Inside or Outside? A Qualitative Comparative Study of 2 Recovery Colleges in Sweden and Norway.

Background: Recovery colleges (RCs) provide users of mental health services with self-management and coping skills, along with actions to promote social inclusion and reduce stigma. Research shows that recovery principles in mental health have the potential to improve services, but are poorly implemented. Better knowledge and understanding of RCs among mental health staff might help in addressing this challenge. Objective: In order to shed light on that assumption, the study compares 2 RCs that differ in their formal relationship with the mental health service-1 "embedded" and 1 "freestanding." This comparative study aims to uncover whether there are differences in the perceived value of the RCs by participants, and in mental health staff views on the benefits and challenges related to RCs, and the potential for collaboration. Methods: The design is an explanatory comparative case study. Thick descriptions of the cases were based on document analysis and stakeholder interviews, subjected to content analysis. A "strategic change management model" guided data collection and analysis. Empirical patterns demonstrating the character and interrelations of the context, content, process, and outcome were identified in the case descriptions, forming tentative explanations of benefits and challenges observed. Results: RC participants reported some differences in experiences possible to relate to course content. Information on mental health services enabled a more efficient use of those resources. A focus on communication and coping strategies helped in building bonds and relationships and finding support in social networks. Both RCs supported empowerment and reduced the sense of stigma. Mental health professionals had a positive image of the RCs but were not well informed about their activities. Few saw the college as an activity that could complement their professional services but had interesting reflections on their workplaces in relation to recovery. Exposure to an RC could support a reorientation from "diagnosis-centered" to a more patient-centered care culture. Users offering peer support could be "go-betweens" and "bridge builders" to mental health services. Conclusions: Mental health staff aware of RCs and having knowledge of their benefits will provide support and guide users to participate. Such positive experiences are more important as a promoter of collaboration with users and the interest to contribute to a recovery-oriented care culture than the organizational form of the RC and its formal link to mental health services.