We continued the data collection until we confirmed that we had sufficient data to account for all aspects of the themes. Data collection ended after we had interviewed and analysed data from 30 participants. Of these 30 people, 15 participated in an individual semi-structured interview, and 15 participated in the focus group interviews. The demographic characteristics of the 30 participants (mean age: 40.4 years; 46.7% women; 50.0% with schizophrenia) are shown in Table 1. The average interview time was 48.3 minutes for the interviews and 65.5 minutes for the focus group interviews.
We present our results in terms of the concept of personal recovery and the recovery-promoting factors.
Concept of personal recovery
We used a coding framework based on the existing CHIME framework  (Additional file 2: Table S1). Coding was done according to the framework, and coders could identify additional themes in the interview data as needed. No new framework was extracted from the data, but new categories were extracted and fell within the existing framework. “Compassion for others” was newly extracted in “Connectedness”, and “Rebuilding/redefining identity not being as shaped by social norms” was newly extracted in “Identity”. The concept of personal recovery and selected narratives from the interviews are summarized in Table 2a.
Compassion for others in Connectedness
Through the experience of mental illness and difficulties, the participants described that they were able to imagine others’ circumstances, including difficult situations, and to accept people with different values. A greater ability to have compassion with others was identified.
I became kinder and had more compassion for others than I did before I experienced illness.
I became able to image the background of others and accept diversity.
I want to understand the feelings of people who are suffering from difficulties and want to make use of that experience in my work.
I used to believe that mental illness was just being lazy, but through my own experience, I understood that mental illness was not laziness but illness, and I found it painful. I could be generous to myself and others.
Rebuilding/redefining identity not being as shaped by social norms in Identity
Participants who experienced mental illness and difficulties, moved away from the social norms of their group (company/school) and their original identities and values changed. They redefined their identity as being less shaped by the expectations of social norms.
Social norms that valueacademic success
I felt that I suffered from illness because of an overemphasis on educational qualifications. Treatment liberated the thought.
Social norms that value diligence or productivity
I started to think that errors and unpredictable things are interesting.
I did not doubt that hard work, good grades, and getting a good job are necessary for wonderful life. But I had no friends. I had the experience of illness and made many friends.
I used to work hard and worked to the limit. Right now, I am consciously resting and not working too hard. (C2, I4, E1, E2)
I used to lose myself in a place where productivity was the top priority, but now I have a place to play my role. (C2, I4, M1, M4)
I come to think that I want to stay as I am. (I2, I4)
Counting of the concept of personal recovery
After the themes were coded, counting was conducted to calculate how frequently each theme appeared in the interviews. We counted the number of narratives for each of the categories within the framework (Table 2b). Connectedness was most frequently coded in our study (35.2%).
The recovery-promoting factors (the participant, others, and medical) and CHIME framework are summarized in Additional file 3: Table S2.
Positive childhood experiences
The existence of positive experiences in childhood (including positive parenting support from neighbours) was newly extracted as a recovery-promoting factor.
My parents raised me to believe in me. I have accepted it and have lived. That encourages recovery.
My neighbour has helped me since my childhood. After I had a mental illness, the neighbour has helped me with housing and working.
Respectful communication from professionals
In psychiatric care, not only were specific therapies important, but respectful communication by professionals also promoted personal recovery. For example, “unconditional positive regard” by the professionals and “support to discuss not only symptoms but also everyday life and enjoyment” were emphasized.
My parents only disapproved of me, but the counsellor accepted me unconditionally.
I was able to talk to my supporter about my daily life. She did not limit my enjoyment and supported me.
Communication from peers
Communication with peers who also experienced mental illness was another recovery-promoting factor. Such communication included interactions that promoted rebuilding an identity that is not shaped by social norms, or helped deconstruct social norms.
When I felt sad that I had an illness I never wanted to have, a person who had also experienced a mental illness gave me a warm smile and warm comments.
I was career-oriented, but a peer taught me to enjoy everyday life.
I had thought that my efforts would improve the situation, but my efforts did not improve my mental illness. I was told that I was good as I was and realized that it is better to rely on medicines and peers.
Support from families
Family attitudes such as unconditional positive regard and caring communication were extracted as recovery-promoting factors.
My family remained calm even though I was confused and emotional and had been with me for a long time, even when my condition was severe. It gave me a sense of security that my family wouldn’t abandon me.
Respectful communication from acquaintances
Words and attitudes from colleagues or friends were extracted.
A colleague also understood my illness and treated me kindly.
Talking to my colleagues about my condition, I was able to work in a way that fits my condition.
My friend did not focus on my illness, and I thought that he was happy to be with me, and he talked to me and treated me as usual.
Self-learning and physical activity were also extracted as recovery-promoting factors.
I was exposed to different values in movies and TV dramas. (People with mental illness are usually working, people living in community meet people with illnesses every day, people consider physical and mental disorders to be the same)
I thought that mental illness was scary and unfamiliar. I understand that mental illness can be scientifically explained.
I was running to build physical strength, deal with loneliness, and improve motivation. Running facilitated recovery.