"I don't believe I'm going to recover from anything." Understanding recovery amongst people with severe mental illness attending community health services in Spain

Purpose The concept of recovery has become the backbone of mental health services and professional practices. However, research aimed at analysing the conceptualisation of recovery of people diagnosed with severe mental illness (SMI) has an obvious Anglo-Saxon bias. Our objective was to analyse what a sample of 51 users of mental health services diagnosed with SMI in Spain understand by recovery. Method The participants were interviewed in depth about their concept of recovery, and their responses were thematically analysed by three observers. Results Four categories of definitions of the concept of recovery were found in the analysis: Socio-Behavioural, Biomedical, Resistance, and Wellbeing-Growth. Inter-rater reliability scores ranged from 0.7 to 0.84 according to Krippendorff's alpha. While the Biomedical category essentially corresponded to the idea of clinical recovery, the Wellbeing-Growth category reproduced the concept of personal recovery (PR) that is dominant in the literature. The most frequent categories were Socio-Behavioural and Biomedical. Assimilation of the PR concept by participants was quite limited. The markedly relational character of the most frequent categories challenges the individualistic core of the classic definition of PR. Conclusions We advocate the need to make alternative recovery concepts and narratives visible to the mental health services' users and practitioners.