This Editorial introduces the Special Issue of the Irish Journal of Psychological Medicine focused on the evolution, implementation, and critique of the recovery approach in mental health. Tracing its roots to the 19th-century writings of John Perceval, a pioneer in lived experience advocacy, we outline how the recovery approach has grown into a global movement grounded in human rights, agency, and systemic transformation. We define the recovery approach and outline its values of shared humanity, justice, equality, respect, and compassion. We then discuss both the global progress made (including advances in peer support, Recovery Colleges, and coproduction in research, policy, and service development) and the significant challenges faced (ranging from tokenism and epistemic inequality to professionalisation and systemic resistance). The Editorial also explores tensions such as ‘neorecovery’, clinician uncertainty, and the co-optation of lived experience roles. We then provide a brief overview of the diverse contributions that comprise the Special Issue. Rather than romanticising the potential of lived experience integration, or celebrating marginal successes, we argue that, as a whole, this scholarly body of work illuminates pathways to mental health system reform and transformative change. These contributions help us inch closer to the promised revolution, a mental health system that has its foundations in equally valued clinical expertise, scientific rigour, and lived experience knowledge. Such a system would assist people that encounter psychological distress and mental illness, in all its forms, to not only heal but overcome, transcend, and flourish beyond suffering.

Over the past century, psychiatrists have neglected the importance of diet in the management of mental illness. This is especially the case in relation to mood disorders. There is now overwhelming evidence to support the view that a Mediterranean diet can play a role in the management of mood disorders. This is not in any way denying the importance of pharmacological and psychosocial strategies in the management of these disorders. Components of the Mediterranean diet not only impact brain function but also gut microbes, which are increasingly recognised as playing a role in the pathophysiology of mood disorders. Nutrition should be a component in the curriculum of psychiatrists in training.

The recovery concept has been widely integrated into mental health policy, services, and research. However, its applicability across diverse contexts and populations remains a subject of ongoing critique. This paper discusses key issues pertaining to the suitability of implementing the recovery approach in child and youth mental health services, including adult-centric foundations of the recovery concept; limited multi-stakeholder participatory research; privileging individualistic ideologies; differences in developmental stages; differences in illness trajectory, mental health experiences, and service provider interactions; and different systems of care and social environments. The paper concludes with recommendations for future research.

The position paper ‘The development of services for treatment of personality disorder in Adult Mental Health Services’ was published by the College of Psychiatrists of Ireland Personality Disorder Special Interest Group (PDSIG) in 2021. Following this, we are advocating for the development of a national treatment strategy for personality disorders in Ireland. As part of this process, we have examined international evidence and best practice guidelines for establishing personality disorder services. Key recommendations from the literature include access to services, continuity of care, a multidisciplinary approach, tiered models of care, collaboration with service users, staff training and supervision, and delivery of evidence-based interventions. These recommendations should form the backbone of a national personality disorder strategy for Ireland.

In this editorial we set out the background to the advent and development of the concept of recovery in mental health care. We follow this with an overview of policy with specific reference to our own locale here in Wales where a recovery-focus is now written into national mental health legislation and policy directions. We briefly summarise our own research in this area and note positive relationships between recovery and social support and quality of life but also limited shared understanding of what recovery might mean alongside gaps in policy aspirations and everyday experiences of using services. The concept of recovery remains contested with concerns it has become a means for neoliberal thinking in services and in effect has been colonised by competing ideas. Despite this (sometimes) conflicting evidence and the polyvalent quality of the concept, recovery retains a sense of vitality and validity as evidenced by contributions to this special issue of the journal. Building on our reading of this growing literature we suggest that recovery necessitates social change, implies an understanding of systems and awareness of complexity and finally must account for and accommodate competing understandings. To achieve its foundational aims, it is imperative that research in this field directly engages and includes people with experience of using mental health services as co-researchers in generating new recovery-focused interventions to address the challenges of severe mental illness experiences.

This Perspective article addresses the issue of recovery in mental health research, policy and practice from a service user/survivor perspective. In doing so, it brings to bear a fundamentally different viewpoint to that which has dominated psychiatric history, one based on lived experience rather than the ideological allegiances of its founders. The article addresses the modern history of Western mental health provision, its over dependence on medicalised individual understandings of wellbeing, the limitations this has imposed and the challenges it has been subjected to. The issue of recovery is examined in its historical context, exploring its strengths and weaknesses. The latter weaknesses have been magnified by the association of recovery by different governments, nationally and internationally, with pressing mental health service users and others experiencing distress into employment; this is often poor quality and unsupported employment. The article puts this in the broader context of a number of values and principles underpinning both the developing psychiatric system survivor movement and the emerging international interest in Mad Studies. In doing so, the article offers a basis for the radical reform of both understandings of madness and mental distress, recognition of their holistic relations and more helpful routes to offering support and engaging with the lived experience and experiential knowledge of mental health service users.

Psychosis is often a traumatic experience that can lead to significant suffering. However, people may also experience posttraumatic growth following psychosis. Posttraumatic growth refers to the positive changes that people experience following a struggle with an adversarial event and has been shown to occur in at least five domains, including a greater appreciation for life; improved relationships with others; greater personal strengths; new life possibilities and spiritual/existential growth. Studies have shown that mental health services can play a key role in facilitating posttraumatic growth. However, there are no recommendations that clinicians can follow to best support posttraumatic growth following psychosis specifically. Without guidance, clinicians risk invalidating people’s experiences of, or providing improper support for, posttraumatic growth. To address this knowledge gap, we reflect on current research and clinical guidelines to recommend ways that clinicians can support posttraumatic growth following psychosis.

A large body of evidence suggests that adolescent mental health has worsened in recent years, particularly amongst young women. We investigated three putative risk factors which are very prevalent in the modern-day life of adolescents: social media use, sexting, and body dissatisfaction We wanted to investigate how these potential risk factors influence adolescents’ mental health, and whether the effects differ between genders.

We used a population-based survey of predominantly students (mean age 15 years) conducted in secondary schools in Ireland (September–December 2021) in one urban area (North County Dublin) and two rural areas (Cavan, Monaghan) – The “Planet Youth North Dublin, Cavan and Monaghan study”. We examined three mental health outcomes (using the Strengths and Difficulties Questionnaire (SDQ)) and self-harm behaviours. We fitted linear mixed models to examine associations between risk factors and mental health outcomes in both genders separately, adjusting for confounders.

All three risk factors were associated with poorer mental health in both genders, with larger effects in females. High social media usage (>4 hrs/day) was associated with increased poor mental health risk. Body dissatisfaction was linked to self-harm and worse mental health, being more prevalent in females (60% vs 36%). Sending sexually explicit messages was associated with poor mental health and self-harm risk in both genders.

Our findings show that high digital use, body image disturbance and sexting behaviours in teenage life have a strong association with poor mental health and self-harm, with these factors being more prevalent in females.

This article explores the shift in mental health recovery from mere symptom management to a holistic approach via the CHIME framework. It delves into the author’s experience, beginning with the loss of his father, a war veteran with mental health struggles, at 16, thrusting him into the role of primary caregiver for his mother, who also battled mental health issues and eventually took her own life. These events spotlight the shortcomings of traditional mental health care and the urgent need for empathetic, multifaceted services. Advocating for co-creation in mental health services, the article outlines a transition towards a system that integrates recovery principles through stages from co-ideation to co-evaluation, emphasising holistic, person-centred care. It calls for a reimagined mental healthcare system that respects individual journeys and is rooted in co-creation, signalling a critical move towards systemic change.

The value of people’s unique lived experience of mental illness (including psychosis), professional treatment and recovery as a valid form of knowledge remains relatively unexplored and under-utilised by mental health professionals, policy makers and by those seeking help. Mutual peer support remains a largely untapped resource, often ignored and distanced from mainstream services. In this reflective perspective article, I share my own experiences as a service user, spouse, close relative and brother-in-law and also as someone who worked for many years in mutual peer support and in the area of recovery. I reflect on the findings of my doctoral narrative research which focused on the role played by Grow Mental Health, Ireland’s largest network of mutual peer support groups, in recovery from a wide range of diagnoses. The main finding from this research suggested that recovery can be experienced as a re-enchantment with life and that mental illness can act as a gateway to mental health rather than be experienced as a form of (often life-long) disability. In the discussion I try and envisage what a recovery oriented mental health system might look like, and what changes would need to be introduced. Despite such a long personal history of dealing with mental illness and witnessing many different levels of recovery, I still have much to learn about mental illness and recovery. I also welcome many recent changes made within the system and indeed this special edition of the journal.

In the last ten years, the recovery movement has significantly influenced mental health services and workers, psychiatric reform, and the advocacy movement worldwide. Within Brazil’s public mental health care system, operates a cohesive, powerful advocacy coalition empowering recovery-oriented practices. This article aims to highlight successful initiatives spearheaded by individuals with lived experience in Brazil. We will also present some challenges, and discuss possible recovery strategies to strengthen mental health services by empowering people with lived experience and promoting social justice. Efforts and initiatives to implement recovery strategies in Brazil are underway, aiming to improve population mental health and substance misuse both within and outside mental health services. These initiatives include peer support, advocacy, testimonies and empowerment, employment, and social, cultural, and artistic initiatives. Some of the challenges to greater participation of individuals with lived experience in this ongoing process of Brazilian psychiatric reform include the following aspects: barriers to the autonomy and independence of lived experience organizations; the longstanding history of racism in Brazilian society; disparities in social indicators such as education and income, between professionals and people with lived experience in mental health and substance misuse. Although progress in Brazil’s psychiatric reform has advanced through recovery initiatives, challenges remain in ensuring leadership roles for people with lived experience. Ongoing success depends on their active involvement, alongside advocacy movements and involvement of broader society.

This paper explores the intersection of physical health and recovery-oriented approaches in psychosis, offering a unique perspective through autoethnography. By combining personal experience with a broader analysis of existing mental health frameworks, the paper highlights the often overlooked importance of physical health in the recovery process for individuals with psychosis. The autoethnographic narrative reveals the complex challenges posed by antipsychotic medications, including weight gain and metabolic complications, and their impact on overall well-being. It emphasizes the dual stigma of mental health challenges and weight gain, highlighting the need for a more integrated, holistic approach to mental health care. Recommendations include enhanced education for healthcare providers, personalized care plans, and a multidisciplinary approach aimed at bridging the gap between physical and mental health in psychosis recovery.