96 Chapter 5 In future research it is important to also include patients with even more severe symptoms and more impaired functioning, for instance in long-term inpatient mental health rehabilitation settings. There is generally an underrepresentation of this patient group, at least partly due to issues with informed consent (62). Adding a category of ‘difficulties’ to the CHIME-framework of personal recovery, has been proposed to better understand the challenges of recovery (63, 64). Also, future qualitative research can focus on more specific questions, such as the consequences of stigmatizing attitudes of professionals (65). Investigating a larger span of narratives, e.g. from patients at risk of psychosis, or other underresearched mental health sub-populations can broaden the understanding of factors influencing personal recovery (66-68). A ‘Psychiatry Story Bank’ is a way to collect diverging first person accounts (69). During the performing of the current research we also considered to compare different subgroups of patients, based on scores on the quantitative recovery measures, but found it difficult to define cut-off scores and were afraid that this division would undermine the personal character of the narratives. However, future research can reconsider this. Efforts have been made before to identify such profiles of recovery (70). Lastly, because personal recovery is a journey undertaken together with significant others, research into the collaboration on recovery within the triad of patient, family and professional is important (33). Conclusion Patients with severe mental illness were interviewed to explore their subjective experience of clinical treatment interventions in their personal recovery stories. Clinical treatment interventions have diverging impact on personal recovery: 1. receiving a diagnosis can lead to relief, but also to stigma, 2. medication has positive effects, but side-effects impair personal recovery, 3. hospitalization and 4. coercive treatment can be helpful, but can also impact the process of recovery negatively, 5. psychological treatment is experienced as beneficial. Mental healthcare practitioners’ awareness of patients’ diverging experiences regarding the impact of clinical treatment interventions on personal recovery is important to carry out recovery-supportive practice that fits an individual patient’s needs. Highlights from the current study are: communicating a diagnosis with a hopeful narrative, developing personalized medication strategies and post-hospital reflection on the use of restraints. Ethical approval The study protocol was reviewed by the ethical committee of the Vrije Universiteit Medical Centre (FWA00017598, reference 2015.350), and was granted an exemption from approval based on the fact that participants in the study were not subject to procedures or interventions, or required to follow rules of behavior.
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