Social support and recovery from mental health problems: a scoping review

Figures & data

Figure 1. The search and data selection process (flow diagram, The prisma group, 2009).

Table 1. Selection and description of studies (N = 29) for the scope. almost all studies except two (Malaysia and China) were conducted in western countries.Findings sorted in to sections a) associations between mental health and social support and b) features of social support oriented services.

Reviewed studies: author(s) & title	Research question(s)/aim(s)	Study subjects	Major findings	Research design & internal validity	External validity/Transferability of the findings
SECTION a) Associations N = 13
Andrea, Siegel, and Teo (2016) Social support and health service use in depressed adults: findings from a national health and nutrition examination study (US)	Investigated the relationship between social support and health service use among men and women with depression	N = 1379 The present analysis was limited to adults aged 40 years and older, experiencing depression	Among those with adequate social support, odds of seeing a non mental health provider were much higher when depression was moderate [Odds Ratio (OR): 2.6 (1.3–5.3)] or severe [OR: 3.2 (1.2–8.7)], compared to those lacking social support. Conversely, odds of mental health service use were 60% lower among those with moderate depression [OR: 0.4 (0.2–1.0)] when social support was adequate as opposed to inadequate	Cross-sectional study design Analysis of data drawn from the 2005–2006 and 2007–2008 waves of the National Health and Nutrition Examination Survey (NHANES), an annual survey of health and nutritional status in the US conducted by the National Centre for Health Statistics (NCHS), Centres for Disease Control and Prevention	By stratifying results by severity of depression, this study first reveals that social support is associated with health service use, almost exclusively among individuals with at least moderate depression
Bjørnestad et al (2017) With a little help from my friends – social predictors of clinical recovery in first-episode psychosis (Norway)	Hypothesized satisfaction with social relationships predicts clinical recovery; secondly, frequency of social interaction predicts clinical recovery; and third, effect of friend relationship satisfaction and frequency will be greater than that of family relationships satisfaction and frequency	N = 178, age 15–65 years; meeting the DSM-IV criteria for a first-episode of schizophrenia, schizophreniform psychosis, schizoaffective psychosis, delusional disorder, brief psychosis, affective disorder with mood incongruent delusions, or psychosis	Main finding was, in line with our hypothesis, that frequency of friendship interaction predicted clinical recovery during a two-year period. This effect was sustained even when we removed the friendship criterion from the recovery measure, indicating that the effect was not simply due to pre-existing friendships. Contrary to our hypothesis, neither social satisfaction variables, nor frequency of social interaction with family members, contributed significantly to the prediction of recovery Findings suggests the possibility of facilitating recovery through helping patients increase frequency of social contacts	Longitudinally comparison design, using different instruments to measure recovery The sample was recruited from the ongoing TIPS-2 study (Early treatment and intervention in psychosis) a Naturalistic follow-along study including a population-based cohort (350.000 individuals) of FEP individuals from January 2002, until August 2013. Univariate and generalized estimating equation analysis	Attrition appears to be random, and the sample can be assumed representative with regard to baseline characteristics
Baiden, Den Dunnen, and Fallon (2017) Examining the independent effect of social support on unmet mental health care needs among Canadians: findings from a population based study (Canada)	Examine the independent effect of social support on unmet mental healthcare needs among adult Canadians after taking into account predisposing, enabling, and need factors of the behavioural model of healthcare service use	N = 3857 20 years and older with some form of perceived mental healthcare need	The study found that close to one in five Canadians (19.6%) had mental healthcare needs, of which 68% had their needs fully met and 32% had unmet needs. Social support was the strongest factor to be associated with unmet needs	Cross-sectional study design Gathers information on factors that influence mental health through a multidisciplinary approach, focusing on social and economic determinants of health. The survey covers individuals aged 15 and above residing in the 10 provinces and uses a multistage cluster sampling design with a random sampling method to select a sample that is representative of the Canadian population	It is likely that the sample is transferable to other contexts. Enhance understanding of the need for developing services towards more social support oriented organization
Finfgled-Connet (2005) Clarification of social support	To clarify the concept of social support	Meta-synthesis strategies	Social support is composed of emotional and instrumental support. It is an advocative interpersonal process characterized by reciprocal exchange of information, it is context specific, and it results in improved mental health. Antecedents of emotional and instrumental support include a perceived need plus a social network and climate that are conducive to the exchange of social support	Review (systematic) Template Verification and Expansion Model. Meta-synthesis strategies. Systematic search/review with rigour in method	All the linguistic analyses and qualitative studies were included in this study. Makes the concept of social support more perceptible
Forrester-Jones et al. (2012) Good friends are hard to find? The social networks of people with mental health illness 12 years after deinstitutionalization (UK)	Assess the social networks of a cohort of people with long-term mental illness living in the community for over a decade	N = 85 39 men and 46 women (mean age: 61 years; range: 38–88). Forty nine (60%) were 65 years or under and 32 (40%) were over 65	Social networks (median 19; range 2–85) were generally larger than those reported in previous studies. Older residents (over 65 years) had closer ties than younger residents. Congregate types of community settings were relatively devoid of social support. Participants living in hostels/small group homes reported higher levels of social support than those currently in hospitals	Mixed-methods design (?) Participants were interviewed using the Social Network Guide. Comparisons were made using generalized linear modelling. Data were analysed in terms of the frequencies of social support and interactional behaviours	Data were analysed in terms of the frequencies of social support and interactional behaviours. Comparisons between participants in the two age groups and those living in different types of accommodation were made using generalized linear modelling for multi-nominal responses (McCullagh & Nelder, 1989)
Kogstad, Mönness, and Sörensen (2013) Social networks for mental health clients: resources and solution (Norway)	Explore to what degree social networks provide relief, recovery and healing, and how the networks interact with professional help	N = 850 Service users with a variety of mental health difficulties Approximately 1/3 of the respondents were men and 2/3 women. Age between 20 and 80	There is a positive statistical correlation between network and wellbeing. The network component is the dominant factor, but another significant factor is “income situation”, discriminating between those engaged in some kind of work/study or not. Social networks emerge as the most important help system	Survey design Quantitative analyses of a sample of 850 informants The questionnaire contained 16 questions,3 dealing with gender, age, living area, job/social security, family and living situation, experiences from different help services, and opportunity to talk through bad experiences	Enables understanding of the association between social network and mental health recovery
Munikanan et al. (2017) Association of social support and quality of life among people with schizophrenia receiving community psychiatric services: A cross sectional study (Malaysia)	Assessing the association between social support and QOL	N = 160 aged 18 years and above diagnosed as having schizophrenia predominantly Malay, aged less than 40	The majority of the respondents (71.9%, N = 115) had poor perceived social support, followed by a lower proportion (44%, N = 27.5) with moderate scores and only one person had a high score (0.6%, N = 1) There was significant positive correlation between the different types of social support (total, family, friends and significant others) and QOL (total). The higher the social support levels in all types of social support perceived by respondents, the higher the quality of life they experienced	A cross-sectional study design. Conducted on 160 individuals with schizophrenia receiving community psychiatric services in Hospital Kuala Lumpur (HKL). The WHOQOL-BREF, Brief Psychiatric Rating Scale (BPRS) and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess QOL, severity of symptoms and social support, respectively	Conducted over a 3-month period in 2015 with data mostly collected at patients’ homes and outpatient psychiatric clinic, whenever patients came for follow up visits The Malay version of MSPSS (validated) demonstrated good psychometric properties in measuring social support Relevant for target group in other settings
Puyat (2013) Is the influence of social support in mental health the same for immigrants and non-immigrants? (Canada)	Examine association between social support and mental health across immigrant groups	N = 42,556 individuals between the ages of 12 and 85 who completed the social support survey module	In comparison with individuals who had moderate levels of social support, individuals with low social support had higher odds of reporting mental disorders and this association appeared strongest among recent immigrants. Using the same comparison group, individuals with high social support had lower odds of reporting mental disorders and this association appeared stronger among longterm immigrants.	Retrospective cross sectional study design. Descriptive statistics for each variable were first calculated. v2 tests were then performed to determine if mental health differed by social support levels, immigration status, age, sex, marital status, education, self-rated health and perceived stress	Applicable to understand mental health in broader contextual way, and the importance of extra social support efforts for recent immigrants. All statistical outputs were weighted to obtain population-based point-estimates of the association between social support and mental health
Smolak et al. (2013) Social support and religion: Mental health service use and treatment of schizophrenia (US)	Examine: (1) the religious perceptions of families, professionals, and the public towards schizophrenia; (2) religious perceptions of the aetiology of schizophrenia; (3) how others perceive religion as a coping mechanism; and (4) how religion influences treatment engagement and help-seeking behaviours	N = 43 Family members and caregivers	Religious beliefs influence the treatment of schizophrenia in the following ways: Religious themes were positively associated with coping, treatment engagement and help-seeking behaviour. Evidence of religious underpinnings was found in perceptions of aetiology. The findings also indicate that there is often both a preference among family members and caregivers to utilize religious based professionals and caution towards mental health professionals	Review (systematic) Forty-three studies were included in this review. One (2%) study was published in the 1980s, 10 (23%) studies were published in the 1990s, and 32 (74%) were published between 2000 and 2010. Twelve (28%) of the studies described studies conducted in the United States, and 18 (42%) were from other countries. The studies investigated the perspectives of family members, professionals, and/or the larger public	Limitations in this investigation include the reliance on published, peer-reviewed English language journals, which consequently limits its analysis to these studies. Also, the methodological calibre and quality of the existing literature, such as the absence of longitudinal studies or randomized controlled trials, is a limitation
Sun et al. (2019) The Influence of Social Support and Care Burden on Depression among Caregivers of Patients with SMI (CN)	Examine the influence of social support and care burden on depression among caregivers of SMI patients	N = 256	Results strongly demonstrates that social support and care burden were predictors of depression, especially social support. Shows that social income and status plays an important role when it comes to the ability to create strong social networks and prevent depression among caregivers	Structural equation modelling (SEM) to test hypothesized relationships among variables	Especially relevant for understanding the burden of caregiving and specific types of social support – relates to social context and recommends improving social network. Opens up the multi-factor complexity of social support
Stockdale et al. (2007) The importance of social context: neighbourhood stressors, stress-buffering mechanisms, and alcohol, drug and mental helath disorders (US)	Examine the relationship among neighbourhood stressors, stress-buffering mechanisms, and likelihood of alcohol, drug, and mental health (ADM)	Adults from 60 US communities (n = 12,716)	Cross-level interactions revealed that violence-exposed individuals in high crime neighbourhoods are vulnerable to depressive/anxiety disorders. Likewise, individuals with low social support in neighbourhoods with high social isolation (i.e., low-average household occupancy) had a higher likelihood of disorders	Conceptual framework design Test a conceptual model that explores effects of neighbourhood stressors and stress-buffering mechanisms on ADM disorders	Wherever possible study use data for the smallest geographic entity to more accurately represent neighbourhood characteristics. Important knowledge considering social environment factors that effects social support
Townley, Miller, and Kloos (2013) A Little Goes a Long Way: The Impact of Distal Social Support on Community Integration and Recovery of Individuals with Psychiatric Disabilities (US)	Document and describe distal supports for individuals with psychiatric disabilities. Focus primarily on the type of social support provided	N = 300 adults using outpatient mental health services and living in independent housing in Columbia, the largest city in South Carolina. 66% female; 64% self-identified as Black, 28% as White, 3% as Latino, 2% as Alaskan Native/Native American, 2% as Asian, and 1% other	Found that distal supports predicted both recovery and community integration after accounting for the influence of traditional social support networks. Traditional social support had larger standardized beta weights and accounted for the most variance in both community integration and recovery; however, distal support still explained a significant amount of unique variance. having traditional social support is perhaps more influential in the community integration and recovery process, the establishment of casual ties with community members plays a unique role in supporting individuals to engage in community life and lead satisfying, productive, and healthy lives	Cross-sectional study design Data collected from a sample of 300 adults using outpatient mental health services and living in independent housing in Columbia, the largest city in South Carolina. Distal supports were assessed using a modified version of the Distal Support Measure. Mixed-methods data preparation and analysis	Relevant to understand different types of social support – transferable to other contexts
Wesselmann et al. (2015) Religious believes about mental illness influence social support preferences (US)	Hypothesized that individuals’ endorsement of the spiritually-oriented causes/treatments belief factor will predict a positive relation with willingness to provide spiritually oriented social support	N = 262 University students in an undergraduate psychology course	Found evidence that individuals’ religious beliefs influence the types of social support they would be willing to give a hypothetical friend who had a mental illness. Christians’ beliefs that mental illness results from immorality/sinfulness and that mental illnesses have spiritual causes/treatments both predicted preference for giving spiritual social support to a hypothetical friend with depression. Evangelical Christians endorsed more beliefs that mental illness has spiritual causes/treatments than Protestant and Roman Catholic Christians, and they endorsed more preference for giving spiritual social support than Roman Catholic Christians. These data, to our knowledge, are the first examining preferences for the types of social support religious individuals are willing to give someone with a mental illness	Survey design Used established measure of religious beliefs about mental illness (Wesselmann & Graziano, 2010) Participants entered the lab individually or in groups and completed the measures at individual workstations. Participants indicated their religious affiliation and then answered subsequent measures. Measures were embedded in various pilot-testing materials.1 These data were collected across two semesters	The factor structure of social support measure did not support the anticipated conceptual structure found in previous social support literature Rather than finding spiritual and secular equivalents of the four types of social support (i.e., appraisal, emotional, informational, and instrumental support) instead found three factors: spiritual, secular counselling and secular instrumental support
SECTION b) features of social support N = 16
de Jong et al. (2016) Enabling social support and resilience: outcomes of a family group conferencing in public mental health care (Netherlands)	Explore effects of Family Group Conf. #1 Has the (quality of) social support for the main actor(s) been increased? 2. Has the main actor(s’)’s resilience been increased? #3 Did the conference have an influence on the improvement of the living conditions of PMHC clients, client systems and neighbourhoods wherein PMHC clients are living? #4 Has the demand for professional care been decreased?	N = 312 Everyone who attended the conference or could reflect on its outcomes	Family Group Conferencing (FGC) is a decision-making model where clients with their social network formulate their own plan. In the analysed cases, the resilience of clients, client systems and neighbourhoods as perceived by several respondent groups increased after the conferences, though not with spectacular amounts. The perceived living conditions of the main actors also improved, the same applies for the quality and quantity of social support	Naturalistic case study-design In 33 cases, it was possible to obtain scores from 245 respondents on scales ranging from 0 to 10 about the situation prior and after the conference on three outcome measures, namely the quality of: (1) social support, (2) resilience and (3) living conditions	Adresses the importance of network gatherings and that it might increase potential considering quality of social support
Gidugu et al. (2015) Individual peer support: A qualitative study of mechanisms of its effectiveness (US)	Clarifying ambiguities in the role of the peer support specialist, to further elucidate the nature and processes of individual peer support, and to clarify what makes peer support effective from the point of view of the recipient	N = 19 To be eligible for the study individuals had to: (a) be an adult with a psychiatric condition, (b) be served by the local behavioural healthcare organization, (c) have received a minimum of 10 sessions of individual peer support	This qualitative study suggests that peer support relationships have hallmarks of traditional helping relationships. Practical supports, role modelling and mentoring, and social opportunities alongside getting emotional support through a normalizing relationship with someone with similar experiences stand out as possibly the most critical and effective aspects of the peer support specialist’s roles	In debth interviews/explorative design Grounded theory/constructivist approach	Relevant experience and sample that can transfer to the target group and services
Horghagen, Fostvedt, and Alsaker (2014) Craft activities in groups at meeting places: supporting mental health users everyday occupations (Norway)	Explore how the participants’ engagements in craft activities in a group supported their way of managing everyday occupations	N = 12 participants had long-lasting mental health illness, were receivers of disability benefits, and participated in the craft group almost daily	Procedures for paradigmatic analysis were followed, and brought forward three themes: doing crafts in a group facilitated stability and routines, skills and abilities, and peer support. The discussion reflected knowledge and experiences of crafts as an activity with a low-risk threshold for participation and its healing value	Focused Ethnography was chosen as a design, to meet the study’s exploratory aim	Allows perspectives from persons with long term mental health problems and direct strategies that can enable social support
Karlsson et al. (2017) Aspects of collaboration and relationships between peer support workers and service users in mental health and substance abuse services – A qualitative study (Norway)	How do service users experience collaboration with peer support workers? What do service users describe as useful and supportive in relationship with peer support workers?	N = 26 17 women and 9 men with a variety of mental health and/or substance abuse challenges	The study describes that service users in this context over all seem to have positive experiences in the collaboration with peer support workers. Collaboration is described as unique, loving and that it can be easier to develop trust than with professional mental health workers. The study also points out that peer support workers can facilitate positive change in mental health services	Five focus group interviews/in depth design Descriptive and explorative design, based in a phenomenological hermeneutical approach	Study not generalizable, but enables important perspectives on social support oriented service and aspects important to develop services
Kloos and Shah (2009) A social ecological to investigating relationships between housing and adaptive functioning for persons with serious mental illness (UK)	Investigate impact of social ecology theory can develop treatment	Account of how social ecology theory transformed a research programme, from examining individual risk factors to investigating the functioning of persons in the contexts of their housing and neighbourhood experiences	Paper reports on how social ecology theory transformed a research programme, focused on risk factors associated with housing into a more comprehensive understanding- the contexts of housing and neighbourhoods can address housing problems and can promote health and recovery from mental illness	Conceptual framework design	Uses relevant research/evidence to build up the investigation and study. Can inspire development in services in different contexts with focus on ecology
Langeland and Wahl (2009) The impact of social support on mental health service users’ sense of coherence: A longitudinal panel survey (Norway)	Investigate the ability of the six social provisions in Weiss’s theory of social support to predict the positive development of sense of coherence among people with mental health problems	N = 107 18–80 years of age, living at home with a variety of mental health challenges	Results indicate that improving social support with special emphasis on opportunity for nurturance might provide important opportunities for increasing sense of coherence among people with mental health problems	Longitudinal survey design	Performed a multiple regression analysis, with change in SOC from baseline to follow-up as dependent variable, and social support and mental symptoms at baseline as independent variables Gives important knowledge to integrate quality in the work with social support
Lamont et al. (2017) Qualitative investigation of the role of collaborative football and walking football groups in mental health recovery (UK)	Aimed to explore the experiences of players in four collaborative football and mental health projects related to; i) the perceived benefits of participation from an individual and community perspective; ii) the key elements underlying success or otherwise of the project as defined by participants, and iii) the role played by football in both the delivery	N = 25 Service users described their mental health diagnoses as: paranoid schizophrenia (n ¼ 2), bipolar disorder (n ¼ 3), depression (n ¼ 2), borderline personality disorder (n ¼ 2); n ¼ 9 did not disclose 21 and 64 years old (86%) of whom were male	Identifies that collaborative football groups can act as a conduit for recovery. Similarly, they can be an important aspect of mental health care and identifies a number of benefits in Common with previous investigations, including promotion of a reconnection with personal history, and improved wellbeing, mutual support, social opportunity, and friendship.	Focus group/in depth interview design Four FGs (60–90 minutes) as a method of gathering data about the experiences of mental health service users and practitioners in collaborative football groups The epistemological underpinning of the study was essentialist/realist as described by Braun and Clarke (2006)	Important perspectives from service users and their view on mental health recovery Supports other research on common topic
Ljungqvist et al. (2016) Money and mental illness: A study of the relationship between poverty and serious psychological problems (SWE)	Can the addition of modest financial support for social and recreational activities have an impact on social intercourse, sense of self, symptoms, and functional level among persons with SMI?	N = 150 The age of the study participants ranged between 18 and 65. The participants were diagnosed as having a SMI by psychiatrists	The concordant results from the study of Davidson et al. and this study indicate that a social initiative in the form of modest financial improvement may lead to a better situation for persons with SMI. Reducing relative poverty seems to enable these persons to regain access to and actually make use of different public and private arenas for social exchange	Intervention study design N = 100 who were in touch with both psychiatric care and with social services directed to persons with severe psychiatric problems. For 9 months they were offered, in addition to treatment and financial support as usual, an extra allowance of 500 SEK (73 USD, 53 Euro) per month. The money presented as a contribution towards social/leisure activities at the free disposal of the participant (Comparison group N = 50)	Based on the American model of Davidson et al. developed in the early 1990s. The design was adapted to Swedish conditions – gives important insight in money support as indirect strategy for boosting social support
Muir et al. (2010) I didn’t like just sitting around all day: facilitating social and community participation among people with mental illness (Australia)	Assesses whether and how supported housing models can assist people with high levels of psychiatric disability to participate meaningfully in the community	N = 92 Service Users of supported housing Australia	Understanding whether and how individualized housing support programmes improve community participation is important to address social exclusion, loneliness, stigma and discrimination, and poor economic participation among people with high levels of psychiatric disability. The HASI Stage One evaluation found that the NGOs’ role in facilitating social and community participation could be instrumental to increasing meaningful activity among programme clients. This support was possible because of permanent social housing and active mental health case management	Longitudinal evaluation design of a supported housing model in Australia: the Housing and Accommodation Support Initiative Stage One (HASI)	Enables knowledge that can be transferable to other services
McKeown, Roy, and Spandler (2015) You’ll never walk alone: supportive social relations in a football and mental health project (UK)	Evaluation of a football and mental health project to explore participants’ experiences of supportive group social relations	N = 46 Mental health service users, majority of individuals accessing IAG were working class, white men, often unemployed and experiencing such difficulties as anxiety, depression, anger, low self-esteem, or difficulties related to drug and alcohol use	Taken together, the relative success of peer-support workers in general psychiatric services, evidence from other specialist areas (such as drug rehabilitation), appreciative service-user narratives, and the findings of this study suggest that more could be made of peer-to-peer support across mental health care. In more transformative terms, the mix of mutual support demonstrated in the IAG initiative is supportive of growing interest in the value of more relational and collectivized models of care, such as therapeutic communities, Open dialogue as alternatives to established models of care	Focus group/in depth interview design Mixed-method evaluation of IAG located in seven professional football clubs in the north–west of England Facilitated six focus groups with players who had completed the programme (40 participants in total) and one with the coaches (6 participants)	Broad perspectives from service users. Experiences gives insight in alternative mental health practices that can be important in recovery
Owczarzak et al. (2013) What is “Support” in supportive housing: client and service providers perspectives (US)	Explore how clients of supportive housing programmes conceptualize support	N = 33 Residents with a variety of mental health problems	Narratives of individualism, independence, and a “do it yourself” ethic pervaded residents’ descriptions of strategies to access welfare benefits and supportive services. These themes were embedded in concerns about coercion, choice, and privacy. Residents discussed these issues in the context of their histories of substance abuse, mental health diagnoses, HIV status, and other personal factors	In-depth orientation/design Semi-structured interviews with 23 residents and 10 service providers from nine different supportive housing programmes in Hartford, Connecticut Data analysis explored residents’ perceptions of and experiences with supportive housing programmes in the context of strategies to access resources and receive emotional, financial, and other forms of support	Perspectives that are transferable to other contexts and points out knowledge that facilitate and hinders social life
Prince et al. (2018) Nine ways that clubhouses foster interpersonal for persons with severe mental illness (US)	#1: What is it about clubhouses that promote closeness? #2: In relation to other types of mental health programmes, what lessons can be learned?	N = 20 People experiencing mental health problems, using Fountain house, New York	Nine clubhouse features that are most central in promoting interpersonal closeness. Other types of mental health programmes can integrate many of the nine features in order to combat the social isolation that can lead to relapse or other adverse consequences	Focus group study in three focus groups applying grounded theory method of analysis Internal validity (Credibility) inherent in focus group process	The clubhouse and the participants are typical of clubhouses for people with mental illness and their users
Smidl, Mitchell, and Creighton (2017) Outcomes of a therapeutic gardening programme in a mental health recovery centre (US)	#1 Do participants in a gardening programme practice personal and social responsibility? #2 How does a gardening programme promote emotional well-being? Physical well-being? Socialization and peer support?	N = 20 younger adults ages 26–49, and the remaining half were 50–72-years-old. Eleven persons were diagnosed with mood disorders, and nine with schizophrenia or schizoaffective disorder	The results of this programme evaluation support the conclusion that building and caring for a garden facilitates mental health recovery, and connects people. As found in previous research, participation varied depending upon the nature of the tasks and the unique needs and preferences of each person	Mixed method-design The project was organized in four phases throughout the course of 1 year. These phases were planning, construction of raised-bed gardens, maintenance of the gardens, and harvest. The United Way’s Outcome Logic Model was used to structure the programme evaluation (United Way of Greater Richmond & Petersburg, 2015)	Example of direct strategy of social support oriented service approach – inspiration for other services
Webber et al. (2015) Enhancing social networks: a qualitative study of health and social care practice in UK mental health services (UK)	Aimed to understand how practitioners help people recovering from psychosis to develop their social networks	(N = 124) N = 51: Sample of people recovering from an episode of psychosis who were in their first or second engagement with mental health services to participate in the study. Participants were largely between 16 and 35 years of age	Findings suggest that shifting the focus of clinicians away from deficits in the social functioning of people with psychosis (e.g. Brugha et al. 1993) to identifying assets and shared interests among them (Rapp & Goscha 2011) encourages social engagement. This study supports Perry’s (2012) findings that changes in social environments impact the social networks of people with severe mental health problems	In-depth orientation/design Qualitative study of practice in six health and social care agencies in England using combinative ethnographic methods (Baszanger & Dodier 1997). Comparative method in grounded theory (Glaser & Strauss 1967)	Cannot be generalized to the whole population of people recovering from an episode of psychosis, but creates solid base of knowledge considering focusing on social predictors in recovery
Webber (2017) A review of social participation interventions for people with mental health problems (UK)	To explore and summarize social participation models	N = 19	Nineteen interventions from 14 countries were identified, six of which were evaluated using a randomized controlled trial. They were grouped together as: individual social skills training; group skills training; supported community engagement; group-based community activities; employment interventions; and peer support interventions. Social network gains appear strongest for supported community engagement interventions, but overall, evidence was limited	Review (systematic) A systematic search of electronic databases was conducted, and social participation interventions were grouped into six categories using a modified narrative synthesis approach	Enables different features of social support oriented interventions that can inspire mental health services
Whitley et al. (2008) The active ingredient of intentional recovery communities: focus group evaluation (US)	Explore and elucidate whether components of these communities appeared to assist recovery from the point of view of consumers, and if so which were the most important factors	N = 38 Participants were openly recruited from within the recovery communities Washington DC	Almost all participants lauded the recovery communities as a significant contributor to positive change in various psychosocial domains. Three aspects of the recovery community appeared to be important in this regard. Though there is significant overlap between these themes, they are differentiated in the results for ease of comprehension. The themes are (i) the community as a place of safety, (ii) the community as a surrogate family, and (iii) the community as socialization and individual growth	Focus group/in depth interview design Four focus groups were held in total (one for each recovery community). Data were analysed according to the grounded theory approach outlined by Glaser and Strauss (1967)	Small-scale qualitative evaluation in a single setting. Important perspectives other services/communities can learn from Not generalizable

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