Mental Health Recovery Narratives

Mental Health Recovery Narratives are personal stories shared by individuals who have experienced mental health challenges, describing their journey towards improved well-being.

These narratives typically recount struggles, turning points, and strategies for managing mental health. They aim to inspire hope, reduce stigma, and provide insights into the recovery process.

Used in clinical settings, peer support, and public awareness campaigns, these stories can foster connection, understanding, and optimism among those facing similar challenges.

Ng, F., Newby, C., Robinson, C., Llewellyn-Beardsley, J., Yeo, C., Roe, J., … & Slade, M. (2022). How do recorded mental health recovery narratives create connection and improve hopefulness?. Journal of Mental Health, 31(2), 273-280. https://doi.org/10.1080/09638237.2021.2022627

Rationale

Mental health recovery narratives are increasingly used in clinical interventions, peer support, and anti-stigma campaigns (Thomas et al., 2016; Charles et al., 2021; London & Evans-Lacko, 2010).

While previous research has examined the impact of creating one’s own recovery narrative (Yanos et al., 2011), limited quantitative investigation has been conducted on the impact of receiving another person’s mental health recovery narrative.

A systematic review identified that recovery narratives could impact feelings of connectedness, understanding of recovery, reduction in stigma, validation of personal experiences, and affective and behavioral responses (Rennick-Egglestone et al., 2019).

However, there is insufficient evidence about the participant or narrative characteristics that predict an increased sense of connection and hope when receiving a mental health recovery narrative.

This study aims to address this gap by identifying characteristics that predict the short-term impact of recorded mental health recovery narratives, as assessed by rating hopefulness and connection after receiving a narrative.

Method

This study was conducted as part of the Narrative Experiences Online (NEON) Programme (reserchintorecovery.com/neon), which is investigating whether receiving recorded mental health recovery narratives improves the quality of life in people who experience mental health issues

The study conducted two independent analyses: an Experimental Study (n=40) and a Clinical Study (n=13).

Both studies involved participants with mental health problems receiving recorded recovery narratives and rating their impact on hopefulness and connection.

The key differences were the number of narratives available, the method of selection (random vs. self-selected or random), and the duration of access (single session vs. 1 month).

Experimental Study

• Used 30 narratives from the NEON Collection (Rennick-Egglestone et al., 2020)
• Narratives were under 10 minutes long
• Participants stated preferences for narrator gender, age, and modality (text, video, audio)
• Up to 10 randomly ordered narratives were shown, accounting for preferences
• Feedback was provided after each narrative

Clinical Study

• Used 100 narratives from the NEON Collection (72 texts, 24 videos, 1 audio, 3 static images)
• Narratives were under 10 minutes long
• Hosted on a website prototype for the NEON trial
• Participants could self-select narratives or receive random ones
• Narratives were tagged based on INCRESE inventory characteristics
• Aimed for ecological validity in a real-world context
• Participants had an initial face-to-face session to learn the system
• Unrestricted access to the platform for 1 month
• No minimum or maximum number of narratives required
• Feedback obtained after each narrative

Sample

Both studies drew from the same population with identical eligibility criteria but used separate groups of participants to avoid bias between the studies.

• Experimental Study: 40 participants (60% female, 82% white)
• Clinical Study: 13 participants (46% female, 77% white)

Inclusion criteria were current self-reported mental health condition; current user of statutory mental health services; aged over 18 years; fluent in English. Exclusion criteria were the self-reported current experience of mental health crises.

Measures

• Inventory of Characteristics of Recovery Stories (INCRESE): Used to characterize narratives
• Herth Hope Index (HHI): Assessed hope in the Experimental Study
• Narrative feedback ratings: Assessed connection to story/narrator and hopefulness

Statistical measures

Univariate multi-level (participant and narrative), mixed effect statistical models were used to analyze the data. Models were implemented in R 3.6.3.

Results

To investigate whether specific characteristics of participants influence short-term hope and connection.

• Experimental Study: Higher baseline levels of hope predicted higher hopefulness ratings
• Clinical Study: Female and younger participants felt more connection with narrators

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Objective 2: To investigate whether narrative/narrator characteristics influence short-term hope and connection.

• Experimental Study: Narratives depicting a narrator living well with mental health problems generated higher hopefulness ratings
• Clinical Study: Participants reported feeling less hopeful to a male narrator compared to non-identifiable

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Objective 3: To investigate whether narratives that mirror personal characteristics of participants are associated with higher narrative feedback ratings (i.e., higher ratings of hope and connection).

• Experimental Study: Participant’s connection with the narrator was higher when the narrator’s gender matched the participant’s preference
• Clinical Study: A match between participant and narrator ethnicity led to higher levels of hope

Insight

This study provides valuable insights into the factors that influence the impact of mental health recovery narratives.

The finding that narratives describing living well with mental health problems generated more hopefulness than those describing full recovery or just surviving day-to-day suggests that authenticity and relatability are crucial elements in promoting hope.

This aligns with qualitative research indicating that perceived authenticity mediates the impact of recovery narratives (Ng et al., 2019).

The study also highlights the importance of diversity in recovery narratives.

The lower connection ratings from participants of ethnic minority backgrounds and the increased hopefulness, when ethnicity matched between participant and narrator, underscore the need for diverse representation in recovery narratives.

This finding extends previous research by emphasizing the role of cultural relevance in the effectiveness of recovery narratives.

Further research could explore the specific components of narratives that participants attend to and how these may differ across diverse populations.

Additionally, investigating the long-term impacts of exposure to recovery narratives and how they influence actual recovery outcomes would be valuable.

Strengths

• Use of narratives in multiple modalities (text, video, audio)
• Inclusion of trans-diagnostic mental health concerns and diverse narrator backgrounds
• Examination of impact in both experimental and real-world clinical settings
• Comparison of randomly selected and self-selected narrative provision methods

Limitations

• Small sample sizes in both studies, limiting generalizability
• Potential low participant engagement in the Clinical Study
• Dichotomous categorization of ethnicity, not accounting for within-group heterogeneity
• Lack of examination of long-term impacts
• Limited to English-speaking participants

These limitations suggest caution in generalizing the findings and highlight the need for larger-scale studies with more diverse populations and longer follow-up periods.

Clinical Implications

The findings have significant implications for clinical practice and public health campaigns. Mental health services and anti-stigma campaigns should consider using narratives that depict individuals living well with mental health problems rather than solely focusing on full recovery stories.

This approach may provide more realistic and hope-promoting portrayals of recovery.

The study also emphasizes the importance of diversity in recovery narratives. Mental health services should strive to include a wide range of narratives that reflect diverse experiences, backgrounds, and stages of recovery.

This diversity can increase the likelihood of individuals connecting with a narrative and feeling hopeful about their own recovery journey.

For clinical practice, the findings suggest that mental health workers should have ongoing discussions with clients about their relationship with recovery, as this may affect how they experience connection and hopefulness when exposed to recovery narratives.

The impact of ethnicity on connection and hopefulness highlights the need for culturally sensitive approaches in mental health interventions.

Providing culture-specific recovery narratives could be a practical means of offering relevant and tailored support, particularly for underserved populations.

References

Primary reference

Ng, F., Newby, C., Robinson, C., Llewellyn-Beardsley, J., Yeo, C., Roe, J., … & Slade, M. (2022). How do recorded mental health recovery narratives create connection and improve hopefulness?. Journal of Mental Health, 31(2), 273-280. https://doi.org/10.1080/09638237.2021.2022627

Other references

Charles, A., Nixdorf, R., Ibrahim, N., Meir, L. G., Mpango, R. S., Ngakongwa, F., … & Mahlke, C. (2021). Initial training for mental health peer support workers: Systematized review and international Delphi consultation. JMIR Mental Health, 8(5), e25528.

London, J., & Evans-Lacko, S. (2010). Challenging mental health-related stigma through social contact. European Journal of Public Health, 20(2), 130-131.

Ng, F., Charles, A., Pollock, K., Rennick-Egglestone, S., Cuijpers, P., Gillard, S., … & Slade, M. (2019). The mechanisms and processes of connection: Developing a causal chain model capturing impacts of receiving recorded mental health recovery narratives. BMC Psychiatry, 19(1), 1-15.

Rennick-Egglestone, S., Elliott, R., Smuk, M., Robinson, C., Bailey, S., Smith, R., Keppens, J., Hussain, H., Pollock, K., Cuijpers, P., Llewellyn-Beardsley, J., Ng, F., Yeo, C., Roe, J., Hui, A., van der Krieke, L., Walcott, R., & Slade, M. (2020). Impact of receiving recorded mental health recovery narratives on quality of life in people experiencing psychosis, people experiencing other mental health problems and for informal carers: Narrative Experiences Online (NEON) study protocol for three randomised controlled trials. Trials, 21(1), 661.

Rennick-Egglestone, S., Morgan, K., Llewellyn-Beardsley, J., Ramsay, A., McGranahan, R., Gillard, S., … & Slade, M. (2019). Mental health recovery narratives and their impact on recipients: Systematic review and narrative synthesis. Canadian Journal of Psychiatry, 64(10), 669-679.

Thomas, N., Farhall, J., Foley, F., Leitan, N. D., Villagonzalo, K. A., Ladd, E., … & Kyrios, M. (2016). Promoting personal recovery in people with persisting psychotic disorders: Development and pilot study of a novel digital intervention. Frontiers in Psychiatry, 7, 196.

Yanos, P. T., Roe, D., & Lysaker, P. H. (2011). Narrative enhancement and cognitive therapy: A new group-based treatment for internalized stigma among persons with severe mental illness. International Journal of Group Psychotherapy, 61(4), 576-595.

Keep Learning

Socratic questions for a college class to discuss this paper:

1. How might the finding that narratives of “living well” with mental health problems are more impactful than those of full recovery challenge traditional notions of mental health treatment goals?
2. In what ways could the lower connection ratings from ethnic minority participants reflect broader issues in mental health care accessibility and cultural competence?
3. How might the use of recovery narratives in clinical settings change the power dynamics between mental health professionals and service users?
4. What ethical considerations should be taken into account when using personal recovery narratives in public health campaigns or clinical interventions?
5. How might the impact of recovery narratives differ across various cultural contexts, and what implications does this have for global mental health initiatives?