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BackgroundCommunity-based recovery-oriented mental health services for people with severe mental disorders have not been fully implemented in Bulgaria, Croatia, Macedonia, Montenegro, and Romania. The RECOVER-E project facilitates the implementation of specialized mental health care delivered by setting up services, implementing the services, and evaluating multidisciplinary community mental health teams. The outcomes of the RECOVER-E project are assessed in a trial-based outcome evaluation in each of the participating countries with a health-economic evaluation linked to these trials. ObjectiveThe aim of this protocol paper is to describe the methodology that will be used for the health-economic evaluation alongside the trials. MethodsImplementation sites have been selected in each of the five countries where hospital-based mental health services are available (care as usual [CAU]) for patients with severe mental disorders (severe depression, bipolar disorder, schizophrenia, and other psychotic disorders). The newly implemented health care system will involve community-based recovery-oriented mental health care (CMHC). At each site, 180 consenting patients will be randomized to either CAU or CMHC. Patient-level outcomes are personal and social functioning and quality-adjusted life years (QALYs). Data on participants’ health care use will be collected and corresponding health care costs will be computed. This enables evaluation of health care costs of CMHC as compared with CAU, and these costs can be related to patient-level outcomes (functioning and QALY gains) in health-economic evaluation. ResultsData collection was started in December 2018 (Croatia), February 2019 (Montenegro), April 2019 (Romania), June 2019 (North Macedonia), and October 2019 (Bulgaria). The findings of the outcome evaluations will be reported for each of the five countries separately, and the five trials will be pooled for multilevel analysis on a combined dataset. ConclusionsThe results of the health-economic evaluation of the RECOVER-E project will contribute to the growing evidence base on the health and economic benefits of recovery-oriented and community-based service models for health systems in transition. Trial Registration(1) ClinicalTrials.gov NCT03922425 (Bulgaria); https://clinicaltrials.gov/ct2/show/NCT03922425 (2) ClinicalTrials.gov NCT03862209 (Croatia); https://clinicaltrials.gov/ct2/show/NCT03862209 (3) ClinicalTrials.gov NCT03892473 (Macedonia); https://clinicaltrials.gov/ct2/show/NCT03892473 (4) ClinicalTrials.gov NCT03837340 (Montenegro); https://clinicaltrials.gov/ct2/show/NCT03837340 (5) ClinicalTrials.gov NCT03884933 (Romania); https://clinicaltrials.gov/ct2/show/NCT03884933 International Registered Report Identifier (IRRID)DERR1-10.2196/17454

Introduction: As an independent medical specialty psychiatry has existed in Bulgaria since 1953. The state introduced the Soviet model of work - dispensary monitoring of patients. This includes home visits of patients with severe mental illness. Mental Health care services in Bulgaria are currently in an unsatisfactory situation and there is a pressing need for reform. Objectives: Mobile psychiatric teams were presented in Bulgaria before 1989, up to 2006 and now. The main problem for the lack of sustainability of the functioning of such teams is the financing of the psychiatric system in Bulgaria. Methods: Mobile psychiatric teams at different time periods were examined. The FACT model is presented as part of the RECOVER-E project in Bulgaria. RECOVER-E project has two parts - implementation and research. Bulgaria is one of the five implementation countries, together with North Macedonia, Croatia, Montenegro and Romania. Results: For the first time the mobile team involves peer worker / expert from experience/, which helps to solve crises. The differences in the activities of the teams in different time periods are described. A proposal is made for the creation of new teams, as well as their sustainable financing after the end of the project. Conclusions: One of the major problems is the fragmentednature and lack of continuity of both care and therapy. After discharge from psychiatric hospital, the patient does not routinely have anyfollow-up appointments or referrals to other professionals. The RECOVER-E project provides an opportunity for a new approach in the treatment of serious mental illness in Bulgaria. Disclosure: All authors participate in the RECOVER-E project as researchers or as participants in mobile teams. The project is funded by the European Commission under the Horizon 2020 program. [ABSTRACT FROM AUTHOR]

Background: Community Mental Health Teams (CMHTs) deliver healthcare that supports the recovery of people with mental illness. The aim of this paper was to explore to what extent team members of five CMHTs newly implemented in five countries perceived that they had introduced aspects of the recovery-oriented, strength-based approach into care after a training week on recovery-oriented practice. In addition, it evaluated what the team members' perceptions on their care roles and their level of confidence with this role were., Method: An observational intervention study using a quantitative survey that was administered among 52 health professionals (21 Nurses, 13 Psychiatrists, 9 Psychologists, 8 Social Workers) and 14 peer workers including the Recovery Self-Assessment Tool Provider Version (RSA-P), the Team Member Self-Assessment Tool (TMSA), and demographic questions was conducted. The measures were self-reported. Descriptive statistics were used to calculate the means and standard deviations for continuous variables and frequencies and percentages for categorical variables (TMSA tool and demographic data). The standard technique to calculate scale scores for each subscale of the RSA-P was used. Bivariate linear regression analyses were applied to explore the impact of predictors on the subscales of the RSA-P. Predictors with significant effects were included in multiple regression models., Result: The RSA-P showed that all teams had the perception that they provide recovery-oriented practice to a moderately high degree after a training week on recovery-oriented care (mean scores between 3.85-4.46). Health professionals with fewer years of professional experience perceived more frequently that they operated in a recovery-oriented way (p = 0.036, B = - 0.268). Nurses and peer workers did not feel confident or responsible to fulfil specific roles., Conclusion: The findings suggest that a one-week training session on community-based practices and collaborative teamwork may enhance recovery-oriented practice, but the role of nurses and peer workers needs further attention., Trial Registration: Each trial was registered before participant enrolment in the clinicaltrials.gov database: Croatia, Zagreb (Trial Reg. No. NCT03862209 ); Montenegro, Kotor (Trial Reg. No. NCT03837340 ); Romania, Suceava (Trial Reg. No. NCT03884933 ); Macedonia, Skopje (Trial Reg. No. NCT03892473 ); Bulgaria, Sofia (Trial Reg. No. NCT03922425 )., (© 2021. The Author(s).)