Dave Sells

Processes of recovery in serious mental illness: Findings from a multinational study

ABSTRACT As part of a growing literature describing processes of recovery in psychotic disorders, this report presents findings of an intensive, international study. Open-ended qualitivite interviews were conducted in Italy, Norway, Sweden, and the United States with a total of twelve individuals who have experience of recovery in psychosis. All interviews were translated into English and transcribed. Investigators from each of these countries collaborated in analyzing the interviews and identifying common elements across the twelve narratives. Themes were identified in each of the following areas: 1) how the individual deals with his or her difficulties; 2) the role of material resources; 3) the various roles of formal and informal health systems; 4) the roles, and absence, of significant others; and 5) the roles of social and cultural factors. Salient themes included the persons determination to get better, establishing a degree of self–control, and struggling to achieve a normal life; the need for material resoures and a sense of home, and the importance of going out and engagging in normal activities; the benifits, and costs, of medication, involvement in mutual support/user groups, and participation in various psychosocial interventions; the need to be accepted as, and to accept oneself as, a normal person who exists beyond the psychosis; the impact of stigma and discrimination, and the imortance of having ones rights respected and returning to a meaningful social role through work and/or positive relationships outside of the formal mental health system. Cultural differences between participants from each country were noted primarily in the nature of the opportunities and supports offered rather than in the nature of the processes described. In closing, implications of these findings are considered both for future research on processes of recovery and for making clinical practice more recovery-oriented.

Others: The Role of Family, Friends, and Professionals in the Recovery Process

Relationships have a tremendous impact on how people recover from schizophrenia. Previous research has focused on the role of clinicians in these supportive relationships, but the current study finds that these relationships can occur within the mental health system, the family, or out in the community. Regardless, it is very important for people in recovery to feel as if they are supported and cared for. In qualitative interviews, we examine the specific aspects that characterize other peoples actions when helping in the recovery process. First, for both professionals and family members, being “there” and available seemed to help people in recovery. Secondly, people helped by doing more than was expected of them, sometimes by lending money or doing something extra to help out the person in recovery. Thirdly, people helped by doing something different than what was expected of them. For professionals, this might mean that they break a minor rule. These factors helped people in recovery feel like they were special, chosen, and “worth” doing something extra for. #Affiliation reflects lend author

The Social Nature of Recovery: Discussion and Implications for Practice

This article provides an interpretation of the key issues that emerged from the research, attempting a possible synthesis of the different themes described in the other papers and beginning a map of recovery as an ongoing interpersonal and social process. From a subjective point of view, there is a dimension of ‘social experience’, which implies the reconstruction of self and the importance of social life as a major goal. Recovery as an interactive journey requires an entire social context ‘provided with meanings’, rather than simply building social ties and relationships within a network. Socialization in a real environment means social inclusion, like efforts made of gaining the status of effective citizenship, in terms of rights, opportunities, and responses to social needs. Therefore, what citizenship is really about seems to be ‘recovery in a social context’. In this framework, a community service can act as a sort of mediator, an agent for integration, recognizing the uniqueness of those processes. #Affiliation reflects lead author.

A Peer-Support, Group Intervention to Reduce Substance Use and Criminality Among Persons With Severe Mental Illness

OBJECTIVE This study compared the effectiveness of two interventions in reducing alcohol use, drug use, and criminal justice charges for persons with severe mental illnesses: first, a community-oriented group intervention with citizenship training and peer support that was combined with standard clinical treatment, including jail diversion services, and second, standard clinical treatment with jail diversion services alone. METHODS A total of 114 adults with serious mental illness participated in a 2 x 3 prospective longitudinal, randomized clinical trial with two levels of intervention (group and peer support for the experimental condition and standard services for the control) and three interviews (baseline, six months, and 12 months). Self-report questionnaires assessed alcohol and drug use, and program databases assessed criminal justice contacts. The authors used a mixed-models analysis to assess alcohol and drug use, repeated-measures analysis of covariance to assess criminal justice charges, and correlational analyses to assess the relation between intervention participation and outcome variables. RESULTS The experimental group showed significantly reduced alcohol use in comparison with the control group. Further, results showed a significant group-by-time interaction, where alcohol use decreased over time in the experimental group and increased in the control group. Drug use and criminal justice charges decreased significantly across assessment periods in both groups. CONCLUSIONS Of the outcomes, only decreased alcohol use was attributable to the experimental intervention. Although this may be a chance finding, peer- and community-oriented group support and learning may facilitate decreased alcohol use over time.

Arenas of Recovery for Persons with Severe Mental Illness

We analyzed informant narratives in terms of the benefits of spending time within various community arenas, including service user organizations, advocacy agencies, the bowling alley, and universities. Themes contributing to recovery from severe mental illness included the understanding and acceptance infromants both gave and received from others, spiritual fulfillment, and even experiences of anger as mechanisms of empowerment to counter social discrimination and neglect. Involvement across various community arenas and the themes it elicited relative to recovery were understood in terms of developing more durable and advantageous understandings of the self. #Affiliation reflects lead author.

Self-Efficacy and Self-Care: Missing Ingredients in Health and Healthcare among Adults with Serious Mental Illnesses

To help inform the design of a self-management intervention for improving the physical health of adults with serious mental illnesses, we conducted focus groups about their perceived medical care and physical health needs. Adults with serious mental illnesses participated in four semi-structured focus groups conducted at a transitional living facility, a social club, and a Hispanic outpatient mental health clinic. Questions included their recent experiences of seeking medical care, the effect of having a mental illnesses diagnosis, strategies for active self-care, and perceived barriers to better physical health. In addition to various systemic barriers to better medical care, participants articulated limited knowledge and self-efficacy regarding active self-management of their physical health. Despite their interest in learning more about health promotion, most participants expressed a sense of personal futility and powerlessness in improving their health. These data suggest that any effort to improve the wellbeing of these adults will need to address self-efficacy in the hope of improving self-care for their physical health needs.

Citizenship, Community, and Recovery: A Group- and Peer-Based Intervention for Persons With Co-Occurring Disorders and Criminal Justice Histories

Group interventions for persons with co-occurring disorders of serious mental illness (SMI) and alcohol or other substance use disorders may positively affect participants’ substance use, criminal justice contacts, and transition to community supports and community living. We report on a group intervention with wraparound peer support that, in earlier research, has shown promise regarding these domains. We provide a detailed description and discussion of the intervention, including case vignettes. We also discuss future research on this intervention and offer recommendations for additional research in this area and with this target population.

Enabling or Engaging? The Role of Recovery Support Services in Addiction Recovery

Recovery capital—the quantity and quality of internal and external resources to initiate and maintain recovery—is explored with suggestions for how recovery support services (RSS) (nontraditional, and often nonprofessional support) can be utilized within a context of comprehensive addiction services. This article includes a brief history of RSS, conceptual and operational definitions of RSS, a framework for evaluating RSS, along with a review of recent empirical evidence that suggests that rather than enabling continued addiction, recovery supports are effective at engaging people into care, especially those who have little recovery capital, and/or who otherwise would likely have little to no “access to recovery.”

Generating Coherence out of Chaos: Examples of the Utility of Empathic Bridges in Phenomenological Research

The purpose of this paper was to provide an example from phenomenological research of moving from rich descriptive interview data to coherent revelatory descriptions employing empathic bridges within the narrative structure of storytelling. We used transcribed data from two interviews concerning recovery from severe mental illness: one with an American woman in her early thirties, and the other with a Swedish man in his mid-thirties. Five investigators analyzed the transcribed data into individual first-person narrative descriptions according to existing empirical phenomenological methods including an independent reading, identification of themes relevant to processes of recovery from severe mental illness, temporal ordering of themes meaningfully reflecting the sequence of the recounted events, and consensus development. Our findings support the use of empathic bridges as a methodological tool with the narrative structure of firstperson storytelling, as well as the viability and importance of employing this tool to better understand processes of recovery for persons with severe mental illness.

Sober Housing and Motivational Interviewing: The Treatment Access Project

This paper describes an innovative program that provides rental subsidies for sober housing and supportive services to persons in early recovery who are homeless and have substance use disorders. Preliminary data point to the success of this program in enhancing recovery and exiting from homelessness. In supporting sober house placements, the Treatment Access Project creates a bridge that supports these individuals in their transition from clinical treatment services to the community. Integration with natural community supports can help to build self-efficacy, which can enhance the likelihood that this population will obtain and maintain abstinence, gainful employment, and permanent housing.