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.

Purpose The purpose of this paper is to explore two research questions: how do people with concurrent substance abuse and mental health disorders (concurrent conditions) experience and describe meaningful activities? And how do meaningful activities influence the recovery process? Design/methodology/approach This qualitative study uses an explorative and interpretive design in a phenomenological-hermeneutic approach. Transcribed interviews are analysed using a phenomenological-hermeneutic method for researching lived experience. The study was submitted to the Norwegian Center for Research Data where it was approved (Case No. 54661). Findings Structural analysis resulted in three overarching themes: achieving a positive identity through actions and feeling worthwhile; physically outside but inside the norms of society, and idleness, isolation, and obstacles on the road to recovery. Meaningful activities, considered a cornerstone in the recovery process, vary widely and are primarily described in social contexts, thereby confirming the significance of social aspects of recovery in addition to recovery as an individual journey. The findings also show that experiencing meaningful activities contributes to recovery capital and the development of recovery-promotive identities. Research limitations/implications The study consisted of a small sample size, recruited at one location which served as a primary research limitation. Practical implications This paper provides insights for health care practitioners and health care decision makers regarding the importance of meaningful activities viewed through a recovery perspective. Originality/value Few studies to date have used a comprehensive approach to describe the influence of experiencing meaningful activities on the recovery process.

Purpose – Hope is regarded central to recovery in a broad range of health conditions including mental health and substance use problems. Still the phenomenon, along with its implications to research and practice, has gained limited attention. The purpose of this paper is to explore first-person accounts of how practitioners nurture and inspire hope. Design/methodology/approach – This qualitative study is part of a larger action research project. Data were collected using in-depth interviews with eight participants. The interviews were transcribed verbatim and analyzed applying thematic analysis. Findings – Hope was perceived as a central phenomenon to practitioners within mental health and substance use services. The following overarching themes were identified through thematic analysis: “Believing in oneself and others,” “Seeing and acknowledging opportunities” and “maneuvering towards hope.” Research limitations/implications – It seems that there is a need for extending knowledge in how practitioners may inspire hope. In addition there seems to be a need for developing more knowledge on how practitioners’ own hope may be nurtured within a system that is constantly undergoing change and new demands. Practical implications – Participants considered their own hope as a prerequisite in being able to hope on behalf of others and strategies for inspiring hope were presented on both an individual and system level. Working conditions and challenges within the service system in itself entailed challenges, which at times made nurturing hope difficult. Systems need to embrace flexibility and openness, allowing efforts aimed at inspiring hope to be made. In addition, practitioner’s own hope and the importance of nurturing it, needs to be acknowledged within services. Hope needs to be viewed as a joint venture, in context and in relation to others. Originality/value – The paper contributes to the knowledge base on hope inspiring practices within a field sometimes associated with challenges and despair. It points out some important preconditions in relation to the challenges practitioners might encounter, both on an individual level and in relation to the service system per se.

No abstract

Background: Staff-directed aggression and violence may have harmful implications for all parts of a mental health service organisation. In an effort to advance the development of competent practice in community mental health and substance abuse services in Oslo, the municipality has offered various courses in the prevention and management of staff-directed aggression and provided supportive tools for practice development. Aim: To explore managers’ perceptions of how participating in education and applying supportive tools have contributed to the development of competence and practice in their own services. Method: Qualitative interviews with 11 managers working in homebased community mental health services were analysed, using qualitative content analysis. Findings: The findings show education and application of tools contributed to: 1) increased awareness and understanding of the complexities of staff-directed aggression; 2) empowered and collaborative practice through negotiations of power relations; and 3) adjustment of perceived management responsibilities and assignments. Conclusion: The findings indicate that managers not only felt their staff had become more knowledgeable and competent following education, but that participation in education also impacted on collaboration within and outside their own services, as well as directly influencing how they dealt with threatening situations in the workplace. Implications for practice: Staff-directed aggression is a complex phenomenon and efficient practitioners are able to keep in mind a number of relevant aspects of practice simultaneously Collaboration in prevention and management of staff-directed aggression requires staff to acknowledge and accommodate service users’ perspectives regarding practice A levelling of power differentials between community mental health services and specialist mental health services takes place when partaking in the same education and sharing vocabulary and conceptual frameworks regarding risk assessment and management