Date of Award

2009

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Bachelor of Science Honours

School

School of Psychology and Social Sciences

Faculty

Faculty of Computing, Health and Science

First Supervisor

Dr Helen McDonald

Second Supervisor

Dr Sonya Girdler

Abstract

Topic: A literature review was conducted to describe and critically examine the research evidence for evaluating the recovery-orientation of mental health services. Purpose: Evaluating recovery-orientation within mental health services is a critical part of quality improvement, and the eventual widespread adoption of recovery-oriented practice. This review aimed to recommend future directions for research, highlight positive changes resulting from recovery-focussed evaluation, and facilitate more effective, consumer-driven evaluation in the future. Sources Used: Electronic databases CINAHL, Psycinfo, Medline and Meditext were searched. Articles were restricted to the English language, and included if they discussed the evaluation or exploration of recovery-oriented practices within one or more mental health services. All research methodologies were considered. Conclusions: A narrative review was possible. Recovery-orientation was evaluated using qualitative and quantitative methodologies. Contrary to recovery principles, a general lack of consumer input was noted. Practitioners tended to rate services higher than consumers, and practitioner knowledge and attitudes around recovery varied. A large portion of research involved the development or use of recovery-orientation assessment tools, most of which required further empirical validation. Overall, methodological rigour was poor, and results were vulnerable to numerous sources of bias. Evidence was limited to level III and IV. However, if mental health services are to become recovery-oriented in an evidence-based manner, conventional ideas around the relative strength of research must be challenged. Evaluation is a catalyst for change, and should be undertaken in a consumer-driven, rigorous and recovery-focussed manner for widespread change to be possible. Objective: This study aimed to evaluate the recovery-orientation of a brand new Community Supported Residential Unit (CSRU) for people with mental illness, from the residents' perspective. Findings would inform quality improvement, and ultimately facilitate strengthened recovery-oriented practice at the CSRU. Methods: This exploratory study used a mixed methods design, employing both qualitative and quantitative data collection methods. A sequential design was used, meaning quantitative survey data informed the collection of qualitative interview data. This design facilitated meeting the demand for quantitative outcomes in mental health research, yet allowed for contextual elaboration. Results: Surveys showed neutral to moderate agreement that the CSRU was recovery-oriented. Participants perceived a strong recovery-orientation in the inviting layout, and weaker recovery-orientation in the diversity of services. Interviews revealed highly diverse perspectives. Respondents suggested the environment permitted the enactment of valued roles, and innately opposed discrimination. Areas for improvement included service individualisation and tailoring, broadening perceptions of the staff role, and empowering residents with information about recovery. Conclusions: Recommendations include the negotiation of aspects of services such as house rules, and increasing awareness of resident needs, preferences, and developmental stage before admission to facilitate individualisation. An induction package is recommended to enhance resident clarity in expectations, perceptions of the staff role, and recovery. Hiring peer support workers is recommended to further empower residents around recovery, and continued recovery-based professional development for staff is suggested. Other mental health services should follow the lead of this organisation, to promote systems transformation to recovery-orientation.

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