New dynamics in mental health recovery and rehabilitation

Research in the field of mental health has long stressed the high burden of mental disorders, which were found to be among the most disabling health conditions. Furthermore, many countries encounter difficulties in maintaining access to mental health care services due to economic stress and governmental priorities which do not include (mental) health. Therefore, new interventions in mental health increasingly engage other sectors of society, making use of local resources and aiming for a better link with local communities. In line with these approaches, the current thesis proposes a closer look at the contribution the agricultural sector can make to facilitate the recovery of people with mental disorders, using the case of care farms. Care farming consists of the use of farms as " a base for promoting mental and physical health, through normal farming activity ". Practiced in countries throughout Europe and the USA, care farming represents a link between agriculture and aspects of traditional health care. Despite the increased use of farm-based care, research on the relevance of these services for people with mental disorders, in the broader context of current mental health services, is still missing. This knowledge gap has been denounced by practitioners, researchers, health care professionals and policy makers alike. Responding calls for more clarity regarding the relevance of care farms, and taking into account the complex challenges in the field of mental health, the current thesis was guided by the following research question: " In what way, and to what extent, can care farms play a role in mental health recovery and rehabilitation? " The concept of recovery – the notion that the majority of people can overcome the consequences of mental disorders and live meaningful lives in community – is increasingly integrated into the field of psychiatric rehabilitation. Several perspectives co-exist: the outcomes research perspective on recovery (problem-oriented, focusing on the limitations of people with mental disorders, as imposed by symptoms or are associated with impaired functioning); the personal narratives perspective on recovery (person-oriented, focusing on the process or the personal journey of recovery, as experienced by people with mental disorders); the system reform / transformation perspective on rehabilitation (focusing on the integration of the recovery concept into mental health care systems, and on finding the most effective Summary ways to organize and deliver services, respectively); and the service provision perspective on rehabilitation (focusing on the operationalization of the recovery concept, for example …