General introduction 13 The third type is personal recovery, a term that originated among people with lived experiences of mental illness and highlights the personal nature of the recovery process (54, 55). Sometimes called subjective recovery (56), it includes components such as spirituality, empowerment, actively accepting the illness, finding hope, reestablishing a positive identity, developing meaning in life, overcoming stigma, taking control of one’s own life, and having supporting relationships (48). In short, it concerns the extent of perceived recovery, sense of purpose, and personal agency (56). Various authors use the acronym CHIME to summarize the key elements of personal recovery: connectedness, hope, optimism about the future, identity, meaning in life, and empowerment (57). (2) Evidence-Based Practices Since the beginning of this century, the implementation of services shown to be effective in improving patient outcomes has become more important. Such services are referred to as Evidence-Based Practices (EBPs). An EBP is an intervention whose effectiveness in helping patients achieve positive outcomes has been supported by research. The highest scientific standard of research design is considered the randomized controlled trial (RCT). When multiple randomized controlled trials show that one intervention consistently outperforms others, there is support for calling that intervention an EBP (58). A consensus had emerged in the United States regarding several effective and efficient mental health interventions aimed at supporting people with SMI. These EBPs focused on symptom management, psychosocial functioning, and quality of life (59). However, research had shown that the vast majority of people with SMI did not receive evidence-based care because it was not part of routine mental health services (59). This was also demonstrated separately in people with schizophrenia (59-61). Six EBPs were selected for the National EBP Project In this context, a relevant US national demonstration project, the EBP Project, was developed and executed by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration (SAMHSA) in collaboration with other national and local mental health authorities and several mental health research centers (59). This project aimed to develop standardized guidelines and training materials, presented as toolkits, and demonstrate how the toolkits could be used to promote faithful implementation of EBPs and improve outcomes for clients in routine mental health settings. The rationale for this EBP project was that it was not enough to know which interventions were supported by research evidence on outcomes but also to know about barriers and strategies regarding implementation (59).
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