Clinical and personal recovery for people with schizophrenia in China: prevalence and predictors

ObjectiveTo examine the literature on how recovery of people with severe mental illness (SMI) is conceptualised in low/middle-income countries (LMICs), and in particular what factors are thought to facilitate recovery.DesignScoping review.Data sources and eligibilityWe searched 14 electronic databases, hand searched citations and consulted with experts during the period May–December 2019. Eligible studies were independently screened for inclusion and exclusion by two reviewers. Unresolved discrepancies were referred to a third reviewer.Data extraction and synthesisAll bibliographical data and study characteristics were extracted using a data charting form. Selected studies were analysed through a thematic analysis emerging from extracted data.ResultsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram offers a summary of the results: 4201 titles, 1530 abstracts and 109 full-text articles were screened. Ten articles were selected for inclusion: two from Turkey, two from India, and one each from China, Swaziland, Indonesia, Egypt, South Africa and Vietnam. Although most studies used qualitative methods, data collection and sampling methods were heterogeneous. One study reported on service provider perspectives while the rest provided perspectives from a combination of service users and caregivers. Three themes emerged from the data analysis. First, studies frame recovery as a personal journey occurring along a continuum. Second, there was an emphasis on social relationships as a facilitator of recovery. Third, spirituality emerged as both a facilitator and an indicator of recovery. These themes were not mutually exclusive and some overlap exists.ConclusionAlthough there were commonalities with how high-income countries describe recovery, we also found differences in conceptualisation. These differences in how recovery was understood reflect the importance of framing the personal recovery concept in relation to local needs and contextual issues found in LMICs. This review highlighted the current sparse evidence base and the need to better understand recovery from SMI in LMICs.

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Longitudinal changes in personal recovery in individuals with psychotic disorders through hospitalisation in a psychiatric ward: preliminary findings

BMC Psychiatry ◽

10.1186/s12888-021-03347-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Norika Mitsunaga-Ohmuro ◽

Noriyuki Ohmuro

Keyword(s):

Self Efficacy ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Self Esteem ◽

Assessment Scale ◽

Psychiatric Ward ◽

Personal Recovery ◽

Recovery Assessment ◽

General Self Efficacy ◽

Recovery Assessment Scale

Abstract Background This study aimed to investigate whether personal recovery indices in individuals with psychotic disorders would change through hospitalisation in a psychiatric ward and to identify factors associated with these changes. Methods Participants underwent assessments for personal recovery using the Questionnaire about the Process of Recovery, Recovery Assessment Scale, and Self-Identified Stage of Recovery Part A and B; clinical symptoms using the Positive And Negative Syndrome Scale; self-efficacy using the General Self-Efficacy Scale; and self-esteem using the Rosenberg Self-Esteem Scale at baseline and before hospital discharge. Wilcoxon signed-rank tests were administered for longitudinal comparisons between baseline and follow-up. Spearman’s rank correlation tests were conducted to assess correlations of longitudinal changes in personal recovery with baseline values of personal recovery as well as baseline values or changes in the Positive And Negative Syndrome Scale, General Self-Efficacy Scale, and Rosenberg Self-Esteem Scale. Results Thirty-four individuals with psychotic disorders completed the assessments. The average duration of the current hospitalisation was 81.9 days (SD, 15.3; median, 85.0; range, 51–128 days). No significant changes were observed in personal recovery, self-efficacy, and self-esteem, although clinical symptoms significantly improved. Significant correlations were found between positive changes in the Recovery Assessment Scale and improvements in negative symptoms; between positive changes in the General Self-Efficacy Scale and those in personal recovery assessed with the Questionnaire about the Process of Recovery, Recovery Assessment Scale, and Self-Identified Stage of Recovery part A; and between positive changes in the Rosenberg Self-Esteem Scale and those in the Self-Identified Stage of Recovery part B. Conclusion This study revealed longitudinal relationships between changes in personal recovery and amelioration of negative symptoms or enhancement of self-efficacy and self-esteem through moderate length of hospitalisation in individuals with psychotic disorders. Considering the small sample size in this study, further studies with a larger sample size are needed to confirm the present finding. Trial registration The protocol of this study is registered in the UMIN Clinical Trials Registry (UMIN-CTR; ID: UMIN000035131).

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The importance of peer support in the recovery process of persons with mental disorders

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1025 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D Stimac Grbic ◽

I Pavic Simetin ◽

A Istvanovic

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Disorders ◽

Mental Health Care ◽

Peer Support ◽

Community Intervention ◽

Recovery Process ◽

Therapeutic Interventions ◽

Hospital Treatment ◽

Personal Recovery

Abstract Issue Care for people with severe mental disorders requires approach that is focused on a person's strengths, not his weaknesses, and is a shift from a deficit model that is often associated with mental illness. Care users and their family members play an important role in this approach. Description of the Problem Mental disorders are the leading group of diseases in Croatia, according to the number of days of hospital treatment. The number of hospitalizations is high, and the rate of hospitalization for depression has tripled in the last twenty years. Such indicators highlight the need for reorientation of mental health care, from hospital-based to community-based, by organizing mobile community intervention teams. Results In Croatia, psychosocial peer teams were established by the NGO Ludruga, financed by local government, to provide peer support to persons with mental disorders. The main activities are: development of a personal recovery plan, home visits and providing psychological support to persons with mental disorders, organizing support groups and education of peer workers. The teams consist of a peer worker, social worker, psychologist, and operate under the supervision of a psychiatrist. The teams have been operating for five years, have had over a hundred users so far and are a significant help to the healthcare system in preventing rehospitalizations. Lessons The goal of therapeutic interventions in mental health care should be recovery. Recovery involves empowering a person to take responsibility for themselves and their health. Peer workers play an important role in the recovery process, providing hope for recovery. Their role must also be recognized by the health system. Key messages People with mental disorders and their families should be co-creators of care and recovery-oriented interventions. Only by comprehensive interventions, tackling all determinants of health, therapeutic goal can be achieved.

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Outcomes of Victorian Prevention and Recovery Care Services: A matched pairs comparison

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867420983473 ◽

2021 ◽

pp. 000486742098347

Author(s):

John Farhall ◽

Lisa Brophy ◽

John Reece ◽

Holly Tibble ◽

Long Khanh-Dao Le ◽

...

Keyword(s):

Clinical Outcomes ◽

Service Use ◽

Inpatient Unit ◽

Index Admission ◽

Personal Recovery ◽

Short Term ◽

Care Services ◽

Routinely Collected Data ◽

Treatment Order ◽

Do So

Objective: In Victoria, Prevention and Recovery Care Services have been established to provide a partial alternative to inpatient admissions through short-term residential mental health care in the community. This study set out to determine whether Prevention and Recovery Care Services are achieving their objectives in relation to reducing service use and costs, fostering least restrictive care and leading to positive clinical outcomes. Methods: We matched 621 consumers whose index admission in 2014 was to a Prevention and Recovery Care (‘PARCS consumers’) with 621 similar consumers whose index admission in the same year was to an acute inpatient unit and who had no Prevention and Recovery Care stays for the study period (‘inpatient-only consumers’). We used routinely collected data to compare them on a range of outcomes. Results: Prevention and Recovery Care Services consumers made less subsequent use of acute inpatient services and, on balance, incurred costs that were similar to or lower than inpatient-only consumers. They were also less likely to spend time on an involuntary treatment order following their index admission. Prevention and Recovery Care Services consumers also experienced positive clinical outcomes over the course of their index admission, but the magnitude of this improvement was not as great as for inpatient-only consumers. This type of clinical improvement is important for Prevention and Recovery Care Services, but they may place greater emphasis on personal recovery as an outcome. Conclusion: Prevention and Recovery Care Services can provide an alternative, less restrictive care option for eligible consumers who might otherwise be admitted to an acute inpatient unit and do so at no greater cost.

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Recovery priorities of people with psychosis in acute mental health in-patient settings: a Q-methodology study

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465820000892 ◽

2021 ◽

pp. 1-14

Author(s):

Catherine Douglas ◽

Lisa Wood ◽

Danny Taggart

Keyword(s):

Mental Health ◽

Q Methodology ◽

Final Analysis ◽

Well Being ◽

Symptom Reduction ◽

Personal Recovery ◽

Mental Health Support ◽

Health Support ◽

Mental Health Hospital ◽

Health Hospital

Abstract Background: Personal recovery from psychosis has been explored extensively in community samples but there has been little exploration with people currently receiving care from an acute mental health in-patient setting. Aims: The aim of this study was to explore the personal recovery priorities of people experiencing psychosis who are currently receiving care from an acute mental health in-patient ward. Method: A Q-methodology mixed-methods approach was adopted. Thirty-eight participants were recruited from an outer London acute mental health hospital. They were required to sort 54 statements regarding personal recovery from most important to least important to reflect their recovery priorities. Thirty-six were included in the final analysis. Results: Analysis revealed four distinct viewpoints relating to factors that promote recovery in the acute mental health in-patient setting. These were: stability, independence and ‘keeping a roof over your head’; hope, optimism and enhancing well-being; personal change, self-management and social support; and symptom reduction through mental health support. Conclusions: Acute mental health in-patient wards need to ensure that they are considering the personal recovery needs of in-patients. Symptom reduction was valued by some, but broad psychosocial factors were also of priority.

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The Individual Recovery Outcomes Counter: preliminary validation of a personal recovery measure

The Psychiatrist ◽

10.1192/pb.bp.112.041889 ◽

2013 ◽

Vol 37 (7) ◽

pp. 221-227 ◽

Cited By ~ 9

Author(s):

Bridey Monger ◽

Scott M. Hardie ◽

Robin Ion ◽

Jane Cumming ◽

Nigel Henderson

Keyword(s):

Internal Consistency ◽

Recovery Factor ◽

Clinical Settings ◽

Service Users ◽

Validity And Reliability ◽

Personal Recovery ◽

Preliminary Validation ◽

Service Outcomes ◽

High Internal Consistency ◽

The Individual

Aims and methodThe Individual Recovery Outcomes Counter (I.ROC) is to date the only recovery outcomes instrument developed in Scotland. This paper describes the steps taken to initially assess its validity and reliability, including factorial analysis, internal consistency and a correlation benchmarking analysis.ResultsThe I.ROC tool showed high internal consistency. Exploratory factor analysis indicated a two-factor structure comprising intrapersonal recovery (factor 1) and interpersonal recovery (factor 2), explaining between them over 50% of the variance in I.ROC scores. There were no redundant items and all loaded on at least one of the factors. The I.ROC significantly correlated with widely used existing instruments assessing both personal recovery and clinical outcomes.Clinical implicationsI.ROC is a valid and reliable measure of recovery in mental health, preferred by service users when compared with well-established instruments. It could be used in clinical settings to map individual recovery, providing feedback for service users and helping to assess service outcomes.

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Detained – what's my choice? Part 1: Discussion

Advances in Psychiatric Treatment ◽

10.1192/apt.bp.107.003533 ◽

2008 ◽

Vol 14 (3) ◽

pp. 172-180 ◽

Cited By ~ 28

Author(s):

Glenn Roberts ◽

Eluned Dorkins ◽

James Wooldridge ◽

Elaine Hewis

Keyword(s):

Mental Health ◽

Personal Experience ◽

Social Inclusion ◽

Mental Health Problems ◽

Personal Responsibility ◽

Health Problems ◽

Psychiatric Services ◽

Psychiatric Practice ◽

Personal Recovery ◽

Collaborative Dialogue

Choice, responsibility, recovery and social inclusion are concepts guiding the ‘modernisation’ and redesign of psychiatric services. Each has its advocates and detractors, and at the deep end of mental health/psychiatric practice they all interact. In the context of severe mental health problems choice and social inclusion are often deeply compromised; they are additionally difficult to access when someone is detained and significant aspects of personal responsibility have been temporarily taken over by others. One view is that you cannot recover while others are in control. We disagree and believe that it is possible to work in a recovery-oriented way in all service settings. This series of articles represents a collaborative dialogue between providers and consumers of compulsory psychiatric services and expert commentators. We worked together, reflecting on the literature and our own professional and personal experience to better understand how choice can be worked with as a support for personal recovery even in circumstances of psychiatric detention. We were particularly interested to consider whether and how detention and compulsion could be routes to personal recovery. We offer both the process of our co-working and our specific findings as part of a continuing dialogue on these difficult issues.

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Recovery colleges: long-term impact and mechanisms of change

Mental Health and Social Inclusion ◽

10.1108/mhsi-01-2021-0002 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Holly Thompson ◽

Laura Simonds ◽

Sylvie Barr ◽

Sara Meddings

Keyword(s):

Mental Health ◽

Lived Experience ◽

Positive Impact ◽

Evidence Base ◽

College Attendance ◽

Personal Recovery ◽

Structured Interviews ◽

Content Type ◽

Educational Paradigm ◽

Long Term Impact

Purpose Recovery Colleges are an innovative approach which adopt an educational paradigm and use clinician and lived experience to support students with their personal recovery. They demonstrate recovery-orientated practice and their transformative role has been evidenced within mental health services. The purpose of this study is to explore how past students understand the influence of the Recovery College on their on-going recovery journey. Design/methodology/approach An exploratory, qualitative design was used and semi-structured interviews took place with 15 participants. Data was analysed using the “framework method” and inductive processes. Findings All participants discussed gains made following Recovery College attendance that were sustained at one year follow-up. Three themes emerged from the data: Ethos of recovery and equality; Springboard to opportunities; and Intrapersonal changes. Originality/value This research explores students’ experiences a year after attendance. This contrasts to most research which is completed immediately post course. This study contributes to the emergent evidence base highlighting the longitudinal positive impact of Recovery Colleges. This study is of value to those interested in recovery-oriented models within mental health. Recovery Colleges are gaining traction nationally and internationally and this research highlights processes underlying this intervention which is of importance to those developing new Recovery Colleges.

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Coaching skills for recovery a decade of providing coaching skills for recovery training at a healthcare NHS foundation trust

Mental Health and Social Inclusion ◽

10.1108/mhsi-11-2020-0076 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Helen Kathryn Cyrus

Keyword(s):

Work Practice ◽

Clinical Approach ◽

Personal Recovery ◽

Content Type ◽

Coaching Skills ◽

The Difference ◽

To Come ◽

The Individual ◽

The Impact ◽

The Brain

Purpose Overview of coaching for recovery. The paper aims to show an overview of work that was carried out over 11 years with groups of mental health and physical staff. As the facilitator who had run this course for the duration in Nottingham, this was an excellent opportunity to be at the forefront of a brand new project. Design/methodology/approach The introduction of the skills are taught over two consecutive days followed by a further day a month later. The idea of coaching is to be enabled to find the answers in themselves by the use of powerful questions and using the technique of the grow model, combined with practice enables the brain to come up with its own answers. Using rapport and enabling effective communication to deliver the outcome. Findings Evidence from staff/clients and the purpose of the paper shows that when you step back it allows the individual patients/staff to allow the brain to process to create to come up with their solutions, which then helps them to buy into the process and creates ownership. Research limitations/implications The evidence suggests that the approach that was there prior to the course was very much a clinical approach to working with clients and treating the person, administering medication and not focussing on the inner person or personal recovery. The staff review has shown that in the clinical context change is happening from the inside out. Practical implications “Helps change culture”; “change of work practice”; “it changed staff focus – not so prescriptive”; “powerful questions let clients come to their own conclusions”; “coaching gives the ability to find half full. Helps to offer reassurance and to find one spark of hope”. Social implications This has shown that the approach is now person-centred/holistic. This has been the “difference that has made the difference”. When this paper looks at the issues from a different angle in this case a coaching approach, applying technique, knowledge and powerful questions the results have changed. The same clients, same staff and same problems but with the use of a different approach, there is the evidence of a different outcome, which speaks for itself. The coaching method is more facilitative, therefore it illicit’s a different response, and therefore, result. Originality/value The results/evidence starts with the individual attending and their commitment to the process over the two-day course. Then going away for the four weeks/six for managers and a commitment again to practice. Returning to share the impact if any with the group. This, in turn, helps to inspire and gain motivation from the feedback to go back to work invigorated to keep going.

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