Community-Based Recreation Therapy and Mental Health

Recovery: A Mixed-Media Participatory Action Research Study

Jessica J. Ariss, Alison Gerlach, J.B. Baker, Keith Barry, Lyn Cooper, Theressa
L. de Vries, Kevin Halligan, Monica Lacroix

Progress in Community Health Partnerships: Research, Education, and Action,

Volume 13, Issue 2, Summer 2019, pp. 161-170 (Article)

Published by Johns Hopkins University Press

DOI: https://doi.org/10.1353/cpr.2019.0016

For additional information about this article

https://muse.jhu.edu/article/726106

Access provided at 25 Aug 2019 06:02 GMT from University of Georgia

ORIGINAL RESEARCH
Community-Based Recreation Therapy and Mental Health Recovery:
A Mixed-Media Participatory Action Research Study
Jessica J. Ariss, MRSc,1 Alison Gerlach, PhD,2 J.B. Baker,3 Keith Barry,3 Lyn Cooper,3 Theressa L. de Vries,3 Kevin Halligan,3 and Monica Lacroix3
(1) Waypoint Centre for Mental Health Care; (2) School of Child & Youth Care, Faculty of Human & Social Development, University of Victoria, Coast Salish Territories;
(3) HERO Centre.
Submitted 15 June 2018, revised 10 December 2018, accepted 14 December 2018
Abstract
Background: Personal recovery is an individualized process
through which people develop a positive identity and live
a meaningful life, with symptoms of mental illness. Few
studies have explored the role of recreation therapy in the
recovery process from the perspectives of individuals with
lived experience of mental illness.
Objectives: To understand how community-based recreation
therapy can support mental health recovery, from the per-
spectives of people diagnosed with mental illness, and to
guide the development, delivery and evaluation of recovery-
oriented mental health services.
Methods: Guided by the principles of participatory action
research (PAR) and photovoice, six participant researchers
(PRs) generated arts-based media and narrative data in
response to the research question: How can therapeutic
recreation, in a community mental health center, support
the recovery of individuals diagnosed with mental illness?
The research group analyzed the qualitative data through a
participatory data analysis process.
T
he focus of mental health rehabilitation services has
shifted away from the traditional goals of treating and
eliminating symptoms of mental illness. The recent
conceptualization of mental health recovery focuses, instead,
on creating a life of dignity and empowerment in which the
service user defines his or her life choices and works toward
a meaningful existence regardless of symptoms or setbacks.
This concept of recovery, as defined by service recipients, is
emphasized in Canadian, American, and international health
pchp.press.jhu.edu
161
Results: The PRs produced and analyzed 24 pieces of arts-
based media and 5 hours of transcribed narrative data
describing their artworks’ relationship to therapeutic recre-
ation and recovery. The PRs identified seven salient themes
through the participatory data analysis process: providing a
safe place, promoting hope, finding balance, developing self-
wisdom, increasing enjoyment, building confidence, and
encouraging self-determination.
Conclusions: Service recipients’ unique preferences and
perspectives must be integral to service development to
deliver therapeutic recreation interventions that are truly
recovery-oriented. The research findings will be used to guide
the delivery of innovative, collaborative, person-centered
programming in community-based mental health settings.
Keywords
Community-based participatory research, leisure activities,
education, sociology and social phenomena, mental health
services, recreation therapy, mental health recovery
promotion strategies.2–4 Mental health service providers are
striving to develop and implement services that are recovery-
oriented. Individuals with mental illness have described the
process of recovery5–7 and a clear framework is emerging
from the evidence.8 Currently, little is known about the
role of therapeutic recreation in recovery. Participation in
1
community-based swimming groups, nature walks, and social
club activities involving games and crafts has been found to
improve self-esteem and mood in individuals diagnosed with
© 2019 Johns Hopkins University Press
162 mental illness.9 Researchers have theorized that involvement
in leisure activities can contribute to mental health recovery.10
Recovery has been described as an individualized pro-
cess through which people develop hopefulness and a posi-
tive identity. The concept of recovery is rooted in a social
11
justice movement that rejects the medical model’s emphasis
on symptoms and highlights the power imbalances that can
exist between mental health service providers and recipients. 12
Mental health service providers who embrace the concept of
recovery aim to incorporate an understanding of the lived
experience of mental illness in the development and delivery
of recovery-oriented services. There is increasing evidence on
the concept of recovery; a recent systematic review and narra-
tive synthesis provides an emerging framework for the concept
of recovery, as defined by individuals with mental illness.8
The CHIME framework describes personal recovery as five,
8
nonlinear, interconnected processes involving connectedness,
hope, identity, meaning, and empowerment.
The documented outcomes associated with participation
in recreation therapy13 seem to be aligned with the five recov-
ery processes identified in the CHIME framework.8 Evidence
suggests that community-based recreation can play a role in
the mental health recovery process by providing environments
that cultivate social connections. Therapeutic recreation
14
interventions have been described in the international litera-
ture as empowering, helping clients increase connections
13
with their communities,15 find meaning and purpose,13 and
develop a positive personal identity. 16
Designing and implementing services that are recovery
oriented requires that recreation therapists understand the
perspectives of individuals with mental illness. Currently,
however, there are few studies that explore mental health
service users’ perspectives of recreation therapy’s role in the
recovery process. 17,18
The existing evidence suggests thera-
peutic recreation can influence mental health service users’
perceptions of the role of leisure in their health and well­
being17 and can foster a sense of purpose toward overcoming
challenges.18 Researchers have highlighted the need for more
participatory research in the field of recreation and leisure.19
The purpose of this article is to report on the findings from a
qualitative study, which aimed to generate knowledge from
the perspective of service users to inform the development of
recovery-oriented therapeutic recreation services.
Progress in Community Health Partnerships: Research, Education, and Action
METHODS
PAR
This study was guided by the principles of PAR method-
ologies,20,21 which have been used successfully in community-
based mental health settings.6 PAR methodology aims to
reduce the power imbalances that can exist in research22 and
consider the social structures that can result in the marginal-
ization of individuals with mental illness before they enter into
a research relationship.23 PAR “involves research participants
in the construction of their own knowledge for their own
purposes.”20 Evidence indicates that engaging in PAR can
result in feelings of empowerment, community integration,
and identity formation, aligning the research process with the
goals of recovery-oriented services.24,25 In this study, mental
health service users were actively engaged in all phases of the
research process, from identifying the purpose and designing
the research methods to generating and analyzing the data.
Research Setting and Partnership
This research was undertaken from July 2016 to May
2017 by the primary author to meet the requirements of a
Master of Rehabilitation Science degree. The research ethics
boards at the University of British Columbia and the research
site, Waypoint Centre for Mental Health Care (Waypoint),
approved the study procedures. The PRs unanimously con-
sented to identifying themselves within this article.
Waypoint is a psychiatric hospital in Penetanguishene,
Ontario, Canada, providing services to individuals with
mental illness.26 This research was undertaken at Waypoint’s
community-based facility called the HERO Centre (Housing,
Employment, Rehabilitation, Our Place Social Club Centre).
The HERO Centre provides outpatient services, a peer-run
social club, and individual and group-based therapeutic
recreation. The therapeutic recreation services offered at the
HERO Centre are recovery oriented,27 strengths based,28 client
centered, and guided by the leisure ability model.29 The leisure
ability model, one of the most prominent models of practice
in the field of therapeutic recreation, depicts the therapeutic
recreation process as a continuum of increasing indepen-
dence involving the following three phases: 1) functional
intervention—­develop functional skills and address barriers
to leisure involvement; 2) leisure education—enhance leisure
Summer 2019 • vol 13.2
awareness, social skills, leisure activity skills, and knowledge
of leisure resources; and 3) recreation participation—support
service users to develop self-determination in leisure.29
The primary author is a recreation therapist at Waypoint
with more than 10 years of practice and teaching experience,
never employed at the HERO Centre. Before developing the
research proposal, the primary author consulted with HERO
Centre clients and peer support workers during two planning
meetings to elicit feedback about favorable research methods
and outcomes. HERO Centre clients reasoned that using
creative research methods and involving service users would
align the research project with the principles of recovery and
have a positive impact on the development of services.
Recruitment and Sample Population
The primary author presented a brief description of the
study to the HERO Centre clients and peer support workers
at a planning meeting and subsequently posted a recruitment
poster on the center’s bulletin board. Clients contacted the
primary author directly to learn more about the study and
consent process. This purposeful sampling method recruited
six PRs who met the inclusion criteria of being over 19 years
of age, diagnosed with mental illness, residing within the
North Simcoe community, and using therapeutic recreation
services at the HERO Centre within the past year. The primary
author discussed the consent process and obtained informed
signed consent from each PR individually before data collec-
tion. The consent process was revisited before hosting the
research exhibit.
The six PRs were all high school educated, primarily
employed, and over the age of 41. A summary of the PRs’
demographic characteristics can be found in Table 1.
Methods of Data Collection
The primary author developed the research methods in
response to feedback from the HERO Centre clients and peer
support workers in the initial planning meetings. During
the second planning meeting, the primary author suggested
photovoice as a method frequently used in PAR, and briefly
explained the steps of a typical photovoice study: identify-
ing community members’ priorities, recruiting participants,
camera training and distribution, photo assignments, discus-
sion of participants’ photographs, data analysis, developing
Ariss et al.
163
Table 1. Participant Researchers’
Demographic Characteristics
Characteristics N %
Gender
Male 3 50
Female 3 50
Age (years)
41–50 2 33.3
51–60 3 50
>60 1 16.7
Employment status
Employed 5 83.3
Unemployed 1 16.7
Education level
High school 5 83.3
College diploma 1 16.7
action plans and communicating results to decision makers.20
The HERO Centre clients expressed support for photovoice,
but suggested a research process that would provide more
opportunities to express personal choice and individuality
in the research methods. In response to this feedback, the
primary author used research methods guided by the structure
of photovoice,20 but with a broader scope to incorporate any
artistic medium selected by the PRs.
The research group (composed of the primary author
and the six PRs) met for five 1- to 2.5-hour meetings at the
public library over a 6-week period. During the meetings, the
research group established the study’s goals, determined the
nature of the arts-based assignments, discussed the artwork
in group interviews, and analyzed the data corpus composed
of the PRs’ artwork, narratives, and selections of the primary
researcher’s field notes. The PRs were provided with materials
for a variety of arts-based methods including photography,
poetry, painting, and drawing, and were asked to create at
least one piece of art, using any medium, in response to the
research question: How can therapeutic recreation services,
in a community mental health center, support the recovery
of individuals diagnosed with mental illness?
The PHOTO technique, which has been used successfully
in a number of studies to elicit PRs’ narratives,20 provided a
series of structured questions that were used to generate PRs’
narrative descriptions of their artwork in relation to the purpose
of the research project. The questions were: (1) Describe your
piece; (2) What is happening in your piece?; (3) Why did you
Community-Based Recreation Therapy
164 focus on this subject matter?; (4) What does this artwork tell
us about your recovery?; and (5) How can this artwork provide
opportunities to support the recovery process? PRs’ narratives
were audio-recorded and transcribed by the primary author.
An overview of the community-based PAR methods can be
found in Figure 1.
Data
The PRs generated 14 poems or songs, 3 drawings, 5
paintings, 1 photograph, 1 felted art piece, and 5 hours of
transcribed narrative data from group discussions describ-
ing their artworks’ relationship to therapeutic recreation and
recovery. The primary author maintained descriptive field
notes to document observations throughout the research
activities and maintained a reflexive journal to document
personal thoughts, feelings, and perceptions about her role
as a researcher.
Data Analysis
The primary author facilitated a participatory data analysis
process, initially developed and described by Jackson,30 to
identify salient themes in the data. Jackson’s30 group-oriented
analytical process was applied with the PRs as follows:
1. Preparing the data. The primary author transcribed the
PRs’ responses to the PHOTO questions and printed
each response on a separate strip of paper.
2. Grouping and coding the data. The PRs randomly
selected narrative responses from the collection of
printed responses and read them silently. Each PR
highlighted the text most relevant to them and added
notes about their interpretations of the data. The pri-
mary author then facilitated a discussion with the PRs
to organize the data into preliminary themes. The PRs
further separated the narrative data by cutting the strips
of paper when needed.

Figure 1. Community-Based Participatory Action Research Process

PR = participant researcher; REB = Research Ethics Board

Progress in Community Health Partnerships: Research, Education, and Action Summer 2019 • vol 13.2
3. Consolidating. Collaboratively, the research group re-
read narrative data aloud and engaged in discussion and
analysis to refine the preliminary themes.
4. Making sense of the data. The PRs discussed and
debated potential theoretical connections and the
meaning of different terms in order to determine the
wording of each theme.
5. Telling the story. The PRs generated suggestions for
recovery-oriented therapeutic recreation services.
The research group hosted an art exhibit to share the
artwork, poetry, and associated narratives.
Rigor
Reflexivity, characterized by a researcher’s continual
analysis of their personal involvement in the research pro-
cess, increases the dependability of research findings.31 The
primary author encouraged the PRs to consider their own
positionality in relation to the data. For example, the PRs
discussed their personal viewpoints of the term “recovery”
and acknowledged how their unique lived experiences could
influence their understanding of the terminology used in the
data. The primary researcher aimed to attenuate the posi-
tion of power she occupied in the research relationship by
emphasizing the significance of lived recovery experiences
and collaborating with the PRs to make research decisions. All
research decisions were clearly documented by the primary
researcher in an audit trail. Maintaining an audit trail can
increase the transparency of the research process and improve
the findings’ dependability and confirmability.32
Achieving triangulation, by including two or more investi-
gators or methods, promotes rigor in qualitative research and
can increase the credibility of the findings.33 By collecting data
through multiple methods including field notes, narrative,
and arts-based methods, triangulation was accomplished.
Investigator triangulation was achieved through the par-
34
ticipatory data analysis process that incorporated multiple
researchers’ perspectives. The PRs reviewed this research
manuscript before publication to provide feedback and ensure
their perspectives were accurately represented.
The PRs decided to host the research exhibit in the lobby
of Waypoint’s in-patient facility because they felt it was
important to share a hopeful message about recovery with
individuals currently receiving in-patient treatment. The
exhibit’s location also facilitated opportunities for integrated
Ariss et al.
knowledge translation—collaboration between service provid- 165
ers and researchers to promote the application of research
findings.35 The exhibit was attended by mental health service
users and providers who reported they found the art, narra-
tives and findings to be relevant and meaningful; this positive
feedback adds credibility to the findings.
FINDINGS
The PRs identified seven salient themes through an itera-
tive dialogical process as described above. What follows is a
summary of the PRs’ perceptions of how community-based
recreation therapy can support the mental health recovery
process.
Offering the Freedom to Choose
The PRs emphasized the importance of providing oppor-
tunities for personal choice and self-determination in mental
health services. One PR, Lyn, articulated this theme when dis-
cussing her desire for community-based mental health centers
to provide diversity in materials and recreational opportunities:
There would be avenues to explore, maybe leather-
work, wood burning, or clay and a kiln . . . I’d love
to see a sewing machine there and remnants of
fabric . . . [This] would give me a reason to get out
of bed and express myself through my art and . . . my
mental illness would not define me.
Another PR, Keith, dealt with this subject matter through
a poem that depicts a romantic relationship between two indi-
viduals receiving mental health services. The words of Keith’s
poem emphasize the importance of creating a therapeutic
environment that respects the expression of personal choice
in intimate relationships: “Johnny and Annie were filthy
rich, nothing to do with money, just a thread and a stitch.
Forbidden fruit, forbidden love, jumping jacks beneath the
cracks. Wilted flowers and touch me nots reflecting on their
souls.” When contemplating the message of the poem Keith
stated, “Love conquers all, right?”
Providing a Safe Place Where Clients are Listened to
Several PRs highlighted the need for community-based
mental health centers to feel like a safe place or a second home.
In discussing her involvement with community-based, peer-run
Community-Based Recreation Therapy
166 social clubs Monica stated, “It’s almost like another home to go
to . . . and to me it’s almost like having another family.” Another
PR, Kevin, echoed these sentiments stating, “That’s what I’ve
come to experience at Waypoint. Safe places where you can
stay and go and think about your problems and your recovery.”
The PRs elaborated on the environmental features and
facilitation styles that create feelings of safety. Lyn described,
“a safe and welcoming place where my soul could sort out
my feelings in my own way. Not in a medical environment
where prescriptions are written in a cold office, and the pos-
sibility of an encounter with ‘Nurse Ratchet’ looms in the air.”
Another PR, Theressa, addressed the importance of feeling
heard, “listening to the client is one of the most important
things.” As Lyn explained, “Understanding and supporting
clients’ unique preferences creates an environment where
people are accepting.”
Promoting Growth and Hope
The PRs described how their involvement in therapeutic
recreation services helped promote personal growth and hope.
Keith: “For the first time, I think, in my life I picked up a paint
brush and painted . . . It gave me the inspiration, like, maybe I
can do things better.” Keith continued to discuss his recovery,
“Especially when it comes to the three; the mental health, the
booze and the drugs. At the end of it all I demonstrate that
you can overcome these things . . . you just need something
to pull you out.” Throughout the group interviews and data
analysis, the PRs closely connected personal growth with the
concept of hope. As Monica explained,
engaged in clarifying the meaning of this theme. Kevin
addressed this in an action painting with various colorful
splatters that symbolized unbalanced emotions, and Theressa
dealt with this in song lyrics: “Hey, hey middle ground,
somewhere between up and down. She’d be safe and sound,
oh to find middle ground.” When discussing the meaning
of her song Theressa stated, “I think a lot of people have a
hard time finding middle ground; especially having mental
illness . . . It’s really hard to find that space of everything being
level in one spot.” The PRs explained that community-based
recreation therapy could provide a sense of balance. As Kevin
stated, “I’m trying to find the happy medium between, ya
know, arcadia and rush hour.” Kevin described the HERO
Centre as “a peaceful place where you can sort of straddle
both worlds, where you can live in somewhere peaceful and
live in somewhere practical.”
The PRs agreed that this perception of balance and ‘middle
ground’ can be experienced when participating in personally
meaningful recreational activities. Lyn created a felted art
piece entitled “Zen” (Figure 2) which symbolized the calm
state she can enter into when creating art:
I was able to create in a calm, quiet and untroubled
state of being, as opposed to a frenetic one that I often
find my brain to be in. It helped me to find a balance

Before I locked myself in a house, closed all the curtains

and I stayed in there and wouldn’t leave . . . Now I’m
doing things more. I feel more confident. I’m stronger
now. I have lots of hope and lots of family and friends
to help me.

An excerpt from one of Keith’s poems conveyed how

therapeutic recreation can foster hope: “Look at those waves
on the bay, we will make this a better day, I think we can sail
away, nothing will bother us today.”

Finding Balance/‘Middle Ground’

All six PRs referred to the concept of balance/“middle
ground” in their artwork or their narrative data. The group Figure 2. Zen

Progress in Community Health Partnerships: Research, Education, and Action Summer 2019 • vol 13.2
 between being in shut-down mode and spinning in 167

all directions.

Lyn further explained how finding balance through thera-

peutic recreation could promote one’s wellness: “[therapeutic
recreation] cannot cure mental illness. It can, however, help
people find a healthy balance in our lives and, in doing so,
make a positive contribution to the quality of our lives.”

Developing Self-wisdom
When selecting a label for this theme, the research
group engaged in discussion to deconstruct the term “self-
wisdom.” Keith explained how the word ‘wisdom’ conveys
the learning that occurred during each of his meaningful life
experiences. The group of PRs identified with his reasoning.
Lyn discussed the personal insight she developed through
life experience:

I will never be ‘recovered’ I will not wake up one day

and say that my illness has magically disappeared and
flush my medications down the toilet. People with
bipolar often come to that conclusion and, as a result,
become dangerously ill.
Throughout the PRs’ narratives and artwork there were
examples of participating in personally meaningful activities
promoting self-discovery. Monica described how her involve-
ment in community-based recreation therapy promoted
re-discovery of self: “I’m more myself again. I’m me.” Keith
used poetry to explore his personal recovery and the process
of developing self-wisdom:
I remember when I was young such a long time ago.
I remember when the claws of the dragon let me
go . . . As the angels would say, be the best you can
be. It took a lifetime, but now, I am free to be me.
Increasing Fun and Enjoyment
The PRs discussed how connecting with a peer-run social
club and participating in therapeutic recreation interventions
can increase opportunities for fun and enjoyment. Monica
stated, “I’ve been smiling a lot more and laughing a lot
more . . . I love everything about the mental health system
and what they’re doing for everybody and myself, I find that
they’re doing a great job.” When describing the meaning of
Figure 3. Recovery Flowers
her mixed-media art piece (Figure 3), Monica provided this
advice to recreation therapists: “Laugh more. That alone is
therapy.” Kevin described how a therapist’s interaction style
could foster or hinder fun and enjoyment stating, “A smile
is better than a frown. Ya know, anything hostile in a human
face tends to send me packing.”
Building Confidence
Several PRs expressed sentiments about their level of self-
confidence. J.B. endorsed the importance of addressing his
low self-confidence: “By sharing my story to the staff or the
support team or the recovery team, that helps them know a
little bit about me and what I’m struggling through . . . The
thing is, I don’t have the confidence all the time.” Monica
discussed how community-based recreation therapy provides
opportunities to build self-confidence: “I have more cour-
age . . . [With the social club] I’ve been going on trips and
places where I wouldn’t normally go . . . and not taking a
nerve pill to do so.”

Ariss et al. Community-Based Recreation Therapy

168
Table 2. Participant Researchers’ Suggestions for
Recovery-Oriented Therapeutic Recreation Services
• ​Involve mental health service users in service development and
delivery.
• ​Listen to service users and deliver person-centered services
according to each individual’s unique preferences.
• ​Build and maintain a trusting therapeutic rapport.
• ​Provide open access to a wide variety of recreational/leisure
opportunities and supplies.
• ​Communicate in ways that are positive and encouraging, but
never condescending, to build confidence,
• ​Include peer support workers and client volunteer positions in
service delivery.
• ​Laugh more.
To highlight the key messages within the research findings,
the PRs developed a list of recommendations for the provision
of recovery-oriented therapeutic recreation services (Table 2).
DISCUSSION AND PRACTICE IMPLICATIONS
The viewpoints discussed represent the perspectives of
six individuals diagnosed with mental illness who have par-
ticipated in community-based recreation therapy. The small
group size and narrow scope are limitations of the present
study; however, this structure allowed each individual’s
opinions to be heard, considered, and discussed. The modi-
fication of traditional photovoice techniques may limit the
validity of the method, as the questions used in the PHOTO
technique20 were adapted from their initial structure and the
PRs used a variety of media to tell their stories. The photovoice
modification was initiated by HERO Centre members and
is supported by research that has successfully incorporated
other mediums into photovoice methods.36,37 Considering
the limitations of the methods and data analysis, these find-
ings may be generalized to similar community-based mental
health settings providing therapeutic recreation services and
a peer-run social club. The PRs felt the themes were relevant
to service recipients and providers in Waypoint’s inpatient
setting. The feedback from the research exhibit indicates the
findings can inform therapeutic recreation services across the
full range of mental health care, from health promotion strate-
gies to inpatient and community-based settings. From the
perspectives of the PRs, community-based recreation therapy
Progress in Community Health Partnerships: Research, Education, and Action
can support the recovery process when service delivery is in
congruence with the themes and suggestions identified in the
research findings. Although the PRs were not presented with
any preconceived definition of the concept of recovery, the
themes generated through the research process seem to be
aligned with previous writings on personal recovery.
The CHIME framework8 depicts recovery as five intercon-
nected processes involving the development of connectedness,
hope, identity, meaning, and empowerment. Three of the
themes identified by the PRs correspond directly with the
processes identified in the CHIME Framework8: “fostering
growth and hope” parallels “hope”; “developing self-wisdom”
resembles “identity”; and “building confidence” corresponds
with “empowerment.” Although the PRs did not explicitly
identify social “connectedness” as a significant theme, the
importance of peer and family support was mentioned
throughout the narrative and arts-based data. The theme
“offering the freedom to choose” is closely related to the
CHIME process of “meaning” because the PRs emphasized
the importance of choosing recreational pursuits that are
personally meaningful.
During the research group’s analysis of the “balance/
middle ground” theme, the primary author considered the
concept’s relationship to Csikszentmihalyi’s theory of flow.38
The primary author shared the central tenets of the theory with
the PRs and they agreed the theory of flow38 could provide
a theoretical underpinning for the “balance/middle ground”
theme identified in the data. Csikszentmihalyi explains, “flow
is a subjective state that people report when they are com-
pletely involved in something to the point of forgetting time,
fatigue, and everything else but the activity itself.”38 Recreation
therapists purport individuals can reach this heightened state
of focus and immersion in an activity when one’s level of skill
matches the activity’s level of challenge.29 This study’s findings
endorse the existence of “flow” and demonstrate how embody-
ing a state of flow can support the mental health recovery
process. Flow has been discussed throughout therapeutic
recreation29,39 and positive psychology38,40 literature. In the
field of therapeutic recreation, these discussions are largely
focused on ways to construct a balance between challenge and
skill in order to promote a state of flow. The importance of self-
determination in leisure was a prominent theme throughout
Summer 2019 • vol 13.2
the research findings and the PRs’ data suggest that partici-
pating in personally meaningful activities can contribute to
one’s ability to achieve a state of flow. This finding has two
noteworthy implications for the field of recreation therapy.
First, the importance of self-determination highlights the need
for recreation therapists to constantly adapt their therapeu-
tic approach and intervention plans in response to service
users’ self-identified goals, preferences and priorities. Second,
recreation therapists are reminded to more fully understand
the personal meaning recreation participation facilitates
for each individual. Recreation therapists can support the
mental health recovery process by communicating openly,
maintaining a trusting therapeutic rapport, and collaborat-
ing with service users to provide accessible and meaningful
recreational opportunities.
The research group shared their research findings with
mental health service providers at the HERO Centre. The ser-
vice providers responded by making some adjustments to their
service delivery. They increased their focus on volunteerism
among clients and improved access to a greater variety of recre-
ational supplies. The HERO Centre continues to involve service
recipients in service development and delivery. Potential future
research directions include repeating the study with the PRs
at a later date or implementing similar participatory research
methods with people receiving inpatient services.
CONCLUSIONS
This research study generated knowledge on recovery-
oriented therapeutic recreation services from the perspectives
of individuals with lived experience of mental illness and
recreation therapy. In alignment with the central tenets of
recovery, individuals with lived experience of mental illness
were involved throughout the PAR process to ensure their
perceptions guided this study. In each stage of their involve-
ment, mental health service users advocated for increased
autonomy and opportunities for self-determination. Through
generating and analyzing arts-based media, the PRs described
how recreation therapy in a community mental health center
can support the recovery process. When service recipients
are involved in the development, delivery and evaluation of
therapeutic recreation interventions, they have the power to
guide the provision of services that are truly recovery oriented.
Ariss et al.
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