Characteristics of mental health recovery narratives: Systematic review and narrative synthesis

Abstract

Background Narratives of recovery from mental health distress have played a central role in the establishment of the recovery paradigm within mental health policy and practice. As use of recovery narratives increases within services, it is critical to understand how they have been characterised, and what may be missing from their characterisation thus far. The aim of this review was to synthesise published typologies in order to develop a conceptual framework characterising mental health recovery narratives. Method A systematic review was conducted of published literature on the characteristics of mental health recovery narratives. Narrative synthesis involved identifying characteristics and organising them into dimensions and types; and subgroup analysis based on study quality, narrator involvement in analysis, diagnosis of psychosis and experience of trauma. The synthesis was informed by consultation with a Lived Experience Advisory Panel and an academic panel. The review protocol was pre-registered (Prospero CRD42018090188). Results 8951 titles, 366 abstracts and 121 full-text articles published January 2000-July 2018 were screened, of which 45 studies analysing 629 recovery narratives were included. A conceptual framework of mental health recovery narratives was developed, comprising nine dimensions (Genre; Positioning; Emotional Tone; Relationship with Recovery; Trajectory; Use of Turning Points; Narrative Sequence; Protagonists; and Use of Metaphors), each containing between two and six types. Subgroup analysis indicated all dimensions were present across most subgroups, with Turning Points particularly evident in trauma-related studies. Conclusions Recovery narratives are diverse and multidimensional. They may be non-linear and reject coherence. To a greater extent than illness narratives, they incorporate social, political and rights aspects. Approaches to supporting development of recovery narratives should expand rather than reduce available choices. Research into the narratives of more diverse populations is needed. The review supports trauma-informed approaches, and highlights the need to understand and support post-traumatic growth for people experiencing mental health issues.

‘I’m proud of how far I’ve come. I’m just ready to work’: mental health recovery narratives within the context of Australia’s Disability Employment Services

“…Whereas others clearly positioned improvements in mental health as occurring within DES. People may also follow different non-linear trajectories of recovery and see themselves at different stages of their journey (recovered, living well, making progress or surviving day-to-day) [69]. This was also evident in the emerging narratives, with some participants reflecting positive trajectories across all CHIME components, with others describing oscillating experiences.…”

“…Ridgway [68] for example used first person narratives to explore lived experiences of recovery of women with long-term psychosocial disability, describing how these narratives could inform recovery-orientated practice. Whilst a recent systematic review of mental health recovery reported on 45 separate studies documenting personal recovery narratives, demonstrating the wide utilisation of narrative inquiry to understand perspectives of recovery [69].…”

Reconstructing Personal Stories in Virtual Reality as a Mechanism to Recover the Self

“…Therefore, the unity of human life [117] can be seen as broken [33,72] and the coherence of the self as disturbed [118] in conditions resulting from traumatic events. However, in the context of recovery therapy [119], this should not be seen as an irresolvable situation, and it is necessary to create another narrative or fiction that "works" [19] to create meaning out of the traumatic event and to include it with consistency in one's life story.…”

Not the story you want? Assessing the fit of a conceptual framework characterising mental health recovery narratives

“…Mental health recovery narratives are first-person lived experience accounts of recovery from mental health problems, which include elements of adversity or struggle and of selfdefined strengths, successes or survival [1]. They have been described as a "key recovery technology" [2], central to the recovery approach within mental health policy and practice [3,4].…”

“…Despite wide-ranging use in mental health practice, and the possibility of creating both benefits and harms, there has been a lack of conceptual clarity and consistency in the definition of recovery narratives [1]. A clearer understanding of their characteristics could ensure that future use of narratives in clinical interventions and practice provide maximum benefit and minimum harms to recipients.…”