Further research could be conducted on the characteristics of non-English language recovery narratives, in order to broaden understanding of cross-cultural or global mental health recovery. A second limitation is that the involvement of an external Lived Experience Advisory Panel was consultative.
The emergence of models of collaborative data analysis [ ] can support more meaningful involvement of external panels of people with lived experience as co-analysts than took place in this review. The reviewed publications include narratives across the range of conditions and experiences of psychological distress.
Subgroup analysis of psychosis and of trauma studies found no important differences in their characterisation compared with those narrating other conditions. This resonates with research on transdiagnostic approaches [ ], which reject mental health perspectives based on competing theoretical positions in favour of an inclusive approach to treatment or services, incorporating multiple perspectives [ ].
The framework provided by the current synthesis could form the basis for an inventory of recovery narrative characteristics. This could be used by those delivering narrative-based interventions as an evidence-based template, ensuring diversity in two ways.
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Firstly, such an inventory could be used as a basis for expanding the range of examples and resources offered within online, written and course-based guides to developing recovery stories. Narrative-based courses could ensure that their content and the way they are structured do not imply that particular elements must be present in order for the narrative to be a recovery story. Similarly, repositories collating stories as a resource may choose to use the framework as a tool to avoid potential biases.
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Requiring an emphasis, for example, on personal choice and responsibility within stories as criteria for inclusion may support the criticism that the use of narratives by mental health services has been co-opted in the service of neo-liberal agendas [ 51 ]. Secondly, the framework could be used to identify potential gaps in collections, highlighting areas where effort may need to be made to target specific communities to ensure their narratives are also included. This would provide a diversity metric for recovery story collections. Considerable work is currently being undertaken on the overlap between childhood trauma and experiences of mental ill health [ , ], and a new conceptual framework providing an alternative to diagnoses gives a central place to stories [ ].
Finally, the current synthesis may form the basis for a matching tool within narrative interventions. This may contribute towards increasing the confidence of practitioners in connecting individuals with the kinds of recovery narratives likely to be most beneficial to them within a particular context or time. However, practitioners may be limited if their conceptualisation of recovery narratives is narrow, and the impact of narratives may be limited if narrators feel no connection with the narratives they access.
The multidimensional understanding of the characteristics of recovery narratives provided by this review may serve to increase the range of ways recovery can be imagined, accessed, and thus realised. This review extends the literature on mental health recovery narratives, by synthesising the various ways in which they have been characterized to produce a conceptual framework.
Recovery narratives have played a vital role in establishing the recovery paradigm for survivor movements and individuals, and within mental health services and policy. Care is needed to ensure that recovery narrative interventions are used to expand the available choices within the narrating of recovery instead of curtailing them.
Practitioners using narrative interventions will need to consider possible limitations of the form, structure and content of any tools offered. Mental health narrative researchers should aim to increase the diversity of populations invited to tell their recovery story. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field.
Abstract Background Narratives of recovery from mental health distress have played a central role in the establishment of the recovery paradigm within mental health policy and practice. Method A systematic review was conducted of published literature on the characteristics of mental health recovery narratives.
Results titles, abstracts and full-text articles published January July were screened, of which 45 studies analysing recovery narratives were included. Conclusions Recovery narratives are diverse and multidimensional. Introduction Recovery has become the established orientation within mental health policy and provision at national [ 1 ] and international [ 2 ] levels.
Eligibility criteria The review was of studies investigating the characteristics of mental health recovery narratives. Inclusion criteria were: Presents or substantially advances an original framework of characteristics of mental health recovery narratives including recovery from trauma and from childhood maltreatment Based on empirical data. Exclusion criteria were: Presents themes arising from narrative data without discussion of the characteristics of narratives themselves Not primarily or partially about mental health, e.
Search strategy A scoping search was undertaken and 12 publications were found. Screening and eligibility assessment Papers identified by the search were uploaded to Endnote, and duplicates removed. Data extraction and quality assessment A data abstraction table was designed, and is presented in the supplementary material S1 Table.
Data analysis A three-stage narrative synthesis approach was used, modified from guidance for the conduct of narrative synthesis within systematic reviews [ 58 ]. Results Results of literature search Forty-five publications were included in the review. Download: PPT. Quality assessment scores The 29 studies published in academic journals were assessed. Participants The 45 included publications analysed first-person lived experience accounts. Narrative synthesis Nine dimensions were derived from thematic analysis of included publications, with each dimension containing a number of types.
Table 1. Characteristics of mental health recovery narratives. Superordinate category: Narrative form Four dimensions related to narrative form were identified: Genre, Positioning, Tone and Relationship with Recovery. Table 2. Dimension 2: Positioning in relation to clinical model.
Table 3. Dimension 3: Emotional tone.
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Table 4. Dimension 4: Relationship with recovery. Table 5. Superordinate category: Narrative structure Three dimensions related to narrative structure were identified: Narrative Trajectory, Use of Turning Points and Narrative Sequence. Table 6. Dimension 6: Use of turning points.
Table 7. Dimension 7: Narrative sequence. Table 8. Superordinate category: Narrative content Two dimensions related to narrative content were identified: Protagonists and Use of Metaphor.
Table 9. Dimension 9: Use of metaphor.
- Characteristics of mental health recovery narratives: Systematic review and narrative synthesis.
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Table Subgroup analyses Four subgroup analyses were undertaken of papers published in academic journals. Discussion This review has identified the existence of a sizeable body of qualitative and mixed-methods literature describing the multidimensional ways in which mental health recovery narratives have been characterised.
Recovery narratives are multidimensional Mental health recovery narratives express individual meaning-making processes within recovery; they also highlight wider socio-economic and systemic influences. Recovery narratives are distinct from illness narratives Recovery narrative analysis in the included publications is rooted in influential work within the medical humanities on illness narratives, notably by psychiatrist and anthropologist Arthur Kleinman [ ] and medical sociologist Arthur Frank [ 24 , 25 ].
Recovery narratives include recovery outside of and within mental health services. Recovery narratives challenge diagnostic master narratives and narrative theory itself. Recovery narratives may help identify and generate post-traumatic growth. Recovery narratives can be non-linear A core domain of recovery is its non-linearity [ ]. Narratives and narrators currently missing from the literature An important contribution of the current synthesis is to highlight the kinds of recovery narratives, narrators or other factors missing from research to date, and some significant gaps were noted.
Strengths and limitations of the review The comprehensive search strategy is one strength of this review, reflecting multidisciplinary interest in narrative approaches. Implications for practice A transdiagnostic approach. Using the framework as a diversity tool. Trauma-informed practice. Using the framework as a matching tool. Conclusion This review extends the literature on mental health recovery narratives, by synthesising the various ways in which they have been characterized to produce a conceptual framework.
Supporting information. S1 File. S1 Table. Data abstraction table. Showing characteristics and findings of the 45 included papers. S2 Table. Summary of quantitative findings. Showing a summary of quantitative findings from two papers. S3 Table. References 1.
Department of Health. Closing the gap: Priorities for essential change in mental health. London: Department of Health, Comprehensive mental health action plan — Report No. Anthony WA. Recovery from mental illness: the guiding vision of the mental health service system in the s. Psychosocial Rehabilitation Journal. View Article Google Scholar 4.
Deegan PE. Recovery: The lived experience of rehabilitation.