Recovery Research Network (RRN)

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:  4^th – 6^th July 2024.  Following an associated French-speaking conference on 3^rd 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, 9^th October to Sunday, 17^th 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 5^th – 8^th 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 30^th, 2023
Review results to submitters: by February 1^st, 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

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:  4^th – 6^th July 2024.  Following an associated French-speaking conference on 3^rd 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^th – 8^th 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

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

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 5^th – 8^th 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

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 12^th European Conference on Mental Health will take place:
Date: Monday September 9^th – Wednesday September 11^th 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 Journal. https://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

Recovery Research Network eBULLETIN

June 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) The 12^th European Conference on Mental Health will take place:
Date: Monday September 9^th – Wednesday September 11^th 2024
Venue:  ICE Congress Center, Marii Konopnickiej 17, 30-302 Kraków, Poland
Conference theme 2024: Navigating Together Towards Better Mental Health
For more information, please see here.

ii) The 13^th European Congress on Violence in Clinical Psychiatry will take place:
Date: 7^th – 8^th November 2024
Venue:  ICE Congress Centre, Kraków, Poland
Conference theme: Towards Violence- and Coercion-Free Mental Health Care
For more information, please see here.

iii) The 33^rd European Congress of Psychiatry will take place:
Date: 5^th – 8^th April 2025
Venue:  Madrid, Spain
Conference theme: Towards Real-World Solution in 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)  Voronka, J. & King C. (2023) Reflections on peer research: Powers, pleasures, pains. British Journal of Social Work, 53(3). 1692-1699
https://doi.org/10.1093/bjsw/bcad010

Abstract
I think a warning I would give to peers, or people who are looking to become peer researchers, if anything, is that the messaging around we want your lived experiences, it’s useful, it’ll help us in our research, it’ll give us insight, and that’s false messaging, because what people don’t let you know is that the majority of the work is navigating bureaucracy, that’s the work, not as much lived experiences. It’s like, lived experiences in small pockets that are professional and digestible, and code switched enough and whatever. [But] It’s actually navigating the bureaucracy, and that wasn’t even said in this job. It isn’t said in any of the peer research jobs I’ve done . . .

ii)  Walsh, A. (2024) Pregnancy in the shadow of psychosis: Navigating first-time motherhood with increased likelihood of postpartum psychosis and postnatal depression.  Journal of Psychiatric Mental Health Nursing.  00:1-6
https://doi.org/10.1111/jpm.13051

Abstract
Introduction: Postpartum psychosis is a life-changing but treatable condition that usually occurs in the first few days to weeks after childbirth affecting 1–2 in 1000 pregnancies. Those who have experienced psychosis before, either as a single episode, related or unrelated to childbirth or as part of a long-term mental health condition have a higher likelihood of experiencing an episode in the postnatal period. 
Aim: In this lived experience narrative the author shares personal experience of planning and navigating pregnancy with a higher likelihood of experiencing postpartum psychosis and postnatal depression around this major life transition due to previous episodes.
Methods: The author utilises a first-person approach to share and reflect on her lived experience. 
Findings: The author shares her experience of receiving care and some of the steps she took to try to manage the impact of pregnancy and birth on her mental health during this major life transition. She describes how care from a specialist perinatal community mental health team and peer support contributed significantly to her family’s well-being.
Discussion: Specialist perinatal community mental health services can improve outcomes for those with a higher likelihood of experiencing postpartum psychosis and postnatal depression by facilitating planning and mitigating some of the risks that could lead to relapse in the perinatal period.

iii)  Peters, L.A., Gomersall, T., Booth, A. & Lucock, M. (2024) Community arts, identity and recovery: A realist review of how community-based arts activities enables the identity change recovery process from serious mental illness.  Journal of Community and Applied Social Psychology.  2024;34e2751
https://doi.org/10.1002/casp.2751

Abstract
Identity has been empirically established as a recovery process from serious mental illness (SMI) yet is often over-looked within intervention evaluations. Community arts presents one such intervention with emerging evidence illustrating the potential for recovery to occur within this context. However, research indicates numerous mechanisms may be involved in the identity recovery process, making it difficult to determine what works, for whom and in what context. The current review aimed to generate new theories to explain how, why and in what context community arts enable the identity change recovery process for individuals with SMI. A realist review was conducted between January and September 2021, with 22 articles and reports reviewed and synthesised to develop a theory. A safe and empowering intervention context was found to be vital to activate three key mechanism pathways: (a) feeling in control of SMI through coping; (b) achieving acceptance through connectedness and (c) overcoming personal challenges. The outcome was the development of positive self-awareness, which enables individuals to redefine identity beyond SMI through both social and personal identities. Novel insights are presented through theory development, utilising the Social Identity Approach to Health and Transformative Learning Theory to conceptualise the findings through a multi-theoretical lens.

iv)  Friesinger, J.G., Topor, A., Lindvig, G. R. & Larsen, I.B. (2024) Micropolitics of mental health recovery: An assemblage analysis of people’s experiences of becoming well.  Community Mental Health Journal.  26 June 2024.
https://doi.org/10.1007/s10597-024-01311-5

Abstract
Mental health recovery takes place in a social and material world. However, socio-material contexts have often been absent from recovery studies. The present study was conducted in Norway, a Scandinavian welfare country. We interviewed people at meeting places who had experiences as service users, focusing on their experiences of becoming well, and analyzed their recovery stories using an assemblage framework. Our analysis identified four constitutive dimensions that promote mental health recovery: an atmosphere of togetherness, doings as more than the act, personal development, and integration in society. We discuss how these dimensions might be seen as social, relational, and material forces that create important micropolitics that challenge the individualistic professionalization of the recovery concept.

vi  Milasan, L. H. (2024) Taking pictures is like treasure hunting: exploring the therapeutic values of photography as a qualitative research method.  International Journal of Qualitative Methods. 23, 1-20
https://doi.org/10.1177/16094069241236219

Abstract
Photography has been increasingly used in qualitative research. However, little is known about the benefits of photography-based research from the perspective of the research participants. This article aims to investigate the views of a group of fifteen mental health service users on the therapeutic benefits and limitations of photography as a research method. For this purpose, visual and textual data from four weekly photography workshops, photo-elicitation interviews, and a reflection and feedback group were thematically analysed. Four overarching themes were identified in support of the therapeutic value of photography: (1) forging social companionship and camaraderie, (2) intra-personal reflection and self-awareness, (3) connection with nature, and (4) photography as an occupation. Therapeutic limitations and challenges of photography as a research method are also discussed. The findings of this study may be applicable beyond the area of mental health and contribute to enhancing the ethical principle of beneficence in research by creating opportunities for personal growth and wellbeing for research participants involved in photography-based studies

 

Other News /Resources
i) Given the recent general election in the UK, it is perhaps timely to include the latest newsletter from the McPin Foundation.  In their Summer edition, they launch their ’10 asks for the next government 2024’ in regard to young people’s mental health.  This is in addition to a range of commentaries on the subject of mental health research.  Relevant links, including a signup page to their newsletter is available here.

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

Recovery Research Network eBULLETIN

July 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) The 12^th European Conference on Mental Health will take place:
Date: Monday September 9^th – Wednesday September 11^th 2024
Venue:  ICE Congress Center, Marii Konopnickiej 17, 30-302 Kraków, Poland
Conference theme 2024: Navigating Together Towards Better Mental Health
For more information, please see here.

ii) The 13^th European Congress on Violence in Clinical Psychiatry will take place:
Date: 7^th – 8^th November 2024
Venue:  ICE Congress Centre, Kraków, Poland
Conference theme: Towards Violence- and Coercion-Free Mental Health Care
For more information, please see here.

iii) The 33^rd European Congress of Psychiatry will take place:
Date: 5^th – 8^th April 2025
Venue:  Madrid, Spain
Conference theme: Towards Real-World Solution in 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., Gasper., R. & Anghel, R. (2024) When UK academics decide to disclose mental distress to employers in the HEI workplace: identity conflict, organisational context and the need for systemic change. Journal of Further and Higher Education. 1-7
https://doi.org/10.1080/0309877X.2024.2386061

Abstract
UK academics currently report increased workplace stress and workload, with decreased work-life balance, but often feel reluctant to disclose mental distress. We distributed an anonymous online qualitative survey to explore factors which lead academics to decide whether to disclose mental distress in the workplace. Thirty-one participants responded, providing qualitative data about institutional and psychosocial factors that informed academics’ decision to disclose, supplemented by information on role position. Data was analysed thematically. Our study reports the individual struggles of academics as they manage their professional identity alongside the demands of the HEI workplace and explores the individual processes of identity conflict that leads to a re-construction of the professional identity after disclosing mental distress. Our findings reinforce the evidence that this decision occurs within the context of an increasingly business-focussed work culture of over-commitment and strain in this sector in which academics are made responsible for their own wellbeing. These findings lead us to recommend further research into disclosure using the lens of identity integration. We endorse important systemic changes by suggesting that universities need to consider factors contributing to poor mental wellbeing as structural issues, which require institutional action. Furthermore, we highlight the need for HEIs to value the hybrid identity of those who are both academics and experts-by-experience. Finally, we advocate for universities to adopt the social model of disability, which promotes inclusion and equality of opportunity for people who experience mental distress. The small study sample size makes the findings tentative, but they are nevertheless significant and intriguing.

ii)  Salzer, M. S. (2024) Building on recovery: Embracing community inclusion in mental
health policies and services.  Community Mental Health Journal. 
https://doi.org/10.1007/s10597-024-01309-z

Abstract
Recovery is real and has had a transformative impact on mental health policies and services, including shifting the focus from chronicity and symptom management to the realization that individuals with mental health issues can lead meaningful lives. However, recovery has been defined, described, understood, and measured in a wide variety of ways that may account for misuses and abuses in its application and possible stagnation in its impact. It is argued that the mental health field must now build upon the strong foundations of recovery by integrating a well-established rights-oriented framework.  While recovery emphasizes personal growth and hope, a rights-based perspective underscores inherent dignity, autonomy, and opportunities for acceptance and embrace in engaging in valued social roles. The addition of a rights-based framework – community inclusion, to conversations involving recovery, is aligned with the origins of recovery and how it is commonly understood, and also connects the mental health field to the dramatic positive impacts that have emerged from the longstanding centrality of this concept in the broader disability community.

iii)  Middleton, K., Cooke, A., & May, R. (2024). “It allowed us to let our pain out”: perspectives from voice-hearers and their voices on the ‘talking with voices’ approach. Psychosis, 16(2), 131–143
https://doi.org/10.1080/17522439.2022.2141840

Abstract
Background:  The “Talking with Voices” (TwV) approach is a novel, formulation-driven approach to helping people who hear distressing voices. It is based on an understanding of voice-hearing as a relational phenomenon, often linked to trauma. Therapy involves facilitation of dialogical engagement between hearers and their voices. There are as yet few empirical studies of the approach.
Method:  The current study explored experiences of the TwV approach from the perspectives of voice-hearers and also of their voices. Ten qualitative interviews were subjected to Interpretative Phenomenological Analysis.
Results:  Both hearers and their voices felt that the TwV approach can be a powerful enabler of positive change, and that it provides a valuable means of working through past trauma. Establishing a safe base – with time to build trust in the process – was considered key, as were the personal qualities of the facilitator, including openness, courage and a non-judgemental approach. Participants also saw flexibility as important, including the ability to try things out within the work. It was also important that the ideas behind the approach made sense to the participant. Perceived barriers included the medicalised nature of current services and the lack of availability of the TwV approach.
Conclusion:  The findings provide support for the acceptability and value of dialogical approaches to helping people who hear voices. In particular, they suggest that participating in TwV can help people develop an understanding of, and a more peaceful relationship with, their voices. The study is novel in eliciting perspectives from the voices themselves, and this yielded valuable insights.

iv)  Kirkbride, J. B., Anglin, D. M., Colman, I., Dykxhoorn, J., Jones, P. B., Patalay, P., Pitman, A., Soneson, E., Steare, T., Wright, T. & Griffiths, S. L.  (2024) The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry. 23(1) 58-90. 
https://doi.org/10.1002/wps.21160

Abstract
People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high‐quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health

v)  Jain, S., Pillai, P. & Mathias, K. (2024) Opening up the ‘black-box’: what strategies do community mental health workers use to address the social dimensions of mental health? Social Psychiatry and Psychiatric Epidemiology. 59, 493–502. https://doi.org/10.1007/s00127-023-02582-1

Abstract
Purpose:  Community-based workers promote mental health in communities. Recent literature has called for more attention to the ways they operate and the strategies used. For example, how do they translate biomedical concepts into frameworks that are acceptable and accessible to communities? How do micro-innovations lead to positive mental health outcomes, including social inclusion and recovery? The aim of this study was to examine the types of skills and strategies to address social dimensions of mental health used by community health workers (CHWs) working together with people with psychosocial disability (PPSD) in urban north India.
Methods:  We interviewed CHWs (n = 46) about their registered PPSD who were randomly selected from 1000 people registered with a local non-profit community mental health provider. Notes taken during interviews were cross-checked with audio recordings and coded and analyzed thematically.
Results:  CHWs displayed social, cultural, and psychological skills in forming trusting relationships and in-depth knowledge of the context of their client’s lives and family dynamics. They used this information to analyze political, social, and economic factors influencing mental health for the client and their family members. The diverse range of analysis and intervention skills of community health workers built on contextual knowledge to implement micro-innovations in a be-spoke way, applying these to the local ecology of people with psychosocial disabilities (PPSD). These approaches contributed to addressing the social and structural determinants that shaped the mental health of PPSD.
Conclusion:  Community health workers (CHWs) in this study addressed social aspects of mental health, individually, and by engaging with wider structural factors. The micro-innovations of CHWs are dependent on non-linear elements, including local knowledge, time, and relationships. Global mental health requires further attentive qualitative research to consider how these, and other factors shape the work of CHWs in different locales to inform locally appropriate mental health care.

vi)  Haeyen, S., Heres, H., & Pol, S. (2024). Making meaning of one’s own life story in words and images: A narrative case report of personal recovery from personality disorder through the interventions “An Empowering Story” and art therapy. Journal of Clinical Psychology. 80, 1736–1753.
https://doi.org/10.1002/jclp.23690

Abstract
Understanding and processing life experiences are essential in the treatment of personality disorders to promote personal recovery and psychological wellbeing. In this qualitative case report, drafted in co‐creation between the client, clinical psychologist, and art therapist, individual treatment consisted of two psychotherapeutic interventions, “An Empowering Story” and life‐story‐focused art therapy, in 12 parallel sessions for 24 weeks. Hilda, 68 years of age, had been diagnosed with an unspecified personality disorder and various traits of borderline personality disorder. She experienced emotional exhaustion following long‐term mental health problems rooted in a traumatic early childhood. This affected her ability to manage her emotions and social relations, resulting in the sense that her life had no meaning. Hilda was invited to reconstruct her life experiences, divided into the past, turning point, and present/ future, in a written and a painted life story. This allowed for the integration of traumatic as well as positive memories, enhanced self‐compassion, and meaning making. She developed self‐reflection and integration of internal conflicts leading to a better emotional balance and self-understanding. Art therapy emphasizes bottom‐up regulatory processes, while narrative psychology supports top-down regulatory processes. The combined approach effectively integrated bottom‐up, experiential, sensory experiences with top‐down, cognitive emotion‐regulation processes.  The results suggest that psychotherapeutic interventions involving a multi‐pronged, complementary, and thus more holistic approach can support personal recovery in personality disorders.

vii) Griffiths, C., Silva, K., Sheldon, A. & Smith, G. (2024). “Well-Track” healthy lifestyle (physical activity, sleep hygiene, diet, wearable activity tracker) coaching in severe mental illness (SMI). Psychology. 15, 1208-1220
https://doi.org/10.4236/psych.2024.157071

Abstract
Background: People who experience Severe Mental Illness (SMI) often have low levels of physical activity, high levels of sedentary behaviour, poor diet, and sleep problems. These factors are linked to worse mental health symptoms, lower wellbeing, greater hopelessness, lower quality-of-life, and physical health-related diseases, including cardiovascular disease, stroke, hypertension, osteoarthritis, cancer, chronic obstructive pulmonary disease, obesity, and diabetes, contributing to 15 – 20 years reduced life expectancy.
Purpose/Aim: This study investigates the impact of Well-Track healthy lifestyle intervention in SMI, it addresses the question: “What is the effect of Well-Track on mental wellbeing and sleep quality/insomnia for SMI patients?”. 
Methods: An open-label patient cohort design with no control group. Pre-intervention, 4-week and 8-week intervention assessments using participant self-report measures: Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and Sleep Conditioning Index (SCI). Participants were seventy-six Community Mental Health Team (CMHT) participants, 35 males and 41 females, with an age range of 20 – 65, and average age of 41 years. An eight-week intervention: a free-to-keep wearable tracker (instructions, set up, and access to apps), exercise, diet and sleep hygiene advice, a motivational interview and goal-setting session and two follow-up support sessions with a health coach.
Results: WEMWBS scores significantly improved, from 37.52 (SD 10.18) to 42.35 (SD 7.14) at 4 weeks and to 44.06 (SD 6.03) at 8 weeks, with large effect sizes. SCI scores significantly improved, from 12.03 (SD 7.29) to 15.45 (SD 8.00) at 4 weeks and to 17.26 (SD 8.12) at 8 weeks, with large effect sizes.
Conclusion: Well-Track was integrated into a SMI physical health check service and was found to be beneficial in terms of improving wellbeing and sleep quality and reducing incidence of insomnia. Well-Track could be delivered through all CMHT and SMI physical health check services to promote healthy lifestyle behaviours.

Other News /Resources

i)  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

Recovery Research Network eBULLETIN

August 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) The 12^th European Conference on Mental Health will take place:
Date: Monday September 9^th – Wednesday September 11^th 2024
Venue:  ICE Congress Center, Marii Konopnickiej 17, 30-302 Kraków, Poland
Conference theme 2024: Navigating Together Towards Better Mental Health
For more information, please see here.

ii) The 13^th European Congress on Violence in Clinical Psychiatry will take place:
Date: 7^th – 8^th November 2024
Venue:  ICE Congress Centre, Kraków, Poland
Conference theme: Towards Violence- and Coercion-Free Mental Health Care
For more information, please see here.

iii) The 33^rd European Congress of Psychiatry will take place:
Date: 5^th – 8^th April 2025
Venue:  Madrid, Spain
Conference theme: Towards Real-World Solution in Mental Health
For more information, please see here.

iv) The Centre for Mental Health in the UK is curating a special issue of Perspectives in Public Health, focusing on the potential impact of global events on the mental health of the public and implications for informing actions on global inequalities

The deadline for submissions is 31 January 2025. Authors should submit via an online submissions system:
https://mc.manuscriptcentral.com/pph

More information is available 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)  Tham, S. S. & Solomon, P. (2024) Practicing cultural humility will achieve recovery-oriented mental health practice and service delivery. Administration and Policy in Mental Health and Mental Health Services Research. 51, 10–13.
https://doi.org/10.1007/s10488-023-01307-5

Abstract
The authors have proposed incorporating the concept of cultural humility to achieve better recovery outcomes. While agencies have mandated staff training in cultural competence, health outcomes have not shown promising results. Given the shortcomings of cultural competence training, cultural humility is being suggested as a complementary approach.  When providers adopt cultural humility into their interactions with service users, it encompasses underlying principles and values consistent with recovery-oriented practices. Cultural humility addresses power imbalances and emphasizes ongoing self-reflection and openness to interpersonal relationships. The authors believe that embracing cultural humility will promote dignity and respect, create a culture of collaboration and partnership, acknowledge the uniqueness of each individual, enhance person-centered care, and foster self-determination and autonomy. The application of a cultural humility lens can promote a recovery-oriented culture within mental health services, and it is the responsibility of providers to actively cultivate cultural humility. Overall, cultural humility presents new opportunities for practice, and its adoption may be a key factor in promoting a recovery-oriented culture within mental health services.

ii)  Levy-Fenner, E., Colucci, E. & McDonough, S. (2024) Lived experiences of mental health recovery in persons of culturally and linguistically diverse (CALD) backgrounds within the Australian context. Journal of Psychosocial Rehabilitation and Mental Health. 11, 7–32.
https://doi.org/10.1007/s40737-022-00319-y

Abstract
Lived experience research related to mental health recovery is advancing, but there remains a lack of narrative material from the perspectives of people from under-represented, non-dominant cultural backgrounds in this domain. This study aimed to explore the lived experiences of mental health recovery in people of culturally and linguistically diverse (CALD) backgrounds in the Australian context. The current study involved a secondary analysis of audio and visual data collected during the digital storytelling project Finding our way in Melbourne, Australia. Thematic analysis was used to understand the lived experience narratives of nine participants in relation to mental health recovery. Five themes were identified through an iterative process of analysis, including Newfound opportunities and care, Family as key motivators and facilitators, Coping and generativity, Cultivating self-understanding and resilience, and Empowerment through social engagement. First person lived experience narratives offer deep insight into understanding the ways in which individuals of marginalised communities conceptualise and embody recovery. These findings further the literature and understanding on how to better serve the needs of people with mental health challenges from CALD communities through informed knowledge of what may be helpful to, and meaningful in, individuals’ recoveries.

iii)  Friesinger, J. G., Topor, A., Lindvig, G.R. & Larsen, I. B. (2024) Micropolitics of mental health recovery: An assemblage analysis of people’s experiences of becoming well. Community Mental Health Journal.  Online:
https://doi.org/10.1007/s10597-024-01311-5

Abstract
Mental health recovery takes place in a social and material world. However, socio-material contexts have often been absent from recovery studies. The present study was conducted in Norway, a Scandinavian welfare country. We interviewed people at meeting places who had experiences as service users, focusing on their experiences of becoming well, and analyzed their recovery stories using an assemblage framework. Our analysis identified four constitutive dimensions that promote mental health recovery: an atmosphere of togetherness, doings as more than the act, personal development, and integration in society. We discuss how these dimensions might be seen as social, relational, and material forces that create important micropolitics that challenge the individualistic professionalization of the recovery concept.

iv)  Chatwiriyaphong, R., Moxham, L., Bosworth, R. & Kinghorn, G. (2023) The experience of healthcare professionals implementing recovery-oriented practice in mental health inpatient units: A qualitative evidence synthesis.  Psychiatric and Mental Health Nursing. 31. 287-302.
https://doi.org/10.1111/jpm.12985

Abstract
Introduction: Recovery-oriented practice underpins an individual’s personal recovery. Mental health nurses are required to adopt a recovery-oriented approach. Globally, a paucity of literature exists on mental health professionals’ experience of recovery-oriented practice in mental health inpatient units.
Aim: The aim of this synthesis was to explore the experiences of healthcare professionals regarding recovery-oriented care in mental health inpatient units by appraising and synthesising existing qualitative research.
Method: Three databases, including MEDLINE, PsycINFO and CINAHL were searched between 2000 and 2021. Data were extracted and synthesised using thematic integrative analysis. The quality of included studies was assessed with the CASP Critical Appraisal Checklist.
Results: Ten qualitative research projects met the inclusion criteria. Four themes were identified (i) developing a safe and hopeful space, (ii) promoting a healing space, (iii) instilling connectedness and (iv) challenges to realising recovery-oriented care.
Discussion: Mental healthcare professionals perceived the principles of recovery-oriented care to be positive and include: therapeutic space, holistic care and person-centred care. Nevertheless, findings revealed limited knowledge and uncertainty of the recovery concept to be key barriers that may hinder implementation into practice.
Implications for Practice: Recovery-oriented practice must underpin consumer and
family engagement, treatment choices and continuity of care to facilitate consumer’s
personal recovery.

v)  Fox, J. & Mano, I. (2024) A duoethnography: female academics’ experiences of gendered health issues at the intersection of middlescence, ethnic origin, social and professional status in the neoliberal academy.  Journal of Organizational Ethnography, Ahead of print:
https://doi.org/10.1108/JOE-02-2024-0007

Abstract
Purpose:  Gender inequality and age discrimination persist in the Higher Education (HE) sectors. The significance of gendered health at middlescence, including peri/menopause, is often negated. This article explores women’s lived experiences of gendered health issues at middlescence in the neoliberal academy through an intersectional lens.
Design/methodology/approach:  Two female academics engaged in dialogic narrative using duoethnography addressing their experiences of gendered health issues in a UK Higher Education Institution (HEI). They recorded intentional written reflections and met to explore their experiences over a four-month period. Thematic analysis was applied to analyse their responses.
Findings:  Both women considered how they self-advocated for their own care at the stage of middlescence whilst seeking health support and in accessing accommodations in the HE workplace. This process impacted on the construction of their professional identity and on their self-concept as social work academics at the dynamic intersection of age, gender, ethnic, social and professional status.
Originality/value:  This article uniquely foregrounds two female academics’ lived experiences of middlescence in a UK HEI conceptualised through an intersectional lens. Their experiences are explored in the context of gendered age discrimination in HE sectors that are perpetuated through masculinized forms of career progression and management. The concept of the ideal academic, a white male, unencumbered by domestic responsibilities, is contested through consideration of care ethics. We acknowledge that forms of epistemic injustice silence women’s narratives in the neoliberal academy but highlight recommendations to enable their stories of gendered health discrimination to be heard.

vi) Middleton, H. (2024) Toxic interactions and the social geography of psychosis: Reflections on the epidemiology of mental disorder.  Abingdon, Routledge.

As part of The international Society for Psychological and Social Approaches to Psychosis Book Series, the following description is taken from the publisher’s website (original italics retained):

Toxic Interactions is a review of quantitative research revealing how urban living, trauma, ethnicity, stress and familial influence the risk of troubling psychotic experiences.

Each of these is reviewed in search of their social implications, and a constructivist approach identifies their common threads. The contributions of newer psychotherapeutic approaches such as Open Dialogue and Recovery programmes are considered, and a consistent interpretation emerges; that is not the observable features of disturbed mental state that deserve key attention, but how these are generally understood by others, and in particular the ‘client’s’ close associates.

Toxic Interactions and the Social Geography of Psychosis will be welcomed by all who find conventional approaches to mental health difficulties unsatisfactory, whether that is as a practitioner frustrated by the counter-productive expectations of their institutional setting, an academic exploring different perspectives a ‘service user’ disappointed by not experiencing the care they feel is needed, or as third party perplexed by the contradictions of contemporary psychiatry.

Other News /Resources

i)  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

Recovery Research Network eBULLETIN

September 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) The 13^th European Congress on Violence in Clinical Psychiatry will take place:
Date: 7^th – 8^th November 2024
Venue:  ICE Congress Centre, Kraków, Poland
Conference theme: Towards Violence- and Coercion-Free Mental Health Care
For more information, please see here.

ii) The 33^rd European Congress of Psychiatry will take place:
Date: 5^th – 8^th April 2025
Venue:  Madrid, Spain
Conference theme: Towards Real-World Solution in Mental Health
For more information, please see here.

iii) The Centre for Mental Health in the UK is curating a special issue of Perspectives in Public Health, focusing on the potential impact of global events on the mental health of the public and implications for informing actions on global inequalities

The deadline for submissions is 31 January 2025. Authors should submit via an online submissions system:
https://mc.manuscriptcentral.com/pph

More information is available here

iv) The 7th Refocus on Recovery conference will take place:
Date: Thursday September 4^th – Friday September 5^th 2025
Venue:  Crowne Plaza Hotel, Nottingham, UK
Conference theme 2025: Reimagining Recovery, with a focus on:
1) the role of lived experience in embedding and supporting recovery
2) new perspectives around mental health and recovery
3) extending recovery beyond mental health

For more information, please see here: https://www.researchintorecovery.com/ronr2025/

 

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)  Guerrero, E., Barrios, M., Sampietro, H. M., Aza, A., Gómez-Benito, J & Guilera, G. (2024) Let’s talk about recovery in mental health: an international Delphi study of experts by experience. Epidemiology and Psychiatric Sciences. 33:e41. https://doi.org/10.1017/S2045796024000490

Abstract
Aims:  The concept of recovery is featured in the strategic plans of the World Health
Organization as well as in other national mental health plans; however, there have been differing interpretations of what it means. This article aims to achieve a consensus on the key aspects of recovery in mental health from the perspective of movements of users and survivors of psychiatry at an international level. Four specific objectives were proposed in this study: (1) to identify what recovery in mental health means, (2) to identify the indicators that a person is progressing in their recovery, (3) to determine the factors that facilitate the recovery process, and (4) to determine the factors that hinder the recovery process.
Methods:  A three-round e-Delphi study was conducted with the participation of 101 users and survivors of psychiatry, adhering to the CREDES checklist to ensure methodological rigour.
Results:  The results reveal 26 key aspects that define recovery, 31 indicating that a person is progressing in their recovery process, 8 that facilitate recovery and 12 that hinder recovery. The most agreed-upon statements for defining recovery highlight the importance of empowerment, leading a fulfilling life, ensuring safe-living conditions and acknowledging individuals as holders of rights. Similarly, empowerment and agency were highly agreed upon as relevant recovery indicators. Key findings underscore the significance of a supportive and respectful social environment in facilitating recovery, while coercion, discrimination, and lack of support from significant others hinder recovery.
Conclusions:  Despite cultural differences and recovery’s subjective nature, our results demonstrate that an international consensus on critical recovery aspects is attainable. Highlighting a significant shift, we emphasize the ‘Transition’ process to signify moving away from the biomedical model approach and advocating for collective rights. Our findings advocate for empowerment, users’ rights and the move towards person-centred care that integrates social, political, and economic contexts. These consensus statements lay the groundwork for future research across diverse regions and cultures, offering insights into recovery’s meaning and potential for innovative approaches in diagnosis, intervention, and evaluation.

ii)  Benkwitz, A., Ogundipe, E. & Spencer, K. (2024) A step towards community inclusion for individuals experiencing mental health challenges: promoting social inclusion and social recovery through physical activity. Mental Health and Social Inclusion, Vol. ahead-of-print No. ahead-of-print. 
https://doi.org/10.1108/MHSI-06-2024-0100

Abstract
Purpose:  After initially positioning this paper within the broader mental health recovery literature, this paper aims to highlight the role that physical activity can play in promoting social inclusion and social recovery for those experiencing mental health challenges.
Design/methodology/approach:  This conceptual paper draws together the limited, but growing, research on how physical activity can facilitate improved social inclusion and benefit an individual’s recovery.
Findings:  For individuals suffering with mental health challenges, not being able to exercise their right to inclusion is concerning from a recovery perspective, because experiencing social inclusion is recognised as a facilitator of recovery. Initial research has demonstrated by embracing community inclusion and supporting initiatives such as physical activity programs, mental health services can better facilitate individuals’ journeys towards social inclusion and social recovery.
Research limitations/implications:  Future research should appreciate the interplay between inclusion, recovery and physical activity. Collaborating with individuals with lived experience, peer mentors and social prescribing teams to explore options for physical activity within local communities fosters empowerment, social inclusion and ensures interventions align with individuals’ preferences and needs.
Practical implications:  Practitioners in health service and community settings should recognise the wide-ranging benefits of physical activity for individuals with mental health challenges, especially in terms of helping their social inclusion and social recovery.
Originality/value:  This paper is unique in synthesising the mental health literature relating to social inclusion, social recovery and physical activity. Initial findings show promise, but more attention is needed to explore the relationship between these elements and how individuals experiencing mental health challenges can be supported using physical activity.

iii)  Dhari, S., Slemon, A., & Jenkins, E. (2024). The Subaltern: Illuminating matters of representation and agency in mental health nursing through a postcolonial feminist lens. Nursing Inquiry, e12661.
https://doi.org/10.1111/nin.12661

Abstract
Inpatient mental health nursing operates with an overarching goal to support people living with mental health challenges by managing risk of harm to self and others, decreasing symptoms, and promoting capacity to live outside of hospital settings. Yet, dominant, harmful stereotypes persist, constructing patients as less than, in need of saving, and lacking self‐control and agency. These dominant assumptions are deeply entrenched in racist, patriarchal, and Othering beliefs and continue to perpetuate and (re)produce inequities, specifically for people with multiple intersecting identities relating to race, class, gender, and culture. This paper explores the relevance of postcolonial feminism, particularly Gayatri Spivak’s concept of Subaltern—conceptualized as groups of people who are denied access to power and therefore continue to be systematically oppressed and marginalized—in illuminating the problematic and dominant assumptions about people living with mental health challenges as lacking agency and requiring representation. Through an understanding of Subalternity, this paper aims to decentre and deconstruct dominant colonial, patriarchal narratives in mental health nursing, and ultimately calls for mental health nursing to fundamentally reconsider prevailing assumptions of patients as needing representation and lacking agency.

iv)  Peters, L. A., Gomersall, T., Booth, A., & Lucock, M. (2024). Community arts, identity and recovery: A realist review of how community-based arts activities enables the identity change recovery process from serious mental illness. Journal of Community & Applied Social Psychology, 34(1), e2751.
https://doi.org/10.1002/casp.2751

Abstract
Identity has been empirically established as a recovery process from serious mental illness (SMI) yet is often overlooked within intervention evaluations. Community arts presents one such intervention with emerging evidence illustrating the potential for recovery to occur within this context. However, research indicates numerous mechanisms may be involved in the identity recovery process, making it difficult to determine what works, for whom and in what context. The current review aimed to generate new theories to explain how, why and in what context community arts enable the identity change recovery process for individuals with SMI. A realist review was conducted between January and September 2021, with 22 articles and reports reviewed and synthesised to develop a theory. A safe and empowering intervention context was found to be vital to activate three key mechanism pathways: (a) feeling in control of SMI through coping; (b) achieving acceptance through connectedness and (c) overcoming personal challenges. The outcome was the development of positive self-awareness, which enables individuals to redefine identity beyond SMI through both social and personal identities. Novel insights are presented through theory development, utilising the Social Identity Approach to Health and Transformative Learning Theory to conceptualise the findings through a multi-theoretical lens.

v)  Chatwiriyaphong, R., Moxham, L., Bosworth, R., & Kinghorn, G. (2024) The experience of healthcare professionals implementing recovery-oriented practice in mental health inpatient units: A qualitative evidence synthesis. Journal of Psychiatric and Mental Health Nursing, 31:(3), 287-302
https://doi.org/10.1111/jpm.12985

Abstract
Introduction:  Recovery-oriented practice underpins an individual’s personal recovery. Mental health nurses are required to adopt a recovery-oriented approach. Globally, a paucity of literature exists on mental health professionals’ experience of recovery    
oriented practice in mental health inpatient units.
Aim:  The aim of this synthesis was to explore the experiences of healthcare professionals regarding recovery-oriented care in mental health inpatient units by appraising and synthesising existing qualitative research.
Method:  Three databases, including MEDLINE, PsycINFO and CINAHL were searched between 2000 and 2021. Data were extracted and synthesised using thematic integrative analysis. The quality of included studies was assessed with the CASP Critical Appraisal Checklist.
Results:  Ten qualitative research projects met the inclusion criteria. Four themes were identified (i) developing a safe and hopeful space, (ii) promoting a healing space, (iii) instilling connectedness and (iv) challenges to realising recovery-oriented care.
Discussion:  Mental healthcare professionals perceived the principles of recovery-oriented care to be positive and include: therapeutic space, holistic care and person centred care. Nevertheless, findings revealed limited knowledge and uncertainty of the recovery concept to be key barriers that may hinder implementation into practice.
Implications for Practice:  Recovery-oriented practice must underpin consumer and family engagement, treatment choices and continuity of care to facilitate consumer’s personal recovery.

Other News /Resources

i)

Writing out of the University of Nottingham, Fiona Ng and Stefan Rennick-Egglestone from the Recovery Research Team, University of Nottingham, make the following call: 

We are inviting you to join the Narrative Experiences Online International Research Consortium (NEON IRC). This consortium extends the work the Recovery Research Team (at the Institute of Mental Health, Nottingham) has done as part of the NEON Study. 

The NEON Study developed an innovative digital intervention which provides people with mental health problems and their carers online access to a wide range of mental health recovery stories. We have shown that NEON can help to improve quality of life and increase meaning making in people with mental health problems. 

You might be interested in joining the NEON IRC if you are:

• Interested in adapting the NEON Intervention for other settings or populations
• Translating the NEON Intervention for use in other languages
• Conducting secondary data analysis on existing NEON data
• Developing new digital health interventions incorporating recovery narratives as an active ingredient
• Writing funding applications to conduct NEON-related research

See our NEON IRC webpage for more information or get in touch researchintorecovery@nottingham.ac.ukto join!

Thanks,
Fiona Ng and Stefan Rennick-Egglestone

ii) In their autumn 2024 newsletter, the McPin Foundation draw attention to a number of news items and updates.  We report some of the key headlines from their website below, but please remember you can sign up for their free newsletter here.

First, there’s a new framework for public involvement & engagement work which we’ve been involved in, and will be very useful if you do public involvement work. Second, our PPI (Patient & Public Involvement) trainingAutumn 2024 is open for registration. Spaces are limited so don’t miss out!

We’re introducing a project many of you will be interested in on subjective experiences of mental healthissues, and we remember our dear friend and trustee Clair Chilvers.

We’ve also got lived experience advice on making conferences more inclusive, young people reflectionsfrom the Peer Action Collective project, your sleep questions answered, our response to Mental Health Act reform in the King’s Speech, and lots more.

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

Recovery Research Network eBULLETIN

October 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) The 13^th European Congress on Violence in Clinical Psychiatry will take place:
Date: 7^th – 8^th November 2024
Venue:  ICE Congress Centre, Kraków, Poland
Conference theme: Towards Violence- and Coercion-Free Mental Health Care
For more information, please see here.

ii) The 33^rd European Congress of Psychiatry will take place:
Date: 5^th – 8^th April 2025
Venue:  Madrid, Spain
Conference theme: Towards Real-World Solution in Mental Health
For more information, please see here.

iii) The Centre for Mental Health in the UK is curating a special issue of Perspectives in Public Health, focusing on the potential impact of global events on the mental health of the public and implications for informing actions on global inequalities

The deadline for submissions is 31 January 2025. Authors should submit via an online submissions system:
https://mc.manuscriptcentral.com/pph

More information is available here

iv) The 7th Refocus on Recovery conference will take place:
Date: Thursday September 4^th – Friday September 5^th 2025
Venue:  Crowne Plaza Hotel, Nottingham, UK
Conference theme 2025: Reimagining Recovery, with a focus on:
1) the role of lived experience in embedding and supporting recovery
2) new perspectives around mental health and recovery
3) extending recovery beyond mental health

For more information, please see here: https://www.researchintorecovery.com/ronr2025/

 

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) Batty, R., Florescu, A., Gulliksen, E., et al. (2024) The potential of citizen mental health science. London: Welcome.
https://wellcomeopenresearch.org/documents/9-581

Executive Summary
In ‘citizen science’ projects, members of the public take part in creating research through delivering all or part of the scientific process, whether collecting or contributing data, participating in analysis, or formulating research questions and designing research studies. This way of working has potential to support the involvement of a greater number and diversity of people in research, and in turn improve the scale and speed of research and its relevance and benefit to the public. Within the field of mental health science, a ‘citizen mental health science’ could use these advantages to improve understanding of and treatments for mental health conditions.

To better understand the potential of citizen science within the mental health field, we first investigated the current use of this term and existing applications of this approach. We then identified challenges, considerations, and opportunities to support the future development of citizen mental health science.

Understanding citizen mental health science
By looking at examples of self-described ‘citizen science’ projects on mental health topics and understanding the perspectives of citizen science stakeholders within the field, we found that in discourse and practice, citizen mental health science has been interpreted in an immense variety of ways that continue to evolve. However, despite this diversity we were able to distinguish two main types:

• Contributory citizen mental health science interprets citizen science as mass data collection and/or analysis and typically includes projects where researchers initiate and design the research project, while a large number of citizens (usually thousands) contribute to a specific part of the research process, often by collecting, contributing or analysing data.
• Co-created citizen mental health science interprets citizen science as democratisation of science and typically includes projects where citizens work together with researchers to jointly design and carry out research projects; this may involve citizens carrying out several or all steps of the scientific process. Project leadership and the level of collaboration and co-creation can vary significantly across projects (e.g. projects can be led by either researchers or citizens, or by both working in equal partnership).

 

Exploring existing projects
We found 45 examples of citizen science projects exploring mental health-related questions. Of these, 23 were contributory, 16 were co-created, and 6 fit within both categories. These varied across key project characteristics including:

• Mental health conditions covered. Most projects aimed to answer research questions about mental health in a broad sense to illuminate a range of conditions. Other projects focused more specifically on one or a few specific conditions or experiences, including depression, anxiety, post-traumatic stress disorder, psychosis, suicidality, and substance use.
• Geographic location. Most projects we found involved citizen scientists in Europe and North America. Others were global in scope or took place across multiple sites across continents. We found only three projects set within low- and middle-income countries (LMICs) and also heard from stakeholders that the term ‘citizen science’ is not often used in many LMIC settings – though there are similar types of research under different labels.
• Digital platforms used. While not all projects used digital platforms to enable their research, some of the more popular types included tools for crowdsourcing data collection or analysis, running research studies, or facilitating online discussion and knowledge sharing. Some projects built custom tools while others used existing social media platforms.
• Citizens’ expertise and lived experience. More projects invited involvement from citizens with lived experience of mental health conditions than from the general public more broadly. Citizens contributed research expertise, subject-matter expertise from different domains, and skills in organisation, advocacy, communication, hypothesis formulation, ideation, and analysis.
• Project duration and engagement frequency. Most projects lasted between a few months to a year, but it is unclear whether this reflects project design or funding constraints. Co-created projects more often involved multiple, regular engagements with citizens across their duration while contributory projects tended to invite one-time or unlimited citizen involvement.

 

Challenges to citizen science in mental health research
Citizen science in mental health research is currently hindered by challenges including inconsistent use of the term, little differentiation from other data-gathering methods, and overlap with existing collaborative approaches. There is no consistent point of reference for what citizen mental health science is and is not even though they are guided by broad principles established within the wide citizen science community. This presents several risks such as undermining established methodological traditions in mental health research. It also makes it difficult for those interested in the approach to explore distinct applications in mental health research, which further challenges the ability to establish specific, scalable practices. In addition, the lack of mental health specific principle and value frameworks, as well as bespoke ethical standards and governance frameworks tailored to the specific needs of citizen mental health science projects, means that there are significant risks including breaches of privacy and trust. While citizen science has potential in mental health research, its current form lacks the necessary distinctiveness and standards to be broadly useful, requiring further explorations of specific use cases and the development of best practices and governance structures.

Considerations and opportunities for future development 
We therefore suggest funders and other citizen mental health science stakeholders account for the following considerations when further developing this space:

• When framing funding calls, be cautious using the term ‘citizen science’ due to its fluid and overlapping scope, and in LMICs its rare usage; instead, clearly specify any desired methodologies, principles or practices, and allow project teams to define how they will approach the research question, including whether citizen science is an appropriate methodology. 
• Provide enough time and funding to support relationship-building, as this is core to developing successful co-created citizen science projects. Funders should also be aware of challenges around digital exclusion that may limit participation diversity and ask projects to consider appropriate mitigation strategies.
• Finally, while safeguarding citizen scientists, especially those with lived experience of mental health challenges is essential, stakeholders should avoid overestimating vulnerability, which could unnecessarily restrict engagement and contributory opportunities.

There are distinct opportunities to enable citizen science to more clearly add value to the existing range of approaches in use within mental health science. These include supporting a variety of projects that address gaps in methods and applications: 

• Co-created projects to achieve greater diversity at scale 
• Citizen science to progress our understanding around social and environmental determinants of mental health
• Large-scale qualitative projects leveraging contributory methods
• Citizen-sourced data analysis projects to utilise subjective judgement and train AI tools
• Contributory projects that involve gathering data from citizens using smartphones
• Citizen-initiated projects by people with lived experience of mental health conditions.

Other opportunities include developing shared principles, standards, and other resources to tackle common barriers:

• Translate and advance data collection instruments for digital affordances
• Develop shared platforms to enable multiple research projects
• Initiate the development of an adaptive, pluralistic ethical framework for citizen-initiated projects
• Establish and promote clear and consistent quality assurance for citizen mental health science
• Create cross-cultural citizen mental health science learning opportunities.

Currently, citizen mental health science lacks precision, to such a degree that it is at risk of being a concept in name but a practice that is undermined by its overlapping application with other research methods. Citizen science has a rich history in scaled data collection and democratisation of the scientific process. Application in mental health needs further development as there are potential benefits, and involved stakeholders are passionate about the approach. Pursuing the directions suggested in this report could help build greater focus, coherence, and momentum in advancing citizen mental health science practice and leveraging it to make progress on core mental health research challenges. 

ii)  Hiltensperger, R., Kotera, Y., Wolf, P. et al. (2024) Measuring fidelity to manualised peer support for people with severe mental health conditions: development and psychometric evaluation of the UPSIDES fidelity scale. BMC Psychiatry, 24(675)
https://doi.org/10.1186/s12888-024-06081-8

Abstract
Background: Peer support workers provide support for people experiencing mental health conditions based on their own lived experience of mental health problems. Assessing fidelity to core ingredients of peer support is vital for successful implementation and intervention delivery. Modifications to its implementation are needed when scaling up to different socio-economic settings, raising further uncertainty about fidelity. As part of a large multi-centre study on peer support called Using Peer Support In Developing Empowering Mental Health Services (UPSIDES), we developed and evaluated the psychometric properties of the UPSIDES Fidelity Scale.
Methods: We constructed the fidelity scale based on an initial item pool developed through international expert consultation and iterative feedback. Scale refinement involved site-level expert consultation and translation, resulting in a service user-rated 28-item version and a peer support worker-rated 21-item version assessing receipt, engagement, enactment, competence, communication and peer support-specific components. Both versions are available in six languages: English, German, Luganda, Kiswahili, Hebrew and Gujarati. The scale was then evaluated at six study sites across five countries, with peer support workers and their clients completing their respective ratings four and eight months after initial peer support worker contact. Psychometric evaluation included analysis of internal consistency, construct validity and criterion validity.
Results: For the 315 participants, item statistics showed a skewed distribution of fidelity values but no restriction of range. Internal consistency was adequate (range α = 0.675 to 0.969) for total scores and all subscales in both versions. Confirmatory factor analysis indicated acceptable fit of the proposed factor structure for the service user version (χ2/df = 2.746; RMSEA = 0.084) and moderate fit for the peer support worker version (χ2/df = 3.087; RMSEA = 0.093). Both versions showed significant correlations with external criteria: number of peer support sessions; perceived recovery orientation of the intervention; and severity of illness.

Conclusions: The scale demonstrates good reliability, construct and criterion validity, making it a pragmatic and psychometrically acceptable measure for assessing fidelity to a manualised peer support worker intervention. Recommendations for use, along with research and practical implications, are addressed. As validated, multi-lingual tool that adapts to diverse settings this scale is uniquely positioned for global application.

iii)  Slade, M., Rennick-Egglestone, S., Robinson, C. et al. (2024) Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with psychosis experience (NEON Trial): a pragmatic randomised controlled trial.  The Lancet Regional Health – Europe, 47, 101101
https://doi.org/10.1016/j.lanepe.2024.101101

Abstract
Background: The Narrative Experiences Online (NEON) Intervention provides self-managed web-based access to mental health recovery narratives (n = 659). We evaluated effectiveness and cost-effectiveness in improving quality of life for adult residents in England with mental health problems and recent psychosis experience.
Methods: Prospectively registered pragmatic parallel-group randomised trial controlling for usual care, recruiting from statutory mental health services and through community engagement activities, with a 52-week primary endpoint (ISRCTN11152837). All trial procedures and the NEON Intervention were delivered by an integrated web-application. Randomisation was through an independently generated list (no stratification). Allocation was masked for statistical staff and the Chief Investigator but not participants. Intervention arm participants received immediate NEON Intervention access. Control arm participants received access after completing primary endpoint questionnaires. The primary outcome was quality of life through the Manchester Short Assessment (MANSA). Serious Adverse Events (SAEs) were collected through web-based safety report forms and identified from health service usage data. The primary analysis was by a prospectively described Intention To Treat principle excluding participants who had registered multiple times, with multiple imputation for missing data.
Findings: Between 9 March 2020 and 1 March 2021, 739 participants were randomised (intervention:370; control: 369), providing more than 90% power to detect a baseline-adjusted difference of 0.25 in the MANSA score. Mean age was 34.8 years (standard deviation (SD) 12.0), 561 (75.9%) were white British, 443 (59.9%) were female, 609 (82.4%) had accessed specialist care mental health services, and 698 (94.5%) had accessed primary care mental health services. Mean baseline MANSA score was 3.7 for control and intervention arms (SD 0.9 and 1.0). 565 (76.5%) participants provided primary endpoint MANSA data with a mean score of 4.1 (SD 1.0) for both arms. We found no significant difference in Quality of Life between the two arms at the primary endpoint (baseline-adjusted difference 0.07, 95% CI −0.07 to 0.21, p = 0.35). The incremental cost-effectiveness ratio (£110,501 per quality-adjusted life-year (QALY)) exceeded the prospectively defined cost-effectiveness threshold (£30,000 per QALY). 158 (42.8%) control arm and 194 (52.4%) intervention arm participants accessed narratives outside of the NEON Intervention. There were no related serious adverse events (SAEs). 116 unrelated SAEs were reported by control arm participants, and 107 by intervention arm participants.
Interpretation: Our findings do not indicate NEON Intervention access for all people with psychosis experience. Future research should consider a) evaluation with current mental health services users; b) optimisation to enable users to find hope-promoting narratives.

iv)  Kotera, Y., Ronaldson, A., Hayes, D. et al. (2024) 28-country global study on associations between cultural characteristics and Recovery College fidelity.  npj Mental Health Research, 3(46).
https://doi.org/10.1038/s44184-024-00092-9

Abstract
Recovery Colleges (RCs) are learning-based mental health recovery communities, located globally. However, evidence on RC effectiveness outside Western, educated, industrialised, rich, and democratic (WEIRD) countries is limited. This study aimed to evaluate associations between cultural characteristics and RC fidelity, to understand how culture impacts RC operation. Service managers from 169 RCs spanning 28 WEIRD and non-WEIRD countries assessed the fidelity using the RECOLLECT Fidelity Measure, developed based upon key RC operation components. Hofstede’s cultural dimension scores were entered as predictors in linear mixed-effects regression models, controlling for GDP spent on healthcare and Gini coefficient. Higher Individualism and Indulgence, and lower Uncertainty Avoidance were associated with higher fidelity, while Long-Term Orientation was a borderline negative predictor. RC operations were predominantly aligned with WEIRD cultures, highlighting the need to incorporate non-WEIRD cultural perspectives to enhance RCs’ global impact. Findings can inform the refinement and evaluation of mental health recovery interventions worldwide.

v) Koops, S., Allott, K. & de Haan, L. et al. (2024) Addressing the Evidence to Practice Gap: What to Expect from International Antipsychotic Dose Reduction Studies in the Tapering Anti-Psychotics and Evaluating Recovery Consortium. Schizophrenia Bulletin, 50(1), 5–8.
https://doi.org/10.1093/schbul/sbad112

Summary
In their short, but informative editorial, Koops et al (2024) draw attention to the work of the international Tapering Anti-Psychotics and Evaluating Recovery (TAPER) Research Consortium.  While outlining 5 project areas the consortium clearly articulates their shared goal to ‘provide meaningful, reliable, and broadly generalizable evidence on a comprehensive range of benefits and harms of antipsychotic reduction and discontinuation in the short- and long term’.

vi) Hunt, J. (2024) Holistic or harmful? Examining socio-structural factors in the biopsychosocial model of chronic illness, “medically unexplained symptoms” and disability.  Disability and Society, 39(4), 1032-1061
https://doi.org/10.1080/09687599.2022.2099250

Abstract
A particular application of the biopsychosocial model is associated in peer-reviewed literature and patient testimony with harms done to chronically ill and disabled people. These harms derive from an empirically unsubstantiated, neoliberal narrative emphasising the role of personal responsibility and effort in ‘recovery’ from ill-health, ignoring socio-structural contributors to chronic illness and disability. Notably, this biopsychosocial model ignores the health-related impact of welfare and disability insurance reforms which the model has been employed to justify. The model and associated interests can thus be recognised as socio-structural phenomena that should be acknowledged in any truly holistic biopsychosocial approach to chronic illness and disability. A critically informed and reflexive approach to biopsychosocial theorising would allow a more holistic and nuanced understanding of chronic illness and disability, with implications for health and social policy that underline and address what ails society as opposed to what is ‘wrong’ with the individual.

vii) J. B. Kirkbride, Anglin, D. M. Colman, I. et al. (2024) The social determinants of mental health and disorder: evidence, prevention and recommendations.  World Psychiatry, 23(1), 58-90.
https://doi.org/10.1002/wps.21160

Abstract
People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high‐quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethno-racial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.

Other News /Resources

i)  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

Recovery Research Network eBULLETIN

November 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) The 33^rd European Congress of Psychiatry will take place:
Date: 5^th – 8^th April 2025
Venue:  Madrid, Spain
Conference theme: Towards Real-World Solution in Mental Health
For more information, please see here.

ii) The Centre for Mental Health in the UK is curating a special issue of Perspectives in Public Health, focusing on the potential impact of global events on the mental health of the public and implications for informing actions on global inequalities

The deadline for submissions is 31 January 2025. Authors should submit via an online submissions system:
https://mc.manuscriptcentral.com/pph

More information is available here

iii) The 7th Refocus on Recovery conference will take place:
Date: Thursday September 4^th – Friday September 5^th 2025
Venue:  Crowne Plaza Hotel, Nottingham, UK
Conference theme 2025: Reimagining Recovery, with a focus on:
1) the role of lived experience in embedding and supporting recovery
2) new perspectives around mental health and recovery
3) extending recovery beyond mental health

Registration is now open, and abstracts can be submitted from 18^th November 2024 to 28^th February 2025

For more information, please see here: https://www.researchintorecovery.com/ronr2025/

iv) Writing out of the School of Health Sciences at Nottingham University, Yasuhiro Kotera (Associate Professor in Mental Health) and colleagues are calling for chapter submissions for their new book “Compassion-Focused Therapy for Mental Health: International Perspectives” to be published by Springer.
The book intends to explore the application of compassion-based interventions including Compassion-Focused Therapy (CFT) in diverse cultural contexts, providing mental health professionals with guidance to adapt these interventions across global settings. Integrating compassion with cultural sensitivity, the book will include case studies, research, reviews, perspectives, and practical interventions to demonstrate how compassion-based interventions can align with various cultural values and beliefs, promoting inclusivity in therapy. The details can be downloaded from here.
For more information please contact:  yasuhiro.kotera@nottingham.ac.uk

Papers and Publications 

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

i)  In addition to Yasuhiro Kotera’s call for chapter submissions in the previous section, a new book authored by Yasuhiro and written in the Japanese language: “Writing Research Articles in Mental Health: Tips and Mental Strategies on How to Keep Publishing in International Journals”, is available to pre-order through Amazon Japan. It is to be released on 19th December 2024, Yasuhiro Kotera writes: How did an ordinary researcher who faced many rejections achieve an h-index of over 40 and 250 publications within just seven years of his first publication? This book presents easy-to-understand tips and mental strategies for consistently publishing papers, undeterred by harsh criticism and internal politics. The Amazon link is here.

ii)  Griffiths, C., McIlhiney, W., Evans, A., O’Neill-Kerr, A., da Silva, K. M., & Jiang, H. (2024). “Flow” Transcranial Direct Current Stimulation (tDCS) for Depression Treatment in a Community Mental Health Team (CMHT) Ser vice: Depression, Functioning, and Health Related Quality of Life Outcomes. Open Journal of Depression, 13(4), 79-96.
https://doi.org/10.4236/ojd.2024.134006

Abstract
Background: People who experience severe mental illness (SMI) have a high prevalence of depression symptoms, which is linked to worse functioning and quality of life. Research evidence indicates that transcranial direct current stimulation (tDCS) can reduce symptoms of depression. Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application that delivered wellbeing behaviour therapy training.
Purpose/Aim: This study investigates if Flow can be introduced to a Community Mental Health Team (CMHT) service and the impact of Flow in treating depression. The study addresses the questions: “what are the depression reliable improvement and remission rates?” and “can Flow significantly reduce depressive symptoms and improve real world functioning (everyday, social and occupational functioning) and health-related quality of life?”.
Methods: An open-label patient cohort design with no control group. Pre-intervention and 6-week follow-up intervention assessments using the participant self-report measures: Patient Health Questionnaire (PHQ-9), Work and Social Adjustment Scale (WSAS), and EuroQol five-dimension (EQ-5D-5L). Participants were 31 CMHT patients, 15 males and 16 females, with an age range of 21 to 64 years, and average age of 42 years.
Results: PHQ-9 reliable improvement and remission rates were 51.61% and 12.9%, respectively. PHQ-9 scores significantly improved, from 20.9 (SD 5.55) to 14.6 (SD 7.33) at 6 weeks, with large effect size. WSAS scores improved from 31.3 (SD 6.02) to 22.5 (SD 11.43) at 6 weeks, with large effect size. EQ-5D-5L results showed significant improvements in the health index score, and three EQ-5D5L dimensions (“mobility”, “self-care”, and “pain”). Conclusion: Flow tDCS treatment was integrated into a CMHT service and was found to be beneficial in terms of improving functioning and quality of life and reducing depression symptoms. Flow FL100 tDCS and wellbeing behaviour therapy training could be offered through all CMHT services to people with SMI to treat depression, enable better functioning, and improve quality of life.

iii)  Johansen, K. K., Lerbæk, B., Slade, M., Castelein, S., & Jørgensen, R. (2024). Paving the Road While Walking – Perspectives from Flexible Assertive Community Treatment Managers on Preparing the Implementation of Peer Support Work (PSW) in Outpatient Services. Issues in Mental Health Nursing, 45(11), 1148–1154.
https://doi.org/10.1080/01612840.2024.2391848

Abstract
This qualitative study explored the perspectives of Flexible Assertive Community Treatment managers on preparation and employment of peer support workers. The study was based on semi-structured interviews with managers (n=5) in Outpatient Services in the North Denmark Region. The analysis was based on an inductive approach to content analysis which led to three themes: (1) An exploratory but energy-loaded process—deciding to employ peer support workers, (2) Paving the road while walking—preparing employment of peer support workers, and (3) Uncertainty about the “how” and the “what”—preparing mental health professionals for collaborating with peer support workers. Together these themes describe an exploratory and unstructured implementation process, revealing a lack of structure during implementation. Such circumstances are known to potentially compromise staff wellbeing, feeling insecure about own professional role, and lack of readiness to embrace peer support workers as colleagues. Applying an implementation framework and addressing the literature on barriers and facilitators may promote successful implementation of peer support worker employment.

iv)  Lerbæk, B., Johansen, K., Burholt, A. K., Gregersen, L. M., Terp, M.Ø., Slade, M., Castelein, S. & Jørgensen, R. (2024) Non-peer professionals’ understanding of recovery and attitudes towards peer support workers joining existing community mental health teams in the North Denmark Region: A qualitative study. International Journal of Mental Health Nursing, 33(6):2043-2053.
https://doi.org/10.1111/inm.13349

Abstract
Peer support is a collaborative practice where people with lived experience of mental health conditions engage in supporting like-minded. Peer support impacts on personal recovery and empowerment and creates value at an organisational level. However, the implementation of peer support into existing mental health services is often impeded by barriers embedded in organisational culture and support in role expectations. Non-peer professionals’ recovery orientation and attitudes towards peer support workers (PSWs) are essential factors in the implementation of peer support, and this study explored non-peer professionals’ understanding of recovery and their attitudes towards PSWs joining existing community mental health teams in one region of Denmark. In total, 17 non-peer professionals participated in three focus groups. Thematic analysis led to three themes: (1) Recovery is a process of “getting better” and balancing personal and clinical perspectives; (2) Realising recovery-oriented practice: a challenging task with conflicting values; and (3) Expectations and concerns about peer support workers joining the team. Recovery-oriented practice faces challenging conditions in contemporary mental health services due to a dominant focus on biomedical aspects in care and treatment. Implementation facilitators and barriers in the employment of PSWs point towards fundamental aspects that must be present when employing PSWs in an organisation. The issues described leading up to the employment of PSWs reflected in this study underpin the importance of preparing an organisation for the employment of PSWs based on the available knowledge.

v)  Yu, T. T. F., & Wong, P. T. P. (2024). Existential wellbeing may be of utmost importance to many people, Academia Mental Health and Well-Being, 1(3). https://doi.org/10.20935/MHealthWellB7416

Abstract
Existential wellbeing (EWB) may be the most important type of wellbeing because, compared with other types of wellbeing, it may be more relevant to all people in all circumstances. However, it remains the most neglected form of wellbeing in mainstream positive psychology (PP). In this brief concept paper, we first explain the fundamental problems pertaining to the PP approach in research on wellbeing, which ignored the PP of suffering and EWB. Next, we present the existential positive psychology (EPP) as a more promising framework for a global wellbeing research that is more realistic, inclusive, and sustainable. Using the EPP framework, we then define the elements, processes, and outcomes of EWB. Finally, we provide several examples to potentiate why EWB may be more relevant to all people, two of which draw on the authors’ lived experiences.

vi)  Benzon, A. & Jørgensen, R. (2024) ‘To loosen up and talk’: Patients´ and facilitators´ experiences of discovery group sessions from the Tidal Model as an introduction before engaging in a person-centred group intervention.  Journal of Psychiatric and Mental Health Nursing, 31(5), 705–715.

Abstract
Introduction: Recovery-oriented interventions delivered individually or in groups are more and more common within mental health nursing. However, persons with mental illness may be cautious about engaging in groups. Therefore, it is important to provide a trusting basis in the group to allow for the best opportunities to promote engagement, attendance and impact of treatment.
Aim: The aim was to explore how discovery group sessions were experienced as introductory sessions from the perspectives of participants and facilitators before engaging in a person-centred group intervention.
Method: A qualitative interview study was conducted, involving four group facilitators and 16 participants with mental illness from five completed groups. Data were analysed with Ricoeur’s theory of interpretation.
Results: The findings showed that the two discovery group sessions were experienced as useful and meaningful to all and created a safe atmosphere and a trusted relationship among group participants and facilitators.
Discussion: Feeling safe and sharing experiences and emotions contribute to the relational
climate in a group. Implication for practice: Addressing concerns about social interactions in persons with mental illness is important in group treatment. This study proved that engaging patients in designing or adapting interventions for mental health services is important to improve quality

vii)  Dhari, S., Slemon, A., & Jenkins, E. (2024). The Subaltern: Illuminating matters of representation and agency in mental health nursing through a postcolonial feminist lens. Nursing Inquiry, 31, e12661.
https://doi.org/10.1111/nin.12661

Abstract
Inpatient mental health nursing operates with an overarching goal to support people living with mental health challenges by managing risk of harm to self and others, decreasing symptoms, and promoting capacity to live outside of hospital settings. Yet, dominant, harmful stereotypes persist, constructing patients as less than, in need of saving, and lacking self‐control and agency. These dominant assumptions are deeply entrenched in racist, patriarchal, and Othering beliefs and continue to perpetuate and (re)produce inequities, specifically for people with multiple intersecting identities relating to race, class, gender, and culture. This paper explores the relevance of postcolonial feminism, particularly Gayatri Spivak’s concept of Subaltern—conceptualized as groups of people who are denied access to power and therefore continue to be systematically oppressed and marginalized—in illuminating the problematic and dominant assumptions about people living with mental health challenges as lacking agency and requiring representation. Through an understanding of Subalternity, this paper aims to decenter and deconstruct dominant colonial, patriarchal narratives in mental health nursing, and ultimately calls for mental health nursing to fundamentally reconsider prevailing assumptions of patients as needing representation and lacking agency.

Other News /Resources

i)  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

Recovery Research Network eBULLETIN

December 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)  The Centre for Mental Health in the UK is curating a special issue of Perspectives in Public Health, focusing on the potential impact of global events on the mental health of the public and implications for informing actions on global inequalities

The deadline for submissions is 31 January 2025. Authors should submit via our online submissions system:  https://mc.manuscriptcentral.com/pph

More information is available here

ii) The 33^rd European Congress of Psychiatry will take place:
Date: 5^th – 8^th April 2025
Venue:  Madrid, Spain
Conference theme: Towards Real-World Solution in Mental Health
For more information, please see here.

iii) The 7^th European Conference on Integrated Care and Assertive Outreach will take place:
Date:  23^rd – 25^th June 2025
Venue:  Mærsk Tower, Panum, Copenhagen
Conference theme:  Closing the gap in psychiatric care for people with serious mental illness.

For more information, including abstract submissions and registration, please see here.

iv) The 7th Refocus on Recovery conference will take place:
Date: Thursday September 4^th – Friday September 5^th 2025
Venue:  Crowne Plaza Hotel, Nottingham, UK
Conference theme 2025: Reimagining Recovery, with a focus on:
1) the role of lived experience in embedding and supporting recovery
2) new perspectives around mental health and recovery
3) extending recovery beyond mental health

For more information, please see here: https://www.researchintorecovery.com/ronr2025/

 

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)  Ambord, N., Burr, C. & Zuaboni, G. (2025) A Glimmer of Hope: The Impact of the Recovery College Bern on Personal Recovery, Well-Being and Self-Stigmatisation – A Mixed Methods Study. International Journal of Mental Health Nursing, 34: e13482. https://doi.org/10.1111/inm.13482

Abstract
Recovery Colleges are mental health education centres co-produced by experts with lived experience with mental health problems and mental health professionals. The aim of the study was to evaluate the impact of a Recovery College in Switzerland on its students’ mental health measured through personal recovery, well-being and self-stigmatisation in a mixed methods approach following the MMARS guideline. Three standardised questionnaires ‘Questionnaire about the Process of Recovery’, ‘WHO-5 Well-Being Index’ and ‘Self-Stigma of Mental Illness Scale Short Form’ were completed by 92 participants as part of a pre-post-evaluation while two focus groups (n = 10) provided further explanations regarding impacts on the three topics. Statistical analyses include paired sample t-test or Wilcoxon signed rank tests for pre-post-test comparisons as well as Cohen’s d to determine effect sizes. For all three questionnaires, significant improvement was shown in the desired direction with low to medium effect sizes. A higher number of courses attended did not result in higher scores in the outcome measurements. The qualitative analysis confirmed these results by providing insights of specific aspects of these positive impacts. These include increased social inclusion, improvement in attitudes towards one’s life and identity, increased engagement in hobbies and healthy behaviours, positive impacts on well-being and decreased self-stigmatisation.  The findings indicate that Recovery Colleges should be made available continuously and further developed also in other regions of Switzerland. Similar projects require continuous evaluation in early development to ensure effectiveness and improve quality

ii)  Cunnington, C., de Courcier, S., Godwin, C., Hannis, J., Lloyd, J., Macklam, S., & Turner, Z. (2024) ‘Flow’: A Film About the Disclosure of Childhood Sexual Abuse. Sociological Research Online, 0(0).
https://doi.org/10.1177/13607804241248347

Abstract
Trauma-informed care is growing in importance in health and social care, with disclosure as a vital first step. Yet evidence suggests that individual interactions with professionals may not facilitate trauma disclosure. ‘Flow’ aimed to address this. The film represents a high-quality, behaviour change resource that can be utilised in a wide range of circumstances. It was co-produced by representatives from the University of Sheffield, NHS England, the Department of Health and people with lived experience of childhood sexual abuse. The film follows the story of Amy, who is preparing for her art exhibition when a comment reignites traumatic childhood memories. She wants to approach her General Practitioner for help but is hindered both by family loyalty and barriers to disclosure within the NHS. ‘Flow’ has been used both in statutory services and non-governmental organisations, as well as being selected for inclusion in two film festivals. It represents an innovative way to communicate research results and foster change.

Please note:  The accompanying video is available for viewing on the article page which is available here.

iii)  Deering, K., Wagstaff, C., Williams, Jo., Bermingham, I. & Pawson, C. (2024) Ontological insecurity of inattentiveness: Conceptualizing how risk management practices impact on patient recovery when admitted to an acute psychiatric hospital. International Journal of Mental Health Nursing, 33, 420–430.
https://doi.org/10.1111/inm.13245

Abstract
Risk management which assesses and mitigates risks such as suicide and violence is under scrutiny, particularly within psychiatric inpatient settings. Restrictive practices, which result from risk assessment, such as observations, physical restraint and ward seclusion can impact negatively on patient recovery, hindering abilities to develop a meaningful life that emphasizes purpose, hope and autonomy, despite experiencing mental distress. Yet, less is known about the impact from the patient’s perspective when first admitted to hospital, a period which among other reasons may come with increasing risk management practices owing to the clinical uncertainties about patients’ risks. In this grounded theory study, we explore the impact on recovery, interviewing 15 adult participants with patient experiences of being in an acute hospital. The main theme of the study, termed a core category with a grounded theory, was identified as “ontological insecurity of inattentiveness”. This highlighted a staff inattentiveness with involving patients with risk management and explaining the purposes of the practice, which raised insecurities about what was happening to the patients when admitted to hospital. Four subcategories support the core category; discounting the patients’ experiences to gain a meaningful grasp of risk management, ambiguity about risk management rules, particularly the reasons around their use, forebodingness to the hospital environment and, management from afar, with patients feeling scrutinized from observations without a voice to offer different views.  It is hoped these findings will add to the field of patient involvement in psychiatric inpatient settings, proposing attempts to raise understanding and inclusivity of risk management, starting when first admitted to hospital.

iv)  Grattan, S., Davies, K., Weise, J., Burns, N., Murray, R., Weldon, J., Ellis, R. & Lappin, J. M. (2024) Development of a framework of the skills and attributes needed by mental health professionals to provide optimal clinical care to people experiencing complex psychosis: A Delphi consensus study.  Australian & New Zealand Journal of Psychiatry, 59(1), 60-73.
https://doi.org/10.1177/00048674241289032

Abstract
Background:  Complex psychosis is associated with high social and economic costs. The key skills and attributes needed by mental health professionals to provide optimal clinical care to people experiencing complex psychosis have not previously been defined. A framework detailing these skills and attributes is needed to support the identification of training needs for those working with this population.
Methods:  A modified online Delphi method was used to reach consensus on the skills and attributes essential for mental health professionals to deliver optimal clinical care to people experiencing complex psychosis. Participants were international healthcare professionals and academic researchers who self-identified as experts in complex psychosis. Participants were asked to rate their level of agreement with each item on a five-point Likert-type scale and to provide comments. Qualitative feedback was used to modify existing, or create new, items for subsequent rounds.
Results:  64 responses were received across three Delphi rounds. 167 items reached consensus and were endorsed (132 in Round 1, 31 in Round 2 and 4 in Round 3). Median score range for endorsed items was 4.5/5, with 88.6% scoring 5/5. All 167 endorsed items were included in the framework, categorised into 14 overarching domains.
Conclusion:  Multiple skills and attributes were identified as being core components required in the delivery of optimal care by mental health professionals to people experiencing complex psychosis. The resulting framework provides a benchmark for training and skill development of mental health clinicians at both individual and team levels to optimise effective working with this high-needs population.

v) O’Connor, C. A., Zufferey, C. & de Anstiss, H. (2025) Governing failed neoliberal subjects: Representations of women’s mental health in Australian mental health policies.  Qualitative Social Work, 24(1), 61-77.
https://doi.org/10.1177/14733250231222020

Abstract
This paper uses Carol Bacchi’s ‘What’s the problem represented to be?’ (WPR) framework to explore representations of women’s mental health in federal and South Australian mental health policies. It argues that mental health policies govern women through neoliberal discourses that individualise mental health and illness while neglecting the social structural factors which significantly influence mental health outcomes and health equity. In a ‘self-monitoring’ neoliberal society, people are increasingly required to seek medical and pharmaceutical intervention to promote ideal personhoods, with women overrepresented in this group. The disciplinary power of the medicalisation discourse categorises women as either ideal or failed neoliberal subjects. This is concerning for social workers because neoliberal and medicalisation discourses shape how women’s mental health is represented in policy and responded to in practice. This paper challenges biomedical and neoliberal discourses underpinning policy representations and identifies the implications for social work and social policy.

vi)  Steingard, S. (2024) Introduction to Special Issue on Recovery at 30: Emancipation, Co-optation, or the End of an Era?  Community Mental Health Journal, https://doi.org/10.1007/s10597-024-01422-z

The above commentary introduces a special issue in Community Mental Health Journal to coincide with the 30^th anniversary of William Anthony’s 1993 pivotal article: ‘Recovery from mental illness: the guiding vision of the mental health service system in the 1990s.’  A range of international contributors include: service users, academics and clinicians.  Dr. Steingard also draws particular attention to the posthumous inclusion of a critically acclaimed piece by Dr. Carl Cohen on the relationship between Neoliberalism and the recovery movement.  We include a reference to Dr Cohn’s engaging and insightful contribution below.

vii)  Cohen, C. I. (2024) Neorecovery: A Critical Analysis of the Relationship between Neoliberalism and the Recovery Movement. Community Mental Health Journal. https://doi.org/10.1007/s10597-024-01275-6

 

Abstract
“Neorecovery” is a portmanteau used to describe the distortions that neoliberalism engendered in the original recovery philosophy. I describe how neoliberalism as an economic model acted externally to the recovery movement to preclude opportunities to implement a wide range of innovative mental health approaches and to curtail safety net and social justice policies for persons with severe mental illness. In addition, I illustrate how the neoliberalism philosophy acted internally by inducing the recovery movement to adopt an individual-focused ethos that minimized the impact of broader social structures that affect well-being and opportunities for self-realization. Recovery’s potentially radical transformative vision can only be achieved by seriously acknowledging the social and political structures that underlie the mental health system and their relationship to the broader society, and ultimately, altering them so that people experiencing severe mental illness can truly flourish.

Other News /Resources

i)  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