Models of mental health recovery: An overview of systematic reviews and qualitative meta-syntheses.

Abstract

Objective: This study systematically reviews the systematic review (SR) evidence on mental health recovery from the perspective of adults with mental illness. Methods: Web of Science, ProQuest Dissertations & Theses, CINAHL, PubMed, PsycINFO, Scopus, and the libraries of the Cochrane Collaboration, Campbell Collaboration, and Joanna Briggs Institute were searched to identify eligible SRs including qualitative primary research. Two reviewers independently conducted data extraction and quality assessment. Overlap of primary studies was calculated. A framework for recovery was generated using reflexive thematic analysis. Results: An ecological model of recovery that included elements of psychological well-being was generated from 25 studies bridging personal/clinical, individual/social, and process/outcome conceptualizations of recovery. The first theme was a definition of recovery as a transformation from a negative identity state marked by despair, brokenness, and helplessness to a positive state of psychological wellbeing. This transformation was contingent upon four additional themes that included: (a) social and environmental conditions supporting access to basic resources and safety; (b) development of a sense of autonomy and personal responsibility; (c) roles and relationships that facilitated the personal experience of belonging and meaning; and (d) enlightenment defined as acceptance of the illness as a part of oneself and insight into how to promote well-being. Conclusions and Implications for Practice: Professionals working in recovery-oriented systems must consider how the subjective self-representations of persons with mental illness and objective social relationships interact to impact recovery. We close by discussing interventions that may promote the personal and social conditions of recovery. Impact and ImplicationsEvidence from systematic reviews of persons with mental illness supports an ecological model of mental health recovery. Clinicians and peers serving persons with mental illness must assess how structural, interpersonal, and intrapersonal factors inhibit or amplify the subjective experience of recovery. Wellness and recovery-oriented services play an important role in supporting positive psychological growth.

Part II: Living Life: A Meta-Synthesis Exploring Recovery as Processual Experiences

“…The three areas of recovery processes (being, doing, and accessing) identified in our meta-synthesis enhance our understanding of the interrelationship of personal efficacy and social capability. Our findings also provide a way to advance the five themes identified by Dell and colleagues in their meta-synthesis of 25 systematic reviews on recovery by specifying the ecologically oriented features of recovery [ 79 ]. The themes generated in that study were (a) recovery as a process of overcoming despair to realize a positive sense of self and well-being, (b) environmental requirements necessary for recovery, (c) the role of autonomy, control, and personal responsibility, (d) the importance of social support and meaningful activities to the development of a sense of belonging and purpose, and (e) developing acceptance of one’s illness and insight into how to establish and maintain wellness ([ 22 ], p. 7–8).…”

“…The general tenet of these themes emphasizes the interplay between the self and the environment during recovery, which supports the processes of recovery. The three fundamental processes in recovery identified in our study thus specify how a person can attain “a positive sense of self and well-being” which Dell and colleagues identified as the key feature of the recovery process [ 79 ].…”

“It’s More Than Just Exercise”: Tailored Exercise at a Community-Based Activity Center as a Liminal Space along the Road to Mental Health Recovery and Citizenship

“…We suggest that experience of affiliation might even be the most important ingredient of the exercise at the activity center. Collaborations, relationships, and peers are significant contributors to increase hope [ 44 ], and recovery is dependent on a sense of belonging [ 5 ]. Considering how the participants in this study described how if they had a bad day, it was not a problem.…”

“…Thus, facing mental health challenges has profound impacts on many domains in life, such as impaired functioning in everyday life and reduced quality of life, as well as dropping out of school, studies and working life [ 2 , 3 , 4 ]. Several recovery studies also point out the impact on identity, the loss of positive roles and several negative effects of the stigma associated with mental health challenges, such as difficulties in finding work [ 5 , 6 ]. In the opposite direction, low education, being outside work and poor finances are important contributors to mental health challenges [ 3 , 7 ].…”

Part I: Dynamics of Recovery: A Meta-Synthesis Exploring the Nature of Mental Health and Substance Abuse Recovery

“…Our findings align with the results of a thematic synthesis by Dell et al of 25 systematic reviews on recovery within an ecological framework. The themes generated in that study were (a) recovery as a process of overcoming despair to realize a positive sense of self and well-being, (b) environmental requirements necessary for recovery, (c) the role of autonomy, control, and personal responsibility, (d) the importance of social support and meaningful activities to the development of a sense of belonging and purpose, and (e) developing acceptance of one's illness and insight into how to establish and maintain wellness ( [76], pp. 7-8).…”