Mental health: what do we know,how did we find it out and what does it mean for nurses?

As part of a qualitative study exploring the health needs of gay men, undertaken in the Lothian area of Scotland (Robertson & Hutcheson 1995), the mental health needs of gay men were elicited through focus groups and individual interviews. A grounded theory approach (Glaser & Strauss 1967) was used to analyse the responses from a sample of 37 gay men. This research followed a social interactionist approach and examined from the respondents' stance the effects of being perceived as deviant and the subsequent impact on self-identity and self-esteem. The findings were that there is a reluctance amongst gay men to disclose their sexuality in health care settings which results in mental health needs remaining unrecognized by health professionals. The research also showed that the respondents faced profound social difficulties when coming to terms with their sexuality, a process that can occur throughout their life time. Those who were married faced the strain of living two lives and cited alcohol misuse and depression amongst the effects of this stressful lifestyle.     

What we can learn about recovery: Lessons from the Fukushima survivors

Recovery from disaster can take a lifetime, and people looking in from outside might not appreciate the stages of recovery. Little talked about is the stigma, which might attach to the survivors of a disaster, especially if it is a man‐made disaster. This paper documents the account of a Japanese nursing student who visited the area 18 months after the Great East Japan earthquake and tsunami, talked to the people there, and shared her reflections. The experiences of the Fukushima survivors are linked to those of victims of other disasters, whose recovery was impeded by being discriminated against and stigmatized.     

A conversation: challenging the relevance and wisdom of separate mental health legislation

This paper explores the dilemmas encountered by mental health nurses when working with mental health legislation. The concerns and considerations of an expert mental health nurse, complemented by the opinion of an expert in health-care and legal issues are presented. It is argued that there is currently a distorted perception with regard to the function and sentiment of mental health legislation, and this paper aims to restore balance in interpreting and working with such law. Viewing mental health legislation primarily as a mechanism for involuntary hospitalization effectively removes any power or recourse given to mental health consumers by the law. Principles of mental health care and legislation are examined as well as the relationship the law has with dangerousness to self or others and mental ill health. A dialogue is established between the two authors to assist the exploration of these legal and clinical issues. The continued relevance of specific mental health legislation is brought into question. It is proposed that the existence of such legislation constitutes discrimination and contributes to stigma associated with mental illness. An alternative legislation for all circumstances where an individual is deemed incompetent is proposed as the most significant step towards mainstreaming of mental health care and an end to discrimination.     

Doing what we can,but knowing our place: Being an ally to promote consumer leadership in mental health

Consumer participation in all aspects of mental health services is clearly articulated as an expectation of contemporary mental health policy. Consumer leadership has been demonstrated to be beneficial to mental health services. Barriers to implementation have limited the realization of this goal. In this discursive paper, we argue that non‐consumers who support consumer partnerships and leadership (known as ‘allies’) have an important role to play in facilitating and supporting consumers in leadership roles. Allies currently have more potential to influence resource allocation, and might be viewed more credibly by their peers than consumer leaders themselves. We call for allies to ensure their role is one of support and facilitation (doing what they can), rather than directing the content or speaking on behalf of the consumer movement (knowing their place). In the present study, we address the importance of allies for the consumer movement. It proposes some ‘rules of engagement’ to ensure that allies do not intentionally or otherwise encroach on consumer knowledge and expertise, so that they maintain the important position of supporting consumers and facilitating the valuing and use of consumer knowledge, expertise, and ultimately, leadership.     

Knowledge and attitudes of mental health professionals and students regarding recovery: A systematic review

This review was conducted to synthesize and critically appraise the literature on knowledge, attitudes, understanding, perceptions, and expectations of mental health professionals (MHPs) and mental health professional (MHP) students' regarding recovery. A systematic search in Scopus, CINAHL, PsycINFO, Web of Science, Medline, and Embase as well as Google scholar and web‐based repositories was conducted. The searches were conducted using a combination of key terms: “mental health professionals”, “students”, ‘knowledge’, “understanding”, “perception” “attitude”, “expectation”, “recovery”. After screening and quality assessment, the review included 29 studies (18 quantitative, 8 qualitative, and 3 mixed‐method studies) published in English, from January 2006 to June 2019, and was analysed systematically using a mixed‐method synthesis. The findings revealed that there is increasing evidence (especially among MHPs) of knowledge, attitudes, understanding, perceptions, and expectations regarding recovery. However, there are disparities in how MHPs perceive and understand recovery. While some understood it to mean a personal process, others explained it as a clinical process. In addition, there was limited knowledge among the MHPs and MHP students regarding the nonlinearity nature of the recovery process and expectations regarding recovery. The implications from these findings are the need for more in‐service training for MHPs, and examination of the curriculum used to educate MHP students. In particular, they should be sufficiently informed about the nonlinearity nature of the recovery process and how to develop hopeful and realistic expectations for consumers throughout the recovery process. The review was preregistered with PROSPERO (Registration No: CRD42019136543).     

Recovery‐focussed care: How it can be utilized to reduce aggression in the acute mental health setting

Consumer aggression is common in the acute mental health inpatient setting. Mental health nurses can utilize a range of interventions to prevent aggression or reduce its impact on the person and others who have witnessed the event. Incorporating recovery‐focussed care into clinical practice is one intervention, as it fosters collaborative partnerships with consumers. It promotes their engagement in decisions about their care and encourages self‐management of their presenting behaviours. It also allows the consumer to engage in their personal recovery as their mental health improve. Yet there is a paucity of literature on how nurses can utilize recovery‐focussed care with consumers who are hospitalized and in the acute phase of their illness. In the present study, we report the findings of a scoping review of the literature to identify how recovery‐focussed care can be utilized by nurses to reduce the risk of consumer aggression. Thirty‐five papers met the inclusion criteria for review. Four components were identified as central to the use of recovery‐focussed care with consumers at risk of becoming aggressive: (i) seeing the person and not just their presenting behaviour; (ii) interact, don't react; (iii) coproduction to achieve identified goals; and (iv) equipping the consumer as an active manager of their recovery. The components equip nurses with strategies to decrease the risk of aggression, while encouraging consumers to self‐manage their challenging behaviours and embark on their personal recovery journey. Further research is required to evaluate the translation of these components clinically in the acute care setting.     

Factors involved in recovery from schizophrenia: a qualitative study of Thai mental health nurses

Recovery-oriented services increasingly are being called for around the world. These services do not just consider recovery from mental illness as symptom remission, but as individuals' ability to redefine their self and to "live well", even with enduring symptoms. However, little is known about the views of Thai nurses regarding the conceptualization of recovery. This article presents the findings of a qualitative study that explored the perspectives of 24 Thai nurses regarding schizophrenia and recovery. Semistructured interviews were conducted with nurses who were providing care for persons who were living with schizophrenia in both hospital and community settings. A thematic analysis identified the personal and environmental factors that were related to recovery. Illness acceptance, hope, and adherence to treatment were viewed as the facilitators of recovery, while a low level of self-responsibility and illness-related factors were barriers. Environmental factors, such as the presence of a supportive environment and accessibility to mental health services, were described as facilitators, while stigma towards mental health illness and fragmented health services were barriers. The implications of these results in promoting recovery-oriented mental health services in Thailand are discussed.     

Recovery college as a transition space in the journey towards recovery: An Australian qualitative study

Recovery colleges are formal learning programs that aim to support people with a lived experience of mental illness. In this study, we aimed to explore the experiences of participants in a pilot recovery college that opened in Adelaide, South Australia, in 2016. A qualitative exploratory study was conducted involving interviews with learners (n = 8) and focus groups with lived experience facilitators (course facilitators with a lived experience of mental illness, n = 5), Clinician facilitators (mental health service staff facilitators, n = 4), and care coordinators (staff providing case management support, n = 5). Three main themes (hope, identity, and the recovery college as a transition space) and two subthemes (recovery college experience and outcomes) were identified. The results showed that the recovery college provided a transition space for shifting learners' identities from patient to student, facilitated by the experiences and outcomes of the recovery college, providing hope for the future. This study highlights the importance of providing mentally healthy and non‐stigmatizing learning environments to promote and cement recovery for people with a lived experience of mental illness.     

Evaluation of mental health recovery and Wellness Recovery Action Planning education in Ireland: a mixed methods pre-postevaluation

higgins a., callaghan p., devries j., keogh b., morrissey j., nash m., ryan d., gijbels h. & carter t. (2012)?Evaluation of mental health recovery and Wellness Recovery Action Planning education in Ireland: a mixed methods pre-postevaluation. Journal of Advanced Nursing68(11), 2418-2428. ABSTRACT: Aim. To report a study evaluating the effectiveness of a Wellness Recovery Action Planning education programme. Background. Internationally, mental health policy is advocating using recovery approaches to care. Underpinning these approaches is investment in education in recovery principles and methods and a need to provide evidence of the impact of this education. Design. The study design employed a mixed methods approach. Methods. Using questionnaires and focus groups, we evaluated 2- and 5-day Wellness Recovery Action Planning Education Programmes and assessed participants' attitudes towards recovery, knowledge of recovery and Wellness Recovery Action Planning beliefs. Data were collected between 2009 and 2010. Participants were people with personal experience of mental health problems, practitioners in mental health services and family members/carers of those with mental health problems. Results. Comparing the pre and postmeasures showed that the programme increased participants' knowledge of and attitudes towards recovery and Wellness Recovery Action Planning. Although this increase was statistically significant for the 2-day programme, it was not so for the 5-day programme. Participants reported being very positive and enthusiastic about the programme and the benefits they had achieved personally and professionally as a result of participating. Conclusions. This exploratory study shows that providing mental health practitioners and people with personal experience of mental health problems with a systematic education and training in recovery principles using the Wellness Recovery Action Planning approach leads to positive changes in people's knowledge, skills and attitudes towards recovery. This education appeared to inspire, invigorate and empower people, and for many, it was a life changing experience.     

Determining the effectiveness of mental health services from a consumer perspective: part 1: enhancing recovery

The routine use of standardized instruments to measure consumer outcomes is now part of mental health policy throughout Australia. However, it has been broadly criticized for (i) not involving consumer input into the design of instruments; and (ii) not reflecting the aspects of care and treatment considered beneficial for recovery by consumers themselves. The importance of the concept of recovery is increasingly considered in the literature. Despite this, there is a paucity of research describing the effectiveness of services in promoting recovery from the perspective of consumers of mental health services. The aim of this study is to explore consumer perspectives in relation to the factors that promote and impede recovery, and the principles that ideally should underpin the evaluation of services. Focus group interviews were conducted with consumers of mental health services (n = 16) from one rural and one metropolitan mental health service in Victoria, Australia. This paper presents Part 1 of the findings, pertaining to aspects of mental health services that enhance recovery. Two main themes arose during the data analysis process: (i) treatment; and (ii) support and social connectedness. Various treatment strategies, including medication and spiritual involvement, were considered helpful. However, support from both staff and peers emerged as a more important and influential factor.     

Role of psychological factors in studying recovery from a transactional stress-coping approach: implications for mental health nursing practices

Over the last decade, the experience of recovering from psychiatric disabilities has received increased attention in mental health nursing. Recovery is a complex experience that can be understood in terms of construct, process, and outcomes. New theoretical frameworks are needed to better understand antecedents, process variables, and outcomes related to recovery. Considering that recovery is a stressful and challenging experience, the transactional stress-coping theory appears relevant to explore the appraisal and coping processes involved in recovery. Based on this theory, a new framework has been built to better understand the phenomenon of stress in recovery. More specifically, a review of the recovery literature had led to the identification of several key recovery concepts, which were then linked to major stress-coping concepts, namely contextual factors, potential stressors, primary and secondary appraisals, coping strategies, and short-term and long-term outcomes. This paper focuses on specific types of personal characteristics that are included in the broad category of contextual factors, namely psychological factors. These factors may act as coping resources, helping people to deal successfully with events interfering with the achievement of recovery goals. The main purpose of this paper is to offer a detailed discussion about how mental health nursing practices may promote the role of psychological factors within the stress-coping process. Three categories of psychological factors are discussed: views about oneself, psychological empowerment, and personal/philosophical orientations in life. A brief summary of the new framework is first offered to introduce its major concepts and basic mechanisms.     

Mental Health Nurses as therapists in a rehabilitation setting: A phenomenological study

Mental Health Nurses have a long tradition of delivering talk‐based interventions across a range of clinical settings. Despite this, Mental Health Nurses receive limited recognition of this contribution. This paper presents findings from a study that explored Mental Health Nurses' experience of delivering talk‐based therapies in an inpatient rehabilitation setting. This study uses semistructured interviews and a phenomenological approach to explore eight Mental Health Nurses' experience. Themes emerging included that: mental health nursing is a talk‐based therapy in its own right, talk‐based therapy was part of everyday nursing care on the floor and integrated talk‐based therapy enhanced recovery opportunities for consumers. However, a further theme was that there were tensions around providing talk‐based therapy conflicted with other roles including unit management and the role of nurses in controlling challenging behaviours. This study found that Mental Health Nurses, in this setting, are offering talk‐based therapy to the people they care for. The findings of this study have implications for research: there needs to be a larger study investigating nurses' use of talk‐based therapy in inpatient settings. If, as the authors expect that, it is found that mental health nurses are offering these therapies generally in inpatient settings, this has serious implications for postgraduate education in Mental Health Nursing policy in terms of recognition that this is happening and finding ways to support nurses to do this well. There also needs to be further research in the best ways to offer talk‐based therapy in these settings.     

Recovery and mental health: a review of the British literature

Recovery is not a new concept within mental health, although in recent times, it has come to the forefront of the policy agenda. However, there is no universal definition of recovery, and it is a contested concept. The aim of this study was to examine the British literature relating to recovery in mental health. Three contributing groups are identified: service users, health care providers and policy makers. A review of the literature was conducted by accessing all relevant published texts. A search was conducted using these terms: 'recovery', 'schizophrenia', 'psychosis', 'mental illness' and 'mental health'. Over 170 papers were reviewed. A thematic analysis was conducted. Six main themes emerged, which were examined from the perspective of the stakeholder groups. The dominant themes were identity, the service provision agenda, the social domain, power and control, hope and optimism, risk and responsibility. Consensus was found around the belief that good quality care should be made available to service users to promote recovery both as inpatient or in the community. However, the manner in which recovery was defined and delivered differed between the groups.