Recovery in Mental Health: A Synthesis of the Perspectives of Experts by Experience, Recovery-Oriented Professionals and Family Caregivers in Relation to the CHIME and SPICE Frameworks.

backgroundRecovery in mental health is a complex and contested concept shaped by stakeholder perspectives. This paper aimed to (1) analyse convergence between experts by experience and recovery-oriented professionals regarding the meaning of recovery and progress recognition and facilitators and obstacles, and to examine how the resulting statements align with the CHIME (i.e., Connectedness, Hope, Identity, Meaning in life, and Empowerment) and SPICE (i.e., Social recovery, Prosperity, Individual recovery and Clinical recovery experience) frameworks; and (2) investigate how family caregivers' supportive actions converge with these perspectives and align with both frameworks.

methodsWe conducted secondary qualitative analyses of three international e-Delphi studies. In Study 1, statements from experts by experience and recovery-oriented professionals were compared to identify convergence and unique contributions and were then examined in relation to CHIME and SPICE frameworks. In Study 2, family caregivers' supportive actions were compared with Study 1 statements concerning the meaning of recovery and progress recognition to examine convergence and were then examined in relation to both frameworks. The Standards for Reporting Qualitative Research were followed.

resultsExperts by experience and recovery-oriented professionals converged on recovery as involving rebuilding a meaningful life, agency, empowerment, self-determination, autonomy, positive identity, connection and safety. Experts by experience emphasised advocacy for rights, financial security, everyday well-being, social support and critical perspectives on diagnosis and treatment. Shared facilitators and obstacles included living environments, coercion, unmet needs, social support, discrimination, social exclusion, self- and social stigma, and holistic approaches to care. Professionals highlighted occupational opportunities, autonomy, self-awareness, peer support and community-based care, whereas experts by experience emphasised ethical practice, rights and violence-free care. Statements concerning the meaning of recovery and progress recognition were most frequently classified under Empowerment in CHIME and Individual recovery in SPICE; facilitators and obstacles were most frequently classified under Empowerment and Connectedness in CHIME and under Social recovery and Prosperity in SPICE. Most supportive actions showed convergence and aligned with both frameworks; those with no direct convergence concerned caregivers' capacities and well-being.

conclusionsDespite differences across stakeholder perspectives, the convergences identified provide a foundation for advancing recovery-oriented mental health care, future research and service development. PATIENT AND PUBLIC INVOLVEMENT STATEMENT: People with lived experience were actively involved throughout all stages of the research. A mental health service user association (ActivaMent Catalunya Associació) was involved in every phase of the three primary studies from which data for this article were drawn, as well as in the preparation of this article. Specifically, experts by experience participated in defining the research questions and outcomes, designing and managing the two studies described in this paper, and analysing and interpreting the data. The person who contributed directly to this article is included as a co-author.