AbstractPromoting a recovery-oriented approach to mental health care is central to Australia’s national mental health strategy. While admission into acute mental health inpatient units is rare, recovery-oriented principles and practices are important in this context with patients often in crisis and in an acute phase of a mental health condition. This is an opportune time to introduce psychological interventions to “kickstart” the recovery process. However, studies exploring the effectiveness of recovery-oriented psychological interventions on acute mental health units are lacking. One of the priorities of Australia’s national mental health strategy is promoting a recovery-oriented approach among young people given their increased vulnerability and the ideal of early intervention. This higher risk young adult age group is the focus of this program of research. The overarching aim of this Doctor of Philosophy program of research is to make an important contribution to development of recovery-based psychological interventions in the acute mental health inpatient setting.
To address the above objectives and research gaps, a mixed methodological approach was employed with four sequential studies conducted. The aim of Study 1 was to systematically review the literature on psychological interventions in the acute mental health inpatient setting to identify gaps in the research. This served to guide the program of research that followed in addition to providing a comprehensive update regarding this area of research (or lack thereof). The objective of Study 2 was to develop and validate the PERC² Up model of mental health recovery, described below, with young adults in both university and acute inpatient mental health settings. This model of mental health recovery was based on the broaden and build theory of positive emotions (Fredrickson, 1988) and modified for this program of research to incorporate variables specific to the acute mental health inpatient setting. The broaden and build theory posits that experiences of positive emotions, albeit brief, broadens people’s perspectives and thought-action repertoires, which in turn serves to build their enduring personal resources, ranging from physical, social, emotional, and psychological. Study 3 included a unique opportunity to compare the mental health of young adults in the university setting to those in the acute mental health inpatient setting, with the intention of highlighting the mental health challenges that university students experience and the need for additional recovery-oriented psychological interventions, based on the PERC² Up model, for young adults in this context. In Study 4, the newly developed PERC² Up model provided the basis for the development of a brief recovery-oriented psychological intervention on an acute inpatient mental health unit for young adult patients. The objective was to evaluate the feasibility and to preliminarily examine the benefits of the intervention, while also collecting data about satisfaction and the immediate impact of the intervention, further developing and contributing to the limited body of literature explaining pathways to mental health recovery in acute mental health inpatient settings.
In conducting the systematic quantitative literature review in Study 1, there was a severe lack of research in the area of recovery-oriented psychological interventions on acute mental health inpatient settings, despite this being an area of high mental health care expenditure, highlighting a need for future research in this area, with a particular focus and needs (a) research in the Australian context, (b) an expansion of the range of interventions offered in research, (c) a focus on interventions that offer a transdiagnostic approach, rather than a focus on a specific diagnosis, (d) an expansion of the data that is collected, incorporating pre/post/follow up measures, a satisfaction survey, and an evaluation of session impact, (e) an inclusion of individuals from a variety of age ranges in intervention studies, and (f) a need for more methodological rigor. In Study 2, the PERC² Up model of mental health recovery was validated with path analysis using data collected from both acute mental health and university young adult samples. Applying the established broaden and build theory of positive emotions to mental health recovery and the acute mental health inpatient setting, this model posits that the experience of positive emotions, albeit brief, leads to the broadening of perspective and thought-action repertoires, which in turn leads to the development of self-compassion and social connectedness (personal resources). These personal resources result in improved psychological well-being and the further experience of positive emotions, resulting in an upward spiral of mental health recovery. This model informed the recovery-oriented psychological intervention detailed in Study 4. In Study 3 young adults in the university setting were found to have comparable levels of positive reappraisal, social connectedness, and psychological well-being to young adults in the acute mental health inpatient setting. Young adults in the university setting did report significantly higher self-compassion, while young adults in the acute mental health setting reported more positive (and negative) emotions. This study demonstrated that the PERC² Up model and the following brief recovery-orientated intervention may also be applicable and beneficial for young adults in university settings.
Study 4, a non-randomised controlled feasibility study involving a brief recovery-oriented psychological intervention, based on the PERC² Up model and incorporating LKM as a mechanism of change, on an acute mental health inpatient unit for young adults, found a significant difference between the intervention and TAU participants in terms of positive reappraisal but not self-compassion, positive emotions, social connectedness, or psychological well-being, after the intervention or TAU. The intervention participants demonstrated significant improvements in positive emotions, positive reappraisal, self-compassion, social connectedness, and psychological well-being following the intervention, while the TAU group only improved significantly in self-compassion. The intervention sessions were immediately impactful with significant improvements in stress, calmness, future positivity, and connectedness to others ratings after meditation sessions. While no statistically significant differences were found between intervention and TAU participants when comparing readmission rates at 6 months post-intervention, the rates of re-admission were comparable to other intervention studies. Recovery-oriented psychological intervention participants were satisfied with the intervention and found it helpful, with all indicating that they were interested in using this practice in their day-to-day lives.
Overall, this program of research has made important contributions to the area of recovery-oriented psychological interventions in the acute mental health inpatient settings with young adults. These contributions include providing a systematic and comprehensive review of the literature on psychological interventions in the acute mental health inpatient setting and validating PERC² Up, a model of acute mental health recovery, which provides a framework for recovery and specific points for mental health intervention. The mental health struggles of university students were also highlighted, demonstrating that the PERC² Up model and subsequently developed psychological intervention are also applicable in this context. This program of research developed and evaluated a brief recovery-oriented psychological intervention, which is the first time this has occurred with an adult sample in the Australian acute mental health inpatient context. This recovery-oriented psychological intervention was found to be feasible with benefits for participants, with high levels of satisfaction and immediate impact. Challenges encountered in conducting research in this context, limitations, and areas for future research are discussed.
|Date of Award
|30 Nov 2022
|Bruce Watt (Supervisor) & Michael Lyvers (Supervisor)