Paper 3: The RETAFORM study - REFOCUS in French service contexts.

French national policy supports implementation of recovery-oriented practice in mental health facilities. But to date, there is no structured training on recovery-oriented practice in France and access to recovery-oriented services remains limited. Our research hypotheses are that implementation of REFOCUS in France i) will improve personal recovery at one year in people diagnosed with serious mental illness (SMI); ii) will improve other recovery-related outcomes at one year (perceived recovery orientation of MH professionals, perceived stigma, stigma stress, self-stigma, perceived coercion, wellbeing and psychosocial function) in people diagnosed with SMI; iii) will improve recovery-orientation and knowledge about recovery in MH professionals; iv) will reduce direct and indirect costs. The design is a Stepped-wedge cluster randomized controlled trial. Data collection has some similar features with the PULSAR study but here adapted to the different service context. Stratified randomization will be according to the nature of the 18 participating teams across southern and central France (community healthcare centres, daycare facilities, crisis management teams, assertive community treatment teams, etc…). Each centre will represent a cluster. Nine clusters will be randomized to receive the REFOCUS training the first year, the remaining clusters receiving the intervention in the second year. The experimental condition is REFOCUS training. The control condition is defined as routine clinical practice. A nested qualitative sub-study will investigate the respective experiences of: Trainers who trained mental health professionals to the REFOCUS intervention; Mental health providers who were trained to the REFOCUS intervention and manual; and Service users who received the REFOCUS intervention. The work is now well under way with training for Step 1 concluded and extensive participant recruitment that can be reported up to date at the time of the presentation.