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Organisational and student characteristics, fidelity, funding models, and unit costs of recovery colleges in 28 countries: a cross-sectional survey

Hayes, Daniel ; Hunter-Brown, Holly ; Camacho, Elizabeth ; McPhilbin, Merly ; Elliot, Rachel A ; Ronaldson, Amy ; Bakolis, Ioannis ; Repper, Julie ; Meddings, Sara and Stergiopoulos, Vicky , et al. (2023) In The Lancet Psychiatry 10(10). p.768-779
Abstract
Background
Recovery colleges were developed in England to support the recovery of individuals who have mental health symptoms or mental illness. They have been founded in many countries but there has been little international research on recovery colleges and no studies investigating their staffing, fidelity, or costs. We aimed to characterise recovery colleges internationally, to understand organisational and student characteristics, fidelity, and budget.

Methods
In this cross-sectional study, we identified all countries in which recovery colleges exist. We repeated a cross-sectional survey done in England for recovery colleges in 28 countries. In both surveys, recovery colleges were defined as services that supported... (More)
Background
Recovery colleges were developed in England to support the recovery of individuals who have mental health symptoms or mental illness. They have been founded in many countries but there has been little international research on recovery colleges and no studies investigating their staffing, fidelity, or costs. We aimed to characterise recovery colleges internationally, to understand organisational and student characteristics, fidelity, and budget.

Methods
In this cross-sectional study, we identified all countries in which recovery colleges exist. We repeated a cross-sectional survey done in England for recovery colleges in 28 countries. In both surveys, recovery colleges were defined as services that supported personal recovery, that were coproduced with students and staff, and where students learned collaboratively with trainers. Recovery college managers completed the survey. The survey included questions about organisational and student characteristics, fidelity to the RECOLLECT Fidelity Measure, funding models, and unit costs. Recovery colleges were grouped by country and continent and presented descriptively. We used regression models to explore continental differences in fidelity, using England as the reference group.

Findings
We identified 221 recovery colleges operating across 28 countries, in five continents. Overall, 174 (79%) of 221 recovery colleges participated. Most recovery colleges scored highly on fidelity. Overall scores for fidelity (β=–2·88, 95% CI 4·44 to –1·32; p=0·0001), coproduction (odds ratio [OR] 0·10, 95% CI 0·03 to 0·33; p<0·0001), and being tailored to the student (OR 0·10, 0·02 to 0·39; p=0·0010), were lower for recovery colleges in Asia than in England. No other significant differences were identified between recovery colleges in England, and those in other continents where recovery colleges were present. 133 recovery colleges provided data on annual budgets, which ranged from €0 to €2 550 000, varying extensively within and between continents. From included data, all annual budgets reported by the college added up to €30 million, providing 19 864 courses for 55 161 students.

Interpretation
Recovery colleges exist in many countries. There is an international consensus on key operating principles, especially equality and a commitment to recovery, and most recovery colleges achieve moderate to high fidelity to the original model, irrespective of the income band of their country. Cultural differences need to be considered in assessing coproduction and approaches to individualising support. (Less)
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contributor
LU
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Lancet Psychiatry
volume
10
issue
10
pages
768 - 779
publisher
Elsevier
external identifiers
  • scopus:85171459247
ISSN
2215-0366
DOI
10.1016/S2215-0366(23)00229-8
language
English
LU publication?
yes
id
d92eb8a8-0773-44fb-a112-cc97eaf7ba06
date added to LUP
2023-11-15 11:11:56
date last changed
2023-11-16 04:03:09
@article{d92eb8a8-0773-44fb-a112-cc97eaf7ba06,
  abstract     = {{Background<br/>Recovery colleges were developed in England to support the recovery of individuals who have mental health symptoms or mental illness. They have been founded in many countries but there has been little international research on recovery colleges and no studies investigating their staffing, fidelity, or costs. We aimed to characterise recovery colleges internationally, to understand organisational and student characteristics, fidelity, and budget.<br/><br/>Methods<br/>In this cross-sectional study, we identified all countries in which recovery colleges exist. We repeated a cross-sectional survey done in England for recovery colleges in 28 countries. In both surveys, recovery colleges were defined as services that supported personal recovery, that were coproduced with students and staff, and where students learned collaboratively with trainers. Recovery college managers completed the survey. The survey included questions about organisational and student characteristics, fidelity to the RECOLLECT Fidelity Measure, funding models, and unit costs. Recovery colleges were grouped by country and continent and presented descriptively. We used regression models to explore continental differences in fidelity, using England as the reference group.<br/><br/>Findings<br/>We identified 221 recovery colleges operating across 28 countries, in five continents. Overall, 174 (79%) of 221 recovery colleges participated. Most recovery colleges scored highly on fidelity. Overall scores for fidelity (β=–2·88, 95% CI 4·44 to –1·32; p=0·0001), coproduction (odds ratio [OR] 0·10, 95% CI 0·03 to 0·33; p&lt;0·0001), and being tailored to the student (OR 0·10, 0·02 to 0·39; p=0·0010), were lower for recovery colleges in Asia than in England. No other significant differences were identified between recovery colleges in England, and those in other continents where recovery colleges were present. 133 recovery colleges provided data on annual budgets, which ranged from €0 to €2 550 000, varying extensively within and between continents. From included data, all annual budgets reported by the college added up to €30 million, providing 19 864 courses for 55 161 students.<br/><br/>Interpretation<br/>Recovery colleges exist in many countries. There is an international consensus on key operating principles, especially equality and a commitment to recovery, and most recovery colleges achieve moderate to high fidelity to the original model, irrespective of the income band of their country. Cultural differences need to be considered in assessing coproduction and approaches to individualising support.}},
  author       = {{Hayes, Daniel and Hunter-Brown, Holly and Camacho, Elizabeth and McPhilbin, Merly and Elliot, Rachel A and Ronaldson, Amy and Bakolis, Ioannis and Repper, Julie and Meddings, Sara and Stergiopoulos, Vicky and Brophy, Lisa and Miyamoto, Yuki and Castelein, Stynke and Goril Klevan, Trude and Elton, Dan and Grant-Rowles, Jason and Kotera, Yasuhiro and Henderson, Claire and Slade, Mike and International Research Consortium, RECOLLECT}},
  issn         = {{2215-0366}},
  language     = {{eng}},
  month        = {{09}},
  number       = {{10}},
  pages        = {{768--779}},
  publisher    = {{Elsevier}},
  series       = {{The Lancet Psychiatry}},
  title        = {{Organisational and student characteristics, fidelity, funding models, and unit costs of recovery colleges in 28 countries: a cross-sectional survey}},
  url          = {{http://dx.doi.org/10.1016/S2215-0366(23)00229-8}},
  doi          = {{10.1016/S2215-0366(23)00229-8}},
  volume       = {{10}},
  year         = {{2023}},
}