Promoting recovery-oriented practice in mental health services: a quasi-experimental mixed-methods study
Open accessAbstract
BACKGROUND: Recovery has become an increasingly prominent concept in mental health policy internationally. However, there is a lack of guidance regarding organisational transformation towards a recovery orientation. This study evaluated the implementation of recovery-orientated practice through training across a system of mental health services. METHODS: The intervention comprised four full-day workshops and an in-team half-day session on supporting recovery. It was offered to 383 staff in 22 multidisciplinary community and rehabilitation teams providing mental health services across two contiguous regions. A quasi-experimental design was used for evaluation, comparing behavioural intent with staff from a third contiguous region. Behavioural intent was rated by coding points of action on the care plans of a random sample of 700 patients (400 intervention, 300 control), before and three months after the intervention. Action points were coded for (a) focus of action, using predetermined categories of care; and (b) responsibility for action. Qualitative inquiry was used to explore staff understanding of recovery, implementation in services and the wider system, and the perceived impact of the intervention. Semi-structured interviews were conducted with 16 intervention group team leaders post-training and an inductive thematic analysis undertaken. RESULTS: A total of 342 (89%) staff received the intervention. Care plans of patients in the intervention group had significantly more changes with evidence of change in the content of patient's care plans (OR 10.94. 95% CI 7.01-17.07) and the attributed responsibility for the actions detailed (OR 2.95, 95% CI 1.68-5.18). Nine themes emerged from the qualitative analysis split into two superordinate categories. 'Recovery, individual and practice', describes the perception and provision of recovery orientated care by individuals and at a team level. It includes themes on care provision, the role of hope, language of recovery, ownership and multidisciplinarity. 'Systemic implementation', describes organizational implementation and includes themes on hierarchy and role definition, training approaches, measures of recovery and resources. CONCLUSIONS: Training can provide an important mechanism for instigating change in promoting recovery-orientated practice. However, the challenge of systemically implementing recovery approaches requires further consideration of the conceptual elements of recovery, its measurement, and maximising and demonstrating organizational commitment.
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Coding by consensus is most consistently used as a measure of reliability in qualitative data analysis in the mental health services area.
““Coding by consensus” in this way by regularly meeting to discuss procedures for assigning codes to segments of data and resolving differences in coding procedures is most consistently used as a measure of reliability in qualitative data analysis in the mental health services area [52,53,54].”
From A Qualitative Study of Participant Feedback on an Acceptance and Commitment Therapy Group-Based Intervention for Parents of Youth with Anxiety Disorders. (2026) · cites this paper as [52]
The Methods > Data collection and analysis passage says the research team discussed its developing coding frame until reaching consensus, supporting this study as an example of consensus-based qualitative coding in mental health services. It does not say that coding by consensus is the most consistently used reliability measure, or describe regular meetings to resolve differences in coding procedures. (LLM, conf=0.86)
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“The ability to assess and measure recovery-focused outcomes from the consumer ’ s perspective supports the adoption of recovery-oriented practice (14, 15).”
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“Holism often features within a person-centred recovery approach aimed at achieving personal integrity and wholeness (Gilburt 2013).”
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- Authors
- Gilburt, H., Slade, M., Bird, V., Oduola, S., & Craig, T. K.
- Affiliations
- King's College London (GB)
- Corresponding author
- Gilburt, Helen
- Venue
- BMC Psychiatry
- Published
- 2013-06-13
- Volume
- 13
- Issue
- 1
- Pages
- 167-167
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC3683325
- OpenAlex
- W2062382422
- Cited by
- 107
- References
- 22
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 8 · 2022: 3 · 2021: 17 · 2020: 11 · 2019: 12 · 2018: 6 · 2017: 8 · 2016: 10 · 2015: 13 · 2014: 7 · 2012: 1
- FWCI
- 18.11
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- Guy's and St Thomas' Charity
- 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
- recovery-oriented care, recovery, mental health services, employee training, organizational change, care planning, multidisciplinary team, implementation, employee perceptions, hope, organizational commitment
- MeSH terms
- Mental Disorders, Health Personnel, Humans, Mental Health Services, Organizational Innovation, Primary Health Care, Program Evaluation, Qualitative Research
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