1. Service User Consultant Role in Day Democratic Therapeutic Communities
Jean Robinson
Service User Consultant
Fifteen, Manchester
TASTE, Tameside and Stockport
Objectives
Description and analysis of the evolving role of Service User Consultant (SUC) in Day Democratic Therapeutic Community (DDTC) services for people with personality disorder difficulties.
Role
My role as SUC is informed by my experience as service user in a residential DTC and my subsequent involvement with DDTCs as SUC working alongside other SUCs, staff and service users.
As SUCs we are part of the Day DTC psychosocial environment which encourages the principles of responsibility, participation and support that can make long-term engagement possible and give opportunity for long-term change, especially in how we relate with others, and consequently allow us to lead better lives.
The earlier stages of development of the SUC role are described by Hyde et al (2005).

2. Service User Consultants
What are our origins?
What are our credentials?
How are we recruited, engaged, appraised, developed?
What do we share of ourselves?
What do we bring?
Where may we take our contributions?
What next for the role and the person?
These are the aspects of the SUC role that I shall cover.

3. What are our origins? Henderson Hospital Residential DTC
Social Therapy
What are our origins?
Our evolution goes back to the Henderson Hospital Residential DTC where Social Therapists lived, worked and socialised with residents and were seen by them more as peers than staff (Reay and Revel, 1999) As residents worked through their time at the Henderson they were able, as real peers, to take their experience of living, working and socialising in that microcosm to other residential DTCs and then to the planning of Day DTCs and now Half-Day DTCs. With the development of Day DTCs the importance of this peer input was considered such that recruitment into a role within the delivery team was given a high priority. The role, after much democratic debate and then voting, was called Service User Consultant.
Social Therapists often came into their role as recent graduates in subjects that would embrace behavioural science and would see the job as a transitional training post. SUCs are graduates of their own personal therapy – and, like Social Therapists, are learning on the job.

4. What are our credentials?
Lived experience of PD difficulties
Personal therapy in tune with DTCs
Experience of hearing feedback and its impact
What are our credentials?
At the heart of all SUC contributions to DDTC services is our lived experience of personality disorder difficulties and therapy that is attuned with the DTC way of working.
A vital part of the role is our experience of the challenging process of learning how to hear feedback from others and tolerate the difficult feelings engendered.
We have walked the path that current group members are struggling along.

5. How are we recruited, engaged, appraised and developed?
Application
Employees or not
Appraised or not
Training
How are we recruited, engaged, appraised and developed?
We apply for the position and go through a selection process
Sometimes we are employees, sometimes not. Mental Health Trusts have struggled to adjust their processes to enable the engagement of people in this role.
Sometimes we are formally appraised, sometimes not. The Pennine Care Trust DDTC delivery team developed a structured appraisal process that has been made available for use by other services. We look at our attendance and involvement, understanding of the role and service, our relationship with the staff team, the personal impact of the work, and our future career development, as well as practical issues such as working conditions and pay.
We take part in annual training days put together by the Day DTC Network. The next training day is on the role of the Service User Consultant. The Fifteen group, with which I work, also has education sessions for the delivery team every three months.

6. What do we share of ourselves?
Structure
Struggles
Risk management
What do we share of ourselves?
I share something of my DTC experiences, my behaviours and my thoughts and feelings. By doing so I endeavour to promote the keeping of structures that make it safe for group members to talk about their feelings and struggles, and take responsibility for themselves and others. I contribute to the management of risky behaviours and situations from my learning in being the risky one and sharing my feelings about being with group members who may be putting themselves or others at risk.
I have to find my place in that therapeutic group, as do staff and group members. When, what and how much to share is a constant dilemma.
We face some challenges in relation to our contributions. Group members may find it easier to be critical and hostile with SUCs rather than with staff. We can be recipients of a barrage of comments such as “you’re no better than me”, ”you are more in need of this group than me”, “you’ve never left”, “you are using this group for yourself”.

7. What do we bring? Hope Role model
Relating effectively, functionally and responsibly
Triangular relationship
Reminder of flattened hierarchy
Humour
Genuineness
Valued support to staff
What do we bring?
Hope that life can be less of a struggle and more fulfilling
Lived experience of group therapy that is consistent with DTC principles, structures and ways of working (Hellin et al, 2009)
A person, shaped by life which includes their therapeutic experience, who can be a role model
A presence that exemplifies how we can develop into people who relate effectively with others and behave more functionally and responsibly
A bridging triangular relationship between group members and staff, which helps to relieve the inherent tensions between these two positions
A grounding/reminding experience for staff, when they assume too much power, authority and responsibility
Humour
Genuineness
Valued support to staff

8. Where may we take our contributions?
DTC service delivery
PD service planning
Education, training and sharing best practice
Marketing
Where may we take our contributions?
DTC service delivery
the therapeutic day (or half day)
supervision
delivery team dynamic administration
service management
Personality Disorder Service planning
Education, training and sharing best practice
for staff and our peers, which may include taking on a mentorship role for newly appointed SUCs
Marketing
The flattened hierarchy of DTCs is taken with us when spreading the word about our services – the staff, SUCs and group members demonstrate in our description of the service how we work together

9. What next for the role and the person in it?
Consolidating and expanding the role
Personal confidence, growth and new opportunities
What next for the role and the person in it?
Consolidating and expanding the role
Graduates from the Day DTCs are among those now coming into this role. We are taking on roles outside the Day DTCs. E.g. I have worked with the setting up, monitoring and review of a Dialectical Behaviour Therapy graduates’ peer group.
Personal confidence, growth and new opportunities
I feel that I have reinvented myself as someone more at ease with myself and life, who is able to rub along with others comfortably.
I welcome new opportunities and challenges and enjoy them.
D’Sa and Rigby (2011) looked at these issues in their paper on the effectiveness of SUCs in specialist personality disorder services.
References
D’Sa, A., and Rigby, M. (2011) The effectiveness of the service user consultant role in specialist personality disorder services. Mental Health Review Journal, 16(4),
Hellin, K., Göpfert, M., Atkinson, D., Davies, J., Hartley, P., Hyde, K., Mallett, S., McClelland, N., Russell, L., Shilling, L. and Winn, D. (2009) Day therapeutic community services for people with personality disorder: A new approach. Clinical Psychology Forum, 197, 37-40
Hyde, K., Davies, J., Göpfert, M., Hartley, P., Hellin, K., McClelland, N., Pass, T., Singh, S. and Weir, A. (2005) Engaging users: the essence of the therapeutic community approach. Therapeutic Communities, 26(3),
Reay, A. and Revel, J. (1999) Social therapists: Being real and being therapeutic. Therapeutic Communities, 20(2),