Table 1.
Details of the individual studies within the included mental health rehabilitation models
| First author (year published) | Country | Study setting | Type of study (quantitative, qualitative, mixed methods) | Study design | Participants N (Intervention group = IG & control group = CG) | Diagnostic breakdown; Mean Age (SD); Gender Male % | Intervention/Comparison | Follow-up | Outcome/measures | Main Outcomes: Effectiveness of Models | Quality rating |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Ahmed et al. (2021) [22] | Sudan | Inpatient setting | Quantitative | Quasi-experimental pre-post-follow-up design for one group | N = 49 |
Schizophrenia; Mean age 31.16 ± 5.12; male 49 (100%) |
Social and Cognitive Rehabilitation Program | 9 months |
Positive and Negative Syndrome Scale (PANSS) Clifford Modified Scale Mini Mental State Examination (MMSE) |
Significant improvement in psychopathology (p = 0.013 post, p = 0.04 follow-up), social skills and cognitive function | 95% |
| Arslan et al. (2014) [23] | Turkey | Community outpatient services | Quantitative | 2-arm parallel group controlled clinical trial | N = 104 (IG = 55; CG = 45) |
Schizophrenia; mean age IG = 40.5 ± 9.1 CG = 41.5 ± 11.5; male 71 (71%) |
Psychosocial Rehabilitation Program + Medication/Medication only | 6 months |
Positive and Negative Syndrome Scale (PANSS); Quality of Life Scale (QLS); Social Functioning Scale (SFS); Schedule for Assessing the Three Components of Insight (SATCI); World Health Organization Disability Assessment Schedule II (WHODAS II) |
Significant improvement in psychopathology, quality of life, social functioning, and insight (all p < 0.001), with a reduction in disability (p = 0.018). | 95% |
|
Asher et al. (2022) [24] |
Ethiopia | Community outpatient services | Quantitative |
2-arm parallel group cluster RCT, computerised randomisation 1:1 Single-centre, single-blinded |
N = 166 (IG = 79; CG = 87) | Schizophrenia, Schizoaffective or schizophreniform disorder; mean age IG = 30 (25–45); CG = 33 (25–40); male 103 (62.05%) | Community-based rehabilitation (RISE) + Facility-based care/Facility-based care | 12 months | WHO Disability Assessment Schedule (WHODAS) | Significant improvement in disability at 12 months (mean difference: − 8.13, p = 0.039) | 100% |
| Brooke-Sumner et al. (2017) [25] | South Africa | Community outpatient services | Qualitative | In-depth individual interviews | N = 6 | Schizophrenia; mean age < 45; male 66.67% | PRogramme for Improving Mental health carE (PRIME) South Africa programme | N/A | N/A | Improved self-esteem, social support, symptoms, reduced social isolation | 90% |
|
Chatterjee et al. (2003) [26] |
India | Community outpatient services | Quantitative | Prospective cohort study | N = 207 (IG = 127; CG = 80) | Chronic schizophrenia, Paranoid illness; mean age 38.1; 36,6; male 61% | Community-based rehabilitation model (CBR)/Outpatient care (OPC) | 12 months |
Positive and Negative Syndrome Scale (PANSS) World Health Organization Disability Assessment Schedule (DAS) |
Significant improvement in psychopathology and disability(all p < 0.001) | 100% |
|
Cheng et al. (2020) [27] |
China | Community outpatient services | Quantitative | Longitudinal, prospective cohort study- 2-arm parallel group | N 128 (IG = 68; CG = 60) | Schizophrenia (77.3), Other (22.7%); IG = mean age 42.07 ± 9.5; CG = 41.34 ± 9.9; male 60 (47%) | Strengths Model of case management/Care as Usual (CAU) | 12 months |
Positive and Negative Syndrome Scale (PANSS) Personal and Social Performance (PSP) Scale Social Function 36 Scale (SF36) Stigma Self-assessment Scale |
No difference between groups- endpoint: Relapse Rate: CM 7.35%, CAU Group: 5% (p = 0.73); PANSS (p = 0.95), PSP (p = 0.92), social functioning/quality of life (p = 0.97), stigma (p = 0.59) | 96% |
| First author (year published) | Country | Study setting | Paradigm (quantitative, qualitative, mixed methods) | Study design | Participants N (Intervention = IG & control = CG) | Diagnostic breakdown; Mean Age (SD); Gender Male % | Intervention/Comparison | Follow-up | Outcome/measure | Main Outcomes: Effectiveness of Models | Quality rating |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Dalum et al. (2018) [28] | Denmark | Community outpatient services | Quantitative | 2-arm parallel group RCT multicentre, single -blinded, block randomisation stratified by diagnosis and CMHC to IMR + CAU or CAU. | N = 198 (IG = 99; CG = 99) | Schizophrenia, bipolar disorder; mean age IG = 41 ± 11.0; CG = 45 ± 11.5; male 109 (55%) | Illness Management and Recovery programme (IMR)/Treatment as usual (TAU) | 9 months |
Illness Management and Recovery Scales (IMRS) Adult State Hope Scale Mental Health Recovery Measure Clients Satisfaction Questionnaire |
No significant differences were observed in illness management as rated by patients (p = 0.14) and staff (p = 0.76), hope (p = 0.53), personal recovery (p = 0.91), or satisfaction with treatment (p = 0.78). | 89% |
| Dissanayake et al. (2024) [29] | Australia | Community outpatient services | Qualitative | Descriptive phenomenological approach, in-depth, semi-structured interviews | N = 6 | Bipolar Affective Disorder (BAD): 2 Psychosis: 1 Post-Traumatic Stress Disorder (PTSD): 1 Schizoaffective + BAD: 1 Unknown: 1, mean age- 29.5; 3 male and 3 female | Strengths Model of case management (SMCM) | N/A | N/A | Importance of client–case manager relationship, strengths assessment (guides personalised interventions), recovery and goals achievement | 95% |
|
Färdig et al. (2011) [30] |
Sweden | Community outpatient services | Quantitative | 2-arm parallel group RCT, multicentre, single-blinded, block randomisation stratified by diagnosis and clinic to IMR + CAU or CAU. | N = 41 (IG = 21, CG = 20) | Schizophrenia, Schizoaffective Disorder; IG = mean age 40.38 ± 6.76 years; CG = 40.45 ± 6.44 years; male 22 (53.7%) | Illness management and recovery programme (IMR)/Treatment as usual (TAU) | 21 months |
Illness Management and Recovery Scale (IMRS) Psychosis Evaluation Tool for Common Use by Caregivers (PECC) Manchester Short Assessment of Quality of Life (MANSA) Ways of Coping Questionnaire (WCQ) Recovery Assessment Scale (RAS) Suicidality (assessed with a modified PECC suicidality subscale) Hospitalization rates Insight (assessed with the insight subscale of the PECC) |
Significant improvement in illness management and psychiatric symptoms (p < 0.001), positive symptoms (p = 0.009), negative symptoms (p < 0.001), depression-anxiety symptoms (p = 0.015), insight (p = 0.002), suicidal ideation (p = 0.013), coping strategies: seeking social support (p = 0.005), escape-avoidance (p < 0.001), planful problem-solving (p < 0.001), not significant: quality of life, recovery perception (RAS) (p > 0.05), hospitalisation (p > 0.05) | 89% |
| First author (year published) | Country | Study setting | Paradigm (quantitative, qualitative, mixed methods) | Study design | Participants N (Intervention = IG & control = CG) | Diagnostic breakdown; Mean Age (SD); Gender Male % | Intervention/Comparison | Follow-up | Outcome/measures | Main Outcomes: Effectiveness of Models | Quality rating |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Fernandez-Miranda et al. (2022) [31] | Spain | Community outpatient services | Quantitative | Observational, longitudinal, Prospective cohort study | N = 688 (IG = 344; CG = 344) | Schizophrenia; mean age 43.4 ± 11.4; male 427 (62.2%) | Case- managed program (CMP)/Care as Usual (CAU) | 10 years |
Clinical Global Impression-Severity (CGI-S) scale Number of hospitalizations Number of suicide attempts Treatment adherence |
Significant reduction in psychopathology (p < 0.005), hospitalisation, fewer suicide attempts, treatment adherence (all p < 0.0001) | 95% |
|
Gelkopf et al. (2016) [32] |
Israel | Community outpatient services | Quantitative | 2-arm parallel group RCT; Multicentre, single-blinded, computer-based randomisation, stratified by age and service dependence, to SBCM-PRS or TAU-PRS | N = 1545 (IG = 808; CG = 737) | Schizophrenia, schizoaffective, and psychotic disorders 81.05%; mean age 39.2 (12.6); male 919 (59.8%) | Strengths-Based Case Management + Psychiatric Rehabilitation Services (SBCM-PRS)/Treatment as usual + Psychiatric Rehabilitation Services (TAU-PRS) | 20 months |
Manchester Short Assessment of Quality of Life (MANSA) Goal Attainment Scaling (GAS) Unmet Needs Scale (constructed by the research team) Self-Efficacy Scale (designed by the research team based on literature) Interpersonal Relationships Scale (based on MANSA) Colorado Symptom Index (CSI) |
Significant improvement in quality of life (p < 0.01), self-efficacy (p < 0.001), unmet needs (p < 0.05), less decline in satisfaction with interpersonal relationships (p < 0.001), service utilisation (p < 0.001), goal attainment, no significant improvement in psychopathology | 89% |
|
Hasson-Ohayon et al. (2007) [33] |
Israel | Community outpatient services | Quantitative | 2-arm parallel group RCT; Multicentre, single-blinded, lottery-based randomisation to IMR or TAU | N = 210 (IG = 119; CG = 91) | IG = Schizophrenia: 95 (80%); CG = Schizophrenia: 81 (89%); IG = mean age 33.92 ± 11.10; CG = 35.45 ± 11.24; male 137 (65%) | Illness management and recovery programme/Treatment as usual (TAU) | 8 months |
Illness Management and Recovery Scale (IMRS) Coping Efficacy Scale (CES) Multidimensional Scale of Perceived Social Support (MSPSS) |
Significant improvement in psychopathology, knowledge, goals factor (p < 0.01), clinician-rated coping factor (p < 0.05), no significant improvement in perceived social support | 82% |
|
Li et al. (2018) [34] |
China | Community outpatient services | Quantitative | 2-arm parallel group RCT; multicentre, stratified cluster randomisation | N = 327 (IG = 199, CG = 185) | Schizophrenia; mean age IG = 40.21 (7.57); CG = 39.70 (7.83); male 197 (51%) | Community-based comprehensive intervention/Face to face interview | 9 months |
Internalized Stigma of Mental Illness Scale (ISMI) Discrimination and Stigma Scale (DISC-12) Global Assessment of Functioning (GAF) Schizophrenia Quality of Life Scale (SQLS) Self-Esteem Scale (SES) Brief Psychiatric Rating Scale (BPRS) Positive and Negative Syndrome Scale for Schizophrenia - Negative Syndrome subscale (PANSS-N) Medication Compliance Assessment, Insight Assessment |
Significant reduction in psychopathology, improved social functioning (both p < 0.001), reduced internalised stigma and discrimination (p < 0.05), no significant difference between groups in quality of life, medication compliance and insight (both p > 0.05) | 86% |
| First author (year published) | Country | Study setting | Paradigm (quantitative, qualitative, mixed methods) | Study design | Participants N (Intervention = IG & control = CG) | Diagnostic breakdown; Mean Age (SD); Gender Male % | Intervention/Comparison | Follow-up | Outcome/measures | Main Outcomes: Effectiveness of Models | Quality rating |
|---|---|---|---|---|---|---|---|---|---|---|---|
|
Mueser et al. (2010) [35] |
United States | Community outpatient services | Quantitative | 2-arm parallel group RCT; Multicentre, single-blinded, computer-based randomisation, stratified by diagnosis (mood disorder or schizophrenia and gender | N = 183 (IG = 88; CG = 95) | Schizophrenia: 51 (27.9%) Schizoaffective: 52 (28.4%) Depression: 44 (24.0%) Bipolar: 36 (19.7%); mean age 60.17 (7.92), male 77 (42.1%) | Helping Older People Experience Success (HOPES)/Treatment as Usual (TAU) | 24 months |
University of California at San Diego Performance-Based Skills Assessment (UPSA) Multnomah Community Ability Scale (MCAS) Social Behaviour Schedule (SBS) Independent Living Skills Survey (ILSS) Revised Self-Efficacy Scale (RSES) Scale for the Assessment of Negative Symptoms (SANS) |
Significant improvement in psychopathology, social skills, psychosocial functioning, self-efficacy (all p < 0.05), community functioning (p < 0.01) | 93% |
|
Pelizza et al. (2023) [36] |
Italy | Community outpatient services | Quantitative | Retrospective cohort study | N = 137 | Schizophrenia/other psychotic disorders (70.1%) Bipolar disorder (17.5%) MDD with psychotic features (12.4%), mean age 32.74 ± 11.15; male 85 (62.0%) | Personal Health Budget (PHB) | 24 months |
Brief Psychiatric Rating Scale (BPRS) Global Assessment of Functioning (GAF) Health of the Nation Outcome Scale (HoNOS) |
Significant improvements in psychiatric symptoms, particularly in negative symptoms, social functioning, and overall functioning (all p < 0.001). | 100% |
|
Puspitosari et al. (2019) [37] |
Indonesia | Community outpatient services | Quantitative | 2-arm parallel group a quasi-experimental study | N = 100 (IG = 50, CG = 50) | Schizophrenia, mean age 39 years; male 65 (65%) | Community-based rehabilitation (CBR)/Routine outpatient care | 16 weeks |
Lehman’s Quality of Life Interview (QOLI) Positive and Negative Syndrome Scale (PANSS) |
Significant improvement in quality of life (p < 0.05); no difference between groups in psychiatric symptoms | 100% |
| First author (year published) | Country | Study setting | Paradigm (quantitative, qualitative, mixed methods) | Study design | Participants N (Intervention = IG & control = CG) | Diagnostic breakdown; Mean Age (SD); Gender Male % | Intervention/Comparison | Follow-up | Outcome/measures | Main Outcomes: Effectiveness of Models | Quality rating |
|---|---|---|---|---|---|---|---|---|---|---|---|
|
Roosenschoon et al. (2021) [38] |
Netherlands | Supported accommodation | Quantitative | 2-arm parallel group RCT; multicentre, single-blinded, 3:2 block randomization stratified by treatment teams to IMR + CAU or CAU. | N = 187 (IG = 116, CG = 71) | Psychotic disorders: 106 (57%) Mood disorder: 61 (33%) Personality disorders: 58 (31%), mean age 44.3 ± 10.4; male 53% | Illness Management and recovery (IMR) + care as usual (CAU)/Care as usual (CAU) | 18 months |
Illness Management and Recovery (IMR) Scale Coping Self-Efficacy Scale (CSES) Multidimensional Scale of Perceived Social Support (MSPSS) Service Engagement Scale (SES) Addiction Severity Index (ASI) Insight Scale Brief Symptom Inventory (BSI) Social Functioning Scale (SFS) Mental Health Recovery Measure (MHRM) Self-Esteem Rating Scale-Short Form (SERS-SF) Internal Stigma of Mental Illness Scale (ISMI) |
Significant improvement in illness self-management (p = 0.048), self-esteem (p = 0.01); no significant difference in hospitalisation rates, social support, coping, medication adherence, insight, addiction between groups | 93% |
|
Salyers et al. (2014) [39] |
United States | Community outpatient services | Quantitative | 2-arm parallel group RCT; multicentre, single-blinded, randomisation to IMR or problem-solving group. | N = 118 (IG = 60; CG = 58) | Schizophrenia, Schizoaffective disorder, mean age 47.7 ± 8.9, male 94 (80%) | Illness Management and recovery (IMR)/Problem-Solving (PS) Control Group | 18 months |
Positive and Negative Syndrome Scale (PANSS) Quality of Life Scale (QLS) Illness Management and Recovery Scale (IMRS) Patient Activation Measure (PAM) Morisky Scale Recovery Assessment Scale (RAS) State Hope Scale |
No significant differences were found between groups in psychopathology, functioning, illness management, service utilisation | 93% |
|
Sohn et al. (2023) [40] |
Korea | Community outpatient services | Quantitative | Retrospective cohort study | N = 759 | Psychotic disorder: 381 (50.20%) Mood disorder: 378 (49.80%); mean age 44.42 years; male 349 (46%) | Intensive Case Management program (S-ICM)) | 9 months | Average Length of Hospital Stay | Hospital stays reduced from 1.47 to 0.26 days/month (p < 0.05); sustained reduction post-intervention. | 100% |
| First author (year published) | Country | Study setting | Paradigm (quantitative, qualitative, mixed methods) | Study design | Participants N (Intervention = IG& control = CG) | Diagnostic breakdown; Mean Age (SD); Gender Male % | Intervention/Comparison | Follow-up | Outcome/measures | Main Outcomes: Effectiveness of Models | Quality rating |
|---|---|---|---|---|---|---|---|---|---|---|---|
|
Swildens et al. (2011) [41] |
Netherlands | Inpatient care, outpatient care and/or sheltered living | Quantitative | 2-arm parallel group RCT; Multicentre, single-blinded, stratified block randomisation | N = 156 (IG = 80; CG = 76) |
Schizophrenia: 50% Schizoaffective: 15% Bipolar Disorder: 20%, MDD: 10% Other: 5%; mean age IG = 46.5 ± 12.2 years; CG = 46.3 ± 12.7 years; male 76 (48.7%) |
Boston Psychiatric Rehabilitation Approach (PR)/Care as usual (CAU) | 24 months |
World Health Organization Quality of Life (WHOQOL-BREF), Camberwell Assessment of Needs, Social Functioning Scale, Personal Empowerment Scale Goal attainment- binary scale |
Significant improvement in achieving personal rehabilitation goals at 24 months (adjusted risk difference: 21%, p < 0.05) and societal participation (p = 0.01); no significant differences in quality of life, social functioning, unmet needs | 93% |
|
Tao et al. (2012) [42] |
China | Community outpatient services | Quantitative | Prospective Controlled Trial | N = 142 (IG = 90, CG = 52) | Schizophrenia; mean age IG = 40.4 (10.0), CG= 43.7 (10.4), male 72 (50.7%) | Sunshine Heart Garden program/Standard community services | 12 months |
Positive and Negative Syndrome Scale (PANSS) Morningside Rehabilitation Status Scale (MRSS) |
Significant improvement in psychopathology, social functioning (both p < 0.001), no significant differences in hospitalisation rates (p = 0.074) | 100% |
|
Tsoi et al. (2019) [43] |
Hong Kong | Supported Accommodation | Quantitative | 2-arm parallel group nonrandomized Controlled Trial | N = 147 service users and 43 caseworkers initially (IG = 73 service users and 23 caseworkers, CG = 74 service users and 20 caseworkers) |
Schizophrenia: 85% Schizoaffective: 5% Bipolar Disorder.: 5% MDD: 3% Other Psychiatric Diagnoses: 2%”, mean age IG= 46.86 (12.90%), CG= 47.51 (13.71%)male 72 (50.7%) |
Strengths model of case management (SMCM)/Treatment as Usual (TAU) | 12 months |
Maryland Assessment of Recovery in People with Serious Mental Illness (MARS) Satisfaction with Life Scale (SWLS) State Hope Scale (SHS) Brief Psychiatric Rating Scale (BPRS) Working Alliance Inventory (WAI) Goal achievement ratings |
Significant improvements in goal setting and higher goal attainment rates (p < 0.01). No significant difference in symptom severity, recovery, satisfaction with life, hope, well-being, work alliance (all p > 0.05) | 100% |
| First author (year published) | Country | Study setting | Paradigm (quantitative, qualitative, mixed methods) | Study design | Participants N (Intervention = IG& control = CG) | Diagnostic breakdown; Mean Age (SD); Gender Male % | Intervention/Comparison | Follow-up | Outcome/measures | Main Outcomes: Effectiveness of Models | Quality rating |
|---|---|---|---|---|---|---|---|---|---|---|---|
|
Van Busschbach et al. (2002) [44] |
Netherlands | Community outpatient services | Quantitative | Prospective cohort study- Naturalistic | N = 35 | 60% schizophrenia, 17% affective disorder, 14% personality disorder, mean age 35 years (range 21–51), male 57% | Centre for Individual Rehabilitation and Education (CIRE) | 12 months |
Verona Service Satisfaction Schedule (VSSS-32) Camberwell Assessment of Need (CAN) EuroQoL Global Assessment of Functioning (GAF) |
Goal Attainment: 46% fully achieved, 34% partly, 14% expected to; significant reductions in needs for daily activities, accommodation, social contacts (p < 0.05); no significant improvement in quality of life or overall functioning. | 95% |
|
Wang et al. (2013) [45] |
China | Community outpatient services | Quantitative | 2-arm parallel group RCT; Single-centre, open-label, coin-toss randomisation | N = 140 (IG = 70, CG = 70) | Schizophrenia; mean age IG = 26.27 ± 6.81, CG = 26.79 ± 6.99, male 54 (19%) | Psychosocial rehabilitation training + antipsychotic mono-medication/Receiving antipsychotic mono-medication | 18 months |
Positive and Negative Syndrome Scale (PANSS) Social Disability Screening Schedule (SDSS) Schizophrenia Cognition Rating Scale (SCRS) |
Significant reduction in relapse rate at 18 months (p < 0.01), significant improvement in psychopathology, social functioning (both p < 0.05) | 89% |
Abbreviations: ASI Addiction Severity Index, BAD Bipolar Affective Disorder, BPRS Brief Psychiatric Rating Scale, BSI Brief Symptom Inventory, CAU Care as Usual, CBR Community-Based Rehabilitation, CES Coping Efficacy Scale, CG Control Group, CGI-S Clinical Global Impression-Severity Scale, CIRE Centre for Individual Rehabilitation and Education, CM Case Management, CMP Case-Managed Program, CSES Coping Self-Efficacy Scale, DAS Disability Assessment Schedule, DISC-12 Discrimination and Stigma Scale, GAF Global Assessment of Functioning, GAS Goal Attainment Scaling, HOPES Helping Older People Experience Success, HoNOS Health of the Nation Outcome Scale, IG Intervention Group, ILSS Independent Living Skills Survey, IMR Illness Management and Recovery Program, IMRS Illness Management and Recovery Scale, ISMI Internalized Stigma of Mental Illness Scale, Insight Assessment Assessment of Insight, Internalized Stigma Internalized Stigma of Mental Illness Scale (ISMI), MANS Manchester Short Assessment of Quality of Life, MARS Maryland Assessment of Recovery in People with Serious Mental Illness, MCAS Multnomah Community Ability Scale, MD Major Depression, MHRM Mental Health Recovery Measure, MMSE Mini-Mental State Examination, MSPSS Multidimensional Scale of Perceived Social Support, Medication Compliance Medication Compliance Assessment, N/A Not Available, OPC Outpatient Care, PAM Patient Activation Measure, PANSS Positive and Negative Syndrome Scale, PANSS-N Positive and Negative Syndrome Scale for Schizophrenia - Negative Syndrome Subscale, PECC Psychosis Evaluation Tool for Common Use by Caregivers, PHB Personal Health Budget, PRIME PRogramme for Improving Mental health carE, PSP Personal and Social Performance Scale, QLS Quality of Life Scale, RAS Recovery Assessment Scale, RCT Randomized Controlled Trial, RISE Rehabilitation Intervention for Schizophrenia Empowerment, RSES Revised Self-Efficacy Scale, S-ICM Intensive Case Management Program, SANS Scale for the Assessment of Negative Symptoms, SBS Social Behaviour Schedule, SDS Social Disability Screening Schedule, SERS-SF Self-Esteem Rating Scale-Short Form, SES Self-Esteem Scale, SF36 Social Function 36 Scale, SHS State Hope Scale, SMCM Strengths Model of Case Management, SQLS Schizophrenia Quality of Life Scale, SWLS Satisfaction with Life Scale, Stigma Self-assessment Stigma Self-assessment Scale, Suicidality Suicidality (assessed with a modified PECC suicidality subscale), TAU Treatment as Usual, Treatment Adherence Treatment Adherence, UPSA University of California at San Diego Performance-Based Skills Assessment, VSSS-32 Verona Service Satisfaction Schedule, WAI Working Alliance Inventory, WCQ Ways of Coping Questionnaire, WHO World Health Organization, WHODAS World Health Organization Disability Assessment Schedule, WHOQOL-BREF World Health Organization Quality of Life Scale