Simon Bradstreet

Harnessing the ‘Lived Experience’: Formalising Peer Support Approaches to Promote Recovery

Recovery is now commonly cited in mental health policy and planning documents. It signals a new approach to service delivery influenced by the lived experience of recovery, a focus on personal strengths and a more optimistic approach to long-term mental health problems. The concept has been extensively developed in the United States and New Zealand where attempts to translate recovery principles into practice are most advanced. In the United States there have been two key federal policy documents of note. First, the report from the surgeon general recommended that all mental health systems have a recovery focus (Sacher, 1999). This report was followed by the president’s New Freedom Commission on Mental Health, which declared that recovery was the ‘goal of a transformed system’ (Fisher, 2003). This federal policy has led to individual states incorporating recovery elements into their state policy to varying degrees. In New Zealand the revised Blueprint for Mental Health Services promotes a recovery approach to service delivery (Mental Health Commission, 1998). In Scotland one of the four key aims of the Scottish Executive’s National Programme for Improving Mental Health and Well-being is ‘promoting and supporting ‘E recovery’ (Scottish Executive, 2003). In 2004 the Scottish Recovery Network was launched to work towards achieving this aim. The network itself comprises a loose affiliation of organisations and individuals with an interest in raising awareness of recovery and in looking at new and innovative ways to promote recovery from long-term mental health problems and mental illness. The network’s main aims are: ■ to raise awareness of recovery from long-term mental health problems ■ to gather and share information about the factors that people identify as having helped or hindered their recovery ■ to encourage local action and to highlight approaches that we believe to be particularly effective in promoting recovery.

Evaluating the feasibility of complex interventions in mental health services: standardised measure and reporting guidelines

BACKGROUND The feasibility of implementation is insufficiently considered in clinical guideline development, leading to human and financial resource wastage. AIMS To develop (a) an empirically based standardised measure of the feasibility of complex interventions for use within mental health services and (b) reporting guidelines to facilitate feasibility assessment. METHOD A focused narrative review of studies assessing implementation blocks and enablers was conducted with thematic analysis and vote counting used to determine candidate items for the measure. Twenty purposively sampled studies (15 trial reports, 5 protocols) were included in the psychometric evaluation, spanning different interventions types. Cohens kappa (κ) was calculated for interrater reliability and test-retest reliability. RESULTS In total, 95 influences on implementation were identified from 299 references. The final measure - Structured Assessment of FEasibility (SAFE) - comprises 16 items rated on a Likert scale. There was excellent interrater (κ = 0.84, 95% CI 0.79-0.89) and test-retest reliability (κ = 0.89, 95% CI 0.85-0.93). Cost information and training time were the two influences least likely to be reported in intervention papers. The SAFE reporting guidelines include 16 items organised into three categories (intervention, resource consequences, evaluation). CONCLUSIONS A novel approach to evaluating interventions, SAFE, supplements efficacy and health economic evidence. The SAFE reporting guidelines will allow feasibility of an intervention to be systematically assessed.

Recovery in Scotland: Beyond service development

Abstract Over the last ten years there has been significant activity related to the promotion and support of recovery in Scotland, much of it linked to the work of the Scottish Recovery Network. A range of government policies have consistently identified recovery as a guiding principle of both service design and mental health improvement efforts. New learning has been developed and shared, workforce competencies reviewed and training developed, and a range of national initiatives put in place. In Scotland, as elsewhere, these efforts have tended to focus primarily on ensuring that mental health services offer environments and practices that support personal recovery. While service improvement is crucial, a wider challenge is ensuring that opportunities and support for self-directed recovery are enhanced outside statutory services. Providing examples, this paper will look at the development of recovery in Scotland – including the work of the Scottish Recovery Network – and consider the potential for building on progress made by rebalancing efforts to support personal recovery, highlighting the importance of public attitudes and community-based learning approaches. We will also touch on the role of identity in personal recovery and consider cultural issues related to the promotion of recovery in Scotland.

Health services, suicide, and self-harm: patient distress and system anxiety

Patients often become distressed in health settings, and provision of emotional support is a routine part of clinical care. However, in some situations, patient distress can become disturbing to both clinicians and patients, and can affect ordinary therapeutic engagement. We argue that health systems that support people presenting with suicidal acts and self-harm are particularly at risk of providing maladaptive responses, which we have termed dysregulation. If health systems become dysregulated, staff and patients might find it difficult to think clearly and respond adaptively. We describe some common characteristics of dysregulation, including negative feelings about patients, an inappropriately narrow focus on diagnosis and risk assessment, and ad-hoc, abrupt, and inconsistent decision making. These dysregulated responses might impair more adaptive responses such as containment of distress, safety planning, and negotiated responsibility with patients and carers. We discuss the main drivers of dysregulation and the implications for clinical practice in the management of self-harm and suicide risk.

Establishing a recovery college in a Scottish University

Purpose – The purpose of this paper is to describe the establishment of the Dumfries and Galloway Wellness and Recovery College (The College) within the University of the West of Scotland. Design/methodology/approach – A narrative approach is taken to outline the project and justify its philosophy. Findings – Progress so far is outlined and the vision for the future is explained. Social implications – It is believed that stigma and discrimination are pernicious and pervasive and a concerted and deliberately conscious attempt is needed to establish an inclusive, egalitarian and aligned approach whereby practices match values base. Originality/value – This is justified as being in keeping with a philosophy based on the concepts of recovery, co-production co-delivery and co-receiving. Although not without precedent this development is innovative in being embedded within the university sector and challenging existing paradigms in terms of the positive and inclusive approach to mental health.

Internalised stigma in mental health: an investigation of the role of attachment style

Internalised stigma is associated with a range of negative outcomes, yet little is known about what determines the internalisation of stigma. In this study we examined the potential role of adult attachment style in the internalisation process in a transdiagnostic sample of adults with experience of recent mental health service use (n = 122), using an online survey. Associations between internalised stigma and perceived public stigma were tested. We also examined whether anxious and avoidant (insecure) attachment styles were positively associated with a significant amount of variance in internalised stigma when controlling for other variables, and whether the relationship between perceived public stigma and internalised stigma was moderated by anxious and avoidant attachment. We found that internalised stigma, perceived public stigma and insecure attachment were commonly reported and that internalised stigma was positively associated with perceived public stigma. However, neither anxious or avoidant attachment were associated with a significant amount of variance in internalised stigma and we found no moderating effect on the relationship between perceived public stigma and internalised stigma for insecure attachment. Despite mixed results, the strength of association between anxious attachment and internalised stigma suggests further research, which addresses some limitations of the current study, is warranted.