1. A conceptual framework for personal recovery in mental health
Mary Leamy
Programme Co-ordinator, REFOCUS study,
Institute of Psychiatry, King’s 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 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,

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
contains 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; and
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 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)

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
Recovery aided by a supportive and healing environment

17. Peer Support Being Part of the Community Support from Others
Relationships
Motivation
Rebuilding Identity
Positive Thinking
Rebuilding of Life
Personal Responsibility
Quality of Life
Control over Life
Meaning of Mental Illness Experiences
Spirituality
Focussing on Strengths

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 )