Presentation on theme: "A conceptual framework for personal recovery in mental health"— Presentation transcript:
1A conceptual framework for personal recovery in mental health Mary LeamyProgramme Co-ordinator, REFOCUS study,Institute of Psychiatry, King’s College, Londonon behalf of REFOCUS teamVictoria Bird, Clair le Boutillier, Julie Williams and Mike Slade
2Overview1. What is personal recovery and why is a conceptual framework needed? 2. Systematic review and narrative synthesis 4. Conceptual framework of personal recovery 5. What next for REFOCUS study?
3What is personal recovery? A deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and contributing life even with limitations caused by the illness.Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.Anthony WA (1993) Recovery from mental illness:the guiding vision of the mental health service system in the 1990s,Psychosocial Rehabilitation Journal, 16,
4A recovery orientation is mental health policy in most English speaking countries. The Mental health plan for England “expectation that services to treat and care for people with mental health problems will be…based on the best available evidence and focused on recovery, as defined in discussion with the service user”, (New Horizons)
5Rationale Key knowledge gaps have been identified: Need for conceptual clarity about the underpinning philosophy of recoveryBetter understanding of the stages and processes of recoveryValid measurement toolsCurrent approaches based on qualitative research or consensus methods, no systematic review has been undertakenNeed a conceptual framework to provide an empirical basis for recovery-oriented research and practice.
6Systematic review Aim: to undertake a systematic review and narrative synthesis of the available literature on recovery, so as to develop a conceptual framework for recoveryEligibility:Identify papers explicitly described or developed a conceptualisation of personal recovery from mental illness.Visual or narrative model of recovery, or themes of recovery which emerged from synthesis of review papers or analysis of primary data.
7Inclusion criteriacontains a conceptualisation of personal recovery from which a succinct summary could be extracted;presented an original model or framework of recovery;was based on either secondary research synthesising the available literature or primary research involving quantitative or qualitative data based on at least three participants;was available in printed or downloadable form; andwas available in English.
8Exclusion criteria(a) studies solely focussing upon clinical recovery; (b) studies involving modelling of predictors of clinical recovery; (c) studies defining remission criteria or recovery from substance misuse, addiction or eating disorders; and (d) dissertations and doctoral theses
9Data searching, abstraction and quality assessment 12 bibliographic databases + web-based and hand searching5208 papers identified819 papers abstracts reviewed376 full papers retrieved97 papers includedPapers quality rated
10Data extraction and Quality assessment Random sub-sample of 88 retrieved papers independently rated against eligibility criteria by 2nd rater (91% agreement concordance)RATS scale used to assess qualitative papers; sub-sample of 10 papers independently rated (acceptable concordence, mean scores 1st rater = 14.8; 2nd rater = 15.1)
11Data analysisA modified narrative synthesis approach was used (Popay et al. 2006)Develop a preliminary synthesisExplore relationships within and between studiesAssess the robustness of the synthesis
12Developing a preliminary synthesis Tabulation of all papersThematic analysis of review papers and highest quality, primary qualitative data studiesVote counting of recovery themes
13Exploring relationships within and between studies Sub-group comparisonstudies which focussed upon a population of people from predominantly Black and Minority Ethnic backgrounds thematically analysed and findings compared to themes within preliminary conceptual framework
14Assessing the robustness of the synthesis Moderately rated qualitative papers thematically analysed until category saturation was achievedAn expert panel asked to comment upon the extent to which the preliminary conceptual framework adequately captures the construct of personal recovery
15Findings Characteristics of Recovery journey comprised 13 dimensions Recovery processes comprised 5 higher order categoriesConnectednessHope and optimism about the futureIdentityMeaning in lifeEmpowermentStages of recovery were varyingly described, but can be mapped on to the Transtheoretical Model of Change
16Characteristics of recovery journey N (%) of 87 studies identifying dimensionIndividual and unique process25 (26%)Non-linear process21 (22%)Recovery as a journey17 (18%)Recovery as active process44 (50%)Recovery as stages or phases15 (17%)Recovery as a struggle14 (16%)Recovery as gradual process13 (15%)Multi-dimensional process13 (13%)Recovery is life-changing experience11 (13%)Recovery without cure9 (9%)Recovery can occur without professional intervention6 (7%)Trial and error processRecovery aided by a supportive and healing environment
17Peer Support Being Part of the Community Support from Others RelationshipsMotivationRebuilding IdentityPositive ThinkingRebuilding of LifePersonal ResponsibilityQuality of LifeControl over LifeMeaning of Mental Illness ExperiencesSpiritualityFocussing on Strengths
18Implications Scientific implications Coding framework provides key-words for undertaking secondary research, provides taxonomy for reviewsCharacteristics of recovery journey - helpful yardstick to measure success in not co-opting personal recovery into mental health system view of worldRecovery processes – when viewed as targets for interventions, highlights need for extended evidence base
19LimitationsTends to over-emphasis individual rather than environmental factors in recoveryNot a rigid or prescriptive model of what recovery is, but pragmatic, organising framework Personal RecoveryEncompasses many multi-dimensional, inter-related, overlapping concepts which cannot easily be separated, so any attempt to reduce this complexity best considered as offering only one of many possible interpretations and synthesisesShould not be regarded as the definitive version
20Thank you Any questions? Further information: Leamy et al. A conceptual framework for personal recovery in mental health: systematic review and narrative synthesis, British Journal of Psychiatry.(accepted on )