The International Journal of Psychosocial Rehabilitation
 

Teaching "Personal Recovery" to Mental Health Professionals through
a Short and Structured Training Programme? A possible challenge

Laura Giusti
Donatella Ussorio
Anna Salza
Massimo Casacchia
Rita Roncone


Department of Life, Health and Environmental Sciences, University Unit "Psychosocial Rehabilitation Treatment,
Early Interventions in mental health", Hospital S. Salvatore L'Aquila, University of L'Aquila, Italy,
Email: rita.roncone@cc.univaq.it

 

Citation:
Roncone R (2020)  Teaching "Personal Recovery" to Mental Health Professionals through a Short and Structured Training Programme? A possible challenge..
International Journal of Psychosocial Rehabilitation. Vol 23 (1)



Abstract

Background: Few studies have investigated specific training for improving the attitudes of mental health professionals toward users’ personal recovery.

Aims: This study assesses the effectiveness of our short, structured Personal Recovery Training Programme (PRTP) for mental health professionals, which provides the latest updates on “personal recovery” and presents the main structural resources and operational procedures required by a mental health recovery-oriented service.

Method: Ninety-two healthcare professionals from Italian mental health services and students of the academic degree in psychiatric rehabilitation techniques completed the Recovery Knowledge Inventory (RKI) pre- and post-training. Participants were divided into two groups: the PRTP group (N=45) and a control group, the Family Psychoeducational Training Programme (FPTP; N=47) for comparison.

Results: Participants’ understanding of personal recovery and general attitude improved more significantly for those in the PRTP than for those in the FPTP group in two domains, “Roles and responsibilities” and “Non-linearity of the recovery process”; participants in the FPTP group showed a significant improvement in the “Role of self-definition and peers in recovery” domain. The two consumers involved in the PRTP have certainly contributed talking about their life and illness experiences to the understanding of the dimension of the “Non-linearity of the recovery process”, highlighting how "ups and downs" can be matched to a recovery process.

Conclusions: Our preliminary findings indicate that the PRTP supported by consumers can improve staff recovery orientation. The translation of the training into routine clinical practice remains unevaluated.

Key words: Recovery, Training, Mental health professionals, Mental illness



 


Introduction

From the perspective of the person with mental illness, recovery means gaining and retaining hope, understanding one’s abilities and disabilities, engagement in an active life, personal autonomy, social identity, meaning and purpose in life, and a positive sense of self (WHO, 2012). Importantly, recovery is defined by the person themself and no other people’s definition of what recovery means. As a key term to define the scope of mental health by the Lancet Commission, this recent definition of “personal recovery” (Patel et al., 2018) seems to make it difficult to scientifically investigate this important construct that has garnered considerable attention in the two last decades. Such premises justify the sometimes-contradictory research results on personal recovery. Several studies, which have examined personal recovery among subjective and personal resources, observed that personal recovery positively mediate the impact of symptoms and cognitive impairment on real-life functioning in subjects with schizophrenia (Galderisi et al., 2014; Galderisi et al., 2016; Rossi et al., 2018; Rossi et al., 2017). On the other side, lower cognitive and clinical insight, lower social functioning, and total independence from the illness condition and the functional status were reported as significant predictors of personal recovery (Chan, Mak, Chio, & Tong, 2018; Giusti et al., 2015; Roe, Mashiach- Eizenberg, & Lysaker, 2011). Liberman and Kopelowicz’s (Liberman and Kopelowicz, 2005) consideration of the concept of recovery being still “in search of research” sounds realistic; however, if it seems difficult to share a common conceptual “personal recovery” paradigm (Cleary and Dowling, 2009), it seems even more challenging to “teach” this vision of a recovery orientation, which require a whole-systems approach, to healthcare professionals (Le Boutillier et al., 2015; Leamy, Bird, Le Boutillier, Williams, & Slade, 2011).

Thus, can the attitude of mental health professionals towards adopting a recovery orientation model be improved?

Using a self-report measure, Crowe et al. (Crowe, Deane, Oades, Caputi, & Morland, 2006) examined the impact of a two-day, recovery-based training programme for mental health workers on the knowledge, attitudes and hopefulness related to the recovery prospects of people with enduring mental illness. The results showed a good improvement in attitudes, hopefulness and knowledge regarding principles of recovery and belief in the effectiveness of collaboration and consumer autonomy support, motivation enhancement, needs assessment, goal striving and homework use.

Some Authors (Meehan and Glover, 2009; Stratford, Brophy, & Castle, 2012) developed and trialled specific training for personal recovery and wellbeing and stressed the importance of a consumer-led recovery training programme, demonstrating significant gains in knowledge of recovery-based practice. Feenay et al. (Feeney, Jordan, & McCarron, 2013) evaluated a recovery-focused teaching programme for medical students in psychiatry, evaluating them before and after either a six-week traditional placement or recovery-focused clinical placement in psychiatry. Following the recovery-focused clinical placement, the medical students’ recovery knowledge significantly increased, and they showed more positive attitudes toward mental illness and psychiatry, greater optimism and more holistic concepts of recovery from mental illness compared with students who underwent a traditional placement. Slade et al. (Slade et al., 2014) identified 10 empirically-validated interventions which support recovery by targeting five key recovery processes: connectedness, hope, identity, meaning and empowerment (the CHIME framework) including, for example, peer support workers, advance directives, wellness recovery action planning, illness management and recovery, recovery education programmes and supported housing. Recently, a new pro-recovery manualised intervention called the REFOCUS intervention – for use in mental health services – was developed (Slade et al., 2015; Slade and Longden, 2015), which comprised two components: recovery-promoting relationships and working practices.

As in Western health settings (Hungerford, Dowling, & Doyle, 2015), mental health professionals in Italy are familiar with the term’s “recovery” and “personal recovery” which they adopted tout-court into their language. Daily, they try to translate it into their practice as a user-centred approach, framed by the principles of self-determination and collaboration, and underpinned by the notion of hope and optimism. A recent Italian investigation involving 426 mental healthcare professionals and students of psychiatric rehabilitation techniques showed a good global orientation toward recovery, reflecting a recovery- oriented biopsychosocial perspective in their attitudes (Giusti et al., 2019). The study included students of “psychiatric rehabilitation techniques”, who were undergoing a three-year academic curriculum to be skilled in properly administering psychosocial interventions. These technicians represent an innovative professional workforce in mental healthcare that has not yet been established outside Italy, and a specific mental-health academic and professional profile, created after the passage of Law 180 (Pingani et al., 2013; Roncone, Ussorio, Salza, & Casacchia, 2016), to work in a psychiatric community team. The study reported that these students and younger mental health workers seemed to show a higher cognitive openness and flexibility than the more experienced colleagues, who still had some difficulty accepting the recovery dimension of “non-linearity” and their users’ well-being “beyond” treatment adherence and psychopathological stability (Giusti, et al., 2019).

To improve the understanding of the users’ “personal recovery” paradigm, in a country such as Italy that has practiced community mental healthcare for 40 years, we developed our short and targeted Personal Recovery Training Programme (PRTP) for mental health professionals.

The aim of our study was to preliminary examine the effectiveness of the PRTP for mental health professionals (psychiatrist, psychologists, nurses and psychiatric rehabilitation technicians) and students of psychiatric rehabilitation techniques compared to the Family Psychoeducational Training Programme (FPTP), which was used as a control. We hypothesised that the exposure to a specific training programme on personal recovery would significantly improve attitudes towards recovery-oriented practices more than a broad-based training course. We were also interested in verifying whether greater improvements would be seen among the students’ and younger professionals’ attitudes regarding personal recovery than among the older mental health professionals.

Methods

Study participants and procedure

In total, 52 mental health professionals from Italian mental health services and 40 students in psychiatric rehabilitation techniques completed the Recovery Knowledge Inventory (RKI) (Bedregal, O'Connell, & Davidson, 2006) at the beginning and end of two different training programmes. Twenty-five mental health professionals and 20 students attended the structured PRTP (experimental group), lasting one day for eight hours, and 27 mental health professionals and 20 students participated in a structured training course on family integrated psychoeducational treatments lasting six days (eight hours per day).

(FPTP, as Control Group). Both courses included the voluntary participation of mental health workers from every part of our country: courses registration included the expression of interest for the training event and the sending of a short curriculum vitae. Any of the trainees in the PRTP asked to train in the FPTP intervention also. The participants’ main socio-demographic data (gender, age) and information regarding professional role, level of experience (years), work setting and previous exposure to recovery training were recorded. Informed consent was obtained from all study participants.

Personal recovery training programme, PRTP

The training, which was organised on September 7, 2015 and directed by the L’Aquila Psychiatric University Unit of the Department of Life, Health and Environmental Sciences, was conducted by leading mental health university and National Health System (NHS) experts. Two consumers were involved as teachers and tutors. Both the consumers were part of the board of the Italian section of the World Association for Psychosocial Rehabilitation and were experienced in teaching, tutoring and talking about their experiences. Table 1 describes the PRTP course, proposed during a national meeting entitled “The recovery process: A new paradigm for mental health services. Easier said than done”.

Table 1: Description of the Personal recovery training programme, PRTP.

Time

(hours)

Teaching

Method

Aim

Activities

½ hour

Lecture

To illustrate the evolution of the

concept of outcome in mental health.

- Didactic presentation

1 hour

Small groups work assisted by a tutor

To improve knowledge and practice of tools to measure the degree of adhesion of the mental health professionals to principles of personal recovery and their effective application in daily practice.

  • Self-assessment of the knowledge and attitudes about personal recovery from mental illness of participants by the RKI (Bedregal, et al., 2006)
  • Reading of “Ten top tips’ for recovery- oriented practice” (Shepherd, Boardman, & Slade, 2008)
  • Self-assessment of participants skills by the “Ten top tips’ for recovery-oriented practice”
  • Discussion

½ hour

Lecture

To share the basic concepts and

principles of the “personal recovery” process.

- Didactic presentation

½ hour

Lecture

To illustrate the influence of the mental health professionals’ work on

the users’ recovery process.

- Didactic presentation

1 hour

Small groups work assisted by a tutor

To improve knowledge and practice of tools to measure and monitor the recovery style and recovery process of users, “Recovery is best judged by the person living with the experience”

(Slade & Longden, 2015)

  • Instrument for assessing and monitoring of personal recovery from mental illness and their scoring
  • Discussion

1 hour

Users personal

reports

To experience the support and the difficulties appreciated by the users in

their recovery processes.

- Personal reports on their recovery process by the two consumers involved in the programme.

½ hour

Lecture

To illustrate the impact of personal, psychosocial and mental healthcare

variables on the user’s recovery process.

- Didactic presentation

½ hour

Lecture

To illustrate the evidence-based integrated treatments and healthy lifestyles for subjects affected by mental disorders.

To illustrate the need to support people suffering from mental disorders, especially young people with psychosis, during their recovery process, through programs aimed at improving their mental and physical health.

- Didactic presentation

1 ½ hour

Small groups work assisted by a tutor

To empower teams to translate recovery ideas into practice and to utilize the skills and resources, both those providing and those using services, to develop innovative ways of promoting recovery and recovery environments.

  • Reading of “The team recovery implementation plan: A framework for creating recovery-focused services” (Repper and Perkins, 2013)
  • Discussion and agreement on criteria suggested by the plan
  • Self-assessment of the degree of implementation of such criteria in their services

½ hour

Large group

To identify the main quality requirements and daily practices of a recovery-oriented mental health service and develop a large consensus

about the main criteria.

  • Discussion
  • Formulation of a list of five main criteria characterising recovery-focused services

½ hour

Lecture

To promote adherence to the model of recovery to determine radical changes in the organisation of mental

health services and the mental health professionals.

-Didactic presentation

Family psychoeducational training programme, FPTP

The FPTP, which included a structured 6-day training course by Falloon (I.R.H. Falloon, 1994) on family cognitive-behavioural psychoeducational treatment was organised at L’Aquila on 14-19 September 2015. The course was conducted by R.R. and the training method is described in Falloon et al. (I.R.H. Falloon et al., 1999). The approach included the following strategies: individual evaluation of each member of the family, assessment of the communication skills and problem-solving capacity of the family as a whole, personal and family objective setting, education regarding the nature of the disorder and its biomedical and psychosocial treatment, identification of early warning signs, improvement of communication skills, structured problem solving and social skills training.

Instruments

The training outcome was assessed using the Recovery Knowledge Inventory, RKI (Bedregal, et al., 2006), in its Italian version (Basso, Boggian, Carozza, Lamonaca, & Svettini, 2016). The RKI is a quick and easy to administer instrument, consistent with the conceptual paradigm of personal recovery and well-known in scientific literature. The scale comprises 20 statements measured on a five-point Likert scale and assesses four different domains of understanding for recovery in mental health: (a) “Roles and responsibilities in recovery” (7 items; range score: 7-35), regarding risk-taking, decision-making and the various and respective roles and responsibilities of people in recovery and behavioural health providers (e.g. people with mental illness should take responsibilities of everyday life); (b) “Non-linearity of the recovery process” (6 items; range score: 6-30), regarding the role of illness and symptom management and the non-linear nature of recovery (e.g. recovery is characterised by a person making gradual steps forward with major steps back); (c) “Roles of self-definition and peers in recovery” (5 items; range score: 5-25), regarding a person’s activities in defining an identity for him/herself, and a life that goes beyond that of “mental patient”, including the valuable roles that peers can play in this process (e.g. the pursuit of hobbies and leisure activities is important for recovery); and (d) “Expectations regarding recovery” (2 items; range score: 2-10), regarding expectations (e.g. everyone is capable of actively participating in the recovery process). Each item is rated on a five-point scale ranging from 1 (strongly disagree) to 5 (strongly agree). Higher scores represent greater orientation to the concept of recovery (cut-off scores are not reported in the literature). Cronbach’s alpha relating to each of the subscales is reported by the authors (Bedregal, et al., 2006) as follows: “Roles and responsibilities in recovery” (0.81), “Non linearity of the recovery process” (-0.70), “Role of self-determination and peers in recovery” (0.63) and “Expectations regarding recovery” (-0.47).

Data analysis

Chi-squared test and one-way analyses of variance (ANOVA) were conducted to examine differences among socio-demographic variables. Five 2x2 factorial ANOVAs were performed to compare the pre-test scores (subscale and total) for the RKI with the scores obtained immediately post training. These enabled us to assess the main effects for time (pre vs. post) and group (PRTP vs. Psychoeducational Training), as well as the interaction between group and time. Participants’ age was included in the model as a covariate (as a variable strictly connected to the level of experience in the mental health field). The estimated effect size (η²p) was also calculated, and a level of significance of p < .05 was adopted. Statistical analyses were performed using SPSS 16.0 (SPSS Inc., Chicago, IL, USA).

Results

Table 2 describes the main socio-demographic and professional data of the participants. Our total sample comprised university students of psychiatric rehabilitation techniques (more than 40% in both group) and young mental health professionals (only 20% older than 40 years), more than 80% women, with a relatively short-term working experience, and without statistically significant differences between the participants in the two groups. All participants reported that they had no received previous “formal training” in personal recovery principles, and those with exposure to this concept gained their knowledge through informal methods rather than structured programmes.

Table 2: Socio-demographic characteristics of the study participants divided into groups.

 

Personal Recovery Training Programme
(N=45)

Comparison Group
(N=47)

Gender, n (%)

 

 

Men

10 (22.2)

7 (15)

Women

35 (77.8)

40 (85)

 

 

 

Age, years – mean (SD)

30 (9.34)

32.1 (12.58)

 

 

 

Work setting, N (%)

 

 

Acute unit (admission wards in inpatient psychiatric facilities)

13 (28.9)

5 (10.6)

Community (community mental health teams)

12 (26.6)

22 (46.8)

University traineeship in Psychiatric Units

20 (44.4)

20 (42.6)

 

 

 

Professions, N (%)

 

 

Psychiatrists

11 (24.4)

4 (8.5)

Nurses

3 (6.7)

5 (10.6)

Psychologists

2 (4.4)

4 (8.5)

Psychiatric rehabilitation technicians

9 (20)

14 (29.8)

Students of psychiatric rehabilitation techniques

 

20 (44.4)

 

20 (42.6)

 

 

 

Years worked in mental health, n (%) (students excluded)

 

 

<15 years

22 (88)

18 (67)

>15 years

3 (12)

9 (33)

Differences in the overall KI scale scores produced a significant time x group interaction. Improvements of the personal recovery concept, as measured by the RKI total score, increased significantly more among those undertaking the PRTP than among those in the FPTP group (F(1,90), = 7.39; p < .001) (Table 3). Significant interactions were found in two domains of the RKI, with greater improvement evident for the PRTP group than for the PFTG: “Roles and Responsibilities” (F(1,90), = 10.20; p < .002); “Non-linearity of the recovery process” (F(1,90), = 12.23; p < .001).

Compared to the PRTP, the PFTG showed a better improvement in the domain of “Role of self-definition and peers in recovery” (F(1,90), = 8.56; p < .005).

No significant interaction time x group was found on RKI total score and component “Expectations regarding recovery”. No statistically significant differences were found when age was included as a covariate in the model.

Table 3: Means and standard deviations Pre-Training (T0) and Post-Training (T1) for the experimental and the comparison groups.

RECOVERY KNOWLEDGE
– DOMAINS (mean, SD)

Personal Recovery Training Programme (n=45)

 

Comparison Group (n=47)

 

F value

 

p

 

ηp2

 

F valuea

 

pa

 

ηp2a

 

T0

T1

T0

T1

 

 

 

 

 

 

Roles and

3.39 (0.46)

3.85 (0.37)

3.38(0.51)

3.41 (0.69)

Time 12.70**

0.001

0.118

Time 4.84*

0.031

0.106

responsibilities

 

 

 

 

Group 4.74*

0.032

 

Group 3.54

0.064

 

 

 

 

 

 

Interaction 10.20**

0.002

 

Interaction 8.89**

 

 

 

 

 

 

 

 

 

 

 

0.004

 

Non-linearity of the

2.41 (0.50)

2.81 (0.72)

2.25(0.43)

2.17 (0.52)

Time 4.94*

0.029

0.139

Time 0.992

0.322

0.133

recovery process

 

 

 

 

Group 14.70**

0.000

 

Group 14.96**

0.000

 

(range 6-30)

 

 

 

 

Interaction 12.23**

0.001

 

Interaction 11.48**

0.001

 

Role of self-

4.33 (0.35)

4.40 (0.50)

4.06 (0.63)

4.46 (0.51)

Time 16.78**

0.000

0.101

Time 0.006

0.937

0.086

definition

 

 

 

 

Group 1.106

0.296

 

Group 0.673

0.415

 

and peers in

 

 

 

 

Interaction 8.56**

0.005

 

Interaction 7.048*

0.010

 

recovery

 

 

 

 

 

 

 

 

 

 

(range 5-25)

 

 

 

 

 

 

 

 

 

 

Expectations

3.29 (0.76)

3.95 (0.72)

2.96 (0.92)

3.30 (0.93)

Time 20.69**

0.000

0.000

Time 0.469

0.496

0.046

regarding recovery

 

 

 

 

Group 9.30**

0.003

 

Group 7.53**

0.008

 

(range 2-10)

 

 

 

 

Interaction 2.25

0.137

 

Interaction 3.701

0.058

 

Total RKI

3.35 (0.35)

3.74 (0.34)

3.16 (0.41)

3.33 (0.37)

Time 47.015**

0.000

0.119

Time 1.491

0.226

0.115

(range 20-100)

 

 

 

 

Group 15.071**

0.000

 

Group 21.39**

0.000

 

 

 

 

 

 

Interaction 7.39**

0.008

 

Interaction 9.73**

0.003

 

*p<.05

**p<.01

ᵃcontrolling for age variable

Discussion

Knowledge and attitudes about the personal recovery paradigm, as identified and measured by the RKI total score, improved among the mental health professionals and students in both training groups. Differences in training outcomes indicated a better improvement for the PRTP group, independently of the age of the mental health professionals, and as an indirect measure of their level of working experience. Participants of the PRTP showed a greater improvement in their general attitude and in the domains “Roles and Responsibilities” and “Non-linearity of the recovery process” compared to participants of the FPTP, which showed an improvement in the “Role of self-definition and peers in recovery”. Both groups improved in the domain of “Expectations regarding recovery”. Participants of the PRTP seemed more aware of the peculiarity of this model of care, promoted by the actual scientific literature and widespread knowledge in the Italian mental health service. The two consumers involved in the PRTP have certainly contributed talking about their life and illness experiences to the understanding of the dimension of the “Non-linearity of the recovery process”, highlighting how "ups and downs" can be matched to a recovery process. We can consider that all our professionals are strongly sensitised to “the individual pattern of taking care” of our service users. Strong parallels exist between the vision of the Italian Mental Health Reform, the Law 180 and the vision of “recovery” being promoted around the world, since they share a fundamental conviction of the right of individuals with mental illnesses to “a life in the community” (Davidson, Mezzina, Rowe, & Thompson, 2010). In Italy, the widespread mental health services culture of the community of psychiatry considers social inclusion, self- determination and citizenship as fundamental basic rights and “provide the necessary foundation for, rather than follow after, recovery” (Davidson, et al., 2010). The dimension of “Non-linearity of the recovery process” the two tutors have certainly contributed talking about their experiences, highlighting how "ups and downs" are possible in the history of illness Participants of the PFTG showed a specific statistically significant improvement in the domain of “Role of self-definition and peers in recovery” compared to participants of the PRTP. Many characteristics of family psychoeducational interventions are consistent with the recovery paradigm in mental health, since they are community-based, emphasise achieving personally relevant goals, work on instilling hope and focus on improving natural supports (Glynn, Cohen, Dixon, & Niv, 2006). The FPTP stressed the important role of the users as the “main experts” in the team, expert for experience of their illness. Moreover, carer- based stress management introduced the concept of the “resource group” and its involvement in the treatments. This approach is not limited to the natural family group and can be used with all households or social support groups found in schools, group homes, mental health services or rehabilitation facilities. Close friends can often be more relevant carers than relatives (Casacchia and Roncone, 2014; I. R. H. Falloon, Held, Roncone, Coverdale, & Laidlaw, 1998), and this perspective is close to the domain of “Role of self-definition and peers in recovery” investigated by the RKI.

In both groups, the RKI domain of “Expectations regarding recovery” increased at the end of the training. These results could be explained by the optimism and renewed motivation that generally follow intense training courses. Additionally, participants of the PRTP could have developed the awareness that the recovery process follows a “subjective and unique” road for each user, out of the biopsychosocial approach that mental health professionals can provide, and expectations of recovery can become a “faith” rather than a realistic and “controlled” outcome variable.

Our PRTP differed from the course lasting four days, which was proposed in an Australian study (Meehan and Glover, 2009), because our PRTP lasted one only day (eight hours); however, the strength of our PRTP was the users’ participation as teachers and tutors in our programme.

Feeney et al. (Feeney, et al., 2013) showed that a recovery teaching programme addressed to medical students was associated with increased knowledge of recovery principles and more positive attitudes toward mental illness. Nevertheless, teaching recovery to medical students is not an easy task; Gordon et al. (Gordon, Huthwaite, Short, & Ellis, 2014) observed that the innovative service-user led tutorials on recovery that they delivered to final year medical students promoted stigmatising attitudes and an extremely pessimistic perspective of users’ outcomes. The students of psychiatric rehabilitation techniques in both groups in our study were enthusiastic about the trainings and showed the same outcome profile as mental health professionals. The choice of such a specific study curriculum positively affected their attitudes towards persons affected by mental illness, without any prejudices.

According to Crowe et al. (Crowe, et al., 2006), for mental health professionals, our short-targeted recovery training, PRTP, had positive effects on the improvement and clarification of recovery attitudes and knowledge both in general and in specific domains of understanding. This preliminary evidence indicates that staff personal recovery orientation can also improve with minimal training (Crowe, et al., 2006). Additionally, our work shows that it was useful to give an operational frame to participants to support the effort to translate theory into practice, even in services that already adopt good practices. Moreover, staff recovery orientation can improve not only with specific training, as in our PFTG, but also with a training like the PFTG, the latter embracing basic personal recovery principles, as the active involvement of users and caregivers, and all the available community resources.

Our study presents three main methodological limitations: First, the sample of our study was small; second, we do not know if the staff’s improved “recovery-orientation” will be maintained over time, or, third, if it will be translated into their clinical daily practice with significant effect. It would therefore be necessary to verify the effective implementation of the acquired skills periodically using a specific tool, such as the “Team Recovery Implementation Plan” (TRIP) (Repper and Perkins, 2013; Shepherd, Boardman, & Burns, 2010), which was developed to help create recovery-focused services.

Conclusion

Improving the understanding of the paradigm of the personal recovery is an incentive for all mental health professionals to change their attitudes in their daily clinical practice towards individuals with mental health disorders and for a recovery-oriented reorganisation of mental health services. The personal contribution of the professionals can support such modification, at least in terms of an individual relationship with the user; however, the structural modification of services could take longer. Training the mental health professionals in the principles and values of personal recovery-based practice is considered a key factor in achieving the transformation of mental health services (Bedregal, et al., 2006; Crowe, et al., 2006; Meehan and Glover, 2009). The positive experience of a recovery structured, short programme can help the dissemination of a new culture, and in a country like Italy, it could be easier than in other countries, considering the existing tradition of community care that needs to be refined in regard to this outcome measures. Nevertheless, recovery is difficult “to control” since it is “defined by the person them self and no other people’s definition of what recovery means”. And this is the main challenge.


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