Recovery Research Network (RRN)
2017 RRN Emails
January 2017
Recovery Research Network eBULLETIN
January 2017
As many of you will know, our colleague Ruth Chandler sadly passed away in December of last year and the Network celebrated Ruth’s life with an obituary in the December edition of the ebulletin. Ruth undoubtedly touched many lives, and we continued to receive the kind words of others. We welcome you to the first ebulletin of 2017 with the remainder of those words:
Claire Warrington, Doctoral Student: Section 136 of the Mental Health Act, University of Brighton
Talking about Ruth using past tense seems so wrong, not only because of the horrible shock that she’s not physically with us anymore but also because she is, and I hope always will be, such a huge part of the work the department does. Ruth taught me and I’m sure so many others such a huge amount. She was so generous with her time and so passionate about making sure the voices of people who are too often not heard were placed at the heart of what we do. I think all of us who worked with her are better for the experience. To say I’ll miss her is an understatement, but what I mean is I’ll miss spending time with her because I will do my best to always honour her memory in my research and to never forget her voice, and her wonderful laugh.
Philippa Case, Research Manager, Research and Development Team, Sussex Partnership
Ruth and I started in the department within one month of each other and we first met at our annual research conference, where I was in awe of her ability to articulate the perfect questions and ask them fearlessly! Over the seven-and-a-half years that we worked together, the awe has remained as I saw the passion and drive to her role in patient and public involvement. On a personal level, I liked Ruth immensely and have learnt so much from her through her approach to work and to life. It will not be the same in the department without her, but we will work to ensure that the values she brought to the team are maintained in the work we do.
Jean Southey, Co-ordinator for Service User and Carer Involvement, Sussex Partnership NHS Foundation Trust
We all relied on Ruth to be our figurehead, flying the flag for Involvement in LEAF and the Involvement team. However she also had the wisdom to delegate, ensuring we were constantly building our own skills and confidence by guiding us in the right direction. Ruth rewarded us with her trust in our thinking and beliefs. She was such a role model; assertively speaking her mind to all and encouraging others to do the same, whilst respecting difference. Anyone who got to know Ruth realised she had rare gifts and was able to offer each one of us a wider world of understanding around how the health system works and how we can build a network of voices to become equal partners in research with our experience. Ruth’s political astuteness was immense and yet she could speak in the most available language at so many different levels. Whilst there is no way we individually can replicate Ruth’s charismatic approach we need to be guided by her example; keeping on message, keeping together and keeping all the initiatives alive to move onwards with Ruth’s vision. I feel privileged to have worked with Ruth for four years. She taught me so much about life and overcoming adversity. I will always remember her cheeky grin, her mischievousness and her great sense of fun. I will really miss her.
Paula Bellers, Communications Officer, Research and Development, Sussex Partnership NHS Foundation Trust
I’ve known Ruth since I joined the department five years ago and I was impressed by her drive, passion for involving people with lived experience in research, honesty, open-heartedness and sense of humour. She was a supportive and protective colleague and a real champion of me personally who was always quick to say ‘thank you’. We worked closely together preparing articles about involvement for our research magazines and several events and she was always enthusiastic, tenacious and keen to get her message across. Ruth’s network stretched far and wide and when I look back over the magazines, you can see that Ruth’s work in involvement runs throughout. I was always proud of her at events – when she spoke, it was always with clarity and honesty and the room sat up and listened! We also shared many conversations about her grandchildren, as well as a similar taste in music. Ruth was an exceptional person; she was a force of nature who liked get things done. I have learned so much from her and will miss her.
Hugo Critchley, Chair in Psychiatry, Brighton and Sussex Medical School
I wish to express my personal condolences to Ruth’s family and friends and express my appreciation and gratitude for the wonderful opportunity to have worked with Ruth. She was an inspiration to myself my colleagues and my team. She enthusiastically supported our work in psychiatry research at Brighton and Sussex Medical School. Her input in shaping and advising on our research has been invaluable. For a period Ruth was also an active member of the Research Ethics and Governance Committee, providing a fresh, insightful and highly-valued input into decision-making about sponsoring and approving research at the University. Recently I had been working with Ruth who led the PPI voice on an external ethics advisory for committee for one of my Research grants and was a collaborator on another, in which we sought to embed patient involvement throughout the delivery of the research. Myself and my colleagues at Brighton and Sussex are deeply saddened by Ruth’s death. She has left a lasting impression. Ruth’s local and national championing of patient involvement in clinical research and practice will have a lasting impact.
Sara Meddings, Psychology and Psychological Therapies Consultant Lead for Recovery and Wellbeing, Sussex Partnership NHS Foundation Trust
Ruth is an inspiration. Her work with LEAF and making lived experience involvement an essential part of all research projects makes me proud to work for Sussex Partnership. She has been a service user leader standing up for people’s rights. She has been a huge supporter of the Recovery College from the start. She has encouraged me to put in research proposals about recovery and lived experience. She has also been a huge support to me especially in my thinking about using my own lived experience. I will miss her. She has been at the forefront of recovery focused research both locally and nationally. I am confident that she has left such an impression that her legacy will live on.
Victoria Hare, Manager Centre for Dementia Studies
Dear Ruth, your contribution to dementia research, is unforgettable. Thank you, much love.
Clara Strauss, Research Fellow, Research and Development Team, Sussex Partnership NHS Foundation Trust
I can’t remember a time when Ruth wasn’t here – when I think of the R&D department, I think of Ruth – her kind hearted, passionate and challenging presence. Quite simply, the R&D department wouldn’t be what it is today without Ruth, it would be poorer and more one-dimensional. There were many times when I agreed with Ruth – and many times when Ruth helped me to change my mind and really see the value of lived experience involvement, opening my eyes to issues and perspectives I wasn’t aware of. There were times when I didn’t agree with Ruth, and she always responded with respect and understanding – but also held her ground – which I respected her for, and which I think was needed. On a personal level I feel so sad to have lost such a unique and valued colleague, and I still half expect to see Ruth walking down the corridor. I will miss her.
Dr Kay Macdonald – Executive Lead for Research, Sussex Partnership NHS Foundation Trust
Our dear Ruth – we will miss her so much. On behalf of the Board and Executive team at Sussex Partnership Trust we would like acknowledge just how much she has helped us develop our research. She was a leading light in helping us understand and be curious about mental health. She leaves a great legacy – her shoes will never be adequately filled.
Duncan Barron, NIHR Research Design Service South East & Brighton & Sussex University Hospital Trust (BSUH) University of Brighton
Ruth Chandler: My ‘Critical Friend’
Ruth first introduced me to an approach to service user feedback and consultation in health research modelled on the Critical Friend Model. This has proved invaluable in my own work. In many ways Ruth was the embodiment of a ‘critical friend’: she was a “trusted person who asks provocative questions…”; she always examined situations through “another lens” and offered her critique “as a friend.” She took time to “fully understand the context” of whatever was set before her and she was always “an advocate for the success” of projects she believed in or people in her life. She didn’t find your flaws; she saw your strengths. She wanted to help and move projects and people forward. Ruth was intellectually challenging and stimulating. Her contributions to discussions were provocative but pertinent. Often she changed your mind. Despite challenges in her own life Ruth was compassionate and caring and took the time to find out about others and offer support and advice that was always apposite. Thanks Ruth; I was fortunate to know you as a ‘critical friend’. You will be greatly missed.
Dr Clio Berry, Research Fellow, University of Sussex and Sussex Partnership NHS Foundation Trust.
Ruth was a true inspiration to me and so many others; both in how she challenged the systems surrounding us and the work we do and how she used her own life experiences in such a remarkably constructive way. She made a real difference to service user and carer involvement both locally and nationally. She motivated and inspired her colleagues, peers and the many students who came into contact with her and her teaching. She was passionately dedicated to improving the lives and experiences of service users and carers.
Ruth had a tremendous amount of bravery and integrity. She was a powerful woman with a powerful presence. She was almost intimidatingly intelligent but open and willing to share her thoughts and ideas with others. She worked hard to include, support and encourage all her colleagues and was a mentor and role model to so many. I and many others benefitted hugely both personally and professionally from working with and learning from Ruth. Most of all, Ruth was honest, funny and human – and she will be so missed.
For Ruth
RRN Meetings
The next meeting of the RRN will be held on:
Tuesday, April 18th in London
(venue to be confirmed and advertised in due course)
If you would like to present at a future meeting of the RRN please email either Shula Ramon or Tony Sparkes. Their contact details are:
Shula: s.ramon@herts.ac.uk
RRN Membership Profile
Anyone who has an interest in recovery research can join the RRN, just fill in the online form available at: https://www.researchintorecovery.com/rrn
Please note that if you join the Network, the details you supply will be circulated to other members of the Network as part of the monthly e-bulletin, but will not be put on our website and will not be shared with any other organisation. If you would like to leave the RRN and have your details removed from our database, please email researchintorecovery@nottingham.ac.uk
Conferences and Events
i) ImROC: What is the Role of Peer Support. Note change of date
Unfortunately a significant number of people are unable to make the Peer Worker Critical Debate; what is the role of peer support? planned for 31 January but are interested in the content. We agree that this is an important issue for us to dedicate time to and explore as a national group of thought leaders. We welcome your attendance on 1 June 2017, one year on from our last peer worker critical debate, to reflect on changes over the last year and set out our expectations and ambitions for the future.
Together we can unpick this challenging issue and consider what this means for our practical locally and collectively. Peer support is a crucial element of supporting recovery for all. At ImROC we are passionate about sharing positive experiences and practice, challenges ourselves to be better and supporting one another to make recovery a reality. This conference is relevant to whole communities including NHS funded mental health providers, commissioners, user led organisations and forums.
The programme chaired by Julie Repper, ImROC Director, includes:
- The debate: what is the role of peer support? It’s not what we do, it’s the way that we do it (Jane Rennison & Sue Williams, Central & North West London NHS Foundation Trust) vs distinct & dedicated peer support (Steve Gillard, St George’s University of London)
- Presentation: developments in the role of peer support (Emma Watson, Peer Support Development Lead, Nottinghamshire Healthcare NHS Foundation Trust)
- Presentation: Peer Support development for substance misuse services (Jon Roberts, Dear Albert, Drug Rehabilitation, Nottingham)
- Interactive workshops led by Rachel Perkins, ImROC Senior Consultant
To book your place please click on this link https://www.surveymonkey.co.uk/r/PGDJZQF
Delegate rates:
£100 plus VAT for ImROC sites
£150 plus VAT for non ImROC sites.
ii) Making Real Change Happen. The 20th International Congress of the ISPS will take place in the city of Liverpool, UK August 30th – September 3rd, 2017
Plenary Speakers will include: Alison Brabban, Jacqui Dillon, Grainne Fadden, Jim van Os Other speakers will include: Richard Bentall, Jim Geekie, Peter Kinderman, Eleanor Longden, Brian Martindale, John Read, Rai Waddingham
See more at: http://tinyurl.com/isps-change
Contact: isps@isps.org or visit www.isps2017uk.org
Twitter: #isps2017uk
iii) Registration and abstract submission are now open for Refocus on Recovery 2017, being held in Nottingham from 18th to 20th September 2017. The event will comprise expert workshops, an international conference and a Mad Celebration event. Conference themes will be Recovery for different groups, Re-situating mental health, Prevention of mental ill-health, Allocating resources.
See more at: https://www.researchintorecovery.com/ror2017
See also the flyers circulated with this edition of the ebulletin.
iv) The 12th ENMESH Conference will be held in Groningen, Netherlands from 5th to the 7th October 2017. Conference themes are Assessment: Understanding the context; Epidemiology: Methodological approaches supporting personalised care; Approaches: Novel approaches using the patient’s own context; and Policy: Societal challenges for community mental health. Further information at http://enmesh2017groningen.com/home/
Papers and Publications
i) Hart, A., Gagnon, E., Eryigit-Madzwamuse, S., Cameron, J., Aranda, K., Rathbone, A. and Heaver, B. (2016) Uniting resilience research and practice with an inequalities approach. SAGE Open 6(4) 1-15.
http://journals.sagepub.com/doi/abs/10.1177/2158244016682477
Abstract
The concept of resilience has evolved, from an individual-level characteristic to a wider ecological notion that takes into account broader person–environment interactions, generating an increased interest in health and well-being research, practice and policy. At the same time, the research and policy-based attempts to build resilience are increasingly under attack for responsibilizing individuals and maintaining, rather than challenging, the inequitable structure of society. When adversities faced by children and young people result from embedded inequality and social disadvantage, resilience-based knowledge has the potential to influence the wider adversity context. Therefore, it is vital that conceptualizations of resilience encompass this potential for marginalized people to challenge and transform aspects of their adversity, without holding them responsible for the barriers they face. This article outlines and provides examples from an approach that we are taking in our research and practice, which we have called Boingboing resilience. We argue that it is possible to bring resilience research and practice together with a social justice approach, giving equal and simultaneous attention to individuals and to the wider system. To achieve this goal, we suggest future research should have a co-produced and inclusive research design that overcomes the dilemma of agency and responsibility, contains a socially transformative element, and has the potential to empower children, young people, and families.
ii) Cameron, J., Sadlo, G., Hart, A. and Walker, C. (2016) Return-to-work support for workers with mental health problems: identifying and responding to key challenges of sick leave
British Journal of Occupational Therapy. 79(5) 275-283.
http://journals.sagepub.com/doi/abs/10.1177/0308022615627176
Abstract
Introduction: This research explored return-to-work and sick leave experiences of workers with mental health issues in contact with acute or community mental health services.
Method: Using a critical realist methodology with a comparative case study and collaborative design, 21 employed participants recovering from mental health problems participated in semi-structured interviews. Data were analysed using inductive and deductive thematic and constant comparative analysis.
Findings: While on sick leave, despite a range of challenges, participants treasured their work identities. They were sustained by positive and troubled by negative memories of work. People missed the routine of work and felt isolated. To varying degrees of success, they searched for alternative activities to fill this gap and promote recovery.
Conclusion: The need for sick leave was not disputed, but an important discovery was its iatrogenic (‘side-’) effects, whereby isolation and reduced activity levels could exacerbate mental health problems. Negative impacts of sick leave need to be mitigated by support to maintain worker identity and orientation and by opportunities and encouragement to sustain routine, activities and social contacts. A new concept of ‘occupational capital’ emerged, comprising accessible external opportunities and supports for occupational participation, and internal capacities and skills required to access these.
iii) Loos, S., Clarke, E., Jordan, H., Puschner, B., Fiorillo, A., Luciano, M., Ivánka, T., Magyar, E., Krogsgaard-Bording, M., Østermark-Sørensen, H., Rössler, W., Kawohl, W., Mayer, B., Slade, M. and CEDAR Study Group. (2017) Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study. BioMed Central.
DOI: 10.1186/s12888-017-1207-4
Abstract
Background: Clinical decision-making is the vehicle of health care provision, and level of involvement predicts implementation and satisfaction. The aim of this study was to investigate the impact of decision-making experience on recovery.
Methods: Data derived from an observational cohort study “Clinical decision making and outcome in routine care for people with severe mental illness” (CEDAR). Adults (aged 18–60) meeting standardised criteria for severe mental illness were recruited from caseloads of outpatient and community mental health services in six European countries. After consenting, they were assessed using standardised measures of decision-making, clinical outcome and stage of recovery at baseline and 1 year later. Latent class analysis was used to identify course of recovery, and proportional odds models to investigate predictors of recovery stage and change.
Results: Participants (n = 581) clustered into three stages of recovery at baseline: Moratorium (N = 115; 19.8%), Awareness/Preparation (N = 145; 25.0%) and Rebuilding/Growth (N = 321; 55.2%). Higher stage was cross-sectionally associated with being male, married, living alone or with parents, and having better patient-rated therapeutic alliance and fewer symptoms. The model accounted for 40% of the variance in stage of recovery. An increased chance of worse outcome (change over 1 year to lower stage of recovery) was found for patients with active involvement compared with either shared (OR = 1.84, 95% CI 1.15–2.94) or passive (OR = 1.71, 95% CI = 1.00–2.95) involvement. Overall, both process (therapeutic relationship) and outcome (symptomatology) are cross-sectionally associated with stage of recovery.
Conclusions: Patient-rated decision-making involvement and change in stage of recovery are associated. Joint consideration of decision practice within the recovery process between patient and clinician is supposed to be a useful strategy to improve clinical practice (ISRCTN registry: ISRCTN75841675. Retrospectively registered 15 September 2010).
iv) Sweeney, A., Clement, S., Filson, B. and Kennedy, A. (2016) Trauma-informed mental healthcare in the UK: what is it and how can we further its development? Mental Health Review Journal. 21(3) 174 – 192.
http://dx.doi.org/10.1108/MHRJ-01-2015-0006
Abstract
Purpose: The purpose of this paper is to describe and explain trauma-informed approaches (TIAs) to mental health. It outlines evidence on the link between trauma and mental health, explains the principles of TIAs and their application in mental health and explores the extent to which TIAs are impacting in the UK.
Design/methodology/approach: The approach is a conceptual account of TIAs including a consideration of why they are important, what they are and how they can become more prevalent in the UK. This is supported by a narrative overview of literature on effectiveness and a scoping of the spread of TIAs in the UK.
Findings: There is strong and growing evidence of a link between trauma and mental health, as well as evidence that the current mental health system can retraumatise trauma survivors. There is also emerging evidence that trauma-informed systems are effective and can benefit staff and trauma survivors. Whilst TIAs are spreading beyond the USA where they developed, they have made little impact in the UK. The reasons for this are explored and ways of overcoming barriers to implementation discussed.
Originality/value: This paper – authored by trauma survivors and staff – describes an innovative approach to mental health service provision that, it is argued, could have immense benefits for staff and service users alike.
v) McWade, B. (2016) Recovery-as-policy as a form of neoliberal state making. Intersectionalities. 5(3) 62-79.
Abstract
In this paper I provide an analysis of the implementation of “recovery” as a policy object and commitment in the United Kingdom. This can be situated as part of the New Labour government’s (1997–2010) reform of the NHS during the 2000s. Through a textual analysis of policy and legislation from this time I draw out a tension between contemporary ideals of choice and autonomy in health care and the specificities of a mental health care system in which psychiatrists are legislatively empowered to treat patients without their consent. In the United Kingdom, evidence continues to show that the most economically and socially disadvantaged members of British society are most likely to be detained under the Mental Health Act (2007). This paper provides an intersectional analysis of the ways in which policy, legislation and psychiatrization enact particular subjects as “failed” citizens. Following Tyler (2010, 2013), I argue that these practices of exclusion and detainment are constituent elements of neoliberal state making, which are discriminatory and unjust.
New Book
i) Slade, M., Bronwell, T., Rashad, T. and Schrank, B. (2017) Positive psychotherapy for psychosis: a clinician’s guide and manual. Routledge.
About the Book (Publisher information)
Positive Psychotherapy for Psychosis describes a new psychological intervention, which for the first time applies emerging research from the field of positive psychology specifically to psychosis. The book contains guidance on adapting the approach for use in individual treatments, and on providing part of the intervention, either as individual sessions or by integrating Positive Psychotherapy for Psychosis sessions into other treatments.
Discussion
Last month we promoted discussion on the topic of:
Given the contemporary issues surrounding mental health and young people, this edition of the ebulletin focuses upon the Munson et al. (2016) paper, based on a US pilot, to ask the readership about how they see the viability of a Cornerstone-type project within other contexts?
We have had no responses on this topic.
This month we would welcome readers’ comments on two interconnected papers whose summaries appear above – Uniting resilience research and practice with an inequalities approach, and Recovery-as-policy as a form of neoliberal state making. Both raise the value of the social justice approach vis-a-vis recovery key components; one concluding that it is possible to bring social justice and recovery together, the other that this cannot be the case. What is your view?
Other News
Shula Ramon and Tony Sparkes co-produce the RRN monthly ebulletin. Please email if there is anything you would like included in the next issue, as we are keen to receive and advertise more news, articles and website references. Information can be posted to either Shula or Tony at the following:
Shula: s.ramon@herts.ac.uk
page updated 8 February 2017
February 2017
Recovery Research Network eBULLETIN
February 2017
RRN Meetings
The next meeting of the RRN will be held on:
Tuesday, April 18th 10am – 4pm
at
The McPin Foundation
32-36 Loman Street, London SE1 0EH
The event will be themed around ‘mental health and identity’
For further details (including description, provisional speakers, map of venue and so on) please see:
https://www.eventbrite.co.uk/e/recovery-research-network-spring-2017-tickets-31708245215
The agenda for the day has yet to be finalised and will be confirmed in due course
If you would like to present at a future meeting of the RRN please email either Shula Ramon or Tony Sparkes. Their contact details are:
Shula: s.ramon@herts.ac.uk
RRN Membership Profile
Anyone who has an interest in recovery research can join the RRN, just fill in the online form available at: https://www.researchintorecovery.com/rrn
Please note that if you join the Network, the details you supply will be circulated to other members of the Network as part of the monthly e-bulletin, but will not be put on our website and will not be shared with any other organisation. If you would like to leave the RRN and have your details removed from our database, please email researchintorecovery@nottingham.ac.uk
An opportunity to join the Recovery Research Network (RRN) Collective
We have three vacancies on the RRN Collective. The role and current Collective members are on the RRN website (researchintorecovery.com/rrn) under the RRN Collective tab. RRN Collective members co-ordinate the monthly e-bulletins, and organise and regularly attend the six-monthly meetings. If this (un-funded) role might be of interest then feel free to contact Mike Slade (m.slade@nottingham.ac.uk) to discuss.
Please can we encourage members to forward their peer-reviewed articles and book publications to us in a timely manner in order that we can best disseminate their literary efforts to the broader membership.
Conferences and Events
i) ImROC: What is the Role of Peer Support. Note change of date
Unfortunately a significant number of people are unable to make the Peer Worker Critical Debate; what is the role of peer support? planned for 31 January but are interested in the content. We agree that this is an important issue for us to dedicate time to and explore as a national group of thought leaders. We welcome your attendance on 1 June 2017, one year on from our last peer worker critical debate, to reflect on changes over the last year and set out our expectations and ambitions for the future.
Together we can unpick this challenging issue and consider what this means for our practical locally and collectively. Peer support is a crucial element of supporting recovery for all. At ImROC we are passionate about sharing positive experiences and practice, challenges ourselves to be better and supporting one another to make recovery a reality. This conference is relevant to whole communities including NHS funded mental health providers, commissioners, user led organisations and forums.
The programme chaired by Julie Repper, ImROC Director, includes:
- The debate: what is the role of peer support? It’s not what we do, it’s the way that we do it (Jane Rennison & Sue Williams, Central & North West London NHS Foundation Trust) vs distinct & dedicated peer support (Steve Gillard, St George’s University of London)
- Presentation: developments in the role of peer support (Emma Watson, Peer Support Development Lead, Nottinghamshire Healthcare NHS Foundation Trust)
- Presentation: Peer Support development for substance misuse services (Jon Roberts, Dear Albert, Drug Rehabilitation, Nottingham)
- Interactive workshops led by Rachel Perkins, ImROC Senior Consultant
To book your place please click on this link https://www.surveymonkey.co.uk/r/PGDJZQF
Delegate rates:
£100 plus VAT for ImROC sites
£150 plus VAT for non ImROC sites.
ii) Making Real Change Happen. The 20th International Congress of the ISPS will take place in the city of Liverpool, UK August 30th – September 3rd, 2017
Plenary Speakers will include: Alison Brabban, Jacqui Dillon, Grainne Fadden, Jim van Os Other speakers will include: Richard Bentall, Jim Geekie, Peter Kinderman, Eleanor Longden, Brian Martindale, John Read, Rai Waddingham
See more at: http://tinyurl.com/isps-change
Contact: isps@isps.org or visit www.isps2017uk.org
Twitter: #isps2017uk
iii) Registration and abstract submission are now open for Refocus on Recovery 2017, being held in Nottingham from 18th to 20th September 2017. The event will comprise expert workshops, an international conference and a Mad Celebration event. Conference themes will be Recovery for different groups, Re-situating mental health, Prevention of mental ill-health, Allocating resources.
See more at: https://www.researchintorecovery.com/ror2017
See also the flyers circulated with this edition of the ebulletin.
iv) The 12th ENMESH Conference will be held in Groningen, Netherlands from 5th to the 7th October 2017. Conference themes are Assessment: Understanding the context; Epidemiology: Methodological approaches supporting personalised care; Approaches: Novel approaches using the patient’s own context; and Policy: Societal challenges for community mental health. Further information at http://enmesh2017groningen.com/home/
Papers and Publications
i) Mezzich, J. E., Kirisci, L., Salloum, I., Trivedi, J., Kar, S. J., Adams, N. and Wallcraft, J. (2016) Systematic Conceptualization of Person Centered Medicine and Development and Validation of a Person-centered Care Index. The International Journal of Person Centred Medicine. 6(4) 219-247.
Abstract
Background: A world-wide movement is emerging for person centered medicine and healthcare collaboratively developed by the International College of Person Centered Medicine and a number of global institutions through annual Geneva Conferences and International Congresses as well as scholarly publications. While frequently quoted definitional notes have been advanced through this maturational process, efforts are needed to conceptualize and measure systematically person-centered care.
Objectives: These included the elucidation of the core concepts of person centered medicine and healthcare, the design of a prototype measuring instrument, and the study of its metric structure, acceptability, reliability and validity.
Methods: The following methodological approaches were employed: A systematic review of the literature, consultation exercises with broad international panels composed of health professionals and representatives of patient and family organizations, and quantitative and qualitative data analyses.
Results: The following key concepts underlying person centered medicine were elucidated: 1) Ethical Commitment, 2) Cultural Sensitivity, 3) Holistic scope, 4) Relational Focus, 5) Individualized Care, 6) Common Ground for Collaborative Diagnosis and Care, 7) People-centered Systems of Care, and 8) Person-centered Education and Research. On this basis, a Person-centered Care Index was developed composed of 8 broad items and 33 sub-items, each measured on a 4-point scale. The study of its metric structure revealed high Cronbach internal consistency (0.95), scale unidimensionality through factor analysis (69 % of the variance accounted for by the first factor), and interesting inter-correlations such as the sub-item attaining the highest correlation with the global average score being “fulfillment of the person’s life project” (0.88). Validation studies in California, London and Lucknow (India) showed quite high levels of inter-rater reliability (above 0.80 intra-class correlations for most items) and substantial content validity.
Discussion: The elucidated core concepts of person centered medicine appear to be consistent with those of international studies on the bases of person- and people-centeredness in primary care and on research and implementation of person centered care. The concepts are also consistent with the key domains of person-centered diagnostic approaches. Further validation studies with larger samples in diverse settings and cultures seem to be warranted.
Conclusions. The emerging core concepts of person centered medicine appear to be robust. The Person-centered Care Index built on such concepts appears to have suitable metrics and substantial acceptability, reliability and content validity. Further empirical research is recommended.
ii) Stead, U., Morant, N. and Ramon, S. (2017) Shared decision-making in medication management: development of a training intervention. BJPsych Bulletin. January 2017. 1-7
doi: 10.1192/pb.bp.116.053819
Summary: Shared decision-making is a collaborative process in which clinicians and patients make treatment decisions together. Although it is considered essential to patient-centred care, the adoption of shared decision-making into routine clinical practice has been slow, and there is a need to increase implementation. This paper describes the development and delivery of a training intervention to promote shared decision-making in medication management in mental health as part of the Shared Involvement in Medication Management Education (ShIMME) project. Three stakeholder groups (service users, care coordinators and psychiatrists) received training in shared decision-making, and their feedback was evaluated. The programme was mostly well received, with all groups rating interaction with peers as the best aspect of the training. This small-scale pilot shows that it is feasible to deliver training in shared decision-making to several key stakeholders. Larger studies will be required to assess the effectiveness of such training.
Discussion
Last month we promoted discussion on the following topics:
Uniting resilience research and practice with an inequalities approach, and Recovery-as-policy as a form of neoliberal state making.
We suggested that both topics raised the value of the social justice approach vis a vis recovery key components; one concluding that it is possible to bring social justice and recovery together, the other that this cannot be the case. Shula has kindly posted the following response:
The two papers recognise the importance of a social justice perspective when focusing on mental health recovery. The paper by Hart et al does so in terms of the relationships between resilience and social justice; while the paper by McWade looks at the issue of social justice in the implementation of the UK Mental Health Act (2007).
Social justice is a wide area, covering many aspects. The aspect focused upon in the Hart et al paper is that of service users’ responsibility vs. the responsibility of the wider social system. The recovery approach has been recently criticised for expecting people with lived experience of mental ill health to take responsibility for their lives and decisions, arguing that this is an attempt by a neo-liberal system to shift burden and failure to this group, ignoring the contribution of social structural elements and in particular of state structural elements.
The recovery approach does indeed aim for people to take control over their lives as much as possible, but without an expectation that the state, representing society at large, should not contribute its share in taking responsibility for enhancing social justice and contributing to the welfare of its citizens, especially those vulnerable.
McWade is looking at a legislation aimed a-priori to make decisions about people in crisis, even against their will, which does not indicate an interest (or an investment) in encouraging people to take more personal responsibility, or to genuinely participate in decision making. Furthermore, it focuses primarily on symptoms reduction, and is not aligned to recovery principles.
It is therefore not surprising that this Act does not pay attention to the fact that those more deprived of social support and living in poverty constitute a larger group among those detained by the application of the Act then those who are less deprived.
The impact of living in poverty by people with lived experience of mental ill health has been noted in a number of studies (e.g. Topor et al, 2013, Mills, 2015) highlighting the ingenuity required to manage to maintain one’s quality of life while living in poverty on the one hand and on the other hand of the harm done by a neoliberal welfare regime to this group of people.
Shula Ramon February 28th 2017
Topor, A. et al (2014) Psychosis and Poverty: coping with poverty and severe mental illness in every day life. Psychosis, 6, 117-127.
Mills, C. (2015) The Psychiatrization of Poverty@ Rethinking the Mental Health-Poverty Nexus. Social and Personality Psychology Compass, 9,5, 213-222.
Other News
Recovery College Research
If you are involved in Recovery College research, you may be interested to know that a list of research groups with current or planned studies investigating Recovery Colleges is being created at www.researchintorecovery.com/rcrg. In order to foster collaboration and connection, feel free to add your details to the list.
Shula Ramon and Tony Sparkes co-produce the RRN monthly ebulletin. Please email if there is anything you would like included in the next issue, as we are keen to receive and advertise more news, articles and website references. Information can be posted to either Shula or Tony at the following:
Shula: s.ramon@herts.ac.uk
page updated 10 March 2017
March 2017
Recovery Research Network eBULLETIN
March 2017
RRN Meetings
The previously advertised RRN meeting on the 18th of April 2017 is now fully booked. Please do not journey to the venue on the day as there is only capacity to allow entry to those people who have reserved a place. In the best RRN tradition, we shall seek to make presentations available on the RRN website soon after the meeting.
For information, the theme of the meeting will be around Identity and mental health and invite presentations from the following speakers:
Alison Faulkner: Some complexities of identity and power in relation to survivor research
Colin King: Surviving research – racialisation from a black perspective
Rhiannon Foster, Kati Turner and Lucy Goldsmith: The importance of personal, social and political identity in mental health recovery
Jessica Worner and Natalie Koussa: Who am I? Peer identities in mental health
Sheena Foster: When survival means losing your identity
Ruth Sayers: – Repairing “spoiled identity”: Using therapy in bipolar recovery
If you would like to present at a future meeting of the RRN please email either Shula Ramon or Tony Sparkes. Their contact details are:
Shula: s.ramon@herts.ac.uk
RRN Membership Profile
Anyone who has an interest in recovery research can join the RRN, just fill in the online form available at: https://www.researchintorecovery.com/rrn
Please note that if you join the Network, the details you supply will be circulated to other members of the Network as part of the monthly e-bulletin, but will not be put on our website and will not be shared with any other organisation. If you would like to leave the RRN and have your details removed from our database, please email researchintorecovery@nottingham.ac.uk
An opportunity to join the Recovery Research Network (RRN) Collective
We have three vacancies on the RRN Collective. The role and current Collective members are on the RRN website (researchintorecovery.com/rrn) under the RRN Collective tab. RRN Collective members co-ordinate the monthly e-bulletins, and organise and regularly attend the six-monthly meetings. If this (un-funded) role might be of interest then feel free to contact Mike Slade (m.slade@nottingham.ac.uk) to discuss.
Please can we encourage members to forward their peer-reviewed articles and book publications to us in a timely manner in order that we can best disseminate their literary efforts to the broader membership.
Conferences and Events
i) ImROC: What is the Role of Peer Support. Note change of date
Unfortunately a significant number of people are unable to make the Peer Worker Critical Debate; what is the role of peer support? planned for 31 January but are interested in the content. We agree that this is an important issue for us to dedicate time to and explore as a national group of thought leaders. We welcome your attendance on 1 June 2017, one year on from our last peer worker critical debate, to reflect on changes over the last year and set out our expectations and ambitions for the future.
Together we can unpick this challenging issue and consider what this means for our practical locally and collectively. Peer support is a crucial element of supporting recovery for all. At ImROC we are passionate about sharing positive experiences and practice, challenges ourselves to be better and supporting one another to make recovery a reality. This conference is relevant to whole communities including NHS funded mental health providers, commissioners, user led organisations and forums.
The programme chaired by Julie Repper, ImROC Director, includes:
- The debate: what is the role of peer support? It’s not what we do, it’s the way that we do it (Jane Rennison & Sue Williams, Central & North West London NHS Foundation Trust) vs distinct & dedicated peer support (Steve Gillard, St George’s University of London)
- Presentation: developments in the role of peer support (Emma Watson, Peer Support Development Lead, Nottinghamshire Healthcare NHS Foundation Trust)
- Presentation: Peer Support development for substance misuse services (Jon Roberts, Dear Albert, Drug Rehabilitation, Nottingham)
- Interactive workshops led by Rachel Perkins, ImROC Senior Consultant
To book your place please click on this link https://www.surveymonkey.co.uk/r/PGDJZQF
Delegate rates:
£100 plus VAT for ImROC sites
£150 plus VAT for non ImROC sites.
ii) Making Real Change Happen. The 20th International Congress of the ISPS will take place in the city of Liverpool, UK August 30th – September 3rd, 2017
Plenary Speakers will include: Alison Brabban, Jacqui Dillon, Grainne Fadden, Jim van Os Other speakers will include: Richard Bentall, Jim Geekie, Peter Kinderman, Eleanor Longden, Brian Martindale, John Read, Rai Waddingham
See more at: http://tinyurl.com/isps-change
Contact: isps@isps.org or visit www.isps2017uk.org
Twitter: #isps2017uk
iii) Registration is open for Refocus on Recovery 2017, being held in Nottingham from 18th to 20th September 2017. The event will comprise expert workshops, an international conference and a Mad Celebration event. Conference themes will be Recovery for different groups, Re-situating mental health, Prevention of mental ill-health, Allocating resources.
See more at: https://www.researchintorecovery.com/ror2017
iv) The 12th ENMESH Conference will be held in Groningen, Netherlands from 5th to the 7th October 2017. Conference themes are Assessment: Understanding the context; Epidemiology: Methodological approaches supporting personalised care; Approaches: Novel approaches using the patient’s own context; and Policy: Societal challenges for community mental health. Further information at http://enmesh2017groningen.com/home/
Papers and Publications
i) Burmeister, O. K. and Marks, E. (2016) Rural and remote communities, technology and mental health recovery. Journal of Information, Communication and Ethics in Society. 14(2) 170-181
Abstract
Purpose: This study aims to explore how health informatics can underpin the successful delivery of recovery-orientated healthcare, in rural and remote regions, to achieve better mental health outcomes. Recovery is an extremely social process that involves being with others and reconnecting with the world.
Design/methodology/approach: An interpretivist study involving 27 clinicians and 13 clients sought to determine how future expenditure on ehealth could improve mental health treatment and service provision in the western Murray Darling Basin of New South Wales, Australia.
Findings: Through the use of targeted ehealth strategies, it is possible to increase both the accessibility of information and the quality of service provision. In small communities, the challenges of distance, access to healthcare and the ease of isolating oneself are best overcome through a combination of technology and communal social responsibility. Technology supplements but cannot completely replace face-to-face interaction in the mental health recovery process.
Originality/value: The recovery model provides a conceptual framework for health informatics in rural and remote regions that is socially responsible. Service providers can affect better recovery for clients through infrastructure that enables timely and responsive remote access whilst driving between appointments. This could include interactive referral services, telehealth access to specialist clinicians, GPS for locating clients in remote areas and mobile coverage for counselling sessions in “real time”. Thus, the technology not only provides better connections but also adds to the responsiveness (and success) of any treatment available
ii) Collins, P. and Crowe, S. (2017) Recovery and practice-based evidence: reconnecting the diverging discourses in mental health. Mental Health and Social Inclusion. 21(1) 34-42
doi: 10.1108/MHSI-09-2016-0028
Abstract
Purpose: The purpose of this paper is to explore the discourses which exist around the alleviation of mental distress, from the different perspective of mental health professionals and service users. It then looks at the use of “practice-based evidence” as a means of bringing together these two diverging discourses.
Design/methodology/approach: Literature on the discourses which exist around the cause and treatment of mental distress, from the perspective of professionals and service users, is first explored. Differences between these two discourses are identified, as are theoretical and practical limitations of current professional diagnostic and treatment paradigms. Finally the use of practice-based evidence as a means of bridging the gap between these two discourses is outlined.
Findings: This paper highlights marked differences between the discourse which exists for professionals, and that for service users, around alleviating mental distress. The use of practice-based evidence is explored, not only as a means of bringing these two varying discourses together, but also as a tool which could help to improve treatment outcome in a way which is more inclusive of service users and fits with both empiricism and a broader recovery ethos.
Originality/value: This paper applies a “practice-based evidence” approach to bringing together the divergent perspectives regarding mental health of service providers and users. In doing so it provides a practical and pragmatic approach to true collaborative working.
iii) Zisman-Ilani, Y., Roe, D., Scholl, I. Härter M. and Karnieli-Miller, O. (2016) Shared Decision Making During Active Psychiatric Hospitalization: Assessment and Psychometric Properties. Health Communication. 32(1) 126-130
Abstract
Encouraging patients to be involved in their care and enhancing shared decision making (SDM) have been advocated over the past two decades as means to enhance patient-centered care. However, one of the barriers to implementing SDM in medical consultations is the need to adapt this approach to various populations and medical settings, including mental health, and developing reliable and practical methods for measuring and assessing SDM. This article presents the psychometric properties and validity of a revised scale, SDM-Q-9-Psy, that assesses SDM in routine care among psychiatric inpatients. Psychiatric inpatients were included in a SDM intervention cohort (n = 46) or a control cohort (n= 40). The adapted scale was administered after a decision-making process. The scale was subsequently psychometrically tested via factor and reliability analyses. It was also tested for convergent validity and for its ability to distinguish the degree of SDM between the intervention and control groups (construct validity). The SDM-Q-9-Psy scale yielded a Cronbach’s α of .94. Convergent and construct validity parameters were good. The SDM-Q-9-Psy scale can be used to evaluate SDM from psychiatric inpatients’ perspective and to provide rapid feedback to mental health professionals, enabling them to monitor their decision-making practice in real-time clinical consultations.
Discussion
In September of last year we included a paper by Lynn Tang. Our discussion section this month draws upon Tang’s (2016) paper and raises an important issue not only for those working with members of the Chinese community , but also for anyone else working with members of ethnic minorities in the context of mental health. Our question encourages a response from the readership to consider:
What are the elements that would help us to create a constructive conceptual way of making sense of the likely connections between understanding cultural fluidity, transformative community development approach and the intersecting structural inequality members of such minority groups are likely to meet?
Other News
Scottish Recovery Network
The Scottish Recovery Network (SRN) produces an e-update and present a number of interesting features and developments on the subject of mental health recovery. Further information can be found at:
https://www.scottishrecovery.net
https://www.scottishrecovery.net/news/
Recovery College Research
If you are involved in Recovery College research, you may be interested to know that a list of research groups with current or planned studies investigating Recovery Colleges is being created at www.researchintorecovery.com/rcrg In order to foster collaboration and connection, feel free to add your details to the list.
Shula Ramon and Tony Sparkes co-produce the RRN monthly ebulletin. Please email if there is anything you would like included in the next issue, as we are keen to receive and advertise more news, articles and website references. Information can be posted to either Shula or Tony at the following:
Shula: s.ramon@herts.ac.uk
Tony: a.sparkes@bradford.ac.uk
page updated 13 April 2017
April 2017
Recovery Research Network eBULLETIN
April 2017
Please can we remind the readership about our standing invitation to respond to a key question related to articles summarised in the ebulletin (see details in the Discussion section later in the ebulletin)
RRN Meetings
The last meeting of the Recovery Research Network was held on the 18th April at the McPin Foundation, London. This was a well-attended and thought-provoking day. Thank you to all who organised the event, including Vanessa Pinfold, and to all those individuals and agencies who contributed to the day.
Thank you to everyone who attended our ’Identity and Mental Health’ meeting, and for our speakers who left us with so much to ponder and reflect upon. This short report was compiled by Vanessa Pinfold. It is written to give a flavour of the session, and is not a full write up of the talks.
We started the meeting with a minute pause to remember our friend Ruth Chandler who helped set up the network and who died in December 2016. This particular discussion on identity would have been something she would have relished.
Dr Alison Faulkner who spoke first really helped us get into the topic quickly. Key areas discussed included changing identities over time, the concept of the “spoiled identity” from Goffman, survivor research using narrative methods, identity judgements including viewpoints of rationality versus irrationality, low versus high status positionalities considering experiential and research expertise, and the role of emotionality in research. Alison also stressed how we must remain aware of privilege in the research sector; some voices remain marginalised both in research teams and the topics investigated. This provided a useful Link to Dr Colin King’s talk – Surviving research: racialisation from a black perspective.
Colin asked whether current mental health practices were fit for purpose taking on board transcultural differences in the needs of people across society? He discussed values based practice, considering historic and current perspectives. The emphasise was on how research often provides too narrow a perspective (particularly white and western) and does not do what it is supposed to do – challenge established practices with new and innovative thinking.
The final session of the morning was delivered by Lucy Goldsmith and Rhiannon Foster from St George’s, University of London, drawing upon personal reflections from their roles as service user researchers.
All the speakers showed how they were ‘far more than a mental health identity’, but being reduced to one thing or another by the judgements or behaviour of others was far too easy. And those judgements were sometimes your own.
Our discussion before lunch drew us towards conversations around recovery, poverty and mental health. This provided an idea for the focus of our next meeting which will be in Oxford: Poverty, social inequalities and mental health.
Our afternoon session started with a presentation from Natalie Koussa at National Voices talking about their work on personalised care and Jessica Worner and Rhianna Blanchard from Together looking at peer identities from delivering peer support in the community. A key point was how peer identities mean different things to different people and should not be used to box or constrain people in peer support projects. Assumptions should not be imposed, such as those linked to race or gender or diagnosis or age.
Our session moved in our next talk to secure care settings. Sheena Foster shared her experiences. The talk title “when survival means losing your identity” gives a strong sense of the journey Sheena and her family have been on through the prison system, high secure and medium secure care. She reflected on the challenges for:
- service users in a system that “strips away” identity;
- families that are unrecognised and side-lined by the system;
- staff that can become victims of institutionalisation.
Sheena’s personal analysis of two care systems (high and medium care) provided an example of hope that things can change for the better. She was clear that she is continuing to campaign for change.
The final session at the meeting was delivered by Ruth Sayers, who works with the McPin Foundation. The title “I live with three people, but I don’t like two of them very much” – my bipolar ID, came from a chance discussion with a local business owner who disclosed their own experiences of living with bipolar. Themes in Ruth’s talk included:
- Identity change points – such as losing paid occupation through mental ill-health or taking psychiatric medication;
- Reconciling multiple identities – finding balance where no one identity overruns another;
The topic – identity and mental health – is vast. That was clear when we started putting the agenda together. We could not do justice to it in a few hours. The idea was to invite a range of speakers to start the conversation that others could follow-up, and surface issues the network could host other meetings around. We thank everyone who attended and hope you found it a useful space for critical thinking.
The next meeting will take place in November, in Oxford. The specific date and time of this meeting of the Recovery Research Network will be advertised in due course. The provisional topic will be around: Poverty and Social Inequality.
If you would like to present at a future meeting of the RRN please email either Shula Ramon or Tony Sparkes. Their contact details are:
Shula s.ramon@herts.ac.uk
RRN Membership Profile
Anyone who has an interest in recovery research can join the RRN, just fill in the online form available at: https://www.researchintorecovery.com/rrn
Please note that if you join the Network, the details you supply will be circulated to other members of the Network as part of the monthly e-bulletin, but will not be put on our website and will not be shared with any other organisation. If you would like to leave the RRN and have your details removed from our database, please email researchintorecovery@nottingham.ac.uk
An opportunity to join the Recovery Research Network (RRN) Collective
We have three vacancies on the RRN Collective. The role and current Collective members are on the RRN website (researchintorecovery.com/rrn) under the RRN Collective tab. RRN Collective members co-ordinate the monthly e-bulletins, and organise and regularly attend the six-monthly meetings. If this (un-funded) role might be of interest then feel free to contact Mike Slade (m.slade@nottingham.ac.uk) to discuss.
Please can we encourage members to forward their peer-reviewed articles and book publications to us in a timely manner in order that we can best disseminate their literary efforts to the broader membership.
Conferences and Events
i) ImROC: What is the Role of Peer Support. Note change of date
Unfortunately a significant number of people are unable to make the Peer Worker Critical Debate; what is the role of peer support? planned for 31 January but are interested in the content. We agree that this is an important issue for us to dedicate time to and explore as a national group of thought leaders. We welcome your attendance on 1 June 2017, one year on from our last peer worker critical debate, to reflect on changes over the last year and set out our expectations and ambitions for the future.
Together we can unpick this challenging issue and consider what this means for our practical locally and collectively. Peer support is a crucial element of supporting recovery for all. At ImROC we are passionate about sharing positive experiences and practice, challenges ourselves to be better and supporting one another to make recovery a reality. This conference is relevant to whole communities including NHS funded mental health providers, commissioners, user led organisations and forums.
The programme chaired by Julie Repper, ImROC Director, includes:
- The debate: what is the role of peer support? It’s not what we do, it’s the way that we do it (Jane Rennison & Sue Williams, Central & North West London NHS Foundation Trust) vs distinct & dedicated peer support (Steve Gillard, St George’s University of London)
- Presentation: developments in the role of peer support (Emma Watson, Peer Support Development Lead, Nottinghamshire Healthcare NHS Foundation Trust)
- Presentation: Peer Support development for substance misuse services (Jon Roberts, Dear Albert, Drug Rehabilitation, Nottingham)
- Interactive workshops led by Rachel Perkins, ImROC Senior Consultant
To book your place please click on this link https://www.surveymonkey.co.uk/r/PGDJZQF
Delegate rates:
£100 plus VAT for ImROC sites
£150 plus VAT for non ImROC sites.
ii) Making Real Change Happen. The 20th International Congress of the ISPS will take place in the city of Liverpool, UK August 30th – September 3rd, 2017
Plenary Speakers will include: Alison Brabban, Jacqui Dillon, Grainne Fadden, Jim van Os Other speakers will include: Richard Bentall, Jim Geekie, Peter Kinderman, Eleanor Longden, Brian Martindale, John Read, Rai Waddingham
See more at: http://tinyurl.com/isps-change
Contact: isps@isps.org or visit: www.isps2017uk.org
Twitter: #isps2017uk
iii) Registration is open for Refocus on Recovery 2017, being held in Nottingham from 18th to 20th September 2017. The event will comprise expert workshops, an international conference and a Mad Celebration event. Conference themes will be Recovery for different groups, Re-situating mental health, Prevention of mental ill-health, Allocating resources.
See more at: https://www.researchintorecovery.com/ror2017
iv) The 12th ENMESH Conference will be held in Groningen, Netherlands from 5th to the 7th October 2017. Conference themes are Assessment: Understanding the context; Epidemiology: Methodological approaches supporting personalised care; Approaches: Novel approaches using the patient’s own context; and Policy: Societal challenges for community mental health. Further information at: http://enmesh2017groningen.com/home/
Papers and Publications
i) McGrath, L., Griffin, V. and Mundy E. (2015) The Psychological Impact of Austerity: A Briefing Paper. PAA. London
https://psychagainstausterity.files.wordpress.com/2015/03/paa-briefing-paper.pdf
Executive Summary (introduction)
This report directly links cuts to public services with mental health problems. Well-established psychological research that explains these links already exists. However, this knowledge has been missing from the debate on austerity so far. Psychologists are often in a position to see the effects that social and economic changes have on people. We also occupy a relatively powerful position as professionals and therefore have an ethical responsibility to speak out about these effects.
ii) Psychologists for Social Change (2017) Universal Basic income: A Psychological Impact Assessment. PAA. London
http://www.psychchange.org/uploads/9/7/9/7/97971280/ubi_briefing_low_res.pdf
Executive Summary (introduction)
This briefing paper is the beginning of a psychological impact assessment of the universal basic income policy (UBI), which would guarantee a regular, unconditional basic income for all citizens of a nation, whatever their employment status, throughout their lifetime.
iii) Slobodin, O. and de Jong, Joop TVM (2015) Mental health interventions for traumatised asylum seekers and refugees: what do we know about their efficacy? International Journal of Social Psychiatry. 61(1) 17-26.
DOI: 10.1177/0020764014535752
Abstract
Background: The prevalence of trauma-related problems among refugees and asylum seekers is extremely high due to adverse experiences associated with forced migration. Although the literature presents a considerable number of guidelines and theoretical frameworks for working with traumatized refugees and asylum seekers, the efficacy, feasibility and applicability of these interventions have little empirical evidence.
Aims: The purpose of this article is to critically review the literature to provide a rationale for developing culturally sensitive, evidence-based interventions for refugees and asylum seekers.
Methods: A literature review integrating research findings on interventions designed especially for traumatized asylum seekers and refugees was conducted. Retained studies had to use some quantitative measurements of post-traumatic stress and to have pre- and post-measurements to evaluate the efficacy of the intervention. Studies included in this review cover a wide variety of interventions, including trauma-focused interventions, group therapy, multidisciplinary interventions and pharmacological treatments.
Results: The majority of studies with traumatized refugees and asylum seekers reported positive outcomes of the intervention in reducing trauma-related symptoms. There is evidence to support the suitability of cognitive-behavioral therapy (CBT) and narrative exposure therapy (NET) in certain populations of refugees. Other intervention studies are limited by methodological considerations, such as lack of randomization, absence of control group and small samples.
Conclusions: This review has again highlighted the shortage of guiding frameworks available to investigators and clinicians who are interested in tailoring interventions to work with refugees and asylum seekers. Theoretical, ethical and methodological considerations for future research are discussed.
iv) Væggemose, U., Lou, S., Frumer, M., Christiansen, N.L., Aagaard, J. and Ørtenblad, L. (2017) Community Families: Bridging the gap between mental health services and civil society – A qualitative study from users’ perspective. International Journal of Social Psychiatry. 63(2) 132-138.
DOI: 10.1177/0020764016687789
Abstract
Background: Social interventions to support people with severe mental illness are important to improving the quality of life. The perspectives of users are essential in this process. This article explores users’ experiences, investments and concerns of a befriending programme.
Material: Focus group and individual qualitative interviews with service users.
Discussion: Overall, the experiences with the programme were positive, and the social interaction was highly valued. However, the fact that the relationships were arranged and facilitated by mental health workers remained an unresolved concern even after several years.
Conclusion: People with severe mental illness benefit from relationships despite the need of professional assistant.
v) Collins, P. and Crowe, S. (2017) Recovery and practice-based evidence: reconnecting the diverging discourses in mental health. Mental Health and Social Inclusion. 21(1) 34-42
DOI: 10.1108/MHSI-09-2016-0028
Abstract
Purpose: The purpose of this paper is to explore the discourses which exist around the alleviation of mental distress, from the different perspective of mental health professionals and service users. It then looks at the use of “practice-based evidence” as a means of bringing together these two diverging discourses.
Design/methodology/approach: Literature on the discourses which exist around the cause and treatment of mental distress, from the perspective of professionals and service users, is first explored. Differences between these two discourses are identified, as are theoretical and practical limitations of current professional diagnostic and treatment paradigms. Finally the use of practice-based evidence as a means of bridging the gap between these two discourses is outlined.
Findings: This paper highlights marked differences between the discourse which exists for professionals, and that for service users, around alleviating mental distress. The use of practice-based evidence is explored, not only as a means of bringing these two varying discourses together, but also as a tool which could help to improve treatment outcome in a way which is more inclusive of service users and fits with both empiricism and a broader recovery ethos.
Originality/value: This paper applies a “practice-based evidence” approach to bringing together the
divergent perspectives regarding mental health of service providers and users. In doing so it provides a practical and pragmatic approach to true collaborative working.
vi) Vandewalle, J., Debyser, B., Beeckman, D., Vandecasteele, T., Deproost, E., Hecke, A. and Verhaeghe, S. (2017) Constructing a positive identity: A qualitative study of the driving forces of peer workers in mental health-care systems. International Journal of Mental Health Nursing. [Early view. Online]
DOI:10.1111/inm.12332
Abstract
There is growing recognition in mental health for the perspective of individuals with lived experience of mental health problems and mental health service use. As peer workers, these individuals can use their specific experience to benefit and support peers and professional caregivers, and to participate at all levels of mental health-care systems. The aim of the present study was to develop a conceptual framework representing the driving forces of peer workers to fullfil their position in mental health-care systems. A qualitative interview approach was employed using principles of grounded theory. Over a period of 5 months in 2014–2015, semistructured interviews were conducted with 14 peer workers in residential and community mental health-care systems. The emerged conceptual framework reveals that peer workers strive towards constructing a positive identity. This process is powered by driving forces reflecting a desire for normalization and an urge for self-preservation. Peer workers realize a meaningful employment by applying their lived experience perspective as an asset, liberating themselves out of restrictive role patterns, and by breaking down stigma and taboo. As a precondition to engage in these normalization processes, peer workers perceive they need to secure their self-preservation by balancing the emergence of adverse emotional fluctuations. The conceptual framework can inform the development of work contexts in which peer workers have an authentic and meaningful contribution, while being offered sufficient support and learning opportunities to manage their well-being.
vii) Strand, M., Gammon, D. and Ruland, C.M. (2017) Transitions from biomedical to recovery-oriented practices in mental health: a scoping review to explore the role of Internet-based interventions. BMC Health Services Research. 17:257. 1-14.
DOI: 10.1186/s12913-017-2176-5
Abstract
Background: The Internet is transforming mental health care services by increasing access to, and potentially improving the quality of, care. Internet-based interventions in mental health can potentially play a role in transitions from biomedical to recovery-oriented research and practices, but an overview of what this may entail, current work, and issues that need addressing, is lacking. The objective of this study is to describe Internet-based recovery oriented interventions (referred to as e-recovery) and current research, and to identify gaps and issues relevant to advancing recovery research and practices through opportunities provided by the Internet.
Methods: Five iterative stages of a scoping review framework were followed in searching and analyzing the literature. A recovery framework with four domains and 16 themes was used to deductively code intervention characteristics according to their support for recovery-oriented practices. Only Internet-based interventions used in conjunction with ongoing care were included.
Results: Twenty studies describing six e-recovery interventions were identified and originated in Australia, Finland, the Netherlands, Norway and USA. The domain supporting personal recovery was most clearly reflected in interventions, whereas the last three domains, i.e., promoting citizenship, organizational commitment and working relationship were less evident. Support for the formulation and follow-up of personal goals and preferences, and in accessing peer-support, were the characteristics shared by most interventions. Three of the six studies that employed a comparison group used randomization, and none presented definitive findings. None used recovery oriented frameworks or specific recovery outcome measures. Four of the interventions were specific to a diagnosis.
Conclusion: Research about how technologies might aid in illuminating and shaping recovery processes is in its formative stages. We recommend that future e-recovery research and innovation attend to four dimensions: evidence-supported interventions, new knowledge about personal recovery, values-based approaches and Internet as a facilitator for organizational transformation. The incremental changes facilitated by e-recovery may help propel a shift in mental health care toward recovery-oriented practices.
Discussion
Drawing upon Lynn Tang’s (2016) paper (see RRN ebulletin Sept 2016) last month we posed the question: What are the elements that would help us to create a constructive conceptual way of making sense of the likely connections between understanding cultural fluidity, transformative community development approach and the intersecting structural inequality members of such minority groups.
We shall retain this question for this month, and invite any commentaries that the question evokes. Comments can be sent to either Shula or Tony, or emailed to: researchintorecovery@nottingham.ac.uk
Other News
The RRN Collective are currently working on putting an invitation out for any budding artists out there to design a logo for the network. Watch this space for details!
Well done!
Congratulations to Dutch user/survivor researchers who recently completed their PhD theses on experiential knowledge (ervaringsdeskundigheid):
Wilma Boevink was awarded a doctorate degree from the Maastricht University on April 13th, 2017. Jim van Os gave a powerful congratulatory speech about Wilma’s contributions and declared his hopes for her to bring about further change by strengthening user research in the Netherlands. Link, free, to Wilma’s thesis-booklet in English: TREE Towards Recovery Empowerment and Experiential Knowledge https://assets.trimbos.nl/docs/e5b58bcc-d191-4b8a-9113-7b9cdbb92624.pdf
A year earlier, in May 2016, Alie Weerman was awarded a doctorate degree at the Free University Amsterdam for her proefschrift (thesis) ‘Care Workers and Social Workers with Experiential Knowledge: Stigma, Addiction and Existential Transformation’ (Ervaringsdeskundige zorg- en dienstverleners. Stigma, verslaving & existentiële transformatie). Link, free, to Alie’s published PhD thesis in Dutch:
Digital technology and mental health
“Questions about using digital technology for mental health problems?
A new national survey has opened to give people the opportunity to direct future research into digital technologies for mental health. We are interested in hearing from people with mental health problems, people who support/care for others with mental health problems and health and social care professionals.
Effective research can help improve care and treatment. If you would like to add your questions, go to: www.mindtech.org.uk/digitalMHQ to complete the survey.”
Shula Ramon and Tony Sparkes co-produce the RRN monthly ebulletin. Please email if there is anything you would like included in the next issue, as we are keen to receive and advertise more news, articles and website references. Information can be posted to either Shula or Tony at the following:
Shula: s.ramon@herts.ac.uk
Tony: a.sparkes@bradford.ac.uk
page updated 11 May 2017
May 2017
Recovery Research Network eBULLETIN
May 2017
RRN Meetings
The next meeting of the Recovery Research Network will be held on the 21st November 2017. The venue will be AG Palmer House, Morrell Crescent, Littlemore, Oxford Health NHS Foundation Trust. OX4 4SU. Refreshments will be available from 9.30am, and the meeting will run from 10am to 4pm. More details about the programme will be made available in due course. The provisional topic will be around: Poverty and Social Inequality
If you would like to present at a future meeting of the RRN please email 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 at: https://www.researchintorecovery.com/rrn
Please note that if you join the Network, the details you supply will be circulated to other members of the Network as part of the monthly e-bulletin, but will not be put on our website and will not be shared with any other organisation. If you would like to leave the RRN and have your details removed from our database, please email researchintorecovery@nottingham.ac.uk
An opportunity to join the Recovery Research Network (RRN) Collective
We have three vacancies on the RRN Collective. The role and current Collective members are on the RRN website (researchintorecovery.com/rrn) under the RRN Collective tab. RRN Collective members co-ordinate the monthly e-bulletins, and organise and regularly attend the six-monthly meetings. If this (un-funded) role might be of interest then feel free to contact Mike Slade (m.slade@nottingham.ac.uk) to discuss.
Please can we encourage members to forward their peer-reviewed articles and book publications to us in a timely manner in order that we can best disseminate their literary efforts to the broader membership.
Conferences and Events
i) ImROC: What is the Role of Peer Support. Note change of date
Unfortunately a significant number of people are unable to make the Peer Worker Critical Debate; what is the role of peer support? planned for 31 January but are interested in the content. We agree that this is an important issue for us to dedicate time to and explore as a national group of thought leaders. We welcome your attendance on 1 June 2017, one year on from our last peer worker critical debate, to reflect on changes over the last year and set out our expectations and ambitions for the future.
Together we can unpick this challenging issue and consider what this means for our practical locally and collectively. Peer support is a crucial element of supporting recovery for all. At ImROC we are passionate about sharing positive experiences and practice, challenges ourselves to be better and supporting one another to make recovery a reality. This conference is relevant to whole communities including NHS funded mental health providers, commissioners, user led organisations and forums.
The programme chaired by Julie Repper, ImROC Director, includes:
- The debate: what is the role of peer support? It’s not what we do, it’s the way that we do it (Jane Rennison & Sue Williams, Central & North West London NHS Foundation Trust) vs distinct & dedicated peer support (Steve Gillard, St George’s University of London)
- Presentation: developments in the role of peer support (Emma Watson, Peer Support Development Lead, Nottinghamshire Healthcare NHS Foundation Trust)
- Presentation: Peer Support development for substance misuse services (Jon Roberts, Dear Albert, Drug Rehabilitation, Nottingham)
- Interactive workshops led by Rachel Perkins, ImROC Senior Consultant
To book your place please click on this link https://www.surveymonkey.co.uk/r/PGDJZQF
Delegate rates:
£100 plus VAT for ImROC sites
£150 plus VAT for non ImROC sites.
ii) Making Real Change Happen. The 20th International Congress of the ISPS will take place in the city of Liverpool, UK August 30th – September 3rd, 2017
Plenary Speakers will include: Alison Brabban, Jacqui Dillon, Grainne Fadden, Jim van Os Other speakers will include: Richard Bentall, Jim Geekie, Peter Kinderman, Eleanor Longden, Brian Martindale, John Read, Rai Waddingham
See more at: http://tinyurl.com/isps-change
Contact: isps@isps.org or visit www.isps2017uk.org
Twitter: #isps2017uk
iii) Registration is open for Refocus on Recovery 2017, being held in Nottingham from 18th to 20th September 2017. The event will comprise expert workshops, an international conference and a Mad Celebration event. Conference themes will be Recovery for different groups, Re-situating mental health, Prevention of mental ill-health, Allocating resources.
See more at: https://www.researchintorecovery.com/ror2017
iv) The 12th ENMESH Conference will be held in Groningen, Netherlands from 5th to the 7th October 2017. Conference themes are Assessment: Understanding the context; Epidemiology: Methodological approaches supporting personalised care; Approaches: Novel approaches using the patient’s own context; and Policy: Societal challenges for community mental health. Further information at http://enmesh2017groningen.com/home/
Papers and Publications
The following article heads a number interesting papers in the section entitled: Forum – shared decision making in mental health care.
i) Slade, M. (2017) Implementing shared decision making in routine mental health care World Psychiatry. 16(2) 146-153.
Abstract
Shared decision making (SDMJ in mental health care involves clinicians and patients working together to make decisions. The key elements of SDM have been identified, decision support tools have been developed, and SDM has been recommended in mental health at policy level. Yet implementation remains limited. Two justifications are typically advanced in support of SDM. The clinical justification is that SDM leads to improved outcome, yet the available empirical evidence base is inconclusive. The ethical justification is that SDM is a right, but clinicians need to balance the biomedical ethical principles of autonomy and justice with beneficence and non-maleficence. It is argued that SDM is “polyvalent”, a sociological concept which describes an idea commanding superficial but not deep agreement between disparate stakeholders. Implementing SDM in routine mental health services is as much a cultural as a technical problem. Three challenges are identified: creating widespread access to high-quality decision support tools; integrating SDM with other recovery-supporting interventions; and responding to cultural changes as patients develop the normal expectations of citizenship. Two approaches which may inform responses in the mental health system to these cultural changes – social marketing and the hospitality industry – are identified.
ii) Shawyer, F., Enticott, J. C., Brophy, L., Bruxner, A., Fossey, E., Inder, B., Julian, J., Kakuma, R., Weller, P., Wilson-Evered, E., Edan, V., Slade, M. and Meadows, G. N. (2017). The PULSAR Specialist Care protocol: a stepped-wedge cluster randomized control trial of a training intervention for community mental health teams in recovery-oriented practice. BMC Psychiatry. 17(172) 1-19.
DOI 10.1186/s12888-017-1321-3
Abstract
Background: Recovery features strongly in Australian mental health policy; however, evidence is limited for the efficacy of recovery-oriented practice at the service level. This paper describes the Principles Unite Local Services Assisting Recovery (PULSAR) Specialist Care trial protocol for a recovery-oriented practice training intervention delivered to specialist mental health services staff. The primary aim is to evaluate whether adult consumers accessing services where staff have received the intervention report superior recovery outcomes compared to adult consumers accessing services where staff have not yet received the intervention. A qualitative sub-study aims to examine staff and consumer views on implementing recovery-oriented practice. A process evaluation sub-study aims to articulate important explanatory variables affecting the interventions rollout and outcomes.
Methods: The mixed methods design incorporates a two-step stepped-wedge cluster randomized controlled trial (cRCT) examining cross-sectional data from three phases, and nested qualitative and process evaluation sub-studies. Participating specialist mental health care services in Melbourne, Victoria are divided into 14 clusters with half randomly allocated to receive the staff training in year one and half in year two. Research participants are consumers aged 18–75 years who attended the cluster within a previous three-month period either at baseline, 12 (step 1) or 24 months (step 2). In the two nested sub-studies, participation extends to cluster staff. The primary outcome is the Questionnaire about the Process of Recovery collected from 756 consumers (252 each at baseline, step 1, step 2). Secondary and other outcomes measuring well-being, service satisfaction and health economic impact are collected from a subset of 252 consumers (63 at baseline; 126 at step 1; 63 at step 2) via interviews. Interview-based longitudinal data are also collected 12 months apart from 88 consumers with a psychotic disorder diagnosis (44 at baseline, step 1; 44 at step 1, step 2). cRCT data will be analyzed using multilevel mixed-effects modelling to account for clustering and some repeated measures, supplemented by thematic analysis of qualitative interview data. The process evaluation will draw on qualitative, quantitative and documentary data.
Discussion: Findings will provide an evidence-base for the continued transformation of Australian mental health service frameworks toward recovery.
iii) Arnold, K., Loos, S., Mayer, B., Clarke, E., Slade, M., Fiorillo, A., Del Vecchio, V., Égerházi, A., Ivánka, T., Munk-Jørgensen, P., Krogsgaard-Bording, M., Kawohl, W., Rössler, W., Puschner, B. and the CEDAR Study Group (2017) Helping alliance and unmet needs in routine care of people with severe mental illness across Europe. The Journal of Nervous and Mental Disease. 205(4) 329-333.
Abstract
The helping alliance (HA) refers to the collaborative bond between patient and therapist, including shared goals and tasks. People with severe mental illness have a complex mixture of clinical and social needs. Using mixed-effects regression, this study examined in 588 people with severe mental illness whether an increase in the HA is associated with fewer unmet needs over time, and whether change in the HA precedes change in unmet needs. It was found that a reduction in unmet needs was slower in patients with higher HA (B = 0.04, p <0.0001) only for patient-rated measures. Improvement in both patient-rated and staff-rated HA over time was associated with fewer subsequent patient-rated (B = −0.10, p < 0.0001) and staff-rated (B = −0.08, p = 0.0175) unmet needs. With positive changes in the HA preceding fewer unmet needs, findings provide further evidence for a causal relationship between alliance and outcome in the treatment of people with severe mental illness.
Shula Ramon and Tony Sparkes co-produce the RRN monthly ebulletin. Please email if there is anything you would like included in the next issue, as we are keen to receive and advertise more news, articles and website references. Information can be posted to either Shula or Tony at the following:
Shula: s.ramon@herts.ac.uk
Tony: a.sparkes@bradford.ac.uk
page updated 6 June 2017
June 2017
Recovery Research Network eBULLETIN
June 2017
RRN Meetings
The next meeting of the Recovery Research Network will be held on the 21st November 2017. The venue will be AG Palmer House, Morrell Crescent, Littlemore, Oxford Health NHS Foundation Trust. OX4 4SU. Refreshments will be available from 9.30am, and the meeting will run from 10am to 4pm. More details about the programme will be made available in due course. The provisional topic will be around: Poverty and Social Inequality
If you would like to present at a future meeting of the RRN please email either Shula Ramon or Tony Sparkes. Their contact details are:
Shula: s.ramon@herts.ac.uk
RRN Membership Profile
Anyone who has an interest in recovery research can join the RRN, just fill in the online form available at: https://www.researchintorecovery.com/rrn
Please note that if you join the Network, the details you supply will be circulated to other members of the Network as part of the monthly e-bulletin, but will not be put on our website and will not be shared with any other organisation. If you would like to leave the RRN and have your details removed from our database, please email researchintorecovery@nottingham.ac.uk
Building capacity in the recovery network community
An exciting opportunity to build capacity in the recovery research community is now available, with two five-year research posts (one reserved for a peer researcher) each with options to undertake a part-time PhD being advertised (closing date 13.7.17) at http://www.nottingham.ac.uk/jobs/currentvacancies/ref/MED1438
An opportunity to join the Recovery Research Network (RRN) Collective
We have three vacancies on the RRN Collective. The role and current Collective members are on the RRN website (researchintorecovery.com/rrn) under the RRN Collective tab. RRN Collective members co-ordinate the monthly e-bulletins, and organise and regularly attend the six-monthly meetings. If this (un-funded) role might be of interest then feel free to contact Mike Slade (m.slade@nottingham.ac.uk) to discuss.
Please can we encourage members to forward their peer-reviewed articles and book publications to us in a timely manner in order that we can best disseminate their literary efforts to the broader membership.
Conferences and Events
i) Making Real Change Happen. The 20th International Congress of the ISPS will take place in the city of Liverpool, UK August 30th – September 3rd, 2017
Plenary Speakers will include: Alison Brabban, Jacqui Dillon, Grainne Fadden, Jim van Os Other speakers will include: Richard Bentall, Jim Geekie, Peter Kinderman, Eleanor Longden, Brian Martindale, John Read, Rai Waddingham
See more at: http://tinyurl.com/isps-change
Contact: isps@isps.org or visit www.isps2017uk.org
Twitter: #isps2017uk
ii) Registration is open for Refocus on Recovery 2017, being held in Nottingham from 18th to 20th September 2017. The event will comprise expert workshops, an international conference and a Mad Celebration event. Conference themes will be Recovery for different groups, Re-situating mental health, Prevention of mental ill-health, Allocating resources.
See more at: https://www.researchintorecovery.com/ror2017
iii) Delivering Excellence in Recovery Oriented Services in Mental Health
Monday 2 October 2017
De Vere West One Conference Centre, London
The Mental Health Taskforce Five Year Forward View for Mental Health focuses on recovery throughout. This one day conference focuses on delivering excellence in Recovery Oriented Services in Mental Health. Through national updates and practical case studies you will hear from expert speakers providing you with the opportunity to learn from established practice to understand and reflect on current challenges and ways of over-coming these challenges. The day will also identify key strategies for improving recovery orientated practice for mental health and look at ways you can implement these changes in your organisation, examine your role in improving recovery orientated services and self-assess and reflect on your own practice.
For further information and to book your place visit http://www.healthcareconferencesuk.co.uk/recovery-oriented-services-mental-health or email nicki@hc-uk.org.uk
Follow the conference on Twitter #MHRecovery
iv) The 12th ENMESH Conference will be held in Groningen, Netherlands from 5th to the 7th October 2017. Conference themes are Assessment: Understanding the context; Epidemiology: Methodological approaches supporting personalised care; Approaches: Novel approaches using the patient’s own context; and Policy: Societal challenges for community mental health. Further information at http://enmesh2017groningen.com/home/
Papers and Publications
Call for Papers: Peer Specialist Services
Submission Deadline: October 1, 2017
The editorial staff for Psychological Services, the official journal of APA Division 18 (Psychologists in Public Service), is inviting manuscripts for a special section on the impact peer specialists are having on the delivery of mental health and health services and outcomes in organized care settings. Drs. Matthew Chinman and Anne Klee have agreed to serve as our guest editors.
More information: http://www.apa.org/pubs/journals/ser/call-for-papers-peer-specialist-services.aspx
i) Castillo, H. and Ramon, S. (2017) “Work with me”: Service users’ perspectives on shared decision making in mental health. Mental Health Review Journal. Vol22(3). (Forthcoming)
Abstract
Purpose: While shared decision making in general health has proven effectiveness, it has received far less attention within mental health practice with a disconnection between policy and ideals. This paper aims to review existing developments, contemporary challenges, and evidence regarding shared decision making in mental health with a particular focus on the perspectives of service users.
Methodology: This is a review of international papers analysed using Narrative Synthesis.
Findings: The review shows that ethical and legal frameworks, accountability and risk are barriers to the utilisation of shared decision making. The traditional psychiatric approach, stigma and imbalances of power also contribute to a lack of professional acknowledgement of service user expertise. Service users experience this imbalance of power and feel they lack choices being “done to” rather than “worked with”.
Practical implications: The article also presents perspectives about how barriers can be overcome with the use of innovative tools such as decision support groups, recovery plans and training for service users and professionals, thus engaging in a therapeutic alliance which enables service users to take back power and acknowledge their own expertise.
Originality: This review is the first with a particular focus on the perspectives of service users and shared decision making.
ii) Ramon, S., Brooks, H., Rae, S. and O’Sullivan, M-J. (2017) Key issues in the process of implementing shared decision-making (SDM) in mental health practice. Mental Health Review Journal. Vol 22(3) (Forthcoming)
Abstract
Although SDM is seen as a favourable approach in mental health settings, its routine use in everyday practice is low. Implementation is judged to be the test of the intention to use SDM because of its value base and its potential to improve mental health practice, across medical, psychological and social interventions carried out by multidisciplinary providers, including peer support workers. Successful implementation is achieved by enhancing the incorporation of understanding SDM as based on different types of knowledge (scientific and experiential) and leading to decisions more acceptable to service users than only to clinicians, thus enabling a more genuine working partnership between the key stakeholders in mental health services.
Purpose: This review article will look at internationally existing publications in the English language on mental health SDM implementation of a variety of interventions, including different methodologies and research methods, age groups and countries. We will aim to provide an overview of: process, degree, and outcomes of implementation; barriers and facilitators; perspectives on implementation by different stakeholders; analysis of the process of implementation in mental health services through the lenses of the Normalisation Process Theory (NPT)
Design: Following a targeted literature search the data was analysed in order to provide an overview of methodologies and methods applied in the articles, as well as of the variables listed above. Three different types of information were included: a content analysis of key issues, reflective understanding coming out of participating in implementation of an SDM project in the form of two narratives written by two key participants in an SDM pilot project, and an NPT analysis of the process of implementation.
Findings: Only a minority of mental health SDM research focuses on implementation in everyday practice. It is possible and often desirable to achieve SDM in mental health services; it requires a low level of technology, it can save time once routinized, and it is based on enhancing therapeutic alliance, as well as service users’ motivation. Implementation requires an explicit policy decision, a clear procedure, and regular adherence to the aims and methods of implementation by all participants. These necessary and sufficient conditions are rarely met, due to the different levels of commitment to SDM and its process by the different key stakeholders, as well as due to competing providers’ objectives and the time allocated to achieving them.
Implications: The review indicates both the need to take into account the complexity of SDM, as well as future strategies for enhancing its implementation in everyday mental health practice. Perhaps because applying SDM reflects a major cultural change in mental health practice, current value attached to SDM among clinicians and service managers would need to be more positive, prominent, and enduring to enable a greater degree of implementation.
iii) Pincus, H. A., Spaeth‑Rublee, B., Sara, G., Goldner, E. M., Prince, P. N., Ramanu, P., Gaebel, W., Zielasek, J., Großimlinghaus, I., Wrigley, M., van Weeghel, J., Smith, M., Ruud, T., Mitchell, J. R. and Patton, L. (2016) A review of mental health recovery programs in selected industrialized countries. International Journal of Mental Health Systems. 10(73)
DOI 10.1186/s13033-016-0104-4
Abstract
The concept of recovery has gained increasing attention and many mental health systems have taken steps to move towards more recovery oriented practice and service structures. This article represents a description of current recovery-oriented programs in participating countries including recovery measurement tools. Although there is growing acceptance that recovery needs to be one of the key domains of quality in mental health care, the implementation integral part of mental health care have been lacking.
iv) Klausen, R. K., Blix, B. H., Karlsson, M., Haugsgjerd, S., & Lorem, G. F. (2016). Shared decision making from the service users’ perspective: A narrative study from community mental health centers in northern Norway. Social Work in Mental Health. 15(3) 354-371.
Abstract
This article aims to contribute to the understanding of shared decision making as an important aspect of user involvement in mental health care from the perspectives of service users. A thematic analysis of interviews with 25 individual service users in three different community mental health centers in Norway identified different understandings of shared decision making. Shared decision making was identified as essential in four contexts: 1) during admission, 2) in individualized treatment, 3) in different treatment contexts, and 4) in user-professional relationships. We consider shared decision making to be inter-twined with treatment from the service user perspective.
Shula Ramon and Tony Sparkes co-produce the RRN monthly ebulletin. Please email if there is anything you would like included in the next issue, as we are keen to receive and advertise more news, articles and website references. Information can be posted to either Shula or Tony at the following:
Shula: s.ramon@herts.ac.uk
Tony: a.sparkes@bradford.ac.uk
page updated 3 July 2017
July 2017
Recovery Research Network eBULLETIN
July 2017
RRN Meetings
The next meeting of the Recovery Research Network will be held on the 21st November 2017. The venue will be AG Palmer House, Morrell Crescent, Littlemore, Oxford Health NHS Foundation Trust. OX4 4SU. Refreshments will be available from 9.30am, and the meeting will run from 10am to 4pm. The provisional topic will be around: Poverty and Social Inequality. Further details will be made available in due course.
Registration for the event can be made by following the link below:
https://rrn-nov17.eventbrite.co.uk
If you would like to present at a future meeting of the RRN please email either Shula Ramon or Tony Sparkes. Their contact details are:
Shula: s.ramon@herts.ac.uk
RRN Membership Profile
Anyone who has an interest in recovery research can join the RRN, just fill in the online form available at: https://www.researchintorecovery.com/rrn
Please note that if you join the Network, the details you supply will be circulated to other members of the Network as part of the monthly e-bulletin, but will not be put on our website and will not be shared with any other organisation. If you would like to leave the RRN and have your details removed from our database, please email researchintorecovery@nottingham.ac.uk
An opportunity to join the Recovery Research Network (RRN) Collective
We have three vacancies on the RRN Collective. The role and current Collective members are on the RRN website (researchintorecovery.com/rrn) under the RRN Collective tab. RRN Collective members co-ordinate the monthly e-bulletins, and organise and regularly attend the six-monthly meetings. If this (un-funded) role might be of interest then feel free to contact Mike Slade (m.slade@nottingham.ac.uk) to discuss.
Please can we encourage members to forward their peer-reviewed articles and book publications to us in a timely manner in order that we can best disseminate their literary efforts to the broader membership.
Conferences and Events
i) Making Real Change Happen. The 20th International Congress of the ISPS will take place in the city of Liverpool, UK August 30th – September 3rd, 2017
Plenary Speakers will include: Alison Brabban, Jacqui Dillon, Grainne Fadden, Jim van Os Other speakers will include: Richard Bentall, Jim Geekie, Peter Kinderman, Eleanor Longden, Brian Martindale, John Read, Rai Waddingham
See more at: http://tinyurl.com/isps-change
Contact: isps@isps.org or visit: www.isps2017uk.org
Twitter: #isps2017uk
ii) Registration is open for Refocus on Recovery 2017, being held in Nottingham from 18th to 20th September 2017. The event will comprise expert workshops, an international conference and a Mad Celebration event. Conference themes will be Recovery for different groups, Re-situating mental health, Prevention of mental ill-health, Allocating resources.
See more at: https://www.researchintorecovery.com/ror2017
iii) Delivering Excellence in Recovery Oriented Services in Mental Health
Monday 2 October 2017
De Vere West One Conference Centre, London
The Mental Health Taskforce Five Year Forward View for Mental Health focuses on recovery throughout. This one day conference focuses on delivering excellence in Recovery Oriented Services in Mental Health. Through national updates and practical case studies you will hear from expert speakers providing you with the opportunity to learn from established practice to understand and reflect on current challenges and ways of over-coming these challenges. The day will also identify key strategies for improving recovery orientated practice for mental health and look at ways you can implement these changes in your organisation, examine your role in improving recovery orientated services and self-assess and reflect on your own practice.
For further information and to book your place visit http://www.healthcareconferencesuk.co.uk/recovery-oriented-services-mental-health or email nicki@hc-uk.org.uk
Follow the conference on Twitter #MHRecovery
iv) The 12th ENMESH Conference will be held in Groningen, Netherlands from 5th to the 7th October 2017. Conference themes are Assessment: Understanding the context; Epidemiology: Methodological approaches supporting personalised care; Approaches: Novel approaches using the patient’s own context; and Policy: Societal challenges for community mental health. Further information at: http://enmesh2017groningen.com/home/
Papers and Publications
Call for Papers: Peer Specialist Services
Submission Deadline: October 1, 2017
The editorial staff for Psychological Services, the official journal of APA Division 18 (Psychologists in Public Service), is inviting manuscripts for a special section on the impact peer specialists are having on the delivery of mental health and health services and outcomes in organized care settings. Drs. Matthew Chinman and Anne Klee have agreed to serve as our guest editors.
More information: http://www.apa.org/pubs/journals/ser/call-for-papers-peer-specialist-services.aspx
i) Tang, L. (2017) Recovery, Mental Health and Inequality: Chinese Ethnic Minorities as Mental Health Service Users. Routledge
About the book:
This book uses the rich narratives of the recovery journeys of Chinese mental health service users in the UK – a perceived ‘hard-to-reach group’ and largely invisible in mental health literature – to illustrate the myriad ways that social inequalities such as class, ethnicity and gender contribute to service users’ distress and mental ill-health, as well as shape their subsequent recovery journeys.
Recovery, Mental Health and Inequality contributes to the debate about the implementation of ‘recovery approach’ in mental health services and demonstrates the importance of tackling structural inequalities in facilitating meaningful recovery. This timely book would benefit practitioners and students in various fields, such as nurses, social workers and mental health postgraduate trainees.
ii) Walsh, F. and Tickle, A. (2017). Listen to me, I’m talking: involvement and recovery. Mental Health Review Journal. 22(2). 111 – 123.
https://doi.org/10.1108/MHRJ-09-2016-0018
Abstract
Purpose: The purpose of this paper is to explore how those engaged in service user involvement (SUI) initiatives perceive involvement and recovery; whether involvement is related to their recovery process and, if so, how.
Design/methodology/approach: An exploratory qualitative method, social constructionist grounded theory, was adopted throughout the research process. Nine semi-structured interviews were undertaken with participants who self-defined as having current or previous mental health problems and who were engaged in SUI initiatives.
Findings: Most participants identified explicit links between their own experiences of SUI and recovery. These links represented a connection between the characteristics they perceived to be inherent to involvement and their personal definitions of recovery. In contrast, experiences of consultation and involvement as patient service users was limited and identified as an area for improvement. The core of the tentative grounded theory constructed suggests that individuals found in involvement elements which were concordant with and supported their own definitions of recovery and which were not apparent in their experiences as patients.
Research limitations/implications: The small sample and narrow constituency of participants limit the nature of the claims made by the study.
Practical implications: This study highlights the value of involvement in promoting recovery and indicates the merit of promoting meaningful involvement across the spectrum of the service user experience.
Originality/value: This study offers a unique contribution to the current literature, highlighting the links made between involvement and personal recovery.
iii) Zisman-Ilani, Y., Barnett, E., Harik, J., Pavlo, A. and O’Connell, M. (2017) Expanding the concept of shared decision making for mental health: systematic search and scoping review of interventions. Mental Health Review Journal. [online]
https://doi.org/10.1108/MHRJ-01-2017-0002
Abstract
Purpose: Much of the existing literature on Shared Decision Making (SDM) in mental health has focused on the use of Decision Aids (DAs). However, DAs tend to focus on information exchange and neglect other essential elements to SDM in mental health. Therefore, the present work aimed to expand the review of SDM interventions in mental health by identifying important components, in addition to information exchange, that may contribute to the SDM process in mental health.
Design:: Systematic and scoping literature search.
Findings: A final sample of 31 records was systematically selected. Most interventions were developed and/or piloted in the US for adults in community psychiatric settings. Although information exchange was a central component of the identified studies, important additional elements were: eliciting patient preferences and values, providing patient communication skills training, eliciting shared care planning, facilitating patient motivation, and eliciting patient participation in goal setting.
Originality: Our review indicates that additional elements, other than information exchange such as sufficient rapport and trusting relationships, are important and needed as part of SDM in mental health. Future SDM interventions in mental health could consider including techniques that aim to increase patient involvement in activities such as goal settings, values, and preference clarification, or facilitating patient motivation, before and after presenting treatment options.
iv) Perestelo-Perez, L., Rivero-Santana, A., Alvarez-Perez, Y., Zisman-Ilani, Y., Kaminskiy, E. and Serrano-Aguilar, P. (2017) Measurement issues of shared decision making in mental health: Challenges and Opportunities. Mental Health Review Journal. [online]
https://doi.org/10.1108/MHRJ-01-2017-0004
Abstract
Purpose: Shared decision making (SDM) is a model of health care in which patients are involved in the decision making process about their treatment, considering their preferences and concerns in a deliberative process with the health care provider. Many existing instruments assess the antecedents, process, or the outcomes of SDM. The aim of this article is to identify the SDM-related measures applied in a mental health context.
Design: We performed a systematic review in several electronic databases from 1990 to October 2016. Studies that assessed quantitatively one or more constructs related to SDM (antecedents, process, outcomes) in the field of mental health were included.
Findings: We included 87 studies that applied 48 measures on distinct SDM constructs. A large majority of them have been developed in the field of physical diseases and adapted or directly applied in the mental health context. The most evaluated construct is the SDM process in consultation, mainly by patients’ self-report but also by external observer measures, followed by the patients’ preferences for involvement in decision making. The most applied instrument was the Autonomy Preference Index (API), followed by the Observing Patient Involvement in Decision Making (OPTION) and the Control Preferences Scale (CPS). The psychometric validation in mental health samples of the instruments identified is scarce.
Research limitations/implications: The bibliographic search is comprehensive, but could not be completely exhaustive. Effort should be invested in the development of new SDM for mental health tools that will reflect the complexity and specific features of mental health care.
Originality/value: We highlight several limitations and challenges for the measurement of SDM in mental health care.
v) Bhanbhro, S., Gee, M., Cook, S., Marston, L., Lean, M. and Killaspy, H. (2016) Recovery-based staff training intervention within mental health rehabilitation units: a two-stage analysis using realistic evaluation principles and framework approach. BMC Psychiatry. 16:292. 1-14.
DOI 10.1186/s12888-016-0999-y
Abstract
Background: Long-term change in recovery-based practice in mental health rehabilitation is a research priority.
Methods: We used a qualitative case study analysis using a blend of traditional ‘framework’ analysis and ‘realist’ approaches to carry out an evaluation of a recovery-focused staff training intervention within three purposively selected mental health rehabilitation units. We maximised the validity of the data by triangulating multiple data sources.
Results: We found that organisational culture and embedding of a change management programme in routine practice were reported as key influences in sustaining change in practice. The qualitative study generated 10 recommendations on how to achieve long-term change in practice including addressing pre-existing organisational issues and synergising concurrent change programmes.
Conclusions: We propose that a recovery-focused staff training intervention requires clear leadership and integration with any existing change management programmes to facilitate sustained improvements in routine practice
vi) Hickey, J. E., Pryjmachuk, S. and Waterman, H. (2017) Essays and Debates in Mental Health: Exploring personal recovery in mental illness through an Arabic sociocultural lens. Journal of Psychiatric and Mental Health Nursing. 24(2) 163–170
Introduction
Arabic culture in the Gulf region (i.e. Qatar, Kuwait, Saudi Arabia, Bahrain, Oman) is characterized by traditional values and beliefs. Islam guides nearly every aspect of life for the majority Muslim population. At the same time, development and globalization in the Gulf region is occurring at such a rapid pace that traditional values are under threat (Teller 2014). This situation sometimes creates tension between various stakeholders regarding what is understood to be good practice (Al-Subaiey 2010).
One example where the potential for tension exists can be found in the concept of personal recovery in mental illness. During the last three decades, personal recovery has become generally understood as an ongoing process that emphasizes hope, identity, meaning and personal responsibility (Ralph et al. 2002, Spaniol et al. 2002, Andresen et al. 2003). However, this understanding has been developed primarily in Western countries, and it is likely that it has inherent Western values that may not be appropriate in non-Western settings. This is important because non-Western countries have begun to incorporate recovery concepts into mental health service planning and development (See, for example Supreme Council of Health, 2013). However, very little research exists to inform our understanding of what recovery looks like in an Arabic context.
This article debates and critiques the concept of personal recovery, using an Arabic contextual lens and argues that recovery concepts should not be transplanted into non-Western contexts without careful contextual adaptation and evaluation.
Other News
United Nations Report Calls for Revolution in Mental Health Care. In a new report, the United Nations Special Rapporteur on the right to health, Dr. Dainius Pūras, calls for a move away from the biomedical model and “excessive use of psychotropic medicines”
http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=21689&LangID=E
Read the full report here:
http://ap.ohchr.org/documents/dpage_e.aspx?si=A/HRC/35/21
Shula Ramon and Tony Sparkes co-produce the RRN monthly ebulletin. Please email if there is anything you would like included in the next issue, as we are keen to receive and advertise more news, articles and website references. Information can be posted to either Shula or Tony at the following:
Shula: s.ramon@herts.ac.uk
Tony: a.sparkes@bradford.ac.uk
page updated 9 August 2017
September 2017
Recovery Research Network eBULLETIN
September 2017
RRN Meetings
The next meeting of the Recovery Research Network will be held on the 21st November 2017. The venue will be AG Palmer House, Morrell Crescent, Littlemore, Oxford Health NHS Foundation Trust. OX4 4SU. Refreshments will be available from 9.30am, and the meeting will run from 10am to 4pm. Please see details below:
Theme: Poverty and Social Inequality
09:30 Refreshments
10:00 Introductions
10:30 Ian Tucker – The changing spaces of mental health: Poverties of opportunity and lived experience
11:10 Iris Elliott – Inevitable and overwhelming? How researchers can challenge commonsensical discourses around poverty and mental health
11:50 Break
12:20 Jed Boardman – Mental Health: Exclusion to Inclusion?
13:00 Lunch
14:00 David McDaid – Dying from inequality: socioeconomics and suicide
14:40 Ian Cummins – Austerity and Mental Health
15:20 Panel discussion
15:40 End of formal meeting
15:40 Recovery Research Network business (all welcome to stay)
16:00 Close
Directions by Road
There is very limited parking at the Littlemore Mental Health centre/AG Palmer House site. It would be best to drive further along Sandford Road, which is the main road going past the entrance to Palmer House and the Littlemore MH site, and park in the road. Then walk back to the venue at Palmer House. Or you could turn left at the traffic lights immediately after the Littlemore MH centre into Armstrong Road, where there usually are some places.
There will be 5 places reserved for presenters at the Palmer House site.
Directions by public transport
Come out of Oxford station and take the number 5 bus (directly ahead down exit stairs). Get off at Queens Lane bus stop (the stop after the High Street stop, when the bus may say “High St Queens Lane”). Then get on a number 3A (at the number 3 bus stop). The 3A’s go every half hour at 8.32, 9.07 and 9.37 and take about 20 mins to destination. Get off at the Littlemore Mental Health centre (hospital) stop, the second stop after a big roundabout. Cross over the road and walk back along the direction you came and you will see a sign at a gateway saying AG Palmer House.
Lunch will be provided but no assistance can be made with travel expenses
Registration for the event can be made by following the link below:
https://www.eventbrite.co.uk/e/recovery-research-network-autumn-2017-tickets-36276872101
If you would like to present at a future meeting of the RRN please email 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 at: https://www.researchintorecovery.com/rrn
Please note that if you join the Network, the details you supply will be circulated to other members of the Network as part of the monthly e-bulletin, but will not be put on our website and will not be shared with any other organisation. If you would like to leave the RRN and have your details removed from our database, please email researchintorecovery@nottingham.ac.uk
An opportunity to join the Recovery Research Network (RRN) Collective
We have three vacancies on the RRN Collective. The role and current Collective members are on the RRN website (researchintorecovery.com/rrn) under the RRN Collective tab. RRN Collective members co-ordinate the monthly e-bulletins, and organise and regularly attend the six-monthly meetings. If this (un-funded) role might be of interest then feel free to contact Mike Slade (m.slade@nottingham.ac.uk) to discuss.
Please can we encourage members to forward their peer-reviewed articles and book publications to us in a timely manner in order that we can best disseminate their literary efforts to the broader membership.
Conferences and Events
i) Delivering Excellence in Recovery Oriented Services in Mental Health
Monday 2 October 2017
De Vere West One Conference Centre, London
The Mental Health Taskforce Five Year Forward View for Mental Health focuses on recovery throughout. This one day conference focuses on delivering excellence in Recovery Oriented Services in Mental Health. Through national updates and practical case studies you will hear from expert speakers providing you with the opportunity to learn from established practice to understand and reflect on current challenges and ways of over-coming these challenges. The day will also identify key strategies for improving recovery orientated practice for mental health and look at ways you can implement these changes in your organisation, examine your role in improving recovery orientated services and self-assess and reflect on your own practice.
For further information and to book your place visit http://www.healthcareconferencesuk.co.uk/recovery-oriented-services-mental-health or email nicki@hc-uk.org.uk
Follow the conference on Twitter #MHRecovery
ii) The 12th ENMESH Conference will be held in Groningen, Netherlands from 5th to the 7th October 2017. Conference themes are Assessment: Understanding the context; Epidemiology: Methodological approaches supporting personalised care; Approaches: Novel approaches using the patient’s own context; and Policy: Societal challenges for community mental health. Further information at: http://enmesh2017groningen.com/home/
iii) The forthcoming meeting of the Qualitative Mental Health Research Network will be taking place on Monday, 16th October 2017, at the McPin foundation, 32-36 Loman street, London SE1 OEH.
The event will comprise 3 talks on different aspects of qualitative research in mental health. Speakers will include:
- Dr Naama Katz, talking about: Mapping Successful Coping Strategies – A new perception for a meaningful life of victims of Crime
- Jonathan Gadsby, talking about: Dialogical narrative analysis work he has conducted with people who hear voices
- Rose Thompson, talking about: An analysis of the different sources of lived experience researchers bought into planning and conducting a recent evaluation of peer support brokerage
For further information please contact Dr. Rose Thompson at rosethompson@mcpin.org
Papers and Publications
Call for Papers: Peer Specialist Services
Submission Deadline: October 1, 2017
The editorial staff for Psychological Services, the official journal of APA Division 18 (Psychologists in Public Service), is inviting manuscripts for a special section on the impact peer specialists are having on the delivery of mental health and health services and outcomes in organized care settings. Drs. Matthew Chinman and Anne Klee have agreed to serve as our guest editors.
More information: http://www.apa.org/pubs/journals/ser/call-for-papers-peer-specialist-services.aspx
i) Aga, N., Vander Laenen, F., Vandevelde, S., Vermeersch, E. and Vanderplasschen, W. (2017) Recovery of offenders formerly labelled as not criminally responsible: uncovering the ambiguity from first-person narratives. International Journal of Offender Therapy and Comparative Criminology. 1-21
DOI: 10.1177/0306624X17730617
Abstract
The recovery paradigm is a widely accepted strength-based approach in general mental health care. Particular challenges arise when applying this paradigm in a forensic context. To address these issues, the present study examined recovery based on first-person narratives of offenders formerly labelled as not criminally responsible of whom the judicial measure was abrogated. Eleven in-depth interviews were conducted to obtain information on lived experiences and recovery resources of this hard-to-reach and understudied population. The interviews focused on recovery and elements that indicated a sense of progress in life. Key themes were derived from the collected data. Descriptions of recovery resources followed recurrent themes, including clinical, functional, social, and personal resources. Participants also reported ambiguous experiences related to features of the judicial trajectory. This was defined as forensic recovery and can be seen as an additional mechanism, besides more established recovery dimensions, that is unique to mentally ill offenders.
ii) Fox, J. (2017) Building on the recovery approach: the development of a conceptual model of service design for carers in mental health. Research, Policy and Planning. 32(3) 183-196.
Abstract
Carers’ views about their role in recovery are under-researched, and studies investigating their needs are underdeveloped. In this study, participatory action research was used; I was supported by a steering group of eight stakeholders to co-produce a training programme on recovery and data collection methods to explore the meaning of recovery for carers. The programme was delivered by me, an expert-by-experience with a diagnosis of schizophrenia, and a carer of her son with a similar diagnosis, to a group of eleven participants. Mainly qualitative data was collected together with supplementary quantitative socio-demographic data from the participants. Selected findings based on the carers’ discussions are presented which focus on how the relationship between carers and professionals can most effectively facilitate service user recovery. Issues of information exchange between carers and professionals and the impact of patient confidentiality are highlighted, the nature of recovery practice is considered, and the participants’ need to be regarded as ‘experts’ is addressed. A conceptual model of service design based on a recovery-oriented ‘triangle of care’ is presented. The potential implementation of this model in the current UK mental health service context is considered with the need for co-production between all stakeholders to ensure its development.
iii) Castillo, H. and Ramon, S. (2017) “Work with me”: service users’ perspectives on shared decision making in mental health. Mental Health Review Journal. 22(3) 166-178.
Abstract
Purpose – While shared decision making (SDM) in general health has proven effectiveness, it has received far less attention within mental health practice with a disconnection between policy and ideals. The purpose of this paper is to review existing developments, contemporary challenges, and evidence regarding SDM in mental health with a particular focus on the perspectives of service users.
Design/methodology/approach – This is a review of international papers analysed using narrative synthesis of relevant data bases.
Findings – The review shows significant barriers to the utilisation of SDM including ethical and legal frameworks, accountability and risk. The medical model of psychiatry and diagnostic stigma also contributes to a lack of professional acknowledgement of service user expertise. Service users experience an imbalance of power and feel they lack choices, being “done to” rather than “worked with”.
Practical implications – The paper also presents perspectives about how barriers can be overcome, and service users enabled to take back power and acknowledge their own expertise.
Originality/value – This review is the first with a particular focus on the perspectives of service users and SDM.
iv) McCaffrey, T. (2017). Evaluating music therapy in adult mental health services: tuning into service user perspectives. Nordic Journal of Music Therapy.
DOI: 10.1080/08098131.2017.1372510
Abstract
Many statutory mental health services worldwide have adopted a recovery-oriented rhetoric. These acknowledge that those who use mental health services have acquired valuable expertise through their contact with services and that such expertise should be used to inform health provision. The focus of this study was to tune into the perspectives of adult service users who have attended music therapy in statutory mental health services in Ireland. This aimed to furnish holistic descriptions of practice so as to augment existing understanding of what may be afforded to those who attend music therapy sessions. Six service users participated in semi-structured interviews in which they described their lived experience of attending music therapy sessions. Interview transcripts were analysed using interpretative phenomenological analysis. Six common themes were found across each of the six participant cases. These included “Music therapy offers an opportunity to be meaningfully occupied”, “Involvement in music therapy can pose challenges”, “Music therapy offers an agreeable process”, “Group music therapy fosters reciprocity”, “Music therapy is flexible and adaptable” and “Lack of musical instruction can cause frustration”. Findings relating to meaningful occupation, challenge, reciprocity and frustration broaden understanding of what music therapy can offer to service users in mental health provision.
Other News
Shula Ramon and Tony Sparkes co-produce the RRN monthly ebulletin. Please email if there is anything you would like included in the next issue, as we are keen to receive and advertise more news, articles and website references. Information can be posted to either Shula or Tony at the following:
Shula: s.ramon@herts.ac.uk
Tony: a.sparkes@bradford.ac.uk
page updated 9 October 2017
October 2017
December 2017
Recovery Research Network eBULLETIN
December 2017
RRN Meetings
The 19th meeting of the Recovery Research Network will be held on 17th May 2018 in Room H2.5, 2nd Floor Hunter Wing, St George’s, University of London, Cranmer Terrace, London SW17 0RE. Directions are available at:
https://www.sgul.ac.uk/about-us/how-to-get-here
All Recovery Research Network events are free. Places are limited and you must register to attend. Registration is available from:
https://www.eventbrite.co.uk/e/recovery-research-network-spring-2018-tickets-41707438070
The provisional theme is ‘User-led initiatives, collective action and co-production’. Further details will be distributed when available. In the meantime however, speaker suggestions are welcome from the readership. Please contact Dr. Emma Kaminskiy (emma.kaminskiy@anglia.ac.uk)
If you would like to present at a future meeting of the RRN please email 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 at: https://www.researchintorecovery.com/rrn
Please note that if you join the Network, the details you supply will be circulated to other members of the Network as part of the monthly e-bulletin, but will not be put on our website and will not be shared with any other organisation. If you would like to leave the RRN and have your details removed from our database, please email researchintorecovery@nottingham.ac.uk
In the previous edition of the RRN ebulletin (November 2017), we welcomed Dr. Emma Kaminskiy and Fortune Mhlanga to the Recovery Research Network Collective. In this edition of the ebulletin we are pleased to welcome also Dr Laura Hill to the collective.
Welcome Laura!
Along with Emma and Fortune, Laura’s profile will be uploaded to the RRN website in due course. Laura’s inclusion means that the RRN collective is now fully populated as we move into 2018.
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.
Conferences and Events
i) Refocus on recovery
Would you like to organise a national recovery conference? An exciting opportunity to build on success has just become available, with the decision to support national Refocus on Recovery conferences. Many Recovery Research Network members will have come to, or know of, the international Refocus on Recovery research conferences which have been run since 2010. The aim has been to develop a community of interest around mental health recovery, and hence to influence national and international mental health policy and practice. The conferences have all so far taken place in England (most recently in Nottingham in September 2017), which limits attendance from people further away (though people from around 25 countries do attend). So to meet demand, there is now the chance to organise national Refocus on Recovery conferences around the world. You can find out more at:
https://www.researchintorecovery.com/RoRNational
ii) RSP4 International Conference on
Recovery-oriented Services and Policy Planning in Mental Health
Successful Stories, Sustainability and Challenges
January 11-12, 2018 | Lecture Hall Il, Centennial Campus, Hong Kong University
The International Conference on Recovery-oriented Services and Policy Planning in Mental Health (RSP 4.0) is one of the few conferences that specifically addresses recovery-oriented services and policy in the Asia Pacific region, tapping into the latest trends of concepts, research and service development while facilitating multilevel discussions, from individual interventions, cultural adaptations to policy implications.
Keynote speakers:
Professor Larry Davidson Professor of Psychiatry and Director of Yale Program for Recovery and Community Health Yale School of Medicine Yale University |
Professor Mike Slade Professor of Mental Health Recovery and Social Inclusion Faculty of Medicine & Health Sciences University of Nottingham |
Call for Abstracts
Scholars and practitioners are invited to submit abstracts for poster presentation on themes pertinent to mental health recovery and policy. They can focus on research or practice wisdom covering the following areas:
- Recovery approach as a form of behavioural health intervention
- Recovery-oriented policy or transformation of workplace culture: Success, sustainability and challenges
- Cross-cultural application of the recovery approach
For further details and registration see:
Papers and Publications
i) Sharma, P. (2015) Musical progressions: a multi-modal approach in healing from bipolar disorder. World Cultural Psychiatry Research Review. 10(3/4) 285-297
Abstract. This self-narrative examines the various engagements that changed this researcher from being an ill person to exploring her musical and creative self. This article follows the method of autoethnographic inquiry in which evidences from personal history, which coincided with 18 years with bipolar disorder is shared from internet sites by the researcher, where such links are in a public domain, for anyone to access. In this span of time, she worked with many aspects of music, to the point that from a state of emotional chaos there emerged an order. Examining creativity as an idea and corroborating from Dabrowski’s theory of positive disintegration, this article illustrates how the current researcher is no longer someone living with a serious mental illness, but a person who got healed and became an artist, researcher and entrepreneur. While some of this is ascribed to the divergent thinking that is attributed to bipolar disorder, she explicates how one musical engagement led to another and brought about her recovery, though none of it had started with a therapeutic goal. What constitutes recovery in mental illness is also elaborated.
ii) Morant, N., Azam, K., Johnson, S. and Moncrieff, J. (2017) The least worst option: user experiences of antipsychotic medication and lack of involvement in medication decisions in a UK community sample. Journal of Mental Health. Early Online 1-7.
DOI: 10.1080/09638237.2017.1370637
Abstract
Background: Treatment decision-making that fully involves service users is an aim across medicine, including mental health.
Aim: To explore service users experiences of taking antipsychotic medication for psychotic
disorders and their perceptions of decision-making about this.
Method: Semi-structured interviews with 20 users of community mental health services, conducted by service user researchers and analysed using thematic analysis.
Results: Antipsychotic medication was perceived to have beneficial effects on symptoms and relapse risk, but adverse effects were prominent, including a global state of lethargy and demotivation. Weighing these up, the majority viewed antipsychotics as the least worst option. Participants were split between positions of ‘‘willing acceptance’’, ‘‘resigned acceptance’’ and ‘‘non-acceptance’’ of taking antipsychotics. Many felt their choices about medication were limited, due to the nature of their illness or pressure from other people. They commonly experienced their prescribing psychiatrist as not sufficiently acknowledging the negative impacts of medication on life quality and physical health concerns and described feeling powerless to influence decisions about their medication.
Conclusion: The study highlights the complexity of agendas surrounding antipsychotic medication, including the pervasive influence of coercive processes and the challenges of implementing collaborative decision-making for people with serious mental health problems.
iii) Moncrieff, J., Azam, K., Johnson, S., Marston, L., Morant, N., Darlton, K. and Wood, N. (2016) Results of a pilot cluster randomised trial of the use of a Medication Review Tool for
people taking antipsychotic medication. BMC Psychiatry. 16:205
DOI 10.1186/s12888-016-0921-7
Abstract
Background: Government policy encourages increasing involvement of patients in their long-term care. This paper describes the development and pilot evaluation of a ‘Medication Review Tool’ designed to assist people to participate more effectively in discussions about antipsychotic drug treatment.
Methods: The Medication Review Tool developed consisted of a form to help patients identify pros and cons of their current antipsychotic treatment and any desired changes. It was associated with a website containing information and links about antipsychotics. For the trial, participants diagnosed with psychotic disorders were recruited from community mental health services. Cluster randomisation was used to allocate health professionals (care co-ordinators) and their associated patients to use of the Medication Review Tool or usual care. All participants had a medical consultation scheduled, and those in the intervention group completed the Medication Review Tool, with the help of their health professional prior to this, and took the completed Form into the consultation. Two follow-up interviews were conducted up to three months after the consultation. The principal outcome was the Decision Self Efficacy Scale (DSES). Qualitative feedback was collected from patients in the intervention group.
Results: One hundred and thirty patients were screened, sixty patients were randomised, 51 completed the first follow-up assessment and 49 completed the second. Many patients were not randomised due to the timing of their consultation, and involvement of health professionals was inconsistent. There was no difference between the groups on the DSES (-4.16 95 % CI -9.81, 1.49), symptoms, side effects, antipsychotic doses or patient satisfaction. Scores on the Medication Adherence Questionnaire indicated an increase in participants’ reported inclination to adherence in the intervention group (coefficient adjusted for baseline values -0.44; 95 % CI -0.76, -0.11), and there was a small increase in positive attitudes to antipsychotic medication (Drug Attitude Inventory, adjusted coefficient 1.65; 95 % CI -0.09, 3.40). Qualitative feedback indicated patients valued the Tool for identifying both positive and negative aspects of drug treatment.
Conclusions: The trial demonstrated the design was feasible, although challenges included service re-configurations and maintaining health professional involvement. Results may indicate a more intensive and sustained intervention is required to facilitate participation in decision-making for this group of patients.
iv) Wood, L. and Alsawy, S. (2017) Recovery in psychosis from a service user perspective: A systematic review and thematic synthesis of current qualitative evidence. Community Mental Health Journal. [Online]
DOI: 10.1007/s10597-017-0185-9
Abstract
There is a growing number of qualitative accounts regarding recovery from psychosis from a service user perspective. The aim of this study was to conduct a systematic review of these qualitative accounts. A thematic synthesis was utilised to synthesise and analyse seventeen studies included in the review. Studies were included if they used a qualitative methodology to explore service users’ experiences of recovery from psychosis as a primary research question. All included studies were subjected to a quality assessment. The analysis outlined three subordinate themes: the recovery journey, facilitators of recovery (e.g. faith and spirituality, personal agency and hope), and barriers to recovery (e.g. stigma and discrimination, negative effects of mental health services and medication). Recovery is an idiosyncratic process but includes key components which are important to people who experience psychosis. These should be explored within clinical practice.
v) Price-Robertson, R., Obradovic, A. and Morgan, B. (2017) Relational
recovery: beyond individualism in the recovery approach, Advances in Mental Health. 15(2)
108-120.
Abstract
Objective: While the recovery approach in mental health currently enjoys immense support, it is not without its critics. The most persistent criticisms focus on the individualism underpinning many conceptualisations of recovery. In this paper, we outline the shortcomings of individualistic approaches to recovery, and explore the alternative notion of relational recovery.
Method: We begin this article by reviewing recent research and theory that critiques individualistic approaches to recovery. We then draw together disparate bodies of research that view recovery as an inherently social process.
Results: Our reading of the literature suggests that although many models of recovery recognise relationships or connectedness as a component of the recovery process, an overemphasis on the ‘inner’, subjective experiences of people with a lived experience of mental ill-health largely obscures the interpersonal contexts of recovery. Interpersonal relationships can more accurately be seen as suffusing all aspects of recovery, including experiences such as hope, identity and empowerment.
Discussion: We conclude by arguing that the way forward for mental health systems lies in developing, promoting and implementing approaches that properly acknowledge the irreducibly relational nature of recovery.
vi) Simmons, M. B., Coates, D., Batchelor, S., Dimopoulos-Bick, T. and Howe, D. (2017) The CHOICE pilot project: Challenges of implementing a combined peer work and shared decision-making programme in an early intervention service. Early Intervention in Psychiatry. 1-8 [Online]
DOI: 10.1111/eip.12527
Abstract
Aim: Youth participation is central to early intervention policy and quality frameworks. There is good evidence for peer support (individuals with lived experience helping other consumers) and shared decision making (involving consumers in making decisions about their own care) in adult settings. However, youth programs are rarely tested or described in detail. This report aims to fill this gap by describing a consumer focused intervention in an early intervention service.
Methods: This paper describes the development process, intervention content and implementation challenges of the Choices about Healthcare Options Informed by Client Experiences and Expectations (CHOICE) Pilot Project. This highly novel and innovative project combined both youth peer work and youth shared decision making.
Results: Eight peer workers were employed to deliver an online shared decision-making tool at a youth mental health service in New South Wales, Australia. The intervention development involved best practice principles, including international standards and elements of co-design. The implementation of the peer workforce in the service involved a number of targeted strategies designed to support this new service model. However, several implementation challenges were experienced which resulted in critical learning about how best to deliver these types of interventions.
Conclusions: Delivering peer work and shared decision making within an early intervention service is feasible, but not without challenges. Providing adequate detail about interventions and implementation strategies fills a critical gap in the literature. Understanding optimal youth involvement strategies assists others to deliver acceptable and effective services to young people who experience mental ill health.
Doctoral (PhD) research
Sam Robertson has kindly shared a sense of her research with the following title and abstract. For further information please contact Sam on:
Title: What does the process of developing a personal narrative involve and how does it contribute to mental health recovery?
Abstract
This research is based on the premise that mental health recovery is a unique and individual journey (Anthony, 1993), rather than an evidence-based ‘one-size-fits-all’ service which characterises current UK recovery-orientated provision. Service users are asked to ‘tell their stories’ within clinical settings as a tool for diagnosis, formulation and treatment plans. There is little current evidence that narrative or narrative development is being used systematically within an NHS therapeutic setting. The aim of this study is to explore the process of developing a personal narrative and its possible contribution to mental health recovery.
This study uses a three-phased approach, where the emergent themes inform subsequent phases. Recovery background, study rationale, literature review (overview of narrative and use of media) and methodology are described to provide context to all phases. Phase 1 involved developing and analysing my recovery autoethnography, ‘From the edge of the abyss to the foot of the rainbow’. Phase 2 used a Participatory Action Research Approach. 11 co-researchers who had developed their personal narratives were recruited to two focus groups to discuss their process in developing their narrative. Six co-researchers continued into Phase 3. This involved PAR (in three cycle). In phase 3 the eight sessions Peer-led Personal Narrative Workshop Programme was developed with accompanying documentation – Programme Framework, Scheme of Work and Session Plans.
Key findings include: a realisation of the difficulty of developing a narrative (reliving trauma); the value of developing narrative within a group setting (supports factors such as collaboration and validation); and the role of ‘the voice of others’ in our narratives (implications for relational ethics). A key element of the Personal Narrative Workshop Programme was ensuring a balanced approach between education content and the time and space to ‘do’ within a supportive environment. Given ‘my insider perspective’, Phase 3 also highlighted: the complexities of using a PAR approach; the multiplicity of roles and tensions of those roles; and the tensions of the PAR process with the need to develop practical outcomes.
Other News
Research Assistant (fixed-term)
The University of Nottingham is currently advertising for a RRN-relevant post:
http://www.nottingham.ac.uk/jobs/currentvacancies/ref/MED466117
Mind-tech: Digital Technology for Mental Health: Asking the right questions
Dear Friends and colleagues
We need your help to set the priorities for future research into Digital Technology for Mental Health. Please take part in this survey to select the 10 questions you think are the most important. It will take about 10-15 minutes and there are prizes to be won for taking part!
Go to survey:
https://nv8w2j7z.optimalworkshop.com/optimalsort/digitalmhq
The project Digital Technology for Mental Health: Asking the right questions, led by NIHR MindTech Healthcare Technology Cooperative, has already carried out a wide reaching consultation to gather in questions about using digital technologies for mental health from people with personal experience of mental health problems and health and social care practitioners. They now need your help to start prioritising which questions are the most important.
To find out more about the project go to www.mindtech.org.uk/digitalMHQ
You can also view a short film about the project at www.youtube.com/watch?v=-jjodDAWZ5Q&t=7s
The project hashtag on social media is #digitalMHQ – be sure to let all in your networks know about the chance to pick their top 10.
Many thanks, Mat
Mat Rawsthorne CGMA
CLAHRC-EM Service User Consultant, REBOOT study
A decade of RRN
The first meeting of the RRN was held on the 23rd April 2009. November 2018 will be the 20th meeting of the RRN, and mark ten years of collegial networking around the topic of research into recovery. Suggestions for marking our 10-year anniversary would be most welcome!
Shula Ramon and Tony Sparkes co-produce the RRN monthly ebulletin. Please email if there is anything you would like included in the next issue, as we are keen to receive and advertise more news, articles and website references. Information can be posted to either Shula or Tony at the following:
Shula: s.ramon@herts.ac.uk
Tony: a.sparkes@bradford.ac.uk