Since the 1980s, recovery has been a core concept in modern mental health policy, with three recognised types: clinical recovery (symptom remission), functional recovery (vocational and social functioning), and personal recovery (an ongoing, person-centred process emphasising strengths, hope, and meaning). In Thailand, consensus on the meaning and application of personal recovery is limited. This study aimed to explore the thoughts, perceptions, and lived experiences of mental health service users, carers, and healthcare professionals regarding mental health recovery and recovery support in primary and community mental healthcare settings in Thailand.
This research constituted Part 1 (experience gathering) of an Experience-Based Co-Design (EBCD) project intended to co-design a culturally adapted recovery-oriented training intervention. The EBCD process used here included stages for setting up, engaging staff and patients, and later co-design phases (not reported in this paper). The experience-gathering phase employed semi-structured interviews and feedback workshops and was reported following COREQ guidelines.
The study was conducted in Chiang Mai, a regional hub with urban and rural populations served by psychiatric, provincial, district, and subdistrict hospitals. A purposive sample included service users (aged 18+ with a diagnosis of mental illness or substance-related disorder, excluding those in relapse), carers of people with such diagnoses, and healthcare professionals experienced in community mental healthcare. Recruitment occurred at a district hospital mental health clinic between April and June 2025 using face-to-face approaches and clinic posters. The first author, with no prior relationship to participants, conducted recruitment.
A Patient and Public Involvement (PPI) team of six members (including a mental health nurse, psychiatrist, psychologist, peer support specialist, person with lived experience, and a carer) helped refine data collection tools. Their input aimed to ensure clarity, cultural appropriateness, linguistic suitability, and to reduce potential stigma during interviews.
Thirty semi-structured interviews, each approximately one hour, were conducted by the first author. Interview guides were informed by the CHIME recovery framework, the Global INSPIRE measure, the Brief INSPIRE, the Recovery Self-Assessment, and a review of factors influencing recovery-oriented practice. The Global INSPIRE was translated into Thai and back-translated for use as a discussion prompt; it was not used as a validated instrument but to aid conversations about personal recovery. Five service users and three carers were video recorded with consent for use in the wider EBCD project.
All interviews were audio recorded, transcribed verbatim, and translated from formal Thai and the Northern Thai dialect into English by a professional transcriber/translator fluent in both dialects and English. The first author maintained ongoing dialogue with the transcriber and translator, reviewed all transcripts against source audio, and provided a glossary of study-specific terms to preserve cultural and conceptual equivalence.
An inductive reflexive thematic analysis following Braun and Clarke’s six phases was conducted by the first author. Coding was performed line-by-line in NVivo (version 15) using English transcripts to facilitate broader team engagement, while the Thai-language materials were referenced to support nuanced interpretation. Analysis identified touchpoints—emotionally salient moments—to inform the EBCD process. Themes were iteratively reviewed and refined through regular meetings with the research team until consensus was reached.
Four interrelated themes emerged from interviews and feedback workshops:
Conceptions of mental health recovery: Participants described recovery beginning with clinical and functional improvement (symptoms and everyday functioning) and progressing toward personal recovery characterised by hope, meaning, identity, and social connectedness.
Attitudes towards recovery: Stakeholders’ attitudes shaped expectations for recovery and influenced the support offered. Positive, recovery-oriented attitudes among providers facilitated collaborative care and shared decision-making.
Characteristics of a successful recovery journey: Successful journeys were described as involving restored daily functioning, re-engagement with social roles, regained hope, and meaningful relationships. Supportive therapeutic relationships were highlighted as enabling factors.
Factors impeding recovery: Barriers were identified at multiple levels — individual (e.g., symptoms), family (e.g., limited understanding), service (e.g., limited specialist resources at primary care), and community (e.g., stigma and lack of acceptance). The role of non-specialist primary care staff, including general nurses and public health officers, was noted as central to service delivery in community settings.
Integrating perspectives from service users, carers, and professionals, the authors propose a culturally situated Recovery Support Model that foregrounds interconnected roles: personal agency, family involvement, professional engagement, and community support. Family support, community acceptance, and supportive healthcare relationships were identified as central drivers of recovery within Thai community mental healthcare. The findings informed the subsequent co-design phase to develop a recovery-oriented training intervention tailored to the Thai context.
The study underscores the need to validate and operationalise personal recovery concepts within Thailand’s sociocultural context and to strengthen recovery-oriented practice across primary and community services. Engaging non-specialist providers and families, addressing community stigma, and promoting collaborative relationships were highlighted as priorities for implementing recovery-oriented care within Thailand’s integrated public health system.