Recovery Camp: Assisting consumers toward enhanced self‐determination

Mental health consumers are often socially isolated and may lack the basic leisure competencies which serve as a critical building block for community (re)integration. Therapeutic recreation (TR), as a treatment modality for people with mental illness, is yet to be fully embraced in the Australian health‐care setting, despite having a strong historical foundation in North America. A team of academics created a TR experience, termed Recovery Camp, which was designed to collectively engage consumers and future health professionals drawn from a range of discipline areas. The 2014 Recovery Camp was staged over a five day period and involved 28 adult consumers living with mental illness. Consumers undertook a diverse range of experiential recreation activities engineered to facilitate individual engagement and to encourage the development of positive therapeutic relationships and teamwork. The camp atmosphere was deliberately community‐based and recovery‐oriented, valuing the lived experience of mental illness. Using a 2 × 3 design involving a camp and comparison group, the study sought to examine the influence of a TR programme on the self‐determination of individuals with a mental illness. Those who participated in the Recovery Camp reported an increase in awareness of self and perceived choice post‐camp, relative to the comparison group. While this difference remained significant for awareness of self at three‐month follow‐up, there was no significant difference in perceived choice between the two groups at follow‐up. Study findings serve to support the role of recreation within a recovery framework to positively change the health‐related behaviour of mental health consumers.     

Preparing Nursing Students for Mental Health Care: The Impact of a Recovery-oriented Clinical Placement

The provision of mental health care has recently focused on the concept of recovery-oriented care. Clinical placements are important for imparting recovery-oriented knowledge and skills to students. However, it has been determined that not all clinical placements are beneficial for future nursing professionals. The aim of this study was to examine what elements of professional learning were facilitated by engagement in a recovery- and recreation-based clinical placement for pre-registration nursing students called Recovery Camp. Qualitative data were collected through individual interviews and reflective journals of pre-registration nurses. Findings from this study indicate that Recovery Camp enhanced students' understanding of stigma, developed their professional knowledge and applied skills, and helped them gain insight into the role a consumer plays in his/her own recovery journey. Placements that allow pre-registration nurses the opportunity to authentically engage with people with a lived experience of mental illness may assist in the effective development of future professionals in meeting their diverse needs.     

Nursing students' reflections on the learning experience of a unique mental health clinical placement

IntroductionThere exists a need for innovative thinking to identify new clinical placement opportunities for nursing students. Recovery-based clinical placements for mental health nurse students remain unique and require investigation.AimTo examine the learning experience of Bachelor of Nursing students who undertook an innovative mental health clinical placement known as Recovery Camp.DesignThis study incorporated qualitative analysis of written reflections. Using Braun and Clarke's (2006) six phases of thematic analysis the corpus of student reflections were reviewed by three members of the research team independent to each other.FindingsFour themes emerged. The theme of Pre-placement Expectations incorporates participant foci on pre-conceptions of Recovery Camp. The theme of Student Learning incorporates the ways in which participants recognised the experience of Recovery Camp influenced learning. Reflections themed under the title Placement Setting include discussion of the Recovery Camp as a clinical placement. The theme of Future Practice incorporates students' reflections on how they plan to practice as nurses as a result the learning experiences of Recovery Camp.ConclusionsAn immersive clinical placement such as Recovery Camp can influence students' perceptions of people with mental illness, have a positive impact on student learning and influence students' decisions about future practice. The learning experience of nursing students whom attend unique, recovery-orientated clinical placements can be both positive and educative.     

Psychometric properties of three instruments to measure recovery

Scand J Caring Sci; 2012; 26; 607–614 Psychometric properties of three instruments to measure recovery Background: The process of recovery is gaining more and more attention within health care for patients with severe mental illness. Therefore, instruments to measure recovery can be useful for clinical and research purposes. Aims: This study evaluates the psychometric properties of three instruments pertaining to recovery for possible application in the Netherlands. The Recovery Attitude Questionnaire and the Recovery Knowledge Inventory were investigated among 210 mental health professionals, and the Recovery Promoting Relationship Scale was administered to 142 mental health consumers. Methods: The factor structure, reliability and internal consistency were examined using the same analysis strategy. First, each questionnaire was submitted to a confirmatory factor analysis based on the factorial structure proposed by the original developers of the questionnaire. In case of a bad fit, an exploratory factor analysis was conducted. Based on factor analyses, subscales were formed for each questionnaire and the internal consistency (Cronbach’s alpha) was assessed. In all three cases the final principal axes solution was obliquely rotated by means of the OBLIMIN rotation procedure. Results: The originally proposed factor structure did not yield an acceptable fit in any of the Dutch samples. After analyses, three instruments are proposed that are suitable for research on recovery‐oriented competencies and the recovery‐promoting relationship for professionals working with people with serious mental illness in the Netherlands. Conclusions: The results in this study may be a step forward and give a new impulse to stimulate research in mental health recovery.     

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.     

Systematic screening for metabolic syndrome in consumers with severe mental illness

The high prevalence of metabolic syndrome (MetS) in people with a mental illness has been reported recently in the literature. Gaps have emerged in the widespread use of systematic screening methods that identify this collection of critical risk factors for cardiac and metabolic disorders in people with severe mental illness. A sample (n = 103) of consumers with severe mental illness was screened for MetS using the Metabolic Syndrome Screening Tool and compared to a sample (n = 72) of consumers who were not receiving a systematic approach to screening for MetS. The results demonstrated ad hoc screening of consumers for MetS in the comparison group, potentially leaving patients at risk of cardiac and metabolic disorders being untreated. Mental health nurses are well placed to show leadership in the screening, treatment, and ongoing management of MetS in people with severe mental illness. A potential new speciality role entitled the ‘cardiometabolic mental health nurse’ is proposed as a means leading to improved outcomes for consumers who have both the complication of physical health problems and a severe mental illness.     

Recovery from severe mental illness,a gender perspective

Scand J Caring Sci; 2010; 24; 557–564
Recovery from severe mental illness, a gender perspective Background and research objectives: Recovery from mental illness is an individual process characterized by regaining a positive sense of self and developing a new meaning. Knowledge concerning differences between male and female recovery processes is, however, limited. The objective of this study was to determine gender diversity in what individuals described as decisive factors for their recovery. Subjects and methods: In this qualitative study based on grounded theory, 30 first‐person accounts of recovery from mental illness are examined. After informed consent from the participants, data were collected through in‐depth interviews with people in recovery from psychosis, bipolar disorders or personality disorders. Results: The results show that in spite of structural gender inequalities, female gender norms seem to be an advantage in the recovery process. The female participants were focused on making sense and meaning in their recovery process, while the male participants were focused on control over symptoms and reinforcement of traditional roles such as occupation and independence. Another result showed psychiatric hospitalization to mainly contribute to male recovery processes. Conclusion: These results provide new insights into gender as an important factor in understanding recovery processes and in providing care to facilitate these processes.     

Undergraduate nursing students’ stigma and recovery attitudes during mental health clinical placement: A pre/post‐test survey study

Undergraduate nursing students have been reported to hold negative and stigmatizing attitudes towards mental health consumers and to be under‐prepared for mental health clinical placement. This study aimed to investigate undergraduate nurses’ stigma and recovery attitudes to mental illness, and describe their understandings of personal recovery on entry and exit to traditional mental health clinical placement. A pre/post‐test survey was administered to N = 249 nursing students in Australia. Demographic data, attitudes towards mental health nursing and clinical placement, the Opening Minds Scale for Healthcare Providers (OMS‐HC), Recovery Attitudes Questionnaire (RAQ‐7), and an open‐ended question on understandings of personal recovery from mental illness were collected on entry (T1) and exit (T2) to placement. At T1, students reported moderate stigma and positive attitudes towards recovery (OMS‐HC mean = 34.6; RAQ‐7 mean = 4.0). At T2, there was a reduction in stigma (social distance P = 0.02, d = 0.26) and improvement in recovery attitudes (P < 0.01, d = 0.40). Attitudes towards mental health nursing and placement also improved (P < 0.01). Having a family member with mental illness predicted improvements in stigma and recovery attitudes. On entry to placement, most students described accurate understandings of personal recovery, which were maintained during placement. The findings indicate that mental health clinical placements are effective in improving students’ mental health stigma and recovery attitudes and provide a prime opportunity to attract students into the field. Co‐produced or consumer‐led education provided by peer workers during clinical placements may improve students’ stigmatizing attitudes and stimulate their interest to work in the field.     

Mental health consumers' perceptions of receiving recovery-focused services

Rationale, aims and objectives  This study examines the experiences of mental health service consumers engaged in various recovery-focused support practices as well as examining consumer valuing of these activities.
Method  A self-report questionnaire was developed drawing on key aspects of the Collaborative Recovery Model (CRM) (responsibility, collaboration, autonomy, motivation, needs, goals, homework). Ninety-two adult consumers from metropolitan, regional and rural non-government organizations and public mental health services in eastern Australian states completed the questionnaire.
Results  Consumers using services provided by CRM-trained workers identified significant changes to service delivery in relation to frequency with which they were encouraged to take responsibility for their recovery, degree to which they collaborated with staff and the extent to which they were encouraged to complete homework activities to assist them to achieve their goals, when compared with consumers using traditional services. The key aspects of the CRM were valued by consumers. No differences were found in terms of overall ratings of clinician helpfulness in assisting recovery between the two groups.
Conclusions  Consumers are able to perceive recovery-focused service changes. Although preliminary, this is a significant step towards assessing the operationalization of recovery principles from the consumer's perspective.     

‘Anyone can have a mental illness’: A qualitative inquiry of pre‐registration nursing students’ experiences of traditional mental health clinical placements

Nurses play a crucial role in mental healthcare provision. Like many countries, Australian nursing students are educated in comprehensive pre‐registration programmes which include mental health clinical placements. Placements play a vital role in students’ education, providing the opportunity to engage with consumers and develop mental health nursing knowledge and skills. There is limited knowledge of student perspectives on traditional placements in contemporary recovery‐oriented mental health services. This interpretive qualitative inquiry aimed to explore nursing students’ experience of traditional mental health clinical placement and how it influenced their practice and their understandings of recovery from mental illness. Data were collected from focus groups with n = 31 nursing students in a large metropolitan public mental health service. Thematic analysis resulted in three themes of experience: humanizing people with mental illness; learning about recovery; and shifting perspectives on mental health nursing. Through a positive placement experience where they felt supported and included by staff, students came to see consumers as people rather than diagnoses, developed greater understanding of mental health nursing work and were more likely to consider mental health nursing as a career choice. Peer‐support workers were an important influence on students’ understandings of recovery and have a key role to play in educating students on placement. Students need to be prepared and supported by university and clinical staff to deal with vicarious trauma that may occur on placement. Mental health placements play a crucial role in attracting students into the field, and it is imperative they remain part of comprehensive pre‐registration education.     

Left alone – Swedish nurses’ and mental health workers’ experiences of being care providers in a social psychiatric dwelling context in the post‐health‐care‐restructuring era. A focus‐group interview study

Scand J Caring Sci; 2010; 24; 427–435
Left alone – Swedish nurses’ and mental health workers’ experiences of being care providers in a social psychiatric dwelling context in the post‐health‐care‐restructuring era. A focus‐group interview study The professional role of nurses and mental health workers in social psychiatry is being re‐defined towards a recovery, client‐focused perspective. Approximately 0.7 percent of the adult population in Sweden suffers from severe mental illness leading to a need for community services. The primary aims of the Mental Health Reform in 1995 in Sweden were to improve the quality of life for people with severe, long‐term mental illness and, through normalization and integration, enhancing their opportunities to communicate with and participate in society. This study examines nurses’ and mental health workers’ views and experiences of being care providers in a municipal psychiatric group dwelling context when caring for clients suffering from severe mental illness. Three focus group interviews were made and thematic content analysis was conducted. Four themes were formulated: ‘Being a general human factotum not unlike the role of parents’, ‘Having a complex and ambiguous view of clients’, ‘Working in a mainly ‘strangled’ situation’, and ‘Feeling overwhelming frustration’. The staff, for instance, experienced a heavy workload that highly involved themselves as persons and restricted organization. The individual relational aspects of the nursing role, the risk of instrumentalizing the staff due to an organizational economical teleopathy (meaning a pathological desire to react goals), and the high societal demands on accomplishing the Mental Health Reform goals are discussed. To redefine the professional role of nurses and mental health workers in the community, in Sweden known as municipality, they need support in the form of continuously education, supervision, and dialogue with politicians as well as the public in general.     

Psychometric assessment of the German version of the Questionnaire about the Process of Recovery

Personal recovery is important for mental health services and service users; moreover, valid and reliable assessment instruments are necessary for measuring personal recovery. Therefore, this study aimed to evaluate the unidimensional factor structure of the German version of the Questionnaire about the Process of Recovery. The study was conducted using a cross-sectional design with a convenience sample. The questionnaire was completed by 200 patients of outpatient services of two psychiatric hospitals in Switzerland. A confirmatory factor analysis was conducted to validate the unidimensional factor structure of the German version of the Questionnaire about the Process of Recovery. Cronbach's alpha was calculated to assess the internal consistency. The results showed an overall acceptable model fit (χ² = 134.188, df = 90, P = 0.002; RMSEA = 0.050, 90% CI: 0.031–0.067; CFI = 0.937; TLI = 0.927) and excellent internal consistency (Cronbach's α = 0.91). These results are consistent with those of studies that have examined the Questionnaire about the Process of Recovery in other languages. This study provides preliminary evidence that the German version of the Questionnaire about the Process of Recovery is a reliable assessment instrument for measuring personal recovery among people with mental illness experiences. However, it is necessary to conduct further psychometric tests to verify the validity and reliability of the instrument. The German version of the Questionnaire about the Process of Recovery can be applied to both research and clinical practice, especially as a means of facilitating communication during the planning and evaluation of treatment goals.     

Effectiveness of a program to facilitate recovery for people with long‐term mental illness in Japan

Recovery is defined as the process of developing new meaning and purpose in life as one grows beyond the catastrophic effects of mental illness. This study aimed to develop a program to facilitate recovery and examine its effectiveness in a randomized controlled trial. The program was developed with three components that enhance benefit finding, personal meaning, and a sense of happiness. Sixty‐three participants with long‐term mental illness were randomly allocated to the intervention group (n = 32) or the control group (n = 31). The intervention group attended eight 2‐h group sessions, with one held every week. Recovery was assessed at baseline, post‐intervention, and at a three‐month follow‐up. In the per‐protocol analysis, after excluding those who dropped out, the intervention group showed significant improvement in recovery compared with the control group (P < 0.05). In the intention‐to‐treat analysis, a repeated measures analysis of variance did not show any significant intervention effect (time × group) (P > 0.05). The program had the potential to facilitate recovery.     

A multidisciplinary learning experience contributing to mental health rehabilitation

Purpose People who access health services often have a range of needs that require the involvement of members from a multidisciplinary team. Teaching future health professionals about the importance of a multidisciplinary approach can be challenging. The aim of this paper is to describe a project called Recovery Camp that enhanced multidisciplinary health education through experiential and immersive engagement with people experiencing mental illness. Method Future health professionals and people with a lived experience of mental illness took part in Recovery Camp — an innovative five-day therapeutic recreation initiative in the Australian bush. Results are presented in a case study format and provide the reflective quotes of participants. The quotes were analyzed using a content analysis to identify core concepts. Results Analyses identified a common appreciation of multidisciplinary learning. The interactions among students and between students and consumers, promoted inter-professional practice and a holistic understanding of mental health care. Conclusions An immersive multidisciplinary approach, embedded within a recovery-based programme, enhances students’ understanding of the significance of multidisciplinary mental health care and treatment.

• Implications for Rehabilitation

• People with a lived experience of mental illness have a range of complex needs that require involvement of members from a multidisciplinary rehabilitation team.

• This study suggested a multidisciplinary, experiential, immersive health education experience — drawing on the principles of therapeutic recreation — can promote inter-professional rehabilitative practice and an appreciation for holistic mental health care.

     

A narrative framework for understanding experiences of people with severe mental illnesses

This article discusses the value of a narrative approach to understand the experiences of people with severe mental illnesses and the systems around them, and the importance of narrative in the patient-practitioner relationship. These are important concepts in the shift to recovery-oriented systems. People lead storied lives which provide coherence and meaning, but that story has the potential to be change. Both consumers and practitioners have stories, and it is the shared decision-making between them that can lead to recovery. Narratives can be illness narratives, initiated by an illness and the search for meaning in it, or counterstories which are inherently political. The article identifies a Framework for Understanding Stories as a means for listening to and understanding stories at multiple levels. It can be useful for nurses to understand complexity and multilevel aspects of an individual's experience. Although people tell their own individual stories, they compose them by adapting narrative types, which a culture makes available. Programs tells a story and provide an important context for both consumers and practitioners. Dominant societal narratives provide an overall context which can be empowering or disempowering for programs, consumers and practitioners. Thus, as the recovery paradigm has become more prominent, people with mental illnesses have increasingly talked and written about recovery.     

Working towards least restrictive environments in acute mental health wards in the context of locked door policy and practice

There has been a shift towards provision of mental health care in community‐based settings in Australia. However, hospitals continue to care for people in acute mental health wards. An increasing proportion of the people in wards are admitted involuntarily, subject to restrictions of movement to minimize risk of harm to self and others. In response to concerns about the safety of people absconding from care, Queensland Health introduced a policy requiring all acute mental health wards in the State to be locked. In response, the Queensland Mental Health Commission funded a project to understand the impact of this policy and develop evidence‐based recommendations regarding provision of least restrictive, recovery‐oriented practices in acute wards. Facilitated forums were conducted with 35 purposively selected participants who identified as consumers, carers, or staff of acute mental health hospital wards, to test the acceptability, feasibility, and face validity of a set of evidence‐informed recommendations for providing least restrictive, recovery‐oriented practices. Participant responses were recorded, and data were analysed through an inductive, thematic approach. A recovery‐oriented approach was supported by all stakeholders. Reducing boredom and increasing availability of peer support workers were considered key to achieving this. Focusing less on risk aversion was reported as central to enabling true Recovery Orientation. This project enabled recognition of the perspectives of consumers, carers, and staff in the consideration of evidence‐informed recommendations that could be implemented to provide least restrictive care in the context of locked doors.