Recent Government policy advocates treating comorbid clients within mainstream mental health services. Health care workers need to recognise the likelihood of high levels of social exclusion among clients with comorbid problems.

This paper discusses methodological issues arising in the initial stages of a larger epidemiological case-control study. Practitioners from both Generic Mental Health and Substance Misuse Services (n = 170) were asked to identify which of their clients, from a time-limited caseload (n = 2341), had comorbid mental health and substance misuse problems. Although practitioners were provided with a definition of 'singly diagnosed' and 'dually diagnosed', it became apparent that these definitions were applied pragmatically, depending on the nature of the client's primary problem and the agency they were presenting to. Issues raised include the time period in which a client was considered to have a concurrent mental health problem and substance misuse, how a 'mental health problem' was defined and whether a personality disorder should be categorized as a 'mental health problem'. There was also some disagreement about whether clients who were being treated primarily by Substance Misuse Services, but were also taking prescribed antidepressants, implicitly had a 'mental health problem'. We raise these methodological issues, as they have implications for determining the prevalence of 'dual diagnosis' and the subsequent provision of services.

Purpose To conduct a systematic review and meta-analysis of quality of life (QoL) outcomes for people with serious mental illness living in three types of supported accommodation. Methods Studies were identified that described QoL outcomes for people with serious mental illness living in supported accommodation in six electronic databases. We applied a random-effects model to derive the meta-analytic results. Results 13 studies from 7 countries were included, with 3276 participants receiving high support (457), supported housing (1576) and floating outreach (1243). QoL outcomes related to wellbeing, living conditions and social functioning were compared between different supported accommodation types. Living condition outcomes were better for people living in supported housing (g = − 0.31; CI = [− 0.47; − 0.16]) and floating outreach (g = − 0.95; CI = [− 1.30; − 0.61]) compared to high-support accommodation, with a medium effect size for living condition outcomes between supported housing and floating outreach (g = − 0.40; CI = [− 0.82; 0.03]), indicating that living conditions are better for people living in floating outreach. Social functioning outcomes were significant for people living in supported housing compared to high support (g = − 0.37; CI = [− 0.65; − 0.09]), with wellbeing outcomes not significant between the three types of supported accommodation. Conclusion There is evidence that satisfaction with living conditions differs across supported accommodation types. The results suggest there is a need to focus on improving social functioning and wellbeing outcomes for people with serious mental illness across supported accommodation types.

More than 450 million people have been estimated to have mental health disorders worldwide with many more experiencing mental health challenges, according to the World Health Organization. People with mental health challenges can find their environments not supportive of their engagement in meaningful daily activities of self-care, work and leisure. While occupational therapists value having an understanding of how the environment impacts on a person's occupational participation, it has been argued that the concept has been poorly defined. The Model of Human Occupation provides a clinically useful definition of the environment. Moreover, the Model of Human Occupation provides clinical assessments and outcome measures that measure how the environment facilitates occupational participation.

Purpose: The purpose of this paper is to present a qualitative analysis of the facilitators of recovery in inpatient psychiatric rehabilitation from the service users' perspective. Design/methodology/approach: Interviews with 31 in-patients were coded and analysed thematically at an interpretive level using an inductive approach. Findings: The dominant themes identified were hope, agency, relationships and opportunity. Totally, 20 subthemes were identified. Agency was more important to men than women and agency, hope and relationships were all more important to detained patients. Research limitations/implications:Interview data were collected in writing rather than taped. The results may not be transferrable to patient populations with significantly different demographic or service factors. Practical implications: Services need to target interventions at the areas identified by service users as important in their recovery. The findings suggest both environmental and relational aspects of care that may optimise recovery. Services also need to be able to measure the quality of the care they provide. A brief, culturally valid and psychometrically assessed instrument for measuring the recovery orientation of services is required. Originality/value: As far as the authors are aware no qualitative work to date has examined the recovery experiences of psychiatric in-patient service users in order to understand what services require to do to enable recovery from their perspective. The conceptual framework identified in this paper can be used to develop a service user self-report measure of the recovery orientation of services.