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Primary health care is in the unique position of being a first level of support and care to individuals with mental health problems. The focus in this service is on diagnosis, medical treatment, and symptom reduction. However, to access it is perceived as challenging by both patients and providers. An increased understanding of the lived experience of encountering primary health care may be beneficial for the delivery of a tailored mental health service to patients. To explore the lived experience of encounters with primary health care of a person with mental health problems. Eleven in-depth interviews were conducted online between October 2022 and April 2023. A descriptive phenomenology study in accordance with Giorgi was used to analyze the material. The essence of the lived experience of being a patient with MHP was a by health professionals, which was the general construction based on four themes, , , The lived experience of being a patient with mental health problems was described as everyday challenges due to their mental health. They never knew whether the support was there for them as patients when encountering primary health care. Acknowledging patients as experts on their life situation is the core element in person-centered care. It is therefore crucial for further research to include patients' experiential knowledge to inform clinical practice and to improve clinical outcomes.

Background A person‐centred and recovery‐oriented approach is an integral part of modern mental health services founded on the experiential knowledge of service users. Their reflections as experts, grounded in their unique experience as service users, play a significant role in developing and improving the existing care. Experiential knowledge is therefore a means to enhance the relevance of research, inform the development of care, and bridge research and practice. Aim To understand service users' experiences of their current mental health services and explore reflections on the Flexible Assertive Community Treatment (FACT) model and its role in future practice. Methods A total of 17 experts participated in individual and dyadic in‐depth interviews. A reflexive thematic analysis was performed on the participants' experiences of current mental health services and on their reflections on a vignette describing an integrative, recovery‐oriented care and support model—FACT. Results The analysis resulted in three themes. The first theme, ‘Losing value and credibility as a person when becoming a service user’, reflected participants' experiences of being reduced to the signs and symptoms of their mental health problems. The second theme, ‘Navigating through the mental health maze’, describes participants view on the current mental health services, while the last theme, ‘Involving service users in their care and support would be empowering’, holds participants' views on the importance of greater involvement in future service design and delivery. Conclusions These results underscore the necessity for enhanced collaboration to empower and provide inclusive, tailored care and support, which the participants emphasised as essential for the future of mental health services. The participants reflected on certain structural concepts, such as hierarchy, caring culture, and financial strains, prior to the implementation of FACT, which need to be addressed before an adaptation of integrative, recovery‐oriented care and support models. Public and Service User Contribution The study planning and process involved stakeholders, including user organisations, Swedish Partnership for Mental Health (NSPH), Skåne and their sister organisation LIBRA Skåne, as well as managers and professionals of mental health services. One of the authors has own experience of mental illness and contributed greatly to the data analysis and the finalising of the manuscript, and two authors have experience as relatives.

Background In primary health care people with mental health needs are often overlooked or masked with physical complaints. It has been suggested that public health nurses lack sufficient knowledge when encountering people with mental health problems. Low levels of mental health literacy among professionals are associated with negative patient outcome. There is a need to understand public health nurses process and strategies used when encountering a person with mental health problems in order to promote mental health. This study aimed to construct a theory that explains the process of public health nurses experience when encountering people with mental health problems based on their knowledge, attitudes, and beliefs about mental health. Methods A constructivist grounded theory design was used to meet the aim of the study. Interviews were conducted with 13 public health nurses working in primary health care between October 2019 and June 2021, and the data analysis was performed according to the principles of Charmaz. Results The core category, “Public health nurses as a relationship builder – to initiate the dialogue” reflected the process while the main categories “Being on your own ” , “Being on top of things- knowing your limits” , and “Professional comfort zone ” reflected conditions that were decisive for initiating a dialogue. Conclusion Managing mental health encounters in primary health care was a personal and complex decision-making process that depends on the public health nurses’ professional comfort zone and acquired mental health literacy. Narratives of the public health nurses helped to construct a theory and understand the conditions for recognizing, managing and promoting mental health in primary health care.

Background Mental health service users often experience difficulties interpreting and regulating sensory stimuli resulting in increased anxiety, decreased abilities to engage in activities and a hampered recovery process. However, there are limited studies on the implementation of such recovery-oriented interventions targeting sensory difficulties via sensory modulation techniques. Therefore, the aim of this study was to investigate staff and manager views on the implementation process of a group-based sensory modulation intervention in mental health outpatient services in Southern Sweden. Methods This mixed method implementation process evaluation included eight outpatient units, which were also study sites for a Randomized Controlled Trial (RCT) (NCT06432114), evaluating the effectiveness of the sensory modulation intervention. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using deductive and inductive content analysis. Results The results indicated that the intervention was highly accepted by the mental health staff. The dose delivered and received were high and the intervention in general met the needs of the target group. Managers and staff reflections indicated that following the intervention service users seemed to feel better prepared to handle anxiety in daily life due to the acquisition of new sensory coping strategies. Staff expressed that they benefitted from acquiring a different perspective or “new sensory glasses” to apply in their clinical practice. However, managers’ and staff reflections also highlighted the need for an adapted manual for people with cognitive issues and more education for staff. Conclusions This study contributed to new knowledge of implementing a recovery-oriented sensory modulation intervention in mental health outpatient services. The implementation was generally carried out as intended. Nonetheless, certain challenges emerged during the implementation process, both within the contextual environment and during the delivery of the intervention. Trial registration Retrospectively registered 20,240,529, in ClinicalTrials.gov NCT06432114.

Background Employment is a vital source for experiencing well-being and lowering the risk of long-term social marginalisation and poverty. For persons with alcohol and drug addiction, it may also improve sobriety. However, the unemployment situation for this group reflects the knowledge gap in effective interventions to support employment. While Individual Placement and Support (IPS) is recognised as evidence-based supported employment for those with serious mental health problems, no scientific evidence for the target group of addiction exists to date. The aim of the present IPS for Alcohol and Drug Addiction in Sweden (IPS-ADAS) trial is to study whether IPS has an effect on gaining employment for this group. Methods The IPS-ADAS trial is a multisite, pragmatic, parallel, and single-blinded, superiority randomised controlled trial (RCT). Participants ( N  = 330) will be randomly assigned (1:1) and participate in IPS plus treatment as usual within Addiction Services (IPS + TAU) or Traditional Vocational Rehabilitation (TVR) available plus TAU (TVR + TAU) for 12 months. The principle of intention-to-treat (ITT) will be applied. The hypothesis is that a significantly larger proportion of IPS + TAU participants will be employed for > 1 day (primary outcome), reach employment sooner, work more hours and longer periods of time, and have a higher income as compared to TVR + TAU participants at 18-month follow-up. We further anticipate that those who benefit from IPS + TAU will use less alcohol and drugs, experience better health, and use less care and support, including support from the justice system, in comparison to TVR + TAU participants, at 6, 12, and 18 months. A supplementary process evaluation, using the IPS Fidelity Scale (25 items) and adhered interviews will address delivery and receipt of the IPS as well as contextual hinders and barriers for coproduction and implementation. Working age (18–65), willingness to work, unemployment, participation in an information meeting about the RCT, treatment for addiction diagnosis, and being financially supported by welfare, constitute eligible criteria. Discussion A primary study on the effectiveness of IPS on employment for the new target group of addictions will add to the international IPS knowledge base and inform national policy to include the underrepresented group in working life. Trial registration WHO International Clinical Trials Registry Platform ISRCTN10492363. Registered on 14 August 2023.

Background There is an evident discrepancy between need and provision of evidence-based return-to-work (RTW) interventions in existing mental health services. Online dissemination of evidence-based interventions is presumed to reduce this gap. However, there is almost no knowledge available on perceived acceptability of digital RTW interventions among service users, which are factors that might influence the development and implementation of future interventions. The aim of this study was to develop knowledge of service user acceptability of mWorks, a proposed digital RTW solution. Methods Participants ( n  = 18) with experience of common mental disorder and sick leave were recruited with a purposive snowball sampling method. Semi-structured interviews ( n  = 12) and one focus group interview ( n  = 6) were conducted. A deductive thematic analysis was performed according to the Theoretical Framework of Acceptability. Results Digital RTW interventions were perceived as acceptable and aligned with participant value. Participants expressed positive attitudes toward having access to support, regardless of time and place. A certain ambiguity between a decline in social interactions and opportunities to RTW in a safe space was reported. Participants were confident in their ability to use digital RTW solutions, but reported the need to reduce stressful elements of using smartphones. Overly demanding digital solutions, i.e. ones requiring high cognitive effort, were described as burdensome. Conclusions For digital RTW solutions to be acceptable, they need to complement traditional services by providing accessible and person-centred support throughout the RTW process. They should be designed to reduce the need for cognitive effort. Future research should explore how to balance user autonomy with other support components in digital interventions.

Background Involving service users in inpatient care and recovery planning has gained interest worldwide. Our purpose was to evaluate the process of implementation of a coproduced Recovery Guide (RG) intervention in 22 inpatient wards in Sweden, in terms of context, implementation process and mechanisms of impact over 12 months. Methods A mixed method design and a process evaluation framework were used to guide data collection and to deductively analyze perspectives and descriptive statistics of delivery from three stakeholder groups. Results Results showed that although initial contextual barriers were present (e.g., lack of resources, and interest, uncertainty in the organization, a dominant illness perspective), it was possible to implement the RG in 14 wards, where 53% of admitted service users received the intervention. Legitimacy of the intervention, engaged managers and staff, capacity of staff and ward organization, coproduction and continuous support from user organization were critical mediators. Mechanisms of impact concerned (1) a new perspective on mental health, well‐being and recovery, (2) capacity building of a recovery approach in inpatient settings and (3) a meaningful outlet for users' thoughts and feelings on recovery, sharing narratives and influencing care and goals. Conclusions The RG intervention has the potential to promote a recovery approach in inpatient mental health services (MHSs). Coproduction among stakeholders created trust and a sustainable implementation that made it possible for wards to resume implementation when contextual barriers had been resolved. Patient and Public Contribution The current study involved stakeholders including a service user organization, the public, first‐line managers and staff (including peer support workers) in inpatient and community MHS and researchers, who greatly contributed to the implementation programme, including codesign of the RG intervention as well as coproduction of the implementation in inpatient MHS. All authors have their own lived experiences of mental health problems as a service user or as a relative.

Background People with severe mental illness (SMI) living in supported housing (SH) struggle in everyday life and we currently lack a comprehensive body of knowledge concerning how the residents experience their day. This paper aimed to gain knowledge about how people with SMI describe a day in SH in Sweden, in particular the activities they most frequently engage in and how they experience what they do in or outside their home. Furthermore, it is important to gain knowledge of which activities motivate residents to leave the housing facility and to participate in the community. This new knowledge can help staff to encourage a recovery process among the residents. Methods One hundred thirty-three people living in SH completed a time-use diary and a mixed-methods approach was applied, including calculations of what activity that was most frequently performed and a manifest content analysis addressing experiences of activity. Results The residents had a low activity level and were often alone. Approximately one-half of the reported activities were performed in their own apartments, and generally unaccompanied. A quarter of the activities were performed in the common areas and a further quarter outside the SH. The most frequently performed activities were quiet and tranquil ones, e.g. listening to music and resting. Doing errands and group activities with staff and residents were the main activities that motivated leaving the facility. The participant experience of a day is presented in three categories: “Experiences of chosen and enforced togetherness and overcoming loneliness”, “Environmental change and emotional balance can generate activity”, and “Met and unmet needs for support, friendship and security”. Conclusions The residents were generally satisfied with their quiet and tranquil lifestyle and appeared to demand little of life, which may relate to previous experiences of institutional life and can constitute a challenge for staff. The findings highlight experiences that can help to improve SH. Services need to support individually adjusted contextual stimuli and individualize the support to help residents find a good balance and motivate them to be active in and outside SH, which can support a recovery process.

Background Activity and participation are critical to health and wellbeing. Limited evidence exists on how to support people with mental illness in participating in everyday activities. Aim To investigate the effectiveness of Meaningful Activities and Recovery (MA&R), a co-led peer occupational therapy intervention focusing on activity engagement, functioning, quality of life, and personal recovery. Methods In a statistician blinded, multicenter RCT including 139 participants from seven community and municipal mental health services in Denmark, participants were randomly assigned to 1) MA&R and standard mental health care or 2) standard mental health care. The MA&R intervention lasted 8 months and consisted of 11 group sessions, 11 individual sessions, and support to engage in activities. The primary outcome, activity engagement, was measured using Profile of Occupational Engagement in People with Severe Mental Illness (POES-S). Outcomes were measured at baseline and post-intervention follow-up. Results Meaningful Activities and Recovery was delivered with high fidelity and 83% completed the intervention. It did not demonstrate superiority to standard mental health care, as intention-to treat analysis revealed no significant differences between the groups in activity engagement or any of the secondary outcomes. Conclusion We did not find positive effects of MA&R, possibly because of COVID-19 and related restrictions. Fidelity assessments and adherence rates suggest that MA&R is feasible and acceptable. However, future studies should focus on refining the intervention before investigating its effectiveness. Trial registration The trial was registered 24/05/2019 at ClinicalTrials.gov NCT03963245.

Background Staff who plan and organize day center activities may need to observe the attendees’ performance and progression. This led us to develop a tool for that purpose, termed General Occupational Engagement in people with Severe mental illness (GOES). The aim was to investigate its psychometric properties in terms of factor structure, internal consistency, corrected item-total correlations (CITC), convergent and discriminant validity, and test-retest stability. Methods Ninety-three day center attendees were assessed by the GOES and instruments addressing constructs hypothesized to be either similar to (activity level, motivation for day center attendance, perceptions of the worker role, hours spent in the day center) or divergent from the GOES (attendees’ ratings of engagement in specified occupations, self-rated health, psychosocial functioning, psychiatric symptoms). A second sample of 41 attendees were included for the test-retest analysis. Exploratory factor analysis, Cronbach’s alpha analysis, Pearson correlations and paired-samples t -tests were performed. Results Exploratory factor analysis indicated one factor, which was in line with the intentions of the scale. The alpha value was 0.85 and all CITC were above 0.30. The tests for convergent validity resulted in correlations ranging between 0.23 and 0.47, most of which were moderately strong and mainly confirmed the hypotheses. Discriminant validity was clearly indicated, since all correlations with the selected constructs were <0.20. GOES also showed preliminary test-retest stability ( r  = 0.32). Conclusions The GOES is ready for use in rehabilitation services and research where productive and other types of activities are of interest. It may serve as an important supplement to attendees’ self-reported occupational engagement.