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Recovery Research Network (RRN)

2024 RRN Emails

January 2024

Recovery Research Network eBULLETIN

January 2024

RRN Meetings
The national and international situation regarding Coronavirus (Covid-19) remains a topic of discussion and while Covid-19 restrictions have ended in the UK, guidance continues to emanate from central government as we learn to live with the virus.  We continue to encourage our readers to keep safe and follow relevant guidance as appropriate.  UK guidance is available here, and international information via the World Health Organisation is available here.

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.

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

RRN Membership Profile
Anyone who has an interest in recovery research can join the RRN, just fill in the online form available here.

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 a world that is learning to live with Covid-19, the limitations upon the free movement of people are lifting. That said, such easing is not necessarily distributed evenly.  Nevertheless, opportunities to attend in-person conferences and events are gathering traction as we now move into 2024.

i) ENMESH – the European Network for Mental Health Service Evaluation, will be holding its 15th International Conference on:
Date:  4th – 6th July 2024.  Following an associated French-speaking conference on 3rd July.
Venue:  45, avenue des Etats-Unis, 78000 VERSAILLES

The central theme of the conference will be: Evaluation in mental health services: everyone’s business and special focus will be given to:

  • Users’ lived experiences
  • Child and adolescent mental health
  • Health system and interdisciplinary approaches to quality
  • New frontiers for research and policy

The call for communications will be open from Monday, 9th October to Sunday, 17th December 2023 for English-language contributions as well as for the French-speaking sessions.  For more information, please see here.

ii) The 23rd International Congress of the International Society for Psychological and Social Approaches to Psychosis (ISPS) will take place at Dipoli, Aalto University, Helsinki Metropolitan Area, Espoo, in Finland, June 5th – 8th 2024.

The title of the conference, Need Adapted Care for Psychosis – the Power of Human Interaction, is in honour of the late Yrjö Alanen’s work on developing the Need Adapted approach.

Key dates:
Abstract submission deadline: November 30th, 2023
Review results to submitters: by February 1st, 2024

For more information, please see here.
iii)  Out of the Department of Health Studies at the Royal Holloway University of London, Dr Lynn Tang announces a call for papers.  Lynn writes:

Call for Papers for Sociological Perspectives of Community Mental Health (to be submitted to Policy Press)
***An edited collection by International Sociological Association RC49 Sociology of Mental Health and Illness***
Abstract submission by:  March 31, 2024

Details about the call:
https://www.researchgate.net/publication/377438044_Call_for_Papers_for_an_Edited_Collection_on_Sociological_Perspectives_of_Community_Mental_Health

The book will be edited by Dr Jeremy Dixon and Professor Silvia Krumm. Abstracts not exceeding 800 words in length should be sent by email to arrive no later than 31st March 2024 to Dr Jeremy Dixon at jd582@bath.ac.uk . Please ensure you include your full name and email address. Please include a subject heading: RC49 Edited Collection.
Thank you very much!

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., Rennick-Egglestone, S., Onwumere, J., Newby, C., Llewellyn-Beardsley, J., Yeo, C., Ali, Y., Pollock, K., Kotera, Y., Pomberth, S., Gavan, S.P., van der Krieke, L., Robotham ,D., Gillard, S., Thornicroft, G., Slade, M. and the NEON Study Group (2024) Pragmatic, feasibility randomized controlled trial of a recorded mental health recovery narrative intervention: Narrative experiences online intervention for informal carers (NEON-C). Front. Psychiatry, 14:1272396.
https://doi.org/10.3389/fpsyt.2023.1272396

Abstract
Introduction:  Informal carers of people with mental health problems often have unmet support needs. Mental health recovery narratives are increasingly accessible, but their relevance to and effect on informal carers have been minimally investigated. The Narrative Experiences Online (NEON) Intervention is a first-in-field intervention that provides informal carers with access to a diverse collection of recorded mental health recovery narratives. This trial aimed to examine the feasibility and acceptability of the NEON Intervention for informal carers.
Methods:  This study involved a two-arm feasibility randomized controlled trial. Carers were randomly assigned to receiving versus not receiving the NEON Intervention. The feasibility aspects investigated included the acceptability of the intervention and of randomization, trial processes, engagement rates, recruitment procedures, attrition, sample size estimation, identification of candidate primary and secondary outcomes, and the feasibility of conducting a definitive trial. A qualitative process evaluation was conducted.
Findings:  A total of 121 carers were eligible, of whom 54 were randomized (intervention: 27, control: 27). Twelve-month follow-up data were available for 36 carers. Carers accessed a mean of 25 narratives over a 12-month period, and the intervention group, compared with the control group, reported a small effect on hope and a moderate effect on the presence of meaning in life. Five modifications were recommended to improve the user experience, applicability, and trial processes.
Discussion:  The NEON Intervention is feasible and acceptable. Significant refinement of the NEON Intervention and trial processes is required to personalize and ensure applicability to carers. Further feasibility testing is recommended prior to a definitive trial.

ii)  Fixsen, A. (2023). Fragile minds, porous selves: Shining a light on autoethnography of mental illness. Qualitative Social Work, 22(1), 140-158.
https://doi.org/10.1177/14733250211046657

Abstract
his article sheds light on autoethnographic accounts of mental illness, to address author and reader concerns and questions and to consider what practitioners can learn from these narrative accounts. Drawing from my own and others’ trajectories, I discuss the drawbacks and dangers of exposing a ‘flawed’ identity, the stigma of serious mental illness, intertextuality issues, the tangled nature of revelation and redemption, framing the ‘Other’ in mental illness autoethnography and depictions of ‘life in the asylum.’ I explain how in telling my own ‘psychiatric’ tale, I looked to the symbolic concept of ‘communitas’ as a means of examining inter-relational processes and collective experience in a psychiatric facility. I argue that, while the act of writing about one’s illness experience can be rightly perceived as a way of reclaiming personal ‘power’ and facilitating healing, attempts to ‘evidence’ recovery can run counter to the writer’s reality of life with or beyond mental illness as personally and socially messy. In answer to the question, ‘at what point does a ‘life in the asylum’ narrative become autoethnographic?’ I argue for the potential of autoethnography to contribute to broader sociological, ethnographic and medical debates and thus impact on policy. Speaking up about mental health through autoethnography can help to promote awareness of the unpredictability and socially constructed nature of mental illness and can inform strategies toward reducing public stigma, tackle the cyclical impact of labels, highlight the need to change social and medical attitudes, and revisualize treatment and support.

iii)  Slade, M., Rennick-Egglestone, S., Elliott, R. A., Newby, C., Robinson, C., Gavan, S. P., Paterson, L., Ali, Y., Yeo, C., Glover, T., Pollock, K., Callard, F., Priebe, S., Thornicroft, G., Repper, J., Keppens, J., Smuk, M., Franklin, D., Walcott, R., Harrison, J., Smith, R., Robotham. D., Bradstreet, S., Gillard, S., Cuijpers, P., Farkas, M., Zeev, D. B., Davidson, L., Kotera, Y., Roe, J., Ng ,F., Llewellyn-Beardsley, J. & the NEON study group. (2024) Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with non-psychotic mental health problems: a pragmatic randomized controlled trial. World Psychiatry, 23(1), 101-112.
https://doi.org/10.1002/wps.21176

Abstract
Narratives describing first-hand experiences of recovery from mental health problems are widely available. Emerging evidence suggests that engaging with mental health recovery narratives can benefit people experiencing mental health problems, but no randomized controlled trial has been conducted as yet. We developed the Narrative Experiences Online (NEON) Intervention, a web application providing self-guided and recommender systems access to a collection of recorded mental health recovery narratives (n=659). We investigated whether NEON Intervention access benefited adults experiencing non-psychotic mental health problems by conducting a pragmatic parallel-group randomized trial, with usual care as control condition. The primary endpoint was quality of life at week 52 assessed by the Manchester Short Assessment (MANSA). Secondary outcomes were psychological distress, hope, self-efficacy, and meaning in life at week 52. Between March 9, 2020 and March 26, 2021, we recruited 1,023 participants from across England (the target based on power analysis was 994), of whom 827 (80.8%) identified as White British, 811 (79.3%) were female, 586 (57.3%) were employed, and 272 (26.6%) were unemployed. Their mean age was 38.4±13.6 years. Mood and/or anxiety disorders (N=626, 61.2%) and stress-related disorders (N=152, 14.9%) were the most common mental health problems. At week 52, our intention-to-treat analysis found a significant baseline-adjusted difference of 0.13 (95% CI: 0.01-0.26, p=0.041) in the MANSA score between the intervention and control groups, corresponding to a mean change of 1.56 scale points per participant, which indicates that the intervention increased quality of life. We also detected a significant baseline-adjusted difference of 0.22 (95% CI: 0.05-0.40, p=0.014) between the groups in the score on the “presence of meaning” subscale of the Meaning in Life Questionnaire, corresponding to a mean change of 1.1 scale points per participant. We found an incremental gain of 0.0142 quality-adjusted life years (QALYs) (95% credible interval: 0.0059 to 0.0226) and a £178 incremental increase in cost (95% credible interval: –£154 to £455) per participant, generating an incremental cost-effectiveness ratio of £12,526 per QALY compared with usual care. This was lower than the £20,000 per QALY threshold used by the National Health Service in England, indicating that the intervention would be a cost-effective use of health service resources. In the subgroup analysis including participants who had used specialist mental health services at baseline, the intervention both reduced cost (–£98, 95% credible interval: –£606 to £309) and improved QALYs (0.0165, 95% credible interval: 0.0057 to 0.0273) per participant as compared to usual care. We conclude that the NEON Intervention is an effective and cost-effective new intervention for people experiencing non-psychotic mental health problem.

iv)  Hultman, L. & Hultman, M. (2023) “Believe me, only I know how I feel.” An autoethnographic account of experiences of epistemic injustice in mental health care. Front. Psychiatry, 14:1058422.
https://doi.org/10.3389/fpsyt.2023.1058422

Abstract
In Sweden, support and service for people with disabilities is provided under the Swedish disability legislation, which has a clear focus on the individual’s right to a life like that of any other citizen and on promoting equality and participation in society. Nevertheless, having a physical impairment makes it clear that equal mental health care is not provided in practice. This becomes particularly salient when there is a need for mental health in-patient care. In this article, the aim is to explore our own experiences of epistemic injustice in relation to mental health care provision in a situation where one of us has a mobility impairment that require the presence of personal assistants in everyday life. Critical personal narrative is applied to highlight the different, but intertwined experiences of a young female mental health user with a physical disability and her mother. Diary entrances, shared discussions and extracts from health care records are used to illustrate how epistemic injustice may occur in health care practices. In the analysis, we use Fricker’s concepts that relate to different aspects of epistemic injustice, to show how power is exerted. Healthcare professionals’ inability to value and integrate patients experience-based knowledge into practice where the lack of a holistic perspective visualizes what happens when people do not fit into predefined categories. Instead of strengthening patients’ rights, health care professionals discredit patients’ and family members knowledge, and thereby giving themselves epistemic privilege. People with the combined experience of both disabilities and mental health issues are vulnerable to epistemic injustice and epistemic harm since they are commonly denied both epistemic credibility and authority. Our results highlight the importance of counteracting resilient structures of social privilege and power and identifying and, in as far as possible, removing the mechanisms that exclude the epistemic resources of people with disabilities and their family members from being part of shared epistemic resources.

 

v)  Wang, L., Norman, I., Edleston, V., Oyo, C. & Leamy, M. (2024) The effectiveness and implementation of psychological first aid as a therapeutic intervention after trauma: An integrative review. Trauma Violence and Abuse, 28:15248380231221492
https://doi.org/10.1177/15248380231221492

Abstract
Psychological First Aid (PFA) is known to be an initial early intervention following traumatic exposure, yet little is known about its optimal implementation and effectiveness. This review aims to examine the evidence for the effectiveness of PFA interventions and how PFA interventions have been designed, implemented, and experienced. MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsychINFO, Embase, Web of Science, PILOTS, and China National Knowledge Infrastructure (in Chinese) databases were searched. Twenty studies from 4,735 records were included and quality rated, followed by an integrative synthesis of quantitative and qualitative evidence. PFA intervention following trauma exposure shows a positive effect for reducing anxiety and facilitating adaptive functioning in the immediate and intermediate term, yet the evidence for reducing post-traumatic stress disorder/depressive symptoms is less compelling. Furthermore, commonalities in the components and techniques across different PFA approaches identified tend to align with four of Hobfoll’s five essential elements: safety, calm, efficacy, and connectedness (as reflected among 7/11 PFA protocols), whereas the “hope” element was less developed. These commonalities include active listening, relaxation/stabilization, problem-solving/practical assistance, and social connection/referral. Intensive techniques such as cognitive reconstruction have also been incorporated, intensifying PFA delivery. The substantial variation observed in PFA format, timing, and duration, coupled with inadequate documentation of fidelity of implementation and adaptation, further constrains the ability to inform best practices for PFA. This is concerning for lay frontline providers, vital in early trauma response, who report implementation challenges despite valuing PFA as a time-sensitive, supportive, and practical approach.

 

vi)  Smit, D., Miguel, C., Vrijsen, J. N., Groeneweg, B., Spijker, J. & Cuijpers, P. (2023) The effectiveness of peer support for individuals with mental illness: systematic review and meta-analysis. Psychological Medicine, 53(11), 5332-5341
https://doi.org/10.1017/S0033291722002422

Abstract
Background:  The benefits of peer support interventions (PSIs) for individuals with mental illness are not well known. The aim of this systematic review and meta-analysis was to assess the effectiveness of PSIs for individuals with mental illness for clinical, personal, and functional recovery outcomes.
Methods: Searches were conducted in PubMed, Embase, and PsycINFO (December 18, 2020). Included were randomized controlled trials (RCTs) comparing peer-delivered PSIs to control conditions. The quality of records was assessed using the Cochrane Collaboration Risk of Bias tool. Data were pooled for each outcome, using random-effects models.
Results:  After screening 3455 records, 30 RCTs were included in the systematic review and 28 were meta-analysed (4152 individuals). Compared to control conditions, peer support was associated with small but significant post-test effect sizes for clinical recovery, g = 0.19, 95% CI (0.11–0.27), I2 = 10%, 95% CI (0–44), and personal recovery, g = 0.15, 95% CI (0.04–0.27), I2 = 43%, 95% CI (1–67), but not for functional recovery, g = 0.08, 95% CI (−0.02 to 0.18), I2 = 36%, 95% CI (0–61). Our findings should be considered with caution due to the modest quality of the included studies.
Conclusions:  PSIs may be effective for the clinical and personal recovery of mental illness.  Effects are modest, though consistent, suggesting potential efficacy for PSI across a wide range of mental disorders and intervention types.

vii)  Mossa, A. (2023) Beyond the asylum. Looking back to move forward: The case of the metropolitan area of Turin, Italy.  Area, 0:0
https://doi.org/10.1111/area.12912

Abstract
My research is situated within the literature looking at the processes of deinstitutionalisation of the mental health system through the lived geographies placed in between the walls of the asylum. It addresses mental health geographers’ call for a situated knowledge about mental health and, by using the Italian psychiatric experience of the 1960s and 1970s as an example, stresses the importance of looking at care in both spatial and relational terms. Through a geographical understanding of the Italian psychiatric reform, that goes from Franco Basaglia’s renowned work to the underrepresented experience of Turin, in northwest Italy, I will examine how space is intertwined with processes of mental health care. Additionally, I assess the role played by the interaction between spatial and relational elements in potentially enabling patients’ self-determination, empowerment and inclusion. The case of Turin—the story of which will be told through the analysis of archival material from a grassroots association called Associazione per la Lotta contro le Malattie Mentali—will serve to expand the common narrative around the Italian lesson and to give resonance to the instrumental role played at the time by both patients and civil society. By looking at the key events that led to the gradual dismantlement of the traditional psychiatric institutions in the metropolitan area of Turin, this paper contributes to the spatial turn in mental health studies, calling upon researchers to look at past achievements as something we still need to learn from and safeguard.

viii)  Haylor, H., Sparkes, T., Armitage, G., Dawson-Jones, M., Double, K. & Edwards, L. (2024)  The process and perspective of serious incident investigations in adult community mental health services: integrative review and synthesis.  BJPsych Bulletin, 1-13.
https://doi.org/10.1192/bjb.2023.98

Abstract
Aims and method:  Serious incident management and organisational learning are international patient safety priorities. Little is known about the quality of suicide investigations and, in turn, the potential for organisational learning. Suicide risk assessment is acknowledged as a complex phenomenon, particularly in the context of adult community mental health services. Root cause analysis (RCA) is the dominant investigative approach, although the evidence base underpinning RCA is contested, with little attention paid to the patient in context and their cumulative risk over time. Results:  Recent literature proposes a Safety-II approach in response to the limitations of RCA. The importance of applying these approaches within a mental healthcare system that advocates a zero suicide framework, grounded in a restorative just culture, is highlighted.
Clinical implications:  Although integrative reviews and syntheses have clear methodological limitations, this approach facilitates the management of a disparate body of work to advance a critical understanding of patient safety in adult community mental healthcare.

ix)  The Refugee Council, Helen Bamber Foundation & Humans for Rights Network (2024) Forced Adulthood: The Home Office’s incorrect determination of age and how this leaves child refugees at risk.  London, The Refugee Council.

A new report from the above authors claims that children seeking asylum in the UK are being placed in unsupervised adult accommodation, leaving them vulnerable and at risk.  The following is taken from the introduction to the executive summary of the report.

Executive Summary
Hundreds of children seeking asylum in the UK are being incorrectly assessed by the Home Office using a short visual assessment shortly after their arrival. This flawed decision-making process results in children being placed in unsupervised adult accommodation and immigration detention, exposing them to significant risks and potential harm. This joint report by the Helen Bamber Foundation, Humans for Rights Network and the Refugee Council provides updated evidence of the Home Office improperly treating large numbers of children seeking asylum as adults upon arrival in the UK.
The report is available here.

x)  Hoppen, T. H., Meiser-Stedman, R., Kip, A., Birkeland, M. S. & Morina, N. (2024) The efficacy of psychological interventions for adult post-traumatic stress disorder following exposure to single versus multiple traumatic events: a meta-analysis of randomised controlled trials. The Lancet Psychiatry, 11(2), 112-122,

Abstract
Background:  Previous meta-analyses of psychological interventions for adult post-traumatic stress disorder (PTSD) did not investigate whether efficacy is diminished in individuals with PTSD related to multiple (vs single) traumatic events. We aimed to assess whether treatment efficacy would be lower in randomised controlled trials involving multiple-event-related PTSD versus single-event-related PTSD.
Methods:  For this meta-analysis, we searched PsycINFO, MEDLINE, Web of Science, and PTSDpubs from database inception to April 18, 2023. Randomised controlled trials involving adult clinical samples (≥70% meeting full PTSD criteria) with adequate size (≥10 participants per arm) were included. We extracted data on trial characteristics, demographics, and outcome data. Random-effects meta-analyses were run to summarise standardised mean differences (Hedges’ g). Trials involving 100% of participants with single-event-related PTSD versus at least 50% of participants with multiple-event-related PTSD (ie, associated with ≥two traumatic events) were categorised. Quality of evidence was assessed using the Cochrane criteria. The review protocol was registered in PROSPERO (CRD42023407754).
Findings:  Overall, 137 (85%) of 161 randomised controlled trials were included in the quantitative synthesis, comprising 10 684 participants with baseline data and 9477 with post-treatment data. Of those randomly assigned, 5772 (54%) of 10 692 participants identified as female, 4917 (46%) as male, and three (<1%) as transgender or other. 34 (25%) of 137 trials exclusively involved women, 15 (11%) trials exclusively involved men, and the remainder were mixed samples. Mean age across the trials was 40·2 years (SD 9·0) ranging from 18·0 years to 65·4 years. 23 (17%) of 137 trials involved participants from low-income and middle-income countries (23 [17%] of 137). Data on ethnicity were not extracted. At treatment endpoint, psychological interventions were highly effective for PTSD when compared with passive control conditions in both samples with single-event-related PTSD (Hedges’ g 1·04 [95% CI 0·77–1·31]; n=11; I2=43%) and multiple-event-related PTSD (Hedges’ g 1·13 [0·90–1·35]; n=55, I2=87%), with no efficacy difference between these categories (p=0·48). Heterogeneity between studies was substantial but outlier-corrected analysis yielded similar results. Moderate-sized effects were found compared with active control conditions with no significant difference between single-trauma and multiple-trauma trials. Results were robust in various sensitivity analyses (eg, 90% cut-off for multiple-trauma trials) and analyses of follow-up data. The quality of evidence was moderate to high.
Interpretation:  Contrary to our hypothesis, we found strong evidence that psychological interventions are highly effective treatments for PTSD in patients with a history of multiple traumatic events. Results are encouraging for clinical practice and could counteract common misconceptions regarding treatment and treatment barriers.

Other News /Resources
i)  Out of the School of Health Sciences, at the University of Nottingham, Dr Fiona Ng writes:

Interested in doing a funded PhD in mental health?
I am looking for a motivated health professional (medic, clin psych, nurse, etc) with an interest in explanatory models in psychosis and posttraumatic growth to do a Ph.D. with me and Prof Mike Slade starting in Oct 2024.

The Ph.D. will be based in the Recovery Research Team at Institute of Mental Health/School of Health Sciences at the University of Nottingham. Funded through the Midlands Mental Health and Neurosciences Ph.D. Programme for Healthcare Professionals, this interdisciplinary Ph.D. will be of interest to health professionals with an interest in theoretical and translational research. Public involvement/lived experience perspectives are core to this Ph.D.

For more information: http://midlandsmhndtp.ac.uk/project/2024-fiona-ng-project

Benefits include:
💳NHS salary for 3 years
🎓Home (UK) fees covered
✈️Generous research, travel, and training costs
👩‍⚕️ Continue with 0.2 FTE clinical work to maintain clinical skills

Applications close 12th April 2024. Feel free to email me to chat about ideas: fiona.ng@nottingham.ac.u

ii)  From the Institute of Mental Health at the University of Nottingham, Dr Olamide Todowede introduces herself and outlines a request for people to take part in the following study:
Room D19, Institute of Mental Health

My name is Olamide Todowede, and I work with Mike Slade on the Citizen Science mental health (C-STACS) study.

We have developed a mental health citizen science project. The project seeks to understand the common self-management approaches that people use to manage their mental health challenges and keep well. People with lived experience of mental health have listed the self-strategies that they commonly use to manage their mental health.   We want to extend this list and also know how common this list we have generated is being used among the populations. Therefore, we are looking for people to assist in classifying (to select based on lived experience or experiences of people around you) how these individuals have told us they manage their mental health challenges and keep well. To take part by clicking on this link: bit.ly/3GpYcLk or scan the study QR code;

By exploring the project in more detail on the project page, on the top right corner, click on the Classify button and you will be able to participate in the study. More information about the study can be found in the About session.

Regards, Olamide

 

ii) 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