---
title: "Personal recovery in Thai primary and community mental healthcare: qualitative perspectives"
id: "plos-one-23-views-on-mental-health-recovery-in-primary-and-community-mental-healthcare"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-23-views-on-mental-health-recovery-in-primary-and-community-mental-healthcare"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0353706"
published_at: "2026-07-20T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Personal recovery in Thai primary and community mental healthcare: qualitative perspectives
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-23-views-on-mental-health-recovery-in-primary-and-community-mental-healthcare
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0353706)
- **Published At:** 2026-07-20T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This qualitative study explored how mental health **service users**, carers, and healthcare professionals in Chiang Mai, Thailand, understand and experience **personal recovery** and recovery support within primary and community mental healthcare. - The research is the experience-gathering phase of an Experience-Based Co-Design (EBCD) project using 30 semi-structured interviews and two feedback workshops to inform a recovery-oriented training intervention. - Recovery was conceptualised by participants as progressing from clinical and functional improvement to a broader **personal recovery** that includes hope, meaning, and social connectedness. - Four themes were identified: (i) conceptions of recovery, (ii) attitudes towards recovery, (iii) characteristics of a successful recovery journey, and (iv) barriers to recovery that operate at individual, family, service, and community levels. - Family involvement, community acceptance, and supportive healthcare relationships emerged as central facilitators of recovery in the Thai context; non-specialist primary care providers (general nurses, public health officers) play a key delivery role. - The study took place in Chiang Mai across district and subdistrict settings; participants were purposively sampled and interviews were conducted in formal Thai or the Northern Thai dialect. - Data collection tools were informed by CHIME, Global INSPIRE and related recovery measures; the Global INSPIRE was translated into Thai for discussion purposes but not formally validated. - Transcription and translation processes emphasised cultural and linguistic fidelity; the first author reviewed transcripts and worked closely with transcribers and translators to preserve meaning. - Reflexive thematic analysis (Braun & Clarke) guided coding and theme development; touchpoints were identified to highlight emotionally significant moments for EBCD. - From the integrated stakeholder perspectives the authors propose a culturally situated **Recovery Support Model** emphasising personal agency, family involvement, professional engagement, and community support as drivers of recovery-oriented practice in Thailand.
## Clinical Analysis & Structured Key Points
SKIP TO MAIN CONTENT Advertisement plos.org Create account Sign in About Browse Publish advanced search 0 Save 0 Citation 32 View 0 Share OPEN ACCESS PEER-REVIEWED RESEARCH ARTICLE Views on mental health recovery in primary and community mental healthcare services in Thailand: A qualitative study Natthapon Inta , Annmarie Grealish, Mary Leamy Published: July 20, 2026 https://doi.org/10.1371/journal.pone.0353706 Article Authors Metrics Comments Media Coverage Abstract Introduction Methods Results Discussion Conclusion Supporting information Acknowledgments References Reader Comments Figures Abstract Introduction Strong community-based services and healthcare providers with a clear understanding and positive attitudes towards recovery, are central to delivering good quality mental health care in collaboration with service users. Although recovery has been explored in several Asian contexts, its interpretation remains diverse, and consensus on the definition and meaning of personal recovery in Thailand is limited. Further research is needed to explore how mental health service users, carers, and healthcare professionals understand and experience recovery and recovery support, in order to advance recovery-oriented practice within the local sociocultural context. Aim To explore thoughts, perceptions, and experiences of mental health service users, carers, and healthcare professionals on mental health recovery and recovery support in Thailand. Methods A qualitative descriptive study using reflexive thematic analysis, which forms the experience gathering phase of an Experience Based Co-Design (EBCD) study. Thirty semi-structured interviews and two feedback workshops with three service users and eight healthcare professionals were conducted. Results Four themes were identified: (i) conceptions of mental health recovery, (ii) attitudes towards recovery, (iii) characteristics of a successful recovery journey, and (iv) factors impeding recovery. Participants viewed recovery as beginning with clinical and functional improvement, progressing to personal recovery characterised by hope, meaning, and social connectedness. Family support, community acceptance, and supportive healthcare relationships were central to recovery, while barriers operated at individual, family, service, and community levels. Conclusion This study integrates the perspectives of mental health service users, carers, and healthcare professionals to generate new insights into personal recovery within Thai community mental health care. From these findings, we propose a culturally situated Recovery Support Model that foregrounds the interconnected roles of personal agency, family involvement, professional engagement, and community support as drivers of recovery-oriented practice within the Thai mental health system. Figures Citation: Inta N, Grealish A, Leamy M (2026) Views on mental health recovery in primary and community mental healthcare services in Thailand: A qualitative study. PLoS One 21(7): e0353706. https://doi.org/10.1371/journal.pone.0353706 Editor: Kuo-Cherh Huang, Taipei Medical University, TAIWAN Received: November 25, 2025; Accepted: June 26, 2026; Published: July 20, 2026 Copyright: © 2026 Inta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: Relevant data are within the paper and its Supporting Information files. However, some data cannot be shared publicly because of ethical considerations. Data are available from King’s College London Research Ethics Committee (contact via rec@kcl.ac.uk) for researchers who meet the criteria for access to confidential data. Funding: NI is funded by Chulabhorn Royal Academy for his PhD scholarship and bench fee for the use of research expenses. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Introduction Since the 1980s, mental health recovery has become a cornerstone of modern mental health policy internationally [1,2]. Three distinct types of recovery are recognised: clinical recovery, functional recovery, and personal recovery. Clinical recovery focuses on symptom remission [3,4]. Functional recovery encompasses vocational functioning, social participation, independent living, and housing stability, reflecting an individual’s capacity to engage meaningfully in everyday life beyond symptom remission [5]. In contrast, personal recovery is an ongoing process that emphasises individuals’ strengths and active involvement in their care. It encourages shared decision making, personal goal setting, and the pursuit of meaningful outcomes beyond the limitations of mental illness [6,7]. As a process of healing and transformation, personal recovery empowers individuals with mental health difficulties to live meaningful lives and reach their full potential within their chosen communities [8]. In line with the principles of deinstitutionalisation, supporting quality of life involves enabling people with mental health conditions to live in the ‘community’ rather than in an ‘institution’ [9]. Promoting personal recovery, hereafter ‘recovery’, in community mental health care requires robust support from community-based mental health services. Achieving meaningful recovery outcomes involves shifting from a predominantly biomedical model to a more holistic, recovery-oriented approach that prioritises individual strengths and overall well-being [10]. The success of such services relies on healthcare providers’ understanding of and attitudes toward recovery, as they play a central role in delivering care in close collaboration with service users [11,12]. A clear and shared understanding of the recovery concept is essential, as it informs and shapes mental health care practices. Although the concept of recovery has been examined in several Asian contexts, its interpretation remains highly diverse. Research on personal recovery among people experiencing mental illness in the region is still in its infancy. Further investigation is therefore required to elucidate how recovery is conceptualised and operationalised [13]. In Thailand, consensus on the definition and meaning of personal recovery remains limited. Further work is therefore warranted to validate the concept within the Thai context and to explore its culturally specific nuances and meanings. Moreover, little research has examined how key stakeholders, including service users, carers, and healthcare professionals, understand and experience recovery. Advancing mental health practice in Thailand towards a more recovery-oriented paradigm will require service users, practitioners, and researchers to cultivate a shared understanding of what effective recovery entails within their sociocultural context. Background Between 2015 and 2023, mental health facilities across Thailand recorded 13,793,884 visits, with anxiety disorders, schizophrenia, and depression representing the three most common conditions among service users [14]. Thailand’s mental health system is structured around 13 regional mental health centres operating under the Department of Mental Health, within the Ministry of Public Health [15]. These centres play a pivotal role in coordinating and supporting community mental health services through collaboration with local healthcare networks, including provincial, district, and subdistrict hospitals [16,17]. At the primary care level, each subdistrict hospital typically employs one to two general nurses, one to two public health officers, and, in some cases, dental personnel and other support staff [18]. Each subdistrict hospital is responsible for the healthcare of 10–15 villages, depending on the district’s size and population density [18]. In Thailand, the community mental healthcare system is integrated within the broader public health system [19], creating a need for shared responsibility among providers of both physical and mental health services. As a result, mental healthcare in primary and community settings is often delivered by non-mental health specialist staff, such as general registered nurses and public health officers [18]. Thai general nurses and public health officers play a pivotal role in disease prevention and control at the frontlines of primary care [20]. In addition to these responsibilities, they work in close collaboration with mental health nurses from the district hospitals to support the provision of mental healthcare services within community settings. To validate the concept of personal recovery within Thai community mental health care, it is essential to consider the perspectives of non-mental health professionals. Their insights help to illuminate the practical realities of delivering mental health services at the primary care level. At present, there are gaps in our understanding of recovery from the viewpoints of key service providers such as mental health nurses [21] and village health volunteers [22]. This study examined the concept of recovery from the perspectives of both mental health professionals, general healthcare professionals, as well as mental health service users and their carers. By drawing on real-world experiences, this study aimed to develop and culturally validate a shared, contextually grounded understanding of recovery within the Thai mental health system. Aim To explore the thoughts, perceptions, and experiences of mental health service users, their carers, and healthcare professionals regarding mental health recovery and recovery support in Thailand. Methods Design This study formed part of a larger project [23] that employed the Experience-Based Co-Design (EBCD) approach [24], which integrates participatory action research and user experience design, to co-design a culturally adapted recovery-oriented training intervention to improve recovery outcomes for mental health service users. The EBCD process consisted of two main parts encompassing six stages. Part 1 focused on gathering experiences (Stage 1: setting up, Stage 2: engaging staff and gathering experiences, Stage 3: engaging patients and gathering experiences), whereas Part 2 involved the co-design phase (Stage 4: co-design meeting, Stage 5: small co-design teams, Stage 6: celebration event) [25]. This paper presents Part 1 of the EBCD process, the experience-gathering phase which used semi-structured interviews and feedback workshops to explore mental health recovery and recovery support needs from the perspectives of service users and healthcare professionals. These findings informed the co-design of a recovery-oriented training intervention in Part 2 of EBCD process [23], with the aim of enhancing the quality of recovery-oriented mental health services. This paper is reported in accordance with the consolidated criteria for reporting qualitative studies (COREQ) guidelines [26]. Study setting and recruitment The study was conducted in Chiang Mai, Thailand, which is a major regional hub for healthcare, education, and culture, encompassing both urban and rural settings. Its diverse population is served by a comprehensive mental healthcare network, including psychiatric, provincial, district, and subdistrict hospitals. This context provided an ideal setting to examine the opportunities and challenges of implementing recovery-oriented practices within Thailand’s evolving mental healthcare system. A purposive sample of service users, carers, and healthcare professionals were selected based on predetermined characteristics. Inclusion criteria for service users comprised individuals aged 18 and over with a diagnosis of mental illness or a substance-related disorder. Individuals experiencing an illness relapse at the time of recruitment were excluded. Carers were identified as individuals who cared for someone with a diagnosis of mental illness or a substance-related disorder. All healthcare professionals with experience of working with mental health service users in community mental health care settings were eligible to participate. Participants were recruited by the first author (NI), who had no prior connection to the study site and no preexisting relationship with any participant. Recruitment was conducted through face-to-face meetings during routine appointments at a mental health clinic in a district hospital between April 2025 and June 2025. Posters displayed within the clinic informed potential participants about the study as they were placed within the clinic setting, they were accessible only to individuals with experience of attending mental health services or their carers. Consistent with Braun and Clarke’s reflexive thematic analysis, which prioritises depth of meaning and richness of interpretation over data completeness, formal data saturation was not sought [27,28]. Recruitment continued until sufficient depth and diversity of experience had been captured to meaningfully address the research objectives. Patient and public involvement To strengthen the research design and methods, a Patient and Public Involvement (PPI) team was engaged to refine the data collection tools. Six PPI members were recruited through the first author’s (NI) connections with Thai mental health staff at a recovery centre in a psychiatric hospital in Thailand, as well as researchers in the field of mental health recovery. The team comprised a mental health nurse, a psychiatrist, a psychologist, a peer support specialist/researcher, a person with lived experience of mental illness, and a carer. Their involvement ensured that the data collection tools were clear, relevant, and linguistically appropriate, while also helping to minimise potential stigma arising from cultural and linguistic differences during the interviews. Data collection The first author (NI), trained in EBCD and qualitative interview techniques, conducted all 30 interviews, each lasting approximately one hour. Interview topic guides (see S1 File) were initially developed in English by the research team and informed by the CHIME mental health recovery framework [29], the Global INSPIRE measure [30], the Brief INSPIRE questionnaire [31], the Recovery Self-Assessment measure [32], and findings from a review of factors influencing the delivery of recovery-oriented practice [12]. The interview guides were translated into Thai by NI with input from the PPI team, then piloted and refined with six PPI members to ensure clarity, cultural appropriateness, and sensitivity. Prior to the interviews, participants with mental health condition completed a version of the Global INSPIRE questionnaire [33] which had been translated into Thai for the purposes of this study to provide insight into participants’ experiences of mental health recovery. This measure was initially translated into Thai by NI, with the back-translation verified by a member of the original development team at the University of Nottingham. The translation was further refined based on feedback from six PPI members. As the Global INSPIRE Thai version had not been formally validated, the measure was used solely as a discussion prompt to explore personal recovery among participants who might be unfamiliar with the concept. It provided a structured framework to guide conversations about personal recovery, rather than generating generalisable findings. Semi-structured interviews were conducted by the first author (NI) in formal Thai or the Northern Thai dialect spoken in Chiang Mai, according to participants’ preferences and took place face-to-face at the hospital, in participants’ homes, or via telephone. All sessions were audio recorded with permission. Core questions explored participants’ perceptions and experiences of mental health recovery and recovery support, in alignment with the primary research objectives. With consent, five service users and three carers were additionally video recorded as part of the broader EBCD study to produce a catalyst film for use in co-design workshops [24]. Following the interviews, all participants were invited to take part in feedback events, a core component of the EBCD experience-gathering phase. These events provided an opportunity for participants to confirm whether the experiences identified in earlier stages accurately reflected their perspectives, thereby enhancing the credibility and trustworthiness of the data interpretation. During the session, preliminary findings from the interviews were presented for participants’ review, comments, and suggestions. Participants were also encouraged to share any additional insights or highlight new ideas that had not emerged during the interviews. Data analysis All interviews were transcribed verbatim and translated from Thai and Northern Thai into English by a professional transcriber and translator who was fluent in formal Thai, the Northern Thai dialect, and English. Transcription was treated as a constructive rather than mechanical process, recognising that selectivity and interpretation inevitably shape the conversion of spoken data into text [34,35]. To minimise potential errors and bias, the first author (NI) met with the transcriber prior to commencement and maintained regular communication throughout, ensuring familiarity with local expressions, cultural meanings, emotional nuances, and technical terminology. NI reviewed all transcripts to verify accuracy, contextual fidelity, and to address any cultural or linguistic ambiguities through discussion with the transcriber and the research team (NI, AG, ML). Translation in qualitative research requires not only linguistic conversion but preservation of context, intention, and cultural meaning [36,37]. NI met with the translator prior to commencement and maintained regular communication throughout to ensure familiarity with the research context and participants’ cultural background. A glossary of study-specific terminology including terms such as mental health recovery and personal recovery, and culturally specific relational terms was provided to support translation accuracy. NI reviewed and verified all English transcripts against the original Thai to ensure accuracy, consistency, and conceptual equivalence. The first author (NI) conducted an independent inductive analysis using Braun and Clarke’s six-phase reflexive thematic analysis comprising: familiarisation with data, coding, generating initial themes, reviewing themes, defining and naming themes, and producing the final report [38,39]. During familiarisation, NI listened to the audio recordings and read all transcripts in both Thai and English to develop a thorough understanding of the data. In the coding stage, English transcripts were used to enable the wider research team (AG, ML) to engage with the data. However, both language versions were considered throughout to support nuanced interpretation and minimise language bias [40,41]. NI conducted a line-by-line analysis of all transcripts using NVivo software (version 15). Initial codes were organised according to the two research objectives: participants’ experiences of recovery and recovery support, facilitating identification of similarities and differences across the dataset. Consistent with EBCD methodology, touchpoints were also identified. Touchpoints refer to emotionally significant moments within participants’ narratives that illuminated aspects of care perceived as meaningful, impactful, or requiring improvement [24,42]. NI generated initial themes and subthemes by consolidating related codes and touchpoints, which were subsequently reviewed and refined through regular meetings with the research team (AG, ML). Themes were iteratively revised until consensus was reached, and
## Related Clinical Research

- [Digital eMPower program reduces anxiety and depression in adults with chronic conditions: randomiz](https://medichelpline.com/clinical-feed/plos-medicine-0-effect-of-a-digital-intervention-on-mental-health-symptoms-in-adults-with.md)
- [Psychometric evaluation of the CISS-SF: validity, reliability, and factor structure](https://medichelpline.com/clinical-feed/plos-one-14-psychometric-properties-of-a-short-form-for-the-coping-inventory-for-stressful.md)
- [Caregiver burden, depression, anxiety, and quality of life among caregivers of people with severe](https://medichelpline.com/clinical-feed/plos-one-20-caregiver-burden-and-its-association-with-depression-anxiety-and-quality-of.md)
- [Polygenic and familial influences on antidepressant continuation, switching, discontinuation and a](https://medichelpline.com/clinical-feed/medrxiv-13-polygenic-and-familial-contributions-to-antidepressant-continuation-switching.md)
- [Dementia-Related Violence in Memory Care: Repeated Resident-to-Resident Attacks Despite Warnings](https://medichelpline.com/clinical-feed/kff-health-news-0-violence-repeatedly-erupts-at-dementia-care-facilities-despite-warnings.md)

## Navigation
- [← Back to General Feed](https://medichelpline.com/clinical-feed/general.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.