The CORE study—An adapted mental health experience codesign intervention to improve psychosocial recovery for people with severe mental illness: a stepped wedge cluster randomized-controlled trial.
Open accessAbstract
BACKGROUND: Mental health policies outline the need for codesign of services and quality improvement in partnership with service users and staff (and sometimes carers), and yet, evidence of systematic implementation and the impacts on healthcare outcomes is limited. OBJECTIVE: The aim of this study was to test whether an adapted mental health experience codesign intervention to improve recovery-orientation of services led to greater psychosocial recovery outcomes for service users. DESIGN: A stepped wedge cluster randomized-controlled trial was conducted. SETTING AND PARTICIPANTS: Four Mental Health Community Support Services providers, 287 people living with severe mental illnesses, 61 carers and 120 staff were recruited across Victoria, Australia. MAIN OUTCOME MEASURES: The 24-item Revised Recovery Assessment Scale (RAS-R) measured individual psychosocial recovery. RESULTS: A total of 841 observations were completed with 287 service users. The intention-to-treat analysis found RAS-R scores to be similar between the intervention (mean = 84.7, SD= 15.6) and control (mean = 86.5, SD= 15.3) phases; the adjusted estimated difference in the mean RAS-R score was -1.70 (95% confidence interval: -3.81 to 0.40; p = .11). DISCUSSION: This first trial of an adapted mental health experience codesign intervention for psychosocial recovery outcomes found no difference between the intervention and control arms. CONCLUSIONS: More attention to the conditions that are required for eight essential mechanisms of change to support codesign processes and implementation is needed. PATIENT AND PUBLIC INVOLVEMENT: The State consumer (Victorian Mental Illness Awareness Council) and carer peak bodies (Tandem representing mental health carers) codeveloped the intervention. The adapted intervention was facilitated by coinvestigators with lived-experiences who were coauthors for the trial and process evaluation protocols, the engagement model and explanatory model of change for the trial.
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Collaborative care planning approaches such as codesign and coproduction have become increasingly important in mental health intervention design and delivery and have been shown to improve service quality.
“Collaborative care planning approaches, such as codesign and coproduction, have thereby become increasingly important in mental health intervention design and delivery, and have been shown to improve service quality (44–47).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [44]
The Introduction (page unavailable) says interest in codesign and coproduction has grown and reports documented organisational improvements from experience-based codesign. But it also says effects on service-level outcomes had not been examined; the Discussion reports a null effect in this mental health trial. The claim overstates the evidence that these approaches have been shown to improve mental health service quality. (LLM, conf=0.86)
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Harvey, C., Zirnsak, T.-M., Brasier, C., Ennals, P., Fletcher, J., Hamilton, B., Killaspy, H., McKenzie, P., Kennedy, H., & Brophy, L. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1259944 · Cited by 37 · see citing works
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- Authors
- Palmer, V. J., Chondros, P., Furler, J., Herrman, H., Pierce, D., Godbee, K., Densley, K., & Gunn, J. M.
- Affiliations
- The University of Melbourne (AU)
- Corresponding author
- Palmer, Victoria J.
- ORCID
- Venue
- Health Expectations
- Publisher
- Wiley
- Published
- 2021-08-04
- Volume
- 24
- Issue
- 6
- Pages
- 1948-1961
- ISSN
- 1369-6513 (ISSN-L)
- 1369-7625
- PMC
- PMC8628597
- OpenAlex
- W3188986896
- Cited by
- 21
- References
- 27
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 3 · 2023: 7 · 2022: 3 · 2021: 1
- FWCI
- 3.93
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Health Expectations (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- severe mental illness, psychosocial recovery, recovery-oriented services, service user involvement, caregivers, intervention implementation, mechanisms of change, lived experience
- MeSH terms
- Community Support, Mental Disorders, Humans, Mental Health, Mental Health Services, Victoria
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