Exploring hope and practice in coexisting psychosis

: staff and service user perspectives

Abstract

Section A
Individuals with co-occurring psychosis and substance use often experience stigma and challenges accessing services. Staff working in services supporting individuals with co-occurring psychosis and substance use are important in shaping experiences of care and treatment outcomes. Little is known about how staff members experience this work and research tends to focus on service user perspectives. This review aimed to explore the literature on how working in services supporting individuals with psychosis and co-occurring substance use perceive their work and how this in-turn shapes their work. Online data bases including Psycinfo, Pubmed and CINAHL were searched and 13 studies were identified and quality assessed. This thematic synthesis found four main themes: Recognising the distinct interaction between psychosis and substance use, Protecting the therapeutic relationship: fear of disengagement shapes treatment interventions and interaction, The responsibility dilemma: how service ambiguity undermines staff confidence and hope and Staff understandings of recovery, change and success. This review highlights the complexity of this work and findings could be used to inform the way that services train and support staff to work with individuals with co-occurring psychosis and substance use.

Section B
Experiences of hopelessness are common amongst individuals who have experienced psychosis, and hope is frequently recognised within recovery-orientated approaches as central to recovery in psychosis. Yet the definition and role of hope remain complex, particularly within the context of substance use. This study aimed to explore experiences of hope from the perspective of service users who have experienced psychosis and used cannabis and the staff who support them. A qualitative design was used, comprising of focus groups with 19 staff participants and semi-structured interviews with six service users. Reflexive thematic analysis was used for the data analysis. Analysis generated themes relating to: hope as a changeable state, the role of cannabis in managing distress and maintaining hope, negotiating responsibility in sustaining hope, competing constructions of hope and recovery and holding hope: the interplay between self, others and belief. Within the five themes, fifteen sub-themes were also identified. Hope was conceptualised as dynamic and relational, influenced by interactions, context, differing meanings and shifting responsibilities. These findings re-iterate the importance of therapeutic relationships in generating and sustaining hope for service users. Also, the importance of open, therapeutic discussions between staff and service users about cannabis use as well as conceptualisations and understandings of hope and recovery.

Date of Award	2026
Original language	English
Awarding Institution	Canterbury Christ Church University