Implementing a Person-Centred Lifestyle Programme in a Mental Health Member Organisation: Implications for Psychiatric Nursing

• Member organisation: A non-profit association run by and for its members. In this study, it is a Swedish association for people with depression or bipolar disorder and their families.

• Person-centred care: Care built around the person's own needs, goals and preferences. The person is treated as an active partner, not a passive patient.

• Recovery-oriented: An approach where "recovery" means living a meaningful, hopeful life with or despite symptoms. It doesn't require symptoms to disappear completely.

• Health promotion: Activities that help people gain more control over their health and improve it, such as exercise, sleep, diet and social contact.

• Peer support: Support from people who have lived through similar mental health experiences.

• Lived experience: Knowledge that comes from having personally faced mental health difficulties.

• Group leader (GL): An organisation member who was trained to run the programme sessions.

• Qualitative descriptive design: A research approach that describes people's experiences in their own words, without testing a hypothesis or measuring outcomes numerically.

• Semi-structured interview: An interview with a guide of set questions that still lets the conversation follow what the participant brings up.

• Qualitative content analysis (manifest level): A method of sorting interview text into codes and categories. "Manifest" means it stays with what people said explicitly rather than reading hidden meanings into it.

• Information power: A way of judging whether a qualitative sample is big enough. The question is whether the data are rich and relevant enough to answer the research question, not whether a set number of people took part.

• CHIME framework: A widely used model of personal recovery with five processes: Connectedness, Hope, Identity, Meaning and Empowerment.

• Mortality gap: People with mental disorders die 10–20 years earlier than the general population, mostly from preventable physical illnesses.

The study had one main aim: to explore how a person-centred lifestyle programme was implemented in a mental health member organisation, and what it added to the organisation's health-promoting work. Within that aim, it asked:

1. How did participants and group leaders experience running and taking part in the programme in this non-clinical, peer-led setting?

2. How might the programme support recovery-oriented, health-promoting care in everyday life, outside formal healthcare?

3. What challenges affect implementing and sustaining such a programme in a member organisation?

4. What role could mental health nurses play in community collaborations such as these?

Context and sample. The programme ran in a local branch of a Swedish non-profit with about 1,200 members in 10 branches. It was offered to members aged 55 and over.

• Training: Three members with lived experience took a two-day course from the researchers, who are psychiatric nurses. They then led the groups and received ongoing supervision.

• Session format: Each session had seven parts, including relaxation, check-ins, health education, health discussions and physical activity.

• Data: 15 people took part (3 group leaders and 12 participants), 3 of whom were family members. After two programme cycles (autumn 2023 and February–March 2024), the researchers held 15 interviews with 13 of them. Two group leaders were interviewed twice; the third leader wasn't available.

The analysis produced three main categories.

1. Support in daily life

• Structure and continuity: The weekly sessions became a "stable point in the week." They helped participants establish routines for sleep, meals and activity. Practical tools like lists, reminders and planners helped them regain a sense of control, which mattered most during periods of distress.

• Lifestyle changes for wellbeing: Physical activity was low-threshold and not about performance, so people could take part even when energy or mood was low. Daily movement, even short walks, was linked to more energy, better mood regulation, better concentration and more confidence. Participants also valued mindfulness, meditation, relaxation, music and talks about nutrition. Motivation rose and fell with mental health, but repeated chances to reflect and practise supported gradual change.

• Complement to healthcare: Participants often described psychiatric services as fragmented, time-limited or hard to access. They saw the programme as filling "a gap between the individual and the healthcare system" by offering continuity, recognition and human connection between clinical appointments. They saw it as an addition to healthcare, not a replacement.

2. The group as a space for sharing

• Belonging: The group felt safe and accepting, so people shared things they would otherwise keep to themselves. Meeting others in similar situations reduced isolation and normalized their mental health struggles. Smaller groups allowed deeper conversations. Group leaders who joined in and shared their own experiences gained credibility and motivated others.

• Hope and meaning: Sharing and reflecting together fostered hope and a sense that change was possible. Participants described recovery as gradual and made of small, meaningful everyday changes. The group also helped them work through unemployment, money worries and changes in identity, which led to more acceptance and less shame and self-criticism.

3. Challenges within the programme

• Recruitment and participation: Irregular attendance and small groups weakened continuity and relationship-building. Short recruitment periods, the narrow age range and changes in participants' health made this worse. Participants suggested starting recruitment earlier, widening the inclusion criteria and explaining the programme's purpose more clearly.

• Organisational vulnerability: The programme depended on a few highly committed people. When group leaders retired or leadership changed, continuity and knowledge transfer suffered. Participants wanted follow-up groups or digital contact after the programme ended. They reported that maintaining behaviour changes was harder than learning about healthy living. Some leaders without a healthcare background found the educational material challenging. Age-related physical limits and fear of injury were also barriers.

Interpretation

• Fit with recovery research: The findings match recovery-oriented views and the CHIME framework. The authors argue that the group was more than a way to deliver content: its relationships shaped how people understood and used the health information.

• Structure plus flexibility: A predictable format meant participants didn't have to plan, and they could join in according to their changing capacity. The combination of structure and flexibility is presented as a key factor enabling participation.

• Lifestyle change in a broad sense: Participants understood "lifestyle change" as more than adopting specific health behaviours. The authors suggest the programme's main contribution may be creating room for agency, reflection and personally meaningful change, rather than meeting set behavioural targets.

• Accessibility vs. sustainability: The low-threshold, flexible design helped people take part, but it relied heavily on a few volunteers. The authors conclude that sustainability is an organisational and structural condition, not a built-in feature of the programme.

Implications for psychiatric nursing

Mental health nurses can connect formal care with member organisations. They can contribute professional knowledge about recovery and health promotion and help combine evidence-based practice with lived experience. These partnerships should add to professional care, not replace it.

Recommendations

• Define clear roles and responsibilities.

• Provide enough organisational capacity and long-term resources.

• Set up ways to transfer knowledge when key people leave.

• Offer follow-up support after the programme ends.

• Begin recruitment earlier and broaden eligibility.

• Simplify materials and add practical tools such as checklists and short guides.

• Future research should study how these collaborations can be set up and sustained.

Limitations (reported by the authors)

• Transferability: One organisation, a small sample, people with affective disorders only, and an age limit of 55+ (set by the collaboration).

• Possible positive bias: Participants chose to take part.

• Possible interpretive bias: The researchers are psychiatric nurses who designed the programme. They tried to reduce this through reflexive discussion and peer debriefing.

• Interview length: Some interviews were short (20–55 minutes), which may have limited depth.