Winsper Catherine, Crawford-Docherty Anne, Weich Scott, Fenton Sarah-Jane, Singh Swaran P
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; R & I Department, Caludon Centre, Coventry and Warwickshire Partnership Trust, Clifford Bridge, Coventry CV2 2TE, UK.
Black Country Partnership NHS Foundation Trust, Delta House, Delta Point, Greets Green Road, West Bromwich, West Midlands B70 9PL, UK.
Clin Psychol Rev. 2020 Mar;76:101815. doi: 10.1016/j.cpr.2020.101815. Epub 2020 Jan 7.
The emergent recovery paradigm prioritises adaption to serious mental illness and a move towards personally meaningful goals. In this review, we combine a theory driven logic model approach with systematic review techniques to forward understanding of how recovery-oriented interventions can help service users in their personal recovery journey. We identified 309 studies meeting our inclusion criteria. Our logic model mapped out intervention typologies and their recovery outcomes, the mechanisms of action underpinning these links, and the contextual moderators of these mechanisms and outcomes. Interventions were associated with recovery outcomes (functional, existential and social) directly and through a sequence of processes, which were underpinned by four common mechanisms: 1) providing information and skills; 2) promoting a working alliance; 3) role modelling recovery; and 4) increasing choice. Moderators of these mechanisms were observed at the service user (e.g., motivation), mental health service (e.g., professional attitudes) and wider environmental (e.g., unemployment rates) level. Recovery-oriented interventions share common critical mechanisms, which can help propel service users towards recovery especially when delivered within pro-recovery and non-stigmatising contexts. Future studies should further examine ways to reduce (or remove) barriers preventing individuals with mental health problems from experiencing the same citizenship entitlements as everyone else.
紧急康复模式将适应严重精神疾病并朝着个人有意义的目标迈进作为优先事项。在本综述中,我们将理论驱动的逻辑模型方法与系统综述技术相结合,以增进对以康复为导向的干预措施如何在服务使用者的个人康复旅程中提供帮助的理解。我们确定了309项符合我们纳入标准的研究。我们的逻辑模型描绘了干预类型及其康复结果、支撑这些联系的行动机制,以及这些机制和结果的背景调节因素。干预措施直接并通过一系列过程与康复结果(功能、生存和社会方面)相关联,这些过程由四个共同机制支撑:1)提供信息和技能;2)促进工作联盟;3)树立康复榜样;4)增加选择。在服务使用者(如动机)、心理健康服务(如专业态度)和更广泛的环境(如失业率)层面观察到了这些机制的调节因素。以康复为导向的干预措施具有共同的关键机制,这有助于推动服务使用者走向康复,尤其是在有利于康复且无污名化的背景下实施时。未来的研究应进一步探讨如何减少(或消除)阻碍有心理健康问题的个人享有与其他人相同公民权利的障碍。