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The person’s values determine the meaning structure of the world they live in and drive their actions. The depressed patient’s values tend to change dramatically over the weeks and usually return to normal. At the height of their illness, patients can constantly feel that they are transgressing important personal and group values.
Examining the values at play is similar to creating a map with three dimensions: (1) the level of organization/proximity to primary stakeholders; (2) the hierarchy; and (3) the temporality of values. The patient’s values can be misaligned with those of others temporarily owing to the illness, and value-mapping can facilitate realignment. Changes in value hierarchy are often necessary for recovery. These changes can be dramatic and can happen at a faster pace whilst the person is becoming ill and during recovery.
The patient can be temporarily cut off from the values they would normally hold. Besides records of their former wishes and collateral information, sources of knowledge about value changes include peer support workers, first-hand narratives, philosophical and social scientific studies, media reports, and art portrayal of depression. Changes in one’s life narrative are also essential for recovery and resilience. The patient’s social environment, including the professionals, can facilitate (or hinder) this.
Psychopathological phenomenology and existential psychotherapy may help us overcome the challenges of integrating the different dimensions of mental illness and developing new treatments. Better characterization of symptoms/syndromes can improve classification and causal modelling, whereas existential psychotherapy has added to our understanding of the influence of our position in the world and in history.
Motivational interviewing has many similarities to VBP. It can increase the person’s agency by drawing out personal meaning and the importance of change. A crucial insight from it is that saying out loud what our values are can greatly enhance our understanding of them. Treatment may mean reducing conflict between the person’s core values by helping the person recognize their environment’s affordances more efficiently or improve their sense-making and thereby alter their values.
Psychiatry has been pioneering in embracing alternative meanings of recovery. The most important consequence of this was that it enabled discussions about recovery as living well with mental ill-health. Co-production has helped to reframe and enhance the relationship between ‘doctor’ and ‘patient’, leading to better outcomes for all.
Recovery together with co-production will enable constructive partnerships between all those affected by mental ill-health to play their part in progressive psychiatry and more progressive communities.
This fascinating book brings together a multidisciplinary team of authors from a variety of backgrounds and lived experience who offer insight into the historical roots and current reasons for the hybrid natural and social scientific conceptual platform of psychiatry. The role of values in the development and recovery from mental illness are covered as well as progressive developments, outlining a novel research methodology. Demonstrating the importance of the integration of each main dimension of psychiatry (such as biological, psychological, social, and existential), the book includes values in theory and research in working out the epistemological foundations of psychiatry as an academic discipline and in clinical practice. Covering the major directions from which the subject of mental ill health has been approached (neurobiology, psychoanalysis and the psychotherapies), the common conditions and the controversies surrounding them are explored. Highly relevant to academics, clinicians and students in psychiatry, psychology, primary and social care.
When health threats are mitigated, the emergency moves into what is known as the "recovery phase." During the recovery phase health officials communicate that the health threat has been mitigated and that the community will move toward a "new normal," express empathy, and continue to state the agency’s commitment to the community. Additionally, the health agency can engage in educating the public about lessons learned during the health response and how to prepare for future emergencies. This chapter outlines how to engage with policymakers after a health emergency. The chapter describes the importance of memorials during the recovery phase and how public health agencies can support communities that want to memorialize large-scale health emergencies. It will also address how agency leadership engages with staff as response operations de-escalate and surge staff return to their regular public health work. The chapter provides practical tips on how to write recovery messages and provides quick response communication planning and implementation steps such as identifying communication objectives, audiences, key messages, and channels and developing communication products/materials. This chapter also includes key tips related to spokespeople, partner agencies, and call centers to ensure message consistency is achieved during the response. Mindfulness is highlighted. A student case study analyzes the COVID-19 outbreak in Georgia using the Crisis and Emergency Risk Communication framework. Reflection questions are included at the end of the chapter.
In the last ten years, the recovery movement has significantly influenced mental health services and workers, psychiatric reform, and the advocacy movement worldwide. Within Brazil’s public mental health care system, operates a cohesive, powerful advocacy coalition empowering recovery-oriented practices. This article aims to highlight successful initiatives spearheaded by individuals with lived experience in Brazil. We will also present some challenges, and discuss possible recovery strategies to strengthen mental health services by empowering people with lived experience and promoting social justice. Efforts and initiatives to implement recovery strategies in Brazil are underway, aiming to improve population mental health and substance misuse both within and outside mental health services. These initiatives include peer support, advocacy, testimonies and empowerment, employment, and social, cultural, and artistic initiatives. Some of the challenges to greater participation of individuals with lived experience in this ongoing process of Brazilian psychiatric reform include the following aspects: barriers to the autonomy and independence of lived experience organizations; the longstanding history of racism in Brazilian society; disparities in social indicators such as education and income, between professionals and people with lived experience in mental health and substance misuse. Although progress in Brazil’s psychiatric reform has advanced through recovery initiatives, challenges remain in ensuring leadership roles for people with lived experience. Ongoing success depends on their active involvement, alongside advocacy movements and involvement of broader society.
The coronavirus disease 2019 (COVID-19) pandemic has impacted global mental health, with individuals with severe mental illness (SMI) being particularly vulnerable. Research on changes in psychiatric symptoms during this pandemic has yielded inconsistent results, often due to individual heterogeneity and a limited focus on broader outcomes such as psychosocial functioning, societal and personal recovery, and quality of life (QoL). Furthermore, long-term effects remain underexplored. This longitudinal cohort study aimed to assess the COVID-19 pandemic’s impact on mental and psychosocial functioning, QoL, and recovery in individuals with SMI, and to explore individual and treatment characteristics associated with outcome changes.
Methods
Two cohorts were included, involving adults (≥18 years) diagnosed with DSM-5 disorders and experiencing long-term impairments. Participants received care between January 1, 2018 and December 31, 2023. Outcomes included the Health of the Nation Outcome Scales, the Manchester Short Assessment of Quality of Life, and the Individual Recovery Outcomes Counter. Changes were analyzed across five pandemic periods using linear mixed models.
Results
Improvements in mental and psychosocial functioning, QoL, and recovery were observed over time, regardless of the COVID-19 pandemic period. However, progress was slower during the COVID-19 pandemic compared to pre-pandemic levels. No individual or treatment characteristics were significantly linked to changes in outcomes.
Conclusion
The findings suggest that the COVID-19 pandemic had a minimal negative impact on individuals with SMI. This may be due to the marginal negative effects of the pandemic on this population, or the mitigating role of stabilizing factors within the current Dutch care models.
Co-production is a relatively new concept with a history spanning back just four decades. However, it is only in the past ten years that it has been applied to mental health. It is now observed as a recovery principle whose presence is necessary for recovery-orientated services to become a reality. Despite this, today, there is still much confusion as per the philosophical, empirical and practical basis within mental health service provision, with key areas lacking theoretical clarity, for example, its definition within the mental health domain along with its ontological and epistemological stance on how the social world should be viewed and, more importantly, interpreted. As such, this paper will examine the concept of co-production within mental health service provision.
Methods:
A scoping review that was compliant with the PRISMA amendments for scoping reviews and followed Arksey and O’Malley’s methodological framework was conducted. The databases CINAHL, Cochrane Online Library, Jstor, Ovid SP, PsycINFO, PsycTESTS, PubMed, RCNi, Science Direct, Web of Science and Wiley Online Library were used to search the peer-reviewed literature. This was supported by a comprehensive search of repositories for grey literature on co-production.
Results:
Ten articles were eligible for inclusion in the study. Through the use of a summative content analysis approach, the results were constructed in order to form a narrative. This narrative would reflect the key aspects of each study as they pertained to one or more of the five headings created as part of phase four of Arksey and O’Malley’s methodological framework. These headings include Co-Production Definition Used, Stated Advantages of Co-Production, Stated Disadvantages of Co-Production, Co-Production Types/Models and Implementing Co-Production.
Conclusion:
The results of this review has added empirically to the literature base on co-production. The study highlights the lack of renumeration for those working in co-production activity that needs to be addressed. Most striking is the formal recognition, for the first time, of a philosophical war between co-production and that of evidence-based practice itself. This is an interesting but important development that requires further study in order to ensure that co-production as a recovery principle can be further enhanced and sustained into the future.
In December 2023, floods and landslides in Hanang District, Northern Tanzania, caused severe casualties, infrastructure damage, and community displacement. We describe the public health emergency response and lessons learnt during this disaster to guide future mitigations.
Methods
Retrospective data collection during the disaster was made through quantitative (description of casualties) and qualitative (interviews and focus groups) approaches to provide insights into psychosocial support, coordination, and other response pillars. Microsoft Excel (2019) was used for quantitative data analysis, and MAX Qualitative Data Analysis was used to manage qualitative data.
Results
Soft tissue injuries, bruises, and lacerations were the most common (60.43%), with 87.77% of casualties recovering and a notable fatality rate of 12.23%. Mental health and psychosocial support reached over 3300 individuals, offering depression assessments and family reconnections. Establishing a dual-level public health response team and implementing the Incident Management System demonstrated the country’s response efficiency.
Conclusions
The public health emergency response to the 2023 floods and landslides in Hanang District was largely effective. This demonstrated strong coordination, capacity, and resilience of Tanzania health system; however, the fatality rate highlighted a need for further investment to improve future disaster prevention, preparedness, and response.
Although cognitive remediation (CR) improves cognition and functioning, the key features that promote or inhibit its effectiveness, especially between cognitive domains, remain unknown. Discovering these key features will help to develop CR for more impact.
Aim
To identify interrelations between cognition, symptoms, and functioning, using a novel network analysis approach and how CR affects these recovery outcomes.
Methods
A secondary analysis of randomized controlled trial data (N = 165) of CR in early psychosis. Regularized partial correlation networks were estimated, including symptoms, cognition, and functioning, for pre-, post-treatment, and change over time. Pre- and post-CR networks were compared on global strength, structure, edge invariance, and centrality invariance.
Results
Cognition, negative, and positive symptoms were separable constructs, with symptoms showing independent relationships with cognition. Negative symptoms were central to the CR networks and most strongly associated with change in functioning. Verbal and visual learning improvement showed independent relationships to improved social functioning and negative symptoms. Only visual learning improvement was positively associated with personal goal achievement. Pre- and post-CR networks did not differ in structure (M = 0.20, p = 0.45) but differed in global strength, reflecting greater overall connectivity in the post-CR network (S = 0.91, p = 0.03).
Conclusions
Negative symptoms influenced network changes following therapy, and their reduction was linked to improvement in verbal and visual learning following CR. Independent relationships between visual and verbal learning and functioning suggest that they may be key intervention targets to enhance social and occupational functioning.
Exhibitions suggest a more complicated history than the familiar caricature of early twentieth-century Japan, which sees the country sliding inexorably into authoritarianism from the late 1920s, then embracing peace and democracy in 1945. The military had always been present at exhibitions and became more prominent in the 1930s. Wartime exhibitions did what they could to mobilize the Japanese people for ‘national defense’. Overseas, however, the government continued to use exhibitions to convince the world of its pacific intent. At home, exhibitions testify as much to commercial energy, municipal ambition, and colonial aspirations, as to militarism. This chapter explores the complicated, increasingly contradictory weave of war and peace during the 1930s and 1940s. Exhibitions not only articulated the need to expand empire and mobilize the nation but also continued to insist on the possibility of international amity and modern life, even as Japan descended into total war. Once it was over, peace and democracy became new keynotes, but the sites, protagonists, and ambitions of exhibitions remained much the same.
Few studies have examined the long-term outcomes of first-episode psychosis (FEP) among patients beyond symptomatic and functional remission. This study aimed to broaden the scope of outcome indicators by examining the relationships between 12 outcomes of FEP patients at 20.9 years after their initial diagnosis.
Methods
At follow-up, 220 out of 550 original patients underwent a new assessment. Twelve outcomes were assessed via semistructured interviews and complementary scales: symptom severity, functional impairment, personal recovery, social disadvantage, physical health, number of suicide attempts, number of episodes, current drug use, dose-years of antipsychotics (DYAps), cognitive impairment, motor abnormalities, and DSM-5 final diagnosis. The relationships between these outcome measures were investigated using Spearman’s correlation analysis and exploratory factor analysis, while the specific connections between outcomes were ascertained using network analysis.
Results
The outcomes were significantly correlated; specifically, symptom severity, functioning, and personal recovery showed the strongest correlations. Exploratory factor analysis of the 12 outcomes revealed two factors, with 11 of the 12 outcomes loading on the first factor. Network analysis revealed that symptom severity, functioning, social disadvantage, diagnosis, cognitive impairment, DYAps, and number of episodes were the most interconnected outcomes.
Conclusion
Network analysis provided new insights into the heterogeneity between outcomes among patients with FEP. By considering outcomes beyond symptom severity, the rich net of interconnections elucidated herein can facilitate the development of interventions that target potentially modifiable outcomes and generalize their impact on the most interconnected outcomes.
This paper explores the intersection of physical health and recovery-oriented approaches in psychosis, offering a unique perspective through autoethnography. By combining personal experience with a broader analysis of existing mental health frameworks, the paper highlights the often overlooked importance of physical health in the recovery process for individuals with psychosis. The autoethnographic narrative reveals the complex challenges posed by antipsychotic medications, including weight gain and metabolic complications, and their impact on overall well-being. It emphasizes the dual stigma of mental health challenges and weight gain, highlighting the need for a more integrated, holistic approach to mental health care. Recommendations include enhanced education for healthcare providers, personalized care plans, and a multidisciplinary approach aimed at bridging the gap between physical and mental health in psychosis recovery.
This study explored the association among dissociative experiences, recovery from psychosis and a range of factors relevant to psychosis and analysed whether dissociative experiences (compartmentalisation, detachment and absorption) could be used to predict specific stages of recovery. A cross-sectional design was used, and 75 individuals with psychosis were recruited from the recovery services of the Gloucestershire Health and Care NHS Foundation Trust. Five questionnaires were used – the Dissociative Experiences Scale – II (DES), Detachment and Compartmentalisation Inventory (DCI), Questionnaire about the Process of Recovery, Stages of Recovery Instrument (STORI), and Positive and Negative Syndrome Scale – and a proforma was used to collect demographic data.
Results
Our findings indicated that compartmentalisation, detachment and absorption, as measured by DES and DCI, do not predict stages of recovery as measured by the STORI.
Clinical implications
The results of this study suggest that there is no simple relationship between dissociative and psychotic symptoms. They also suggest a need to assess these symptoms separately in practice and indicate that special approaches to treatment of psychosis may be needed in cases where such symptoms have a significant role.
The aim of this study was to explore the role of managers and employees with an assigned responsibility (i.e. inspirers) when integrating recovery-enhancing activities into everyday work in a primary health care setting.
Background:
The possibility of recovery during the workday is essential for employee wellbeing. However, the literature on workplace interventions focusing on recovery is scarce. Especially with regard to the importance of local driving forces, like managers and inspirers.
Methods:
Two focus groups and two individual interviews were conducted in this qualitative interview study. In total, ten managers and inspirers from different primary health care centres were interviewed about their experiences of brief recovery interventions at their workplaces. A semi-structured interview guide was used, and the qualitative analysis was conducted by using systematic text condensation.
Findings:
From a leadership perspective, two themes with promoting factors for recovery interventions were identified. These were structural promoting factors (including authorisation, communication, and integration) and cultural promoting factors (including attitude, support, and open-mindedness). This knowledge can contribute to future workplace environment development with the focus on recovery during the workday. The results also showed several positive effects of integrated recovery, both on an individual and group level. Hence, this study is a valuable addition to the work recovery research, in terms of understanding the importance of investing in recovery at work.
Substance use disorders (SUD) present significant public health challenges. The management of SUD is complex and involves a range of approaches, including psychotherapy, motivational interviewing, medications, psychosocial interventions, and peer recovery. This chapter provides an overall review of the main aspects involved in the diagnosis and management of SUDs.
Natural disasters can cause widespread death and extensive physical devastation, but also harmfully impact individual and community health following a disaster event. Nature-based recovery approach can positively influence the mental health of people and community’s post-natural disasters. In response to the Australian bushfire season of 2019-2020, Zoos Victoria, in partnership with the Arthur Rylah Institute, worked with local communities in East Gippsland to support people’s recovery through experiencing, supporting, and witnessing nature’s recovery.
Methods
This mixed-method study explored how nature improved the recovery of remote and rural communities affected by the Black Summer bushfires in East Gippsland. The research studied the individuals’ feelings about being involved in nature-based community events and their lived experiences. Data were collected from June to September 2023 through a nature-based community recovery project survey and community interviews.
Results
The findings demonstrated that engagement with natural environments promotes positive psychological, mental, and general well-being of people from bushfire-affected communities. Positive feedback from participants indicated the success of the Nature-Based Community Recovery Project in East Gippsland after the Black Summer bushfire.
Conclusions
This research provides insights for future recovery projects and ensures that sustainable nature-based recovery solutions for bushfire-impacted communities can be established.
England's primary care service for psychological therapy (Improving Access to Psychological Therapies [IAPT]) treats anxiety and depression, with a target recovery rate of 50%. Identifying the characteristics of patients who achieve recovery may assist in optimizing future treatment. This naturalistic cohort study investigated pre-therapy characteristics as predictors of recovery and improvement after IAPT therapy.
Methods
In a cohort of patients attending an IAPT service in South London, we recruited 263 participants and conducted a baseline interview to gather extensive pre-therapy characteristics. Bayesian prediction models and variable selection were used to identify baseline variables prognostic of good clinical outcomes. Recovery (primary outcome) was defined using (IAPT) service-defined score thresholds for both depression (Patient Health Questionnaire [PHQ-9]) and anxiety (Generalized Anxiety Disorder [GAD-7]). Depression and anxiety outcomes were also evaluated as standalone (PHQ-9/GAD-7) scores after therapy. Prediction model performance metrics were estimated using cross-validation.
Results
Predictor variables explained 26% (recovery), 37% (depression), and 31% (anxiety) of the variance in outcomes, respectively. Variables prognostic of recovery were lower pre-treatment depression severity and not meeting criteria for obsessive compulsive disorder. Post-therapy depression and anxiety severity scores were predicted by lower symptom severity and higher ratings of health-related quality of life (EuroQol questionnaire [EQ5D]) at baseline.
Conclusion
Almost a third of the variance in clinical outcomes was explained by pre-treatment symptom severity scores. These constructs benefit from being rapidly accessible in healthcare services. If replicated in external samples, the early identification of patients who are less likely to recover may facilitate earlier triage to alternative interventions.
Increasing pressure to return to work coupled with increasing feelings of inadequacy. Reached rock bottom, and was persuaded to start lithium, and after all this time, started to slowly improve.
This chapter discusses the general principles relating to the assessment of compensation for loss resulting from a civil wrong. Since courts and legislatures often lay down legal rules for a particular area of law, the assessment of compensation differs between areas. This is why Part 2 contains separate chapters for contract, tort, the Australian Consumer Law and equity. However, there are several commonalities between the areas, in particular, contract and tort. This chapter discusses the rules that are common to at least contract and tort. Most of them also apply in equity and under the Australian Consumer Law. Deviations from those rules in equity or under the Australian Consumer Law are discussed in the relevant chapters. This chapter also provides a brief introduction to those matters that differ between contract and tort. Comprehensive treatment is given to the date of assessment; even though there are significant differences between the causes of actions, there has been considerable convergence.