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Some benefits of the project include:
- creating the conditions in regions/cities where service users have access to improved care that supports recovery;
- creating an evidence base that supports and facilitates the implementation of community mental health services;
- leveraging content expertise to navigate local factors that affect system reform, and to share the positive work being done in the project with key stakeholders
3. What are the key messages from this project?
RECOVER-E is a three-and-a-half-year Horizon 2020 research initiative funded by the European Commission, bringing together 16 partners from 11 countries in Europe to drive transformations in mental health service delivery for people with severe mental illness. It aims to stimulate good practices in community-based mental health care to serve the needs better of people with severe mental illness.
4. What is the ideal destiny of the project results after it is over?
Ideally, the project would contribute to a society in which service users have access to improved care that supports recovery. Second, the project would contribute to putting a foundation in place to continue offering and paying for the delivery of community-based mental health services by multidisciplinary community mental health teams.
5. What would be the financial and psychological benefits of Recover-e project and its’ possible applications? Why can’t we leave mental health care system as it is now in those countries?
With respect to the financial benefits: It’s still too early to discern what the economic benefits of the project’s intervention are. But we are currently collecting data to inform a health economic evaluation that will show back both the budget impact of introducing a community mental health service into the system as well as the cost-effectiveness of the intervention compared to care as usual in each of the five sites.
As for the psychological benefits: Focusing on recovery goals and care goals of patients and working towards that collaboratively, providing care where the patient wants it (e.g. via home visits, in public places like a café or public garden, in the clinic). In some countries without a decentralized mental health care system, people with severe mental illness are repeatedly admitted and discharged from hospital because there are no appropriate community alternatives. This cycle of re-hospitalization does not facilitate social integration and functioning, or recovery, which further affects quality of life. Care delivery through community mental health teams enables clients to work on their recovery across various aspects of life while participating and building/maintaining bonds within their communities.
6. How is the project engaged with community mental health leaders?
The site leaders in the five implementation sites are community mental health champions in their own settings and in Europe and are not only involved in local community mental health initiatives at the policy and clinical level, but also in other parts of Europe. Several project partners are also leading and members of other community mental health initiatives in Europe, such as the EuCOMS network.
Visit EUCOMS website
7. What kind of specialists are involved in the project (and from which countries)?
In each of the five implementation sites, there is a research team and a community mental health team. The community mental health team is staffed by a mix of psychiatrists, psychologists, nurses, social workers and peer workers (i.e. persons with lived experience of a severe mental illness). Outside of the 5 implementation countries, we have consortium partner organizations from 6 other countries that include service user organizations (peer specialists), implementation science experts, health services researchers, clinical specialists and trainers, professional associations for psychologists and psychiatrists, and think tanks dedicated to policy and practice change in mental health and addiction care.
8. How are mental and public health institutes involved? What organizations are involved?
As mentioned above, the RECOVER-E consortium includes a large complementary mix of partners including clinical mental health services that have gone through similar transformations in their service delivery approaches as the 5 RECOVER-E project sites are going through now. In our consortium we have academic institutions, think tanks for mental health and addiction, service user organizations, professional associations, and public health institutes involved. Public health and mental health institutes are involved in the 5 sites in both the delivery and evaluation of the intervention, which are the multidisciplinary community mental health teams.
9. How are you planning to get better policy impact?
Having policy impact through our work will require a combination of efforts. First, it is important to map out the current decision-makers in each site and gauge their support towards mental health services development. Then, each site has made a policy influencing strategy which specifies one key policy ask related to mental health services development, around which a targeted action plan is formulated to engage decision-makers. Finally, two policy dialogue sessions (one in the beginning and one of the end) bring together national and regional stakeholders country to discuss priorities, evidence gaps, and project results needed to contribute to sustaining service delivery transformations made throughout the duration of the project.
10. How psychology and EFPA are involved? How can we benefit and contribute?
Psychologists are a crucial part of the community mental health teams and in working with service users towards achieving their recovery and treatment goals. EFPA is an important partner in the dissemination of the project findings and lessons learned, specifically by raising awareness of these service delivery changes and lessons learned with national professional associations of psychologists both in the RECOVER-E implementation sites and beyond. Part of the process of deploying a new service delivery model for severe mental illness in these 5 sites has involved a needs assessment and situation analysis of the current mental health system in each site, as well as an extensive training and mentoring program. Ultimately, our hope is that these training materials and tools for monitoring developments in mental health care are institutionalized and embedded in ongoing professional associations in each of the 5 sites, a process which EFPA plays an important role in facilitating.
11. Which practices can be implemented in other countries?
Multidisciplinary community mental health teams are already active in many countries throughout Europe and globally. We have evidence that they work and in many settings are preferred as a service delivery approach by service users. Countries that are currently working to reform or improve their mental health care systems may benefit from understanding, tailoring, and adopting various practices and processes taking place in RECOVER-E (for example in relation to implementation or policy influencing processes and strategies).
12. What are “mobile teams”? Are there similar interesting findings or initiatives that can be used?
Mobile teams are multidisciplinary community mental health teams that deliver care to people with severe mental illness such as schizophrenia, bipolar disorder and severe depression. The teams consist of a mix of professions like psychiatrists, psychologists, peer workers, social workers and nurses, in order to provide holistic care that takes into account the service user’s social, personal and clinical context and recovery goals into account. Such teams operate within mental health services in many countries globally and in some well-resourced systems, there are even specialized community mental health teams (e.g. forensic assertive community treatment teams, specialized treatment teams for dual diagnosis, etc).
13. What are the workpackages? Who are workpage leaders and what’s the difference between the packages? Are they implemented similarly in all the three countries?
Work packages are essentially sub-components of work in the project, or represent a certain theme of work in a project. Work package leaders are representatives from a number of the 16 consortium partners, who meet regularly in the form of the project’s management team and discuss progress and issues ongoing in each of the work packages. Some of the work packages are more general and cut across the whole project (e.g. Work Package 1 which is Overall Management and Coordination, and Work Package 7, Dissemination) versus other work packages which are really content focused and focused on efforts to support work in the 5 RECOVER-E sites (e.g. WP3 which is implementation support or WP6, Bridging the gap between Policy and Practice). All Work Packages are implemented across the 5 countries in a similar method.
Where can we find more information about this?
More information about the Work Packages can be found on our project website:
14. How are the project results monitored and assessed?
We have a comprehensive evaluation approach within the project, which is currently ongoing. Let me share with you our specific research objectives:
- testing the impact of the intervention on patient outcomes and service utilisation outcomes;
- gathering in-depth data on implementation processes, which includes identifying key contextual factors, barriers, and facilitators of implementation; and
- assessing the cost-effectiveness of the intervention compared to usual care.
- The outcomes and results of the research on the community-based service delivery in the five sites will be shared with policymakers, stakeholders in Central and Eastern Europe, healthcare providers, and researchers through policy dialogues, conference presentations, briefings, reports, and journal articles.
In order to understand the processes of the teams and the impact on care, the work of the teams will be evaluated using a mix of research methods. First, five hybrid effectiveness-implementation trials have been devised (1 per trial site) to assess the effects of the teams and of the delivery of new team-based community mental health care approach on implementation outcomes (i.e. the coverage and fidelity of evidence-based care at the health system level) and on patient-level outcomes (i.e. health gains in terms of improved role functioning and better health-related quality of life). These five trials have a pragmatic, non-blinded study design; patients are to be randomised into two parallel groups: receiving new community-based versus receiving hospital-based mental health care. Alongside the trials, a health economic evaluation will assess the cost-effectiveness of the intervention compared to care as usual, as well as assess the net benefits of the intervention across the 5 trials. To evaluate implementation outcomes and identify intervention and contextual factors that enhance sustainable implementation of community-based mental healthcare, a qualitative process evaluation will be carried out.
15. How psychologists from Croatia, Romania, Bulgaria can learn more, participate, contribute?
As I mentioned before, psychologists are a key member of the community mental health teams and an important partner in delivering therapies and services in a way in which is supportive of the recovery journey and recovery goals of a service user. There are a few ways I think psychologists from the RECOVER-E sites can learn more, participate and contribute.
First, identify how a service delivery structure like a community mental health team delivering outreach care could be adapted for your setting or practice. What would need to change to make this way of working possible, and in what way would it help your clients? Second, what kind of professional development and capacity building opportunities would you need and how can you work with your national association for psychologists and local and national policymakers to advance these efforts? Third, this is an important networking opportunity for psychologists working in the RECOVER-E project to connect with their peers and share challenges and lessons learned from delivering care in a new way, which can lead to new synergies and opportunities in the mental health system going forward.