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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

February 2024

Recovery Research Network eBULLETIN

February 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

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.

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)  Brinchmann, B., Wittlund, S., Lorentzen, T., Moe, C., McDaid, D., Killackey, E., Rinaldi, M., & Mykletun, A. (2024) The societal impact of individual placement and support implementation on employment outcomes for young adults receiving temporary health-related welfare benefits: a difference-in-differences study. Psychological Medicine, 1-9.
https://doi.org/doi:10.1017/S0033291723003744

Abstract
Background: Individual placement and support (IPS) is an evidence-based practice that helps individuals with mental illness gain and retain employment. IPS was implemented for young adults at a municipality level through a cross-sectoral collaboration between specialist mental healthcare, primary mental healthcare, and the government funded employment service (NAV). We investigated whether IPS implementation had a causal effect on employment outcomes for all young adults in receipt of a temporary health-related rehabilitation (work assessment allowance, WAA) welfare benefit, measured at the societal level compared to municipalities that did not implement IPS.
Method: We used a difference in differences design to estimate the effects of IPS implementation on the outcome of workdays per year using longitudinal registry data. We estimate the average effect of being exposed to IPS implementation during four-years of implementation compared to ten control municipalities without IPS for all WAA recipients.
Results: We found a significant, positive, causal effect on societal level employment outcomes of 5.6 (p = 0.001, 95% CI 2.7–8.4) increased workdays per year per individual, equivalent to 12.7 years of increased work in the municipality where IPS was implemented compared to municipalities without IPS. Three years after initial exposure to IPS implementation individuals worked, on average, 10.5 more days per year equating to 23.8 years of increased work.
Conclusions: Implementing IPS as a cross sectoral collaboration at a municipality level has a significant, positive, causal, societal impact on employment outcomes for all young adults in receipt of a temporary health-related rehabilitation welfare benefit.

ii)  Winter, D. A., Hammoud, R., Todorova, I. & Cipolletta, S. (2024) Construing the COVID-19 Pandemic in the UK: A qualitative study.  Journal of Constructivist Psychology.
https://doi.org/10.1080/10720537.2023.2300058

Abstract
The COVID-19 pandemic and measures used to contain it have had a significant psychosocial impact. This paper reports a study of its psychological effects in 108 UK residents who completed an online survey between the first and second waves of the pandemic asking them to describe the main difficulties that they experienced and how they coped with these, what they had learnt from the pandemic, and their anticipations of a post-pandemic future. Deductive thematic content analysis of the results in terms of diagnostic constructs of personal construct psychology identified overarching themes of transitions, with themes of anxiety, threat, loss of role, sadness, contempt, and stress; strategies, with themes of constriction, hostility, and individual coping strategies; reconstruction, including revision of superordinate constructs, revision of subordinate constructs, and no reconstruction; and anticipations, with themes of recovery of certainty and structure, constriction, dilation, aggression, and no anticipation. Two contrasting patterns were observed, one characterized by failure to reconstrue, hostility, and/or constriction, and the other by revision of superordinate constructs, dilation, and/or aggression.

iii)  Ali, Y., Rennick-Egglestone, S., Llewellyn-Beardsley, J., Ng, F., Yeo, C., Franklin, D., Perez Vallejos, E., Ben-Zeev, D., Kotera, Y. & Slade, M. (2024) Perception and appropriation of a web-based recovery narratives intervention: qualitative interview study. Frontiers in Digital Health, 6:1297935.
https://doi.org/10.3389/fdgth.2024.1297935

Abstract
Introduction:  Mental health recovery narratives are widely available to the public, and can benefit people affected by mental health problems. The NEON Intervention is a novel web-based digital health intervention providing access to the NEON Collection of recovery narratives. The NEON Intervention was found to be effective and cost-effective in the NEON-O Trial for people with non-psychosis mental health problems (ISRCTN63197153), and has also been evaluated in the NEON Trial for people with psychosis experience (ISRCTN11152837). We aimed to document NEON Intervention experiences, through an integrated process evaluation.
Methods:  Analysis of interviews with a purposive sample of intervention arm participants who had completed trial participation.
Results:  We interviewed 34 NEON Trial and 20 NEON-O Trial participants (mean age 40.4 years). Some users accessed narratives through the NEON Intervention almost daily, whilst others used it infrequently or not at all. Motivations for trial participation included: exploring the NEON Intervention as an alternative or addition to existing mental health provision; searching for answers about mental health experiences; developing their practice as a mental health professional (for a subset who were mental health professionals); claiming payment vouchers. High users (10 + narrative accesses) described three forms of appropriation: distracting from difficult mental health experiences; providing an emotional boost; sustaining a sense of having a social support network. Most participants valued the scale of the NEON Collection (n = 659 narratives), but some found it overwhelming. Many felt they could describe the characteristics of a desired narrative that would benefit their mental health. Finding a narrative meeting their desires enhanced engagement, but not finding one reduced engagement. Narratives in the NEON Collection were perceived as authentic if they acknowledged the difficult reality of mental health experiences, appeared to describe real world experiences, and described mental health experiences similar to those of the participant.
Discussion: We present recommendations for digital health interventions incorporating collections of digital narratives: (1) make the scale and diversity of the collection visible; (2) provide delivery mechanisms that afford appropriation; (3) enable contributors to produce authentic narratives; (4) enable learning by healthcare professionals; (5) consider use to address loneliness.

iv)  Fox, J. (2024) Autoethnographic reflections on mental distress and medication management: Conceptualising biomedical and recovery models of mental health. Community Mental Health Journal.
https://doi.org/10.1007/s10597-024-01230-5

Abstract
This article uses autoethnography to explore the author’s lived experiences of mental distress and how she has conceptualised and explained these symptoms to herself using both the biomedical and recovery models of care. Autoethnography is a process of personal reflection that enables connection between the personal and the political. Experiences of mental distress are recounted alongside the decision to reduce medication. This personal experience is then explored in the context of limited evidence base on the effectiveness of reducing medication and the situation in which prescribers often feel reluctant to recommend and support service users in these choices. Shared decision-making in medication management is introduced which is an approach which draws on the models of recovery and co-production challenging traditional biomedical approaches which locate the prescriber as expert. Moreover, the radical service user led model is highlighted, within which, the Hearing Voices Network and Open Dialogue offer alternative approaches which promote co-production and empowerment. The author connects the personal to the political and reflects on her dual identity as an expert-by-experience and social work academic. She details how she has drawn on biomedical explanations to describe her distress yet has been challenged by the recovery model throughout her journey of recovery. She concludes that her own position, in identifying herself as an academic and expert-by-experience is an important step in challenging notions of expertise and approaches to mental health care.

v)  The Lancet (2024). Editorial:  Severe mental illness in the UK: a crisis of compassion.  The Lancet, 403(10427), 587.
https://doi.org/10.1016/S0140-6736(24)00308-8

Balanced against a range of contemporary mental health awareness campaigns, and in recognition of the recent media reporting of the Valdo Calocane case, this editorial from the Lancet reasserts timely questions about how we treat some of the most vulnerable people within the UK.  Commentary is contextualised with reference to the Lancet’s Commission on ending stigma and discrimination in mental health  published in October 2022.

vi)  Jeffery, A., Gascoigne, C., Dykxhoorn, J., Blangiardo, M., Geneletti, S., Baio, G. & Kirkbride, J. K. (2024) The effect of immigration policy reform on mental health in people from minoritised ethnic groups in England: An interrupted time series analysis of longitudinal data from the UK Household Longitudinal Study cohort.  Lancet Psychiatry, 11(3), 183–92.
https://doi.org/10.1016/S2215-0366(23)00412-1

Abstract
Background:  In 2012, the UK Government announced a series of immigration policy reforms known as the hostile environment policy, culminating in the Windrush scandal. We aimed to investigate the effect of the hostile environment policy on mental health for people from minoritised ethnic backgrounds. We hypothesised that people from Black Caribbean backgrounds would have worse mental health relative to people from White ethnic backgrounds after the Immigration Act 2014 and the Windrush scandal media coverage in 2017, since they were particularly targeted.
Methods:  Using data from the UK Household Longitudinal Study, we performed a Bayesian interrupted time series analysis, accounting for fixed effects of confounders (sex, age, urbanicity, relationship status, number of children, education, physical or mental health impairment, housing, deprivation, employment, place of birth, income, and time), and random effects for residual temporal and spatial variation. We measured mental ill health using a widely used, self-administered questionnaire on psychological distress, the 12-item General Health Questionnaire (GHQ-12). We compared mean differences (MDs) and 95% credible intervals (CrIs) in mental ill health among people from minoritised ethnic groups (Black Caribbean, Black African, Indian, Bangladeshi, and Pakistani) relative to people of White ethnicity during three time periods: before the Immigration Act 2014, after the Immigration Act 2014, and after the start of the Windrush scandal media coverage in 2017.
Findings:  We included 58 087 participants with a mean age of 45·0 years (SD 34·6; range 16–106), including 31 168 (53·6%) female and 26 919 (46·3%) male participants. The cohort consisted of individuals from the following ethnic backgrounds: 2519 (4·3%) Black African, 2197 (3·8%) Black Caribbean, 3153 (5·4%) Indian, 1584 (2·7%) Bangladeshi, 2801 (4·8%) Pakistani, and 45 833 (78·9%) White. People from Black Caribbean backgrounds had worse mental health than people of White ethnicity after the Immigration Act 2014 (MD in GHQ-12 score 0·67 [95% CrI 0·06–1·28]) and after the 2017 media coverage (1·28 [0·34–2·21]). For Black Caribbean participants born outside of the UK, mental health worsened after the Immigration Act 2014 (1·25 [0·11–2·38]), and for those born in the UK, mental health worsened after the 2017 media coverage (2·00 [0·84–3·15]). We did not observe effects in other minoritised ethnic groups.
Interpretation:  Our finding that the hostile environment policy worsened the mental health of people from Black Caribbean backgrounds in the UK suggests that sufficient, appropriate mental health and social welfare support should be provided to those affected. Impact assessments of new policies on minority mental health should be embedded in all policy making.

vii)  Griffiths, C., Walker, K. & Willis, A. (2024) A Qualitative Study Exploring the Experience and Value of Flow Transcranial Direct Current Stimulation (tDCS) and Behaviour Therapy Training Software Used at Home for Community Mental Health Team (CMHT) Patients with Symptoms of Depression. Open Journal of Depression, 13, 6-23.
https://doi.org/10.4236/ojd.2024.131002.

Abstract
Background: Flow FL-100 is a self-administered transcranial direct current stimulation (tDCS) device with evidence of effectiveness in treating symptoms of depression. The Flow intervention also provides access to software application delivered wellbeing behaviour therapy training. Flow was offered by a community mental health team (CMHT) to those who experienced depressive symptoms. Participants completed six weeks use of Flow. This study explored participants’ experiences and views on feasibility, acceptability, useability, and value of Flow.
Methods: A qualitative methodological approach was employed, involving in-depth semi-structured interviews. Interpretative Phenomenological Analysis (IPA) was applied. Out of a sample of 27 participants using Flow, 14 participants, seven females and seven males consented to be interviewed. The age range was 21 – 63 years (M = 40.21, SD = 13.99). Results: There was support for the feasibility, acceptability, useability and value of Flow. Most participants used Flow as per standard protocol and described a positive impact on depressive symptoms, mood, motivation, and functioning.
Conclusion: Flow has been successfully integrated into a CMHT depression treatment. It is important to offer CMHT patients an evidenced-backed alternative to existing depression treatments (anti-depressant medication and psychotherapies). The results support the use of Flow as a treatment option for CMHT patients with symptoms of depression.

viii)  Cooper, R. E., Saunders, K. R. K., Greenburgh, A., Shah, P., Appleton, R., Machin, K., Jeynes, T., Barnett, P., Allan, S. M., Griffiths, J., Stuart, R., Mitchell, L., Chipp, B., Jeffreys, S., Lloyd-Evans, B., Simpson A. & Johnson, S. (2024) The effectiveness, implementation, and experiences of peer support approaches for mental health: a systematic umbrella review. BMC Med, 22(72).
https://doi.org/10.1186/s12916-024-03260-y

Abstract
Background:  Peer support for mental health is recommended across international policy guidance and provision. Our systematic umbrella review summarises evidence on the effectiveness, implementation, and experiences of paid peer support approaches for mental health.
Methods:  We searched MEDLINE, EMBASE, PsycINFO, The Campbell Collaboration, and The Cochrane Database of Systematic Reviews (2012–2022) for reviews of paid peer support interventions for mental health. The AMSTAR2 assessed quality. Results were synthesised narratively, with implementation reported using the CFIR (Consolidated Framework for Implementation Research). The protocol was registered with PROSPERO (registration number: CRD42022362099).
Results:  We included 35 reviews (426 primary studies, n = 95–40,927 participants): systematic reviews with (n = 13) or without (n = 13) meta-analysis, or with qualitative synthesis (n = 3), scoping reviews (n = 6). Most reviews were low or critically low (97%) quality, one review was high quality. Effectiveness was investigated in 23 reviews. Results were mixed; there was some evidence from meta-analyses that peer support may improve depression symptoms (particularly perinatal depression), self-efficacy, and recovery. Factors promoting successful implementation, investigated in 9 reviews, included adequate training and supervision, a recovery-oriented workplace, strong leadership, and a supportive and trusting workplace culture with effective collaboration. Barriers included lack of time, resources and funding, and lack of recognised peer support worker (PSW) certification. Experiences of peer support were explored in 11 reviews, with 3 overarching themes: (i) what the PSW role can bring, including recovery and improved wellbeing for service users and PSWs; (ii) confusion over the PSW role, including role ambiguity and unclear boundaries; and (iii) organisational challenges and impact, including low pay, negative non-peer staff attitudes, and lack of support and training.
Conclusions:  Peer support may be effective at improving some clinical outcomes, self-efficacy, and recovery. Certain populations, e.g. perinatal populations, may especially benefit from peer support. Potential strategies to successfully implement PSWs include co-production, clearly defined PSW roles, a receptive hierarchical structure and staff, appropriate PSW and staff training with clinical and/or peer supervision alongside safeguarding. Services could benefit from clear, coproduced, setting specific implementation guidelines for PSW. PSW roles tend to be poorly defined and associations between PSW intervention content and impacts need further investigation. Future research should reflect the priorities of providers/service users involved in peer support.

ix)  Marshall, P., Barbrook, J., Collins, G., Foster, S., Glossop, Z., Inkster, C., Jebb, P., Johnston, R., Jones, S. H., Khan, H., Lodge, C., Machin, K., Michalak, E., Powell, S., Russell, S., Rycroft-Malone, J., Slade, M., Whittaker, L., & Lobban, F. (2024) Designing a Library of Lived Experience for Mental Health: integrated realist synthesis and experience-based co-design study in UK mental health services. BMJ Open, 14:e081188.
https://doi.org/10.1136/bmjopen-2023-081188

Abstract
Objective:  Living Library events involve people being trained as living ‘Books’, who then discuss aspects of their personal experiences in direct conversation with attendees, referred to as ‘Readers’. This study sought to generate a realist programme theory and a theory-informed implementation guide for a Library of Lived Experience for Mental Health (LoLEM).
Design:  Integrated realist synthesis and experience-based co-design.
Setting:  Ten online workshops with participants based in the North of England.
Participants:  Thirty-one participants with a combination of personal experience of using mental health services, caring for someone with mental health difficulties and/or working in mental health support roles.
Results:  Database searches identified 30 published and grey literature evidence sources which were integrated with data from 10 online co-design workshops conducted over 12 months. The analysis generated a programme theory comprising five context-mechanism-outcome (CMO) configurations. Findings highlight how establishing psychological safety is foundational to productive Living Library events (CMO 1). For Readers, direct conversations humanise others’ experiences (CMO 2) and provide the opportunity to flexibly explore new ways of living (CMO 3). Through participation in a Living Library, Books may experience personal empowerment (CMO 4), while the process of self-authoring and co-editing their story (CMO 5) can contribute to personal development. This programme theory informed the co-design of an implementation guide highlighting the importance of tailoring event design and participant support to the contexts in which LoLEM events are held.
Conclusions:  The LoLEM has appeal across stakeholder groups and can be applied flexibly in a range of mental health-related settings. Implementation and evaluation are required to better understand the positive and negative impacts on Books and Readers.

x)  Lases, M.N., Bruins, J., Ng, F., Rennick-Egglestone, S., Llewellyn-Beardsley, J., Slade, M. & Castelein, S. (2024) Feasibility, validity and reliability of the Dutch translation of INCRESE (INCRESE-NL) inventory to characterize mental health recovery narratives. Journal of Recovery in Mental Health, 7(1), 31–49.
https://doi.org/10.33137/jrmh.v7i1.39398

Abstract
Objective:  Methods for characterizing mental health recovery narratives are needed to enable the selection of helpful narratives which can support the recovery processes of other people. The Inventory of Characteristics of Recovery Stories (INCRESE) is an existing English-language tool to characterize recovery narratives, which is not available in Dutch. The aims of this study were to create a Dutch translation of INCRESE and to evaluate the feasibility of sustained and routine use, as well as its validity and reliability.
Research design and methods:  INCRESE was translated into Dutch (INCRESE-NL) using an established translation methodology. Six coders with different professional backgrounds rated 30 purposively selected Dutch narratives using INCRESE-NL and then completed an evaluation survey. Feasibility was assessed qualitatively and content validity both qualitatively and quantitatively. Gwet’s AC1 agreement coefficient was used to calculate intercoder reliability.
Results:  Coders evaluated INCRESE-NL as a suitable instrument to capture important characteristics of recovery narratives with an acceptable administrative burden. The content validity index was sufficient for 5/7 sections of INCRESE-NL. Most items were found to be clear and suitable for capturing the corresponding characteristic, although some missed strict coding rules or clear descriptions, especially in section 4 on narrative characteristics. Gwet’s AC1 could be calculated for 67/77 items, of which 62 scored sufficient and five scored below threshold. Gwet’s AC1 coefficients corresponded well with the original INCRESE Fleiss Kappa values.
Conclusions:  INCRESE-NL has sufficient feasibility, validity, and reliability and can be used to characterize Dutch recovery narratives.

xi)  Thomsen, D. K., Christensen, T. Ø., Hansen, M. T. & Slade, M. (2024). Mental health staff perspectives on personal recovery: A narrative study on positive professional impact of recovery-oriented care. Journal of Recovery in Mental Health, 7(1), 12–30. https://doi.org/10.33137/jrmh.v7i1.40671

Abstract
Objective:  Methods for characterizing mental health recovery narratives are needed to enable the selection of helpful narratives which can support the recovery processes of other people. The Inventory of Characteristics of Recovery Stories (INCRESE) is an existing English-language tool to characterize recovery narratives, which is not available in Dutch. The aims of this study were to create a Dutch translation of INCRESE and to evaluate the feasibility of sustained and routine use, as well as its validity and reliability.
Research design and methods:  INCRESE was translated into Dutch (INCRESE-NL) using an established translation methodology. Six coders with different professional backgrounds rated 30 purposively selected Dutch narratives using INCRESE-NL and then completed an evaluation survey. Feasibility was assessed qualitatively and content validity both qualitatively and quantitatively. Gwet’s AC1 agreement coefficient was used to calculate intercoder reliability.
Results:  Coders evaluated INCRESE-NL as a suitable instrument to capture important characteristics of recovery narratives with an acceptable administrative burden. The content validity index was sufficient for 5/7 sections of INCRESE-NL. Most items were found to be clear and suitable for capturing the corresponding characteristic, although some missed strict coding rules or clear descriptions, especially in section 4 on narrative characteristics. Gwet’s AC1 could be calculated for 67/77 items, of which 62 scored sufficient and five scored below threshold. Gwet’s AC1 coefficients corresponded well with the original INCRESE Fleiss Kappa values.
Conclusions:  INCRESE-NL has sufficient feasibility, validity, and reliability and can be used to characterize Dutch recovery narratives.

xi)  Thomsen, D. K., Christensen, T. Ø., Hansen, M. T. & Slade, M. (2024). Mental health staff perspectives on personal recovery: A narrative study on positive professional impact of recovery-oriented care. Journal of Recovery in Mental Health, 7(1), 12–30. https://doi.org/10.33137/jrmh.v7i1.40671

Abstract
Background:  Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries.
Method:  Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed.
Results:  397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions.
Discussion:  Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.

xiii)  Horowitz, M. & Taylor, D. (2024) The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs.  Wiley-Blackwell.

Both Dr. Horowitz and Prof. Taylor have lived experience of their own deprescribing, and the impact this has had on their lives.  Indeed, Dr Horowitz was the subject of a recent article written by Charlotte Lytton in The Times in February this year.  A link to the article, via ‘Mad in America’ is available here.  The following narrative is taken from the publisher’s flyer:

Comprehensive resource describing guidelines for safely reducing or stopping (deprescribing) antidepressants, benzodiazepines, gabapentinoids and z-drugs for patients, including step-by-step guidance for all commonly used medications, covering common pitfalls, troubleshooting, supportive strategies, and more.

Most formal guidance on psychiatric medication relates to starting or switching medications with minimal guidance on deprescribing medication. In 2023, the World Health Organisation and the United Nations called for patients, as a human right, to be informed of their right to discontinue treatment and to receive support to do so.

The Maudsley Deprescribing Guidelines fills a significant gap in guidance for clinicians by providing comprehensive and authoritative information on this important aspect of treatment.

This evidence-based handbook provides an overview of principles to be used in deprescribing. This is derived from fundamental scientific principles and the latest research on this topic, combined with emerging insights from clinical practice (including from patient experts).

Building on the recognised brand of The Maudsley Prescribing Guidelines, and the prominence of the authors’ work, including in The Lancet Psychiatry on tapering antidepressants (the most read article across all Lancet titles when it was released). The Maudsley Deprescribing Guidelines covers topics such as:

  • Why and when to deprescribe antidepressants, benzodiazepines, gabapentinoids and z-drugs.
  • Barriers and enablers to deprescribing including physical dependence, social circumstances, and knowledge about the discontinuation process.
  • Distinguishing withdrawal symptoms, such as poor mood, anxiety, insomnia, and a variety of physical symptoms from symptoms of the underlying disorder that medication was intended to treat.
  • The difference between physical dependence and addiction/substance use disorder.
  • Explanation of why and how to implement hyperbolic tapering in clinical practice.
  • Specific guidance on formulations of medication and techniques for making gradual reductions, including using liquid forms of medication, and other approaches.
  • Step-by-step guidance for safely stopping all commonly used antidepressants, benzodiazepines, gabapentinoids and z-drugs, including fast, moderate and slow tapering regimens or schedules for each drug, and guidance on how to tailor these to an individual.
  • Troubleshooting issues which can arise on stopping these medications, including akathisia, withdrawal symptoms, acute or protracted, and relapse.

Written for anyone interested in safe deprescribing of psychiatric medications including psychiatrists, GPs, pharmacists, nurses, medical trainees, and interested members of the public. The Maudsley Deprescribing Guidelines is an essential resource on the subject that provides practical guidance on how to improve patient outcomes in this field of medicine.

xiv)  Pryer, S., Davies, K. & Hislop, K. (2023) The connected lives we live: Autoethnographic accounts of disability, mental Illness and power. The British Journal of Social Work, 53(3), 1525–1543.
https://doi.org/10.1093/bjsw/bcac211

Abstract
In this article, we use a collaborative approach to autoethnography to explore experiences of power in relation to our identities as people with disabilities and/or mental illnesses. We draw on elements of Bronfenbrenner’s ecological systems framework to consider how we enact our own power or struggle against systemic power in making meaning of our lives. As a team of lived experience researchers we wrote, shared and thematically analysed a series of narratives about our personal (microsystem) and institutional (macrosystem) relationships. Through this research process we were able to identify common experiences of being resilient in the face of institutions that dehumanised and problematised us and tried to render us voiceless – exerting ‘power over’. In contrast, reflections on our personal relationships highlighted experiences of reciprocity, respect and autonomy that energised our efforts towards meaningful and powerful identities – power with’. We conclude that by generating strength through our own advocacy, perseverance and caring relationships, we engage dynamics (mesosystem) of empowerment and identity to resist oppressive power at structural levels. This exemplifies the importance of person-centred social work premised on self-determination, autonomy and dignity, and socially just social work that advocates for equitability and fights structural discrimination.

 

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

iii)  Out of the Violence, Abuse and Mental Health Network (VAMHN) Fischer et al (n.d.) produce an infographic entitled: Learning from the voices of wisdom: Understanding & exploring the impacts of violence.  The infographic is reproduced below and represents an assertion of what is important to the Survivor Panel.

 

 iv) 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 2024

Recovery Research Network eBULLETIN

March 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:  4 – 6 July 2024.  Following an associated French-speaking conference on 3 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

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 5 – 8,  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.

For more information, please see here.

 

iii)  Westminster Health Forum policy conference:
Next steps for long COVID care and research in England
Timing: Morning, Tuesday, 21st May 2024                          ***Taking Place Online***

This conference will discuss next steps for long COVID care and research in England.

For more information including a draft agenda, keynote/speakers and how to book onto the conference see here.

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)  Lorien, L. M., Arthur, M., Keiler, K., Lowry, J. & Ryan, K. (2024) Recovery-oriented practice in a hospital mental health service.  International Journal of Mental Health Nursing,
https://doi.org/10.1111/inm.13316

Abstract
As part of mental health reform in Australia, new policies were introduced to support recovery-oriented practice; however, little has changed in hospital settings focused on managing risk and remediating acute symptoms. Previous studies have indicated that patients’ experiences of personal recovery, during a hospital admission, may not mirror that of people living in the community, with patients being more likely to experience disconnection, hopelessness and disempowerment. Using a Participatory Health Research approach, eight mental health professionals, a patient advocate and an external researcher formed a research partnership to answer the question: How can staff enhance recovery-oriented practice in a hospital-based mental health service? The COREQ checklist was used for reporting the methods, analysis and findings. The methods comprised patient focus groups (n = 16 participants), interviews with managers (n = 7) and an online survey for staff (n = 17). Researchers analysed the feedback from the consultations using inductive thematic analysis, identifying two themes: relational recovery and recovery interventions. The findings indicate that relational recovery is key to recovery during a hospital admission and interventions that increase connectedness or reduce the impact of symptoms enhance personal recovery.

 

ii)  Johansson, J. A., & Holmes, D. (2023). “Recovery” in mental health services, now and then: A poststructuralist examination of the despotic State machine’s effects. Nursing Inquiry, 31, e12558.
https://doi.org/10.1111/nin.12558

Abstract
Recovery is a model of care in (forensic) mental health settings across Western nations that aims to move past the paternalistic and punitive models of institutional care of the 20th century  toward more patient-centered approaches. But as we argue in this paper, the recovery-oriented services that evolved out of the early stages of this liberating movement signalled a shift in nursing practices that cannot be viewed only as improvements. In effect, as “recovery” nursing practices became more established, more codified, and more institutional(ized), a stasis developed. Recovery had been reterritorialized. The purpose of this paper is to examine some of the threads of recovery, from its early days of antipsychiatry activism to its codification into mental health—including forensic mental health—institutions through the lens of poststructuralist philosophers Gilles Deleuze and Felix Guattari. We believe that Deleuze and Guattari’s scholarship provides the necessary, albeit uncomfortable, framework for this critical examination. From a conceptualization of recovery as an assemblage, we critically examine how we can go about creating something new, caught in a tension between stasis and change.

 

iii)  Kirkegaard Thomsen, D., Østergaard Christensen, T., Tranberg Hansen, M. & Slade, M. (2024). Mental Health Staff Perspectives on Personal Recovery: A Narrative Study on Positive Professional Impact of Recovery-Oriented Care. Journal of Recovery in Mental Health, 7(1), 12–30.
https://doi.org/10.33137/jrmh.v7i1.40671

Abstract
Objectives:  Mental health staff play an important role in facilitating personal recovery. We examined how mental health staff perceived personal recovery and the professional and personal benefits of their experience with supporting the personal recovery of service users.
Research Design and Methods:  Forty-eight mental health staff wrote a narrative about a service user with severe mental illness that they believed to be in the process of personal recovery and elaborated on the impact of this professional experience. Interpretive phenomenological analysis was used to illuminate 1) staff conceptualizations of personal recovery, 2) professional contribution to recovery, and 3) positive impact of recovery-oriented care on staff.
Results:  Staff conceptualizations of recovery focused on social connections and positive subjective states, as well as symptom remission and illness management. Professional contributions were narrated as encompassing treatment, relationships, and conversations as well as time and team collaboration. Impact on the staff included strong positive emotions, professional gains with respect to learning and self-esteem, motivation for and meaning in work, as well as belief in recovery.
Conclusions:  This latter finding suggests that sharing narratives about service users in the process of personal recovery may increase work pleasure and help reduce burnout in mental health staff.

 

iv)  Poon, A. W. C., Hofstaetter, L., & Judd-Lam, S. (2024). Experiences of mental health carers examined using a recovery framework. Australian Social Work, 1–15. https://doi.org/10.1080/0312407X.2023.2298925

Abstract
Carers are a crucial support in the recovery of people with mental illness in the community. As they are often severely affected by the impact of mental illness of the person they care for, carers need to recover from the impact alongside the care recipient.  While mental health services focus on the recovery of people with mental illness, carers’ recovery is largely neglected. Using the CHIME (Connectedness, Hope and optimism about the future, Identity, Meaning in life and Empowerment) recovery framework, the authors of this study aimed to examine carers’ experiences and what they needed in their own recovery. A mixed methods approach was used to analyse the responses of 1,918 carers who completed the Australian 2020 National Carer Survey. Thematic analysis was used to identify themes regarding carers’ experiences against the elements of CHIME. Quantitative findings regarding subjective wellbeing and perception of support were used to complement the themes. Themes aligned with CHIME but indicated poor recovery. Recognition (R) was found to be an important recovery factor for carers. Without adequately addressing the needs and wellbeing of carers and giving due recognition for their contribution, carers have difficulty progressing in their own recovery. CHIME-R may be appropriate as a recovery framework for carers.

 

v)  Murphy, J., Mulcahy, H., Mahony, J. O., Bradley, S., & Ryan, D. (2024). Exploring individuals’ experiences of hope in mental health recovery: Having a sense of possibility. Journal of Psychiatric and Mental Health Nursing, 00, 1–11. https://doi.org/10.1111/jpm.13013

Abstract
Introduction: The experience of hope is widely acknowledged and empirically sup-ported as a key catalyst of mental health recovery. Lived experience accounts of hope are critical in accessing data on what has been termed a nebulous concept. This article is the second presentation of data from this study and provides further context to improve understanding of hope and optimise 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.
Results: This article explores the second of three experiential group themes: Hope as Having a sense of possibility ‘I will be ok’ which is informed by feeling safe and feeling connected.
Discussion: Having a sense of possibility is easier when basic needs are met and people feel connected to self, others and the universe. The use of creativity as a pathway to the imagination is positively experienced. The role of family, friends and health-care professionals as hope reservoirs is critical. Finally, the framing of medication use emerged as significant.
Implications for  Practice:  It is important that all stakeholders appreciate the interpretation of hope and use the understanding and skill in harnessing its therapeutic potential.

 

vi)  Gill, N., Drew, N., Rodrigues, M., Muhsen, H., Morales Cano, G., Savage, M., Pathare, S., Allan, J., Galderisi, S., Javed, A., Herrman, H. and Funk, M. (2024). Bringing together the World Health Organization’s Quality Rights initiative and the World Psychiatric Association’s programme on implementing alternatives to coercion in mental healthcare: a common goal for action. BJPsych Open. 2024;10(1):e23.
https://doi.org/10.1192/bjo.2023.622

Abstract
Background:  Stakeholders worldwide increasingly acknowledge the need to address coercive practices in mental healthcare. Options have been described and evaluated in several countries, as noted recently in major policy documents from the World Health Organization (WHO) and World Psychiatric Association (WPA). The WHO’s Quality Rights initiative promotes human rights and quality of care for persons with mental health conditions and psychosocial disabilities. A position statement from the WPA calls for implementation of alternatives to coercion in mental healthcare.
Aims:  We describe the engagement of both the WHO and WPA in this work. We discuss their mutual aim to support countries in improving human rights and quality of care, as well as the differences between these two organisations in their stated goals related to coercion in mental healthcare: the WHO’s approach to eliminate coercion and the WPA’s goal to implement alternatives to coercion.
Method:  We outline and critically analyse the common ground between the two organisations, which endorse a similar range of rights-based approaches to promoting non-coercive practices in service provision, including early intervention in prevention and care and other policy and practice changes.
Results:  Advocacy and action based on an agreed need to find practical solutions and advances in this area have the power to build consensus and unify key actors.
Conclusions:  We conclude that persons with lived experience, families, mental health professionals and policy makers are now coming together in several parts of the world to work toward the common goals of improving quality, promoting human rights and addressing coercion in mental health services.

 

vii)  Conneely, M., Roe, D., Hasson-Ohayon, I., Pijnenborg, G. H. M., van der Meer, L. & Spayer, H. (2024)  Antipsychotics and identity: The adverse effect no one is talking about. Community Mental Health Journal
https://doi-org.brad.idm.oclc.org/10.1007/s10597-024-01255-w

Abstract
People who take antipsychotics, and people who are prescribed antipsychotics without taking them, experience effects which are not frequently discussed: effects on their identity and sense of self. Qualitative research indicates the relationship between taking APs and identity is multi-layered, and changeable. Taking APs can restore people to their earlier, pre-symptom sense of self. Being prescribed and taking APs can also, on the other hand, be experienced as damaging, erasing and dulling people’s sense of who they are. This complexity deserves exploration in clinical practice, which we believe is currently not done routinely. More work is needed to understand whether, and how, the relationship between identity and APs is being addressed. We outline the importance of having discussions in a clinical space around identity, and a sense of agency, on the grounds that true recovery-oriented care, which enacts shared decision-making principles, demands it. Further, we argue that it will allow for better therapeutic alliance and trust to be forged between clinician and client, ultimately leading to better care.

 

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:

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

We have developed two mental health citizen science projects which we would like members to participate in. We’re also keen to hear from future collaborators interested in mental health citizen science – you can email me at:  olamide.todowede@nottingham.ac.uk

We know that many people are living with mental health challenges, but not seeking or receiving support from mental health services. We’ve created a survey to learn from UK residents about the strategies they use to manage mental health challenges. For project 1, people in the UK can complete a short survey (10 mins) at the following link https://www.healthresearch.study/participate/citizen-science/

For project 2, we are exploring how to transform mental health services and how best to support recovery for people with lived experience of mental health challenges. We want to get new ideas for what a better mental health system, or a more responsive mental health recovery society, can look like. We invite you to join us in imagining a more positive future for those of us in society who struggle with mental health difficulties, by writing short optimistic endings to 11 scenarios co-produced with the public. Take part here: https://www.researchintorecovery.com/citizen-science-envisioning-recovery-support/

Regards,

Olamide

 

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 2024

Recovery Research Network eBULLETIN

April 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) 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.

For more information, please see here.

ii) ENMESH – the European Network for Mental Health Service Evaluation, will be holding its 15th International Conference on:
Date:  4 – 6 July 2024.  Following an associated French-speaking conference on 3 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

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 5 – 8,  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.

For more information, please see here.

 

iii)  Westminster Health Forum policy conference:
Next steps for long COVID care and research in England
Timing: Morning, Tuesday, 21st May 2024                          ***Taking Place Online***

This conference will discuss next steps for long COVID care and research in England.

For more information including a draft agenda, keynote/speakers and how to book onto the conference see here.

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)  Hiltensperger, R., Ryan, G., Ben-Dor, I.A. et al. (2024) Implementation of peer support for people with severe mental health conditions in high-, middle- and low-income-countries: a theory of change approach. BMC Health Services Research 24(480) https://doi.org/10.1186/s12913-024-10990-5

Abstract
Background:  Stakeholder engagement is essential to the design, implementation and evaluation of complex mental health interventions like peer support. Theory of Change (ToC) is commonly used in global health research to help structure and promote stakeholder engagement throughout the project cycle. Stakeholder insights are especially important in the context of a multi-site trial, in which an intervention may need to be adapted for implementation across very different settings while maintaining fidelity to a core model. This paper describes the development of a ToC for a peer support intervention to be delivered to people with severe mental health conditions in five countries as part of the UPSIDES trial.
Methods:  One hundred thirty-four stakeholders from diverse backgrounds participated in a total of 17 workshops carried out at six UPSIDES implementing sites across high-, middle- and low-income settings (one site each in India, Israel, Uganda and Tanzania; two sites in Germany). The initial ToC maps created by stakeholders at each site were integrated into a cross-site ToC map, which was then revised to incorporate additional insights from the academic literature and updated iteratively through multiple rounds of feedback provided by the implementers.
Results:  The final ToC map divides the implementation of the UPSIDES peer support intervention into three main stages: preparation, implementation, and sustainability. The map also identifies three levels of actors involved in peer support: individuals (service users and peer support workers), organisations (and their staff members), and the public. In the UPSIDES trial, the ToC map proved especially helpful in characterising and distinguishing between (a) common features of peer support, (b) shared approaches to implementation and (c) informing adaptations to peer support or implementation to account for contextual differences.
Conclusions:  UPSIDES is the first project to develop a multi-national ToC for a mental health peer support intervention.  Stakeholder engagement in the ToC process helped to improve the cultural and contextual appropriateness of a complex intervention and ensure equivalence across sites for the purposes of a multi-site trial. It may serve as a blueprint for implementing similar interventions with a focus on recovery and social inclusion among people with mental ill-health across diverse settings.

ii)  Swords, C. & Houston, S. (2024) Service user perspectives on recovery: the construction of unfulfilled promises in mental health service delivery in Ireland.  The Journal of Mental Health Training, Education and Practice, 19(2), 96-107.
https://doi.org/10.1108/JMHTEP-11-2022-0090

Abstract
Purpose:  The concept of personal recovery is now a key pillar of service delivery. It aims to support individuals to flourish and establish a new identity following an acute episode or diagnosis. This view of recovery is unique to each person on that journey. However, there has been a significant focus on measuring these experiences. This paper aims to explore the influence of social constructionism on the concept of recovery within an Irish context, seeking to understand the influence of language, discourse and power on service users’ experiences.
Design/methodology/approach:  A qualitative, interpretivist methodology was adopted for this case study design. Semi-structured interviews were conducted with 12 service users. Thematic analysis was chosen as the method of analysis.
Findings:  Personalising recovery did not always lead to the removal of biological symptoms, but with the appropriate supports, individual’s recovery journey was greatly enhanced. On the contrary, personal recovery places overwhelmingly responsibility on the individual to succeed, largely driven by neoliberal discourse. This focus on individualism and the pressure to succeed was further experienced when people sought to re-integrate into society and participate in normalised social order. Ultimately, for many service users, they viewed personal recovery as an unfulfilled promise.
Research limitations/implications:  It is not a representative sample of service users within an Irish context.
Originality/value:  To the best of the authors’ knowledge, this is the first study to explore influence of social constructionism on the concept of personal recovery within a mental health service context.

iii)  Redublo, T., Paul, S., Joshi, A., Arbour, S., Murray, R. & Chiu, M. (2024) We-Care-Well: Exploring the personal recovery of mental health caregivers through Participatory Action Research.  Frontiers in Public Health, 12. 
https://www.doi.org/10.3389/fpubh.2024.1366144

Abstract
Family caregivers play a critical role in supporting the recovery journeys of their loved ones, yet the recovery journeys of family caregivers have not been well-explored. Using a Participatory Action Research approach, we explore the personal recovery journeys of family caregivers for individuals with mental illness. This case study involved piloting and exploring the impact of a novel online workshop series offered to mental health caregivers at Ontario Shores Centre for Mental Health Sciences. Recovery courses and workshops conventionally engage patients living with mental health conditions. In the current case, the recovery model is adapted to the needs and experiences of their family caregivers, resulting in a pilot workshop series called “We Care Well”. Through participant-led discussions, interactive and take-home activities, and experiential learning, caregivers co-created workshop content and engaged in peer-learning on seven personal recovery-oriented topics. This included: self-care, resilience-building, non-violent communication, storytelling, and mental health advocacy. Throughout the sessions, participants implemented their learnings into their caregiving roles, and shared their experiences with the group to progress through their own recovery journeys. The We Care Well series was found to be an effective intervention to adapt and apply the personal recovery framework to mental health caregivers. PAR, and co-design are viable approaches to engage caregivers in mental health research, and can facilitate knowledge exchange, as well as relationship building with peers and program facilitators.

iv)  Rose, D., & Beresford, P. (2024) PPI in psychiatry and the problem of knowledge.  BMC Psychiatry, 24(52)
https://doi.org/10.1186/s12888-023-05398-0

Abstract
This article begins by locating Patient and Public involvement ((PPI) historically and argues that ‘mental health’ was a special case. This movement held promise for service users in repositioning them as researchers as opposed to ‘subjects’. We argue, however, that ultimately it failed and was reduced to involved publics ‘tinkering at the edges’.  In respect to this we reference institutions, hierarchies, organisations and the overall political climate. Ultimately, however, it failed at the level of knowledge itself in that the underlying assumptions of conventional researchers, their aims and goals, clashed with those of the assumptions and aims of survivors. However, we argue that all is not lost, the mainstream itself is imploding and beneath the surface forms of distinctly survivor-led knowledge are emerging.

v)  de Winter, L., Jelsma, A., Vermeulen, J. M., van Weeghel, J., Hasson-Ohayon, I., Mulder, C. L., Boonstra, N., Veling, W. & de Haan, L. (2024) Long-term changes in personal recovery and quality of life among patients with schizophrenia spectrum disorders and different durations of illness: A meta-analysis.  Schizophrenia Bulletin, sbae045
https://doi.org/10.1093/schbul/sbae045

Abstract
Background and Hypothesis:  In schizophrenia spectrum disorders (SSD) personal recovery and subjective quality of life (S-QOL) are crucial and show conceptual overlap.  There is limited knowledge about how these outcomes change over time. Therefore, we investigated changes in personal recovery or S-QOL for patients with SSD. We specifically focused on the influence of the patients’ durations of illness (DOI) on changes in personal recovery and S-QOL.
Study Design:  We included 46 studies investigating longitudinal changes in quantitative assessments of personal recovery or S-QOL for patients with SSD. Outcomes were categorized in overall personal recovery, overall S-QOL connectedness, hope and optimism, identity, meaning in life, and empowerment. We evaluated effect sizes of change between baseline and follow-up assessments. We also evaluated potential moderating effects, including DOI on these changes in outcomes.
Study Results:  We found small improvements of overall personal recovery and S-QOL, but marginal or no improvement over time in the other more specific outcome domains. Patients without a schizophrenia diagnosis, a younger age, and more recent publications positively influenced these changes. We found no significant influence of DOI on the changes in any outcome domain.
Conclusions:  Improvement in personal recovery or S-QOL of people with SSD is modest at best.  However, these studies did not fully capture the personal narratives or nonlinear process of recovery of an individual.  Future research should focus on how to shift from a clinical to more person-oriented approach in clinical practice to support patients in improving their personal process of recovery.

vi)  Ragins, M. (2024) 30 Years of recovery: Perspectives from an aging revolutionary.  Community Mental Health Journal.  
https://doi.org/10.1007/s10597-024-01276-5

Abstract
Mark Ragins, award-winning past medical director of the MHALA Village and long-term Recovery Movement leader reflects upon the progress and disappointments of the last 30 years developing and promoting recovery. He describes the Recovery Model as a true “Thomas Kuhn” revolution built on three paradigm shifts (from illness-centered to person-centered, from professionally-driven to client-driven, and from deficit-based to strengths-based). Since it has always been an outsider movement, it has grown up in isolated “bubbles”. Despite considerable accomplishments – in values, services, structures, outcomes, and tools – it has never been free to fully blossom into the full system it likely can be. Also, these bubbles have been more likely to compete with each other than to coalesce. A number of serious outside events in the last 15 years, from recessions to housing unaffordability to a pandemic may have limited Recovery’s ability to truly challenge and even replace the Medical Model system. True revolutions are always challenging and take time, but the “force” of the Recovery Movement is worth passing forwards to the next generation to create their own “spin-offs”.

vii)  Claisse, C., Durrant, A. C., Branley-Bell, D., Sillence, E., Glascott, A. & Cameron, A. (2024) ‘Chugging along, plugging in and out of it’: Understanding a place-based approach for community-based support of mental health recovery.  Social Science & Medicine, 348, 116823
https://doi.org/10.1016/j.socscimed.2024.116823

Abstract
Community-based Mental Health (MH) organisations in the United Kingdom (UK) are facing challenges for sustaining in-person service delivery. Without empirical evidence that demonstrates the value of a place-based approach for MH recovery, and the types of resources needed to build nurturing spaces for peer support, community-based MH organisations will struggle to maintain their physical spaces. We present empirical insights from a case study involving interviews with 20 students accessing peer support services at the Recovery College Collective, a community-based MH organisation located in the North East of England. The interview study aims to evidence how a place-based approach can afford MH recovery. We draw from discourses on place-making and interpret our interview findings through an established framework that highlights four mechanisms through which place impacts recovery: place for doing, being, becoming and belonging. We use this framework to structure our findings and highlight key qualities of place for establishing and maintaining MH recovery. Our contribution is two-fold: we address a gap in the literature by providing empirical understandings of how place influences MH recovery, whilst extending previous research by considering the role that place plays in community-based organisations. This is timely because of the challenges faced in securing in-person service delivery post-pandemic, and a shift towards remote service provision models. We highlight key implications: (i) Accessing a physical place dedicated to MH support is vital for people who do not have anywhere else to go and are socially isolated due to their health conditions; (ii) Connecting through peer-to-peer interaction is an integral part of the recovery process, and learning from people with lived experience can inform a place-based approach that best suit their needs; and (iii) Recognising the value of place for MH support, and the resources needed for peer support delivery in the community, will help secure places that our research participants described as lifesaving.

viii) Senior, J. & LaMarre, A. (2024) Hearing voices, but whose?  Constructions of schizophrenia in introductory psychology textbooks.  Theory and Psychology, 34(2), 191-213.
https://doi.org/10.1177/0959354323121543

Abstract
Introductory psychology courses have a broad reach; their textbooks are instrumental in disseminating information about mental distress. In this study, we present the theoretical implications of a Foucauldian discourse analysis of constructions of schizophrenia in six introductory psychology textbooks assigned in Aotearoa/New Zealand and Australia. We identify three interconnected discursive constructions within the textbooks: object-for-study, social problem, and unrecoverable illness. These constructions converge to position people with a diagnosis of schizophrenia (PWDS) as sites for biomedical intervention and generate biomedical treatment as necessary but non-curative. Notably, the voices of PWDS are absent from the texts. We contend that amplifying counter discourses and the voices of PWDS is essential to provide the context, meaning, and hope that is missing from these textbooks, and broader society. We work with Mad Studies to present potential ways of theorising otherwise around these experiences—and leveraging this theory in textbook writing.

ix) Lim, J. M., Barlas, J., Kaur, D., & Ng, P. (2024) Unmasking the struggle: A scoping review exploring post-traumatic stress symptoms in caregivers of individuals with neurodevelopmental, psychiatric and neurocognitive disorders. Trauma, Violence, & Abuse, 0(0)
https://doi.org/10.1177/15248380241241018

Abstract
The impact of caregiving on caregivers’ mental health is typically considered within the caregiver stress and burden literature; however, more recently, research has investigated the experience of post-traumatic stress symptoms (PTSS) in caregivers.  As an emerging area of research, it is timely to conduct a scoping review to map the existing literature in relation to PTSS among adult caregivers of children and adults with neurodevelopmental disorders (NDD), neurocognitive disorders, and psychiatric disorders. The scoping review was conducted using Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines and Arksey and O’Malley’s five-stage methodology framework. Published and unpublished gray literature between 2005 and 2022 was included in the scoping review. Nine thousand one hundred and twenty-five studies were originally identified for screening and 22 studies were selected for inclusion in the final review. Trauma and PTSS experienced by NDD caregivers were related to news breaking, NDD diagnosis, and behavioural issues, whereas caregivers of individuals with psychosis reported aggression and violence as traumatic events. Studies showed that up to half of caregivers reported PTSS, although no conclusions could be drawn about prevalence rates. A wide variety of tools measuring PTSS were used across the 22 studies. Many symptoms of PTSS were reported by caregivers, and cognitive appraisals were associated with PTSS in caregivers. The findings highlight the importance of recognizing the impact of trauma in caregiver mental health and the potential value of using traumatic stress frameworks with these populations. Research should be expanded to establish prevalence rates and to examine the long-term impact of trauma on caregiving as caregivers and care recipients age.

 

Other News /Resources
i)  Authored by Jacqui Dillon, Chair of Trustee Board for the International Society for Psychological and Social Approaches to Psychosis UK, the following text and URL link is taken from the introduction to the May 2024 ISPS UK Bulletin:

I wanted to tell you about this wonderful new book: https://www.whsmith.co.uk/products/traces-of-madness-a-graphic-memoir/fernando-balius/mario-pellejer-ruiz/paperback/9781637790700.html  which I was recently asked to review. It’s a graphic memoir on the subject of voice-hearing written by Fernando Balius and illustrated by Mario Pellejer. This raw and uniquely hopeful graphic memoir shows the power of community and understanding and pushes back against the pervasive stigma and discrimination surrounding experiences defined as ‘psychotic’. It’s a great way to introduce people to what can be a difficult subject as well as being funny, moving, and insightful – highly recommended!

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

May 2024

Recovery Research Network eBULLETIN

May 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

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

For more information, please see here.

ii) The 12th European Conference on Mental Health will take place:
Date: Monday September 9th – Wednesday September 11th 2024
Venue:  ICE Kraków Congress Center, Marii Konopnickiej 17, 30-302 Kraków, Poland
Conference theme 2024: Navigating Together Towards Better Mental Health

For more information please see here.

 

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)  Fox, J. & Sangha, J. (2024) Exploring our professional role and existential identity as social work Academics in challenging racism and mental health.  Stigma, Ethics and Social Welfare
https://doi.org/10.1080/17496535.2024.2352207

Abstract
Social work is underpinned by values of anti-oppressive practice and social justice. Our professional standards require social workers to consider their personal and professional development. Thus, this article combines a reflection on both our professional role as academics and our existential identity as social workers in challenging racism and mental health stigma. To progress equality of opportunity, we argue it is necessary to understand first what we mean by an ‘integrated society’ before we can secondly challenge diverse forms of oppression. We conclude by positing that a community free of interpersonal, institutional and structural oppression may only be possible within a virtual world.

ii)  Frances, D. (2024) The co-production of an intervention facilitating informal caregivers to support adults at risk of suicide and serious self-harm: a brief report. Journal of Recovery in Mental Health, 7(1), 20-28

Abstract
The recovery model in mental healthcare increasingly recognizes suicidal behaviour as an interpersonal issue, with caregivers seen as essential in prevention. In the UK, as in other parts of the world, there is growing consensus in policies, guidelines, and academic research towards carer involvement in a person’s mental healthcare, yet inconsistency in practice remains commonplace.
In response to the theme of poor family involvement consistently identified in reports into deaths by suicide in Devon (UK), Devon Partnership NHS Trust has developed Stronger Together, a training program for carers of suicidal adults. The program, co-produced with carers and service users, also includes a collaborative learning component with healthcare staff.
This report explores the program’s co-production and my personal involvement. Co-production shaped Stronger Together, aligning it with national policy and research findings. Its co-delivery and co-learning approach uniquely addresses carers’ needs and fosters staff-carer collaboration. Learning from this initiative could help other mental health trusts foster a culture of carer collaboration, potentially improving patient safety, reducing caregiver burden, and enhancing support for patients and families to reduce deaths by suicide. It also strengthens the case for co-production of training that effectively meets the needs of participants and delivers on its outcomes

iii)  Hayes, D., Camacho, E.M., Ronaldson, A. et al. (2024) Evidence-based Recovery Colleges: developing a typology based on organisational characteristics, fidelity and funding. Social Psychiatry and Psychiatric Epidemiology, 59, 759–768.
https://doi.org/10.1007/s00127-023-02452-w

Abstract
Purpose: Recovery Colleges (RCs) have been implemented across England with wide variation in organisational characteristics. The purpose of this study is to describe RCs across England in terms of organisational and student characteristics, fidelity and annual spending, to generate a RC typology based on characteristics and to explore the relationship between
characteristics and fidelity.
Methods: All RC in England meeting criteria on recovery orientation, coproduction and adult learning were included. Managers completed a survey capturing characteristics, fidelity and budget. Hierarchical cluster analysis was conducted to identify common groupings and generate an RC typology.
Results:  Participants comprised 63 (72%) of 88 RC in England. Fidelity scores were high (median 11, IQR 9–13). Both NHS and strengths-focussed RCs were associated with higher fidelity. The median annual budget was £200,000 (IQR £127,000–£300,000) per RC. The median cost per student was £518 (IQR £275–£840), cost per course designed was £5,556
(IQR £3,000–£9,416) and per course run was £1,510 (IQR £682–£3,030). The total annual budget across England for RCs is an estimated £17.6 m including £13.4 m from NHS budgets, with 11,000 courses delivered to 45,500 students. 
Conclusion:  Although the majority of RCs had high levels of fidelity, there were sufficiently pronounced differences in other key characteristics to generate a typology of RCs. This typology might prove important for understanding student outcomes and how they are achieved and for commissioning decisions. Staffing and co-producing new courses are key drivers of spending. The estimated budget for RCs was less than 1% of NHS mental health spending.

iv)  Haun, M. H., Girit, S., Goldfarb, Y. et al. (2024) Mental health workers’ perspectives on the implementation of a peer support intervention in five countries: qualitative findings from the UPSIDES study. BMJ Open, 14:e081963.
https://doi.org/10.1136/bmjopen-2023-081963

Abstract
Objective: The introduction of peer support in mental health teams creates opportunities and challenges for both peer and non-peer staff. However, the majority of research on mental health workers’ (MHWs) experiences with peer support comes from high-income
countries. Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) is an international multicentre study, which aims at scaling up peer support for people with severe mental illness in Europe, Asia and Africa. This study investigates MHWs experiences with UPSIDES peer support.
Design: Six focus groups with MHWs were conducted approximately 18 months after the implementation of the UPSIDES peer support intervention. Transcripts were analysed with a descriptive approach using thematic content analysis.
Setting: Qualitative data were collected in Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be’er Sheva (Israel) and Pune (India).
Participants: 25 MHWs (19 females and 6 males) from UPSIDES study sites in the UPSIDES Trial (ISRCTN26008944) participated.
Findings: Five overarching themes were identified in MHWs’ discussions: MHWs valued peer support workers (PSWs) for sharing their lived experiences with service users (theme 1), gained trust in peer support over time (theme 2) and provided support to them (theme 3). Participants from lower-resource study sites reported additional benefits, including reduced workload. PSWs extending their roles beyond what MHWs perceived as appropriate was described as a challenge (theme 4). Perceptions about PSWs varied based on previous peer
support experience, ranging from considering PSWs as equal team members to viewing them as service users (theme 5).
Conclusions: Considering local context is essential in order to understand MHWs’ views on the cooperation with PSWs. Especially in settings with less prior experience of peer support, implementers should make extra effort to promote interaction between MHWs and PSWs. In order to better understand the determinants of successful implementation of peer support in diverse settings, further research should investigate the impact of contextual factors (eg, resource availability and cultural values).

v)  Marshall. P., Booth, M., Coole, M. et al. (2004)  Understanding the impacts of online mental health peer support forums: Realist synthesis. JMIR Mental Health, 11:e55750
https://doi.org/10.2196/55750

 

Abstract
Background:  Online forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation.
Objective:  This study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users.
Methods:  We conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff.
Results:  Synthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users’ perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety.
Conclusions:  This is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability.

vi)  McPhilbin, M., Stepanian, K., Yeo, C. et al. (2024) Investigating the impact of the COVID-19 pandemic on recovery colleges: multi-site qualitative study. BJPsych Open, 10(3):e113. http://doi.org/10.1192/bjo.2024.70

Abstract
Background: During the COVID-19 pandemic, mental health problems increased as access to mental health services reduced. Recovery colleges are recovery-focused adult education initiatives delivered by people with professional and lived mental health expertise. Designed to be collaborative and inclusive, they were uniquely positioned to support people experiencing mental health problems during the pandemic. There is limited research exploring the lasting impacts of the pandemic on recovery college operation and delivery to students.
Aims:  To ascertain how the COVID-19 pandemic changed recovery college operation in England.
Method:  We coproduced a qualitative interview study of recovery college managers across the UK. Academics and co-researchers with lived mental health experience collaborated on conducting interviews and analysing data, using a collaborative thematic framework analysis.
Results:  Thirty-one managers participated. Five themes were identified: complex organisational relationships, changed ways of working, navigating the rapid transition to digital delivery, responding to isolation and changes to accessibility. Two key pandemic-related changes to recovery college operation were highlighted: their use as accessible services that relieve pressure on mental health services through hybrid face-to-face and digital course delivery, and the development of digitally delivered courses for individuals with mental health needs.
Conclusions: The pandemic either led to or accelerated developments in recovery college operation, leading to a positioning of recovery colleges as a preventative service with wider accessibility to people with mental health problems, people under the care of forensic mental health services and mental healthcare staff. These benefits are strengthened by relationships with partner organisations and autonomy from statutory healthcare infrastructures.

vii)  Moeller, S. B., Larsen, P.V., Austin, S. et al. (2024) Scalability, test–retest reliability and validity of the Brief INSPIRE-O measure of personal recovery in psychiatric services. Frontiers in Psychiatry, 15:1327020.
http://doi.org/10.3389/fpsyt.2024.1327020

Abstract
Introduction:  Mental health services have transitioned from treating symptoms to emphasizing personal recovery. Despite its importance, integrating personal recovery into clinical practice remains work in progress. This study evaluates the psychometric qualities of the Brief INSPIRE-O, a five-item patient-reported outcome measure assessing personal recovery.
Method:  The study collected data from 2018 to 2020 at the Mental Health Services, Capital Region of Denmark, using an internet-based system examining 8,192 non-psychotic patients – receiving outpatient treatment.
Materials:  This study evaluated the Brief INSPIRE-O and used measures of symptomatology (SCL-10), well-being (WHO-5), and social functioning (modified SDS).
Results: The study population comprised 76.8% females with a mean age of 32.9 years, and diagnoses included anxiety (28%), depression (34%), and personality disorder (19%). The mean Brief INSPIRE-O score (39.9) was lower than the general population norm (71.1). The Brief INSPIRE-O showed acceptable test–retest reliability (0.75), scalability (0.39), and internal consistency (0.73). Correlations with other mental health criteria were in the expected direction for symptomatology (−0.46), well-being (0.60), and social functioning (−0.43) and remained consistent across diagnoses.
Discussion:  The Brief INSPIRE-O demonstrated strong psychometric qualities and could be recommended as a measure of personal recovery for use in both research and clinical practice. Its strong theoretical basis and short completion time make it suitable for use for research. Incorporating Brief INSPIRE-O into clinical assessment will further support the process of mental health systems re-orientating towards personal recovery.

viii)  Guarino. A., Negrogno, L., Compare, C. et al. (2024) “A feeling of safeness and freedom”: The promotion of mental health recovery through co-production in an Italian community organization.  Community Mental Health Journalhttps://doi.org/10.1007/s10597-024-01279-2

Abstract
In mental health promotion, recovery is a process that leads to personal strengthening, control over crucial life decisions, and participation in communities through relevant professional, educational, or family social roles. Co-production, a key aspect of the recovery-oriented approach, emphasizes collaboration and active participation of people with mental health first-hand experience, family members, and citizens. Even though studies on co-production are limited and fragmented, there is evidence that co-production leads to positive outcomes, including improved well-being, empowerment, social connectedness, inclusion, and personal competencies. This study aimed to contribute to the limited literature on co-production in mental health by evaluating the co-production process in a non-profit mental health organization and its impact on empowerment processes and personal recovery outcomes. The research team adopted a collaborative approach and conducted qualitative research, including 13 individual semi-structured interviews and four focus groups. Results showed how the different dimensions of empowerment are promoted in and by the organization: (a) co-production processes supported empowered outcomes on an individual level, such as self-awareness; (b) the organization was perceived to promote empowering processes, such as a sense of safeness and protection; (c) co-production was a mean to build and maintain a network with mental health services that acknowledges the dignity and value of each subjectivity and promotes participation and recovery. Peer support workers were seen as facilitators of mental illness management, and the organization as a place for sharing mental health experiences and fostering individual recovery journeys.

 

ix)  Richards, S. J., O’Connell, K. A., & Dickinson, J. K. (2024). A missed opportunity to cultivate positive attitudes about mental health recovery among undergraduate nursing students – A quasi-experimental controlled study. Issues in Mental Health Nursing, 45(4), 391–398
https://doi.org/10.1080/01612840.2023.2291653

Abstract
Introduction: Mental health recovery is a critical concept that needs to be thoroughly understood and supported by nurses. Undergraduate nurse educators have the opportunity to clarify misconceptions and cultivate positive recovery attitudes.
Aim: To assess the impact of an undergraduate nursing course on attitudes toward mental health recovery and the relationship between recovery attitudes and prejudice toward those who experience a mental illness.
Methods: A quasi-experimental pretest-post-test, non-equivalent-control group study was conducted using a sample of undergraduate nursing students in New York City (N = 126). The intervention group was assigned to an undergraduate mental health nursing course and the control group to a paediatric/maternal health nursing course. Attitudes toward mental health recovery and prejudice were measured at the beginning and end of the semester. Two-way mixed analyses of variance were used to determine the differences in students’ attitudes. Pearson product-moment correlation analyses were used to assess the relationship between prejudice toward people who experience a mental illness and attitudes toward recovery.
Results: The mental health nursing course had no measurable impact on students’ recovery attitudes. However, there was a moderate-to-strong inverse relationship between recovery attitudes and prejudice toward those who experience a general mental illness (r = −0.54), depression (r = −0.60), or schizophrenia (r = −0.43).
Conclusions: Curriculum reform is needed to optimize the impact of undergraduate education on students’ attitudes. Possible changes include a more holistic approach to mental health that does not over accentuate the biomedical model, the use of nontraditional clinical sites that provide students an opportunity to interact with those further along in their recovery, and the inclusion of those in recovery in curriculum development. As there was a moderate-to-strong inverse relationship between recovery attitudes and prejudice, educational interventions that positively impact one may also impact the other. Further research is needed to investigate if the relationship is causal.

x)  Woodnutt, S., Allen, C., Snowden, J. et al. (2024) Could artificial intelligence write mental health nursing care plans?  Journal of Psychiatric Mental Health Nursing, 31, 79–86.

Abstract
Background: Artificial intelligence (AI) is being increasingly used and discussed in care contexts. ChatGPT has gained significant attention in popular and scientific literature although how ChatGPT can be used in care-delivery is not yet known.
Aims: To use artificial intelligence (ChatGPT) to create a mental health nursing care plan and evaluate the quality of the output against the authors’ clinical experience and existing guidance. 
Materials & Methods: Basic text commands were input into ChatGPT about a fictitious person called ‘Emily’ who presents with self-injurious behaviour. The output from ChatGPT was then evaluated against the authors’ clinical experience and current (national) care guidance.
Results: ChatGPT was able to provide a care plan that incorporated some principles of dialectical behaviour therapy, but the output had significant errors and limitations and thus there is a reasonable likelihood of harm if used in this way. 
Discussion: AI use is increasing in direct-care contexts through the use of chatbots or other means. However, AI can inhibit clinician to care-recipient engagement, ‘recycle’ existing stigma, and introduce error, which may thus diminish the ability for care to uphold personhood and therefore lead to significant avoidable harms.
Conclusion: Use of AI in this context should be avoided until a point where policy and guidance can safeguard the wellbeing of care recipients and the sophistication of AI output has increased. Given ChatGPT’s ability to provide superficially reasonable outputs there is a risk that errors may go unnoticed and thus increase the likelihood of patient harms. Further research evaluating AI output is needed to consider how AI may be used safely in care delivery.

xi) The following short article (link below) is taken from Social Europe, a platform for democratic discussion of contemporary social issues.  Authors Ioannis Vardakastanis and Haydn Hammersley write about the barriers to inclusion that persons with disabilities experience, and the lack of political will to address this.  Their argument is set in context of the June ‘24 elections for the European Parliament, and the de facto marginalisation of a significant section of the European community.  

To read the article click here.

Other News /Resources
i) Authored by Jacqui Dillon, Chair of Trustee Board for the International Society for Psychological and Social Approaches to Psychosis UK, the following text and URL link is taken from the introduction to the May 2024 ISPS UK Bulletin:

I wanted to tell you about this wonderful new book: https://www.whsmith.co.uk/products/traces-of-madness-a-graphic-memoir/fernando-balius/mario-pellejer-ruiz/paperback/9781637790700.html  which I was recently asked to review. It’s a graphic memoir on the subject of voice-hearing written by Fernando Balius and illustrated by Mario Pellejer. This raw and uniquely hopeful graphic memoir shows the power of community and understanding and pushes back against the pervasive stigma and discrimination surrounding experiences defined as ‘psychotic’. It’s a great way to introduce people to what can be a difficult subject as well as being funny, moving, and insightful – highly recommended!

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