Presentation on theme: "Mental Health Recovery and Wellness: Role of Occupational Therapy"— Presentation transcript:
1 Mental Health Recovery and Wellness: Role of Occupational Therapy Kathlyn L. Reed PhD, OTR, FAOTA, MLISAssociate Professor EmeritaTexas Woman’s University: Houston
2 ObjectivesDiscuss concept of maintaining health and wellness after recovering from a mental illnessDescribe programs developed by occupational therapists designed to assist in maintaining wellness and recoveryIllustrate examples of selected programs.
3 Criteria for Article Selection IncludedExcludedOriginal article or abstract in EnglishPublished betweenOne or more authors is an occupational therapist OR methodology includes an assessment developed by an occupational therapist(s) OR occupational therapy is used in methodology section AND data on one or more daily living activity is reported54 studies met criteriaArticles not in EnglishArticles published before 2000Articles in which the involvement of occupational therapy or occupational therapist(s) could not be established (authorship, data collector, therapist) or occupational therapy was used as the control groupBooks, chapters, blogs, web pages, videos, news articles, CATs, protocols, clinical trial or grant proposals, Cochrane reviews
4 Search Strategy & Databases Wellness OR recovery OR self help AND mental* ill* OR mental health OR psychiatr* OR psychotic OR psychosis OR neuropsychiatr* OR schizophrenia OR bipolar AND occupational therap*MEDLINEPsychiatry & Behavioral SciencesPsycINFOCINAHLProquest Nursing & Allied HealthHealth Reference CenterOT SeekerGoogle
5 Definition: WellnessWellness is a conscious, deliberate process that requires a person to become aware of and make choices for a more satisfying lifestyleA wellness lifestyle includesa self-refined balance of health habits:adequate sleep, rest, and good nutrition;productivity and exercise;participation in meaningful activity; andconnection with people and communities that are supportive.Swarbrick M. (1997). A wellness model for clients. Mental Health Special Interest Section Quarterly, 20, 1-4.
6 Definition: Recovery Definitions depend on perspective Outcome: ability to lead a good and satisfying life despite illness or presence of symptoms (Deegan, 2001)Process: a non-linear lived experience involving both self-discovery and transformation and culminating in an understanding that symptoms of illness are not definitive in terms of one’s self-identify (Davidson et al, 2005)Philosophical underpinnings: concepts such as hope, connection, healing, empowerment, self-help, mutual-help, self-determination, family involvement, resiliency, choice, justice, responsibility, skill building, community involvement, education and role development, focus on strengths and possibilities, positive culture for healing. (Casey, 2008)
7 Changing Models Client centered Focus on wellness and function Medical ModelWellness/RecoveryProfessional in chargeFocus on illness and dysfunctionFocus on disability and lack of competenceFocus on controlling or reducing symptomsTends to be reductionisticGoal is cure and eliminating symptoms of illnessClient centeredFocus on wellness and functionFocus on ability and competenceFocus on aspects of health, well-beingTends to be holisticGoal is “doing” daily activity regardless of symptoms
8 Changing Models Illness Centered Models Person Centered Models Diagnosis is foundationBegins with assessment of symptoms of illnessServices bases on diagnosis & treatment neededServices work toward illness reduction goalsTx: symptom driven & rehab: disability drivenTrack illness progress toward symptom reduction & cureUse techniques that promote illness control & reduction of risk of damage from illnessRelationship is foundationBegins with welcoming – outreach and engagementServices based on personal suffering & help neededServices work toward qualify of life goalsTreatment & rehabilitation are goal drivenTrack personal progress toward recoveryUse techniques that promote personal growth and self responsibility
9 Changing ModelsIllness CenteredPerson CenteredRecovery from illness is addressed first, then disabilityRelationship only exists to treat illness & is carefully restricted throughout to keep it professionalServices end when illness is curedPersonal recovery is central from beginning to end of interventionRelationship may change and grow throughout and continue even after services endServices end when person manages own life and attains meaningful rolesAuthor: Mark Ragins, MD
10 Barriers to WellnessLack of financing to support health promotion interventionsLack of synergy between medical and mental health servicesResistance to change in mental health service delivery models, infrastructure, and settingsNegative attitudes and prejudice among health care providersLack of health information that addresses the diverse needs of people with psychiatric disabilities
11 Barriers to WellnessNegative health care experiences by persons with mental illness that keep them awaySide effects of psychiatric medicationMembership in a diverse community (racial, ethic, disability, sexual orientation, immigrant)Access to quality health careInadequate health insurance coveragePovertySource: Center for Psychiatric Rehabilitation, Boston University cpr.bu.edu/resources/newsletter/wellness-recovery-pledgeAND Decreased involvement by occupational therapy practitioners in mental health programing
12 Assessments: Non OT Brief Symptom Inventory (BSI) Coping with Symptoms Checklist (SCS) Yanos, Knight & Bremer, 2003Cybernetic Coping Scale (CCS) Edwards && Baglioni, 1993IMR Scale Self-Report: Mueser & Gingerich, 2005Norbeck Social Support Questionnaire (NSSQ). (Norbeck, Lindsey, & Carrieri, 1981)Perceived Social Support Scale (PSSS) Blumenthal et al, 1987Qualify of Life Interview (QoL). Lehamn, 1988Recovery Assessment Scale: Corrigna, Slazer, Ralph, Sangster, & Keck, 2004Rosenberg Self-Esteem scale (RSES) Rosenberg,Symptom Distress Scale
13 Adapted from Swarbrick, M. (2006). A wellness approach Adapted from Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29, (4),
14 Dimensions of Wellness: Physical Physical involves maintenance of a healthy body, good physical health habits, good nutrition and exercise and obtaining appropriate health care.It is important to empower people to focus on nutrition, exercise, smoking cessation, and stress awareness reduction as means of self-care and prevention of co-occurring medical conditions.It is important to offer services and supports that empower or serve users to establish health habits and routines and access timely preventative and needed healthcare services.
15 Dimensions of Wellness: Physical Diet and nutritionPhysical activitySleep/RestStress management/relaxationMedical care/screeningsHealth habits and routinesSwarbrick, M Wellness and recovery: A self-defined balance of health habits. Recovere-works
16 Dimensions of Wellness: Intellectual Intellectual involves lifelong learning, application of knowledge learned, and sharing knowledge.We need to recognize people’s creative abilities and help individuals find ways to expand knowledge and skills while helping them discover the potential for sharing those gifts with others.Services and supports should help people pursue personal interests and remain current on issues, as well as offer opportunities to share ideas.
17 Dimensions of Wellness: Environmental Environmental involves being able to be and feel physically safe, in safe and clean surroundings and able to access clean air, food, and waterThis includes both our micro-environment (places where we live, learn, work, etc.) and our macro environment (our communities, country, and planet).Services and support should help people to create living, learning, and working spaces that promote learning, contemplation and relaxation
18 Dimensions of Wellness: Spiritual Spiritual involves having meaning and purpose and a sense of balance and peace.This is one of two aspects of life which keep many people going in their recoveries.The mental health system sometimes views spirituality as pathology rather than helping people to connect with cultural, religious, and/or spiritual traditions and environments which enhance self-identity
19 Dimensions of Wellness: Social & Emotional Social involves having relationships with friends, family, and the community and having an interest in and concern for the needs of others and humankind.Social support and connectedness is a key ingredient to support recoveryEmotional involves the ability to express feelings, enjoy life, adjust to emotional challenges, and cope with stress and traumatic life experiences.Emotional stability helps an individual recognize conflict as being potentially health, and enhances self-acceptance, and contentment.
20 Dimensions of Wellness: Financial Financial involves ability to have financial resources to meet practical needs, and a sense of control and knowledge about personal finances.Financial instability can result in emotional distress thus attention to financial economic self-sufficiency is a central focus of assessment and intervention.
21 Dimensions of Wellness: Occupational Occupational involves participating in activities that provide meaning and purpose, including employment, volunteer work, and engagement on meaningful activity connected to social roles.People find self-definition through their jobs, structure their lives, develop a sense of self-efficacy, develop and maintain relations, maintain incomes that support financial wellness, and more.Under and over employment undermine recovery, thus access to evidenced based supported employment services is essential for any funded service delivery system, and key to transcend the poverty trap too often faced by service users.Swarbrick, M. (2012).
22 Goal Setting Based on SMART Method Specific: Goals should be specific, using action words (walking, scheduling, purchasing etc.)Measurable: Use specific criteria that indicate attainment or degree of attainment: times per week, number of items or thingsAchievable: Goal should require some effort but be within reach of the individualRealistic: Goal should be possible to accomplish: avoid too easy or never: use reduce or increase over timeTimely: Provide a clear target for completion of work toward goalBrice, Swarbrick & Gill, 2014
23 Goal Setting: Diet and Nutrition I will create healthy eating habits by maintaining a daily food, sleep, and stress log.I will record number of hours slept, number of times I am waking up in middle of night and time and what I ate.I will record activity during day causing stress and triggering eating habitsI will lose 5 lbs per month for next 3 months by eating vegetables 3 days per week and walking 20 minute 2 days per weekI will take lunch to work three times per weekSource: Brice, Swarbrich & Gill, 2014
24 Goal Setting: Physical Activity I will do weekly physical activity (warm up, karate, or calisthenics) for 30 minutes (3 days) and create a flexible exercise scheduleI will go to the YMCA on Tuesdays and Thursdays ad continue my3 to 4 days per week of aerobic activityI will do aerobic yoga activity for 20 to 30 minutes 6 days per weekI will work on strength training twice per week, on Tuesdays and Saturdays, 6 p.m. and 1 p.m. respectively
25 Goal Setting: Relaxation/Stress Management I will listen to gospel and rhythm and blues music on Mondays, Wednesday, and Fridays for 2 hourI will read for enjoyment on Saturday afternoon or evening for 30 minutesI will schedule relaxation 5 days per week for at least 45 minutes by logging day/length of time and activity (e.g., science fiction, DVD series, reading).
26 StatisticsMost Frequent Topics: diet and nutrition, physical activity, relaxation/stress management, sleep & restAverage Contacts per Person: 10 session (range 4-17). Time not stated.Fifty-nine % achieved goals, 28% partiallyImportant to help clients identify strengths – and that reaching goals can become strengthsLogs help: have clients keep a log/diaryBrice, Swarbrick, & Gill, 2014
27 Wellness Coaching: Swarbrick Coaching is a positive supportive relationship between the coach and the person who wants to make a change (Swarbrick, 2010, Wellness coaching: Supervisor manual, p. 6)Coaching includes:Help person to clarify problem/need for change or improvementDetermine if there is a clear goalBrainstorm actions to be takenDetermine the actionSet an accountability stepSet a time frame to accomplish the action
28 Model of Human Occupation Volition: when people have autonomy and control over their lives they are better motivated to find values, interests and purpose. The Recovery Model recognizes people have ‘hopes, dreams, goals, and choices’Habituation: the Recovery Model encourages responsibility, with the emphasis upon community and social environments. This in turn facilitates individual having a daily routine that is purposeful, fulfilling and structure which varies for each individual depending upon his or her stage of recoveryMind-Brain-Body Performance: the Recovery Model facilitates development of skills to enhance confidence, self-esteem, concentration and social interaction, leading to an improvement in individual’s quality of lifeWimberly & Peters, 2003, recovery in acute mental health, OT News, July, p. 25
29 Recovery Star ModelOT News, October, 2012, p. 47
30 Recovery Star ModelPerson follows a ‘ladder of change’ comprised of five stages with two choices as each levelBeing stuckAccepting helpBelievingLearningSelf relianceUsing a scale of one to 10In 10 domainsManaging mental healthTrust & hopeIdentify & self-esteemResponsibilitiesAddictive behaviorRelationshipsWorkSocial networdksLiving skillsSelf-care
31 Recovery Star: Self-Care Ladder StuckI don’t look after myselfI don’t look after myself but occasionally I realize I feel awfulAccepting HelpI didn’t used to feel so bad – I want helpI’m working with someone to feel betterBelievingI want to take responsibility for looking after myself wellI’m doing things differently because I want to feel betterLearningI’m learning what makes me feel goodI’m building a healthy way of lifeSelf-RelianceI’m learning to maintain a healthy way of lifeI have a sense of well-being and know how to maintain it.MacKeith & Burns (2008). Mental Health recovery star: User guide. Mental health Providers Form and Triangle Consulting.
32 Clubhouse ModelClubhouses are local community centers that provide members with opportunities to build long-term relationships and obtain employment education and housing including:A work-ordered day in which talents & abilities of members are recognized & utilized within ClubhouseParticipation in consensus-based decision making regarding all important matters relating to running ClubhouseOpportunities to obtain paid employment through Transitional Employment programAssistance in accessing community-based educational resourcesAccess to crisis intervention services when neededEvening/weekend social and recreational eventsAssistance in securing & sustaining safe, decent & affordable housing
33 GROW Model: Twelve Stages of Decline We gave too much importance to ourselves & our feelingsWe grew inattentive to God’s presence & providence & God’s natural order in our livesWe let competitive motives, in our dealings with others, prevail over our common personal welfareWe expressed our suppressed certain feelings against better judgment of conscience or sound adviceWe began thinking in isolation from others, following feelings & imagination instead of reasonWe neglected care and control of our bodiesWe avoided recognizing our person decline & shrank from task of changingWe systematically disguised in our imaginations real nature of our unhealthy conductWe become a prey to obsessions, delusions & hallucinationsWe practice irrational habits, under elated feelings of irresponsibility or despairing feelings of inability or compulsionWe rejected advice & refused to co-operate with helpWe lost all insight into our condition
34 Grow Model: Twelve Steps of Recovery We admitted we were inadequate or maladjusted to lifeWe firmly resolved to get well and co-operate with help that we neededWe surrendered to healing power of a wise loving GodWe made a personal inventory and accepted ourselvesWe made a moral inventory & cleaned out our heartsWe endured until curedWe took care & control of our bodiesWe learned to think by reason rather than by feelings & imaginationWe trained our wills to govern our feelingsWe took our responsible & caring place in societyWe grew daily closer to maturityWe carried GROW’s hopeful, healing, & transforming message to others in need.GROW founded by Father Cornelius Keogh in Australia in 1957
35 Wellness Recovery Action Plan: Copeland Six sections: Usually kept in a notebookDaily Maintenance ListWhat I’m like when I am feeling all rightThings I need to do for myself every day to keep myself feelings all rightsAdditional things I might need to do (or that would be good to do)TriggersThings that, if they happen, might cause an increase in my symptomsAction Plan – Things that I can do if my triggers come up to keep them from becoming more serious symptomsEarly Warning SignsSome early warning signs that others have reported and/or I have observedThings I must do if I experience early warning signs:Things I can do if they feel right to me
36 WRAP Continued When Things are Breaking Down Crisis Plan Signs/symptoms that indicate that things are getting worseAction Plan – Things that can help reduce my symptoms when they have progressed to this pointCrisis PlanPart 1 – What I’m like when I’m feeling well (reference Daily Maintenance List)Part 2 – SYMPTOMS that indicate that others need to take over full responsibility for my care and make decision on my behalfPart 3 – These are my SUPPORTERS, the people who I want to take over for me when the symptoms I listed in Part 2 come upPart 4 – Medications/SupplementsPart 5 – TreatmentsPart 6 – Community PlanPart 7 – Treatment FacilitiesPart 8 – Help from othersPost Crisis Plan: Inactivating the Crisis PlanSymptoms, lack of symptoms or actions that indicate that my supporters o longer need to use this Crisis Plan
37 Occupational Therapy Role Goals:Empower clients to take action for themselves:self manage, self direct, and live wellDevelop competencies that enable participation, not just contain illness (White, 2011)Models: UseClient centered approachWellness and recovery strategiesCollaborative and interdisciplinary techniquesLearn-by-doing models (Swarbrick & Duffy, 2000)
38 Occupational Therapy Role Develop and implement self-help center policy and procedure guidelines for conducting focus groupAssist in developing self-help center manual to facilitate management and leadership structureAssist consumers to engage in mutual group planning process to formulate decisions and action plansHelp consumer groups identify and define issues, areas, and components needed to address policy and procedures for center/program administrationSupport development of program components such as socialization, recreation, self-help, peer counseling, advocacy and wellness and recovery.Work with groups of clients to develop and implement programsWork with groups of client to develop manuals for consumer leaders to useSwarbrick & Duffy, 2000
39 SummaryConsumer-Run Self-Help approaches appear to work best for mood & anxiety disorders & those with physical health issues (Goering et al, 2006)Most common issues are stable housing, employment, and avoiding emergency room visits (Goering et al, 2006). However, depends on what questions are asked in survey questionnaire.Positive relationships are most important to people who attend self-help centers and related directly to level of satisfaction with program (Swarbrick, 2009; Swarbrick, Schmidt & Pratt, 2009)
40 References: Wellness/Recovery AOTA (2011). Occupational therapy’s role in mental health recovery. Bethesda, MD: AuthorAsmundsdóttir, E.E. (2009). Creation of new services: Collaboration between mental health consumers and occupational therapists. Occupational Therapy in Mental Health, 25(2), (Level V, interview, Iceland)Ayash, H. (2007). Changing the way we work. OT News, (Level V, program description, UK)Brice, G.H., Swarbrick, M.A., & Gill, K.J. (2014). Promoting the wellness of peer providers through coaching. Journal of Psychosocial Nursing, 52(1), (LevelBrown, C. (Ed.). (2001). Recovery and wellness: Models of hope and emplowerment for people with mental illness. New York: Haworth Press.Caldweell, B.A., Scianfani, M., Swarbrick, M. & Piren, K. (2010). Psychiatric nursing practice & the recovery model of care. Journal of Psychosocial Nursing, 48(7), (Level V, overview, USA)Casey, R. (2008). Towards promoting recovery in Vancouver Community Mental Health Services, International Journal of Psychosocial Rehabilitation, 12 (2), (Level V, literature review, Canada)Chen, S.P., Krupa, T., Lysaght, R., McCay, E. & Piat, M. (2013). The development of recovery competencies for in-patient mental health providers working with people with serious mental illness. Administrative Policy in Mental Health, 40, (Level V, interview, Canada)
41 References: Wellness/Recovery Clayton, J. & Tse, S. (2003). An educational journey towards recovery for individuals with persistent mental illness: A New Zealand perspective. Psychiatric Rehabilitation Journal, 27(1), (Level V, program description, New Zealand)Copeland, M.E. (2001). Wellness recovery action plan: A system for monitoring, reducing and eliminating uncomfortable or dangerous physical symptoms and emotional feelings. Occupational Therapy in Mental Health, 17(3/4), (Level V, model, USA)Crawley, M., Lovell, P. & Clarke, S. (2012) Understanding recovery through creative means. OT News, 20(3), 31 (Level V, program description, UK)Deegan, P.E. (2001). Recovery as a self-directed process of healing and transformation. Occupational Therapy in Mental Health, 17(3/4), (Level V, narrative, USA)Elliott, S., & Jenkins, V. (2011). Assisting recovery in adult mental health day services. OT News, 20(4) (Level V, program description, UK)Fieldhouse, J. (2012). Community participation and recovery for mental health service users: An action research inquiry. British Journal of Occupational Therapy, 75(9), (Level V, interview, UK)Gibson, R.W., D’Amico, M. Jaffe, L. & Arbesman, M. (2011). Occupational therapy interventions for recovery in the areas of community integration and normative life roles for adults with serious mental illness: A systematic review. AJOT, 65, (Systematic review, USA)
42 References: Wellness/Recovery Hanssens, T. (2006). Revisiting recovery. Advance for Occupational Therapy Practitioners, 22(5), 12. (Level V, USA)Hurley, E. & McKay, E.A. (2009). The recognition and adoption of the recovery approach by occupational therapists in acute psychiatric settings in Ireland. Irish Journal of Occupational Therapy, 37(2), (Level V, Ireland)Jahrami, H., Panchasharam, G. & Saif, Z. (2012). Wellness: The overlooked intervention for individuals with psychosis in the Kingdom of Bahrain. Occupational Therapy International, 19(3), (Level V, Bahrain)Kelly, M., Lamont, S. & Brunero, S. (2010). An occupational perspective on the recovery journey in mental health. British Journal of Occupational Therapy, 73(3), (Level V, Australia)Knott, J. (2010). Wellbeing for life. OT News, 18(11), 29 (Level V, UK)Krupa, T. & Clark, C. (2009). Using tensions in practice to promote the integration of treatment and rehabilitation in a a recovery-oriented system. Canadian Journal of Community Mental Health, 28, (Level V, Canada)Lal. S. (2010). Prescribing recovery as the new mantra for mental health: Does one prescription serve all? Canadian Journal of Occupational Therapy, 77(2), (Level V, Canada)
43 References: Wellness/Recovery Lloyd, C., King, R. McCarthy, M. & Scanlan, M. (2006). The association between leisure motivation and recovery: A pilot study. Australian Occupational Therapy Journal, 54(1), (Level V, correlation, Australia)Lloyd, C., Waghorn, G. & Williams, P.L. (2008). Conceptualising recovery in mental health rehabilitation. British Journal of Occupational Therapy, 71(8), (Level V, Australia)McKendrick, N., White, M., McCutcheon, S., Craig, L. & Davidson, A. (2010). Walking on the road to mental health recovery. OT News, 18(3), (Level V, program description, UK)McKenzie, R. (2013). The recovery star in action. OT News, 21(1), (Level V, case study, UK)Peloquin, S.M. (2010). Occupational therapy among women in recovery from addiction. OT Practice, 15(May 24), 12-15, 22. (Level V, program description, USA)Pitts, D.B. (2004). Understanding the experience of recovery from persons labeled with psychiatric disabilities. OT Practice, 9(5), CE1-CE8 (Level V, overview, USA)Potter, S. (2012). Implementing recovery through organisational change. OT News, 20(10), (Level V, program model, UK)
44 References: Wellness/Recovery Pratt, C.W., Lu, W., Swarbrick, M. & Murphy, A. (2011). Selective provision of illness management and recovery modules. American Journal of Psychiatric Rehabilitation, 14, (Level V, USA)Reberiro Gruhl, K.L. (2005). The recovery paradigm: Should occupational therapists be interested? Canadian Journal of Occupational Therapy, 72(2), (Level V, overview, Canada)Robertson, C. (2012). Home but away. OT News, 21(12), (Level V, survey, UK)Sutton, D.J., Hocking, C.L. & Smythe, L.A. (2012). A phenomenological study of occupational engagement in recovery from mental illness. Canadian Journal of Occupational Therapy, 79(3), (Level V, narratives, New Zealand)Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29(4), (Level V, USA)Swarbrick, M. (2010). Peer Wellness Coaching Supervisor Manual. Freehold, NJ: Collaborative Support Programs of New Jersey, Institute for Wellness and Recovery Initiatives. (Level V, program description, USA)Swarbrick, P. (2010). Defining wellness. Words of Wellness, 3(7), 1-2. (Level V, USA)
45 References: Wellness/Recovery Swarbrick, M. (2012) A wellness approach to mental health recovery. In: A Rudnick (Ed). Recovery of people with mental illness, pp New York: Oxford University Press. (Level V, USA)Swarbrick, M. (2012). Putting wellness into personal practice. Words of Wellness, 5(9), 1-2. (Level V, USA)Swarbrick, M. (2012). Wellness & Aging. Words of Wellness, 5(9), 3-4. (Level V, overview, USA)Swarbrick, M. (2013). A wellness and recovery model for state psychiatric hospitals. Occupational Therapy in Mental Health, 25 (3-4), (Level V, program description, USA)Swarbrick, M.A. (2013). Integrated care: Wellness-oriented peer approaches: a key ingredient for integrated care. Psychiatric Services, 64(8), (Level V, overview, USA)Swarbrick, M.A. (2013). Wellness-oriented peer approaches: A key ingredient for integrated care. Psychiatric Services, 64(8), (Level V, USA)Swarbrick, M. & Brice, G.H. (2006). Sharing the message of hope, wellness, and recovery with consumers psychiatric hospitals. American Journal of Psychiatric Rehabilitation, 9, (Level V, USA)
46 References: Wellness/Recovery Swarbrick, P. & Burkhardt, A. (2000). Spiritual health: Implications for the occupational therapy process. Mental Health Special Interest Section Quarterly. 23(2), 1-3. (Level V, USA)Swarbrick, P., Hutchinson, D.S., & Gill, K. (2008). The quest for optimal health. International Journal of Mental Health,37(2), (Level V, USA)Swarbrick, M., Murphy, A.A., Zechner, M., Spagnolo, A.B. & Gill, K.J. (2011). Wellness coaching: A new role for peers. Psychiatric Rehabilitation Journal, 34(4), (Level V, program description, USA)Swarbrick, M., Roe, D., Yudof, & Zisman, Y. (2009). Participant perceptions of a peer wellness and recovery education program. Occupational Therapy in Mental Health, 25(3-4), (Level V, survey, USA)Swarbrick, M., & Stahl. (2009). Wellness and recovery through asset building services. Occupational Therapy in Mental Health, 25(3-4), (Level V, program description, USA)Swarbrick, M. & Yudof, J. (2009). Words of wellness. Occupational Therapy in Mental Health, 25(3-4), (Level V, overview, USA)Swarbrick, P., Yudof, J. & Garafano, J. (2011). Personal wellness, recovery, and quality of life. Words of Wellness, 4(8), 3-6. (Level V, overview, USA)
47 References: Wellness/Recovery Tsang, H.W.H., Angell, B., Corrigan, P.W., Lee, Y.T., Shi, K., Lam, C.S. Jin, S. & Fung, K.M.T. (2007). A cross-cultural study of employers’ concerns about hiring people with psychotic disorders: Implications for recovery. Social Psychiatry and Psychiatric Epidemenology, 41, (Level V, survey, Hong Kong)White, C., Casey, R. & Chen, S.P. (2011). Toward recovery-oriented mental health care: Next steps for occupational therapists. Occupational Therapy Now, 13(3), (Level V, overview, Canada)Wimberley, L. & Peters, A. (2003). Recovery in acute mental health, OT News, 11(7), 25 (Level V, program model, UK)Winters, N. (2013). Dancing to recovery. OT News, 21(2) 23. (Level V, program description – dancing, UK)Wollenberg, J.L. (2001). Recovery and occupational therapy in the community mental health setting. Occupational Therapy in Mental Health, 17(3/4), (Level V, USA)
48 References: Self-Help/Consumer-Led Bledsoe, C. (2001). Unique eyes and different windows of opportunity: The consumer provider perspective. Occupational Therapy in Mental Health, 17(3/4), (Level V, overview, USA)Doughty, C. & Tse, S. (2011). Can consumer-led mental health services be equally effective? An integrative review of CLMH services in high-income countries. Community Mental Health Journal, 47, (Level V, literature review, New Zealand)Goering, P., Durbin, J., Sheldon, C.T., Oclocka, J., Nelson, G. & Krupa, T. (2006). Who uses consumer-run self-help organizations? American Journal of Orthopsychiatry, 76(3), (Level V, survey, Canada)Mack, S. (2001). Where the rainbow speaks and catches the sun: An occupational therapist discovers her true colors. Occupational Therapy in Mental Health, 17(3/4), (Level V, autobiography, USA)Rebeiro, K.L., Day, D.G., Semeniuk, B., O’Brien, M.C., & Wilson, B. (2001). Northern initiative for social action: An occupation-based mental health program. AJOT, 55, (Level V, survey, interview, focus, Canada)Swarbrick, M. (2009). Designing a study to examine peer-operated self-help centers. Occupational Therapy in Mental Health, 25(3-4), (Level V, survey, USA)
49 References: Self-Help/Consumer-Led Swarbrick, M. (2007). Consumer-operated self-help centers. Psychiatric Rehabilitation Journal, 31(1), (Level V, program description, USA)Swarbrick, M. (2006). Consumer-operated self-help services. Journal of Pyschosocial Nursing, 44(12), (Level V, survey, USA)Swarbrick, P. & Duffy, M. (2000). Consumer-operated organization and programs: A role for occupational therapy practitioners. Mental Health Special Interest Section Quarterly, 23(1), 1-4. (Level V, overview, USA)Swarbrick, M. & Ellis, J. (2009). Peer-operated self-help centers. Occupational Therapy in Mental Health, 25(3-4), (Level V, overview, USA)Swarbrick, M., Schmidt, L.T. & Pratt, C.W. (2009). Consumer-operated self-help centers. Journal of Psychosocial Nursing, 47(7), (Level V, program description, USA)White, C.M. (2011). Self-management: A close companion to recovery in mental illness. Occupational Therapy Now, 13(5), (Level V, overview, Canada)Wright, C.V. & Rebeiro, K.L. (2003). Exploration of a single case in a consumer-governed mental health organization. Occupational Therapy in Mental Health, 19(2), (Level V, case study, Canada)