Table 4.

Identified themes of the thematic analysis

Themes	Data
1 ‐ Parity/ respectful relationship versus Asymmetric relationships
Feeling respected and treated as a par	User 5 (female): “Above all I can say that here at the Marco Cavallo there is the presence of an association which is quite strong (.) thus, you enter in a service where we are persons ‐ not just educators of mental health, but also simple citizens who are here to do something together (…) rather than finding yourself closed in a room with a specialist, with a psychiatrist or a psychologist seated behind a table who poses questions (.) who exploits and judges us from above…”
	Professional 2 (female): “I was much impressed by the relations with the persons, where you do not instill a sort of asymmetry but parity, where all have a stake and collaborate”
Parity is missing in traditional services	Professional 1 (female): “I have known the mental health center of [place nearby] where I did my internship. The difference you certainly may note at the Marco Cavallo is that at the other center there is a clear distinction between the professional and the user – whereas here at the MCC‐center all these distinctions do not exist”
2 ‐ Focus on people strengths versus Focus on illness
MCC values each person, focusing on strengths and potentialities	User 1 (male): “What I always say is that here at the MCC you do – here is the Doing. There is much emphasis on challenging the capabilities of each of us, even those hidden. Every day we put ourselves to the test in different situations and bring out our best (.) and for sure we are not abandoned to ourselves, left maybe in a room, watching television or talking about the‐more‐and‐less (.) every day we do something – we can give a lot”
Traditional services focus on illness	Professional 3 (female): “What I certainly have noted is, that the [traditional] mental health centers – in most cases – are ambulatory services. People with mental issues come to the service and ask for a colloquium, psychotherapy, receive a pharmacological therapy (.) so what is valorized most in these services is the aspect of the illness (…) negative aspects of the person. At the MCC instead, the capacities are valorized, the resources of every single person are really put into practice. In the Marco Cavallo, the persons put themselves at stake, mobilize their proper resources and can undertake and practice some activities they never had a chance to do before”
Positive attitude promotes social inclusion and employability	User 11 (male): “This is an important aspect of the center since it does not chronicize but allows the person – with the work – to face the external world, to socialize”
	Professional 4: (female) “The Marco Cavallo must not be considered a destination point because (.) it is clear that it is a sort of trampoline, where people can learn and obtain some capacities which are put to practice in the outside world…”
3 ‐ Freedom versus Control
Free agency	User 17 (male): “at the Marco Cavallo I find a different ambient (.) I feel freer and do not feel observed”
Feeling obliged and passive in traditional services	User 15 (male): “The Marco Cavallo was and is a place where one liberates his mind because you do something else differently (..) This is for me the Marco Cavallo! There is no waiting line for the therapy; there is not the obsessive cleanliness – this ‘you‐need‐to‐do‐this‐and‐that‐between‐eight‐and‐ten' (.) there is no professional you must give account to, there is no television at a specific hour (.) There are none of these regulations of time which institutions ask for (.) I organize my time by myself (.) I come in the morning with the bus at my free will, because no one here obliges me (…) I have also frequented another day center where there were many laboratories frequented by many people (…) there, we all – almost – have been obliged to do the same exercise, even if we didn't like it (.) here instead I have my arts‐laboratory, where I do what I would like to be able to do…”
Experience of the centre openness in contrast to previous experiences with traditional services	Family member 3 (male): “I remember, when one went to the mental health center, one rang [the bell], entered a room, the door behind us being locked (.) you needed to ring at a different doors to call the nurse who would come out to say: “you need to wait for half an hour, an hour” and then closed the door again. The experience at the mental health center has been the frequentation of a stagnant ambient, the frequentation of interiors, an inward directed psychology and psychiatry. I lamented this. Here I have found, above all, open doors. Even now there are these open doors (.) I can go and direct myself wherever I want to, frequent whatever I want and come at the hours I want to”
4 ‐ Psychological continuity versus discontinuity
Frustration due to lack of continuity in therapeutic relations at traditional services	User 2 (male): “The [previous] public mental health center has not been very appropriate for me because of the continuous change of psychiatrist and psychologists. In 20 years, I had each year a different one. I believe that I could have stayed better than I am even now if I would have had the same psychiatrist or the same psychologist (.) but overall, I had 20–22. Telling my story all the time from the start has been stressful – it did not make me feel well to remember those things…”
	User 4 (male): “You may get used to talking to get to everything you have inside, with a doctor [but] after a certain period he or she disappeared (.) I needed to restart everything from the start (.) and this – honestly – I did not find right…”
MCC is a place with stable and authentic relations	User 3 (female): “Not having a family I have started one here, in a sane and clean context, where there is no prejudice”
	(Users 4, male): “Here [at the Marco Cavallo], I feel well because you are my friends”
5 ‐ Social inclusion versus Segregation
Feeling disempowered and out of society in traditional services	User 10 (male): “In the community where I was before for two and a half years, I was annihilated. (.) First, they gave me a lot of psychiatric pharmaceuticals(..) when I came out, I was even not able to take the bus. Let us say, that I went out, had to return home to my mother (.) I forgot almost the life as it was (…) after all these experiences in these communities I had difficulties reinserting myself in society. I was not able to find work, had difficulties. With this day center – the Marco Cavallo – I have found good possibilities to reinsert myself in society”
Experiencing social and work inclusion	Family Member 1 (male): Before we felt isolated from the world, even go out from home was difficult (.) Because, when this situation happens (mental health issues) is like grief in the family, and there is a general pressure. Now, having had the opportunity to be involved in the center, we have understood the difference to our previous life and the actual one (.) It was giving us the possibility to alleviate the family burden and insert our son in a social and even working context, giving him also some economic autonomy
6 ‐ Recovery versus Chronicity
MCC associated with the concept of recovery – missing in traditional services	Family Member 3 (male): “Here, for the first time, I heard about the concept of recovery which goes beyond the word – but is the result of an organized system in which more persons undertake a journey, something which in ten years of mental health systems, of SPDC (psychiatric ward), of private structures, of psychologists, seems to have been negated (.) all told me that I would need to resign, that it would be definitive and that one would need to organize accordingly. Here at the Marco Cavallo, instead, I feel that I can heal (.) in a couple of years the journey has been one of cure, that of my wife and that of my own (.) because every problem is dealt with from a holistic perspective, more global (.) here there has been the possibility to take on the journey to grow together”
Take on responsibilities and regain self‐confidence	Users 17 (male): “Before I believed that I could rely only on medication, quite heavy medication, on medical controls but I was unable to win my fears (.) My illness started in the '90ies and was quite severe so you can imagine how many medications I have taken (.) In this journey, we are doing here (at MCC) we start wishing to improve our mental health (.) not only based on medication but with the activities we are doing in the center, and, overall, with the fact that we are taking responsibilities, being more self‐confident… I never experienced something like this before”