Exploring the Process of Professional Role Redefinition Towards Recovery-Oriented Care Through Joint Crisis Plans in...

Background/Objectives: Japan's mental healthcare system is characterized by the world's highest number of psychiatric beds, widespread "social hospitalization," and a structurally entrenched managerial support model that frequently undermines patient autonomy. Joint Crisis Plans (JCPs)-collaboratively developed crisis management documents-have been increasingly adopted as a care coordination tool; however, their role in transforming professional practice towards recovery-oriented support remains underexplored. This study aimed to elucidate the experiences of professionals utilizing JCPs across diverse facility types and to develop a theoretical understanding of the process by which they redefine their role from 'manager' to 'recovery companion'. Methods: A qualitative design using the Modified Grounded Theory Approach (M-GTA), grounded in symbolic interactionism, was employed. Semi-structured interviews were conducted with 13 professionals (7 nurses, 6 mental health and welfare workers) across nine facilities (psychiatric hospitals, 24-h residential facilities, outpatient facilities) in the Kanto region of Japan. Theoretical sampling continued until saturation. Data were analyzed using the constant comparative method, with validity ensured through team checking. Results: Nine categories and 23 subcategories were extracted. A three-stage support transformation process emerged: (1) Initial Stage and Motivation, in which professionals confronted the limitations of managerial practice; (2) Role Redefinition and Practice through Collaboration, involving joint crisis management, strength-based support, and network building; and (3) Stage of Integration of Perspectives and Implementation of Recovery-Oriented Practice, in which professionals witnessed individual recovery and integrated new support values into their practice. Negative cases revealed that JCP effectiveness is contingent on the co-construction of shared meaning rather than procedural compliance. Conclusions: JCP was suggested to function as a potential tool to facilitate navigating and reframing structural managerial barriers in Japanese mental healthcare. The creation of a shared language through JCP was associated with supporting conditions for individual self-determination, alleviating professional conflicts, and contributing to shifts in organizational culture.