We examined, over a two-year period, the impact of a user-developed and userrun recovery programme (Toward Recovery, Empowerment and Experiential Expertise-TREE) on outcomes in individuals with severe mental illness, as add-on to care as usual. A randomised wait-list controlled design of TREE added to care as usual (CAU) (n = 80), versus CAU only (n = 83), was implemented in patients with severe mental illness. Follow-up was at 12 and at 24 months after inclusion. Primary outcome measures were empowerment, mental health confidence and loneliness. Secondary outcomes were quality of life, self-reported symptoms, care needs, service use and community outcomes (likelihood institutional residence and paid employment). TREE was associated with more mental health confidence (effect size for each year in TREE: 0.058, p = 0.043), less care needs (effect size for each year in TREE:-0.088, p = 0.002), less self-reported symptoms (effect size for each year in TREE:-0.054, p = 0.040) and less likelihood of institutional residence (risk ratio with each year in TREE: 0.79, p = 0.027). User-developed and user-run recovery programmes may bring about small but reliable changes in recovery and community outcome after two years. More research is required to examine how such programmes can become more successful within the context of disability-focused mental health services.

Key clinicians in all regions perceived the guidelines as an important factor in improving the quality of schizophrenia care. QUARTS can be a helpful instrument for service monitoring and development.

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BackgroundFor the last four decades, there has been a shift in mental healthcare toward more rehabilitation and following a more humanistic and comprehensive vision on recovery for persons with severe mental illness (SMI). Consequently, many community-based mental healthcare programs and services have been developed internationally. Currently, community mental healthcare is still under development, with a focus on further inclusion of persons with enduring mental health problems. In this review, we aim to provide a comprehensive overview of existing and upcoming community mental healthcare approaches to discover the current vision on the ingredients of community mental healthcare.MethodsWe conducted a scoping review by systematically searching four databases, supplemented with the results of Research Rabbit, a hand-search in reference lists and 10 volumes of two leading journals. We included studies on adults with SMI focusing on stimulating independent living, integrated care, recovery, and social inclusion published in English between January 2011 and December 2022 in peer-reviewed journals.ResultsThe search resulted in 56 papers that met the inclusion criteria. Thematic analysis revealed ingredients in 12 areas: multidisciplinary teams; collaboration within and outside the organization; attention to several aspects of health; supporting full citizenship; attention to the recovery of daily life; collaboration with the social network; tailored support; well-trained staff; using digital technologies; housing and living environment; sustainable policies and funding; and reciprocity in relationships.ConclusionWe found 12 areas of ingredients, including some innovative topics about reciprocity and sustainable policies and funding. There is much attention to individual ingredients for good community-based mental healthcare, but very little is known about their integration and implementation in contemporary, fragmented mental healthcare services. For future studies, we recommend more empirical research on community mental healthcare, as well as further investigation(s) from the social service perspective, and solid research on general terminology about SMI and outpatient support.

A reach percentage of 74% in two years time is too ambitious and needs to be adjusted. Systematic integration of the modules into routine daily practice is feasible, but requires solid program management and continuous effort to involve clients and practitioners.