Long-term admissions in psychiatric facilities often result in a gradual erosion of the identity of people diagnosed with severe mental illnesses (SMIs) into merely “patient.” Moreover, experiences of loss often reduced people's sense of purpose. Although regaining a multidimensional identity and a sense of purpose are essential for personal recovery, few interventions specifically address this, while at the same time take people's often considerable cognitive and communicative disabilities into consideration. This study describes the development process of a new intervention through user-centered design (UCD). UCD is an iterative process in which a product (in this case, an intervention) is developed in close cooperation with future users, such that the final product matches their needs. The design process included three phases: an analysis, design, and evaluation phase. In the analysis phase, the “problem” was defined, users' needs were identified, and design criteria were established. In the design phase, the collected information served as input to create a testable prototype using a process of design and redesign, in close collaboration with service users and other stakeholders. This resulted in an intervention entitled “This is Me” (TiM) in which service users, together with a self-chosen teammate, actively engage in new experiences on which they are prompted to reflect. Finally, in the evaluation phase, TiM was implemented and evaluated in a real-life setting. In a small feasibility pilot, we found indications that some people indeed demonstrated increased reflection on their identity during the intervention. Furthermore, TiM seemed to benefit the relationship between the service users and the mental health professionals with whom they underwent the experiences. The pilot also revealed some aspects of the (implementation of) TiM that can be improved. Overall, we conclude that UCD is a useful method for the development of a new psychosocial intervention. The method additionally increased our knowledge about necessary factors in targeting personal recovery for people with complex mental health needs. Moreover, we conclude that TiM is a promising tool for supporting people with SMI in redeveloping a multidimensional identity and a renewed sense of purpose.

Background Introduction: As a human being we give meaning to our stories, in relation to the social and physical context. For people with severe and complex mental health needs, who have been dependent on (intensive) residential psychiatric support for a long time, it is possible that talents and qualities disappear because this part of their identity has been buried under a long psychiatric history. This can result in people’s identity becoming limited to ‘patient’, and the experience of life as meaningless. Objectives For these service-users, few interventions aimed at personal recovery are available that match their cognitive and communicative skills. In this project, we developed a new psychosocial intervention to stimulate self-reflection and personal recovery. Methods The development of the intervention took place through a “user-centred-design process” (UCD). UCD is an iterative design process in which the needs and wishes of the user are the starting point, and they remain central in the product design circle. Throughout the whole design process, service users, significant others, mental health professionals, peer support workers, artists, and researchers collaborate in order to design a first testable prototype. For each step of design process, we organized focus group meetings and brainstorm sessions with all stakeholders as well as individual interviews with service users. Based on the input in these meetings and interviews, the design was adapted. This was done for each consecutive step, which made the whole design process iterative by nature. Results A new psychosocial intervention entitled “This Is Me” was developed as a “journey of discovery” through the lives of service users at both verbal and non-verbal levels. From the UCD process four basic principles underlying the intervention were disentangled that have been incorporated in the intervention: 1) “gaining new experiences”, 2) “attention for (self)stigma”, 3) “equal treatment as a person”, 4) “uniqueness of the individual”. This resulted in an intervention in which service-users, together with a teammate, engage in new experiences. Moreover, they are prompted to reflect on these experiences upon their return. With this process, we aim to support people in (re)discovering roles, talents and characteristics to broaden the identity from ‘patienthood’ to ‘personhood’. Discussion Conclusions: UCD was a useful method for the development of a new psychosocial intervention targeting identity for people with complex mental health needs. The process resulted into new knowledge about factors that are important in the (re)development of identity. In addition, we will present the first results of a pilot study in which we assessed the feasibility and effectiveness of the intervention.