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A conceptual framework for personal recovery in mental health Mary Leamy Programme Co-ordinator, REFOCUS study, Institute of Psychiatry, Kings College,

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Presentation on theme: "A conceptual framework for personal recovery in mental health Mary Leamy Programme Co-ordinator, REFOCUS study, Institute of Psychiatry, Kings College,"— Presentation transcript:

1 A conceptual framework for personal recovery in mental health Mary Leamy Programme Co-ordinator, REFOCUS study, Institute of Psychiatry, Kings College, London on behalf of REFOCUS team Victoria Bird, Clair le Boutillier, Julie Williams and Mike Slade

2 Overview 1. 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?

3 What is personal recovery? A deeply personal, unique process of changing ones 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 ones 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,

4 A 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)

5 Rationale Key knowledge gaps have been identified: Need for conceptual clarity about the underpinning philosophy of recovery Better understanding of the stages and processes of recovery Valid measurement tools Current approaches based on qualitative research or consensus methods, no systematic review has been undertaken Need a conceptual framework to provide an empirical basis for recovery-oriented research and practice.

6 Systematic review Aim: to undertake a systematic review and narrative synthesis of the available literature on recovery, so as to develop a conceptual framework for recovery Eligibility: 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.

7 Inclusion criteria (i)contains a conceptualisation of personal recovery from which a succinct summary could be extracted; (ii)presented an original model or framework of recovery; (iii) was based on either secondary research synthesising the available literature or primary research involving quantitative or qualitative data based on at least three participants; (iv)was available in printed or downloadable form; and (v)was available in English.

8 Exclusion 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

9 Data searching, abstraction and quality assessment 12 bibliographic databases + web-based and hand searching 5208 papers identified 819 papers abstracts reviewed 376 full papers retrieved 97 papers included Papers quality rated

10 Data extraction and Quality assessment Random sub-sample of 88 retrieved papers independently rated against eligibility criteria by 2 nd rater (91% agreement concordance) RATS scale used to assess qualitative papers; sub- sample of 10 papers independently rated (acceptable concordence, mean scores 1 st rater = 14.8; 2 nd rater = 15.1)

11 Data analysis A modified narrative synthesis approach was used (Popay et al. 2006) Develop a preliminary synthesis Explore relationships within and between studies Assess the robustness of the synthesis

12 Developing a preliminary synthesis Tabulation of all papers Thematic analysis of review papers and highest quality, primary qualitative data studies Vote counting of recovery themes

13 Exploring relationships within and between studies Sub-group comparison –studies 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

14 Assessing the robustness of the synthesis Moderately rated qualitative papers thematically analysed until category saturation was achieved An expert panel asked to comment upon the extent to which the preliminary conceptual framework adequately captures the construct of personal recovery

15 Findings Characteristics of Recovery journey comprised 13 dimensions Recovery processes comprised 5 higher order categories –Connectedness –Hope and optimism about the future –Identity –Meaning in life –Empowerment Stages of recovery were varyingly described, but can be mapped on to the Transtheoretical Model of Change

16 Characteristics of recovery journey N (%) of 87 studies identifying dimension Individual and unique process 25 (26%) Non-linear process 21 (22%) Recovery as a journey 17 (18%) Recovery as active process 44 (50%) Recovery as stages or phases 15 (17%) Recovery as a struggle 14 (16%) Recovery as gradual process 13 (15%) Multi-dimensional process 13 (13%) Recovery is life-changing experience 11 (13%) Recovery without cure 9 (9%) Recovery can occur without professional intervention 6 (7%) Trial and error process 6 (7%) Recovery aided by a supportive and healing environment 6 (7%)

17 Dreams and Aspirations Belief in Recovery Individuality Positive Self Identity Control over Life Personal Responsibility Focussing on Strengths Spirituality Quality of Life Meaning of Mental Illness Experiences Rebuilding of Life Rebuilding Identity Relationships Peer Support Support from Others Being Part of the Community Motivation Positive Thinking

18 Implications Scientific implications –Coding framework provides key-words for undertaking secondary research, provides taxonomy for reviews –Characteristics of recovery journey - helpful yardstick to measure success in not co-opting personal recovery into mental health system view of world –Recovery processes – when viewed as targets for interventions, highlights need for extended evidence base

19 Limitations Tends to over-emphasis individual rather than environmental factors in recovery Not a rigid or prescriptive model of what recovery is, but pragmatic, organising framework Personal Recovery Encompasses 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 synthesises Should not be regarded as the definitive version

20 Thank 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 )

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