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Background: Mental health problems and financial difficulties each increase the risk of social exclusion. However, few large studies representing a broad age range have investigated the combined social effect of having both difficulties. The purpose of this cross-sectional study was to examine associations of mental health problems, financial difficulties, and the combination of both with social exclusion. Methods: This analysis was based on responses from 28,047 adults (age > 18 years) from the general population participating in The Norwegian Counties Public Health Survey 2019. Respondents answered questions about their financial situation, mental health problems, and social exclusion. Social exclusion was measured as a lack of social support, low participation in organized social activities, low participation in other activities, missing someone to be with, feeling excluded, and feeling isolated. Adjustments for sex and age were made in multivariable logistic regression analyses. Results: Having mental health problems or financial difficulties was associated with various measures of social exclusion (odds ratios [ORs] with 95% confidence intervals [CIs]: 1.33 [1.23–1.43] to 12.63 [10.90–14.64]). However, the odds of social exclusion strongly increased for respondents who reported a combination of mental health problems and financial difficulties compared with those who did not report either (ORs [CIs]: 2.08 [1.90–2.27] to 29.46 [25.32–34.27]). Conclusions: Having the combination of mental health problems and financial difficulties is strongly associated with increased risk for social exclusion, far beyond the effect of either factor alone. [ABSTRACT FROM AUTHOR]

Mental health recovery takes place in a social and material world. However, socio-material contexts have often been absent from recovery studies. The present study was conducted in Norway, a Scandinavian welfare country. We interviewed people at meeting places who had experiences as service users, focusing on their experiences of becoming well, and analyzed their recovery stories using an assemblage framework. Our analysis identified four constitutive dimensions that promote mental health recovery: an atmosphere of togetherness, doings as more than the act, personal development, and integration in society. We discuss how these dimensions might be seen as social, relational, and material forces that create important micropolitics that challenge the individualistic professionalization of the recovery concept. [ABSTRACT FROM AUTHOR]

Since the 1970s, psychiatric care in the western world has undergone fundamental changes known as de-institutionalisation. This has changed the living conditions for people with severe mental illness. The purpose of this study was to investigate the living conditions and utilisation of care and social services for a group of people in Sweden with diagnosis of psychosis over a 10-year period, 2004–2013. During this period, psychiatric care decreased at the same time as interventions from the social services increased. Half of the persons in the studied group did not have any institutional care, that is, neither been hospitalised nor dwelling in supported housing, during the last 5 years, and just over 20% had no contact with either psychiatry or the municipality's social services during the last 2 years of the investigated period. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Recovery‐oriented studies show that the quality of the professional relationship plays an essential role in the recovery from mental illness. Within mental health care in general, previous studies show that helpful professional relationships are characterized by several reciprocal aspects, such as friendship resemblance and self‐disclosure.The literature is scarce on in‐depth explorations of professional relationships within the often long‐lasting and intimate help context of institutional supportive housing. Explorations of staff members' experiences are absent. The scientific rationale of this study was to expand the current knowledge about professional relationships in mental health care by exploring staff members' descriptions of helpful professional relationships in supportive housing institutions. What this paper adds to existing knowledge: The study shows that helpful relationships may involve staff experiences of reciprocity in terms of both a two‐way influence between staff and residents and a reciprocal gain from being part of the helpful relationships.A conceptualization of reciprocity that complements existing concepts is suggested and connected to a "good match" between staff and residents. What are the implications for practice?: When support and care are intended to be provided within a dyadic relationship, both parties' preferences should be considered when pairing service users and professionals.Practitioners should get involved in ways that open up for being influenced and inspired by the service user's characteristics, such as personality and attitude. Furthermore, they should dare to enjoy and make use of the company of the service user in ways that promote multifaceted reciprocity. Introduction: In the aftermath of the deinstitutionalization in western countries, new community‐based mental health services have been established. An essential object of studies in this new institutional landscape has been helpful professional relationships, but we still lack knowledge about helpful relationships in community‐based institutional supportive housing. Aim: To explore how staff members describe their relationships with residents who have identified them as helpful. Methods: Qualitative interviews with nine staff members were analysed using thematic analysis. Results: "Reciprocity" was identified as the main theme, and two subthemes were developed: "Something influential about the resident" and "Value for the staff member." Discussion: The findings are discussed and related to existing conceptualizations of reciprocity in professional relationships, and an additional conceptualization is suggested. Implications for practice: To promote reciprocity, managers should consider both parties' personal preferences when matching professionals and service users. Further, professionals should get involved in ways that open up for being influenced and inspired by several of the service user's characteristics. They should allow themselves to enjoy the company of the service user in ways that promote multifaceted reciprocity. [ABSTRACT FROM AUTHOR]

Recurrent factors contributing to a recovery process from co-occurring mental health and addiction problems mentioned by users and professionals have been analyzed as part of working alliances and helpful relationships. Still, we lack knowledge about how helpful relationships are developed in daily practice. In this article, we focus on the concrete construction of professional helpful relationships. Forty persons in recovery and fifteen professionals were interviewed. The interviews were analyzed according to thematic analysis, resulting in three themes presented as paradoxes (1) My own decision, but with the help of others; (2) The need for structures and going beyond them; and (3) Small trivial things of great importance. Micro-affirmations have a central role in creating helpful relationships by confirming the individuals involved as more than solely users or professionals. More attention and appreciation should be paid to practices involving micro-affirmations. [ABSTRACT FROM AUTHOR]

Our daily lives and sense of self are partly formed by material surroundings that are often taken for granted. This materiality is also important for people with mental health problems living in supported housing with surroundings consisting of different healthcare services, neighbourhoods, buildings or furniture. In this study, we explored how understandings of tenants are expressed in the materialities of supported housing. We conducted ethnographic fieldwork in seven different supported accommodations in Norway and analysed the resultant field notes, interviews, photographs and documents using Situational Analysis. The analysis showed that supported housing materialities expressed a blurry picture comprising widening and narrowing understandings of tenants, both by others and by themselves. Widening understandings concerned how tenants were living their lives in their own ways in private rooms while maintaining a social life in common areas. Narrowing understandings pertained to understand the tenants based solely on their diagnosis and need for care and control in hospital‐like buildings. The following discussion focusses on the ideas that underlie narrowing materialities and on the importance of striving for atmospheres that entail a sense of belonging. [ABSTRACT FROM AUTHOR]

Purpose: Persons with severe mental health problems (SMHP) point out financial strain as one of their main problems. De-institutionalisation in welfare countries has aimed at normalisation of their living conditions. The aim of the study was to follow the changes in income and source of income during a 10-year period for persons with a first-time psychosis diagnosis (FTPD).Methods: Data were gathered from different registers. Data from persons with FTPD were compared to data on the general population. Two groups with different recovery paths were also compared: one group without contact with the mental health services during the last five consecutive years of the 10-year follow-up, and the other with contact with both 24/7 and community-based services during the same period.Results: SMHP led to poverty, even if the financial effects of SMHP were attenuated by welfare interventions. Even a recovery path associated with work did not resolve the inequalities generated by SMHP.Conclusions: Attention should be paid to the risks of confusing the effects of poverty with symptoms of SMHP and thus pathologizing poverty and its impact on human beings. Adequate interventions should consider to improve the financial situation of persons with SMHP. [ABSTRACT FROM AUTHOR]

Places where people live are important for their personal and social lives. This is also the case for people with mental health problems living in supported housing. To summarise the existing knowledge, we conducted a systematic review of 13 studies with different methodologies regarding the built environment in supported housing and examined their findings in a thematic analysis. The built environment of supported housing involves three important and interrelated themes: well-being, social identity and privacy. If overregulated by professionals or located in problematic neighbourhoods or buildings, the settings could be an obstacle to recovery. If understood as meaningful places with scope for control by the tenants or with amenities nearby, the settings could aid recovery. [ABSTRACT FROM AUTHOR]

Background: Despite repeated attempts, it has not been possible to reach a consensus on the definition of recovery. In this paper, we use the term "institutional recovery" and focus on the persons' use of services. Aim: What type of services were used by men and women who were diagnosed for the first time with psychosis? How did different cut-offs of length of follow up influence the findings? Method: Interventions for 386 persons diagnosed for the first time with psychosis were followed up for 10 years. Data were collected from registers covering psychiatric and social work services and prisons. Results: Results varied according to cut-off. Nevertheless, even using the higher cut-off, fifty-five percent of the persons had no stay in 24/7 institutions during the follow-up's last 5 years. More than 40% had only community-based treatment and support. Fifteen percent had no interventions at all. A 2-year cut-off doubled the percentage of persons with no interventions. No statistically significant gender differences were found. Conclusions: Institutional recovery could be a useful recovery measure. However, the results from different studies are dictated by choices made by the research team, which should be clarified and discussed. [ABSTRACT FROM AUTHOR]

The aim of this study is to present concrete descriptions of the content in the construction of helpful relationships with staff, according to users. Starting with the re-occurring concept of the meaning of “little things” in recovery studies, a literature review was done. A thematic analysis shows that small things play an important role in improving a person’s sense of self. Small things seem to be an invisible but effective parts of a recovery-orientated practice, but they might be defined as unprofessional and their efficacy negated. [ABSTRACT FROM AUTHOR]

During a 9-month period, 100 persons with SMI were given approx. 73 USD per month above their normal income. Sixteen of the subjects were interviewed. The interviews were analysed according to the methods of thematic analysis. The money was used for personal pleasure and to re-establish reciprocal relations to others. The ways in which different individuals used the money at their disposal impacted their sense of self through experiences of mastery, agency, reciprocity, recognition and security. The findings underline the importance of including social circumstances in our understanding of mental health problems, their trajectories and the recovery process. [ABSTRACT FROM AUTHOR]

The downsizing of psychiatric hospitals has created a new institutional landscape in the local community to support people with severe mental problems in their daily living. This study explores meeting places in Norway from the users' perspectives. The users used four metaphors to describe these meeting places: "like a home", "like a family", "like a landing ground" and "like a trampoline". The users have decorated the interiors of the meeting places with hearts made from various materials, and these could be considered as symbols of the places. The metaphors used: the hearts and the rooms and interiors, reflect old ideas about calmness and dignity rather than new ideas based on New Public Management. [ABSTRACT FROM AUTHOR]

Background:The relationship between severe mental illness, poverty and social isolation has been explored in a number of studies. Aim:The purpose of the study was to explore the relationship between financial strain and social isolation. Methods:Sixteen persons with severe mental illness were interviewed about their experience of having a severe mental illness, living in poverty and the effect these circumstances had on their social relationships. The interviews were analysed according to thematic analysis. Results:The overarching theme was “the cost of having friends”; it consisted of five categories: the loss of friends; making do without friends; dependence on friends and family; supported socialisation; and money as an aid to recovery. The participants experienced a connection between their financial circumstances, their social relationships and their lack of initiative in maintaining and developing a social network. Conclusions:The results underline the importance of considering the person in his/her social context in order to avoid the risk of interpreting rational strategies for coping as psychiatric symptoms. [ABSTRACT FROM AUTHOR]

The relationship with professionals is an important factor in relation to the outcome of interventions directed to persons with severe mental problems. However, the current knowledge regarding the development of helpful relationships within Individual Placement and Support (IPS) services is limited. The aim of the study was to investigate how participants in IPS services described their relationship with their IPS coach. The article is based on interviews from a Swedish government evaluation of IPS services, thematically analyzed. The results showed that the relationship with the coach is central for the participants’ success in the service. The main theme, “something different - as a human being” highlighted that the conditions for the relationship are different within IPS as compared to traditional services. The other themes were “here and now action,” “closer to wish-fulfilment – impact on the self,” and “from role to person.” The principles of IPS parallel the results from research about helpful relationships and offers good preconditions for the occurrence of such relationships. This can represent a bridge between evidence based methods and research on helpful relationships, and should be possible to implement in the development of evidence based methods as well as of treatment as usual. [ABSTRACT FROM AUTHOR]

Several studies have indicated a co-occurrence between mental problems, a bad economy, and social isolation. Medical treatments focus on reducing the extent of psychiatric problems. Recent research, however, has highlighted the possible effects of social initiatives. The aim of this study was to examine the relation between severe mental illness, economic status, and social relations. Method: a financial contribution per month was granted to 100 individuals with severe mental illnesses for a 9-month period. Assessments of the subjects were made before the start of the intervention and after 7 months' duration. A comparison group including treatment as usual only was followed using the same instruments. Significant improvements were found for depression and anxiety, social networks, and sense of self. No differences in functional level were found. Social initiatives may have treatment and other beneficial effects and should be integrated into working contextually with persons with severe mental illnesses. [ABSTRACT FROM AUTHOR]

During the last decades services to people with severe mental health problems have gone through important changes. Terms as de-, trans-, reinstitutionalisation and dehospitalisation has been used. The objective of the study was to collected data about the changes in a welfare society about the new institutional landscape after the mental hospital area. Data about interventions from social welfare agencies, psychiatric care, and prisons were collected from local and national register as well as data about cause of death and socio-economic status for 1355 persons treated with a diagnosis of psychosis in a Stockholm area 2004-2008. Psychiatric in-patient care and prisons are marginalized. Different interventions in open care touched a very large number of persons. Social welfare agencies play an increasing role in this context. The total institutions have been replaced by a network of micro-institutions sometimes offering help but also control. [ABSTRACT FROM AUTHOR]

Background: Establishing a working alliance has been found to be of great importance for the outcome of professional interventions for people diagnosed with severe mental illnesses.Aim: The aim of the present study was to analyse the concrete actions of helpful professionals in establishing a working alliance.Method: Interviews with 58 persons diagnosed with severe mental illness who were in a recovery process or had recovered were analysed using Grounded Theory.Results: The core category that emerged from the analysis was termed ‘going beyond’. It was constituted on three subcategories: challenging the rationality of the institutions, restoring the professional as a person and restoring the user as a person.Conclusion: Users’ experience-based knowledge about helpful professionals calls into question the traditional view of professional roles. [ABSTRACT FROM AUTHOR]

In psychiatry, it is assumed that the social conditions of everyday life do not in themselves affect the severity of an individual’s mental ill health. Rather, the illness is the cause of problems that the individual meets in daily life. However, recent studies indicate that social factors can explain behavior that has ordinarily been regarded as symptoms of mental illness. The aim of the present study is to investigate how people with a psychosis diagnosis manage their economic difficulties. Nineteen persons with a psychosis diagnosis were interviewed on several occasions in the course of a follow-up study. The interviews were analyzed according to Grounded Theory. The present study shows that the persons had developed different rational ways of coping with economic strain: reducing their expenses, increasing their incomes or borrowing money and acquiring debts. Living under poverty negatively affects their possibility to acquire and maintain a social network and their sense of the self. The study contributes to our knowledge of the nature of psychosis and its relationship to the social context. [ABSTRACT FROM AUTHOR]

the de-, re- and trans-institutionalization of psychiatric care has resulted in a number of changes in the interventions available to persons with severe mental disorders. Aims This article describes the design of a naturalistic follow-up study of persons with a psychosis diagnosis, the characteristics of the study population, and the interventions they received prior to study participation from various agencies in and outside of mental healthcare. Method: data from various registers, such as psychiatric and social services case registers, criminal records, and the cause of death register have been collected and analyzed. Results Under the period 1997–2004, 42% were in contact only with out-patient care, 58% were in contact with the social services, and 2% had served prison sentences. Conclusions Studies need to include interventions that are provided beyond the scope of psychiatric services in order to assess the extent of the existing support network and the long-term outcomes for persons with a psychosis diagnosis. The lack of a gender perspective in psychiatric research also needs to be addressed. [ABSTRACT FROM AUTHOR]

Research has shown the importance of the relationship between professionals and users for the outcome of interventions in psychiatry. The aim of this study is to analyze time as one factor in the development of working alliances. Fifty-eight persons in recovery from diagnosis of severe mental illness were interviewed about helping factors in their recovery process. Two aspects of time were considered to be of importance for the construction of working alliances: the quantity of time, that is, getting more time than expected during, between, and after the sessions; and the quality of time, that is, having undisturbed and focused time, the experience of being in the professional thoughts between the sessions and timing in one's life. Those experiences give the person a sense of being a real-life person and not an abstract patient, and this lays the groundwork for establishing a working alliance. The management of time is an important factor in the creation of a working alliance and should be given greater attention in the development of experience- and evidence-based practice. [ABSTRACT FROM AUTHOR]

Background: The quality of the relationship between professional and user is one of the important factors in the recovery process. However, more knowledge is needed concerning the components of helping relationships and characteristics of the helping professional. The aim of this study was to explore users' experiences of helping relationships with professionals. Data and methods: This was a grounded theory analysis of 71 qualitative interviews to explore users' experience of helping relationships and their components, in psychiatric care in Sweden. Discussion: Within the three main categories - interpersonal continuity, emotional climate and social interaction - two core themes were found that described vital components of helping relationships: a non-stigmatizing attitude on the part of the professionals and their willingness to do something beyond established routines. Conclusions: The focus in psychiatric treatment research needs to be broadened. In addition to research on the outcome of particular methods and interventions, the common factors also need to be investigated, above all, what is the effect of the quality of the relationship between user and professional. Greater attention needs to be paid, as well, to how helping respective obstructive relationships in psychiatric services arise, are maintained or are modified. [ABSTRACT FROM AUTHOR]

Background: People who have been diagnosed with schizophrenia are regarded as being no longer capable of making rational choices. Method: Fifteen users with psychosis diagnosis participated to 10 focus group sessions about different aspects of everyday life. The discussions were tape recorded and the transcript analyzed using a grounded theory inspired methodology. A core category that emerged was making choices in crises situations. Results: Users have to choose whether or not they want help, to whom to turn for help, and how to describe their problems so as to get the kind of help they seek. The choices were based on past experiences in connection with the choices available. They were constantly making quality judgements of the care workers they came into contact with. Experiencing a sense of comradeship emerged as a vital criterion. Conclusions: The ability to make rational choices often existed parallel with hallucinations and delusions. This ability could form the basis for a true collaboration between users and professionals. The findings of this study indicate that such collaboration is possible, but that it requires a reassessment of our traditional knowledge base. [ABSTRACT FROM AUTHOR]

Despite much effort to positively affect long-term outcome in psychosis and schizophrenia many patients are still facing a poor outcome with persistent psychotic symptoms and decline in social functioning. The aim of this study was to examine the relationship between financial strain and social network and five-year outcome of first episode psychosis (FEP). FEP patients were divided into recovered ( n = 52) and non-recovered ( n = 19). Each person was matched according to age and gender with four persons ( n = 284) from a longitudinal population-based study. All persons had answered an extensive questionnaire including social network, quantitative and qualitative, financial strain and mental health. Linear regression analysis showed that both financial strain and social network were associated, and had a unique contribution, to outcome. The results indicate that FEP patients might benefit from interventions that reduce financial strain thus facilitating daily life and cultural and social activities. [ABSTRACT FROM AUTHOR]

Relationships have a tremendous impact on how people recover from schizophrenia. Previous research has focused on the role of clinicians in these supportive relationships, but the current study finds that these relationships can occur within the mental health system, the family, or out in the community. Regardless, it is very important for people in recovery to feel as if they are supported and cared for. In qualitative interviews, we examine the specific aspects that characterize other people's actions when helping in the recovery process. First, for both professionals and family members, being “there” and available seemed to help people in recovery. Secondly, people helped by doing more than was expected of them, sometimes by lending money or doing something extra to help out the person in recovery. Thirdly, people helped by doing something different than what was expected of them. For professionals, this might mean that they break a minor rule. These factors helped people in recovery feel like they were special, chosen, and “worth” doing something extra for. [ABSTRACT FROM AUTHOR]

The purpose of this paper was to provide an example from phenomenological research of moving from rich descriptive interview data to coherent revelatory descriptions employing empathic bridges within the narrative structure of storytelling. We used transcribed data from two interviews concerning recovery from severe mental illness: one with an American woman in her early thirties, and the other with a Swedish man in his mid-thirties. Five investigators analyzed the transcribed data into individual first-person narrative descriptions according to existing empirical phenomenological methods including an independent reading, identification of themes relevant to processes of recovery from severe mental illness, temporal ordering of themes meaningfully reflecting the sequence of the recounted events, and consensus development. Our findings support the use of empathic bridges as a methodological tool with the narrative structure of firstperson storytelling, as well as the viability and importance of employing this tool to better understand processes of recovery for persons with severe mental illness. [ABSTRACT FROM AUTHOR]

The concept of recovery is commonly described as multifaceted and contested in the field of mental health and substance abuse. The aim of this study is to explore how understandings of recovery and recovery orientation of services are developed through daily practices and collaboration between service users and professionals. Eight pairs of participants were interviewed together, in accordance with the dyadic interview method. The dyads/pairs consisted of service users and professional helpers. A collaborative hermeneutic-phenomenological analysis was used to analyse data. Data were analysed into three overarching and entangled themes, exploring how recovery-oriented collaboration and knowledge encompasses (a) recovery as relational processes. These processes are entangled with (b) recovery as situated in time and place. Furthermore, relational processes and dimensions of time and place are situated in and supported or hindered by (c) recovery orientation as part of the municipal policies, understood as the regulations, frameworks and decisions guiding mental health and substance abuse services in the municipality. The further development of recovery-oriented services should focus on facilitating open-ended and flexible ways of developing practices and relationships. This involves recognizing how relationships contribute to the development of knowledge and practices. [ABSTRACT FROM AUTHOR]

The aim of this study is to explore how material things might become involved in the recovery process of people with mental health difficulties. Empirical material from three different studies on various aspects concerning mental health issues that each of the authors had conducted was reanalysed through a phenomenological item analysis. We discovered that mundane objects such as a mobile phone, a bench, a door and a key have agency to contribute to peoples' recovery and wellbeing. Things became agents that created contexts that initiated physical, social and emotional movements. By giving attention to materiality we might become aware of the importance of things as agents in living in general and in recovery processes for people with mental health difficulties in particular. [ABSTRACT FROM AUTHOR]

Background: User involvement, based on respect and carried out through dialogue, has been shown to lead to increased self-respect, self-confidence and positive identity. In Sweden, the Social Service Act requires that interventions be designed and implemented together with the individual concerned. The basic criterion for social support is prolonged severe mental illness (usually at least 6 months), with no criteria for specific diagnosis or institutional history. The most common form of social support is 'support in daily living', a community care intervention for people aged 18 years or older who have their own homes and living arrangements. Aim: This article aims to deepen our understanding of user involvement at the individual level in the provision of an ongoing social work intervention. What elements of user involvement can be found in users' and support workers' descriptions of helpful support in daily living? Method: Qualitative interviews were conducted with 18 users, who had experienced support in daily living as helpful, and 16 interviews with the users' support workers. Results: Three major, interconnected themes emerged: Constant dialogue; Framing the flexibility, in relation to formalized intervention plans and regulations; The importance of 'small things', decisions concerning daily life. Conclusion: Both users and support workers described user involvement at the individual, micro-level to be an integral part of helpful support in daily living. It was possible to create a space for dialogue and co-creation in which users were involved in formulating and deciding the contents of their support at an informal level, to influence their own everyday lives. While a formal framework of rules, restrictions and plans surrounds meetings between users and professionals, a facilitating factor may be the absence of too detailed plans and regulations, leaving trust to users and professionals and their capacity to manage most of the choices they have to make. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to explore the ways in which "small things" may be of importance for people with mental health difficulties. Method: Empirical material from three different studies was reanalysed through a phenomenological, dialogical, approach. Results: We discovered some paradoxical aspects of small things: i.e., they could be about "something" that was difficult or even impossible to identify. The unidentifiable could be about bodily, sensual experiences that are superficial (i.e., belonging to the surface). The interaction with others highlighted as significant could be about doing something fun, talking nonsense or kidding around, and hence not at all about making sense of something—a kind of important nonsense. We summarize these aspects in three themes: the importance of the unidentifiable, the superficial and nonsense. These aspects can be regarded as small things—even "nothings"—that make it possible "to stay in the world". Conclusion: We elaborate on the findings in relation to the following: Gumbrecht's critique of the prevailing hermeneutic world-view with its idea that "interpretation is humankind's exclusive way of relating to the world", Ingold's idea that social life is lived in relations of "interfacility" and hence a turn to surfaces is needed for a "restoration of social life", and Biesta's idea of existence as "coming into the world in the presence of others". [ABSTRACT FROM AUTHOR]

This paper points out some problematic aspects of qualitative research based on interviews and uses examples from mental health. The narrative approach is explored while inquiring if the reality of life here is forced into the formula of a chronological story. The hermeneutic approach, in general, is also examined, and we ask if the reality of life in this scenario becomes caught up in a web of interpretations. Inspired by ideas from Bakhtin and phenomenology, we argue for interview-based research that stays with unresolvedness and constantly question the web of interpretations and narratives that determine our experiences. This also chimes with certain dialogical practices in mental health in which tolerance of uncertainty is the guiding principle. Concludingly, we suggest that interview-based research could be a practice of 'un-resolving' in which researchers, together with the participants, look for cracks, contradictions, and complexities to prevent the qualitative fallacies of well-organized meanings and well-composed stories. [ABSTRACT FROM AUTHOR]

Background:Although being personal in relationships with service users is commonly described as an important aspect of the way that professionals help people with severe mental problems, this has also been described to bring with it a need to keep a distance and set boundaries.Aims:This study aims to explore how professionals working in psychiatric care view being personal in their relationships with users.Method:Qualitative interviews with 21 professionals working in three outpatient psychiatric units, analyzed through thematic analysis.Results:Being personal in their relationships with users was described as something that participants regarded to be helpful, but that also entails risks. Participants described how they balanced being personal by keeping a distance and maintaining boundaries in their relationships based on their “experience-based knowledge” to counter these risks. While these boundaries seemed to play an important part in the way that they act and behave, they were not seen as fixed, but rather as flexible and dynamic. Boundaries could sometimes be transgressed to the benefit of users.Conclusions:Being personal was viewed as something that may be helpful to users, but that also entails risks. Although boundaries may be a useful concept for use in balancing these risks, they should be understood as something complex and flexible. [ABSTRACT FROM AUTHOR]

Background: The lack of social and material perspectives in descriptions of recovery processes is almost common in recovery research. Aim: Consequently, we investigated recovery stories and how people with mental health and/or addiction challenges included social and material aspects in these stories. Method: We conducted focus group and individual interviews. We investigated how the participants narrated their stories and how they assembled places and people in their recovery stories. Results: We found that narratives of recovery became assemblages where humans and their environments co-exist and are interdependent. Conclusion: As such, narratives about recovery are about everyday assemblages of well-being into which stories of insecurity are interwoven, without a start or stop point. [ABSTRACT FROM AUTHOR]

Background: The relationship with professionals has proved to be important with regard to outcome for persons with severe mental illness (SMI). The understanding of non-helpful relationships is important complementary knowledge to that regarding helpful relationships. Aim: To review the available qualitative research providing knowledge of non-helpful relationships from the perspective of persons with SMI. Method: A review of qualitative studies, based on an earlier systematic search, analyzed through thematic analysis. Results: The main themes were "non-helpful professionals", "organization versus relation" and "the consequences of non-helpful relationships with professionals". Examples of professionals described as non-helpful were pessimistic and uncaring professionals who were paternalistic and disrespectful. Discontinuity, insufficient time and coercion were some of the contextual factors described as non-helpful. These sorts of relationships were non-helpful because they hindered helpful relationships from developing and contributed to further suffering, instilling hopelessness and hindering personal growth. Conclusions: Non-helpful relationships with professionals can be understood as impersonal relationships that contain no space for negotiation of the relationship nor of the support and treatment provided through it. It is important that organizations provide professionals with favorable conditions to negotiate the organizational framework and to treat persons with SMI as whole human beings. [ABSTRACT FROM AUTHOR]

Relationships with professionals have been shown to be helpful to persons with severe mental illness (SMI) in relation to a variety of services. In this article, we aimed to synthesize the available qualitative research to acquire a deepened understanding of what helpful relationships with professionals consists of, from the perspective of persons with SMI. To do this, we created a meta-ethnography of 21 studies, through which ten themes and an overarching interpretation were created. The findings show that helpful relationships with professionals are relationships where the persons with SMI get to spend time with professionals that they know and trust, who gives them access to resources, support, collaboration and valued interpersonal processes, which are allowed to transgress the boundaries of the professional relationship. The overarching interpretation shows that the relationship that persons with SMI form with professionals is a professional relationship as well as an interpersonal relationship. Both these dimensions entail actions and processes that can be helpful to persons with SMI. Therefore, it is important to recognize and acknowledge both the functional roles of service user and service provider, as well as the roles of two persons interacting with each other, in a manner that may go beyond the purview of the traditional professionalism. Furthermore, the helpful components of this relationship are determined by the individual preferences, needs and wishes of persons with SMI. [ABSTRACT FROM AUTHOR]

Background: Recovery research often describes recovery from mental illness as a complex individual process. In this article a social perspective on recovery is developed. Aims: To ascertain which factors people regard as decisive to their own recovery and what makes them beneficial. Methods: In-depth interviews were conducted with 58 persons in Sweden who had recovered from severe mental illness. Interviews were qualitatively analyzed using grounded theory. Results: Three dimensions of contributing recovery factors were identified. Social relationships emerged as the core category throughout these dimensions. Conclusions: The results show that recovery processes are social processes in which social relationships play a key role. [ABSTRACT FROM AUTHOR]

Informants in the present study identified poverty, unemployment, substandard living conditions and homelessness as being among the major struggles they faced within their recoveries from psychosis and depression. In considering the benefits of material resources, many informants discussed the notion of having a home, referring to it as a place for growth, development, and control; a means for balancing the need for socializing with privacy; and having a place to long for and dream about. All informant narratives suggested the importance of having a secure base from which to launch efforts towards recovery. By contrast, informants varied in their explanations of what transforms the physical structure of a house or an apartment, into a place that feels like a home. [ABSTRACT FROM AUTHOR]

The deinstitutionalization of mental health institutions has enabled service users to live in the community and search for what Duff coins 'enabling places.' These places were explored through walking interviews, in which service-users led the way. This analysis revealed features which made places promote liveable lives: places help people explore, places help people stand out, places give people responsibilities, and places dare people. An adverse feature was also identified: places define people by their problems. Overall, we suggest that 'living needs a landscape' to capture how a diversity of places form an 'enabling landscape'. This suggests a shift of focus in research and treatment, from internal to external landscapes. • Living needs a landscape made of diverse places offering opportunities to engage in socio-material practices together with others. • Places are enabling as they 'help people to explore,' 'help people stand out,' 'give people responsibilities' and 'dare people.' • Places, with their material, social, and affective resources, collectively form enabling landscapes. • A shift in focus from individuals' inner mental landscapes to outer material and social landscapes is suggested. [ABSTRACT FROM AUTHOR]

People with severe mental illness face a different 'interventional' landscape compared to some decades ago, when mental hospitals were dominant, in Sweden as well as in the rest of the Western world. The aim of the research reported in this article was to follow men and women diagnosed with psychosis for the first time over a 10-year period, and to explore what interventions they experienced. The interventions, here defined as "spheres", were either community-based or institutional. A third sphere represents no interventions. Based on data from registers and using a time-geographic approach, the individuals were visualised as 10- year trajectories where their transitions between the different spheres were highlighted. The results show a great diversity of trajectories. Two main categories were detected: two-spheres (community-based and no interventions) and three-spheres (adding institutional interventions). One third of the population experienced only community-based interventions, with a higher proportion of men than women. Consequently, more women had institutional experience. Two sub-categories reveal trajectories not being in the interventional sphere in a stepwise manner before the 10th year, and long-term trajectories with interventions in the 10th year. The most common pattern was long-term trajectories, embracing about half of the population, while one-fifth left the institutional sphere before the 5th year. [ABSTRACT FROM AUTHOR]

Living conditions for persons with severe mental illness (SMI) in Sweden have changed dramatically in recent decades, mainly due to the closure of mental hospitals in the 1990s and the subsequent development of community-based interventions. Thereby, people with SMI have experienced care interventions in various forms, which vary according to how the treatment is institutionally organised over the years. There is, however, a lack of knowledge concerning what "care paths" persons with SMI have undergone in this fragmented institutional landscape. In this article we present a time-geography-inspired visualisation method to address this. A set of 437 persons, first diagnosed with psychosis between 2000–2004, were studied over 10 years with regard to their contact with various care institutions. We constructed time-geographic paths of intervention for these individuals and visualised them at an aggregate level. The initial exploration conducted using the proposed visualisation method showed gender and age differences in some respects, but also that the initial periods after the psychosis diagnoses were similar in terms of in-patient care interventions among men and women. The proposed visualisation method is promising and should be further developed for deeper analysis of long-term individual paths of intervention. [ABSTRACT FROM AUTHOR]

Psychotropic drugs, particularly antipsychotic types, are a cornerstone of the treatment of people with psychosis. Despite numerous studies showing that drug treatment with psychotropic drugs initially alleviates psychiatric symptoms, the proportion of people with mental health problems and symptoms that do not follow doctors' prescriptions, thus exhibiting so-called non-adherence, is considerable. Non-adherence is predominantly seen as a clinical feature and as a patient characteristic that is especially due to patients' poor understanding that they are ill. There is also a widespread notion that non-adherence is of great disadvantage to the patient. This article is based on interviews with 19 persons diagnosed with psychosis. It challenges the notion of patients being either adherent or non-adherent to the doctor's orders. The findings show that persons with psychosis are active agents when it comes to adjusting medication. The interviewees created their own strategies to gain power over treatment with psychotropic drugs. The most common strategies were to adjust the doses or take breaks of varying lengths from the medication. These deviations from prescriptions were important to conceal, not only from their own psychiatrists, but from all psychiatric staff. [ABSTRACT FROM AUTHOR]

People with severe mental illness (SMI) are often described as lonely and socially incapable – an inability resulting from the mental illness. The aim of this article is to explore experiences of being alone among persons with SMI. The article is based on interviews with 19 persons diagnosed with psychosis who were interviewed between four and nine times over a period of three years. The findings show that experiences of being alone can be identified bytwoconcepts: aloneness and loneliness. The persons in the study appeared as socially able and active in relation to their social lives. However, a social agent does not operate in a void but in interaction with specific living conditions; the experiences of aloneness and loneliness may be viewed as the result of the interplay between the individual and the social and material environment. [ABSTRACT FROM PUBLISHER]

Being in recovery from bipolar disorder involves work-related concerns. The specific aims of this study are to: 1) understand the role of work in recovery from bipolar disorders, and 2) understand how people with such disorders deal with work-related challenges. These topics are examined from the stance of the recovery process, in which work-related activities were explored. Semi-structured, qualitative interviews were conducted with persons who had experienced recovery from bipolar disorder. Analysis was performed through thematic and phenomenological analysis, with hermeneutic phenomenology and reflexive methodology as a framework. The findings are presented through the following themes: 1) many types of work – finding meaning and a focus; 2) helpful roles and contexts – to be much more than a person with an illness; 3) making work possible – the role of supportive relationships and supportive medications, and 4) the costs of working too much – finding a meaningful and healthy balance. [ABSTRACT FROM PUBLISHER]

This article offers examples of the ways in which qualitative methods have informed, and may inform, mental health policy in Canada and beyond. Three initial uses of these methods are identified: to generate hypotheses to be tested by other means; to explore the subjective experiences and everyday lives of people with mental illnesses; and to investigate processes of recovery and the active role of the individual in recovery. Given the recent focus in mental health policy in Canada, the United States, and around the world on transforming mental health systems to promote recovery and the emphasis recovery places on the individual's own first-hand perspective, we argue that qualitative methods will become increasingly useful as psychiatry shifts away from symptom reduction to enabling people to live satisfying, hopeful, and meaningful lives in the community. [ABSTRACT FROM AUTHOR]

We analyzed informant narratives in terms of the benefits of spending time within various community arenas, including service user organizations, advocacy agencies, the bowling alley, and universities. Themes contributing to recovery from severe mental illness included the understanding and acceptance infromants both gave and received from others, spiritual fulfillment, and even experiences of anger as mechanisms of empowerment to counter social discrimination and neglect. Involvement across various community arenas and the themes it elicited relative to recovery were understood in terms of developing more durable and advantageous understandings of the self. [ABSTRACT FROM AUTHOR]

This article analyzes the role of social factors in recovery from psychosis, which can be helpful as well as hinder the process of recovery. Informants found their roles as psychiatric patients constituted a major barrier to social adaptation. They experienced stigma both within their natural social networks and mental health services, which often led to self-stigmatization. Given this stigma, the right to have a say in one's care and the right to other forms of self-advocacy were crucial in recovery. The sense of belonging to a place or a group of people outside institutions could be the first step. In addition to existing social networks, informants found these social arenas in their places of employment, clubs, day centres, shelters, or Internet communities. Spending time within new and different people and social groups also raised awareness of informants' desires and abilities to become citizens in their own communities. [ABSTRACT FROM AUTHOR]

This article provides an interpretation of the key issues that emerged from the research, attempting a possible synthesis of the different themes described in the other papers and beginning a map of recovery as an ongoing interpersonal and social process. From a subjective point of view, there is a dimension of ‘social experience’, which implies the reconstruction of self and the importance of social life as a major goal. Recovery as an interactive journey requires an entire social context ‘provided with meanings’, rather than simply building social ties and relationships within a network. Socialization in a real environment means social inclusion, like efforts made of gaining the status of effective citizenship, in terms of rights, opportunities, and responses to social needs. Therefore, what citizenship is really about seems to be ‘recovery in a social context’. In this framework, a community service can act as a sort of mediator, an agent for integration, recognizing the uniqueness of those processes. [ABSTRACT FROM AUTHOR]

Expanding on the introduction to the multinational study described in the first article, this article briefly reviews informants’ contexts of treatment across Italy, Norway, Sweden, and the United States, and provides a cursory description of each informant, organized according to her or his respective country. The informant descriptions are followed by illustrative third-person narratives drawn from interviews with two informants from Sweden. As a counterpoint to themes derived across informant narratives, such as the roles of home, significant others, and coping strategies, this article attempts to illustrate how such themes are interwoven within the context of individuals’ lives and personal journeys toward recovery. [ABSTRACT FROM AUTHOR]

As they began the journey of recovery from psychosis, informants described the importance of making their own initial decision to get well and maintain their physical and mental health. Developing a sense of self-control in their lives by managing their symptoms, determining how they spend their time, developing their own ways of defending themselves from stigma and social demands, and listening to their own needs and experiences were crucial to developing a sense of independence and agency. Informants described aiding their own recovery by allowing and encouraging new and different identities beyond their status as mental patients and apart from the person they were before the illness. Developing this new identity often enabled them to feel strong and to derive meaning from the difficult experiences of their illness. As in much of the informants' descriptions of their recovery processes, this development of identity and sense of purpose and independence often occurred beyond the scope of the mental health system and its professionals. [ABSTRACT FROM AUTHOR]

As part of a growing literature describing processes of recovery in psychotic disorders, this report presents findings of an intensive, international study. Open-ended qualitivite interviews were conducted in Italy, Norway, Sweden, and the United States with a total of twelve individuals who have experience of recovery in psychosis. All interviews were translated into English and transcribed. Investigators from each of these countries collaborated in analyzing the interviews and identifying common elements across the twelve narratives. Themes were identified in each of the following areas: 1) how the individual deals with his or her difficulties; 2) the role of material resources; 3) the various roles of formal and informal health systems; 4) the roles, and absence, of significant others; and 5) the roles of social and cultural factors. Salient themes included the person's determination to get better, establishing a degree of self–control, and struggling to achieve a normal life; the need for material resoures and a sense of home, and the importance of going out and engagging in normal activities; the benifits, and costs, of medication, involvement in mutual support/user groups, and participation in various psychosocial interventions; the need to be accepted as, and to accept oneself as, a normal person who exists beyond the psychosis; the impact of stigma and discrimination, and the imortance of having one's rights respected and returning to a meaningful social role through work and/or positive relationships outside of the formal mental health system. Cultural differences between participants from each country were noted primarily in the nature of the opportunities and supports offered rather than in the nature of the processes described. In closing, implications of these findings are considered both for future research on processes of recovery and for making clinical practice more recovery-oriented. [ABSTRACT FROM AUTHOR]