Recovery from Severe Mental Health Problems: A Systematic Review of Service User and Informal Caregiver Perspectives

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Twenty-five (40%) studies specified participants' ethnicities; out of these, 19 were predominantly of white-European background.

“Twenty-five (40%) studies specified participants' ethnicities; out of these, 19 were predominantly of white-European background.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Recovery was understood as having sufficient resources available to have an acceptable quality of life and live independently from family.

“Recovery was understood as having sufficient resources available to have an acceptable quality of life and live independently from family.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The review included 62 studies.

“The remaining 62 studies were included in this review.”

• Also stated in: § Abstract · plain

  “Sixty-two studies were analyzed.”

May combine two claims.

Empowerment was a central aspect underlying legal and political recovery; recovery goals were related to rebelling against socially imposed rules or practices considered to stand in the way of well-being and advocating for fairer legislation.

“Empowerment was one of the central aspects underlying this theme; recovery goals were related to rebelling against socially imposed rules or practices which users considered to stand in the way of their well-being and advocating for fairer legislation.”

May combine two claims.

An important part of externally derived social recovery was being allowed to take risks, considered to have adequate judgement in everyday life and legal capacity to consent in formal contexts.

“An important part of externally derived social recovery was being allowed to take risks, this is to be considered to have adequate judgement in everyday life and legal capacity to consent in formal contexts.”

May combine two claims.

The socially constructed nature of recovery was emphasized repeatedly, with social discrimination and experiences of stigma being perceived as the opposite of recovery in many studies.

“The socially constructed nature of recovery was emphasized repeatedly, with social discrimination and experiences of stigma being perceived as the opposite of recovery in many of the studies (36, 40, 47, 49–52).”

• cites [36] Gopal, 2020, What constitutes recovery in schizophrenia? Client and caregiver perspectives from South India, Int J Soc Psychiatry. sourceNot checked yet

  Not checked in the free run.

• cites [40] Nxumalo Ngubane, 2019, The experiences and meanings of recovery for Swazi women living with “schizophrenia.”, J Psychiatric Mental Health Nurs sourceNot checked yet

  Not checked in the free run.

• cites [47] Cárcamo, 2019, Mental health care for persons with a severe psychiatric diagnosis and their recovery, Psicoperspectivas Individuo y Sociedad. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Theme one (Prosperity) aligned with social and political recovery paradigms; themes two and three (Social and Individual Recovery) overlapped with REFOCUS-CHIME, SAMHSA, and USA consumer/survivor movement; theme four (Clinical Recovery Experience) aligned with the bio-medical recovery paradigm.

“Theme one (Propsperity) was aligned with the social and political recovery paradigms; themes two and three (Social and Individual Recovery) overlapped with the definition of recovery of the REFOCUS-CHIME, SAMHSA, and USA consumer/survivor movement, and theme four with the bio-medical recovery paradigm.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Six (10%) of the included papers focused on a low-income sample.

“However, six (10%) of these papers focused on a low-income sample.”

May combine two claims.

Five distinct recovery paradigm categories were identified: USA consumer/survivor recovery movement (n = 19, 30%); REFOCUS-CHIME model (n = 12, 19%); Social recovery (n = 8, 13%); Political recovery (n = 3, 5%); and Bio-medical recovery (n = 3, 5%).

“Five distinct categories/models were identified: USA consumer/survivor recovery movement (including Substance Abuse and Mental Health Services Administration—SAMHSA- model) (n = 19, 30%); REFOCUS-CHIME model of recovery (n = 12, 19%); Social recovery (n = 8, 13%); Political recovery (n = 3, 5%), and Bio-medical recovery (n = 3, 5%).”

May combine two claims.

Perspectives of experts by experience were present particularly in the development of models of recovery in the USA, and to a lesser extent in the REFOCUS-CHIME model and the Political recovery paradigm; the remaining paradigms emerged mainly from reflections of mental health professionals and social/political theorists.

“Further exploration of the paradigms referenced highlighted that the perspectives of experts by experience were present particularly in the development of models of recovery in the USA, and to a lesser extent in the REFOCUS-CHIME model and the Political recovery paradigm. The remaining paradigms emerged mainly from reflections of mental health professionals and social/political theorists.”

May combine two claims.

Service users' definitions of recovery tended to prioritize social aspects, particularly being accepted and connecting with others, while caregivers focused instead on clinical definitions of recovery such as symptom remission; social and political aspects were more common among user samples and clinical recovery goals more prevalent among carer samples.

“Service users' definitions of recovery tended to prioritize social aspects, particularly being accepted and connecting with others, while caregivers focused instead on clinical definitions of recovery such as symptom remission.”

• Also stated in: § Key Messages · plain

  “Users' knowledge, experience, and narratives of recovery tended to prioritize social aspects, whereas caregivers focused on clinical understandings of recovery.”

• Also stated in: § Recovery Themes · plain

  “At the same time, social and political aspects of recovery were more common among user samples, while clinical recovery goals were more prevalent among carer samples.”

May combine two claims.

Sixty (97%) studies included a user sample, and nine (15%) included a caregiver sample.

“Sixty (97%) studies included a user sample, and nine (15%) included a caregiver sample.”

May combine two claims.

Both service users and caregivers emphasized individual aspects such as becoming self-sufficient and achieving personal goals, which was strongly linked with having economic means for independence.

“Both groups emphasized individual aspects such as becoming self-sufficient and achieving personal goals, which was strongly linked with having economic means for independence.”

May combine two claims.

All themes were present to a greater or lesser extent in users' definitions of recovery; some themes were also part of caregivers' understanding.

“All themes were present to a greater or lesser extent in users' definitions of recovery; the cases where themes were also part of caregivers' understanding of recovery are highlighted where applicable.”

May combine two claims.

Two interrelated types of social recovery were identified: externally derived social recovery requiring approval and acceptance from the group, and social recovery derived from personal initiative consisting of socializing, establishing meaningful relationships, being a productive member of the community, and fulfilling family roles.

“Two interrelated types of social recovery were identified. One was an externally derived social recovery which required approval and acceptance from the group.”

• Also stated in: § Theme 2: Social Recovery · plain

  “The other type of social recovery was derived from personal initiative and consisted of: socializing and establishing meaningful relationships, being a productive member of the community, and fulfilling family roles.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Study settings were primarily English-speaking (n = 51, 82%) and high-income countries (n = 58, 94%).

“Study settings were primarily English-speaking (n = 51, 82%), high-income countries (n = 58, 94%).”

May combine two claims.

Only a small number of studies took place in low-income countries, focused on minoritized populations, or included caregivers' perspectives.

“At the same time, only a small number of studies took place in low-income countries, focused on minoritized populations, or included caregivers' perspectives.”

Probably not a substantial claim: may not pass S3 (load-bearing).

People with mental health problems which affect social interaction, such as people with a diagnosis of personality or bipolar disorder, were thought to face a greater challenge to achieve social recovery.

“People with mental health problems which affect social interaction, such as people with a diagnosis of personality or bipolar disorder, were thought to face a greater challenge to achieve social recovery.”

• cites [57] Katsakou, 2012, Recovery in borderline personality disorder (BPD): a qualitative study of service users' perspectives, PLoS ONE. sourceNot checked yet

  Not checked in the free run.

• cites [53] Kverme, 2019, Moving toward connectedness – a qualitative study of recovery processes for people with borderline personality disorder, Front Psychol. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

An important recovery goal was gaining new knowledge. This included knowledge about yourself (personal growth), knowledge about mental health, and knowledge gained through formal education.

“An important recovery goal was gaining new knowledge. This included knowledge about yourself (personal growth), knowledge about mental health, and knowledge gained through formal education.”

May combine two claims.

Being self-sufficient and having control over one's mental health problems and their consequences were highly prevalent recovery goals.

“Being self-sufficient and having control over one's mental health problems and their consequences were highly prevalent recovery goals.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Recovery within this theme is described as an internal fight, coming to the realization that "It needs to be me" (48).

“Recovery within this theme is described as an internal fight, coming to the realization that “It needs to be me” (48).”

• cites [48] Hancock, 2018, Understanding the ups and downs of living well: the voices of people experiencing early mental health recovery, BMC Psychiatry. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

In both cases the final aim was to develop strategies to feel better, building higher self-esteem, and self-awareness.

“In both cases the final aim was to develop strategies to feel better, building higher self-esteem, and self-awareness.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Individual recovery encompassed six subthemes: "Normalcy"; "Temporal understandings of recovery and identity"; "Recovery and knowledge"; "Recovery as an individual responsibility," "Appearance and hygiene," and "Recovery as a positive frame of mind."

“This theme of individual recovery encompassed six subthemes: “Normalcy”; “Temporal understandings of recovery and identity”; “Recovery and knowledge”; “Recovery as an individual responsibility,” “Appearance and hygiene,” and “Recovery as a positive frame of mind.””

Probably not a substantial claim: may not pass S3 (load-bearing).

A line of the recovery literature focused on understanding recovery through ordinary everyday activities.

“A line of the recovery literature focused on understanding recovery through ordinary everyday activities.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The idea of returning to a former identity was a prominent topic throughout the literature, however, it was particularly highlighted in the definition of recovery of older adults presented by (66) "The single core category identified from the analysis was 'Continuing to be me.' This related to the permanent and established sense of identity which service user participants held [...]."

“The idea of returning to a former identity was a prominent topic throughout the literature, however, it was particularly highlighted in the definition of recovery of older adults presented by (66) “The single core category identified from the analysis was ‘Continuing to be me.’ This related to the permanent and established sense of identity which service user participants held […].””

• cites [66] Daley, 2013, Development of a framework for recovery in older people with mental disorder, Int J Geriatr Psychiatry. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

There were two contrasting views regarding the temporal focus of the recovery journey: one described recovery as the ability to focus on future goals, having hope and seeing "the light at the end of the tunnel," while the other described it as the ability to live in the present and complete daily routines.

“There were two contrasting views regarding the temporal focus of the recovery journey: one described recovery as the ability to focus on future goals, having hope and seeing “the light at the end of the tunnel” (61), while the other described it as the ability to live in the present and complete daily routines (related to the “Normalcy” subtheme).”

• cites [61] Vander Kooij, 2009, Recovery themes in songs written by adults living with serious mental illnesses/thèmes de rétablissement dans des chansons écrites par des adultes ayant une maladie mentale sévère, Can J Music Ther.Not checked yet

  Not checked in the free run.

May combine two claims.

This contrasting view of recovery was also present in different identity goals, with some service users striving to develop a "new self" by learning from their experience, and others wanting to return to the roles and occupation or everyday activities from before experiencing mental health problems.

“This contrasting view of recovery was also present in different identity goals, with some service users striving to develop a “new self” by learning from their experience (62, 63), and others wanting to return to the roles and occupation or everyday activities from before experiencing mental health problems (58, 64).”

• cites [62] Leavey, 2005, Youth experiences of living with mental health problems: emergence, loss, adaptation and recovery (ELAR), Can J Commun Mental Health. sourceNot checked yet

  Not checked in the free run.

• cites [63] Ridge, 2006, “The old me could never have done that”: how people give meaning to recovery following depression, Qual. Health Res. sourceNot checked yet

  Not checked in the free run.

• cites [58] Tweedell, 2004, Families' experience during recovery or nonrecovery from psychosis, Arch Psychiatr Nurs. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The third parent theme focused on individual goals, needs, and responsibilities.

“The third parent theme focused on individual goals, needs, and responsibilities.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Recovery was described as general feelings and attitudes that were considered positive or the opposite of being unwell, dissatisfied, or unsuccessful.

“Recovery was described as general feelings and attitudes that were considered positive or the opposite of being unwell, dissatisfied, or unsuccessful.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

This was described as feeling at ease, enjoying leisure moments or not experiencing constant anxiety and fear.

“This was described as feeling at ease, enjoying leisure moments or not experiencing constant anxiety and fear.”

May combine two claims.

Data from sixty-two studies originating mainly from high-income countries were synthesized and analyzed resulting in the SPICE model of recovery.

“Data from sixty-two studies originating mainly from high-income countries were synthesized and analyzed resulting in the SPICE model of recovery.”

May combine two claims.

With regard to diagnosis, there were two opposing views: recovery as embracing the label and recovery as dropping the label.

“With regard to diagnosis, there were two opposing views: recovery as embracing the label and recovery as dropping the label.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Examples when clinical recovery experience was present in the literature were references to recovery goals such as "chemical balance" (63), "adherence to treatment" (79), or "reducing clinical symptoms" (47, 51, 67, 80).

“Examples when this was present in the literature were references to recovery goals such as “chemical balance” (63), “adherence to treatment” (79), or “reducing clinical symptoms” (47, 51, 67, 80).”

• cites [63] Ridge, 2006, “The old me could never have done that”: how people give meaning to recovery following depression, Qual. Health Res. sourceNot checked yet

  Not checked in the free run.

• cites [79] Mizuno, 2015, Experiences of community-dwelling persons recovering from severe mental illness, Arch Psychiatr Nurs. sourceNot checked yet

  Not checked in the free run.

• cites [47] Cárcamo, 2019, Mental health care for persons with a severe psychiatric diagnosis and their recovery, Psicoperspectivas Individuo y Sociedad. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

A person with mental health problems reaching independence was a particularly important recovery goal for caregivers, this included financial autonomy and independent living that reduced the reliance on caregiver/family support and reaching emotional stability.

“A person with mental health problems reaching independence was a particularly important recovery goal for caregivers, this included financial autonomy and independent living that reduced the reliance on caregiver/family support (as mentioned in the subtheme “Economic recovery”) and reaching emotional stability.”

• cites [58] Tweedell, 2004, Families' experience during recovery or nonrecovery from psychosis, Arch Psychiatr Nurs. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Accounts of recovery found in the literature that fall within this category include "being positive" (78), "being happy and successful" (67, 77), "finding hope and purpose" (48), or "having a meaningful and satisfying life" (69), without a deeper description about what this meant.

“Accounts of recovery found in the literature that fall within this category include “being positive” (78), “being happy and successful” (67, 77), “finding hope and purpose” (48), or “having a meaningful and satisfying life” (69), without a deeper description about what this meant.”

• cites [78] Gillard, 2015, Understanding recovery in the context of lived experience of personality disorders: a collaborative, qualitative research study, BMC Psychiatry. sourceNot checked yet

  Not checked in the free run.

• cites [67] Simonds, 2014, Adolescents with anxiety and depression: is social recovery relevant?, Clin Psychol Psychother. sourceNot checked yet

  Not checked in the free run.

• cites [77] Kartalova-O'Doherty, 2010, Recovering from recurrent mental health problems: giving up and fighting to get better, Int J Mental Health Nurs. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

This conceptualization of recovery as an individual responsibility was strongly linked to empowerment, which in turn was linked to having economic means for independence.

“This conceptualization of recovery as an individual responsibility was strongly linked to empowerment, which in turn was linked to having economic means for independence (43, 73, 74).”

• cites [43] Basso, 2016, Recovery in Italy: an update, Int J Mental Health. sourceNot checked yet

  Not checked in the free run.

• cites [73] Brijnath, 2015, Applying the CHIME recovery framework in two culturally diverse Australian communities: qualitative results, Int J Soc Psychiatry. sourceNot checked yet

  Not checked in the free run.

• cites [74] Santos, 2018, Recovery from schizophrenia: the case of Mexican-origin consumers and family caregivers, J Nervous Mental Dis. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

This view was especially prevalent in literature from the user/survivor or feminist movements, and it was linked to poor practices of mental health services.

“This view was especially prevalent in literature from the user/survivor or feminist movements, and it was linked to poor practices of mental health services.”

May combine two claims.

Some studies described improving appearance and keeping up good hygiene as part of personal recovery; the focus of this goal was adding to a personal sense of worth, rather than complying with social rules.

“Some studies described improving appearance and keeping up good hygiene as part of personal recovery; the focus of this goal was adding to a personal sense of worth, rather than complying with social rules.”

May combine two claims.

Clinical understandings of recovery were particularly common among carers (it was the predominant theme in five out of the nine papers that presented caregivers views) and it was normally presented as part of the guidance they received from their psychiatrist.

“Clinical understandings of recovery were particularly common among carers (it was the predominant theme in five out of the nine papers that presented caregivers views) and it was normally presented as part of the guidance they received from their psychiatrist.”

Classified as probably not a substantial claim.

Another aspect of dominant definitions of recovery that is contested in our findings of the clear distinction between clinical and personal recovery.

“Another aspect of dominant definitions of recovery that is contested in our findings of the clear distinction between clinical and personal recovery.”

May combine two claims.

However, along with providing further evidence in support of previously defined models and definitions of recovery, this review identified additional dimensions, namely social (externally derived), political and economic aspects of recovery, and factors related to social reciprocity and acceptance.

“However, along with providing further evidence in support of previously defined models and definitions of recovery, this review identified additional dimensions, namely social (externally derived), political and economic aspects of recovery, and factors related to social reciprocity and acceptance.”

May combine two claims.

Within these themes, users' understanding of recovery revolved especially around connecting with others, and recovery as an individual responsibility to reach control over mental health problems.

“Within these themes, users' understanding of recovery revolved especially around connecting with others, and recovery as an individual responsibility to reach control over mental health problems.”

May combine two claims.

In the case of informal carers, the most common themes when defining user recovery were Recovery as an Individual Responsibility, particularly reaching autonomy/being self-sufficient, and Clinical Recovery Experience, mainly symptom remission.

“In the case of informal carers, the most common themes when defining user recovery were Recovery as an Individual Responsibility, particularly reaching autonomy/being self-sufficient, and Clinical Recovery Experience, mainly symptom remission (see Table 3).”

May combine two claims.

With respect to practice, worrying levels of stigma and discrimination in psychiatric practice were identified in users' testimonies and reflected in caregivers' notion of recovery.

“With respect to practice, worrying levels of stigma and discrimination in psychiatric practice were identified in users' testimonies and reflected in caregivers' notion of recovery.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A protocol was developed a priori and registered on PROSPERO (CRD42017076450).

“A protocol was developed a priori and registered on PROSPERO (CRD42017076450).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

To establish consistency in study selection, 300 randomly selected records at title and abstract screening and 50 records at full text screening were independently reviewed by the author and a second screener, with discrepancies resolved via discussion.

“To establish consistency in the study selection, 300 randomly selected records at the title and abstract screening stage, and 50 records at the full text screening stage were independently reviewed by the author and a second screener, and discrepancies were resolved via discussion.”

Probably not a substantial claim: may not pass S2 (checkable).

These are important gaps in the literature that require further attention.

“These are important gaps in the literature that require further attention.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Seven criteria for quality appraisal were adopted from different published tools to appraise transparency, description of key terms, and coherence.

“Given the plurality of methodologies used in the identified studies, seven criteria for quality appraisal were adopted from different published tools (29–31)1 with the aim of appraising transparency, description of key terms, and coherence.”

• cites [29] Hong, 2018Not checked yet

  Not checked in the free run.

• cites [30] Bromley, 2002, LSTM, Criter Eval Qual StudNot checked yet

  Not checked in the free run.

• cites [31] Dixon-Woods, 2004, The problem of appraising qualitative research, Qual. Safety Health Care. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The concept of clinical recovery derives from research led by mental health professionals and involves diagnosis and measures of symptoms and psychosocial functioning designed and rated by professionals.

“The concept of clinical recovery derives from research led by mental health professionals: it involves diagnosis, and measures of symptoms and psychosocial functioning designed and rated by professionals (5, 6).”

• cites [5] SladeM Cambridge University PressPersonal Recovery and Mental Illness: A Guide for Mental Health Professionals - Mike Slade - Google Books2009 sourceNot checked yet

  Not checked in the free run.

• cites [6] Piat, 2012, Service providers' experiences and perspectives on recovery-oriented mental health system reform, Psychiatr Rehabil J. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim. May combine two claims.

Critics of the clinical recovery model have highlighted limitations regarding lack of sensitivity to variability across individuals and contexts, and not including outcomes meaningful to service users.

“However, critics of the clinical recovery model have highlighted limitations regarding the lack of sensitivity to variability across individuals and contexts, and not including outcomes that are meaningful to service users (7).”

• cites [7] Crawford, 2011, Selecting outcome measures in mental health: the views of service users, J Mental Health. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The review followed the PRISMA statement.

“This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (26).”

• cites [26] Moher, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, Ann Int Med. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Predominant definitions of recovery currently reflect understandings of mental health which focus on an individual perspective, while this review found an important emphasis on socio-political aspects.

“Predominant definitions of recovery currently reflect understandings of mental health which focus on an individual perspective, while this review found an important emphasis on socio-political aspects.”

May combine two claims.

Since the 1990s, the focus in the field of recovery has shifted to personal recovery, derived from literature led by mental health service users/survivors, focusing on attitudes toward life, personal growth and abilities, contribution to the community, and life satisfaction.

“Since the 1990's, the focus in the field of recovery has shifted to an approach derived from literature led by mental health service users/survivors. This has been referred to as personal recovery, it stems from and focuses on attitudes toward life, personal growth and abilities, contribution to the community, and life satisfaction (8, 9).”

• cites [8] Leamy, 2011, Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis, Br J Psychiatry. sourceNot checked yet

  Not checked in the free run.

• cites [9] Anthony, 1993, Recovery from mental illness: the guiding vision of the mental health service system in the 1990s, Psychos Rehabil J. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

All studies met 50% or more of the quality criteria assessed, and 31 studies (50%) fulfilled all 7 criteria.

“All studies met 50% or more of the quality criteria assessed, and 31 studies (50%) fulfilled all 7 criteria.”

Probably not a substantial claim: may not pass S3 (load-bearing).

There has been criticism about personal recovery being defined in individualistic terms that neglect collectivist values more present in some cultural groups.

“There has, however, been criticism about personal recovery being defined in individualistic terms (16) that neglect collectivist values that are more present in some cultural groups (17–20).”

• cites [16] Price-Robertson, 2017, Relational recovery: beyond individualism in the recovery approach, Adv Mental Health. sourceNot checked yet

  Not checked in the free run.

• cites [17] Slade, 2014, Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems, World Psychiatry. sourceNot checked yet

  Not checked in the free run.

• cites [18] Rose, 2014, The mainstreaming of recovery, J Mental Health. sourceNot checked yet

  Not checked in the free run.

• cites [19] Tanaka-Matsumi, 1976, Cross-cultural variations in the phenomenological experience of depression, J Cross Cult Psychol. sourceNot checked yet

  Not checked in the free run.

• cites [20] Chiba, 2010, Reliability and validity of the Japanese version of the Recovery Assessment Scale (RAS) for people with chronic mental illness: scale development, Int J Nurs Stud. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim. May combine two claims.

The personal recovery approach aims to have users' perspective at the heart of service development and research, and is considered distinct from clinical recovery that focuses on achieving clinically-defined goals.

“This approach aims to have users' perspective at the heart of service development and research, and it is considered distinct from “clinical recovery” that focuses on achieving clinically-defined goals (10–13).”

• cites [10] Farkas, 2007, The vision of recovery today: what it is and what it means for services, World Psychiatry.Not checked yet

  Not checked in the free run.

• cites [11] Slade, 2009 sourceNot checked yet

  Not checked in the free run.

• cites [12] Piat, 2009, What does recovery mean for me? Perspectives of Canadian mental health consumers, Psychiatr Rehabil J. sourceNot checked yet

  Not checked in the free run.

• cites [13] van Os, 2006, Standardized remission criteria in schizophrenia, Acta Psychiatrica Scandinavica. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Recovery is now a focus world-wide and the intention to develop recovery-oriented services is typically present in official mental health service strategies.

“Recovery is now a focus world-wide and the intention to develop recovery-oriented services is typically present in official mental health service strategies (25).”

• cites [25] Patel, 2018, The Lancet Commission on global mental health and sustainable development, Lancet. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The latter was highlighted as particularly important in (67) study about adolescent service users.

“The latter was highlighted as particularly important in (67) study about adolescent service users.”

• cites [67] Simonds, 2014, Adolescents with anxiety and depression: is social recovery relevant?, Clin Psychol Psychother. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Self-discovery was also a significant part of recovery for young people in (68) study, pointing to the limited life experience before mental health problems creating an additional vulnerability.

“Self-discovery was also a significant part of recovery for young people in (68) study, pointing to the limited life experience before mental health problems creating an additional vulnerability.”

• cites [68] McCauley, 2017, Service user engagement: a co-created interview schedule exploring mental health recovery in young adults, J Adv Nurs. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

This distinction was discussed by (65), who found participants wishing to reflect on and integrate the disorder experience into a new identity, while others wished to leave the experience behind and focus on symptom management.

“This distinction was discussed by (65), who found participants wishing to reflect on and integrate the disorder experience into a new identity, while others wished to leave the experience behind and focus on symptom management.”

• cites [65] de Jager, 2016, Investigating the lived experience of recovery in people who hear voices, Qual Health Res. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Milbourn et al. noted that in order to appreciate participants' understandings of recovery, the list of everyday routines needs to be broadened to include personally meaningful activities which may be considered negative by others, such as "recreational drugs and paying for sex."

“Milbourn et al. (46) noted that in order to appreciate participants' understandings of recovery, the list of everyday routines needs to be broadened to include personally meaningful activities which may be considered negative by others, such as “recreational drugs and paying for sex.””

• cites [46] Milbourn, 2014, Do the everyday experiences of people with severe mental illness who are “hard to engage” reflect a journey of personal recovery?, J Mental Health. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

As stated in (71), participants did not consider mental health services to promote self-management and this was seen as going against their recovery.

“As stated in (71), participants did not consider mental health services to promote self-management and this was seen as going against their recovery.”

• cites [71] Todd, 2012, “Recovery” in bipolar disorder: how can service users be supported through a self-management intervention? A qualitative focus group study, J Mental Health. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

McCabe et al. pointed out in forensic mental health services "everyday activities such as walking and discussing books were talked about in the language of therapies administered by services. The 'reader group' and the 'walking group' were all discussed in terms of therapeutic interventions rather than fulfilling hobbies that people adopt in everyday life."

“McCabe et al. (60) pointed out in forensic mental health services “everyday activities such as walking and discussing books were talked about in the language of therapies administered by services. The ‘reader group’ and the ‘walking group’ were all discussed in terms of therapeutic interventions rather than fulfilling hobbies that people adopt in everyday life.””

• cites [60] McCabe, 2018, Contested understandings of recovery in mental health, J Mental Health. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Less widely cited recovery paradigms propose social and political factors to be taken into account, and add pursuing civil rights to the aims of recovery.

“Less widely cited recovery paradigms propose social and political factors to be taken into account, and add pursuing civil rights to the aims of recovery (23, 24).”

• cites [23] Hopper, 2007, Rethinking social recovery in schizophrenia: what a capabilities approach might offer, Soc Sci Med. sourceNot checked yet

  Not checked in the free run.

• cites [24] Pelletier, 2015, Citizenship and recovery: two intertwined concepts for civic-recovery, BMC Psychiatry. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim. May combine two claims.

Participants in both groups were described as currently not having symptoms, good quality of life and no psychological distress.

“Participants in both groups were described as currently not having symptoms, good quality of life and no psychological distress, for this reason the authors advocated for the latter approach to recovery to not be pathologized.”

• cites [65] de Jager, 2016, Investigating the lived experience of recovery in people who hear voices, Qual Health Res. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Ridge and Ziebland (63) used the term "coming out of the closet," since accepting the given diagnosis was understood as way to achieve authentic living without trying to pass as "normal."

“Ridge and Ziebland (63) used the term “coming out of the closet,” since accepting the given diagnosis was understood as way to achieve authentic living without trying to pass as “normal.””

• cites [63] Ridge, 2006, “The old me could never have done that”: how people give meaning to recovery following depression, Qual. Health Res. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Participants wished to assert their position as experts by experience and those who did not engage with services were seen as "winners".

“Participants wished to assert their position as experts by experience and those who did not engage with services were seen as “winners”: “taking responsibility is at the heart of the recovery process as people are empowered to make their own choices and focus on their own outcomes.””

• cites [71] Todd, 2012, “Recovery” in bipolar disorder: how can service users be supported through a self-management intervention? A qualitative focus group study, J Mental Health. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

A representative description of this understanding of recovery can be found in Kartalova-O'Doherty and Tedstone Doherty (77) "Personal definitions of recovery fell into two broad areas: getting rid of negative feelings, such as anxiety, depression, or panic attacks; and acquiring positive feelings and actions, such as peace of mind [...]."

“A representative description of this understanding of recovery can be found in Kartalova-O'Doherty and Tedstone Doherty (77) “Personal definitions of recovery fell into two broad areas: getting rid of negative feelings, such as anxiety, depression, or panic attacks; and acquiring positive feelings and actions, such as peace of mind […].””

• cites [77] Kartalova-O'Doherty, 2010, Recovering from recurrent mental health problems: giving up and fighting to get better, Int J Mental Health Nurs. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Davis (76) who conducted an ethnography in a women's psychiatric ward noted "Wearing their own clothing again adds to their appearance of well-being. [...] this makes it all the more difficult for them to see themselves as" "sick persons."

“Davis (76) who conducted an ethnography in a women's psychiatric ward noted “Wearing their own clothing again adds to their appearance of well-being. […] this makes it all the more difficult for them to see themselves as” “sick persons.””

• cites [76] Davis, 1967, Patient perceptions of self-recovery and staff expectations, Comprehens Psychiatry. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Adame and Knudson (81) "Another traditional construction from the survivors' narratives was "recovery from the mental health system" [...] all four participants felt that recovering from psychiatric interventions (e.g., ECT, drugs, solitary confinement) was one of, if not the biggest, challenge in their entire healing process".

“Examples can be found in Adame and Knudson (81) “Another traditional construction from the survivors' narratives was “recovery from the mental health system” […] all four participants felt that recovering from psychiatric interventions (e.g., ECT, drugs, solitary confinement) was one of, if not the biggest, challenge in their entire healing process””

• cites [81] Adame, 2007, Beyond the counter-narrative, Narrat Inquiry. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Some studies found both views represented in their sample, such as (49) who studied recovery in people diagnosed with personality disorder and concluded that most found it useful and "For a minority of participants however the diagnosis of personality disorder was seen as unhelpful - representing a direct comment on them as a person, or as a representation of their previous behaviour, not a 'ment'

“At the same time, some studies found both views represented in their sample, such as (49) who studied recovery in people diagnosed with personality disorder and concluded that most found it useful and “For a minority of participants however the diagnosis of personality disorder was seen as unhelpful - representing a direct comment on them as a person, or as a representation of their previous”

• cites [49] Shepherd, 2017, Seeking to understand lived experiences of personal recovery in personality disorder in community and forensic settings – a qualitative methods investigation, BMC Psychiatry. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Brijnath (73) challenged traditional personal recovery literature writing: "Participants' emphasis on being 'cured', achieving an endpoint in their depression and discontinuing medicines runs counter to the recovery discourse that emphasises that one can be ill and still live a meaningful, contributory life."

“Brijnath (73) challenged traditional personal recovery literature writing: “Participants' emphasis on being ‘cured’, achieving an endpoint in their depression and discontinuing medicines runs counter to the recovery discourse that emphasises that one can be ill and still live a meaningful, contributory life.””

• cites [73] Brijnath, 2015, Applying the CHIME recovery framework in two culturally diverse Australian communities: qualitative results, Int J Soc Psychiatry. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

In (40), participants believed health professionals, traditional healers and religious leaders had used labeling as a form of coercion to support their own ideas of recovery.

“and in (40), where participants believed health professionals, traditional healers and religious leaders had used labeling as a form of coercion to support their own ideas of recovery.”

• cites [40] Nxumalo Ngubane, 2019, The experiences and meanings of recovery for Swazi women living with “schizophrenia.”, J Psychiatric Mental Health Nurs sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

A participant in the study by Santos et al. (74) expressed "[I want to] maintain...good hygiene..., fitness, exercise, nutrition...."

“A participant in the study by Santos et al. (74) expressed “[I want to] maintain…good hygiene…, fitness, exercise, nutrition….””

• cites [74] Santos, 2018, Recovery from schizophrenia: the case of Mexican-origin consumers and family caregivers, J Nervous Mental Dis. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A distinctive understanding of recovery was presented by (75) who studied the views of forensic psychiatric patients (offenders with mental health problems). For the most part participants chose to rely on medication and medical guidance, rather than their own judgment and active participation.

“A distinctive understanding of recovery was presented by (75) who studied the views of forensic psychiatric patients (offenders with mental health problems). For the most part participants chose to rely on medication and medical guidance, rather than their own judgment and active participation: “Their lack of control was in most cases, simply stated as an incontrovertible fact.””

• cites [75] Mezey, 2010, Perceptions, experiences and meanings of recovery in forensic psychiatric patients, J Forensic Psychiatr Psychol. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim. May combine two claims.

(82) wrote "Even though carers are the closest people that many consumers have in their life, carers had major divergence in their views on mental health recovery. Contrasting to consumers and nurses, none of the carers described regaining one's sense of self as an important aspect to mental health recovery. The carers' views on mental health recovery closely related to the traditional views of

“(82) wrote “Even though carers are the closest people that many consumers have in their life, carers had major divergence in their views on mental health recovery. Contrasting to consumers and nurses, none of the carers described regaining one's sense of self as an important aspect to mental health recovery. The carers' views on mental health recovery closely related to the traditional views of”

• cites [82] Jacob, 2015, Mental health recovery: lived experience of consumers, carers and nurses, Contempor Nurse. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Piat et al. (12) remarked that "The prominence of the illness perspective of recovery among consumers was unexpected. Many looked for recovery outside of themselves: in a cure, or in dreams of disappearing symptoms."

“Piat et al. (12) remarked that “The prominence of the illness perspective of recovery among consumers was unexpected. Many looked for recovery outside of themselves: in a cure, or in dreams of disappearing symptoms.””

• cites [12] Piat, 2009, What does recovery mean for me? Perspectives of Canadian mental health consumers, Psychiatr Rehabil J. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Brijnath (73) found that Indian participants found meaning in life through religion, while "For Anglo participants, meaning in life was derived from the illness experience itself. Participants talked about the importance of a diagnostic label in validating how they felt, discovering their inner strength and learning to live with depression."

“Brijnath (73) found that Indian participants found meaning in life through religion, while “For Anglo participants, meaning in life was derived from the illness experience itself. Participants talked about the importance of a diagnostic label in validating how they felt, discovering their inner strength and learning to live with depression.””

• cites [73] Brijnath, 2015, Applying the CHIME recovery framework in two culturally diverse Australian communities: qualitative results, Int J Soc Psychiatry. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Findings from the study by (58): "They longed for their relative to be able to take care of themselves, live independently, or have improved judgment and concentration, or to work and become functional and self-sufficient."

“An example of this are the findings from the study by (58): “They longed for their relative to be able to take care of themselves, live independently, or have improved judgment and concentration, or to work and become functional and self-sufficient.””

• cites [58] Tweedell, 2004, Families' experience during recovery or nonrecovery from psychosis, Arch Psychiatr Nurs. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The same study reported that this understanding of recovery led caregivers to think recovery was impossible as they understood these goals (e.g., symptom remission, retuning to pre-illness status) as unattainable.

“Also, the same study reported that of importance was that this understanding of recovery led caregivers to think recovery was impossible as they understood these goals (e.g., symptom remission, retuning to pre-illness status) as unattainable: “‘I don't understand what you mean by recovery from mental illness, there isn't one… we went to the psychiatrist the other day and she said [that] the”

• cites [82] Jacob, 2015, Mental health recovery: lived experience of consumers, carers and nurses, Contempor Nurse. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

It has been the focus of recent calls for a paradigm change in the field of global mental health, particularly in the context of the COVID-19 pandemic.

“It has been the focus of recent calls for a paradigm change in the field of global mental health (106–108), particularly in the context of the COVID-19 pandemic (109).”

• cites [106] Mezzina, 2019, The practice of freedom: human rights and the Global Mental Health Agenda sourceNot checked yet

  Not checked in the free run.

• cites [107] Cosgrove, 2020, The cultural politics of mental illness: toward a rights-based approach to global mental health, Commun Mental Health J. sourceNot checked yet

  Not checked in the free run.

• cites [108] Cosgrove, 2020, A critical review of the Lancet Commission on global mental health and sustainable development: time for a paradigm change, Critic Public Health. sourceNot checked yet

  Not checked in the free run.

• cites [109] Kola, 2021, COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health, Lancet Psychiatry sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

These definitions of recovery are present in the themes "Individual recovery" and "Social recovery" (derived from personal initiative) proposed in this review, which focuses on personal growth, autonomy, and individual initiatives.

“These definitions of recovery are present in the themes “Individual recovery” and “Social recovery” (derived from personal initiative) proposed in this review, which focuses on personal growth, autonomy, and individual initiatives.”

Probably not a substantial claim: may not pass S3 (load-bearing).

This would affect decisions such as that made by (110) of removing items related to symptom management and medication from a personal recovery measure.

“This would affect decisions such as that made by (110) of removing items related to symptom management and medication from a personal recovery measure.”

• cites [110] Mak, 2016, Validation of the Recovery Assessment Scale for Chinese in recovery of mental illness in Hong Kong, Qual Life Res. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Petros et al. (88) suggested an adaptation of the REFOCUS-CHIME model of recovery (paradigm 2 in Table 2) to underline the bi-directional nature of recovery.

“Petros et al. (88) suggested an adaptation of the REFOCUS-CHIME model of recovery (paradigm 2 in Table 2) to underline the bi-directional nature of recovery.”

• cites [88] Petros, 2016, Autovideography: the lived experience of recovery for adults with serious mental illness, Psychiatric Q. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

They wrote "perceived reciprocity within [...] relationships is correlated with higher levels of satisfaction in support and higher levels of personal confidence, self-esteem, and perceived recovery."

“To this respect they wrote “perceived reciprocity within […] relationships is correlated with higher levels of satisfaction in support and higher levels of personal confidence, self-esteem, and perceived recovery.””

• cites [88] Petros, 2016, Autovideography: the lived experience of recovery for adults with serious mental illness, Psychiatric Q. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Tekin (112) pointed to risks of diagnosis being a "double-edged sword" that on one hand may facilitate self-understanding and communication, while on the other hand may lead users to make sense of situations focusing only on unrealistic dichotomous outcomes.

“Tekin (112) pointed to risks of diagnosis being a “double-edged sword” that on one hand may facilitate self-understanding and communication, while on the other hand may lead users to make sense of situations focusing only on unrealistic dichotomous outcomes.”

• cites [112] Tekin, 2011, Self-concept through the diagnostic looking glass: narratives and mental disorder, Philosoph Psychol. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Marshall et al. (83) also found informal carers had pessimistic views about the potential for recovery and emphasized clinical aspects of recovery.

“Marshall et al. (83) also found informal carers had pessimistic views about the potential for recovery and emphasized clinical aspects of recovery.”

• cites [83] Marshall, 2013, Carers' hope, wellbeing and attitudes regarding recovery, Commun Mental Health J. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Some authors have highlighted the social role of diagnostic labels, such as Cruwys and Gunaseelan (111) who found that people diagnosed with depression tended to identify more with their diagnosis when they faced stigma, using the identification with a group as a buffer against discrimination.

“Some authors have highlighted the social role of diagnostic labels, such as Cruwys and Gunaseelan (111) who found that people diagnosed with depression tended to identify more with their diagnosis when they faced stigma, using the identification with a group as a buffer against discrimination.”

• cites [111] Cruwys, 2016, “Depression is who I am”: mental illness identity, stigma and wellbeing, J Affect Disord. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The importance of factors related to social justice which fall under the theme "Prosperity" is widely supported by research on social determinants of health.

“The importance of factors related to social justice which fall under the theme “Prosperity” is widely supported by research on social determinants of health (93–95).”

• cites [93] Verhaegh, 2011, Social justice is pivotal to mental health care, Psychiatrische Praxis. sourceNot checked yet

  Not checked in the free run.

• cites [94] Wickham, 2014, Why does relative deprivation affect mental health? The role of justice, trust and social rank in psychological wellbeing and paranoid ideation, J Public Mental Health. sourceNot checked yet

  Not checked in the free run.

• cites [95] Morrow, 2012, Towards a social justice framework of mental health recovery, Stud Soc Just. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable).

This disparity between a social and a clinical understanding of clinical language has great importance for the development of meaningful mental health evaluation tools and clinician-user communication.

“This disparity between a social and a clinical understanding of clinical language has great importance for the development of meaningful mental health evaluation tools and clinician-user communication.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Yates et al. (100) addressed this gap in recovery literature by studying in detail the social and environmental conditions in which recovery takes place, concluding recovery should be understood as an interaction of ecological processes such as the co-occurrence of personal growth and self-determination in contexts of social structures that restrict personal agency.

“Yates et al. (100) addressed this gap in recovery literature by studying in detail the social and environmental conditions in which recovery takes place, concluding recovery should be understood as an interaction of ecological processes such as the co-occurrence of personal growth and self-determination in contexts of social structures that restrict personal agency.”

• cites [100] Yates, 2012, Recovery, place and community mental health services, J Mental Health. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

An example of this is (90) including the domains "family involvement" and "social ties and integration" as part of their scale to measure personal recovery in Chinese culture.

“An example of this is (90) including the domains “family involvement” and “social ties and integration” as part of their scale to measure personal recovery in Chinese culture.”

• cites [90] Mak, 2018, Development and validation of attitudes towards recovery questionnaire across Chinese people in recovery, their family carers, and service providers in Hong Kong, Psychiatry Res. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

This is consistent with a review of user autobiographical accounts provided by (85), who concluded that recovery was "a growing sense of agency and autonomy, as well as greater participation in normative activities, such as employment, education, and community life," or the study conducted by (86) who wrote "For our participants, successful living is fundamentally connected to" "not being

“This is consistent with a review of user autobiographical accounts provided by (85), who concluded that recovery was “a growing sense of agency and autonomy, as well as greater participation in normative activities, such as employment, education, and community life,” or the study conducted by (86) who wrote “For our participants, successful living is fundamentally connected to” “not being”

• cites [85] Drake, 2014, Recovery and severe mental illness: description and analysis, Can J Psychiatry. sourceNot checked yet

  Not checked in the free run.

• cites [86] Boumans, 2017, Coping with psychotic-like experiences without receiving help from mental health care. A qualitative study, Psychosis. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

This is consistent with the findings of the systematic review conducted by (87) to synthesize typologies of user recovery narratives. The authors found that recovery narratives incorporated social, political and human rights aspects to a greater extent than illness narratives.

“This is consistent with the findings of the systematic review conducted by (87) to synthesize typologies of user recovery narratives. The authors found that recovery narratives incorporated social, political and human rights aspects to a greater extent than illness narratives.”

• cites [87] Llewellyn-Beardsley, 2019, Characteristics of mental health recovery narratives: systematic review and narrative synthesis, PLoS ONE. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

At the same time, some researchers have suggested there may be an excessive representativeness of user narratives which align with medical views due to user samples consisting for the most part of responsive persons who are in a disempowered position.

“At the same time, some researchers have suggested there may be an excessive representativeness of user narratives which align with medical views due to user samples consisting for the most part of responsive persons who are in a disempowered position (78, 113, 114).”

• cites [78] Gillard, 2015, Understanding recovery in the context of lived experience of personality disorders: a collaborative, qualitative research study, BMC Psychiatry. sourceNot checked yet

  Not checked in the free run.

• cites [113] Rector, 2009Not checked yet

  Not checked in the free run.

• cites [114] Castillo, 2013, A recovery journey for people with personality disorder, Int J Soc Psychiatry. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Despite identifying a limited amount of research from LMICs that focused on recovery, the key role of economic sufficiency, housing, and respect of basic human rights in mental health are highly present in literature relating to both LMICs and BME groups.

“Despite identifying a limited amount of research from LMICs that focused on recovery, the key role of economic sufficiency, housing, and respect of basic human rights in mental health are highly present in literature relating to both LMICs and BME groups (103–105).”

• cites [103] Câmara, 2011, Percepções de transtorno mental de usuários da Estratégia Saúde da Família, Rev Gaúcha Enferm. sourceNot checked yet

  Not checked in the free run.

• cites [104] Blignault, 2009, Community perceptions of mental health needs: a qualitative study in the Solomon Islands, Int J Mental Health Syst. sourceNot checked yet

  Not checked in the free run.

• cites [105] Sanders-Phillips, 1996, The ecology of urban violence: its relationship to health promotion behaviors in low-income Black and Latino communities, Am J Health Promotion. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

These understandings of recovery were consistent with less prominent recovery paradigms (3 and 4 in Table 2).

“These understandings of recovery were consistent with less prominent recovery paradigms (3 and 4 in Table 2).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Mixed methods allow for the inclusion of larger samples, such as Delphi studies used for questionnaire development.

“Studies benefitted from patient and public involvement; ethnographic methodologies, which allow for study of individuals who are not usually inclined to engage in research activities otherwise; the use of measures such as autovideography to allow participants to shape their own data freely; and mixed methods that allow for the inclusion of larger samples, such as Delphi studies used for”

Probably not a substantial claim: may not pass S3 (load-bearing).

The use of PRISMA guidelines and quality assessment of the studies added transparency and rigor to the research.

“The use of PRISMA guidelines and quality assessment of the studies added transparency and rigor to the research.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

“The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The comprehensive recovery model provided by this review offers a template for further research in the field and a guide for policy and practice development.

“The comprehensive recovery model provided by this review offers a template for further research in the field and a guide for policy and practice development.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

These are direct barriers to recovery and therefore there is a pressing need to consider the negative effects that narrow medicalized attitudes have on people's lives.

“These are direct barriers to recovery and therefore there is a pressing need to consider the negative effects that narrow medicalized attitudes have on people's lives.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Ethnographic methodologies allow for study of individuals who are not usually inclined to engage in research activities otherwise.

“Studies benefitted from patient and public involvement; ethnographic methodologies, which allow for study of individuals who are not usually inclined to engage in research activities otherwise; the use of measures such as autovideography to allow participants to shape their own data freely; and mixed methods that allow for the inclusion of larger samples, such as Delphi studies used for”

Probably not a substantial claim: may not pass S3 (load-bearing).

The use of measures such as autovideography allowed participants to shape their own data freely.

“Studies benefitted from patient and public involvement; ethnographic methodologies, which allow for study of individuals who are not usually inclined to engage in research activities otherwise; the use of measures such as autovideography to allow participants to shape their own data freely; and mixed methods that allow for the inclusion of larger samples, such as Delphi studies used for”

Classified as probably not a substantial claim. May combine two claims.

Service users who underlined the importance of bi-directional communication for recovery may adhere better to treatments of a dialogical nature, while users less interested in active engagement and meaning-making, such as those searching to achieve normalcy through completing everyday routines, could find more use in mindfulness-oriented techniques.

“Service users who underlined the importance of bi-directional communication for recovery may adhere better to treatments of a dialogical nature (54), while users less interested in active engagement and meaning-making, such as those searching to achieve normalcy through completing everyday routines, could find more use in mindfulness-oriented techniques (118, 119).”

• cites [54] Moltu, 2017, What are “good outcomes” in public mental health settings? A qualitative exploration of clients' and therapists' experiences, Int J Mental Health Syst. sourceNot checked yet

  Not checked in the free run.

• cites [118] Barnhofer, 2009, Mindfulness-based cognitive therapy for depression and suicidality sourceNot checked yet

  Not checked in the free run.

• cites [119] Siegel, 2010Not checked yet

  Not checked in the free run.

May combine two claims.

Service user and carer accounts reviewed in this study show experiences of severe mental health problems are multifaceted and require an ecological/holistic approach.

“Service user and carer accounts reviewed in this study show experiences of severe mental health problems are multifaceted and require an ecological/holistic approach.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The SPICE model of recovery proposed in this review provides context and depth to the construct of recovery and adds further evidence emphasizing the importance of social and clinical aspects of recovery.

“The SPICE model of recovery proposed in this review provide context and depth to the construct of recovery, and add further evidence to emphasize the importance of social and clinical aspects of recovery.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Clinical and personal recovery are intrinsically related and can complement each other; optimal provision of services can be achieved by combining the strength of professional's knowledge and epidemiological research, with stakeholder's experience and feedback about their needs.

“Clinical and personal recovery are intrinsically related and can complement each other; optimal provision of services can be achieved by combining the strength of professional's knowledge and epidemiological research, with stakeholder's experience and feedback about their needs (117).”

• cites [117] Van Eck, 2018, The relationship between clinical and personal recovery in patients with schizophrenia spectrum disorders: a systematic review and meta-analysis, Schizophr Bull. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

Predominant definitions of recovery currently reflect Western understandings of mental health which focus on an individual perspective, without adequately addressing important socio-political aspects.

“Predominant definitions of recovery currently reflect Western understandings of mental health which focus on an individual perspective, without adequately addressing important socio-political aspects.”

Probably not a substantial claim: may not pass S2 (checkable).

With sufficient attention to holistic models of recovery that represent the broad range of domains that interest users and carers, along with the promotion of their active participation, the recovery movement can continue toward fulfilling its commitment to have people with lived experience at the center of decision-making in mental health.

“With sufficient attention to holistic models of recovery that represent the broad range of domains that interest users and carers, along with the promotion of their active participation, the recovery movement can continue toward fulfilling its commitment to have people with lived experience at the center of decision-making in mental health.”

• AssumptionRests on an assumption: Evidence-based recovery research and practice relies on accurate representations of recovery goals and experiences in order to adequately address people's needs.

Classified as probably not a substantial claim.

The applicability of the review's findings outside the context of high-income, white-European populations should be done with caution.

“Therefore, applicability of these findings outside of this context should be done with caution.”