title: Mental health reform at a systems level: widening the lens on recovery-oriented care.
abstract: This paper is an initial attempt to collate the literature on psychiatric inpatient recovery-based care and, more broadly, to situate the inpatient care sector within a mental health reform dialogue that, to date, has focused almost exclusively on outpatient and community practices. We make the argument that until an evidence base is developed for recovery-oriented practices on hospital wards, the effort to advance recovery-oriented systems will stagnate. Our scoping review was conducted in line with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (commonly referred to as PRISMA) guidelines. Among the 27 papers selected for review, most were descriptive or uncontrolled outcome studies. Studies addressing strategies for improving care quality provide some modest evidence for reflective dialogue with former inpatient clients, role play and mentorship, and pairing general training in recovery oriented care with training in specific interventions, such as Illness Management and Recovery. Relative to some other fields of medicine, evidence surrounding the question of recovery-oriented care on psychiatric wards and how it may be implemented is underdeveloped. Attention to mental health reform in hospitals is critical to the emergence of recovery-oriented systems of care and the realization of the mandate set forward in the Mental Health Strategy for Canada.
authors.affiliation: Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Head, Psychology Service, Complex Mental Illness Program, Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Kidd
authors.affiliation: Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Medical Director, Underserved Populations Program, Centre for Addiction and Mental Health, Toronto, Ontario.
authors.forename: Kwame J
authors.initials: KJ
authors.lastname: Mckenzie
authors.affiliation: Student, City University, Department of Psychology, London, England; Research Analyst, Complex Mental Illness Program, Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario.
authors.forename: Gursharan
authors.initials: G
authors.lastname: Virdee
mesh_terms: D002170:Canada; D018166:Health Care Reform; D006760:Hospitalization / Q000639:trends; D006778:Hospitals, Psychiatric / Q000592:standards; D006801:Humans; D007297:Inpatients; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation*; D009936:Organizational Innovation; D010346:Patient Care Management / Q000379:methods / Q000458:organization & administration / Q000639:trends; D058996:Quality Improvement; D012050:Rehabilitation, Vocational / Q000379:methods / Q000639:trends