How do community-based arts activities enable the identity change recovery process from serious mental illness: A protocol for a realist review

Background: Serious mental illness (SMI) has been identified as a key health issue to be addressed due to static recovery rates, increasing the burden on mental health services. Emerging evidence indicates that community arts activities can support SMI recovery, however the complexity of such social interventions makes it difficult to determine what works, how and in what context. In addition, identity change is one particular recovery process that is often overlooked within intervention evaluations. The aim of this research is to discover causal explanations of how, why and in what context do community-based arts activities enable the identity change SMI recovery process.
Methods: A realist review will be conducted utilising four search cycles: (1) background; (2) programme theories; (3) empirical evidence; (4) middle-range theory. Each cycle will include both structured literature searches and citation searching within a wide range of sources to include both empirical and grey literature. An initial programme theory will be used to define broad search terms, which will be refined as programme theory develops. Similarly, inclusion criteria will be adapted throughout the review, with literature items being appraised and selected for relevance, richness and rigour. An expert panel of stakeholders will be consulted throughout the process to contribute literature suggestions, check programme theory salience and dissemination.
Discussion: This realist review will explore the contextual features of living with SMI and what mechanisms are activated through community arts interventions and why. A particular focus will be on the outcome of the identity change SMI recovery process.