Knowledge and Attitudes of Mental Health Professionals and Students Regarding Recovery in Australia

Introduction Recovery-oriented mental health practice is significant to the lives of people with severe mental illness as it promotes personal transformation and social inclusion. Despite the increasing attention to recovery-oriented practice, studies have identified several environmental and personal factors that affect its implementation. In view of this, research has been undertaken globally regarding the knowledge and attitudes of mental health professionals (MHPs), with focus on elements such as the non-linearity of recovery process and the role of self-definition and peers, to help improve professionals’ capabilities for delivering recovery-based practice. The Recovery Knowledge Inventory (RKI) has been primarily used in previous studies to assess health professionals and students’ knowledge across different developed countries including the United States of America (USA), Ireland, Japan, and Italy. However, previous studies and the RKI tool developers have identified issues with the RKI tool. To date, however, there have been limited empirical studies in Australia about recovery attitudes and knowledge, particularly among MHPs and students. The few existing studies largely address mental health nurses’ views of recovery within an acute setting, promoting recovery oriented practice in mental health services, and the lived experience of recovery from the perspective of consumers, carers and nurses. More so, the few empirical studies that have been undertaken in Australia have focused largely on qualitative or quantitative methods alone, with only a few employing mixed methods designs to achieve complexity and complementarity in data analysis. In addition, a preliminary empirical literature review showed that most of the commonly used instruments used currently to measure knowledge and attitudes regarding recovery were developed purposely for professionals, with no instruments specifically developed to assess students’ knowledge of and attitudes towards recovery. Methods This thesis is the first research study that has undertaken an exploratory sequential mixed methods study to develop greater in-depth understanding of mental health recovery; particularly regarding the measurement of knowledge and attitudes. The thesis was conceptualised in three phases: review of empirical papers, concepts, and theories; fieldwork (recruitment and data collection); and analysis of data. The first phase was used to identify the gap in the literature, especially empirical evidence, and review the available theories on recovery-oriented practices. Three papers were published as part of this phase of the thesis. This phase was also used to identify the common measure/s of mental health recovery knowledge and attitudes, and to identify their limitations. The second phase of the study involved field work. The phase purposively recruited 18 participants (10 MHPs and 8 students) to participate in an interview to explore the key elements related to recovery and recovery-oriented practice. The participants for the qualitative interviews were recruited until saturation occurred and when no new information emerged. These qualitative interviews also produced a publication in the thesis series. Subsequently, the information obtained from these literature reviews and qualitative interviews informed the revision and refinement of the RKI scale (with permission of the original authors). The revised draft items were then reviewed and modified by experts and stakeholders to determine face and content validity, and select the final items for quantitative analysis. The two-stage review panel consisted of eight members, including three practitioners (two who were also caregivers), two consumers, two mental health academics and a PhD student. The third phase recruited 173 (115 MHPs and 58 students) participants with an online survey using Qualtrics. The data were used for the validation of the adapted tool. The quantitative data were analysed using descriptive and inferential statistics, including exploratory factor analysis, reliability analysis, spearman correlation and Mann U Whitney Test. Phase three resulted in the development and psychometric testing of the adapted Recovery Knowledge and Attitudes (R-KAS) measure, and a paper that has also been submitted for publication. Results Findings from the three literature reviews showed increasing evidence regarding mental recovery. However, there were disparities in how MHPs perceive and understood recovery. Also, the final literature review identified several recovery measures in use that do not meet the evaluation criteria for psychometric properties. In addition, consumers were mostly excluded from the development of the measures or the conceptual construction that underpins the measures. The dimensions of recovery that were identified in this review were then synthesized into a conceptual framework named the Consolidated Framework for Recovery-oriented Services (CFRS). In the final phase, the empirical quantitative study produced an adapted scale, the R-KAS, which measures mental health recovery knowledge and attitudes among practitioners and trainees. This measure has three subscales of Competence, Roles and Responsibilities, and Process. The subscales within this adapted measure generally had excellent reliability. The results suggested that the practitioners and trainees mostly had high levels of knowledge and attitudes towards the recovery concept, specifically in areas of competence, roles and responsibilities and process issues. Conclusions and implications for policy and practice The thesis provides information on the global knowledge, attitudes and expectations of MHPs regarding recovery. Also, the various tools available to measure recovery have been organised and discussed. A new conceptual framework known as Consolidated Framework for Recoveryoriented Services (CFRS) has been developed. This framework can be used to implement, monitor and evaluate recovery services. Finally, the thesis has provided an adapted instrument that has utility in assessing practitioners and trainees’ knowledge and attitudes towards recovery. The instrument developed from this thesis is important to facilitate the delivery of appropriate mental health recovery-based training. The thesis concludes with implications for policies, mental health service provision, training of mental health professionals and students, as well as suggestions for future research