Clinical and consumer recovery efforts continue to advance more successful recovery agendas. Limited research into the effect of the expectation to recover and what strategies are most effective in enhancing recovery impedes coherent recovery programming. What factors are significantly associated with recovery expectancy and recovery strategies is still largely unknown. Thus, this study addresses three key gaps in the field. First, which factors associate with the expectation of recovery and is expectation related to strategy choice? Second, what are common strategies for recovery from mental illness and what factors are associated with each strategy? Third, does recovery expectancy or severity of mental illness mediate or moderate the relationship between clinical, social and service factors and recovery strategies? This study surveyed a sample of 350 randomly chosen participants from a community mental health organization with varying degrees of mental illness in a cross-sectional study utilizing instruments that measured clinical/historical, social, and service factors and recovery. The results were examined in multivariate analysis targeted to address the gaps noted above. The six recovery strategies included: (1) effective illness management, (2) positive future orientation, (3) meaningfulness, personal control, and hope, (4) recognizing support, (5) help seeking, and (6) symptom eradication. Recovery expectancy was not significantly predicted by any of the clinical, social, or service factors. Although 25% of the variance was explained by the full model, factors associated with expectancy differ from recovery strategies and require further investigation. Except for symptom eradication, recovery expectancy was significantly negatively associated with each recovery strategy.Main effects models were significant for all six recovery strategies. The social factor constructs (social support, empowerment, stigma) were most consistently and robustly associated with all recovery strategies. Variance explained in full models ranged from 71% for positive future orientation to 19% for symptom eradication. However, no mediating or moderating effects were detected for recovery expectancy or illness severity. The results of this study further the understanding of recovery and provide information for development of recovery programs.

Interest in the ability of people to recover from a severe mental illness has a long history. During the 1980s, however, there was a paradigm shift away research driven by clinicians immersed in the quantitative, objective microcosm of anatomy and physiology towards understanding recovery from a consumer perspective. Even so the experiences of consumers has remained relatively unexplored, with the lion's share of research emanating from the United States of America. At the time of writing the proposal for this study in 2000, there was not even one Australian study of a mental health consumer perspective of recovery from severe mental illness reported in the literature. The principal aim of conducting this research was to address this need. The author, therefore, undertook this grounded theory study to: (a) explore what recovery from the effects of a severe mental illness meant to the consumers in Western Australia; (b) identify what consumers of mental health services in Western Australia wanted in their lives; and thus (c) develop a substantive theory of recovery. Fifteen participants diagnosed with either an affective disorder or schizophrenia were each interviewed and the resultant data were analysed using the constant comparative method. Comparative analysis is a long-held method of analysing data in sociology. Analysis is achieved by asking questions such as what, when, where, how, of the data and comparing similarities and differences with the various concepts within and across sets of data. The findings revealed that the basic social psychological problem (BSPP) for participants was LOSS. In order to address this problem, participants engaged in the basic social process (BSP) of OVERCOMING LOSS. The BSP is a title given to the central theme that emerges from the data and illustrates that a social process occurs overtime. The BSP emerged as a process comprising three phases: First Recuperation, second Moving Forward and third Getting Back. The analysis further revealed that the participants viewed recovery as either

Thesis (Ph.D.)--Purdue University, 2010. / Title from screen (viewed on April 1, 2010). Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Gary R. Bond. Includes vitae. Includes bibliographical references (leaves 68-77).

Thesis (Ph.D.)--Purdue University, 2010. / Title from screen (viewed on May 25, 2010). Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Gary R. Bond, John McGrew, Kevin Rand, Dennis Devine. Includes vita. Includes bibliographical references (leaves 73-85).

While tobacco use remains a leading preventable risk factor for mortality and morbidity in Canada (Patra, Rehm, Baliunas & Popova, 2007), the overall smoking prevalence rate of Canadians has decreased substantially from close to 50% of the population in 1965 to 16.1% of the population in 2012 (Canadian Tobacco Use Monitoring Survey (CTUMS) 2012; Reid, Hammond, Rynard & Burkhalter, 2014). However, up to 85% of individuals with a mental illness continue to use tobacco products (Harris, Parle & Gagne, 2007), contributing to an inequitable distribution of negative health outcomes for this population. Individuals with severe mental illness die an estimated twenty-five years earlier than the general population, with sixty per cent of these deaths due to cardiovascular, pulmonary and infectious disease (Parks, Svendsen, Singer, & Foti, 2006). A recent study that examined specific tobacco-attributable deaths in these populations found that tobacco accounted for 53% of deaths in individuals with schizophrenia, 50% of all deaths for those diagnosed with a depressive disorder, and 48% of all deaths for those with a diagnosis of bipolar disorder (Callaghan et al., 2014). This research project is intended to increase our understanding of what constitutes an effective intervention for smoking cessation and smoking reduction in a population of individuals with severe mental illness who are homeless or vulnerably housed, living in a large urban setting. Two areas of inquiry were proposed. The first inquiry examined data collected as part of a needs assessment to determine the overall prevalence rate of smoking and related behaviours for a population of individuals with severe mental illness receiving services from a community mental health agency. We found that the tobacco use prevalence was 72%, and 62% of smokers had high or very high levels of nicotine dependence; however almost half of respondents (47%) were interested in quitting or reducing tobacco within the next 6 months. Smokers were found to be over 9 times more likely to have a co-occurring substance use disorder (OR=9.44, 95%CI[6.33,14.08]). The second inquiry was a pilot study conducting a randomized controlled trial design to evaluate smoking cessation and smoking reduction outcomes for two groups of individuals (n=61) with severe mental illness receiving different smoking cessation interventions. Clients randomly assigned to the routine Smoking Cessation group (SC-R) received up to 24 weeks of no-cost Nicotine Replacement Therapy (NRT) and clients assigned to the Smoking Cessation Plus group (SC+) received up to 24 weeks of no-cost Nicotine Replacement Therapy (NRT) plus two initial individual sessions of motivational interviewing followed by weekly psychosocial group interventions for up to 24 weeks. Primary outcomes were levels of tobacco use at the 3-month and 6-month follow-up. The 7-day point prevalence abstinence rate measured at 3 months was 21.9% (n=7) for the SC+ group and 13.8% (n=4) for the SC-R group (OR=1.75,95%CI[.46,6.74]). At 6 months, the 7-day point prevalence abstinence rate was 12.5% (n=4) for the SC+ group and 6.9% (n=2) for the SC-R group (OR=1.93, 95%CI[.33,11.41]). Secondary outcomes included change in reported quality of life, physical health and mental health status functioning over the course of the study. We found that there were no statistically significant differences in the smoking quit or smoking reduction rates between the two treatment groups. At the 3-month time point the overall quit rate for both groups combined was 18% (n=11) and at the 6-month time point the quit rate was 10% (n=6). Reduction in the number of daily cigarettes smoked was statistically significant over time (F [1.68, 98.90] = 55.13, p < .001, η p 2 = 0.48) for both groups, as was the overall reduction of the FTND score (F [2, 94] = 17.98, p < .001, η p 2 = 0.28). This research demonstrates that collecting vital tobacco prevalence and dependency information is a straightforward and important task for community mental health agencies. Individuals with mental illness have both the interest and ability to quit or reduce their use of tobacco. Practitioners need to be aware of alternative smoking practices that may contribute to understanding tobacco use patterns and dependence in this population. Other factors such as co-morbid substance use disorder and level of community functioning may influence smoking status and, consequently, how treatment is provided. The findings of the pilot trial demonstrate the feasibility of conducting smoking cessation research with the population. Findings also suggest that a larger definitive trial is warranted to examine the effectiveness of the SC+ intervention. This research adds to the limited but growing knowledge base of how to address tobacco use and provide treatment to this vulnerable group, and will contribute to advances in population health by informing effective interventions with the attendant implications for program and policy development.

<div><div><div><p>Objectives: Previous research suggests an association between working alliance, the collaborative and affective bond between patient and therapist, and improved therapeutic treatment outcomes within treatment of severe mental illness (SMI). However, little is known about the mechanisms through which working alliance improves outcomes in this population. Through investigating key elements of recovery within SMI, two possible mediators—patient activation and hope—appear particularly relevant to the relationship between working alliance and improved treatment outcomes. The current study aimed to examine patient activation and hope as potential mediators in the relationship between working alliance and improved depression in individuals with SMI. Additionally, the current study investigated whether or not the patient’s evaluation of which provider is most important to their recovery significantly moderated the relationship between working alliance and patient activation/hope.</p><p>Methods: The current study was a secondary analysis of longitudinal (baseline, 6-month, and 12-month) data comparing two interventions aimed at reducing treatment provider burnout in community mental health settings primarily serving individuals with SMI. Participants (maximum N for analyses = 346) completed measures of working alliance with a linked provider on their treatment team, patient activation, hope, and depression at baseline, 6 months, and 12 months. Using moderated mediation analysis, 6-month patient activation and 6-month hope were examined as mediators in the relationship between baseline working alliance and 12-month improved depression (change score between 12-month and baseline depression). Additionally, whether or not the patient deemed their linked provider as most important to their recovery was tested as a moderator in the relationship between baseline working alliance and 6-month patient activation/hope.</p><p>Results: Overall, the current study’s hypothesized model was not supported. Baseline working alliance did not significantly predict improved depression 12 months later. Further, both patient activation and hope measured at month 6 in the study did not significantly mediate the relationship between working alliance quality at baseline and improved depression at month 12. Additionally, whether or not the patient believed their linked provider was most important to their recovery did not significantly moderate the relationship between baseline working alliance and 6-month patient activation or 6-month hope. However, results indicate that better quality working alliance at baseline did significantly predict higher patient activation at 6 months. Lastly, the current study found a significant positive correlation between importance of provider and baseline working alliance.</p></div></div></div><div><div><div><p>Discussion: Results suggest that improvement in depression may not be a key SMI treatment outcome that relates to working alliance, patient activation, and hope. Further, fostering a positive working alliance (e.g., collaboratively developing goals/tasks in-session) may increase patient’s ability, willingness, and confidence in managing their own mental health care. Additionally, a positive working alliance may also contribute to how important the patient believes the provider is to their recovery. However, those that have seen their provider for longer (e.g., more chronically ill) may be less active in managing their own mental health care. Limitations and possible future directions are discussed.</p></div></div></div>

Indiana University-Purdue University Indianapolis (IUPUI) / Aim: Early psychosis has been identified as period during which rapid identification and treatment can lead to significant improvement in clinical and functional outcomes. Despite increased research, no studies have examined early psychosis in Veteran populations. It is unknown whether Veterans differ from non-Veterans at this stage of the disorder, and if the treatments offered to non-Veterans are appropriate to implement in Veteran Affairs Medical Centers. Given differences that appear between Veterans and non-Veterans in chronic psychosis, additional work is necessary to determine the best way to approach specialized treatment for Veterans experiencing early psychosis. Methods: The current study is a secondary analysis of assessment batteries collected at a community-based early intervention program and at a local Veteran Affairs Medical Center. Assessment results were compared for Veterans’ and non-Veterans’ background characteristics, symptoms, and neurocognitive deficits. Results: Significant differences were found between the two samples on age of illness onset, marital status, education level, positive symptoms of psychosis, and neurocognitive functioning. Logistic regression analyses identified age of onset as a potential underlying factor. Conclusions: While some aspects of illness presentation appear similar between Veterans and non-Veterans, there are important differences between these populations. Pre-existing treatment interventions, such as Social Skills Training, cognitive remediation approaches and cognitive behavior therapy for psychosis may be appropriate to implement with Veterans. Others– such as family based interventions or supported employment services – may need to be tailored to maximize the benefit for Veterans.

Introduktion Det förekommer att sjukvårdspersonal återspeglar samhällssynen som råder kring personer med psykisk sjukdom, där okunskap kan leda till stigma. Hälso- och sjukvårdslagen framhåller rätten till god vård och hälsa för alla, men i dagsläget finns inte nationella register beträffande psykisk ohälsa i primärvården, trots att det är dit de flesta patienter vänder sig. Upplevelsen av vårdmötet är av vikt då det kan bli avgörande för vidare vård. Syfte Att undersöka hur patienter med psykisk sjukdom upplever bemötande i primärvården. Metod Detta är en litteraturöversikt med deskriptiv design och kvalitativ ansats, baserat på tio kvalitativa originalartiklar valda från vetenskapliga tidskrifter funna via sökmotorn PubMed. Resultat Fyra kategorier framkom, holistisk syn, fördomar, kommunikation, samt kontinuerlig relation. Att inte bli tagen på allvar eller trodd på, bristande engagemang, samt nedsatt kommunikation mellan personal och vårdformer liksom mellan sjukvårdspersonal och patienter ledde till ökad osäkerhet. Förebyggande arbete, fast och erfaren vårdkontakt liksom avsatt tid var uppskattat då det gav känsla av meningsfullhet. Slutsats Patienter med psykisk sjukdom önskade bli bemötta holistiskt, där både psykiska och somatiska åkommor ses. Då områden som kunskap, engagemang, kommunikation och hol­istiskt synsätt ingår i sjuksköterskans kompetensbeskrivning, är litteraturöversiktens fynd viktiga insikter för omvårdnad som sjuksköterskan bör ta hänsyn till / Introduction It happens occasionally that healthcare staff reflect society’s views on people with severe mental illness, where lack of knowledge easily turns into stigmatization. The Health and Medical Care Act emphasizes patients’ right to good care and health for all, yet there is currently no national register regarding mental illness in primary care, despite that is where most patients turn to. The patient’s experience of that encounter is of importance as it can be crucial for further care.  Aim To describe how patients with severe mental illness experience the encounter from health care staff in primary care. Method Literature review, with descriptive design and qualitative approach, based on ten qualitative articles selected from scientific journals through the search engine PubMed. Results The result developed into four categories, holistic view, prejudice, communication, and continuous relationships. Not to be taken seriously or believed in, lack of engagement and coordination among staff as well as between various forms of healthcare organizations and patients led to increased feelings of uncertainty. Preventive care, experienced and a fixed care contact, along with designated time was appreciated as it gave a sense of meaning. Conclusion Patients with severe mental illness desired a holistic approach, where both mental and somatic ailments are seen. Areas such as knowledge, commitment, communication and a holistic approach are included in the nurse's competence description. The findings of the literature review are important attainments for nursing that the nurse should take into account.

Indiana University-Purdue University Indianapolis (IUPUI) / The primary purpose of the current study was to determine the relationship between employment and the nonvocational functioning of people with severe mental illness in a prospective 24 month study, as a partial replication of another study. An employment typology was utilized that was comprised of participants at four employment levels: no work (those who did not work the entire study period), minimal work (those who worked 24 weeks or less in competitive and/or noncompetitive, paid employment), paid work (those who worked 24 or more weeks, the majority of which was spent in noncompetitive, paid employment), and competitive work (those who worked 24 or more weeks, the majority of which was spent in competitive employment). Both objective and subjective outcomes were addressed, including quality of life, symptoms, psychiatric hospitalizations, social networks, and residential status. Participants consisted of persons with severe mental illness (most with a schizophrenia-spectrum disorder) who were receiving employment services at a large, urban psychiatric rehabilitation center. Mixed effects regression modeling and logistic regression were used to analyze the date. Results indicate that the competitive work group experienced an accelerated improvement in negative symptoms across time and was less likely to have psychiatric hospitalization days as compared with the no work group. The paid work group showed an accelerated improvement in social network scores across time as compared with the no work, minimal work, and competitive work groups. The full sample demonstrated improvements across the study period regardless of employment typology status in the areas of overall quality of life, financial quality of life, cognitive symptoms, and social networks. In conclusion, this study adds to the growing body of evidence indicating that work, particularly periods of extended competitive work may lead to important benefits in clinical and social domains, although threats to internal validity that could not be ruled out preclude a causal link from being established. Future research is needed to further investigate this relationship, particularly in regards to those outcomes that are not well understood, such as residential status.

Mindfulness utövas av sjuksköterskor i en ökad omfattning både i öppenvården och slutenvården och ges till allt sjukare patienter. Omvårdnadsåtgärder inom psykiatrisk vård syftar till att stärka patientens förmåga till återhämtning, vilket väcker frågan kring vilka verktyg psykiatrisjuksköterskan bör använda, då självkänsla, empowerment och livskvalitet står för en stor del av hälsoupplevelsen hos patienter. Syftet var därför att sammanställa kunskap om mindfulness och dess betydelse för återhämtning i psykiatrisk vård. Då ämnet var lite beforskat inom omvårdnadsforskningen utfördes en systematisk integrerad litteraturstudie. Tjugofyra artiklar utgjorde grunden för vårt resultat, som visar att det finns oenighet i synen på återhämtning och vilka mätmetoder som ska användas för att mäta återhämtning. Återhämtning kan främjas eller motverkas av Mindfulness, vilket i första hand beror på huruvida fokus på återhämtning ligger inom den biomedicinska eller den psykosociala modellen. Om sjuksköterskor tolkar återhämtning utifrån den psykosociala modellen, gör en helhetsbedömning av patientens somatiska och psykiska hälsa och härefter planerar åtgärder utifrån patientens individuella behov, kan mindfulness bli en omvårdnadsåtgärd som bidrar till återhämtning. Studien kan då utgöra ett underlag för hur sjuksköterskor inom psykiatrin kan använda mindfulness som omvårdnadsåtgärd för att uppnå återhämtning för patienterna.