Research into Recovery and Wellbeing

A website about the work of the recovery research team at the Institute of Mental Health

The University of Nottingham

May 2020

Recovery Research Network eBULLETIN


May 2020

RRN Meetings

The 23rd meeting of the Recovery Research Network (RRN) was due to be hosted by Camden and Islington NHS Foundation Trust.  Due to the current developments with regard to Covid-19, this event has been cancelled.

The coronavirus pandemic is having unprecedented effects both nationally and internationally.  During this time of social distancing and self-isolation, remaining connected to our networks is important.  Please can we encourage our readership to continue to submit material to e-bulletin using the detail below.  As ever, comments are welcome from the readership about articles included in the ebulletins.

Thank-you. Please stay safe, and our best wishes to you all.


Please submit material to either Shula Ramon or Tony Sparkes. Their contact details are:




Coronavirus and Mental Health

The impact of coronavirus, and government measures to restrict its transmission, means that we have to pay particular attention to our mental health and wellbeing.  There is a considerable amount of advice and information available online.  In this edition, we have included some examples at the end of the ebulletin.  


RRN Membership Profile

Anyone who has an interest in recovery research can join the RRN, just fill in the online form available at:


Please note that if you join the Network, the details you supply will be circulated to other members of the Network as part of the monthly e-bulletin, but will not be put on our website and will not be shared with any other organisation. If you would like to leave the RRN and have your details removed from our database, please email


A Call to PhD Students and their Supervisors

Please could we remind the readership that PhD students (and their supervisors) are particularly welcome to join the RRN.  The forum provides a unique opportunity to network and build research capacity. The network also provides a collegial environment to present doctoral work.


Recovery Research: We would like to learn from your experience of conducting recovery research.  Therefore, would readers kindly get in touch with the Network to let us know about the things that have helped and the things that have hindered during your experience of undertaking recovery research. Please send your comments to either Tony or Shula.


Conferences and Events 

In an attempt to restrict the spread of coronavirus, limitations upon the free movement of people are evident in many countries throughout the world.  As you will no doubt be aware, such measures have impacted upon national and international travel and hospitality.


Whilst it is almost certain that traditional face-face conferencing/events will not be taking place in their ‘traditional’ format, please check with the organisers.  It may be that alternative or innovative platforms are being utilised to deliver such events going forward.  


Papers and Publications 

In addition to peer-reviewed literature and work of a purely academic nature, the ebulletin also welcomes the submission of material that would include grey literatures (such as briefing papers, reports and so on) that attest to the broader impact of personal recovery.


i)  Moran, G.S., Kalha, J., Mueller-Stierlin, A.S., Kilian, R., Krumm, S, Slade, M., Ashleigh, C., Mahlke, C., Nixdorf, R., Basangwa, D., Nakku, J., Mpango, R., Ryan, G., Shamba, D., Ramesh, M., Ngakongwa, F., Grayzman, A., Pathare, S., Mayer, B. and Puschner, B. (2020)  Peer support for people with severe mental illness versus usual care in high-, middle- and low-income countries: study protocol for a pragmatic, multicentre, randomised controlled trial (UPSIDES-RCT)  Trials.  21:371.  1-15



Background: Peer support is an established intervention involving a person recovering from mental illness supporting others with mental illness. Peer support is an under-used resource in global mental health. Building upon comprehensive formative research, this study will rigorously evaluate the impact of peer support at multiple levels, including service user outcomes (psychosocial and clinical), peer support worker outcomes (work role and empowerment), service outcomes (cost-effectiveness and return on investment), and implementation outcomes (adoption, sustainability and organisational change).

Methods: UPSIDES-RCT is a pragmatic, parallel-group, multicentre, randomised controlled trial assessing the effectiveness of using peer support in developing empowering mental health services (UPSIDES) at four measurement points over 1 year (baseline, 4-, 8- and 12-month follow-up), with embedded process evaluation and cost-effectiveness analysis. Research will take place in a range of high-, middle- and low-income countries (Germany, UK, Israel, India, Uganda and Tanzania). The primary outcome is social inclusion of service users with severe mental illness (N = 558; N = 93 per site) at 8-month follow-up, measured with the Social Inclusion Scale. Secondary outcomes include empowerment (using the Empowerment Scale), hope (using the HOPE scale), recovery (using Stages of Recovery) and health and social functioning (using the Health of the Nations Outcome Scales). Mixed-methods process evaluation will investigate mediators and moderators of effect and the implementation experiences of four UPSIDES stakeholder groups (service users, peer support workers, mental health workers and policy makers). A cost-effectiveness analysis examining cost-utility and health budget impact will estimate the value for money of UPSIDES peer support.

Discussion: The UPSIDES-RCT will explore the essential components necessary to create a peer support model in mental health care, while providing the evidence required to sustain and eventually scale-up the intervention in different cultural, organisational and resource settings. By actively involving and empowering service users, UPSIDES will move mental health systems toward a recovery orientation, emphasising user-centredness, community participation and the realisation of mental health as a human right.


ii)  Milner, K., Crawford, P., Edgley, A., Hare-Duke, L. and Slade, M. (2020)  The experiences of spirituality among adults with mental health difficulties: a qualitative systematic review.  Epidemiology and Psychiatric Sciences.  29  e34 1-10



Aims. Despite an increasing awareness of the importance of spirituality in mental health contexts, a ‘religiosity gap’ exists in the difference in the value placed on spirituality and religion by professionals compared with service users. This may be due to a lack of understanding about the complex ways people connect with spirituality within contemporary society and mental health contexts, and can result in people’s spiritual needs being neglected, dismissed or pathologised within clinical practice. The aim of this qualitative systematic review is to characterise the experiences of spirituality among adults with mental health difficulties in published qualitative research.

Methods. An electronic search of seven databases was conducted along with forward and backward citation searching, expert consultation and hand-searching of journals. Thirty- eight studies were included from 4944 reviewed papers. The review protocol was pre-registered (PROSPERO:CRD42017080566).

Results. A thematic synthesis identified six key themes: Meaning-making (sub-themes: Multiple explanations; Developmental journey; Destiny v. autonomy), Identity, Service-provision, Talk about it, Interaction with symptoms (sub-themes: Interactive meaning-making; Spiritual disruption) and Coping (sub-themes: Spiritual practices; Spiritual relationship; Spiritual struggles; Preventing suicide), giving the acronym MISTIC.

Conclusions. This qualitative systematic review provides evidence of the significant role spirituality plays in the lives of many people who experience mental health difficulties. It indicates the importance of mental health professionals being aware of and prepared to support the spiritual dimension of people using services. The production of a theory-based framework can inform efforts by health providers to understand and address people’s spiritual needs as part of an integrated holistic approach towards care.


iii)  Charles, A., Thompson, D., Nixdorf, R., Ryan, G., Shamba, D., Kalha, J., Moran, G., Hiltensperger, R., Mahlke, C., Puschner, B., Repper, J., Slade, M. and Mpango, R. (2020) Typology of modifications to peer support work for adults with mental health problems: systematic review.  British Journal of Psychiatry. 216(6)  301-307



Background:  Peer support work roles are being implemented internationally, and increasingly in lower-resource settings. However, there is no framework to inform what types of modifications are needed to address local contextual and cultural aspects.

Aims:  To conduct a systematic review identifying a typology of modifications to peer support work for adults with mental health problems.

Method:  We systematically reviewed the peer support literature following PRISMA guidelines for systematic reviews (registered on PROSPERO (International Prospective Register of Systematic Reviews) on 24 July 2018: CRD42018094832). All study designs were eligible and studies were selected according to the stated eligibility criteria and analysed with standardised critical appraisal tools. A narrative synthesis was conducted to identify types of, and rationales for modifications.

Results:  A total of 15 300 unique studies were identified, from which 39 studies were included with only one from a low-resource setting. Six types of modifications were identified: role expectations; initial training; type of contact; role extension; workplace support for peer support workers; and recruitment. Five rationales for modifications were identified: to provide best possible peer support; to best meet service user needs; to meet organisational needs, to maximise role clarity; and to address socioeconomic issues.

Conclusions:  Peer support work is modified in both pre-planned and unplanned ways when implemented. Considering each identified modification as a candidate change will lead to a more systematic consideration of whether and how to modify peer support in different settings. Future evaluative research of modifiable versus non-modifiable components of peer support work is needed to understand the modifications needed for implementation among different mental health systems and cultural settings.


iv)  Karban, K. Sparkes, T., Benson, S., Kilyon, J. and Lawrence, J.  (2020)  Accounting for social perspectives: an exploratory study of approved mental health professional practice.  British Journal of Social Work.  bcca037



The role of the Approved Mental Health Professional (AMHP) in England and Wales was intended to provide a social perspective as a ‘counterweight’ to a medical perspective when compulsory detention to psychiatric care is being considered as part of an assessment under the 1983 Mental Health Act (MHA). However, with few exceptions, there is relatively little written about AMHPs’ understandings of a social perspective and their experiences of applying this in practice. This article will discuss the findings of a small-scale qualitative study involving twelve AMHPs, highlighting the different accounts of how social perspectives may be understood and implemented. Some of the tensions that may arise when undertaking MHA assessments and the challenges of implementing a social perspective in practice will be considered. The conclusion highlights the complexity of AMHP practice and the diverse ways in which AMHPs attempt to apply a social perspective. It is clear, however, that an understanding of social perspectives is firmly embedded in the practice of the AMHPs involved in this study.


v)  Nappo, N. and Fiorillo, D. (2020) Volunteering and self-perceived individual health: cross-country evidence from nine European countries.  International Journal of Social Economics.  47(3) 285-314



Purpose:  The paper studies the simultaneous effect of formal and informal volunteering on self-perceived individual health across nine European countries while controlling, among other things, for socioeconomic characteristics and social and cultural participation.

Design/methodology/approach:  This paper employs the 2006 wave of the EU-SILC dataset for estimating recursive trivariate probit models using instrumental variables.

Findings:  The paper finds that although formal volunteering and informal volunteering are correlated with each other, they have different impacts on health. Formal volunteering is never correlated with higher self-perceived individual health except in the Netherlands. In contrast, informal volunteering is related to lower self-perceived individual health in Austria, Finland, France, the Netherlands, Spain, and Italy. 

Research limitations/implications:  The first limitation concerns the absence of other measures of volunteering, such as volunteering hours that are not available in the employed dataset. The second limitation is that the dataset collection on social and cultural variables in EU-SILC is cross-sectional while the optimal dataset should be a panel data. The third limitation is that instrumental variables are observed in the same year of declaring self-perceived individual health while the optimal timing would be at least one year before.

Practical implications:  Findings of the paper show that formal volunteering has no effect on self-perceived individual health while informal volunteering has negative consequences.

Social implications:  Volunteering is performed because of an individual decision and could be considered a consequence of how social responsibilities are distributed within countries. Our results show that informal volunteering has a negative effect on health; this is likely to depend on how people manage stress coming from performing this altruistic activity. It is likely that a more cautious distribution of social responsibilities could prevent the negative effects of informal volunteering on health.

Originality/value:  The originality of the present paper is in simultaneously examining the impact of formal and informal volunteering on self-perceived individual health. Furthermore, most of the existing studies on formal volunteering and health focus on a single country; this paper compares nine European countries characterized by different social, cultural, economic, and institutional features. Finally, the paper addresses the issue of reverse causation.


vi)  Gibbs, M., Griffiths, M. and Dilks, S. (2020) A grounded theory of how service users experience and make use of formulation in therapy for psychosis.  Psychosis.  Online:



Objectives: This study set out to explore service user experiences of formulation during individual therapy for psychosis, and develop a grounded theory of the processes involved.

Method: Semi-structured interviews were undertaken with 11 service users and two clinical psychologists with experience of formulation in therapy for psychosis.

Design: Grounded theory was used to examine the qualitative data collected.

Results: An emerging model was constructed to conceptualise the processes that occur during the sharing of a formulation. “Linking previous experiences with current ways of being” and “Building the therapeutic relationship” emerged as core, reciprocally influential processes. “Making use of new understandings” was also identified as an important process.

Conclusions: The findings suggest that formulations should be developed collaboratively and progressively with service users, and that care should be given to the emotions that arise as a result. Further research is necessary to elaborate our understanding of formulation given the importance placed on it in United Kingdom clinical psychology.


vii)  From the author of the critically acclaimed 2018 book Start, Graham Morgan writes in Mental Health Knowledgeabout his experience of living under a compulsory treatment order.  See:

Morgan, G. (2020) Winning or Losing?  The irreconcilable realities of life under a compulsory treatment order.  Mental Health Knowledge.  20th January 2020.  Online here


Other News / Resources


i)  Released on the 19th May, and along with over 30 organisations, YoungMinds issued an open letter to the Government to encourage them to take necessary measures to mitigate the impact of Covid-19 upon the mental health of children and young people.  The letter can be accessed via the following link:


ii)  Dr Juliana Onwumere, senior lecturer and consultant clinical psychologist, writes out of Kings College London to encourage participation in a new survey exploring carers' experiences during covid-19.  More information and the survey itself can be found here:


Note:  Please click the blue button at the bottom left to access the next page.


iii)  Recovery stories

Mike Slade’s Narrative Experiences Online (NEON) study has launched a new interactive website which provides online access to mental health recovery stories. We have collected hundreds of stories from around the world, in text, video and audio form, and preliminary evidence suggests that these stories can help people feel connected to others including the storyteller. We are now running three trials using this website, the largest of which is called the NEON Trial. 


RRN members can help us in two ways:

1.     Recruitment and participation

The NEON Trial is currently recruiting people who:  

  • Have experienced psychosis or psychosis-like experiences in the past 5 years
  • Have experienced mental health distress in the past 6 months
  • Live in England
  • Aged over 18 years
  • Have access to the internet
  • Can provide informed consent

    If you or someone else you know meet the inclusion criteria, more information and eligibility checking can be accessed here www.recoverystories.ukWe would also like to recruit people who have cared for others experiencing mental health problems.


2.     Promotion of the Trial

Would you help us to promote the NEON Trial through your networks? You can use any of the publicity materials available at or just tweet:

Can real-life mental health recovery stories help you with your own mental health? Access hundreds of recovery stories in the NEON Trial. Help researchers @InstituteMH understand the benefits of accessing other people’s recovery narratives. See

Follow us on Twitter (@neontrials), Instagram (@neontrials) and Facebook today!

iii)  Coronavirus and Mental Health (information)

The following links are intended to illustrate the range of information and advice that is currently available with regard to Covid-19.  It is neither exhaustive, nor is it arranged in any particular order. Apologies for any obvious omissions.


World Health organisation

Social Care Institute for Excellence

Centre for Mental Health

Mental health Foundation



Carers UK

National Service User Network

British Psychological Society

British Association of Social Workers

Royal College of Psychiatrists

Royal college of Nursing

Royal College of Occupational Therapists


ii)  Shula Ramon and Tony Sparkes co-produce the RRN monthly ebulletin. Please email if there is anything you would like included in the next issue, as we are keen to receive and advertise more news, articles and website references. Information can be posted to either Shula or Tony at the following: