Effects and feasibility of a peer-run course on the recovery of people with major psychiatric problems: a randomised controlled trial and feasibility study

Background/Objectives: Research on the effectiveness of peer-run services on the recovery of people with major psychiatric problems has been limited and poorly controlled. The effects of the peer-run course „Recovery is up to you“ on recovery were evaluated and its feasibility was assessed.

Methods: Recruitment of people with major psychiatric problems took place in the Netherlands between 2006 and 2008. The effects were evaluated in a RCT design. A total of 333 people were randomized to the experimental condition (N=168) or control condition (N=165). Assessments took place at baseline, after 3 months (i.e. at the end of the course) and after 6 months. Data were analyzed using multilevel analysis. For the feasibility study interviews were held with course instructors and participants after each course. 38 courses were evaluated. Course instructors also filled out checklists after each session of the course. Clients were specially trained and involved as research assistants in the standardisation process of the course manual and workbook, the pilot-study of the measures, the assessments and the interpretation of the analyses. Furthermore, they interviewed participants and had an advisory role during the study. These clients or research assistants were not participants in the course or study.

Results: After three months, participants in the experimental group had significantly higher scores on key elements of recovery: empowerment, hope and self-efficacy beliefs. There was evidence for a weak positive effect on quality of life, task-oriented coping and general mental health, and a weak negative effect on emotion-focused coping. There were no effects on physical health, loneliness, and avoidant coping. The effects of the intervention persisted three months after finishing the course. Similar results were found for those initially placed on a waiting list (control condition) when they participated in the course six months later. The feasibility study showed that participants and course instructors had very positive experiences with the course. Course instructors adhered closely to the course protocol and were highly motivated. There were no structural problems with the standardized manual. Participants mentioned three important factors for their recovery: modelling, the group process and the course material.

Discussion/Conclusions: The findings imply that the peer-run course contributes to the improvement of important domains of recovery. Peer-run services, such as ‘Recovery is up to you', are of added value for recovery-oriented mental health care because they offer participants an opportunity to make an active start with their recovery.

Funding: Netherlands Organisation for Health Research and Development (grant no. 100003017).

Keywords: Recovery-oriented interventions, recovery, treatment effectiveness.