Turning to Service Users for the Understanding of Current and Future Mental Health Services in the Development Process of Research and Practice: A Qualitative Study

Abstract

Background: A person-centred and recovery-oriented approach is an integral part of modern mental health services founded on the experiential knowledge of service users. Their reflections as experts, grounded in their unique experience as service users, play a significant role in developing and improving the existing care. Experiential knowledge is therefore a means to enhance the relevance of research, inform the development of care, and bridge research and practice.

Aim: To understand service users' experiences of their current mental health services and explore reflections on the Flexible Assertive Community Treatment (FACT) model and its role in future practice.

Methods: A total of 17 experts participated in individual and dyadic in-depth interviews. A reflexive thematic analysis was performed on the participants' experiences of current mental health services and on their reflections on a vignette describing an integrative, recovery-oriented care and support model-FACT.

Results: The analysis resulted in three themes. The first theme, 'Losing value and credibility as a person when becoming a service user', reflected participants' experiences of being reduced to the signs and symptoms of their mental health problems. The second theme, 'Navigating through the mental health maze', describes participants view on the current mental health services, while the last theme, 'Involving service users in their care and support would be empowering', holds participants' views on the importance of greater involvement in future service design and delivery.

Conclusions: These results underscore the necessity for enhanced collaboration to empower and provide inclusive, tailored care and support, which the participants emphasised as essential for the future of mental health services. The participants reflected on certain structural concepts, such as hierarchy, caring culture, and financial strains, prior to the implementation of FACT, which need to be addressed before an adaptation of integrative, recovery-oriented care and support models.

Public and service user contribution: The study planning and process involved stakeholders, including user organisations, Swedish Partnership for Mental Health (NSPH), Skåne and their sister organisation LIBRA Skåne, as well as managers and professionals of mental health services. One of the authors has own experience of mental illness and contributed greatly to the data analysis and the finalising of the manuscript, and two authors have experience as relatives.

Abstract (Swedish)

Aim
To understand service users' experiences of their current mental health services and explore reflections on the Flexible Assertive Community Treatment (FACT) model and its role in future practice.

Methods
A total of 17 experts participated in individual and dyadic in-depth interviews. A reflexive thematic analysis was performed on the participants' experiences of current mental health services and on their reflections on a vignette describing an integrative, recovery-oriented care and support model—FACT.

Results
The analysis resulted in three themes. The first theme, ‘Losing value and credibility as a person when becoming a service user’, reflected participants' experiences of being reduced to the signs and symptoms of their mental health problems. The second theme, ‘Navigating through the mental health maze’, describes participants view on the current mental health services, while the last theme, ‘Involving service users in their care and support would be empowering’, holds participants' views on the importance of greater involvement in future service design and delivery.

Conclusions
These results underscore the necessity for enhanced collaboration to empower and provide inclusive, tailored care and support, which the participants emphasised as essential for the future of mental health services. The participants reflected on certain structural concepts, such as hierarchy, caring culture, and financial strains, prior to the implementation of FACT, which need to be addressed before an adaptation of integrative, recovery-oriented care and support models.

Public and Service User Contribution
The study planning and process involved stakeholders, including user organisations, Swedish Partnership for Mental Health (NSPH), Skåne and their sister organisation LIBRA Skåne, as well as managers and professionals of mental health services. One of the authors has own experience of mental illness and contributed greatly to the data analysis and the finalising of the manuscript, and two authors have experience as relatives.

• author: Nilsson, Emmy ; Tjörnstrand, Carina ; Lindqvist, Daniel ; Wetterling, Jenny ; Lexén, Annika and Bejerholm, Ulrika
• organization: Mental Health, Activity and Participation (research group); LU Profile Area: Proactive Ageing; Unit for Biological and Precision Psychiatry (research group); Psychiatry (Lund)
• alternative title: Att vända sig till brukare för att förstå nuvarande och framtida psykiatrisk vård och stöd i utvecklingsprocessen av forskning och praktik: En kvalitativ studie
• publishing date: 2026-01-24
• type: Contribution to journal
• publication status: published
• subject: Health Care Service and Management, Health Policy and Services and Health Economy
• in: Health Expectations
• volume: 29
• issue: 1
• article number: e70574
• publisher: Wiley-Blackwell
• external identifiers: pmid:41578886
• ISSN: 1369-6513
• DOI: 10.1111/hex.70574
• project: Ups and Downs in Mental Health-En ny flexibel vård och stödmodell för ökad hälsa och fungerande i vardagen bland personer med alarmerande och komplexa mbehov av psykisk hälsa
• language: English
• LU publication?: yes
• id: eb3c080d-4c6d-4e24-8db6-fa259fbb87d5
• date added to LUP: 2026-01-26 08:25:39
• date last changed: 2026-01-27 03:35:19