Issue 113. Feature... Recovery Colleges. Co-Production in Action: The value of the lived experience in Learning and Growth for Mental Health

Transcription

1 Feature... Recovery Colleges. Co-Production in Action: The value of the lived experience in Learning and Growth for Mental Health KATHERINE H GILL This paper explores the value of co-production, in the context of the recently established South Eastern Sydney Recovery College (SESRC). The SESRC is a pioneering educational initiative in Australia, focused on learning and growth for better mental health, and demonstrating advances in recovery-oriented public mental health service practice. The SESRC embeds the lived experience of the consumer voice within every aspect of the College, from initiation, planning, course development, course facilitation, the day-to-day running of the College, the governance structures through to the outcomes evaluation research. Staff interviews and course evaluations highlight the value of co-production within the Recovery College setting. The overarching themes identified through the establishment stages of the College, were that the lived experience within the co-production framework was transformational and life changing in the mental health setting. Furthermore, coproduction was not without challenges and we experiences many learning experiences during the initial stages of setting up the College and developing the courses. Students attending the College indicated that the inclusion of the lived experience along with professional experience was powerful and inspiring. South Eastern Sydney Local Health District in partnership with the St. George and Sutherland and City East Community Colleges (local registered training organisations) was awarded a NSW Health Innovations in Integrated Care Project Grant ( ) to pilot the mental health Recovery College as a new and innovative approach for delivery of recovery-oriented services. The Recovery College initiative aligns with The National Framework for Recovery-oriented Mental Health Services (Commonwealth of Australia, 2013) and Australia s National PAGE 10

2 Recovery-Oriented Mental Health Practice Recovery-oriented mental health practice supports people to recognise and take responsibility for their own recovery and wellbeing; to define their unique goals, wishes and aspirations. The recovery framework sees recovery as a personal and individual journey and a process in which people with mental health concerns develop a meaningful and contributing life with or without ongoing symptoms of the mental illness. programs, co-developed and co-delivered by people with lived experience of mental health concerns and health professionals. The College is open to mental health consumers, their carers, families and friends; as well as mental health staff, volunteers, and staff of College partner organisations. For carers, families, friends and health professionals, the College is an opportunity to better understand mental health challenges and to support people in their journey of recovery. All of the courses come from a recovery perspective to inspire people to have hopeful and meaningful lives. Standards for Mental Health Services 2010 which draw on national and international research to provide a consistent approach to recovery-oriented mental health practice and service delivery. The National Framework specifies that recovery-oriented mental health services have a responsibility to work in partnership with a broad cross section of services and community groups, and to embrace and support the development of new models of peer-run programs and services. Recovery-oriented approaches recognise the value of the lived experience and bring this together with the expertise, knowledge and skills of mental health practitioners. Recovery approaches challenge traditional notions of professional power and expertise by helping to break down the conventional divide between consumers and staff (Australian Health Ministers Advisory Council, 2013). Within recovery paradigms all people are respected for the experience, expertise and strengths they contribute. Personal recovery has been described as a journey of discovery, making sense and finding meaning in one s life journey (Repper and Perkins 2012). In recovery a person becomes an expert in managing his/her own self-care, identifying and building on unique strengths and resourcefulness to build a new sense of self to pursue personal aspirations and life goals (Perkins, Repper et al. 2012). Principles identified as important in facilitating recovery include having a sense of hope, a locus of control, and opportunities to build a life beyond mental illness (Boardman and Shepherd 2009). The Recovery College concept The Recovery College approach, whilst new to Australia, is recognised internationally as a key feature of contemporary, recovery-oriented mental health services. The Recovery College model used in South Eastern Sydney is based on the highly regarded Recovery Colleges in the United Kingdom (Perkins and Repper, 2012), a model that evolved from the Recovery Education Centres in the USA (Recovery Innovations in Arizona, Boston University Centre for Psychiatric Rehabilitation). The Recovery College is an innovative model that converts traditional treatment approaches into educational opportunities to develop consumers self-management skills, to enhance recovery and reduce dependence on mental health services. The College offers comprehensive education and training PAGE 11 Co-Production and the Recovery Colleges Co-production frameworks involve an equal partnership between professionals and service users, working collaboratively to plan and deliver services. Co-production frameworks recognise that both partners have vital contributions to make, and both partners bring vital expertise and knowledge which can be harnessed and synthesised to improve the quality of services. The principles of co-production are a fundamental component of the Recovery College model, whereby people with lived experience of mental health concerns (otherwise known as consumers or service users) are brought together with health professionals as equal partners to plan and deliver new educational programs. Co-production has been fundamental to the establishment and implementation of the SESRC and is incorporated into all facets including planning and course development, governance, administration and the day-to-day running of the College, course facilitation and research and evaluation. Within the Recovery College setting those who attend the courses are regarded as students, whether they are clinicians, clinical students, corporate staff, carers or consumers. Those facilitating the courses are educators, with each course facilitated by both a clinical and a peer educator. Co-production is recognised as having the potential to transform the way services are delivered and systems are structured. It creates new relationships between those who use services and the professional staff and goes well beyond traditional consultation or tokenistic participation (Slay and Stephens 2013). Within the co-production framework both partners contribute equally and both are valued for the vital contributions that their professional and/or lived experience brings to planning and delivery of programs. Co-production requires a shift in the organisational structure and culture. Professionals need to be prepared to take on the feedback, advice and decisions made by those with lived experiences. New structures of management and governance that incorporate the lived experience of service users at every level need to be developed and new risk management policies need to be identified and implemented (Needham and Carr 2012).

3 Co-production requires a redefining of the way the experts view service users. Instead of being people who have needs and are dependent on and/or passive recipients of the professional expert advice and opinion, service users are now seen as the expert in their personal recovery journey. The expertise, assets and value of the lived experience of the consumer worker is recognised and harnessed within the health system in order to improve the quality of services delivered. Outcomes to date The Recovery College commenced delivery of courses in July As of September 2014, eleven courses have been delivered through three streams: indicated that sometimes the process was very positive, rewarding and empowering. I felt I was respected, there were no power dynamics, we communicated well, shared equally and we both felt comfortable and safe in saying what we thought. But in other cases, the experience was different: It wasn t an equal experience, I felt my opinion was over ridden, and I wasn t able to vocalise On one occasion the clinician put a line through my work. This made me feel disempowered and I lost self-esteem. On this occasion it was not a safe and equal experience. 1. Understanding Mental Health Conditions and Treatment Options 2. Rebuilding Your Life: Developing Knowledge and Skills 3. Getting Involved in Mental Health Services and Making a Difference To date, 107 students have enrolled with the College, all courses had the maximum number of enrolments and all had waiting lists. Service users of the South East Sydney Local Health District mental health services are eligible to attend the Colleges free of charge. Students attending the courses have included consumers (43%), carers (11%), clinicians (25%) clinical students (18%) and corporate staff (4%). On completion of each course, student feedback and course evaluation is undertaken. In September 2014 staff interviews were undertaken to review and reflect on the process of co-production within the Recovery College setting. Those interviewed included peer support educators, consumer workers, clinician educators, and members of the Recovery College management team (n=6). Staff were asked to consider the strengths, benefits and challenges of co-production and were given an opportunity to reflect on the co-production process in their specific capacity within the College, the lessons learned and what could be done to improve and refine the process. All interviews identified consistent and common themes which are discussed below. Co-production The peer educator experience Interviews with peer educators with lived experience highlighted the value of co-production both personally and for transformation of the mental health system. Benefits to the consumer worker included enhanced selfesteem, personal and professional growth, development of a sense of purpose, hope and meaning in life, feeling valued, improved networks, connections and skills for future employability. Peer educators involved in co-development of courses indicated that the experience of co-development was highly dependent on the particular clinician they were working with. Peer educators The peer educators indicated that at times there was uncertainty over expectations and who does what. I felt I was left to do everything, that I had to always take the lead, on this occasion the clinician stepped back too much, like [they] didn t understand the collaborative process of coproduction [they] left everything to the last minute, when I like to be prepared and organised. The peer educators found course delivery to be a positive and rewarding experience. I felt empowered with the delivery it was so moving and powerful for all. I could see the amazing benefits for the students as they began to talk, write and reflect in a recovery based way. The students wanted to keep coming back they found meaning and purpose in life and realised they were more than their illness. [The course delivery helped to] break down barriers, we had directors sitting next to consumers who were inpatients at the time they were chatting like they were equal It s a new paradigm, transformational and so beneficial to the recovery movement. Consumers employed by the Recovery College have indicated that they felt valued and respected. They appreciated the openness and safety of disclosure, and found the experience to be rewarding for both personal and professional growth. It was challenging, but I learned a lot, I was taken to another level made to think in a new way, made to think more deeply. I have learned such wisdom from the Recovery College staff. PAGE 12

4 Co-production The clinician experience All clinicians interviewed spoke positively about the benefits of co-production. The clinicians identified that they were able to learn and better understand the consumers perspectives. Testimonials collected through the evaluation process include: I know it is good but I needed to go away and process, it is not that easy to change It was a bit of a culture shock at first, a steep learning curve Sometimes I felt a bit alienated and out of my depth. I learned things that I would never get from a text book the sharing of experiences was so important, I could understand the other point of view the consumer voice is authentic, it addresses things at a deeper level and has more impact it is really life changing for people to be able to listen and talk openly about experiences it helps to break down the barriers in a practical way. The more people are exposed to this the more we will get changes in the culture and community. I saw that the clinician is not always the person with all the answers, instead clinicians need to be creative and open minded co-production opens up new possibilities, it s a real challenge for the system to be comfortable with not knowing all the answers, to be doing with instead of doing to so empowering for the consumer it is how services need to be moving. Consumers bring a variety of backgrounds to the mental health service, whereas mental health clinicians are often (but not always) career health professionals with training in one of five disciplines. Consumer workers bring so many skills and knowledge bases, as well as lived experience e.g. teaching, research, education, arts, accounting, business, community work, law, engineering, linguistics, sociology, construction, science, hospitality [examples from consumer workers at SESRC]. Some clinicians found the experience more challenging than others. Clinician feedback included: It was a positive experience, but challenging, a huge change to go from the clinical setting to an educational setting and managing a class In course development it was hard to move away from a clinician mindset to working with a consumer educator with a different perspective I had to develop new ways of interacting and listening, I had to be open-minded and take a step back While it is helpful to combine the different perspectives it needs to be acknowledged that clinicians also need support and training It is such a different way of doing things and can be a bit destabilising PAGE 13 Co-production The student experience Student feedback and course evaluation indicated that the sharing of lived experiences was inspirational and empowering. All students indicated that they gained valuable knowledge, greater awareness and understanding of recovery. The students valued the lived experience recounts where they could learn from other people s experience; they appreciated the openness of the discussions, the authentic consumer voice and the practical examples and experiences of people who have successfully recovered. Students commented that the Recovery College was so different to anything experienced before and took them to another level in their understanding of recovery. Students valued the safe environment to share experiences. They appreciated the strengths based approach and the positive outlook on recovery. 100% of students indicated that their expectations had been met or exceeded, and 100% of students indicated they would recommend the course to others. The clinicians and clinical students attending the courses valued the input of consumers: Professionals can learn a lot by working together with consumers and understanding their point of view Continue with the consumer perspective very interesting Hopefully this recovery College concept and involvement of consumers will continue to grow Great Start!! Co-production The Recovery College team experience Prior to the establishment of the Recovery College, the mental health service had increasingly been working in partnership with consumers in an educational capacity through various projects. This experience was essential to the successful implementation of the Recovery College co-production model, as the Recovery Colleges required clinicians and consumers to take a leap forward towards a truly equal relationship (Recovery College Management). Interviews with the Recovery College team highlighted some challenges in setting up this new co-production model. For example, in order to meet the time and budget constraints of the project, the processes were rushed and a bit ad-hoc. One of the team members said: We tried to run before we could walk.

5 Other challenges emerged because of the staging of some of the project processes. For example, the peer educators were employed prior to the clinical educators which meant that they had already completed a large amount of work before the two came together. This fact, together with separate meetings between peer and clinical educators resulted in some tensions in the initial stages. Another lesson the team learned was underestimating the amount of support and training that all the educators required. One of the team members said: people needed to do training on co-production, recovery and purposeful story telling prior to developing courses. A number of strategies have now been put in place to address these issues, including a comprehensive train-the-trainer program, joint consumer/clinician educator meetings and clearer guidelines for course development. Summary The Recovery College concept is regarded as transformational in the delivery of recovery-oriented services. The College has the potential to break down barriers and stigma thus creating openness and understanding of recovery-oriented practice, with the authentic human voice encapsulating the lived experience. The co-production process challenges the way service users and the mental health profession view recovery. While some clinicians have fully embraced the co-production process, others have found the process more challenging. In having to adapt their thinking and language use, some clinicians began to doubt their expertise and what they had done before. It was identified that all involved needed training and support as this process was so revolutionary and different. To promote equality and develop a safe and collaborative relationship, combined training with both peers and clinical educators was identified as important. About the Author Dr. Katherine Gill is a Registered Occupational Therapist and is undertaking the Research and Evaluation for the South Eastern Sydney Recovery Colleges. Katherine has a background in medical and mental research, and also works in the health industry. References Australian Health Ministers Advisory Council The National Framework for Recovery-oriented Mental Health Services: A Guide for Practitioners and Providers, Commonwealth of Australia. J. Boardman, and G. Shepherd Implementing Recovery: A new framework for organisational change. Centre for Mental Health. C. Needham and S. Carr Co-production: an emerging evidence base for adult social care transformation. Social Care Institute for Excellence. London. R. Perkins and J. Repper Implementing Recovery through Organisation Change: Recovery Colleges. Centre for Mental Health. London. J. Repper, R. Perkins, M. Rinaldi and H. Brown A journey of discovery for individuals and services. In Working in Mental Health: Practice and policy in a changing environment. P. Phillips, T. Sandford and C. Johnston (eds.). Routledge. Oxford J. Slay and L. Stephens Co-production in mental health: A literature review. new economics foundation. London. PAGE 14