CHIME in practice: a qualitative exploration of CHIME framework training experiences and outcomes for service users and mental health professionals

In recent years, recovery has received increasing attention in medical contexts, particularly within mental health programs. The focus has been on developing interventions that promote service users’ recovery from somatic or mental health challenges (Kellmann et al., 2023). Recovery has been defined in various ways across different contexts. In medical settings, it is often described as an ongoing healing process aimed at achieving a higher degree of wellness (Onken et al., 2007). The concept of recovery encompasses a person’s ability to pursue hopes and goals and lead a meaningful, self-determined life despite ongoing mental health challenges (Davidson and Roe, 2007).

Psychiatrist William Anthony’s widely used definition states that recovery is “a deeply personal, unique process of change in attitude, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and constructive life despite the limitations caused by mental health experiences” (Anthony, 1993). This recovery movement shifts away from the traditional deficit-focused model (pathogenetic) toward empowerment, resilience and hope (Davidson and Roe, 2007; National Center on Substance Abuse and Child Welfare, 2012). Despite calls for reform, biomedical views of recovery still prevail among mental health professionals (Moreta et al., 2016) and the provision of recovery-oriented services remains sporadic (Boutillier et al., 2014; Perkins and Slade, 2012; Pincus et al., 2016; Tse et al., 2013).

Recovery-oriented practice approaches extend beyond addressing mental health challenges, aiming instead to empower individuals throughout their recovery journey (McGregor et al., 2014). From a mental health-care perspective, the effectiveness of care is measured not only by clinical outcomes but also by the subjective experiences of individuals receiving care. Recovery training programs within mental health centers focus on empowering service users through collaborative efforts with staff, emphasizing the importance of tailoring care to individual needs (McPherson et al., 2021).

Key values in recovery-oriented practice include fostering respectful, collaborative relationships and emphasizing hope, self-determination, meaning and purpose (Farkas et al., 2005). MHPs need to shift from a position of expertise and authority to one in which they provide coaching toward the goals of service users (Slade, 2012). These practices aim to build support that facilitates recovery and well-being and the professional’s belief in understanding recovery (Bird et al., 2014; Wood and Alsawy, 2017; Van Weeghel et al., 2019; Gyamfi et al., 2022).

One prominent framework developed to guide recovery-oriented practices is the CHIME Framework – an acronym for Connectedness, Hope and Optimism, Identity, Meaning in Life and Empowerment. Developed by Leamy et al. (2011) through a systematic review of 87 articles, the CHIME framework provides a comprehensive depiction of the recovery process and is widely recognized for its utility in mental health care (Brijnath, 2015). Figure 1 illustrates the CHIME Framework’s components, which serve as a foundational reference for recovery-oriented practice.

The CHIME Framework has been widely adopted in mental health services to promote recovery-oriented practices. Its principles are often used to train MHPs and engage service users, aiming to enhance positive outcomes for both groups. Evidence demonstrates that CHIME fosters recovery by emphasizing connectedness, hope, identity, meaning and empowerment (Hine et al., 2023; Salkeld et al., 2012). However, implementing these principles consistently across diverse settings presents challenges (Poon et al., 2024). Peer support and specialized training have been shown to promote CHIME principles, yet service users and carers often report gaps in comprehensive support (Zeng and Chung, 2020). In addition, staff may grasp recovery concepts but still require practical tools and adaptations, such as the CHIME Secure framework to address challenges in specialized contexts like forensic or supported accommodation settings (Kvia et al., 2020; McPherson et al., 2021; Senneseth et al., 2021). While several studies have evaluated recovery training experiences and outcomes for MHPs, showing improvements in recovery-oriented knowledge, attitudes and competencies, there is limited evidence addressing service user and service-level outcomes (Jackson-Blott et al., 2019; Lau and Hutchinson, 2021).

This qualitative study seeks to address this gap by exploring the experiences and outcomes of service users and MHPs following CHIME-based recovery training. By examining the perspectives of both groups, the study aims to bridge the gap between theoretical frameworks and practical applications, contributing to the growing body of evidence on recovery-oriented practices.

We used a qualitative research design, as it allows for a detailed analysis of events or situations from an expert perspective to deepen understanding (Braun and Clarke, 2006). The research team consisted of mental health staff, researchers and service users who contributed to the design, conduct and interpretation of the study. The involvement of key stakeholders in addressing relevant issues aligns with participatory research approaches. This approach has several advantages: it optimizes decision-making, improves access to information on effectiveness, enhances understanding of complex issues and creates opportunities for shared learning and reflection. As a result, it increases transparency and lends greater authenticity to the qualitative findings (Mackenzie et al., 2012).

We conducted CHIME Framework training sessions for five cohorts of MHPs and service users at a mental health care center from September 2022 to June 2023. Each cohort had an average of 15 participants, including service users, peer workers and social workers. The sessions were conducted by two staff members of the Recovery College Guetersloh-OWL (AZ and JO).

Established in 2019, Recovery College Guetersloh-OWL offers co-productive educational programs aimed at empowering individuals to independently manage mental health challenges while promoting well-being and emotional development. These programs are uniquely designed using a co-production model, in which course content is collaboratively developed and delivered by individuals with lived experience of mental health challenges, alongside professionals with specialized training in mental health care (e.g. psychiatric nurses and therapists). This approach integrates experiential knowledge and clinical expertise, contributing to a holistic learning environment that supports personal recovery and resilience.

The CHIME Framework training was a half-day session lasting four hours. It used a blended learning approach that incorporated interactive presentations, group discussions and role-playing activities to enhance engagement and deepen understanding (see Table 1). The sessions were cofacilitated by a mental health professional and an individual with lived experience, ensuring a comprehensive perspective that integrated both theoretical knowledge and real-world recovery experiences.

We recruited four service users and four mental health staff members to participate in the study. Participants were required to meet the following inclusion criteria: they had to be at least 18 years old, capable of providing informed consent and have completed the CHIME Framework training. Exclusion criteria included being under 18 years of age, lacking the capacity to provide informed consent or not having participated in the CHIME Framework training. Invitations to participate were distributed through post and telephone, with support from the mental health center staff.

The study team developed the interview guidelines (see Table 2), which were informed by the experiences of the team and the existing literature on recovery and recovery-oriented work. The team was composed of six members from the Recovery College Guetersloh-OWL, which included two trained professionals and four staff members with lived experience of mental health challenges. Pilot interviews were conducted prior to the main data collection to refine the methodology.

The study team used focus group discussions (FGDs) as the primary qualitative data collection method. The FGDs allowed for in-depth exploration of participants’ perceptions, learning experiences and the applicability of the CHIME Framework in practice. The focus group interview was conducted in December 2023 and lasted approximately 45 min. The discussion was facilitated by a researcher with a PhD and five years of experience in qualitative interviewing. The facilitator was a neutral party who was not involved in delivering the training. The interview was audio-recorded and transcribed verbatim, with all identifying information removed to ensure confidentiality. The transcripts were subsequently processed using AmberScript software (AmberScript, 2024) to manage, organize and analyze the data.

We performed inductive thematic analysis following the six-step process outlined by Braun and Clarke (2006) to identify both semantic and latent themes within the data. The analysis aimed to explore the main themes emerging from participants’ accounts without any prior theoretical assumptions (Braun and Clarke, 2006).

The research team first familiarized themselves with the data and generated initial codes (steps 1 and 2). Patterns were then identified to capture initial thoughts on potential themes (steps 3 and 4), which were discussed collaboratively within the team. Coding was deemed complete once the team agreed that no further themes could be identified (Llewellyn-Beardsley et al., 2019). Subsequently, we reviewed the identified themes based on team feedback (step 4).

All participants signed and received a copy of the consent form and were informed that they could withdraw from the study at any time. No identifying information was used in reporting the findings.

All data described in the survey were analyzed and processed following internationally applicable ethics regulations, in compliance with national law and adhering to the Declaration of Helsinki of 1975 (revised version).

Eight participants took part in focus group interviews, which consisted of a single discussion lasting approximately one hour. Participants ranged in age from 31 to 66 years (M = 45.2 years) and included four MHPs and four service users, comprising five females and three males. Sociodemographic details are presented in Table 3.

All participants completed the CHIME Framework Recovery training, providing a common foundation for the discussions. From the focus group interview, five overarching themes were identified, reflecting the participants’ experiences and outcomes (see Figure 2).

Both mental health professionals (MHPs) and service users reported that the training broadened their perspective on the meaning of recovery. They shared that recovery goes beyond merely managing symptoms; instead, it is a personal journey centered on growth, hope and empowerment. This journey enables individuals to discover a sense of purpose, harness their personal strengths and make informed choices that foster resilience and enhance overall well-being. However, experiences and interpretations of recovery varied among both service users and MHPs, influenced by their unique perspectives and subjective experiences. This highlights the deep personal and subjective nature of recovery. Here is a perspective from one of the service users:

The MHPs also emphasized that the training helped them understand the critical role of recognizing and embodying recovery, acknowledging its value in fostering a supportive and empowering environment. Here is a perspective from the MHPs:

Participants reported that the training helped them reflect on the importance of the relationship between service users and MHPs, emphasizing its critical role in supporting recovery within mental health centers. They described the relationship as essential for fostering safety, trust and a sense of belonging, which are fundamental elements for healing and personal growth. Here is a perspective from one of the MHPs:

Service users reported that the training helped them understand the value of peer support in the recovery process. They shared that relationships with others in the training who had faced similar challenges helped reduce feelings of isolation and stigma, while also providing a sense of validation and hope. This shared experience fostered a supportive environment where individuals felt understood and empowered in their recovery journey. Here is a perspective from one of the service users:

During the training, we explored how service users perceive empowerment in the recovery process. Participants shared that the process involves overcoming personal challenges, healing from past mental health struggles and gaining the strength to bring about positive changes in their lives. A key takeaway was that, with the right support, individuals are able to engage in self-reflection, cultivate resilience and reclaim their sense of agency. This enables them to rebuild confidence and develop the necessary skills to thrive in various aspects of their lives. One of the service users shared her perspective, shedding light on empowerment:

The MHPs shared that the training broadened their understanding of how empowerment plays a crucial role in the recovery process. Particularly, the significance of the collaborative effort between service users and their support systems.

In addition, the MHPs underscored that empowerment through education, therapy and fostering autonomy and self-efficacy is vital. These elements, they noted, are intertwined and essential for encouraging individuals to actively participate in their healing journey. This, in turn, helps build their confidence, resilience and ability to thrive as they regain control over their lives. Here is a perspective from one of the MHPs:

The service users reported that the training helped them reflect on some of the challenges they face during the recovery process, particularly highlighting areas where the service utilization is not fully conducive to their healing.

They described two primary barriers to recovery. The first barrier was the nature of their mental health conditions, which often led to a heavy reliance on medication, leaving limited opportunities to explore other treatment alternatives. The second barrier was systemic issues within mental health services, including strained relationships with staff, fluctuating staff assignments and the inability to effectively address individual needs.

Some service users voiced concerns about the overemphasis on medication as the primary approach to managing difficult days. They reported that other meaningful activities, such as therapy or engaging in personal hobbies, were sometimes overlooked in favor of relying solely on medications. One service user shared this perspective:

MHPs reported systemic barriers within mental health services that hindered effective care delivery. These included understaffing, which led to high caseloads and staff burnout, as well as rigid policies that imposed bureaucratic restrictions, limiting flexibility in treatment approaches and service delivery. In addition, service users often express mistrust toward institutions, driven by past negative experiences or systemic discrimination, further complicating efforts to build therapeutic relationships and provide person-centered care. One of the MHPs shared this perspective:

Participants shared that the training helped them reflect on mental health stigma. Service users and MHPs reported that the training broadened their knowledge and altered their attitudes toward stigma. They explained that societal stigma often arises from widespread misconceptions about mental health challenges, leading to feelings of shame and discrimination. These negative perceptions make it harder for individuals to seek support and openly discuss their struggles.

Within the mental health center, some service users also reported feeling stigmatized by the MHPs or other service users, which further impacted their self-esteem and engagement in treatment. One service user shared his experience, shedding light on how stigmatizing attitudes can hinder personal growth:

MHPs emphasized the importance of creating inclusive environments, combating stigma through education and promoting empathy and understanding:

Both service users and MHPs emphasized the critical need for greater participation and coproduction within mental health centers. Service users particularly highlighted the importance of being actively involved in decision-making about their care plans. They stressed that it was essential for their preferences to be considered and for them to have a voice in the process.

Service users further shared that when they felt heard and respected in their care decisions This not only improved their sense of agency but also contributed to better engagement in their recovery journey. Their involvement in shaping their care plans was seen as a key factor in promoting empowerment and a more holistic approach to mental health. Here is a perspective from one of the service users:

MHPs also recognized the numerous benefits of co-production in improving treatment outcomes. During the training, they highlighted how collaborative approaches, where service users are actively involved in their care decisions, help foster trust and promote a sense of ownership and empowerment. MHPs emphasized that involving service users in the decision-making process contributes to more effective, person-centered care, which is essential for improving the overall well-being of individuals accessing mental health services. Here is a perspective from one of the MHPs:

This qualitative program evaluation explored the subjective experiences and outcomes of a brief CHIME Framework training program for service users and mental health staff in a mental health center. The findings highlight the reciprocal influence of recovery training on both groups, offering insight into shared recovery journeys and emphasizing areas of alignment and improvement. Integrated into the CHIME Framework (Connectedness, Hope, Identity, Meaning in Life and Empowerment) (Leamy et al., 2011), these insights underscore the importance of collaborative and recovery-focused approaches to care (Hungerford and Fox, 2013).

Participants emphasized recovery as a deeply personal and dynamic process. For service users, caring and trusting relationships with staff were instrumental in fostering personal growth and confidence, aligning with previous research on the importance of trust, meaningful engagement and collaborative decision-making in recovery (Wood and Alsawy, 2017; Lau and Hutchinson, 2021). Staff members also experienced a personal transformation, reporting a renewed sense of purpose and fulfillment in their work by witnessing service users’ resilience and progress.

Service users initially described feelings of disconnection, isolation and a lack of purpose. However, the recovery training facilitated reconnection with themselves, others and their values, helping them rediscover meaning and purpose. Many participants highlighted the role of community and peer support in creating a sense of belonging and validation, which further motivated them toward health and well-being. This experience of connection and meaning highlights recovery as a process of growth and resilience for both staff and service users (Hine et al., 2023; Salkeld et al., 2012; Senneseth et al., 2021).

Positive interpersonal relationships between service users and staff were central to the recovery process. The training enhanced these relationships, fostering stronger partnerships, mutual respect and shared understanding. Staff reported improved skills in supporting service users and creating an empowering environment. These findings echo the work of Salkeld et al. (2012), which demonstrated that CHIME Framework training could drive lasting changes in professional identities and working relationships, strengthening collaboration and empathy in mental health settings. In addition, therapeutic relationship between service users and MHPs have consistently been found to be significant for positive outcomes (Martin et al., 2000) across various care settings (Priebe and McCabe, 2008; Salkeld et al., 2012). Service users often report that their relationship with health-care providers is the most important component of care (Johansson and Eklund, 2003), along with their active engagement in the recovery process (Kirsh and Tate, 2006; Dixon et al., 2016).

Empowerment emerged as a key outcome of recovery training. Service users gained self-awareness, confidence and coping strategies, enabling greater autonomy and engagement in their recovery journey. For staff, the training enhanced their capacity to foster an empowering environment through collaborative decision-making and individualized care. By promoting empowerment, the training cultivated a culture where individuals feel valued, supported and motivated to actively participate in their care (Hine et al., 2023; Salkeld et al., 2012).

Despite the positive outcomes, participants identified persistent barriers. Staff reported challenges in implementing recovery-focused approaches due to organizational resistance, limited resources and entrenched practices that prioritize standardization over personalization. Service users faced societal stigma, limited access to community support and relapse triggers, which often perpetuated feelings of helplessness. Communication gaps between staff and service users also hindered progress. Addressing these barriers requires systemic changes, resource allocation and efforts to dismantle rigid practices that impede recovery-focused care (Nakanishi et al., 2021; Senneseth et al., 2021).

Stigma emerged as a significant obstacle for both staff and service users. While service users experienced discrimination in employment, housing and social settings, staff encountered stigma within professional circles, which limited their ability to advocate for recovery-oriented practices. These findings reinforce the need for ongoing education, advocacy and community engagement to challenge societal biases and foster an inclusive culture that promotes acceptance and support (Clarke et al., 2013; Gee et al., 2015; Amsalem et al., 2018).

Enhanced involvement and coproduction were key outcomes of the training. Staff embraced collaborative decision-making, actively integrating service users’ perspectives into care planning and program development. Service users reported feeling empowered and valued through their participation, which strengthened trust and mutual respect. This approach aligns with the CHIME Framework’s emphasis on empowerment and connectedness, fostering personalized care and improving satisfaction for both groups. Ultimately, coproduction nurtures a culture of shared responsibility and partnership, enriching the recovery experience in mental health-care centers.

This study is limited by its small sample size and qualitative design, which restricts the generalizability of the findings and highlights their exploratory nature. However, it is one of the few studies to evaluate the experiences and outcomes of CHIME Framework recovery training for both mental health practitioners (MHPs) and service users. While some studies have assessed recovery training experiences and outcomes for MHPs, showing improvements in recovery-oriented knowledge, attitudes and competencies, there remains limited evidence on outcomes at the service user and service levels (Jackson-Blott et al., 2019; Lau and Hutchinson, 2021). A notable strength of this study is the active involvement of service users in the research design and participatory data collection processes, which ensures the inclusion of key stakeholders’ perspective.

The findings offer valuable implications for the design and support of mental health centers, contributing to the growing body of research on individual recovery and recovery-oriented practices. Understanding the subjective experiences of service users and MHPs is critical for developing effective care strategies and fostering collaborative, recovery-oriented environments.

Future research should address the limitations of this study by expanding the sample size and enhancing participant diversity, particularly with respect to gender representation, to strengthen the robustness and generalizability of the findings. Moreover, using quantitative and longitudinal research designs is recommended to establish causal relationships between CHIME Framework training and participants’ meaningful engagement in mental health practice and recovery processes.

The practical implications of a study on recovery training for both mental health professionals (MHPs) and service users are both extensive and transformative. This type of training fosters collaboration and cultivates a recovery-focused mindset by promoting mutual understanding, dismantling power imbalances and integrating lived experiences into mental health care practices.

Positive outcomes from such a study could encourage mental health centers to enhance recovery-oriented practices, develop innovative training programs and enact meaningful policy reforms. Moreover, it could lead to a strategic reallocation of resources, prioritizing effective training initiatives and fostering greater participation of service users in their own recovery journeys.

Recent qualitative research explored the experiences and outcomes of CHIME Framework training for both mental health professionals (MHPs) and service users within a mental health center. The findings revealed that recovery-focused training for both groups not only benefits individuals but also fosters a shift toward recovery-oriented organizational practices.

In summary, the study highlights the crucial role of recovery training for MHPs and service users in cultivating a collaborative, recovery-focused approach to mental health care practices.

The authors would like to extend their sincere gratitude to all those who contributed to the successful completion of this study. Special thanks to Svenja Frensemeier for her meticulous proofreading of the article. The authors are also grateful to Malte Strathmeier and Eckhard Sallerman for their valuable support in conducting the focus group discussions. Their appreciation goes to Gesellschaft für Sozialarbeit e.V. Bielefeld (GfS) for generously providing both the venue and participants for the study. Their support was instrumental in making this research possible.