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Recovery Star: validating user recovery

  • Geoff Dickens (a1), Judy Weleminsky (a2), Yetunde Onifade (a2) and Philip Sugarman (a1)
Aims and method

Mental Health Recovery Star is a multifaceted 10-item outcomes measure and key-working tool that has been widely adopted by service providers in the UK. We aimed to explore its factorial validity, internal consistency and responsiveness. Recovery Star readings were conducted twice with 203 working-age adults with moderate to severe mental health problems attending a range of mental health services, and a third time with 113 of these individuals.


Mental Health Recovery Star had high internal consistency and appeared to measure an underlying recovery-oriented construct. Results supported a valid two-factor structure which explained 48% of variance in Recovery Star ratings data. Two Recovery Star items (‘relationships’ and ‘addictive behaviour’) did not load onto either factor. There was good statistically significant item responsiveness, and no obvious item redundancy. Data for a small number of variables were not normally distributed and the implications of this are discussed.

Clinical implications

Recovery Star has been received enthusiastically by both mental health service providers and service users. This study provides further evidence for its adoption in recovery-focused mental health services and indicates that items relating to addictive behaviour, responsibilities and work could be further developed in future.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Geoff Dickens (
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Declaration of interest

J.W. and Y.O. were employed by the Mental Health Providers Forum, the commissioners of Mental Health Recovery Star, at the time of the study.

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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Recovery Star: validating user recovery

  • Geoff Dickens (a1), Judy Weleminsky (a2), Yetunde Onifade (a2) and Philip Sugarman (a1)
Submit a response


The Mental Health Recovery Star: great for care planning but not as a routine outcome measure

Helen, T Killaspy, Reader and honorary consultant in rehabilitation psychiatry
21 February 2012

Dickens et al's paper (The Psychiatrist, Vol 36, 2012) reporting on the internal validity of the Mental Health Recovery Star provides evidence for the internal consistency and factor structure of the Mental Health Recovery Star. The authors state that it is assessing a single underlying recovery related construct. However, there is a problem with this statement, since recovery in this context is, by definition, a subjective construct. Therefore the application of any predetermined constructs (the ten domains of the Recovery Star) can only be considered to be assessing an individual's recovery if those domains happen to coincide with an individual's own priorities.Furthermore, a separate study (currently under review for publication) has investigated the external validity of this tool and found inter-rater reliability of 9 of the 10 domains to be below the generally accepted level (ICC > 0.7).Dickens et al present findings from routinely collected data and suggest these are evidence of the Recovery Star's sensitivity to change in an individual's progress over time (i.e. its responsiveness). The problem is that unless the same member of staff was involved in repeat ratings, these findings are likely to be invalid given the issues with inter-rater reliability. In addition, responsiveness to change needs to be corroborated by an established measure. And, finally, if earlier ratings were discussed between the staff and service user before re-rating (as is encouraged through the training and manual accompanying the Recovery Star)then neutrality is likely to have been reduced, as both may have an investment in showing progress has been made. One further, fundamental issue is that the "Ladder of Change" used to assess progress in each of the ten domains has not been validated psychometrically. The Recovery Star is very popular and has merit as a tool to enhance discussion of recovery goals between staff and service users. However, while Dickens etal's findings have helped with understanding some of the Recovery Star's psychometric properties, they do not provide evidence for its adoption as a routine outcome measure.

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Conflict of interest: None declared

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