Recovery-Oriented Practice in Mental Health Inpatient Settings: A Literature Review

Waldemar, Anna Kristine; Arnfred, Sidse; Petersen, Lone; Korsbek, Lisa

doi:10.1176/appi.ps.201400469

Cited by 73 publications

(92 citation statements)

References 35 publications

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“…To assist people with SMI achieve their goals, service-wide frameworks for recovery-oriented care provision are clearly needed [36–39], together with validated intervention strategies and programs [16, 38], and workforce education programs promoting recovery-enabling competencies and positive attitudes [52, 74]. …”

Section: Discussionmentioning

confidence: 99%

“…Within this context, and given the limited availability of established service-wide, recovery-focused models of care [36–39], a broader framework for an Integrated Recovery-oriented Model (IRM) for MH services was formulated, which sought to support and promote ‘ remediation , restoration and reconnection ’.…”

Section: Introductionmentioning

confidence: 99%

“…While the provision of recovery-oriented care is a guiding principle, implementing recovery-oriented or recovery-enabling [52] practices requires transformations within MH systems [10, 38, 39]. In some sectors, such as MH inpatient settings, there is limited research directly addressing recovery-oriented practice [39, 53]. However, a recovery enabling framework has been proposed to address workforce gaps in core recovery competencies among inpatient providers [52].…”

Section: Introductionmentioning

confidence: 99%

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An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges

et al. 2017

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BackgroundOver past decades, improvements in longer-term clinical and personal outcomes for individuals experiencing serious mental illness (SMI) have been moderate, although recovery has clearly been shown to be possible. Recovery experiences are inherently personal, and recovery can be complex and non-linear; however, there are a broad range of potential recovery contexts and contributors, both non-professional and professional. Ongoing refinement of recovery-oriented models for mental health (MH) services needs to be fostered.DiscussionThis descriptive paper outlines a service-wide Integrated Recovery-oriented Model (IRM) for MH services, designed to enhance personally valued health, wellbeing and social inclusion outcomes by increasing access to evidenced-based psychosocial interventions (EBIs) within a service context that supports recovery as both a process and an outcome. Evolution of the IRM is characterised as a series of five broad challenges, which draw together: relevant recovery perspectives; overall service delivery frameworks; psychiatric and psychosocial rehabilitation approaches and literature; our own clinical and service delivery experience; and implementation, evaluation and review strategies. The model revolves around the person's changing recovery needs, focusing on underlying processes and the service frameworks to support and reinforce hope as a primary catalyst for symptomatic and functional recovery. Within the IRM, clinical rehabilitation (CR) practices, processes and partnerships facilitate access to psychosocial EBIs to promote hope, recovery, self-agency and social inclusion. Core IRM components are detailed (remediation of functioning; collaborative restoration of skills and competencies; and active community reconnection), together with associated phases, processes, evaluation strategies, and an illustrative IRM scenario. The achievement of these goals requires ongoing collaboration with community organisations.ConclusionsImproved outcomes are achievable for people with a SMI. It is anticipated that the IRM will afford MH services an opportunity to validate hope, as a critical element for people with SMI in assuming responsibility and developing skills in self-agency and advocacy. Strengthening recovery-oriented practices and policies within MH services needs to occur in tandem with wide-ranging service evaluation strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1164-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges

et al. 2017

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“…However, medication and focus on symptoms and deficits become prominent when exploring the specific measures health professionals use to support personal recovery (Aston & Coffey 2012;Chen et al 2013;Cleary et al 2013). While achieving the knowledge and attitudes of recovery orientation theoretically, health professionals in inpatient settings seem to have significant difficulties in modifying their practices accordingly (Waldemar et al 2016;Zuaboni et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Recovery‐oriented practice: Participant observations of the interactions between patients and health professionals in mental health inpatient settings

Waldemar

Esbensen

Korsbek

et al. 2018

Int J Mental Health Nurs

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Despite an increasing attention towards recovery orientation in the mental health services, the provision of recovery-oriented practice is challenged in the inpatient wards. Moreover, the existing research within this area is modest and we currently have limited knowledge of how recovery-oriented practice is integrated into inpatient settings. A cornerstone of recovery-oriented practice is the collaboration, patient involvement, and choices, particularly when deciding and planning treatment options. Thus, this ethnographic study aimed to explore how recovery-oriented practice is reflected in the interactions between patients and health professionals around treatment in two mental health inpatient wards in Denmark. Participant observations were conducted in two mental health inpatient wards from November 2014 to January 2015. The Recovery Self-Assessment scale inspired the observation guide and the initial data analysis. Field notes were analysed deductively and inductively using qualitative content analysis. One theme with four subthemes emerged showing that interactions were characterized by an 'as-if collaboration' where 'negotiating on limited grounds' was an important feature of interactions, in which health professionals seemed to have superiority, acting on behalf of 'competing demands'. Patients had to navigate in a field of 'inconsistent guidance and postponed decisions' and faced tendencies of 'control and condescending communication'. The results suggest that recovery oriented values such as equal collaboration, choice and patients' personal preferences are reflected rhetorically in the interactions between patients and health professionals. However, they are negotiated within organizational logics and often overruled by competing demands.

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“…In this meeting, we first presented the results of the study on the team and staff member level (including the fidelity and RKI) and client level (including the quality of life, personal recovery, social functioning, hope, empowerment, self‐efficacy and care needs) separately. Subsequently, participants were divided into mixed groups of five to six people and asked to formulate three to five barriers to and three to five facilitators of implementation of the CARe methodology in a team according to model fidelity and working with the CARe methodology in practice and to write these down. Afterwards, the barriers and facilitators were exchanged and discussed fully.…”

Section: Methodsmentioning

confidence: 99%

Training professionals in a recovery‐oriented methodology: a mixed method evaluation

Bitter

Roeg

Nieuwenhuizen

et al. 2019

Scandinavian Caring Sciences

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Background Several studies have reported difficulties concerning the implementation of recovery‐oriented interventions. In this study, the effect of training in the Comprehensive Approach to Rehabilitation (CARe) on daily practice was evaluated. Additionally, we aimed to acquire insight into the experiences with the implementation process involving professionals, management and trainers. Methods Fourteen teams for sheltered and supported housing in the Netherlands participated in this study. As part of a cluster‐randomised controlled trial (RCT) design, eight teams received training in the CARe methodology. Model fidelity (using the CARe fidelity audit) and professionals’ knowledge of recovery (using the Recovery Knowledge Inventory) were measured for all teams until 20 months after the start. Afterwards, an evaluation meeting with participating stakeholders was organised in which barriers and facilitators of the implementation of the CARe methodology were inventoried. Results Ten months after the training, the intervention teams scored higher than the control teams on the fidelity subscales: ‘recovery’, ‘strengths orientation’ and ‘amount of training and coaching’. Twenty months after the training, only the effect of ‘amount of coaching and training’ remained. Additionally, ‘methodological working’ clearly differed between the groups after 20 months in favour of the intervention teams. In all teams, model fidelity was moderate at both measurements. The knowledge of recovery of the trained teams was slightly and significantly higher at 10 and 20 months after training. Although professionals were positive about recovery and strength‐oriented working, they experienced several organisational and societal barriers. Conclusion Training in the CARe methodology improved the fidelity and knowledge of recovery among professionals. However, the differences were small, and fidelity decreased over time. More in‐depth knowledge is needed on which barriers professionals experience in practice so that tailored training and implementation strategies can be developed. Furthermore, more attention is needed for professional development and the translation of theory into practice.

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Recovery-Oriented Practice in Mental Health Inpatient Settings: A Literature Review

Abstract: Research is needed to clarify the concept of recovery and how it applies to mental health inpatient settings. The challenges to recovery-oriented practice posed by the current organization of such settings should be examined.

Cited by 73 publications

References 35 publications

An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges

An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges

Recovery‐oriented practice: Participant observations of the interactions between patients and health professionals in mental health inpatient settings

Training professionals in a recovery‐oriented methodology: a mixed method evaluation

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