164 Chapter 8 For the purpose of assessing the recovery supporting competencies of professionals, measures have been developed (62), for instance the Recovery Promoting Relationships Scale (RPRS), that evaluates the core interpersonal skills and the skills to utilize recovery-promoting strategies to enhance hopefulness, empowerment and self-acceptance (63). The Recovery Knowledge and Attitude Scale (R-KAS) assesses recovery knowledge and attitudes among professionals and students (64). The INSPIRE is a measure that can be used to gain insight in the perceived recovery support staff gives to patients (65, 66). Attitudes of professionals towards recovery can improve with training (67, 68). This education can also reduce the use of restraints and improve work satisfaction of mental health professionals (69). A Recovery Oriented Intake, involving peer experts, might be a good start of a conversation with a patient, instead of a pure medical oriented intake (70, 71). Of interest and promising is the REFOCUS team-level intervention targeting staff behavior to increase focus on values, preferences, strengths, and goals of patients with psychosis, and staff-patient relationships, through coaching and partnership (72). Some other recovery supporting interventions have been subject of research and have been empirically validated, e.g. peer support, wellness recovery action planning (WRAP), recovery colleges or recovery education programs, individual placement and support (IPS), supported housing, and mental health trialogues (73-77). A 12week peer-run course on recovery showed a positive effect on empowerment, hope, and self-efficacy (78). Another user-developed, user run recovery programme was associated with better mental health confidence, less care needs, less self-reported symptoms and less likelihood of institutional residence (79). Also, a tool has been developed to support patients with severe mental illnesses in redeveloping an identity and a renewed sense of purpose (80). The results of the qualitative interviews in chapter 5 highlight that clinical treatment interventions, such as diagnosis, medication, hospitalization, coercion and psychological treatment, can have diverging impact on personal recovery. This implies that a personalized approach, based on the experiences and needs of a specific patient, is vital in recovery-oriented care. Examples are: communicating a diagnosis with a hopeful narrative (81); developing personalized medication strategies (82), for instance with The Personal Antipsychotic Choice Index (83) and the Subjective Well-being Under Neuroleptic Treatment Scale (SWN) (84, 85); and post hoc reflection on the use of hospitalization and restraints (86-88). Psychological treatments have shown to have the potential to contribute to personal recovery, also in patients with severe mental illness. Specifically, Acceptance and Commitment Therapy (ACT) seems to provide a recovery-consistent model for patients with psychosis, emphasizing personal choice and values (89, 90).
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