126 Chapter 7 A better understanding of the processes at play between persons with severe mental illness, family and professionals during recovery may facilitate collaboration in a triad. In this participative qualitative study, we performed a bottom-up exploration of the experience of collaboration during recovery. By bottom up, we mean that we took the subjective experience of persons with mental illness, family and professionals as a starting point and focus. We chose this bottom up approach because we wanted to give persons with severe mental illness and their family a voice on collaboration in mental healthcare. We chose the context of long term mental healthcare for persons with severe mental illness (most have a history of psychosis or enduring psychotic experiences), where both mental health issues and mutual contact between the three parties are long-term by definition. Focusing on relational aspects of their accounts, we developed themes representing processes of collaboration for recovery in a triad, aiming to help a collaborative recovery supporting practice. METHODS Study design, aim and setting We performed a participative qualitative study using a reflexive thematic analysis of interviews and focus groups according to Braun and Clarke (25, 26). We aimed to develop a bottom up understanding of collaboration for recovery, based on subjective experiences of persons with severe mental illness, family or important others (“family”) and mental healthcare workers (“professionals”) on their contact with the other parties during the recovery process. Our research was set in the context of long-term mental healthcare practice in Amsterdam, the Netherlands, which is predominantly, but not exclusively, aimed at persons with a severe mental illness who have a psychotic disorder (27, 28). Persons with mental illness in this type of care have the following general attributes: a mental illness with a protracted character, with severe impairments in social domains, and the need for prolonged and coordinated contact with mental health networks focused on multiple areas of life (29). Specifically, we focused on persons receiving assertive community based treatment or treatment in long-term inpatient rehabilitation units. Both types of care are aimed at people with a severe mental illness who (regularly) need an assertive approach by mental health professionals, to engage effectively with mental health services. People often remain in care of these type of services for years, if not decades. By including the long-term inpatient mental health rehabilitation setting, we specifically sought to include the otherwise marginalized voice of people with the most complex mental health needs and their family, whose needs could not be adequately addressed in a community mental health setting (30, 31). Prolonged harmful situations for themselves or others often have resulted, including loss of housing (27).
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