Angus Buchanan

Do the everyday experiences of people with severe mental illness who are “hard to engage” reflect a journey of personal recovery?

Abstract Background: Recovery experiences should bring hope, identity, meaning and personal responsibility to the lives of people experiencing severe mental illness (SMI). Aims: To describe the recovery experiences of individuals experiencing SMI who are labelled “hard to engage” and who receive mental health assertive community treatment (ACT). Methods: A qualitative approach was used to gather descriptive data from 11 adults diagnosed with SMI who live in the community. Data were gathered over 12 months through one-to-one meetings using field notes and audio recordings. Results: Longitudinal findings provided insight into the everyday experiences and include the themes of: personal understandings of recovery, potential for agency and everyday routine. Conclusions: Opportunities for recovery experiences that hold purpose and meaning are limited for individuals receiving ACT and do not reflect definitions of personal recovery within contemporary literature. Further debate is required to address the gap between theory and the reality of recovery experiences.

Understanding the episodic everyday of disrupted lives: Scoping the occupational therapy literature

Background. The concept “everyday” appears unchallenged and problematic when applied to people who experience disrupted lives through illness or disability. Purpose. This study draws upon social and philosophical theory to review the relevance of the concept “everyday” when applied to contemporary occupational therapy and the lives of individuals who experience biographical disruption. Method. A literature review guided by a scoping framework was undertaken followed by a critical analysis drawing on Bauman to determine the frequency and meaning of the concept “everyday” used in the occupational therapy and occupational science literature. Findings. Definitions of the “everyday” are used infrequently despite recurrent use of the concept. A large proportion of literature reviewed in this manuscript does not acknowledge or discuss the philosophical and sociological influences that contribute to an understanding of the “everyday,” leaving the reader to make her or his own interpretations. Implications. Reconceptualizing lived “everyday” experience within the contextual “here and now” provides a postmodern “episodic” lens for occupational therapists working with individuals who experience biographical disruption. Description. Le concept du « quotidien » semble incontesté et problématique lorsqu’on l’applique aux personnes dont la vie est perturbée par la maladie ou le handicap. But. Cette étude s’appuie sur la théorie sociale et philosophique pour examiner la pertinence du concept du « quotidien » lorsqu’on l’applique à l’ergothérapie contemporaine et à la vie des personnes vivant une rupture biographique. Méthodologie. Une recension des écrits orientée par un cadre de délimitation de l’étendue été menée, suivie d’une analyse critique s’appuyant sur les travaux de Bauman, en vue de déterminer la signification du concept du « quotidien » et la fréquence de son utilisation dans la littérature en ergothérapie et en science de l’occupation. Résultats. Les définitions du « quotidien » ne sont pas utilisées fréquemment, malgré l’usage récurrent du concept. Une bonne partie de la littérature recensée dans ce manuscrit ne reconnaît pas ou ne discute pas des influences philosophiques et sociologiques qui favorisent la compréhension du « quotidien », ce qui entraîne le lecteur à faire ses propres interprétations. Conséquences. La reconceptualisation de l’expérience « quotidienne’ vécue dans le contexte du « ici et maintenant » fournit une perspective « épisodique » postmoderne aux ergothérapeutes qui travaillent auprès de personnes qui vivent une rupture biographique.

The lived experience of everyday activity for individuals with severe mental illness

Engagement in everyday activity is an underplayed area when attempting to understand mental illness. Little is known about the everyday activities of individuals who experience severe mental illness and who are labelled ‘hard to engage’. This article reports on the findings of a longitudinal study. Eleven individuals receiving community mental health services were interviewed over a 12-month period through one-to-one meetings using field notes and audio recordings. Phenomenological methodology was employed to explore the types of activities that constituted participants’ everyday lives and the meanings they attributed to them. Three themes emerged from the findings: illness identity; embodied crisis and managing supports; and boredom. The meanings of everyday activities were conveyed through self-narrative and often as a consequence of the provision of mental health care for the individual. When not receiving medication or attending groups, participants felt alone and ‘bored’, trapped in the mundaneness of the everyday.

A qualitative exploration of the recovery experiences of consumers who had undertaken shared management, person-centred and self-directed services

BackgroundThe mental health sector across states in Australia is moving to offering individualised funds and shared management, person-centred and self-directed (SPS) services. However, little is known about the recovery experiences of consumers with mental illness who had used a SPS service that was recently introduced in Western Australia. This study explored the recovery experiences of these consumers.MethodsData relating to sixteen consumers’ lived experiences were analysed using an abbreviated grounded theory approach. These data had been developed in the past by consumers, the Guides (staff) and an independent evaluator.ResultsFour over-arching categories, and related sub-categories, emerged. These suggested that consumers’ recovery experiences included them gaining: 1) a greater sense of empowerment; 2) expanded connections with the community, others and ‘the self’; 3) an enriched sense of ‘the self’; and 4) an enhanced quality of life.ConclusionsAccess to SPS services, including having access to individualised funds, high quality shared management and person-centred relationships with the Guides, and a chance to self-direct services enabled consumers to have control over all aspects of their recovery journey, facilitated change and growth, and improved their capacity to self-direct services. Most consumers encountered a number of positive recovery experiences at varied levels that enhanced their lived experiences.

The impact of services that offer individualised funds, shared management, person-centred relationships, and self-direction on the lived experiences of consumers with mental illness

BackgroundMental health service providers across Australia, including Western Australia (WA), have begun to offer individualised funds, shared management, person-centred and self-directed (SPS) services. No research exists on the impact of SPS services on the lived experiences of these particular consumers. This study explored the impact of a SPS service offered for the first time in WA to consumers with mental illness.MethodsData on sixteen consumers’ lived experiences were analysed using an abbreviated grounded theory approach. These data had been developed by the consumers, Guides (staff) and an independent evaluator, and most of it had been collected in the past prior to the commencement of the study.ResultsThree over-arching categories, and related subcategories, emerged indicating that 1) access to individualised funds enabled practical and psychological benefits to consumers; 2) consistent contact in shared management and person-centred relationships enhanced the provision of timely and meaningful staff support to consumers; and 3) high quality shared management and person-centred relationships with staff and the opportunity to self-direct enabled consumers’ change and growth.ConclusionsSPS services enhanced consumers’ lived experiences and enabled staff to provide and consumers to experience timely access to recovery resources, consistent contact, responsive and high quality support, and self-direction of services. In this, consumers changed, grew and achieved desired recovery experiences. The overall impact of the SPS service seemed to be founded on the goodness of fit between person characteristics of staff and consumers, which enabled rich support that provided for corrective emotional experiences. This enabled consumers to build meaningful and hopeful lives where they started to live with, and beyond, their mental illness.

A systematic review evaluating the psychometric properties of measures of social inclusion

Introduction Improving social inclusion opportunities for population health has been identified as a priority area for international policy. There is a need to comprehensively examine and evaluate the quality of psychometric properties of measures of social inclusion that are used to guide social policy and outcomes. Objective To conduct a systematic review of the literature on all current measures of social inclusion for any population group, to evaluate the quality of the psychometric properties of identified measures, and to evaluate if they capture the construct of social inclusion. Methods A systematic search was performed using five electronic databases: CINAHL, PsycINFO, Embase, ERIC and Pubmed and grey literature were sourced to identify measures of social inclusion. The psychometric properties of the social inclusion measures were evaluated against the COSMIN taxonomy of measurement properties using pre-set psychometric criteria. Results Of the 109 measures identified, twenty-five measures, involving twenty-five studies and one manual met the inclusion criteria. The overall quality of the reviewed measures was variable, with the Social and Community Opportunities Profile-Short, Social Connectedness Scale and the Social Inclusion Scale demonstrating the strongest evidence for sound psychometric quality. The most common domain included in the measures was connectedness (21), followed by participation (19); the domain of citizenship was covered by the least number of measures (10). No single instrument measured all aspects within the three domains of social inclusion. Of the measures with sound psychometric evidence, the Social and Community Opportunities Profile-Short captured the construct of social inclusion best. Conclusions The overall quality of the psychometric properties demonstrate that the current suite of available instruments for the measurement of social inclusion are promising but need further refinement. There is a need for a universal working definition of social inclusion as an overarching construct for ongoing research in the area of the psychometric properties of social inclusion instruments.

The experience of social inclusion for people with intellectual disability within community recreational programs: A systematic review

ABSTRACT Background: Social inclusion is a vital domain in quality of life and is enhanced through recreational programs. People with intellectual disability have been provided with fewer opportunities to participate in these groups, thus hindering social inclusion. Method: Five databases (CINAHL, Ovid, ProQuest, ScienceDirect, and Wiley Online Library) were electronically searched and narrowed using inclusion/exclusion criteria. The methodological quality was assessed using standard quality assessment criteria. Results: Out of 135 retrieved results, 12 articles were included. Data were predominantly collected using questionnaires, scales, and interviews. Ages of the people with intellectual disability ranged from 5 to 65 years, and the sample size ranged from 30 to 2,556 persons. Four key themes became apparent in the literature: (1) the impact of physical and social independence, (2) the amount of social interaction and participation, (3) the impact of culture and attitudes, and (4) the outcomes of social inclusion. Conclusions: Social inclusion and participation in leisure activities for people with intellectual disability increase with greater functional independence and positive community attitudes. This participation results in positive outcomes. People with an intellectual disability participate less in recreational programs. Further research is needed regarding the experience from the person’s point of view.

Men with disabilities – A cross sectional survey of health promotion, social inclusion and participation at community Men's Sheds

BACKGROUND The intersections between chronicity, disability and social inequality are well understood. Novel ways to counter the social determinants of health and disability are needed. Mens Sheds are a community space where men can participate in a range of shared activities and potentially experience a health and social benefits. OBJECTIVE This cross-sectional survey was conducted to inform future research by determining who attended Mens Sheds and the range of health, social, community, and educational activities undertaken there. This paper explores the membership of people with disabilities (PWD) at Mens Sheds and the factors that predict their membership. METHODS An online survey link was sent to all known Mens Sheds internationally in 2012. Data were analyzed using descriptive and inferential (univariate and multivariate) statistics. RESULTS 32.2% of international sheds and 29% of Australian sheds specifically targeted the inclusion of PWD. 80% of these sheds have significantly more members with disabilities than sheds who do no target PWD. Factors associated with greater membership of PWD included the provision of transport, social outings and promoting occupational skills. CONCLUSIONS PWD are being encouraged to join and are joining Mens Sheds. This is significant as the value of participation and inclusion toward better health and wellbeing is well known. Mens Sheds offer a community space where the social determinants of chronicity and disability can potentially be countered.

Respecting recovery: research relationships with people with mental illness

Purpose – The lived experience of individuals who experience mental illness should be at the heart of recovery-orientated practice and research. The purpose of this paper is to outline key ethical and practical issues that both respect principles of recovery and are fundamental to establishing and maintaining a research relationship with people with severe mental illness (SMI). Design/methodology/approach – Theoretical frameworks of recovery, discourse ethics and critical reflexivity were used in a 12-month longitudinal community study to construct and build methodology to inform the collection of rich descriptive data through informal discussions, observations and interviews. Detailed field notes and a reflective journal were used to enable critical reflexivity and challenge normative assumptions based on clinical and lay views of SMI. Findings – The paper provides an analysis through three vignettes which demonstrate how the principles of recovery were incorporated in an ethically grounded research rela...

Development of a fidelity measure for community integration programmes for people with acquired brain injury

Abstract Objective: The paper describes development of the Assessment of Community Integration Programme Attributes (ACIPA) measure based on a descriptive community integration framework. The purpose of this measure is to allow evaluation of community integration programmes for adults with acquired brain injury (ABI). Methods: The Community Integration Framework (CIF) was used to design a fidelity evaluation measure through consultation with 37 participants from five stakeholder groups (practitioners, researchers, policy-makers, people with ABI and family members of people with ABI) using semi-structured interviews, focus groups, iterative surveys and a multi-attribute utility (MAU) method. Results: The resultant measure included seven themes and 21 attributes. Each attribute included indicators and probing questions. Weights were assigned to each theme and constituent attributes. Conclusion: Programme evaluation commonly focuses on outcomes, often overlooking analysis of programme processes. Although it requires further psychometric (reliability and validity) development, the Assessment of Community Integration Programme Attributes may be used to assess the relationship between programme processes and specific outcomes and also to inform the development of programmes aiming to enhance community integration for adults with ABI.