Participant-reported recovery-related outcomes during routine community mental health support: a CHIME-informed...

Recovery-oriented community mental health services seek to support personal recovery, everyday participation, and person-centered care, but these outcomes may not improve in parallel. Objective: To examine longitudinal changes in personal recovery, perceived person-centered care, occupational performance, and satisfaction with performance among adults receiving routine community support in the Spanish public social services system. The Connectedness, Hope and optimism about the future, Identity, Meaning in life, and Empowerment framework informed outcome evaluation and interpretation.

A longitudinal pre-post evaluation without a comparison group included 159 adults receiving routine community mental health support. Participant-reported outcomes were assessed at baseline and follow-up using the 24-item Recovery Assessment Scale, the Spanish version of the Client-Centred Rehabilitation Questionnaire, and the Canadian Occupational Performance Measure. Separate linear mixed models were fitted for each primary outcome, adjusting for sex, age, primary diagnostic group, primary support program domain, primary support intensity, secondary support receipt, and time-by-sex interaction. Sensitivity analyses examined alternative model specifications.

Occupational performance increased from baseline to follow-up (adjusted mean change 0.73, 95% confidence interval 0.46-0.99; Holm-adjusted p-value <0.001), as did satisfaction with performance (0.86, 95% confidence interval 0.59-1.13; Holm-adjusted p-value <0.001). No statistically significant longitudinal change was detected in personal recovery (0.85, 95% confidence interval -1.81 to 3.52; Holm-adjusted p-value = 0.529) or perceived person-centered care (0.11, 95% confidence interval -0.05 to 0.26; Holm-adjusted p-value = 0.361). No primary outcome showed evidence of differential change by sex. Sensitivity analyses yielded the same substantive conclusions.

Complementary recovery-related outcomes may follow different trajectories during routine community support and should not be treated as interchangeable indicators of recovery. These findings highlight the value of multidimensional participant-reported outcome monitoring alongside individualized planning to inform the ongoing review and adaptation of community support to changing needs, priorities, and life goals. Systematic multidimensional outcome monitoring may help determine whether planned supports actually remain aligned with changing needs, priorities, and life goals, and may strengthen the ongoing individualization and quality improvement of community mental health services.