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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” 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]
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Qualitative and Mixed Methods in Mental Health Services and Implementation Research
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“Gilburt et al. (2013) used mixed methods to achieve complementarity in their evaluation of implementation of a recovery-oriented practice through training across a system of mental health services, using a quantitative audit of care plans in a random sample of 700 patients to assess change in core…”
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“For example, a review of 3,526 care plan action points for 700 service users found 2,489 (71%) were for staff to action, with only 725 (21%) for joint action and 287 (8%) for action by the service user.(24) Therefore the third working practice was focussed on supporting service users to identify, strive towards and ac…”
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“Furthermore, there is a recognized need for effective anti-stigma interventions with a strong focus on recovery (Gilburt et al., 2013).”
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“Potential problems which may arise were seen as coming from attempts at implementation at the meso and organisational levels of mental health settings, rather than at the interface between users and health professionals [23].”
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Wallace, G., Bird, V., Leamy, M. C., Bacon, F., Boutillier, C. L., Janosik, M., Macpherson, R., Williams, J., & Slade, M. (2016) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-016-1257-9 · Cited by 33
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“In this regard, training can be an important mechanism for enhancing skills and promoting recovery-oriented practices [52].”
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“This coincides with recovery-oriented approaches [39] and descriptions of helpful relationships [13].”
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The Transformation From Custodial to Recovery-Oriented Care
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Walsh, F. P., Meskell, P., Burke, E., & Dowling, M. (2017) · Issues in Mental Health Nursing · doi:10.1080/01612840.2017.1346014 · Cited by 24
“Staff have identified the qualities they see as essential in the implementation of recovery in practice, including experience, caring, flexibility, commitment, energy, open-mindedness, a positive attitude and open to change (Gilburt et al., 2013).”
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Recovery as a Model of Care? Insights from an Australian Case Study
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Lean on me: the potential for peer support in a non-government Australian mental health service
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“The literature on recovery indicates that mental health clinicians and service managers are confused by the term and meaning of what working in a recovery orientation entails [27,34], exemplified in the findings in this study.”
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Raeburn, T., Hungerford, C. L., Sayers, J. M., Escott, P., López, V., & Cleary, M. L. (2015) · Issues in Mental Health Nursing · doi:10.3109/01612840.2015.1011760 · Cited by 15
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“Evaluation is often a challenge in implementing a recovery approach [5, 10, 12, 14] including in other PIR programs [32].”
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Recovery in Psychosis: Perspectives of Clients with First Episode Psychosis
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The social capitals of recovery in mental health
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“In the current example, patients’ perspectives and experience were central to study the novel and unique facility design, in keeping with recovery-oriented principles (Gilburt et al., 2013).”
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“This is because most of the research has so far focused primarily on individual-level impacts of recovery innovations and as a result impacts at the service delivery level have been less well articulated, with the exception being “changing practice” which is well described in other studies [38, 40, 49, 50, 52].”
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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).”
BackgroundTraining professionals in a recovery‐oriented methodology: a mixed method evaluation
Bitter, N. A., Roeg, D. P. K., van Nieuwenhuizen, C., & van Weeghel, J. (2019) · Scandinavian Journal of Caring Sciences · doi:10.1111/scs.12644 · Cited by 9
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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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“Mental health settings seeking to promote recovery via patient centred care that promotes involvement and engagement seem to struggle to achieve recovery oriented practice [18].”
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“In this regard, empowerment education and training mental health champions have become important mechanisms for improving skills and facilitating empowerment actions (79).”
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Schmit, M. K., Oller, M. L., Tapia-Fuselier, J. L., & Schmit, E. L. (2020) · Journal of Counseling & Development · doi:10.1002/jcad.12295 · Cited by 7
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Teaching Clinicians the Practice of Recovery-Oriented Care
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Self-citationChancen und Probleme des Recovery-Ansatzes aus psychiatrischer Sicht
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“Initiatives operating between education, health, and community systems frequently encounter ambiguity relating to governance structures, commissioning responsibilities, funding arrangements, and institutional accountability [19, 56].”
Eiroá‐Orosa, F. J. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1152581 · Cited by 3
“The number of professionals who have participated in the countries that pioneered the Recovery model can be counted in the hundreds of thousands, including mandatory training campaigns in various territories (e.g., Way et al., 2002; Gilburt et al., 2013; Wilrycx et al., 2015).”
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Nurses’ Perceptions on How Recovery-Oriented Mental Health Care Can Be Developed and Implemented
Kealeboga, K. M., Manyedi, M. E., & Moloko-Phiri, S. S. (2023) · Nursing Research and Practice · doi:10.1155/2023/4504420 · Cited by 2
“It is crucial for countries implementing a recoveryoriented mental health approach to have proper guidelines and policies to guide its implementation [2, 3, 48, 49].”
BackgroundZappa, A., Scanlan, J. N., Honey, A., & Hancock, N. (2025) · Journal of Mental Health · doi:10.1080/09638237.2025.2607985 · Cited by 2
“Inclusion and use of recovery-focused PROMs have been promoted internationally for two reasons: to measure recovery-focused outcomes, and to support greater recovery-orientation in service delivery (Gilburt et al., 2013).”
Clarke, E., Leamy, M. C., Bird, V. J., Janošik, M., Jordan, H., Le, B. C., Macpherson, R., Riley, G., Sanger, K., Williams, J., et al. (2020) · Archives of Psychiatry and Mental Health · doi:10.29328/journal.apmh.1001014 · Cited by 2
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“Measuring recovery from the perspective of the person receiving care enables the development of personalized, collaborative approaches to mental health services, which are core elements of recovery-oriented practice [6, 7].”
Older adult recovery: “What are we working towards?”
Rankin, S., & Petty, S. (2016) · Mental Health Review Journal · doi:10.1108/mhrj-09-2014-0033 · Cited by 2
Mental health staff perspectives on supporting recovery
Boutillier, C. L. (2017) · Research Portal (King's College London) · Cited by 2
Weaver, N. (2019) · Cronfa (Swansea University) · doi:10.23889/suthesis.53686 · Cited by 3
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Bridekirk, J., Ham, E., Ball, L. C., & Thege, B. K. (2021) · International Journal of Forensic Mental Health · doi:10.1080/14999013.2021.1973153 · Cited by 1
Koretsidou, C., O’Toole, C., Galavan, E., McKeon, J., & McGilloway, S. (2024) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2024.58 · Cited by 1
Opinión de las Enfermeras de Salud Mental de España sobre el enfoque de Recuperación
Contreras, J. L. M., Huizing, E., Vera, A. M. P., Cócera, J. A. L., & y Cuidados, G. R. (2017) · Revista Española de Enfermería de Salud Mental · doi:10.35761/reesme.2017.1.04 · Cited by 1
Mental Health Nursing Education: Past, Present, and Future
Chan, S. W. (2018) · Mental health and illness worldwide · doi:10.1007/978-981-10-0866-5_4-1 · Cited by 1
Development of Peer-Leadership Program focused on Recovery of People with Mental Illness
Kim, M. J., & Lee, K. (2020) · Journal of the Korea Academia-Industrial cooperation Society · doi:10.5762/kais.2020.21.6.256 · Cited by 1
“이러한 의도는 Gilburt 등이 실시한 회복기반 프로그램과 동일하다[28].”
Mental Health Nursing Education: Past, Present, and Future
Chan, S. W. (2019) · Mental health and illness worldwide · doi:10.1007/978-981-10-2350-7_4 · Cited by 1
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““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 [52–54].”
Advancing Recovery in Adult Mental health Inpatient Services in Ireland
Synnott, J. (2015) · Figshare · doi:10.25419/rcsi.10813289
The Implementation of Recovery: A Literature Review Mundakir *
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De-Escalation and Safety Intervention in Mental Health Crisis
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Perceptions of organizational change by actions of training: systematic literature review
de Mello, C. G., & Zerbini, T. (2025) · Estudos de Psicologia (Campinas) · doi:10.1590/1982-0275202542e220005
Piat, M., Wainwright, M., Sofouli, E., Vachon, B., Deslauriers, T., Préfontaine, C., & Frati, F. (2021) · Figshare · doi:10.6084/m9.figshare.14545090
Piat, M., Wainwright, M., Sofouli, E., Vachon, B., Deslauriers, T., Préfontaine, C., & Frati, F. (2021) · Figshare · doi:10.6084/m9.figshare.14545078
Metadata
- 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
- 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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