Investigating the Meaning and (Cost-)Effectiveness of Dutch Recovery Colleges

August 8, 2025 updated by: Hans Kroon, Tilburg University

Recovery colleges (RC) aim to promote the recovery of people who experience mental vulnerabilities. Rather than facilitating treatment of illness (as regular mental health care services [MHCS] do), RCs are learning environments, with a special focus on peer support and co-creation. While MHCS are founded on scientific and professional knowledge, RCs value the knowledge and abilities of those with lived experiences as such. By sharing experiences, RC attendees can inspire and support each other (hence 'peer support') and they can use their experiences to contribute to the educational program (hence 'co-creation'). In the Netherlands RCs are 100% peer run, meaning that no mental health care workers are involved.

Despite promising premature findings on the effectiveness of RC attendance (e.g., positive impacts on MHCS use, mental wellbeing and functioning, quality of life, empowerment and more), large, controlled studies are extremely scarce. Furthermore, the way RCs are managed in the Netherlands seems to differ from the RCs that have been studied before. While RCs in some countries are a coproduction of peers and mental health practitioners, RCs in the Netherlands are 100% peer run, although they are usually hosted by MHCS. In turn, this research project aims to investigate the (cost-)effectiveness of RCs in the Netherlands. In terms of effectiveness, we expect that RC attendance improves feelings of empowerment. Besides, we investigate impacts on quality of life, mental health, loneliness, satisfaction with treatment and support and self-stigma. We also determine the cost-effectiveness of Dutch RCs.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This quantitative study is part of a larger research project that entails qualitative analysis of:

  • the meaning of Enik RC for its partakers (the first RC established in the Netherlands in 2015);
  • the position that RCs can and should have in the Dutch MHCS landscape;
  • a fidelity measure to define the core elements of Dutch RCs and to obtain an overview of the available initiatives in the Netherlands

The research project is executed in close collaboration with co-researchers who are partakers of Enik RC. The findings of the pre-registered quantitative study will be evaluated and contextualized in co-creation as such.

NOTE: The Observational Study Model is both Cohort (monitoring for a period of 2 years) and Case-Control (comparing RC partakers with non-partakers).

NOTE: Enik Recovery College has 7 established locations in the region of Utrecht at the time of our recruitment. All are included.

NOTE: Fameus has 4 established locations (Breda 2x, Tilburg, Roosendaal). All are included.

NOTE: This study is conducted both by Tilburg University (Department Tranzo) and Trimbos-institute (Department of Reintegration and Community Care) as primary organizations. The PI is also affiliated with both.

NOTE. The aimed sample size at t0 is N=120 in the RC condition. So 120 partakers of RCs will be matched with members from the PPG.

Study Type

Observational

Enrollment (Actual)

142

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Netherlands
      • Apeldoorn, Netherlands
        • Korak
      • Haarlem, Netherlands
        • Herstelacademie Haarlem en Meer
      • Tilburg, Netherlands
        • Fameus
      • Utrecht, Netherlands
        • Enik Recovery College

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

14 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

RC population (RC Group): Partakers in any way from these four Recovery Colleges: Enik Recovery College, Fameus, Korak, Herstelacademie Haarlem en Meer.

PPG population (Control Group): National panel for which participants are recruited via mental health care facilities and Regional Institutes for Protected Living (RIPLs).

Description

Inclusion Criteria:

  • For RC group: needs to attend one of the four participating RCs regularly, at least more than once.
  • Needs to experience severe mental illness/psychological vulnerabilities (both self-reported or officially diagnosed).
  • Needs to master the Dutch language to sufficient extent to understand the surveys.
  • Is 18 years or older.

Exclusion Criteria:

  • For the RC group: does not attend one of the four participating RCs regularly.
  • Does not experience severe mental illness/psychological vulnerabilities.
  • Does not master the Dutch language to a sufficient extent.
  • Is younger than 18 years old.
  • For the control group (PPG): attends an RC regularly, but not one of the four participating RCs. If an existing PPG member attends one of the four participating RCs regularly, they are allocated to the RC group.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Other
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
RC Group
Recovery College partakers in any way (see description of intervention).
Behavioral: Recovery College participation
Recovery College participation in any way (visitors, course/retreat participants, volunteers, employees).
Control Group
Participants with similar mental health profile as RC group, but do not participate in an RC. These participants are sampled from the Panel Psychisch Gezien (PPG), monitored by the Trimbos-institute.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Empowerment
Time Frame: t0 = baseline, t1= 1 year later, t2 = 2 years later.

Operationalized by means of four subscales (Confidence and Purpose, Connectedness, Self-management and Professional help) of the Netherlands Empowerment List.

Source: Boevink, W., Kroon, H., Delespaul, P., & Van Os, J. (2016). Empowerment according to persons with severe mental illness: development of the Netherlands empowerment list and its psychometric properties. Open Journal of Psychiatry, 7(1), 18-30. http://dx.doi.org/10.4236/ojpsych.2017.71002
t0 = baseline, t1= 1 year later, t2 = 2 years later.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Quality of Life (effectiveness)
Time Frame: t0 = baseline, t1= 1 year later, t2 = 2 years later.
Operationalized by means of the Maastricht QoL Scale. Source: Drukker, M., Bak, M., à Campo, J., Driessen, G., Van Os, J., & Delespaul, P. (2010). The cumulative needs for care monitor: a unique monitoring system in the south of the Netherlands. Social psychiatry and psychiatric epidemiology, 45(4), 475-485. https://link.springer.com/content/pdf/10.1007/s00127-009-0088-3.pdf
t0 = baseline, t1= 1 year later, t2 = 2 years later.
Change in Mental Health (effectiveness)
Time Frame: t0 = baseline, t1= 1 year later, t2 = 2 years later.
Operationalized by means of the MHI-5 scale. Source: Rumpf, H. J., Meyer, C., Hapke, U., & John, U. (2001). Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry research, 105(3), 243-253. https://doi.org/10.1016/S0165-1781(01)00329-8
t0 = baseline, t1= 1 year later, t2 = 2 years later.
Change in Loneliness (effectiveness)
Time Frame: t0 = baseline, t1= 1 year later, t2 = 2 years later.
Operationalized by means of the DeJong Gierveld Loneliness Scale. Source: De Jong-Gierveld, J., & Van Tilburg, T. (1990). Manual of the loneliness scale. Amsterdam, Netherlands: Vrije Universiteit.
t0 = baseline, t1= 1 year later, t2 = 2 years later.
Change in Satisfaction with Treatment and Support (effectiveness)
Time Frame: t0 = baseline, t1= 1 year later, t2 = 2 years later.
Operationalized by means of an inventory adapted from Nivel. Source: Menting, J. De Zorgmonitor - Nationaal Panel Chronisch zieken en Gehandicapten. Uit: www.nivel.nl [Laatst gewijzigd op 18-03-2021; geraadpleegd op 30-08-2022]. URL: https://www.nivel.nl/nl/nationaal-panel-chronisch-zieken-en-gehandicapten/de-zorgmonitor
t0 = baseline, t1= 1 year later, t2 = 2 years later.
Change in Self-stigma (effectiveness)
Time Frame: t0 = baseline, t1= 1 year later, t2 = 2 years later.
Operationalized by means of the ISMI-10 scale. Source: Boyd, J. E., Otilingam, P. G., & DeForge, B. R. (2014). Brief version of the Internalized Stigma of Mental Illness (ISMI) scale: Psychometric properties and relationship to depression, self esteem, recovery orientation, empowerment, and perceived devaluation and discrimination. Psychiatric Rehabilitation Journal, 37(1), 17-23. https://doi.org/10.1037/prj0000035
t0 = baseline, t1= 1 year later, t2 = 2 years later.

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change Health Care and Services Use (cost-effectiveness)
Time Frame: t0 = baseline, t1= 0.5 year later, t2 = 1 year later, t3 = 1.5 years later, t4 = 2 years later.

Use of health care facilities (e.g., GP, mental health care facilities, psychiatric hospital), services use (e.g., municipality services) and medication, to be transformed into economic costs by the use of the iMTA costing tool.

Source: Kanters TA, Bouwmans CAM, Van der Linden N, Tan SS, Hakkaart-van Roijen L. Update of the Dutch manual for costing studies in health care. Plos One.
t0 = baseline, t1= 0.5 year later, t2 = 1 year later, t3 = 1.5 years later, t4 = 2 years later.
Change in Health Status (cost-effectiveness)
Time Frame: t0 = baseline, t1= 0.5 year later, t2 = 1 year later, t3 = 1.5 years later, t4 = 2 years later.
Operationalized by means of the EQ-5D. Source: Rabin, R., & Charro, F. D. (2001). EQ-SD: a measure of health status from the EuroQol Group. Annals of medicine, 33(5), 337-343. https://doi.org/10.3109/07853890109002087
t0 = baseline, t1= 0.5 year later, t2 = 1 year later, t3 = 1.5 years later, t4 = 2 years later.
Change in Employment Status (cost-effectiveness)
Time Frame: t0 = baseline, t1= 0.5 year later, t2 = 1 year later, t3 = 1.5 years later, t4 = 2 years later.
Whether or not the participant has paid employment or a volunteering job.
t0 = baseline, t1= 0.5 year later, t2 = 1 year later, t3 = 1.5 years later, t4 = 2 years later.
Change in Absenteeism and Presenteeism (cost-effectiveness)
Time Frame: t0 = baseline, t1= 0.5 year later, t2 = 1 year later, t3 = 1.5 years later, t4 = 2 years later.
The amount of working days participants were ill and could not work (absenteeism), and the amount of working days participants were ill but still went to work (presenteeism). Regarding presenteeism we inquire about the % of work done as compared to an average working day. This will be transformed into costs.
t0 = baseline, t1= 0.5 year later, t2 = 1 year later, t3 = 1.5 years later, t4 = 2 years later.
Change in Providing and Receiving Informal Care (cost-effectiveness)
Time Frame: t0 = baseline, t1= 0.5 year later, t2 = 1 year later, t3 = 1.5 years later, t4 = 2 years later.
Questions whether participant provides informal care (and if so, how many hours per week) and whether participant receives informal care from e.g., family or friends (and if so, how many hours per week). This will be transformed into costs.
t0 = baseline, t1= 0.5 year later, t2 = 1 year later, t3 = 1.5 years later, t4 = 2 years later.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Tilburg University

Collaborators

Stichting tot steun VCVGZ
Trimbos-institute (also primary organization conducting the study)
Lister
Gemeente Utrecht

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 17, 2022

Primary Completion (Actual)

January 31, 2025

Study Completion (Actual)

January 31, 2025

Study Registration Dates

First Submitted

October 27, 2022

First Submitted That Met QC Criteria

November 9, 2022

First Posted (Actual)

November 17, 2022

Study Record Updates

Last Update Posted (Actual)

August 13, 2025

Last Update Submitted That Met QC Criteria

August 8, 2025

Last Verified

April 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • TSB_RP390

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Sharing Time Frame

Upon request.

IPD Sharing Access Criteria

PI reviews requests.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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