Mental Health Reform at a Systems Level: Widening the Lens on Recovery-Oriented Care

Abstract

This paper is an initial attempt to collate the literature on psychiatric inpatient recoverybased care and, more broadly, to situate the inpatient care sector within a mental health reform dialogue that, to date, has focused almost exclusively on outpatient and community practices. We make the argument that until an evidence base is developed for recoveryoriented practices on hospital wards, the effort to advance recovery-oriented systems will stagnate. Our scoping review was conducted in line with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (commonly referred to as PRISMA) guidelines. Among the 27 papers selected for review, most were descriptive or uncontrolled outcome studies. Studies addressing strategies for improving care quality provide some modest evidence for reflective dialogue with former inpatient clients, role play and mentorship, and pairing general training in recovery oriented care with training in specific interventions, such as Illness Management and Recovery. Relative to some other fields of medicine, evidence surrounding the question of recovery-oriented care on psychiatric wards and how it may be implemented is underdeveloped. Attention to mental health reform in hospitals is critical to the emergence of recovery-oriented systems of care and the realization of the mandate set forward in the Mental Health Strategy for Canada. W W W Réforme de la santé mentale au niveau des systèmes : élargir nos vues sur les soins orientés vers le rétablissementCet article est une première tentative de colliger la littérature sur les soins axés sur le rétablissement de patients psychiatriques hospitalisés et, plus généralement, de situer le secteur des soins des patients hospitalisés dans le dialogue sur la réforme de la santé mentale qui, jusqu'ici, a porté presque exclusivement sur les pratiques ambulatoires et communautaires. Nous alléguons que jusqu'à ce qu'une base de données probantes soit établie pour les pratiques axées sur le rétablissement dans les services d'hospitalisation, les efforts en vue d'améliorer les systèmes axés sur le rétablissement stagneront. Notre étude de portée a été menée conformément aux lignes directrices des éléments de rapport préférentiels pour les revues systématiques et les méta-analyses de 2009 (PRISMA). Sur les 27 articles sélectionnés pour la revue, la plupart étaient des études descriptives ou de résultats non contrôlés. Les études abordant les stratégies d'amélioration de la qualité des soins offrent une évidence modeste pour le dialogue réflectif avec d'anciens patients hospitalisés, le jeu de rôle et le mentorat, et le jumelage de la formation générale en soins axés sur le rétablissement avec la formation en interventions spécifiques, comme le programme de prise en charge de la maladie et de rétablissement. En ce qui concerne d'autres domaines de la médecine, l'évidence à la question des soins axés sur le rétablissement dans les services d'hospitalisation et à la manière de les mettre en oeuvre est sous-développée. L'attention portée à...

Understanding perceptions of community participation in persons with severe mental illness: A mixed-methods approach

“…Seven of the nine participants in the smallest activity space size category (<5 km) have lives in these spaces that converge with traditional understandings of community: a physical presence in a geographic area that includes social contact with others and engagement with meaningful places. These participants were strongly connected to cultural or religious communities or social service organizations, which were located in close proximity to their home addresses (ID 15,8,4,2,16,27,28). For these participants, small activity spaces reflected social ties within a local geographic area, consistent with results from previous studies where people with smaller activity spaces were shown to experience a stronger sense of community.…”

“…The role of discrimination was prominent in shaping this aspect of community participation, resonating with the intense stigmatization of psychoses. 27 Herein lies one of the central dilemmas in the field -whether service environments should cultivate a community ethos (as in early sanitarium models) or strictly emphasize out-of-hospital community participation. Indeed, enhancing community participation is clearly complex, as evidenced by the unclear benefits of public awareness campaigns designed to reduce discrimination.…”

“…Indeed, enhancing community participation is clearly complex, as evidenced by the unclear benefits of public awareness campaigns designed to reduce discrimination. 27,28 A clear concern lies in the finding that small activity spaces were, for some, determined by fears of violence and victimization. Obviously relevant to SMI populations where trauma is common and there is a dose response relationship between victimization and illnesses such as psychosis, 29 it brings to light questions of human rights and the substandard living conditions being made available.…”

“…5 In literatures of community development, poverty, and welfare reform, combining mapping with qualitative inquiry has been found to be a highly effective way for people to describe their understanding of and participation in communities. 4,[10][11][12] One example of this type of approach for an SMI population is Townley et al's 5 use of social mapping to examine sense of community and activity in the Southeastern United States. This study emphasized the salience of "home" as the most important activity location, and observed that those with a smaller radius of community activity had a stronger sense of community integration, though lower life satisfaction.…”

Recovery-oriented Medical Training: An Informational Rapid Literature Review for the University of Recovery as a New Concept of Co-learning between Patients and (Future) Healthcare Providers

“…One paper is about physicians being trained to psychiatric/psychosocial rehabilitation (PSR) principles [38]. Several are about improving already established practices for inpatients [39,40], for instance through the implementation of advance directives [41], and at a system's level [42].…”