study design was a pre and post data collection without a control, with twenty-four participants with treatment-resistant depression (TRD). Measures used were Fitbit activity and sleep data, and patient-rated Recovering Quality of Life (ReQoL-20), Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder (GAD-7).
Results: Response and remission rates were, respectively: 34.8% and 39% for PHQ-9; 34.8% and 47.8% for GAD-7. ReQoL-20 response and reliable improvement were 29.4% and 53%. PHQ-9, GAD-7 and ReQol-20 scores significantly improved, with large effect sizes. Analysis of Fitbit activity and sleep data yielded non-significant results. The Fitbit data machine learning model classified two levels of depression to 82% accuracy.
Limitations: rTMS treatment was open-label and adjunct to existing antidepressant medication. No control group. Female patients were overrepresented.
Conclusions: Improvements on the ReQoL-20 and aspects of sleep and activity indicate the positive impact of rTMS on the individual’s real world functioning and quality of life. A wearable activity tracker can provide feedback to patients and clinicians on sleep, physical activity and depression levels. Further research could be undertaken through a sufficiently powered RCT comparing rTMS versus rTMS with use of a Fitbit, its software applications, and sleep and physical activity advice.

v) de Wet, A., Sunkel, C. and Pretorius, C. (2022) Opportunities and challenges: a case for formal peer support work in mental health in a South African context. Advances in Mental Health. Online:
https://doi.org/10.1080/18387357.2022.2032776

Abstract
Objective: Peer support in mental health has gained much attention especially in high income countries (HICs). Peer support can be delivered informally or formally. Both informal peer support and formal peer support work in mental health (PSWMH) hold promise for service users’ recovery and increasingly delivered in low- and middle-income countries (LMICs) too, to overcome large treatment gaps between mental health care needs and limitations in services.
Method: 37 semi-structured interviews and 3 focus groups with 14 service users, 12 service providers and 12 carers of service users at three tertiary psychiatric hospitals in the Western Cape, South Africa, were conducted. Data were analysed using reflexive thematic analysis.
Results: Support as facilitator to recovery was generated as a theme, including peer support; described as beneficial for both service users and peer support workers.
Discussion: The benefits lead to the exploration of the opportunities and challenges for PSW-MH in the study context. While there is still a long way to go to the successful inclusion of formal peer support within health care services in South African contexts, we have discussed the possible ways in which such inclusion can be beneficial on various levels, if the challenges to PSW-MH are heeded.

vi) Fox, J. (2022) Experiences of being cared-for: The perspective of an Expert-by-Experience in Mental Health. Front. Psychiatry 13(824542). Online:
https://doi.org/10.3389/fpsyt.2022.824542

Abstract
It is difficult to understand what it feels like for people with mental ill-health to be cared-for and supported by family members; this experience is often little-explored. Narratives about caring have been increasingly written alongside first-person accounts of recovery, however, there is a dearth of literature written to gain the perspective of being cared-for because of mental distress. Thus, using autoethnography, I present three critical incidents occurring at different points in my recovery to enable exploration of experiences of being cared-for. Firstly, a critical incident at the point of acute unwellness is introduced, secondly an incident during a consultation with a health professional is highlighted, and finally a moment of transition when embarking on an independent life with my husband-to-be is described. I use autoethnography to connect “the autobiographical and personal to the cultural, social, and political”. I consider how the identity of a carer is continually negotiated in a relationship with the service user in both the “private” and the “public” worlds during recovery. I reflect on how professionals can support both service users and carers in a triangle of care, by providing information and support, alongside promoting the development of independence and agency for the service user whilst in the caring relationship. Finally, I introduce a service model which promotes a family network approach to empower the service user and highlight training programs on recovery that enable carers. I conclude by suggesting the potential of both approaches to support carers to promote the recovery of the service user.

vii) Nixdorf, R., Nugent, L., Aslam, R., Barber, S., Charles, A., Meir, L. G., Grayzman, A., Hiltensperger, R., Kalha, J., Korde, P., Mtei, R., Niwemuhwezi, J., Ramesh, M., Ryan, G., Slade, M., Wenzel, L. and Mahlke, C. (2022) A multi-national peer support intervention: the UPSIDES pilot phase, Advances in Mental Health 20(1) 2-14. Online:
https://doi.org/10.1080/18387357.2021.2020140

Abstract
Objective: Using Peer Support in Developing Empowering Mental Health Services (UPSIDES) is evaluating implementation of a peer support worker (PSW) intervention at six recruiting sites (Germany, India, Israel, Tanzania, and Uganda) (ISRCTN26008944). The aim of this study is to evaluate the pre-trial pilot phase.
Method: The initial training to prepare individuals for the PSW role and the implementation of the peer support (PS) intervention was evaluated using a multi-method design comprising six focus groups (FG; n = 22) and questionnaires capturing the perspectives of service users, PSWs, peer trainers, and mental health staff members (n = 21).
Results: Findings were organised across eleven key implementation themes: organisational culture, PSW training, PSW role definition, staff willingness and ability to work with PSWs, resource availability, financial arrangements, support for PSW well-being, PSW access to a peer network, acceptance, preparation, and other challenges.
Discussion: The following recommendations are made, based on this pilot phase: the PS training should train on practical skills using role- playing exercises; PSWs should work in teams, including role reflection with colleagues (intervision) or with a highly experienced coach (supervision); necessary resources and tools for networking should be provided; and continuous awareness-raising about PS is needed.

Other News / Resources
i) Prof. Shula Ramon draws attention to the online MSc Mental Health Recovery and Social Inclusion Programme at the University of Hertfordshire.

An informative short video on the Programme is available here:
https://www.youtube.com/watch?v=urg9l3Zw1rQ

 

ii) Coronavirus and Mental Health (information)

The following links are intended to illustrate the range of information and advice that is currently available with regard to Covid-19. It is neither exhaustive, nor is it arranged in any particular order. Apologies for any obvious omissions.

World Health organisation
Gov.uk
Social Care Institute for Excellence
Centre for Mental Health
Mental health Foundation
Mind
Rethink
Carers UK
National Service User Network
British Psychological Society
British Association of Social Workers
Royal College of Psychiatrists
Royal College of Nursing
Royal College of Occupational Therapists

iii) Shula Ramon and Tony Sparkes co-produce the RRN monthly e-bulletin. 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:

Shula:     s.ramon@herts.ac.uk
Tony:      a.sparkes@bradford.ac.uk

April 2022

Recovery Research Network eBULLETIN

April 2022

RRN Meetings
Due to the ongoing developments with regards to Covid-19 both nationally and internationally, RRN in-person meetings continue to be suspended at the present time. Nationally however, the current move towards the easing of restrictions represents an optimistic turn to the possibility of resuming face-to-face meetings. The current arrangements are under constant review by the RRN Collective and more information about this possibility will be circulated in due course. In the meantime, we would encourage our readers to keep safe and follow relevant guidance as appropriate.

Please can we urge our readership to continue to submit material to the e-bulletin using the detail below. As ever, comments are welcome from the readership about articles included in the e-bulletins.

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:
Shula: s.ramon@herts.ac.uk
Tony: a.sparkes@bradford.ac.uk

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. There is a considerable amount of advice and information available online. We continue to include examples at the end of the e-bulletin.

RRN Membership Profile
Anyone who has an interest in recovery research can join the RRN, just fill in the online form available at:
https://www.researchintorecovery.com/events/rrn/join/

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, Events and Calls for Papers
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 likely that face-face conferencing/events will not be taking place in their ‘traditional’ format, it may be that alternative or innovative platforms are being utilised to deliver such events going forward.

i) International Shared Decision Making Conference 2022.
The 11th International Shared Decision Making Conference takes place June 20-22 2022 with a pre-conference June 19. The venue for the conference is Comwell Kolding (Denmark) – just next to the site of Lillebaelt University Hospital – Kolding site.

Conference registration for the above event opened on Monday 1st November 2021. For further details, please see here
https://www.isdm2022.com

ii) 14th European Network on Mental Health Services Evaluation

https://targetconferences.com EMNESH2022.com
ENMESH2022.com/program-at-a-glance:
Focus on: Collectivism and Individualism in Mental Health

June 27-29, 2022, Tel Aviv, Israel.

iii) Dr Stefan Rennick-Egglestone draws attention to the following Special Issue:
Special Issue of Perspectives in Public Health on “Recovery outside of mental health services”

Recovery Research Network members Dr Stefan Rennick-Egglestone and Dr Theo Stickley will co-edit a special issue of the journal Perspectives in Public Health, to be published in May 2023, with submission due by end of September 2022.

The theme for the special issue is “Recovery outside of mental health services: what can public health contribute?”. The editors would particularly like to hear about practice and research that focuses on increasing wellbeing as it relates to mental health, and which is not necessarily situated in statutory mental health services. They welcome contributions covering the entire age-span from childhood through to end-of-life, both national and international, and they can include articles that draw on the author’s experience of mental health problems to make recommendations for public health policy and practice.

Details of the special issue will be published on the journal website https://journals.sagepub.com/home/rsh soon, or contact Stefan through stefan.egglestone@nottingham.ac.uk

Papers and Publications
In addition to peer-reviewed literature and work of a purely academic nature, the e-bulletin 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) Ibrahim, N., Ng, F., Selim, A., Ghallab, E., Ali, A. and Slade, M. (2022) Posttraumatic growth and recovery among a sample of Egyptian mental health service users: a phenomenological study. BMC Psychiatry 22(555). Online:
https://doi.org/10.1186/s12888-022-03919-x

Abstract
Background: Delivery of recovery-oriented mental health practice is fundamental to personal recovery. Yet, there is lack of service users’ accounts on what constitutes mental health recovery in Egypt.
Objectives: The aim of this study was to explore mental health recovery meaning informed by people with personal experience of recovery.
Methods: A phenomenological research design was used. Semi-structured qualitative interviews were conducted with 17 adult community-dwelling individuals who identified as recovered/recovering from mental health issues. An inductive thematic analysis approach was used to analyses participants’ responses.
Results: Participants predominately reported personal and functional definitions of mental health recovery. Posttraumatic growth was the strongest theme comprising: relation to others, spirituality, new possibilities, identity & strengths, and appreciation of life. Themes of acceptance and forgiveness, functional and clinical recovery, and finding hope were also identified.
Conclusions: This is the first study to explore mental health recovery meaning among a sample of people with lived experience of mental health issues in Egypt. Findings suggest that developing and implementing psychosocial interventions to support posttraumatic growth among people with mental health issues is a priority.

ii) Carpenter-Song, E., Acquilano, S. C., Noel, V., Al-Abdulmunem, M., Torous, J. and Drake, R. E. (2022) Individualized intervention to support mental health recovery through implementation of digital tools into clinical care: feasibility study. Community Mental Health Journal 58 99–110. Online:
https://doi.org/10.1007/s10597-021-00798-6

Abstract
Myriad digital tools exist to support mental health but there are multiple barriers to using these tools in routine care. This study aimed to assess the feasibility of an intervention incorporating a support role to help the clinical team identify and use technology to promote recovery. The technology specialist intervention is 3 months in duration and comprises four stages: goal setting, researching and evaluating tools, demonstrating and selecting tools, and ongoing support. We implemented the intervention in a community mental health center and a dual diagnosis treatment program, working with eight clients and their case managers. Clients and case managers willingly engaged with the technology specialist and found the intervention beneficial. Integration and collaboration with the care team facilitated implementation of the technology specialist in these real-world settings. Clients reported that the intervention made it easy to try a digital tool. Six of the eight participants stated that they made substantial progress toward their goals. The technology specialist is a promising new role for mental health care delivery to augment traditional services and enhance individualized recovery.

iii) Piat, M., Sofouli, E., Wainwright, M., Albert, H., Rivest, M-P., Casey, R., LeBlanc, S., Labonté, L., O’Rourke, J. and Kasdorf, S. (2022) Translating mental health recovery guidelines into recovery-oriented innovations: A strategy combining implementation teams and a facilitated planning process. Evaluation and Program Planning. 91 102054. Online:
https://doi.org/10.1016/j.evalprogplan.2022.102054

Abstract
Recovery is the focus of mental health strategies internationally. However, little translation of recovery knowledge has occurred in mental health services. The purpose of this research is to bridge the gap between recovery guidelines and practice by developing a new implementation strategy involving the formation of implementation teams made up of different stakeholders (service users, service providers, managers, knowledge users) and facilitating a 12-meeting implementation planning process. Seven mental health organizations across Canada successfully completed the process of translating the guidelines into a recovery-oriented innovation that was implemented. Fifty-five implementation team members were interviewed upon completion of the 12-meeting process. Findings indicate that implementation team members perceived the structured planning process as positive. Nevertheless, the language of implementation science remains difficult to understand for a non-academic audience. Key elements of the 12-meeting process included the value of consensus building among implementation team members and the subsequent shifting power relationships. While working with diverse stakeholders came with certain challenges, the process in itself was a form of system transformation. This type of engaged planning process was a significant departure from the more top-down approaches to organizational change that staff were used to.

iv) Jatta, S., Brunton-Smith, I. and Meadows, R (2022) Inequalities in recovery or methodological artefact? A comparison of models across physical and mental health functioning. SSM – Population Health 17 101067. Online:
https://doi.org/10.1016/j.ssmph.2022.101067

Abstract
Considerable attention has been paid to inequalities in health. More recently, focus has also turned to inequalities in ‘recovery’; with research, for example, suggesting that lower grade of employment is strongly associated with slower recovery from both poor physical and poor mental health. However, this research has tended to operationalise recovery as ‘return to baseline’, and we know less about patterns and predictors when recovery is situated as a ‘process’. This paper seeks to address this gap. Drawing on data from the UK Household Longitudinal Study, we operationalise recovery as both an ‘outcome’ and as a ‘process’ and compare patterns and predictors across the two models. Our analysis demonstrates that the determinants of recovery from poor health, measured by the SF-12, are robust, regardless of whether recovery is operationalised as an outcome or as a process. For example, being employed and having a higher degree were found to increase the odds of recovery both from poor physical and mental health functioning, when recovery was operationalised as an outcome. These variables were also important in distinguishing health functioning trajectories following a poor health episode. At one and the same time, our analysis does suggest that understandings of inequalities in recovery will depend in part on how we define it. When recovery is operationalised as a simple transition from poor health state to good, it loses sight of the fact that there may be inequalities (i) within a ‘poor health’ state, (ii) in how individuals are able to step into the path of recovery, and (iii) in whether health states are maintained over time. We therefore need to remain alert to the additional nuance in understanding which comes from situating recovery as a process; as well as possible methodological artefacts in population research which come from how recovery is operationalised.

v) Murphy, J., Mulcahy, H., O’ Mahony, J. and Bradley, S. (2022) Exploring individuals’ experiences of hope in mental health recovery: An interpretative phenomenological analysis. Journal of Psychiatric and Mental Health Nursing(Early View). Online:
https://doi.org/10.1111/jpm.12833

Abstract
Introduction: Mental health services have embraced the philosophy and practice of recovery. Research has confirmed hope as a micro-process of recovery. The lived experience of hope has received scant attention. This is required to improve understanding and optimize its therapeutic potential
Aim: To explore how individuals describe and make sense of their experience of hope in mental health recovery.
Method: A qualitative interpretative phenomenological analysis (IPA) approach was used. The sample was accessed via email networks. Data were generated through semi-structured interviews and analysed using an IPA framework.
Results: Three superordinate themes emerged: “Without it we would wither up and die”—Hope as intrinsic to life; “I will be ok”—Having a sense of possibility and “Making it happen”—Moving forward. Individuals referenced hope by its absence when attempts were made to end life, and as present but hidden in tortuous circumstances.
Discussion: Individuals were more familiar with the concept of hopelessness, had a ready-to-hand vocabulary of “having no hope” and used this by default to inform what hope meant.
Implications for Practice: It is important that all stakeholders appreciate the context specific interpretation of hope and cultivate dialogue and understanding to harness its therapeutic potential.

vi) Damsgaard, J. B. and Brinkmann, S. (2022) Me and us: Cultivating presence and mental health through choir singing. Scandinavian Journal of Caring Sciences. (early View) Online:
https://doi.org/10.1111/scs.13078

Abstract
Background: An increasing body of qualitative and quantitative research suggests that choir singing can improve mental and physical health and wellbeing. A recurring phenomenon is social agency and social and emotional competences. However, there is little consensus about the underlying impact mechanisms and the special nature of music as a medium for music-based social–emotional
competence.
Aim: This research was carried out to explore how the participants experienced engaging and singing in the choir A Song for the Mind in order to understand the social and emotional aspects in relation to choir singing and mental health.
Method: Six women and two men were interviewed. The study involved open-ended interviews and applied Paul Ricoeur’s phenomenological–hermeneutic theory of interpretation in processing the collected data.
Findings: Two themes emerged—The Singing Me and Cultivating Us. Joining the choir, singing and engaging with the lyrics, helped the participants get in contact with complex feelings and visualise and express challenges. This formed feelings of connecting to oneself and opening up to become aware of the world such as nature, the other person and the choir. Songs, melodies, tones, lyrics—singing together—formed a relation between the participants and the other and the group. This was a meaningful, and to some, a life-changing experience, and an important learning process to the professionals. As the participants are sensing and connecting to themselves, there is an opening for growing a nascent presence and awareness.
Conclusion: Joining the initiative A Song for the Mind instils an attention to the other person(s). The singing process seems to evoke presence, leading to awareness towards relational aspects and solidarity. In a choir singing perspective, and health care practice in general, this can be seen as a budding and ground-breaking formation of cultural activities holding learning and empowering potentials instilling mental health.

vii) Thoits, P. A. (2022) Mental health treatment histories, recovery, and well-being. Society and Mental Health 12(1) 1-16

Abstract
Epidemiological and sociological research on recovery from mental disorder is based on three rarely tested medical model assumptions: (1) recovery without treatment is the result of less severe illness, (2) treatment predicts recovery, and (3) recovery and well-being do not depend on individuals’ treatment histories. I challenge these assumptions using National Comorbidity Survey-Replication data for individuals with any disorder occurring prior to the current year (N = 2,305). Results indicated that (1) untreated remissions were fully explained by less serious prior illness, (2) treated individuals were less likely to recover due to more serious illness, and (3) people who had past-only treatment were more likely to recover than the never-treated, while those in recurring and recently initiated care were less likely to recover. Treatment histories predicted greater well-being only if recovery had been attained. Histories of care help to explain recovery rates and suggest new directions for treatment-seeking theory and research.

viii) Trustam, E., Chapman, P. and Shanahan, P. (2022) Making recovery meaningful for people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities. 35(1) 252–260.

Abstract
Background: A recovery approach within mental health services has gained momentum. Its meaning for adults with intellectual disabilities recovering from mental health disorders is less understood. Peoples’ experiences of recovery were explored to help inform recovery-focused recommendations for clinical practise.
Method: A qualitative design using interpretative phenomenological analysis was applied. Nine interviews with people with intellectual disabilities who had experienced mental health disorders were conducted.
Results: Two themes that emerged focusing on entry to service and the recovery experience. Subthemes for entry to service included unfair treatment, valuing information and managing expectations. The recovery experience subthemes were therapeutic alliance, self-management, emotional development, autonomy, connectedness, positive identity and a belief in recovery.
Conclusions: Hearing peoples’ experiences directly allowed the current themes to emerge in the context of living with lifelong disabilities. This article adds to the sparse literature and highlights considerations for recovery-based interventions for people with intellectual disabilities.

Other News / Resources
i) Prof. Shula Ramon draws attention to the online MSc Mental Health Recovery and Social Inclusion Programme at the University of Hertfordshire.

An informative short video on the Programme is available here:
https://www.youtube.com/watch?v=urg9l3Zw1rQ

ii) Coronavirus and Mental Health (information)

The following links are intended to illustrate the range of information and advice that is currently available with regard to Covid-19. It is neither exhaustive, nor is it arranged in any particular order. Apologies for any obvious omissions.

World Health organisation
Gov.uk
Social Care Institute for Excellence
Centre for Mental Health
Mental health Foundation
Mind
Rethink
Carers UK
National Service User Network
British Psychological Society
British Association of Social Workers
Royal College of Psychiatrists
Royal College of Nursing
Royal College of Occupational Therapists

iii) Shula Ramon and Tony Sparkes co-produce the RRN monthly e-bulletin. 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:

Shula:     s.ramon@herts.ac.uk
Tony:      a.sparkes@bradford.ac.uk