A longitudinal evaluation of routine mental health support found a narrow but measurable change: participants' adjusted performance scores for activities they had prioritised rose by 0.73 points from baseline to follow-up. Their adjusted satisfaction scores rose by 0.86 points. The 95% confidence intervals ran from 0.46 to 0.99 for performance and 0.59 to 1.13 for satisfaction, and both Holm-adjusted p-values were below 0.001.
That improvement was not matched by the study's broader measures. The adjusted personal recovery score changed by 0.85 points, but its 95% confidence interval ranged from minus 1.81 to 3.52 and the p-value was 0.529. Perceived person-centered care, measured with a seven-dimension score, changed by 0.11 points, with a 95% confidence interval from minus 0.05 to 0.26 and an adjusted p-value of 0.361. The analysis therefore detected no statistically significant change in either outcome.
The pattern was more specific than a general recovery gain
The split between the measures is the important point. A participant could report better performance in selected activities and greater satisfaction with that performance without showing a detectable change in a broader measure of personal recovery or in perceived person-centered care. RAS-24, CCRQ-e and COPM were treated as complementary participant-reported measures. CHIME was used as a conceptual framework, not as a direct or exclusive measure of a single recovery process.
At the individual level, a two-point improvement was reported by a minority of participants. Of 157 participants with paired COPM assessments, 29, or 18.5%, increased performance by at least two points. Thirty, or 19.1%, increased satisfaction by at least two points. The study presents these proportions as descriptive rather than definitive evidence that the changes were clinically important.
A routine service, measured from more than one angle
The evaluation included 159 participants. Most were male, with 108 people, or 67.9%, in the male group. Mean age was 49.07 years, with a standard deviation of 12.38 years. The largest diagnostic group was schizophrenia spectrum and other psychotic disorders at 40.9%, followed by other psychiatric disorders at 35.8% and depressive and bipolar disorders at 23.3%.
Participants received routine support through individualized plans. Each person had at least one structured individual contact per week, tailored to identified needs and personal goals. The evaluation was a longitudinal pre-post study without a concurrent comparison group, so participants were assessed against their own baseline rather than against a separate group.
The main analysis used repeated-measures models, which account for more than one observation from the same participant, and adjusted for demographic, diagnostic and support variables. The model also tested whether change over time differed by sex. Mixed models used all available outcome observations, meaning that a participant with only one valid assessment could remain included without a complete pre-post pair.
What the study can, and cannot, say
The absence of a comparison group matters. The increase in COPM performance and satisfaction cannot by itself be attributed to the support, because the design measured change within one group over time. The results show higher average scores at follow-up than at baseline for these two outcomes, not a causal estimate of the service's effect.
Nor did the analysis find evidence that change differed by sex across the four primary outcomes. The time-by-sex p-values were 0.490 for RAS-24, 0.753 for CCRQ-e, 0.716 for COPM performance and 0.900 for COPM satisfaction. Sensitivity analyses produced the same substantive conclusions, including when support modality replaced support intensity and when the analysis used baseline-adjusted ANCOVA.
Taken together, the pattern shows why these outcomes should not be treated as interchangeable: participant-prioritized activity scores rose, while the broader recovery and care measures did not show detectable change. The study does not show that the modest group-level rise in COPM scores was clinically important for most participants, or that it came from the support itself. Different measures can move differently during the same period.
The study received ethics approval and written informed consent was obtained from participants. It was funded through a competitive public grant from the UEMC-Valladolid Provincial Council's 5th Call for Research Projects and Talent Retention, identified as Line1-EACA. The datasets are not publicly available because of ethical and confidentiality restrictions, but may be obtained from the corresponding author on reasonable request.
Paper data and sources
Original title: Participant-reported recovery-related outcomes during routine community mental health support: a CHIME-informed longitudinal evaluation
Authors: Fernández-Rodríguez O, García-Bravo C, Fernández-Blanco M et al.
Journal/Repository: Frontiers in public health
Status: Peer-reviewed
First online: 2026-10-08
DOI: Not available
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