Objective: The attitudes of mental health professionals towards consumers’ recovery are far more pessimistic than what is needed for the recovery-orientation to truly permeate systems of care. It has become pressing to depict determinants for these attitudes and how they evolve during professionalization. This, in the hopes to adjust not only medical education, but also ongoing training of professionals. Methods: A systematic search of PubMed and PsycINFO databases was conducted, yielding a net 15 303 records. Twenty-two publications from specific educational journals and reference lists were added. Finally, thirty-four full texts were read, from which twenty-two articles were included. Results: From the reviewed studies emerged five main determinants: profession, education, age, clinical experience, and nature of the contact with consumers. Traditional clinical placements during residency, negative experiences with acute patients, younger age and the professional attitudes of psychiatrists seem to all be determining factors for professionals’ pessimistic attitudes towards recovery. Conclusions: This review found specific determinants for attitudes in recovery and four out of five can be acted upon. For a recovery-orientation to be implemented across our mental health system, we formulate recommendations within the Canadian context for revision of curriculum, recovery-specific training, and operationalisation through state/provincial technical assistance centers.

Aims No instrument has been developed to explicitly assess the professional culture of mental health workers interacting with severely mentally ill people in publicly or privately run mental health care services. Because of theoretical and methodological concerns, we designed a self-administered questionnaire to assess the professional culture of mental health services workers. The study aims to validate this tool, named the Mental Health Professional Culture Inventory (MHPCI). The MHPCI adopts the notion of ‘professional culture’ as a hybrid construct between the individual and the organisational level that could be directly associated with the professional practices of mental health workers. Methods The MHPCI takes into consideration a multidimensional definition of professional culture and a discrete number of psychometrically derived dimensions related to meaningful professional behaviour. The questionnaire was created and developed by a conjoint Italian-Canadian research team with the purpose of obtaining a fully cross-cultural questionnaire and was pretested in a pilot study. Subsequently, a validation survey was conducted in northern Italy and in Canada (Montreal area, Quebec). Data analysis was conducted in different steps designed to maximise the cross-cultural adaptation of the questionnaire through a recursive procedure consisting of performing a principal component analysis (PCA) on the Italian sample (N = 221) and then testing the resulting factorial model on the Canadian sample (N = 237). Reliability was also assessed with a test-retest design. Results Four dimensions emerged in the PCA and were verified in the confirmatory factor analysis: family involvement, users' sexuality, therapeutic framework and management of aggression risk. All the scales displayed good internal consistency and reliability. Conclusions This study suggests the MHPCI could be a valid and reliable instrument to measure the professional behaviour of mental health services workers. The content of the four scales is consistent with the literature on psychosocial rehabilitation, suggesting that the instrument could be used to evaluate staff behaviour regarding four crucial dimensions of mental health care.

Background: Most existing conceptual models of residential environments and housing programs were developed over a decade ago or lack comprehensiveness. The attributes to be used to describe housing programs with adequate specification remain unclear including the attributes that mediate service user outcomes. In this study, group concept mapping was used to develop a conceptual model of housing and community-based residential settings for adults with severe mental illness based on stakeholder perceptions and values. Methods: Participants were selected through purposive sampling and included service users, family members, staff working in residential facilities, mental health workers and managers. Participants (n=221) generated 1,382 statements describing attributes of housing and community-based residential settings for adults with severe mental illness (99% saturation). Thematic content analysis was conducted to analyze the statements and create a list of 140 selected statements. Participants then rated (n=416) and sorted into categories (n=73) the selected statements. Descriptive statistics were computed for each statement relative importance. Multidimensional scaling and hierarchical cluster analysis were used to produce the conceptual model (maps). Stakeholders (n=12) were also involved in the interpretation of the maps. Results: The findings show overall concordance between stakeholders in relation to statements perceived importance (rating) and the statements interrelationships (sorting). The stress value of 0.23 indicates that the two-dimensional solution of the multidimensional scaling analysis fits the data set (goodness of fit). The final conceptualization includes 12 clusters: (1) A balanced and healthy housing system; (2) Quality and management practices (facility/local level); (3) Physical external environment;