Benjamin Milbourn

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.

A meta-analysis of Mindfulness Based Interventions (MBIs) show that MBIs are effective in reducing acute symptoms of depression but not anxiety

Objective of the review: To determine the effectiveness of mindfulness based interventions (MBIs) in reducing primary symptomology in people experiencing current episodes of anxiety or depression through a meta-analysis of randomised controlled trials (RCTs). Search strategies: A meta-analysis of 1517 records were identified though MEDLINE, Web of Science, Scopus, Proquest and PsychINFO; as well as three leading clinical trial registers using the key phrases of Mindfulness-Based Cognitive Therapy (MBCT), Mindfulness Based Stress Reduction (MBSR)combined with anxiety and depression. Selection criteria: The selection criteria included: (i) RCTs; (ii) participants 18 years or older; (iii) mindfulness was a core part of the intervention used both within therapy and between therapy sessions; (iv) studies included a psychometrically reliable and valid outcome measure of depression and anxiety; and (v) all participants met the full criteria for a current episode of a DSM IV diagnosis of either depression or anxiety or a subgroup of either condition. Explicit exclusion criteria were used to assist the screening process. The rating procedure, number of raters involved and inter-rater agreement was not reported. Methods of review: Twelve studies met the final inclusion criteria. Means, standard deviations and sample size for the primary symptom measure and for measures of depression and anxiety were entered into Review Manager (RevMan) [Computer program]. Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012. The review team then calculated the standardised mean difference (SMD: a measure of ‘effect size’) where possible. Post-intervention between group-effect sizes were calculated using a random effects model; Hedges g was used to calculate the effect size for each study. The Jadad scale was used to independently assess the methodological quality of RCTs. Results: Twelve studies (578 participants) met the final inclusion criteria. The Jadadrating scale was used to evaluate the quality of the included studies. Between group benefits of MBI relative to control conditions on primary symptom severity were significant (Hedges g = 0.59, 95% CI = 0.12 to 1.06). MBI was effective in reducing depressive symptom severity (Hedges g = 0.73, 95% CI = 0.09 to 1.36), but not anxiety symptom severity (Hedges g = 0.55, 95% CI = 0.09 to 1.18, when there was an inactive control (Hedges g = 1.03, 95% CI = 0.40 to 1.66), but not an active control (Hedges g = 0.03, 95% CI = 0.54 to 0.48). MBCT were found to be effective (Hedges g = 0.39, 95% CI = 0.15 to 0.63), but not MBSR (Hedges g = 0.75, 95% CI = 0.31 to 1.81). Author’s conclusions: MBIs used with people experiencing acute episodes of depression provide significant benefits to reducing primary symptom severity. MBIs may also produce similar patient outcomes as group cognitive behavioural therapy and may offer people experiencing depression with a secondary therapy option. The findings also suggest there is limited evidence to support the use of MBIs in reducing the symptoms of acute episodes of anxiety. Contact details of original author: Clara Strauss: c.y. strauss@sussex.ac.uk

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.

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...

The relationship between time spent in volunteering activities and quality of life in adults over the age of 50 years: A systematic review:

Introduction Increased attention has focused on the importance of time spent by ageing adults in volunteering. The aim of this systematic review was to analyse literature exploring the relationship between time spent volunteering and quality of life for adults over the age of 50 years. Method Electronic searches of nine databases located relevant articles involving adults over the age of 50 in volunteering activities that included psychological, physical and social quality of life domains. The quality of the selected articles was assessed and data extracted using preferred reporting items for systematic reviews and meta-analyses. Results Of the 65 articles retrieved, 22 were reviewed and eight included in the final review. Studies included one randomised controlled trial, one cross-sectional and six longitudinal studies. Levels of time spent volunteering by participants within the studies varied considerably. Articles retrieved reported positive quality of life outcomes including increases in life satisfaction, self-esteem and social support and a slowed functional decline. Conclusion Volunteering is identified as an important occupation for adults over the age of 50, although the relationship between time spent volunteering and the impact on quality of life outcomes is still not fully understood. Future research is required to better understand the impact of time spent volunteering on quality of life.

Re-imagining occupational wellbeing: Development of an evidence-based framework

BACKGROUND/AIM Occupational therapists concern themselves with understanding engagement in everyday activity as a mode of facilitating wellbeing. However, there appears to be little consensus within the literature as to how engagement in meaningful activities contributes to wellbeing. Currently, there are no published evidence-based frameworks for wellbeing to support occupational therapy practitioners to address wellbeing with clients. The purpose of the study was to establish an evidence-based contemporary framework, domains and descriptive statements defining occupational wellbeing. METHODS A multiphase, exploratory sequential mixed methods design, using both qualitative and quantitative approaches was used. Two phases were identified for data collection. The first phase involved exploration of the domains of occupational wellbeing, through conducting a literature review and two focus groups. The Delphi technique was employed in the second phase to refine and corroborate the domains of occupational wellbeing with an expert panel. RESULTS Six new domains of occupational wellbeing were generated in the first phase of the study, namely: Competence, autonomy, contentment and pleasure, identity, hope and belonging. In the second phase, five out of the six domains reached a consensus level of 70% or more. Hope was the only domain not to reach consensus. CONCLUSION The framework for occupational wellbeing produced by this study was created using evidence-based, replicable methodology and garnered support from a highly regarded expert key informant group of occupational therapy and occupational science academics. Further exploration to determine whether there is widespread support and applicability for these domains with normative and vulnerable population groups is required.

A qualitative study of occupational well-being for people with severe mental illness

Abstract Background/aim: People with severe mental illness (SMI) do not receive adequate attention in research or clinical practice. They are considered hard to reach and difficult to engage. Information is needed to help provide support for this vulnerable population. This paper aims to investigate the well-being of adults diagnosed with SMI and receiving Assertive Community Treatment (ACT) by applying the occupational well-being framework to the everyday activities of this vulnerable group of people. Materials and methods: Eleven adults diagnosed with an SMI, living in the community, participated in semi-structured interviews over a 12-month period. A longitudinal design was used to collect data through using field notes and audio recordings. For this paper, secondary analysis was conducted by coding the data deductively thereby investigating the participants’ experiences in relation to the seven Occupational Well-being framework descriptors (accomplishment, affirmation, agency, coherence, companionship, pleasure and renewal). Results: Participants’ everyday activities and occupational well-being appeared severely restricted and largely determined by the type of care they received. There was minimal evidence of the well-being descriptors, though all the participants reported experiencing some form of pleasure, even though some of the pleasurable experiences negatively impacted their health. Conclusion/significance: The episodic nature of SMI means that people living with an SMI require continuity in key relationships and support to achieve Occupational Well-being. Occupational therapists working with mental health consumers need to facilitate the types of activities that foster well-being through accomplishment, affirmation, agency and companionship, and that derive pleasure in healthy and positive ways.