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Title: Supporting the recovery of black individuals who use community mental health services
Author: Bird, Victoria Jane
ISNI:       0000 0004 5368 3183
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2015
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Despite a recovery orientation being mental health policy within England, the perceptions of recovery and the effectiveness of recovery-focused interventions for black individuals are under-researched. This thesis describes the development and evaluation of an intervention to support the recovery of black individuals who use community mental health services. The Medical Research Council (MRC) framework for designing and evaluating complex interventions was the guiding scientific framework, with an embedded experimental mixed method design adopted. A systematic review and narrative synthesis identified the evidence base regarding the meaning of recovery for mental health service users. The Conceptual Framework of Recovery was developed from the review. Only one study included in the review focused on the perceptions of recovery for black individuals. Four focus groups with 26 participants and 14 semi-structured interviews were conducted with service users who self-ascribed their ethnicity as black. The results were used to develop the Framework of Recovery Support, in which identity - (re)gaining a positive sense of self, was central to recovery. The Conceptual Framework of Recovery and Framework of Recovery Support were used to develop a component of the REFOCUS pro-recovery intervention called Working Practice 1: Understanding Values and Treatment Preferences. The effectiveness of the REFOCUS intervention for black individuals was assessed in a pre-planned subgroup analysis of a cluster randomised controlled trial (RCT). One hundred and ten service users participated in the RCT, with 81 (74%) followed up after 12 months. The two primary outcomes were personal recovery (Questionnaire about the Process of Recovery) and service satisfaction (Client-Satisfaction Questionnaire - 8 item version). Secondary outcomes included hope, empowerment, wellbeing, quality of life, symptom levels and clinical need. Multilevel mixed-effects regression modelling, which controlled for clustering at the team level, was conducted for the analysis of treatment effect. A process evaluation embedded within the trial included interviews with eight individuals who had received the intervention. Results indicated that the intervention had no effect on either recovery (p=0.693) or service satisfaction (p=0.77). However, the intervention significantly improved service user-rated level of met need. Overall the intervention was well-received and associated with positive experiences, however the process evaluation highlighted issues with routine implementation.
Supervisor: Jamieson-Craig, Thomas Kern ; Slade, Mike Dominic Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available