How to set up, run and develop recovery orientated services What Does Excellence in Recovery Orientated Services Look Like? How to set up, run and develop recovery orientated services Phil Morgan: Lead for Recovery and Social Inclusion, Dorset Healthcare; Co-Lead Dorset Wellbeing and Recovery Partnership; ImROC Consultant

What Does Excellence Look Like? Whose Recovery is it?

Recovery Orientated Organisations “Any services, or treatments, or interventions, or supports must be judged in these terms – how much do they allow us to lead the lives we wish to lead?” (Repper & Perkins, 2003) ImROC 10 Organisational Challenges Culture Change- not just within services

It is about peoples’ experience Its about valuing lived experience It is thinking beyond services

“Individuals and communities hold their own solutions” Co-Production Break at4:30 restart14:45 “Individuals and communities hold their own solutions”

What Does Excellence Look Like? Acknowledging and Sharing Power

Evolution or Revolution: Social Justice and citizenship Human Rights Perspectives on mental health Alternatives to traditional provision Community Capacity Building Public Health

Dorset HealthCare CQC Report “We rated the acute wards for adults of working age… as outstanding because:” The service model and acute care pathway optimised patients’ recovery, comfort and dignity was in place. Staff were motivated and working towards recovery approaches. Evidence of initiatives implemented to involve patients in their care and treatment. There was a varied, strong and recovery orientated programme of therapeutic activities, many of which were instigated at the suggestion of patients. .

The CQC spoke with patients and their relatives The vast majority of comments were positive and complimentary about their experience of care. We were told that staff were particularly empathetic and developed egalitarian relationships with their patients that supported recovery. They told us that they found staff to be caring, kind, professional and supportive towards them Most patients felt that they were actively involved in looking at choices for and making decisions about their care and treatment

CQC- Good Practice Partnership with Local Peer Led Organisation Peer Specialists inputting into the wards Peer Carers Safewards Access to the Recovery Education Centre Hidden Talents Project

The Dorset Wellbeing and Recovery Partnership The WaRP established in May 2009, putting people with lived experience at the heart of mental health service design, training and delivery. Partnership between Dorset HealthCare NHS and Dorset Mental Health Forum Partnership of lived experience expertise alongside professional expertise. January 2011 became ImROC Demonstration site.

Dorset Mental Health Forum Independent Charity, established since 1992. Run and led by people with range of lived experience. Funded by NHS, County Councils, grant makers ….. Consultation, representation, strategic partner, training. Recovery orientated organisation – strengths based. Rediscovery of skills, identity, value. Hope. Opportunity to reframe experiences, peer mentoring. Social movement and lived experience infrastructure.

Our Initial Attempts “you’re only supposed to blow the bloody doors off” https://www.youtube.com/watch?v=WlYZ1kAUk7Y

Shared Definition of Recovery Links to shared humanity Importance of experience Importance of learning Professionals don’t have all the answers It is about what is possible Julie Repper (2009) Daniel Gonzalez Enquiry

Creating a tipping point

Hurry Slowly Make mistakes Importance of 2-5-10 Recovery as a subversive activity Tipping point- invite only- branding Top level sign up – bottom up Never waste a crisis Celebrate Success

Need to work on multiple areas simulateously

Development of Peer Specialists . Development of Peer Specialists Done at the pace required for each individual Identifying an individuals strengths and interests and building work pattern related to that Graded exposure to increasing degrees of challenging work Place and Train Supervision and mentoring Advance directives and self management enhancement Informal support Flexible working Support from NHS WaRP team

Development of Teams Get Invited . Development of Teams Get Invited Ensure sign up and buy-in of team leader Identify team of core staff who will support implementation of recovery approach Deliver TRIP to the team Identify team of peer workers Co-produce and co-deliver training for rest of team, with WaRP, core peers and core staff Small steps (peer2peer, scoping, support to projects, recovery skills workshops, 1:1) Project plan Review and reflect

Recovery Education Centre . Recovery Education Centre Recovery Education Centre – pilot term in 2012 -6 courses 13 times, now over 30 courses and over 100 sessions per term Over 2000 registered students. Open and inclusive- marketed at people in secondary care mental health services, carers and supporters and staff All courses co-produced and co-delivered 96% of students completing evaluation from giving positive feedback.

Key Principles of Recovery Education . Key Principles of Recovery Education Individuals and Communities Hold their Own Solutions Underpinned by principles of personal recovery and co-production It is delivered within the framework of further education All courses co-produced and co-delivered by professionals and people with lived experience All courses offer learning activities that meet a range of learning styles Every learner has their own learning plan and personal support plan Student to student (or to trainer) learning is as valuable as trainer to student learning

Value of Recovery Education . Value of Recovery Education Individuals have Identified it has changed their life Of 100 Learning Plan Reviews, top three changes: -Sense of hope and acceptance -Better able to Self-Manage -Better Relationships Provides the driver for learning and change across all recovery focused projects

Added Value of Recovery Education Less stigmatising approach Promoting Self-Management – people doing things for themselves People don’t fall off a cliff edge of service usage or not New opportunities around community and business partnerships Potential to improve wellbeing of the workforce Cross-fertilisation of lived experience, recovery approach and services Principles cross translate across all Long Term Conditions

Levels of Recovery Education Prevention and Resilience Building (e.g. Skills and Learning) Recovery Education Centre Intensive Community Recovery Education Recovery Skills Workshops (Urgent Care Pathway) e.g. RESTORE

Hidden Talents Supporting the lived experience of staff in traditional roles Dual function peer support and organisational development Aims to challenge stigma and discrimination and promote wellbeing of all staff 2015 Hidden Talents Film and Board Sign Up

Current Initiatives Co-Produced Safety Plans training . Current Initiatives Co-Produced Safety Plans training Co-Produced Crisis Planning training Mental Health Managers Workshops REACH Peer carers crisis support Staff Mental Health and Wellbeing CMHT Review CCG –Acute care Pathway Review Engagement Events ImROC Learning Sets CaMHs Inpatient work Pain Service and other Long Term Conditions

Evaluating Recovery Narratives the gold standard? The value of testing proof of concept The value of understanding peoples experience The challenge of evaluating continuous improvement

Evaluating Recovery The extent a service is recovery focused Personal Experience Personal Recovery Outcomes Social Measures Clinical Measures (incl. physical health) PROMs Cost-Effectiveness

Challenges Service cuts across health, social care, and voluntary sector Misappropriation and misinterpretation of personal recovery “We’re doing it already” It’s no silver bullet Working against vested interests Change can be peripheral rather than core Moving from involvement to genuine Co-Production Emotionally challenging – peer support essential

Our Discoveries and Strengths …… Establishing the validity of Wellbeing and Personal Recovery as concepts. Recovery contagion. Value and inspiration of lived experience expertise and development of partnership working. Parallel process of recovery journeys of individuals, teams and organisations. Engaging commissioners. Transforming experience, unlocking potential.

Our Learning It important to model recovery principles at all times and come back to core principles at times of pressure- this includes not taking short cuts Focus on process not outcomes People have to challenge and be challenged and willing to share power Do not underestimate small steps and power of people’s experience

…and finally This is more than traditional user involvement, it is partnership working and needs to happen at all levels not just in service delivery Risks need to be taken, and the approach underpinned by learning There needs to be organisational sign up and buy-in It provides huge opportunities to do things differently, it is important to try something ….and as Larry Davidson says “hurry slowly”

Questions? To contact and for further information: philip.morgan@dhuft.nhs.uk www.dorsethealthcare.nhs.uk/services/recovery www.dorsetmentalhealthforum.org.uk www.imroc.org