Cultural differences can have a big impact on mental health recovery provisions, a new study from the University of Nottingham has shown.
The groundbreaking study, led by Dr Yasu Kotera at the University of Nottingham, has shown that the effectiveness of Recovery Colleges (RCs)—educational centres supporting people with mental health challenges—is significantly shaped by national cultural values.
This innovative study, part of an NIHR-funded programme, was also co-led by Professor Mike Slade at the University of Nottingham, and Professor Claire Henderson at the King's College London. The researchers looked across 28 countries and revealed how national culture influences the way mental health services—specifically RCs—are run, using cultural indices and data from 169 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 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, most RCs have been developed in Western countries, which share similar cultural characteristics. This has previously raised questions about how well the model fits in other parts of the world, especially where values around independence, group harmony, or emotional expression may differ.
In this 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. They then analysed how these scores were linked to cultural characteristics, using Hofstede's widely recognised framework of national culture.
The study found that seven of the twelve core components of RCs are influenced by cultural characteristics. They found 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—it 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.
This research shows that 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 study highlights a need to adapt the RC model to local cultures—particularly in countries where services are just starting to emerge.
These findings are especially relevant as RCs continue to expand globally—including into low- and middle-income countries such as Brazil, where planning is already underway.
The research team now plans to use these insights to refine the RECOLLECT Fidelity Measure to better reflect global cultural diversity. They also call for more qualitative research and collaboration with local stakeholders to further understand how to make RCs culturally inclusive.
