1. 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

2. What Does Excellence Look Like?
Whose Recovery is it?

3. 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

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

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

6. What Does Excellence Look Like? Acknowledging and Sharing Power

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

9. 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. .

10. 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

11. 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

12. 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.

13. 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.

14. Our Initial Attempts
“you’re only supposed to blow the bloody doors off”

15. 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

16. Creating a tipping point

18. 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

19. Need to work on multiple areas simulateously

20. 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

21. 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

22. Recovery Education Centre.
Recovery Education Centre
Recovery Education Centre – pilot term in 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.

23. 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

24. 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

25. 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

26. 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

28. 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

29. 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

30. 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

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

32. 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

33. 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.

34. 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

35. …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”

36. Questions?
To contact and for further information: