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Background Mental health policy is for staff to transform their practice towards a recovery orientation. Staff understanding of recovery-orientated practice will influence the implementation of this policy. The aim of this study was to conduct a systematic review and narrative synthesis of empirical studies identifying clinician and manager conceptualisations of recovery-orientated practice. Methods A systematic review of empirical primary research was conducted. Data sources were online databases ( n = 8), journal table of contents ( n = 5), internet, expert consultation ( n = 13), reference lists of included studies and references to included studies. Narrative synthesis was used to integrate the findings. Results A total of 10,125 studies were screened, 245 full papers were retrieved, and 22 were included (participants, n = 1163). The following three conceptualisations of recovery-orientated practice were identified: clinical recovery, personal recovery and service-defined recovery. Service-defined recovery is a new conceptualisation which translates recovery into practice according to the goals and financial needs of the organisation. Conclusions Organisational priorities influence staff understanding of recovery support. This influence is leading to the emergence of an additional meaning of recovery. The impact of service-led approaches to operationalising recovery-orientated practice has not been evaluated. Trial Registration The protocol for the review was pre-registered (PROSPERO 2013: CRD42013005942 ).

Various problems are associated with schizophrenia which may theoretically lead to impaired educability about treatment. The Understanding of Medication Questionnaire, designed to measure knowledge about treatment in schizophrenia, is described and presented. An educational programme based on a specially designed information booklet was developed. Sixty-four patients with DSM-III-R diagnosis schizophrenia were randomly allocated to groups receiving none (control), one session or three sessions of education. Pre-intervention low levels of knowledge about illness and treatment increased significantly immediately after a standard education session. Three education sessions led to significantly greater knowledge gain than one session. There was no significant change in the control group. Only the PANSS negative syndrome score independently and consistently explained a significant proportion of the education effect. The influence on educability of attitudes to education, impaired insight, cognitive impairment and other variables were considered. Three sessions of education led to significantly increased insight, but no change in compliance. Techniques appropriate for educating schizophrenic patients were discussed, and the value of involving patients in education emphasised. A series of patient education sessions is needed to consolidate learning, rather than a single informing process. The strong association between impaired learning and more severe negative schizophrenic syndrome emphasises the need for responsible prescribing of antipsychotic treatment in schizophrenia.

Purpose Policy is increasingly focused on implementing a recovery-orientation within mental health services, yet the subjective experience of individuals receiving a pro-recovery intervention is under-studied. The aim of this study was to explore the service user experience of receiving a complex, pro-recovery intervention (REFOCUS), which aimed to encourage the use of recovery-supporting tools and support recovery-promoting relationships. Methods Interviews ( n  = 24) and two focus groups ( n  = 13) were conducted as part of a process evaluation and included a purposive sample of service users who received the complex, pro-recovery intervention within the REFOCUS randomised controlled trial (ISRCTN02507940). Thematic analysis was used to analyse the data. Results Participants reported that the intervention supported the development of an open and collaborative relationship with staff, with new conversations around values, strengths and goals. This was experienced as hope-inspiring and empowering. However, others described how the recovery tools were used without context, meaning participants were unclear of their purpose and did not see their benefit. During the interviews, some individuals struggled to report any new tasks or conversations occurring during the intervention. Conclusion Recovery-supporting tools can support the development of a recovery-promoting relationship, which can contribute to positive outcomes for individuals. The tools should be used in a collaborative and flexible manner. Information exchanged around values, strengths and goals should be used in care-planning. As some service users struggled to report their experience of the intervention, alternative evaluation approaches need to be considered if the service user experience is to be fully captured.

Pre-defined, researcher-selected outcomes are routinely used as the clinical end-point in randomized controlled trials (RCTs); however, individualized approaches may be an effective way to assess outcome in mental health research. The present study describes the development and evaluation of the Individualized Outcome Measure (IOM), which is a patient-specific outcome measure to be used for RCTs of complex interventions. IOM was developed using a narrative review, expert consultation and piloting with mental health service users (n=20). The final version of IOM comprises two components: Goal Attainment (GA) and Personalized Primary Outcome (PPO). For GA, patients identify one relevant goal at baseline and rate its attainment at follow-up. For PPO, patients choose an outcome domain related to their goal from a pre-defined list at baseline, and complete a standardized questionnaire assessing the chosen outcome domain at baseline and follow-up. A feasibility study indicated that IOM had adequate completion (89%) and acceptability (96%) rates in a clinical sample (n=84). IOM was then evaluated in a RCT (ISRCTN02507940). GA and PPO components were associated with each other and with the trial primary outcome. The use of the PPO component of IOM as the primary outcome could be considered in future RCTs. Copyright © 2015 John Wiley & Sons, Ltd.

Background Current national policy in the UK is to make all psychiatric inpatient areas non-smoking by the end of 2018. Methods A mixed qualitative approach, using a survey with a semi-structured format and a World Café method. Discussion This pilot project explored views and experiences of staff and patients in making an inpatient recovery unit a smoke-free zone. A number of issues that were causing anxiety in patients and staff members were identified. Conclusion The focus group generated a number of possible interventions which may help to achieve a smoke-free environment while supporting inpatients who are giving up smoking.

Aim To evaluate an e-prescribing pilot project that took place in a recovery unit in Gloucestershire. Method Nursing and medical staff recorded the time it took to prescribe and administer medication electronically and in paper form. A structured questionnaire was used to assess staff experience and attitudes to e-prescribing after the pilot had ended. Findings It took longer to prescribe and administer medication electronically as compared to using paper prescriptions. Staff identified benefits of e-prescribing, but had a greater number of concerns. Conclusion For e-prescribing to be used safely and for the benefit of patients in the future, the system needs to evolve to meet prescribing needs. Staff will need support and education to switch to this new way of working.

The present study aimed to assess, in an epidemiologically representative sample of patients with psychosis, the relationship between patient and staff perception of need and to investigate the association between unmet need and study variables when assessed by patients and staff, respectively. Of 474 cases of functional psychosis identified in the locality, 225 were assessed using the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) to rate staff and patients' perceptions of need. Unmet need was rated most highly in social/relationship domains by patients and keyworkers. Levels of total met and unmet need were rated similarly as aggregate scores and in differing domains, by staff and patients. Levels of staff agreement between patient and staff ratings were \"substantial\" in all domains except safety to others, where agreement was \"fair\" and in which staff appeared to perceive higher risk than patients. Staff, but not patients, rated significantly more unmet need in non-Caucasian groups. No other variable studied was associated with unmet need. The levels of agreement between patient and staff ratings were significantly higher in the present study than previously reported. Possible reasons for the higher concordance found in this study were the use of keyworkers who knew patients well. Further, keyworkers may have been influenced in their assessment of need by awareness of patients' perceived need. Joint needs assessment may strengthen the therapeutic alliance, improve our understanding of priority needs and aid in service development. Work is needed to ensure that care is targeted explicitly towards unmet need.

Background: Some psychiatric illnesses tend to predispose patients to metabolic syndrome. Some psychiatric medications have been linked with an elevated risk of metabolic syndrome. Metabolic syndrome has an increased risk of cardiovascular disease and type 2 diabetes. Method: The following data were obtained from the last 6 months’ medical notes of inpatients in two rehabilitation units: waist circumference; BP; fasting blood tests: triglycerides, HDL cholesterol and glucose; psychiatric and medical diagnoses and medication. Results: 58% of the patients met the criteria for metabolic syndrome. However, due to lack of appropriate physical monitoring in some cases, only 19% had previously been diagnosed. Therefore not all the patients with metabolic syndrome were being appropriately treated or monitored. Conclusion: A systematic approach to assessment and management of physical health needs in people with severe mental illness is necessary. Suggestions for improvement include: healthy lifestyle encouragement; refer patients with metabolic syndrome to GP for treatment; optimization of current psychiatric treatment; monitor waist circumference, fasting lipids and glucose 4 times a year if patient has ≥ 3 criteria, or twice yearly if patient has 0–2 criteria; monitor BP monthly for all patients.

There is a paucity of research into the relationship between insight and variables including cognitive function, educational background and symptomatology in schizophrenia. Sixty-four patients with DSM-III-R diagnosis schizophrenia were assessed with the Schedule for Assessment of Insight, Mini Mental State cognitive test, a new measure of knowledge about treatment (the Understanding of Medication Questionnaire), and educational background and compliance assessments. Insight scores correlated significantly with a range of variables. In a multiple regression analysis only knowledge about treatment and number of years in education explained a significant proportion of insight. Educational background and the intellectual ability required to learn complex concepts, such as models of mental illness, appear to be more important than previously considered. Research is limited by the lack of a generally accepted definition of insight.