Cultural differences can have a big impact on mental health recovery provision, a new study from the University of Nottingham has shown.
The study, led by Dr Yasuhiro Kotera at the University of Nottingham (pictured), has shown that the effectiveness of Recovery Colleges (RCs) – educational centres supporting people with mental health challenges – is significantly shaped by national cultural values. Part of an NIHR-funded programme, the study was co-led by Professor Mike Slade at the University of Nottingham, and Professor Claire Henderson at King’s College London. The researchers looked across 28 countries and revealed how national culture influences the way mental health services, and specifically RCs, are run, using cultural indices, and data from 169 colleges RCs around the world.
First introduced in England in 2009, RCs now operate in 28 countries across five continents. Rather than focusing solely on clinical treatment, RCs offer educational courses that are said to ‘empower people with mental health difficulties to lead meaningful and fulfilling lives’.
These courses – co-produced and co-delivered by people with lived experience and professionals—cover topics such as understanding mental health, developing life skills, and planning for recovery, and are seen as a mental health innovation.
However, say the researchers, most RCs have been developed in Western countries, which share similar cultural characteristics, previously raising questions about how well the model fits elsewhere in the world – especially where values around independence, group harmony, or emotional expression may differ.
In the current study, published in General Psychiatry (BMJ), the researchers surveyed 169 RC managers in 28 countries, covering over 55,000 students. The team assessed how closely RCs follow 12 core operational components such as equality, learning, and community focus, and then analysed how these scores were linked to cultural characteristics, using Hofstede’s ‘widely recognised’ framework of national culture.
The study found seven of the 12 core components of RCs are influenced by cultural characteristics, and that RCs in countries with Individualistic and Indulgent cultures were more likely to emphasise co-production and community connection. They also explained how RCs in countries with ‘short-term-oriented cultures’ scored higher on equality, ‘perhaps because they prioritise immediate, practical outcomes over long-term planning’.
Another finding was the strong role of Individualism, which influenced nearly every part of RC operations – from how learning is delivered, to how people’s strengths are described. In more collectivist societies, the open sharing and self-promotion encouraged by RCs may feel uncomfortable or inappropriate.
Dr Yasu Kotera, Associate Professor of Cross-Cultural Mental Health at the University of Nottingham, and Collaborative Researcher at the University of Osaka, and the study’s lead author, said: “This research shows culture really matters in mental health recovery. Recovery Colleges are a powerful way to support people, but they cannot be one-size-fits-all. Understanding how cultures shape recovery processes helps us deliver more inclusive and effective care and tools around the world.”
The research teams says the study ‘highlights a need to adapt the RC model to local cultures – particularly in countries where services are just starting to emerge’.