Exploration of recovery of people living with severe mental illness (SMI) in low/middle-income countries (LMICs): a scoping review

Abstract

ObjectiveTo examine the literature on how recovery of people with severe mental illness (SMI) is conceptualised in low/middle-income countries (LMICs), and in particular what factors are thought to facilitate recovery.DesignScoping review.Data sources and eligibilityWe searched 14 electronic databases, hand searched citations and consulted with experts during the period May–December 2019. Eligible studies were independently screened for inclusion and exclusion by two reviewers. Unresolved discrepancies were referred to a third reviewer.Data extraction and synthesisAll bibliographical data and study characteristics were extracted using a data charting form. Selected studies were analysed through a thematic analysis emerging from extracted data.ResultsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram offers a summary of the results: 4201 titles, 1530 abstracts and 109 full-text articles were screened. Ten articles were selected for inclusion: two from Turkey, two from India, and one each from China, Swaziland, Indonesia, Egypt, South Africa and Vietnam. Although most studies used qualitative methods, data collection and sampling methods were heterogeneous. One study reported on service provider perspectives while the rest provided perspectives from a combination of service users and caregivers. Three themes emerged from the data analysis. First, studies frame recovery as a personal journey occurring along a continuum. Second, there was an emphasis on social relationships as a facilitator of recovery. Third, spirituality emerged as both a facilitator and an indicator of recovery. These themes were not mutually exclusive and some overlap exists.ConclusionAlthough there were commonalities with how high-income countries describe recovery, we also found differences in conceptualisation. These differences in how recovery was understood reflect the importance of framing the personal recovery concept in relation to local needs and contextual issues found in LMICs. This review highlighted the current sparse evidence base and the need to better understand recovery from SMI in LMICs.

Service Providers Perspectives on Personal Recovery from Severe Mental Illness in Cape Town, South Africa: A Qualitative Study

“…Given that personal recovery includes being able to participate in everyday life and everything that holds meaning and purpose for an individual, the factors influencing recovery extend past the confines of services offered by the health sector or the abilities of an individual with SMI. A scoping review on recovery from SMI in LMICs found that social networks and supportive relationships with others facilitated social inclusion and recovery (Gamieldien et al, 2021 ). If personal recovery happens in community and requires long term relational support, then service providers must consider where and how MHSUs can access this network once discharged from hospital.…”

“…The interest in research on recovery from SMI in LMICs is relatively new. A scoping review exploring the recovery of people living with SMI in LMICs (Gamieldien et al, 2021 ) found similarities but also contextual differences in how stakeholders from high income countries and LMICs frame personal recovery from SMI.…”

Peer-led recovery groups for people with psychosis in South Africa (PRIZE): protocol for a randomised controlled feasibility trial

“…For example, it is proposed that family support has greater influence on recovery in low- and middle-income countries (LMICs) compared to high-income countries (HICs). Likewise, social connectedness and interdependence may be more pertinent indicators of recovery in LMICs [ 6 ].…”

Peer-led recovery groups for people with psychosis in South Africa (PRIZE): protocol for a randomized controlled feasibility trial

“…Likewise, social connectedness and interdependence may be more pertinent indicators of recovery in LMICs. 4 Community-based psychosocial support offers bene ts in terms of reducing symptom severity and improving functioning in people with psychosis. 5,6 Task-sharing, that is the delivery of circumscribed aspects of healthcare by less specialised workers with specialist support, is championed to increase coverage of community-based care.…”

“…Peer support groups may also provide a good t in LMIC settings where family and sociallyoriented mechanisms of recovery are prominent. 4 Whilst there is little evidence to date that peer support approaches provide greater bene ts than usual care in reducing hospital readmission or relapse [11][12][13][14] , there is some evidence that group peer support interventions are effective in supporting personal recovery in people with schizophrenia, depression and bipolar disorder. 14 However there is an absence of high quality evidence for peer support approaches for people with psychosis in LMIC.…”