Table 4 Intervention characteristics: themes and examples from each innovation group

E-innovations

Flexibility

Some service users appreciated the flexibility the online portal offered compared to in-person consultations because these were available 24 hours a day, and they offered a diversity of modules and content that could be adapted to each clientʼs needs and interests [85, 88, 89].

Lived experience

Incorporating videos of people with lived experience of mental illness was valued by some, but not all users [89, 90].

Family-focused innovations

Flexibility

Flexible program content for group sessions enabled the facilitators to tailor the program to meet the unique needs and context of the particular group (for example based on the age of participantsʼ children) [93].

Peer workers

Flexibility

Flexibility in defining peer workers’ roles [104, 115] and in terms of the timing, structure, and frequency of sessions with service users [101, 109] helped peer workers adapt their services to service user and community needs.

Relationship Building

Managing relationships with staff and service users can be a complex process due to peer workers having to shift identities from that of a service user to that of a service provider, while at the same time continuing to juggle these identities in their work [102, 105, 114]. Their role is to develop close trusting relationships with service users but managing boundaries and ending relationships can be emotionally complex [99, 104, 109, 114].

Lived experience

Peer workers were thought to have an advantage compared to clinical staff because they enable greater control over choices rather than tell clients what to do [98, 104, 109], and were less controlling and intrusive and could be trusted because they did not have the power to take away service users’ rights [106]. Because of their lived experience they are more credible and trusted [104, 106, 109] and service users open-up more to them [103, 104, 106, 114].

Personal recovery planning

Flexibility

Workbooks and guides could help structure the process of recovery planning, but flexibility was important for the acceptability of the intervention among staff and clients (in terms of being optional, tailoring it to service users’ interests, including unstructured space (e.g. for drawing) and adapting to service usersʼ pace) [115, 117].

Relationship building

Personal recovery planning involves close relationship building between service providers and service users that entailed a certain amount of complexity around managing the relationship, navigating boundaries, and dealing with a sense of loss when the relationship was required to end at the end of the intervention [109].

Lived experience

Recovery planning interventions designed or co-designed by people with lived experience was seen as an important design feature [109, 115, 116].

Recovery colleges

Flexibility

Designing the college so that all students could easily join and sign-up for courses without need for referral or prerequisites was highly appreciated, as was being able to make oneʼs own choices of what to take, how much to participate in class, and dropping a course without being penalized [125, 127, 129].

Relationship building

Practitioner tutors can experience some challenges related to negotiating their dual role of colleague and clinician if the peer co-tutor is also their client and becomes unwell while working together [126].

Lived experience

Including people with lived -experience as peer tutors delivering recovery college courses was valued because of their insight into what people are going through, because students could identify with them, and because their stories of recovery inspired hope and optimism among staff and service user students [125, 128, 129].

Service navigation and coordination

Flexibility

In comparison to traditional case management, service navigation and coordination initiatives appeared to have fewer boundaries—for example service providers could do whatever it took to support recovery, and could meet clients in the community rather than in an office [110, 134].

Relationship building

Relationships are formed between service navigators/coordinators and service users and there was concern on both sides about managing program exiting, transitions to other programs, and scaling back frequency of contacts [133].

Staff training

Lived experience

Including people with lived experienced, for their real-life inspirational examples of recovery, and the sense of equality they brought to sessions, increased comfort, encouraged openness, and challenged prior identities as professional or service user [135, 137].