Strengthening community-based recovery-orientated mental health services: stakeholder insights on recovery from severe mental health conditions

Aim Globally, severe mental health conditions contribute significantly to the burden of disease. In South Africa, there is a considerable treatment gap in the recovery of persons with severe mental health conditions. These persons are mostly treated on an in-patient basis in specialised psychiatric hospitals with limited access to community-based recovery-orientated services. Given the international drive to transform mental health services and reduce the treatment gap, especially in low- and middle-income countries, it is pertinent to understand how recovery from severe mental health conditions is conceptualised from multiple stakeholder perspectives, including those with lived experience of the condition. This qualitative descriptive study explores how diverse stakeholders understand recovery from severe mental health conditions, identifying possibilities for intersectoral collaboration. Method Seventeen purposively selected service providers from health services and non-profit organisations, four mental health service users, and three of their caregivers in Cape Town participated in the study. Data collected using semi-structured interviews, focus groups and visual participatory methods were thematically analysed. Findings Three themes identifying opportunities to implement intersectoral collaboration emerged: barriers to personal recovery; finding meaningful participation; and affirming agency. Health service providers primarily focused on medication adherence and symptom reduction in health settings. In contrast, mental health service users and their caregivers suggested that their recovery was facilitated by long-term relational support from a range of service providers, including non-profit mental health organisations. Additionally, mental health service users valued access to interventions outside health settings, promoting meaningful engagement in their living, learning, working and socialising environments. Conclusion Intersecting contextual, socio-economic, cultural, and spiritual factors beyond the health sector influence recovery. Appropriate services for severe mental health conditions are multi-dimensional and treatment considerations should accommodate this complexity.