Moving Towards a Mental Health Recovery Orientation in Community Mental Health Clinics: The Influence of Leadership and Organizational Climate

Background and Purpose:  Over the last decade, implementation research has demonstrated the importance of organizational factors in determining uptake and effectiveness of new practices. These factors include organizational climate (e.g., cohesion, autonomy, strength of communication and stress among staff) and transformational leadership (e.g., leaders who motivate and inspire their staff). Within mental health settings, studies have demonstrated how these factors are critical to organizational readiness for an implementation effort, predicting both provider practice behavior and service user outcomes. While researchers have examined organizational factors in relation to the translation of evidence-based practices, less attention has been paid to their influence over recovery-oriented practices. Agencies around the country are now vested with the task of shifting to a recovery orientation, which means honoring self-determination and working with individuals to support their unique recovery trajectories. This quantitative study set within community mental health clinics examined whether transformational leadership was positively associated with recovery orientation and whether this association was mediated by organizational climate.   

Method:  This study recruited a sample of providers (N=273) from 14 community mental health clinics as part of a multi-state NIMH-funded randomized controlled trial. Executive leadership staff (N=49), supervisors (N=81), and direct care staff (N=143) completed a baseline survey as part of the trial. Recovery orientation was measured by the Recovery Self-Assessment Scale, transformational leadership was measured by Multifactor Leadership Questionnaire and organizational climate was measured by the Organizational Readiness for Change scale. Multivariate regression models examined the effect of transformational leadership on recovery orientation, organizational climate on transformational leadership, and organizational climate on recovery orientation. A Sobel test was then conducted to examine whether the effect of transformational leadership on recovery orientation was mediated by organizational climate.

Results:  Transformational leadership was found to be positively associated with recovery orientation (B=.331, p<.01), when controlling for years at agency, years in mental health, and age. The model R²was 0.333. When testing for mediation, organizational climate was found to be positively associated with transformational leadership (B=.588, p<.01) and recovery orientation (B=.444, p<.01). Results of the Sobel test showed that the association between transformational leadership and recovery orientation was significantly mediated (Z=6.54, p<.01) by organizational climate with 45.29% of the total effect of transformational leadership on recovery orientation being mediated by organizational climate.

Conclusions and Implications:  As with the uptake of evidence-based practices, study findings indicate that organizational factors play an important role in the shift to a recovery orientation among community mental health clinics.  Given that recovery is a values based approach, this study confirms that transformational leaders who have the ability to inspire and motivate their staff promote the uptake of recovery.  However, the study also found that organizational climate partially mediated the effect of transformational leadership on recovery orientation suggesting that transformative leaders are more effective within a positive organizational climate. Leaders, therefore, must also pay attention to creating a cohesive and supported staff in order to deliver recovery-oriented services successfully.