Psychosocial rehabilitation strategies should be expanded to address difficulties as a component of the recovery process for people with mental illness. However, empirical evidence remains limited because few longitudinal studies have examined occupational dysfunction, defined as negative experiences in daily activities, as a factor associated with recovery. This study aimed to examine the influence of difficulty in daily life and occupational dysfunction on changes in the recovery process in individuals with severe and persistent mental illness. Participants were community-dwelling individuals with severe and persistent mental illness (schizophrenia, bipolar disorder, and major depression) voluntarily responding to recruitment in 16 community facilities. Data from a longitudinal observational study with repeated assessments of the recovery process were analyzed using latent growth modeling with a Bayesian estimation approach. The hypothesized model examined the direct and indirect relationships among difficulty in daily life, occupational dysfunction, and changes in the recovery process. This multicenter study consisted of data collected from 63 participants. The results from the Bayesian latent growth modeling demonstrated good model fit (convergence statistics for Bayesian estimation: 1.001; posterior predictive p-value: 0.35) and statistical significance of the influence of difficulty in daily life and occupational dysfunction on changes in the recovery process. The findings suggested the importance of addressing occupational dysfunction as well as difficulty in daily life. Comprehensive assessment of negative experiences in daily activities may contribute to person-centered practices for the recovery process of individuals with severe and persistent mental illness.
Dementia is increasingly common in older adults, causing cognitive decline, functional impairment, and reduced QoL. Reminiscence therapy (RT) evokes personal memories, stimulates cognition, and enhances well-being. The aim was to re-examine individualized RT (iRT) using a nonparametric approach to detect subtle changes in cognition, mood, and QoL. A multicenter, single-blind randomized controlled trial of iRT included 122 older adults with dementia from Portuguese day care and long-term care institutions. The intervention group (n = 62) received 26 iRT sessions, twice weekly for 13 weeks, while the control group maintained usual activities. Outcomes were global cognition, memory, executive function, mood, and self-reported QoL, assessed at baseline, post-intervention (T1), and three-month follow-up (T2), and re-analyzed using the Aligned Rank Transform approach. The re-analysis revealed a significant short-term improvement in global cognition that was not detected in the original analysis. The intervention produced a significant improvement in global cognition. These improvements in MMSE scores were not maintained at the T2. Nonparametric re-analysis reveals effects missed by conventional models. iRT improves global cognition at T1. Beyond clinical efficacy, these findings contribute to the methodological and clinical understanding of psychosocial interventions for dementia and support further investigation of iRT in care settings.
Mental illness remains a global issue with limited community treatment options. In response, there has been a shift toward community-based approaches, such as the international Clubhouse model, which uses a “work-ordered day” structure. This study examines the impact of a London, England-based Clubhouse on members’ well-being and recovery, aiming to advance mental health care. A primary qualitative study was conducted at Mosaic Clubhouse with 16 participants. Data were collected through semi-structured interviews and focus group discussions, then thematically analyzed following ethical guidelines. Four themes emerged reflecting participants’ recovery experiences: “A Sense of Stability and Well-being” (improved daily functioning through structured support), “A Sense of Purpose” (finding meaning through contribution to the Clubhouse community), “A Sense of Achievement” (personal growth through skill development and autonomy), and “A Sense of Belonging” (social connections and acceptance within a supportive community). Participants described feeling “less bad” about themselves, having their lives “come back to life,” and experiencing reduced admissions. Challenges identified included staff turnover, repetitive activities, and limited board diversity. The study highlights the importance of addressing fundamental human needs in mental health interventions. It supports community-based recovery models that emphasize collaboration, empowerment, and belonging. The Clubhouse model aligns with evolving mental health care paradigms and underscores the role of these needs in both community and hospital-based approaches. Future research could examine which specific Clubhouse activities drive recovery-relevant outcomes and how these can be scaled to help close treatment gaps.
Moving beyond a traditional deficit-based model of recovery in substance use disorders (SUDs), the current study is grounded in contemporary strength-based personality framework, which frames Personality Functioning Strengths (PFS) as dynamic, context‑specific motives, goals, strategies, values and socio‑cognitive capacities that promote psychological well‑being in SUDs. The study addresses the precise question: What personality functioning strengths do individuals with SUDs identify as aiding their recovery? Ten adult participants (seven men, three women; mean age 31.5 years, range 18–43) with DSM‑5‑diagnosed SUDs, abstinent for ≥ 1 month, engaged in psychotherapy and in early‑mid recovery (1–5 years) were purposively recruited from a tertiary treatment centre in Bangalore. Based on the philosophical assumption and aim of the study, the concept of “informational power” was used to determine the sample size. Data was analysed using reflexive thematic analysis (RTA) following Braun and Clarke’s six‑phase framework, with iterative coding, theme development and peer debriefing supported by ATLAS.ti software. Five overarching themes of PFS were identified: (1) Being Emotionally Resilient, characterised by gratitude, hope, and humour; (2) Being Goal-Directed and Thinking Flexibly, which includes creativity, determination, and self-reflection; (3) Being Self-Aware and Value-Driven, involving self-care, autonomy, and help-seeking; (4) Building Connections with Empathy, encompassing conflict resolution and fostering social bonds; and (5) Being Rooted in Culture, which draws on family values, spirituality, and a sense of social responsibility. The findings highlight that PFS are multifaceted, spanning emotional, cognitive, interpersonal, and cultural domains. Integrating culturally anchored PFS, such as family values and a sense of oneness into SUD treatment better aligns with a strengths‑based, recovery approach in the Indian sociocultural context. The results have implications for refining strengths-based frameworks and developing culturally sensitive assessments and interventions for individuals with SUDs.
Individuals with severe mental illness engage in less physical activity than the general population and face an increased risk of early mortality. Participating in physical activity can offer numerous benefits for this cohort. Furthermore, digital exclusion is common among this cohort for various reasons. Understanding their general digital engagement and the barriers to such engagement may help develop innovative support strategies to promote physical activity and digital engagement among this population, which may prove advantageous. However, the complexities of their physical and mental health pose challenges, particularly within Irish mental health residential settings. This study aims to assess the current barriers and facilitators to physical activity and digital engagement for individuals with severe mental illness living in Irish mental health residential settings. Qualitative interviews were conducted with service users and their clinicians in an Irish mental health residential setting to understand their experiences of engaging with digital technology and physical activity. Nine out of 12 participants either met or exceeded the weekly moderate physical activity guidelines (150–300 min). No participant met the guidelines for vigorous physical activity (75–150 min). Participants demonstrated considerable variability in total step counts. Clinician support was found to be essential to facilitate physical activity and digital technology engagement for participants, while the individuals’ mental health symptoms and age acted as barriers. To enhance the physical and mental well-being of individuals with severe mental illness in an Irish mental health residential setting, digital technology may be an innovative strategy to encourage physical activity.
Recovery research has mainly focused on optimistic, progress oriented narratives, yet such accounts often overlook experiences in which recovery is hindered rather than supported. This study examines non‑recovery stories as told by people with lived experience of recovery from mental health challenges and/or substance use in Norway. The aim was to explore how participants describe situations hindering recovery, and to develop knowledge about barriers embedded in everyday service encounters and wider welfare arrangements. The article draws on qualitative data collected in 2019 through focus groups, paired and individual interviews with a total of 29 participants. A reflexive thematic analysis was conducted. For the purposes of this paper, we selectively analysed interview segments in which participants described non‑recovery situations. Three overarching themes were developed. The first captures how medication was frequently prioritised over listening, dialogue and relational continuity. The second theme concerns encounters with professionals characterised as distant, unavailable or procedural, “like talking to a wall”, which participants experienced as invalidating and as barriers to trust, recognition and engagement. The third theme highlights how rigid welfare structures, bureaucratic demands, unstable housing and economic precarity shaped everyday life conditions, producing cycles of discontinuity, insecurity and abandonment that undermined recovery. The findings show that recovery is shaped as much by social, organisational and material environments as by individual capacities or clinical interventions. Attending to non‑recovery stories broadens understandings of recovery and underscores the need for service models that address the relational and structural conditions within which recovery is expected to unfold.
Obesity is highly prevalent in individuals with severe mental disorders (SMD) and contributes to increased morbidity and mortality. This study aimed to investigate the clinical and treatment-related correlates of obesity in patients with SMD in a real-world outpatient setting. This cross-sectional retrospective study included 296 patients diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. Sociodemographic and clinical data were obtained from the patients’ medical records. Obesity was defined as a body mass index (BMI) ≥ 30 kg/m2. Group comparisons were performed using parametric and non-parametric tests, as appropriate. Correlation analyses and multivariate logistic regression were conducted to identify factors associated with obesity. Of the 296 patients in the study, 160 were diagnosed with psychotic disorders and 136 with bipolar disorders. Of the total sample, 121 were female and 175 were male. The mean BMI of the sample was 30.2 ± 6.2 kg/m2. Obesity was associated with a lower education level (p = 0.011), a higher number of hospitalizations (p = 0.010), and increased psychiatric comorbidity (p = 0.037). No significant associations were found between obesity and antipsychotic use, antipsychotic polypharmacy, or the total medication count. BMI showed weak positive correlations with age (r = 0.138, p = 0.018) and hospitalization frequency (r = 0.181, p = 0.002) and a negative correlation with education (r = − 0.141, p = 0.015). In multivariable analysis, hospitalization frequency emerged as an independent predictor of obesity (OR = 1.10, 95
Disability discourse has evolved significantly over time. Among contemporary frameworks, the human rights model of disability emphasizes the empowerment of individuals with disabilities to exercise their social, economic, and political rights and to overcome structural barriers that hinder the realization of their full potential. Drawing on this model, this study explores the critical role of community-based social welfare services in promoting the social inclusion and quality of life of individuals with psychiatric disabilities in Korea. Utilizing secondary data from A Survey on the Operation and Use of Psychiatric Rehabilitation Facilities and the Human Rights of the Users—the first nationwide and pioneering survey of individuals with psychiatric disabilities who regularly access community psychiatric rehabilitation services in Korea—this study explores how satisfaction with welfare needs is associated with the perceived exercise of rights. Maslow’s hierarchy of needs is used as an interpretive framework. Findings indicate that housing, employment, and belongingness needs are significant predictors of perceived exercise of rights (interpreted as rights-based outcomes). These results underscore the urgent need for integrated, person-centered community mental health and social care interventions to address the complex welfare needs of this marginalized population and to enhance their meaningful participation and autonomy in community life. Given the secondary data and cross-sectional nature of the data, and the absence of a comparison group without psychiatric disability, findings should be interpreted as exploratory rather than as empirical validation of Maslow’s hierarchy.
Covid-19 infection had disrupted the routine care for most medical settings. Residential psychiatric rehabilitation settings while do remain a relatively closed community often face challenges when an outbreak occurs due to limited access to emergency care and challenges in ensuring adherence to guidelines by the residents due to the nature of their illness. The current study was taken up to outline the experience of managing the COVID-19 outbreak (during the third wave: Omicron prominent) in a psychiatric rehabilitation centre in South India. A retrospective analysis was carried out by evaluating the data of patients (N = 32) at the rehabilitation facility during the outbreak (January 2022). The management during the first two waves, reasons for outbreak in third wave, the creation of four zones and the steps taken to contain the outbreak are discussed. The study analyses the symptoms, signs, and outcomes of the infected patients. The outbreak management followed the 4-zone algorithm (Fig. 1) with 22/32 (69
Young adults living with chronic illness and acquired visual impairment are at increased risk of depression due to disruptions in identity, autonomy, and social functioning. While reminiscence therapy has been widely studied in older adults, its application in younger individuals with complex medical and sensory conditions remains limited. This case report describes a 29-year-old woman with end stage renal disease undergoing long-term hemodialysis, with total blindness and clinically significant depressive symptoms (PHQ-9 score 19). A sensory-adapted reminiscence-based psychosocial intervention was delivered during routine hemodialysis sessions. The intervention consisted of two sessions over one week, each lasting approximately 45–60 min. Sessions used audio-based stimuli including nature sounds, spiritual recordings, culturally familiar narratives, and guided autobiographical reflection to facilitate emotional processing and recall. During the sessions, the patient showed observable changes in affect, emotional expression, and narrative engagement. These included reduced visible distress, improved emotional flexibility, increased narrative coherence, and greater willingness to engage in social interaction. No post intervention psychometric reassessment or follow up evaluation was conducted. This case illustrates the feasibility of delivering sensory adapted reminiscence-based psychosocial support within a medical setting. The observations suggest potential clinical utility; however, conclusions regarding efficacy remain limited due to the absence of standardized outcome measures and follow up.
Policies across countries are striving to support the mental health needs of young adults and promote inclusive higher education. There is a lack of evidence on the challenges faced by Students with Mental Health Conditions (SwMHC) and the available support at Higher Educational Institutions (HEIs). This study aimed to explore the challenges faced by SwMHC in higher education, available support, and the utilization of institutional support services. A qualitative phenomenological approach and purposeful sampling were used to understand the experiences of SwMHC. Ten participants were interviewed online, by telephone, or face-to-face, based on their preference. Most participants were diagnosed with a mental illness, and three participants were diagnosed with a neurodevelopmental condition. Data were collected between August 2024 and June 2025 and transcribed and coded simultaneously. Qualitative data analysis was conducted using Atlas.ti version 25. Qualitative data analysis gave rise to 435 codes,10 categories, and three themes: (a) sailing through a sea of challenges; (b) supports to stay afloat; and (c) portrait of an inclusive and supportive institution. SwMHC face multiple academic and social challenges in HEIs. Institutional support services play a major role in creating an enabling and supportive environment for SwMHC. The study findings can inform institutional practices and educational policies.
Stroke is a leading cause of long-term disability and is often accompanied by psychological difficulties that may affect recovery and social reintegration. To estimate the rates of anxiety and depression, the prevalence of anxiety and depression among stroke survivors and to examine their associations with social support and functional independence. A cross-sectional study included 157 post-stroke patients. Anxiety and depression were assessed using Hospital Anxiety and Depression Scale, social support using Medical Outcomes Study Social Support Survey, and functional status using the Barthel Index. Associations were examined using both univariable and multivariable logistic regression analyses. Among the participants, 14.0
Background: Persons with mental illness (PwMI) continue to face considerable barriers in accessing employment, particularly due to stigma, limited employer awareness, and inadequate workplace accommodations. Despite global evidence supporting the employability of PwMI, limited data exists on employer perspectives in the Indian context. This study aims to explore employers’ knowledge, attitude, and willingness to hire and support PwMI in Tamil Nadu, India. Materials and methods: A cross-sectional survey was conducted among employers across four organizational sectors: corporate, non-corporate, unorganized, and NGOs. A self-structured questionnaire assessed socio-demographic characteristics, beliefs, willingness to hire, workplace accommodations, and perceived facilitators and barriers. Data were analysed using descriptive statistics. Results: A total of 286 participants took part in the study. While the majority of the employers believed that PwMI deserved equal employment opportunities (64.7
Despite the global recognition of the shortened life expectancy and heightened mortality risks for children with cerebral palsy, limited research exist on the impact of such loss on parents, particularly in Sub-Saharan African countries like Ghana. Therefore, this study explored the lived experiences of bereaved parents of children with cerebral palsy in the Accra Metropolis, Ghana. Utilizing the qualitative research design, data were gathered from eight bereaved parents through semi-structured interviews. Thematic analysis was employed to analyze the data. The study found that following the loss, the bereaved parents experienced profound grief, with some attributing their child’s death to inadequate healthcare services and delayed intervention. In coping with their grief, parents relied on their religious faith, support groups, and some distraction techniques. Some parents also experienced prolonged grief. Based on the findings of the study, some recommendations were made for policy and practice.
Parents of children with Autism Spectrum Disorder (ASD) often experience heightened emotional distress, difficulties in adjustment, and a compromised quality of life. While the severity of ASD symptoms has been consistently linked to these negative outcomes, the psychological mechanisms underlying these associations remain underexplored. The present study examines the mediating roles of parental stress and adjustment in the relationship between ASD severity and parental quality of life. A cross-sectional correlational study design was employed with 52 parents of children with ASD in Bengaluru, India. Participants completed standardised measures assessing ASD severity, parental stress, adjustment, and quality of life. Data was analysed using Pearson’s correlations and mediation analysis with SmartPLS, and ethical approval was obtained prior to data collection. Findings indicate that greater parent-report ASD severity is associated with increased parental stress and adjustment difficulties, while higher stress and poorer adjustment are linked to lower QoL. Mediation analysis demonstrated that parental stress significantly mediated the relationship between ASD severity and QoL (β = − 0.165, p = .035), whereas parental adjustment did not emerge as a significant mediator (β = − 0.116, p = .165). The direct effect of parent-report ASD severity on QoL was non-significant (β = 0.108, p = .410). Additionally, parents reporting greater engagement in leisure activities showed higher QoL, highlighting the potential role of adaptive coping and self-care. These findings underscore parental stress as a key mechanism influencing parental well-being and suggest that interventions targeting stress management and leisure engagement may enhance QoL among parents of children with ASD.
Physical activity (PA) has demonstrated significant benefits for individuals experiencing mental distress; however, existing research has predominantly focused on quantitative symptom reduction, overlooking personal recovery and mechanisms underpinning positive outcomes. This study evaluates the ‘Moving Lives, Healthy Minds’ (MLHM) programme—a 24-week community-based PA intervention for service users of two Community Mental Health Teams (CMHTs). Employing realist evaluation methodology and the CHIME-D framework, this study explores what works, for whom, and why, by identifying the contextual and causal mechanisms behind experienced outcomes.Data were collected through a combination of exploratory and realist interviews, as well as repertory grids, with 17 mental health service users (MHSUs) who engaged with MLHM sessions. Data were analysed using interpretative phenomenological analysis and refined within context-mechanism-outcome (CMO) configurations. Findings revealed that PA sessions acted as a catalyst for personal recovery by fostering connectedness, hope, identity, meaning, and empowerment—five outcomes that align closely with CHIME-D. Notable contextual challenges experienced by MHSUs, such as social isolation, low self-confidence, lack of routine, and perceived stagnation in care, were addressed through MLHM offering MHSUs safe spaces for social engagement, opportunities to feel valued within a group and to challenge and better self, and routine creation. This study contributes to a growing body of literature exploring PA’s role in personal recovery. By moving beyond outcome measurement to examine underlying mechanisms, this research enhances understanding of how PA interventions can be designed and implemented to support meaningful recovery journeys in mental health service users.
Since the late 1990s, Greece has undertaken a transition from asylum-based to community mental health care, creating a network of psychosocial rehabilitation units (PSRUs). Among these, Type A7 housing units provide 24/7 care to adults with severe mental disorders and histories of repeated hospitalization, emphasizing stabilization, functional recovery, and social inclusion (Tsiantis et al. in World Psychiatry 9(2):141–142, 2010; Kallergis and Tsiantis in Psychiatriki 31(2):158–165, 2020; Economou et al. in J Affect Disord 145(3):308–314, 2012; Pantelidou and Sidiropoulou in Hell J Nurs Sci 11(2):55–63, 2018; Vlachos et al. in Psychiatriki 25(4):269–276, 2014; National Institute of Mental Health (NIMH) in Understanding psychosis). To assess changes in autonomy, education/employment readiness, social/family integration, and health/self-care among residents following admission to A7 PSRUs, using a mixed-methods, pre–post comparative design (Esser and Vliegenthart 2017). Quantitative data came from medical records and functional scales (including the Barthel Index) at baseline (T0) and one month (T1), along with counts of individual psychotherapy sessions and medication adjustments. The observation window corresponded within a month in the unit. Statistical analysis used paired-samples t tests (p < 0.05). Effect sizes (Cohen’s d) were calculated to support interpretation of the magnitude of change. Qualitative data (psychologists’ treatment plans, session notes, structured observation using the SOAP framework) captured lived experiences and contextualized change. Improvements were observed across domains. Mean anxiety level at follow-up was 35.5/83; mean psychiatric hospitalizations were 0.8 per resident; mean achieved goals were 12.3/32.7; mean individual sessions were 54.6; mean medication adjustments were 15.3, reflecting active case management and stabilization. Admission to A7 PSRUs was associated with meaningful functional gains and enhanced social participation. These findings represent early indications of progress within the first month of residence and should be interpreted within the context of short-term observation. Findings align with international community psychiatry literature and highlight the need for sustained funding, staff training, and anti-stigma initiatives to consolidate outcomes (Tsiantis et al. 2010; Kallergis and Tsiantis 2020; Economou et al. 2012; Pantelidou and Sidiropoulou 2018; Mezzina 2014; Tsemberis, 2010; Vlachos et al. 2014; Papanikolaou et al. in Psychiatriki 27(2):131–138, 2016; Bond and Drake, 2015).
Well-being is closely linked to employment status and plays a vital role in supporting individuals with mental illnesses in the workforce. Individual Placement and Support (IPS) programs that adopt a recovery-oriented approach to employment have been widely implemented to assist this population. Prior research examining IPS programs has focused mainly on work-related correlates of well-being. However, the relationship between community participation and well-being among workers with mental illness has not been sufficiently examined. This study aimed to clarify the relationship between well-being and community participation, measured by the number of participation domains and days, among workers with mental illnesses enrolled in IPS programs. Data were collected from July to September 2024 from 168 employed individuals diagnosed with mental and behavioral disorders who were receiving services at 15 institutions offering IPS programs. Participants’ demographic data, well-being scores, and community participation data were analyzed using multiple regression analysis. The results showed that well-being (M = 44.6, SD = 8.9), as the dependent variable, revealed significant associations with both the number of community participation domains (B = 0.61, p = 0.011) and participation days (B = 0.08, p = 0.002). These findings suggest that broader and more frequent community participation may contribute to higher levels of well-being among workers with mental illness receiving IPS programs.
