Hélène Provencher

The role of work in the recovery of persons with psychiatric disabilities.

This study explored the role of work in the recovery of employed and unemployed persons with psychiatric disabilities. Fourteen persons with psychiatric disabilities participated in semi-structured interviews. Content analysis revealed that the experience of recovery was based on six major dimensions: self-definition, empowerment, connections to others, meaning of work, vocational future, and meaning of recovery. Differences in these six dimensions led to the identification of three profiles of recovery: recovery as uncertain, recovery as a self-empowering experience, and recovery as a challenging experience. Each profile described a specific context in which participation in work or avoidance of work can be understood and vocational interventions can be designed.

Complete mental health recovery: bridging mental illness with positive mental health

Purpose – The purpose of this paper is to propose that the study, and the promotion, of recovery can be augmented by adopting the model of mental health as a complete state.Design/methodology/approach – A literature review of the last two decades was undertaken and pathways to complete mental health in recovery are proposed.Findings – More work is needed to further develop interventions oriented towards the promotion of positive mental health in recovery, targeting the enhancement of positive emotions towards life and a sense of fulfillment in private and social life. Positive mental health also deserves more research attention to assess the full range of recovery outcomes related to the restoration and optimization processes. A better understanding of individual and environmental factors facilitating or hindering the achievement of complete mental health in recovery is warranted as well.Originality/value – Unlike previous conceptions, the model presented in the paper proposes to redefine recovery from th...

The role of relatives in discharge planning from psychiatric hospitals: the perspective of patients and their relatives.

This study prospectively assessed the preferences and satisfaction of 98 psychiatric inpatients and 40 of their relatives with family involvement in discharge planning. Preferences questionnaires were administered during hospitalization. Satisfaction questionnaires were completed 3 months later. Preferences noted by most participants included information concerning patient health status, ways to prevent further hospitalizations, services for relatives, and signs of patient decompensation. More relatives than patients felt that post-discharge residence and activities were important areas to be involved in. Most participants were satisfied if relatives were involved in discharge planning. However, up to 89% of patients, and 84% of relatives, reported no communication between clinical staff and relatives regarding discharge. When this was the case, satisfaction rates dropped sharply, especially for relatives. The need for increased communication between clinicians and relatives regarding discharge planning remains a problem.

Predictors of caregiver satisfaction with mental health services.

The objective of this study is to examine the relative contribution of three main factors (characteristics of services and service providers, characteristics of patients and caregivers, and impact of psychiatric illness) to caregiver satisfaction with services. Results of this study are based on the responses of 154 family caregivers of individuals with mental illnesses in Quebec, and indicate that these aspects play a predictive role in caregiver satisfaction with services. A multiple regression model explained 42% of the variance in satisfaction. Collaboration with professionals is the key determinant in the model, as it contributes more than any other variable to satisfaction. Results demonstrate the importance of obtaining a better understanding of caregivers’ satisfaction with services in order to increase their involvement in community integration.

Attributions of causality, responsibility and blame for positive and negative symptom behaviours in caregivers of persons with schizophrenia

BACKGROUND Causal, responsibility and blame attributions for positive and negative symptom behaviours were examined in 70 caregivers of persons with schizophrenia. METHODS The majority of subjects belonged to self-help group organizations. The three types of attributions for positive and negative symptom behaviours were assessed by self-report questionnaires. RESULTS The extent of patient responsibility did not differ between the two types behaviours. Intentionality and knowledge were equally important in predicting responsibility for positive symptom behaviours, while intent was the most important predictor of responsibility for negative symptom behaviours with the patient capacity playing a significant but minor role. The entailment model was not supported for the two types of behaviours. CONCLUSIONS Increased attention should be given to responsibility dimensions in assigning moral accountability to the patient. The entailment model should be further explored in problematical caregiving situations.

The caregiver's perception of behavioral disturbance in relatives with schizophrenia: a stress-coping approach.

This article suggests some theoretical orientations in studying behavioral disturbance from a stress-coping perspective. First, an overview of Lazarus and Folkmans cognitive theory of stress is presented. Secondly, some linkages are proposed between the rating scales used to measure behavioral disturbance and the concepts of this theory. Future research directions are then suggested to further explore the affective, cognitive and behavioral responses related to the management of disturbing behaviors.

Mental health self-management questionnaire: Development and psychometric properties

BACKGROUND Through self-management, people living with depression, anxiety or bipolar disorders can play an active role in their recovery. However, absence of a validated questionnaire limits empirical research on self-management. The study aimed to develop a French instrument, the Mental Health Self-Management Questionnaire (MHSQ), and to investigate its psychometric properties METHODS A pool of 86 items was created based on a qualitative study with 50 people in recovery from depression, anxiety or bipolar disorders. The 64 most pertinent items were identified following ratings from 14 experts. A sample of 149 people in recovery completed these items and criterion-related measures (specific aspects of self-management, clinical and personal recovery, social desirability), and 93 participants also completed MHSQ two weeks later RESULTS Exploratory and confirmatory factor analyses show that MHSQ is composed of three subscales: Clinical (getting help and using resources), Empowerment (building upon strengths and positive self-concept to gain control) and Vitality (active and healthy lifestyle). These subscales had satisfying consistency and test-retest reliability, and were mostly unrelated to social desirability. Correlations with criterion variables support convergent and concurrent validity, especially for Empowerment and Vitality. Comparison of structural models provides evidence of the distinct nature of MHSQ in comparison to the constructs of clinical and personal recovery LIMITATIONS Longitudinal studies with larger samples are needed to explore the validity of MHSQ for predicting recovery over time CONCLUSION MHSQ is a psychometrically-sound instrument, useful for establishing the role of self-management in recovery and monitoring the efficacy of self-management support programs.

Self-Management Strategies in Recovery From Mood and Anxiety Disorders

Mood and anxiety disorders are the most prevalent mental disorders. People with such disorders implement self-management strategies to reduce or prevent their symptoms and to optimize their health and well-being. Even though self-management strategies are known to be essential to recovery, few researchers have examined them. The aim of this study is to explore strategies used by people recovering from depressive, anxiety, and bipolar disorders by asking 50 of them to describe their own strategies. Strategies were classified according to dimensions of recovery: social, existential, functional, physical, and clinical. Within these themes, 60 distinct strategies were found to be used synergistically to promote personal recovery as well as symptom reduction. Findings highlight the diversity of strategies used by people, whether they have depressive, anxiety, or bipolar disorders. This study underscores the importance of supporting self-management in a way that respects individual experience.

Recovery: A Complete Mental Health Perspective

Distinct views of the recovery experience prevail in the literature, including divergent opinions about how to define and measure recovery outcomes. This chapter proposes that the study, and the process, of recovery can be augmented by adopting the model of mental health as a complete state. Based on this model, recovery is viewed as flourishing in life in spite of having a mental illness and relies on two complementary experiences, the restoration from mental illness and the optimization of positive mental health. Six pathways to complete mental health in recovery are proposed, which result from the combination of mental illness and positive mental health outcomes. Directions for future research are suggested, including a better understanding of the potential role of flourishing in reducing the person’s vulnerability to mental illness.

Instruments Measuring Behavioral Disturbance in Relatives with Schizophrenia

This article presents a review of 16 instruments measuring behavioral disturbance of persons with schizophrenia as perceived by their family members. Information about the domain, the types of rating scales, and the psychometric properties of these instruments are provided. Future directions in the study of behavioral disturbance are proposed.