Ryan, P. (2011), "Editorial", The Journal of Mental Health Training, Education and Practice, Vol. 6 No. 1. https://doi.org/10.1108/jmhtep.2011.55506aaa.002
Emerald Group Publishing Limited
Copyright © 2011, Emerald Group Publishing Limited
Article Type: Editorial From: The Journal of Mental Health Training, Education and Practice, Volume 6, Issue 1
This edition of the journal has a particular emphasis on Recovery, four of which draw upon in various ways the Sainsbury Centre Recovery initiative. What is perhaps particularly of significance here is that whilst previous accounts of Recovery have focused on individual “stories of recovery or the approaches that user groups have developed to facilitate Recovery in their own members, these four articles focus on attempts to mainstream recovery into the very fabric of how NHS Trust mental services are delivered. Some might argue that mainstream services becoming Recovery focused is an inherent impossibility unless the power differentials inherent in the professional-client relationships are themselves transformed into genuine partnership and collaboration. This of course, is precisely what these papers claim is underway – a genuine transformation of mainstream services into ones that amongst other things redistribute power and authority within these management and organisational structures. – see Box 1 in the Boardman and Shepherd paper for an overview of the Recovery challenge facing mainstream services. None of these papers contain evaluative data of outcome so it is far too early to say whether these interesting and innovative attempts of fundamentally restructuring mainstream services is actually working. The attempt to do so is however welcome.
The articles in this edition of the journal have a particular emphasis on Recovery, four of which focus on the Sainsbury Centre Recovery initiative. Jed Boardman and Geoff Shepherd in their paper present the outline of a methodological approach drive forward the implementation of recovery-oriented mental health services in a systematic and dynamic way. They highlight ten key challenges for the implementation of recovery-orientated services, summarised in Box 1 of their paper. They have been working towards for several years now the development of a two part implementation strategy for recovery-oriented services which could be applied by local mental health providers (statutory and non-statutory) and by commissioners of mental health services. The methodology consists of a two part procedure, which is carried out jointly between providers (or providers and commissioners) and their local stakeholders (Shepherd et al., 2010). In the first part of the process the stakeholders try to get to grips with the complexities of the ideas (the “vision”) and assess the stage of progression of the main, local NHS provider on each of the ten key organisational challenges (see box 1 in their paper) using a simple, three stage classification (“engagement”, “development” and “transformation”). After completing this general assessment, the provider and others then move to the second part of the process. In this the main NHS provider, commissioners and other stakeholders jointly agree the priorities for organisational change, and develop “smart” indicators to measure progress towards recovery-oriented services. Whilst it is still too early to be able to assess the overall success and effectiveness of this approach, it is very welcome to have a clear well written account of the methodology itself.
The paper by Ruth Chandler and Julie Repper builds on the Recovery methodology described by Boardman and Shepherd by focusing on the recovery of family and friends in particular. They make the valid point that the recovery needs of carers have been overshadowed by the priorities given to service users. Chandler and Repper describe an approach based on a life story methodology, which attempts to bridge the gap between providers of services, users and carers. The paper argues that families and friends can quite literally become “the poor relations” so far as mental health services are concerned, and that the human development needs of carers should be given a far higher profile. Their life story approach is innovative, non-stigmatic and offers an approach to working with carers which is innovative, progressive and which recognizes their individuality and uniqueness, and correctly identifies a gap between existing policy and recovery-oriented practice. They conclude by suggesting the Life Story approach “as a training platform to consider the humanity of family and friends as of equal worth to people who use services and people who provide them.”
Professor Shulamit Ramon’s article valuably adds to the still scarce literature of how best, in practical specific terms, to develop recovery-oriented services and is a distillation of her own reflections both of her own attempts to implement such services and her observations based on the work of Boardman and Shepherd. She rightly cautions us to avoid over-simplification of the concept of Recovery, emphasing its uniqueness to each individual. She briefly explores complexity theory and learning organisation approaches as providing conceptual frameworks, concluding that the former offers a more comprehensive approach. Some case studies are described which illustrate these issues, and organisational story-telling is proposed as an innovatory methodology for “the study of the process of organisational change in the recovery implementation. Furthermore, story telling offers a way of involving both professional providers and service users in creating the (recovery) ethos of the organisation.”
The article by Glenn Roberts, John Good, James Wooldridge and Elina Baker gives a vivid account of the experience in Devon of collaborating with the Sainsbury Centre workshops designed to facilitate recovery-oriented services. The particular emphasis in this paper is on workforce development issues and how best large multi-disciplinary teams can be similarly inspired with the vision of recovery and change their practice accordingly: They did this through a series of workshops which attempted to address the need to identify key priorities required if a workforce was to shift towards a recovery focus. The authors correctly identify that:
Reorienting services around a focus on personal recovery implies a shift of power and authority towards enabling people to make informed choices and take control of their own lives. This has profound implications not only for the content of future training and development but the whole process involved in equipping workers to support such outcomes.
The article recounts the success the authors believe they had in this ambitious but necessary endeavour. But equally importantly, this article contains a lot of specific detailed information as to useful training and development strategies needed to produce these effects, and has valuable reflections on how best to harmonise those with “lived experience” within this process.
The final article in this edition is not directly focused on Recovery as such but rather addresses the important issue in its own right of how best to optimise inter-disciplinary working (IPE) in the educational context, and describes this with respect to cohorts of trainees on the doctorate in clinical psychology and undergraduate mental health nursing students. They define IPE as occurring when “‘two or more [healthcare] professions learn with, from, and about each other to improve collaboration and the quality of care’ (Freeth et al. 2005, p. 11). IPE differs from multi-professional education, as in the latter, people from different professions learn alongside one another but do not collaborate in shared tasks.” Effective inter-professional working is widely claimed to enhance service delivery, user satisfaction, and most importantly, clinical outcomes. The project reported in this article was an attempt to develop effective inter-professional education (IPE) across staff groups who work in the mental health arena. Qualitative and quantitative data from this two-year project showed an increase in positive attitudes in attitudes towards professionals from each profession over a two-year period, though no overall improvement. Qualitative analysis of participant comments provided more encouraging support for improvement in attitudes, within the theme areas of teamwork and collaboration, professional identity, and roles and responsibilities. Overall, the project provided important information on building positive attitudes within the mental health workforce, while identifying challenges that need to be anticipated and addressed. The article does however end on a cautionary note: “However, the apparent ease with which inter-professional conflict was triggered within this project underlines the need for further work to anticipate and address potential challenges”.
Freeth, D., Hammick, M., Reeves, S., Koppel, I. and Barr, H. (2005), Evaluating Interprofessional Education: A Self-Help Guide, Higher Education Academy Health Science and Practice Network, London
Shepherd, G., Boardman, J. and Burns, M. (2010), Implementing Recovery: A Methodology for Organisational Change, Sainsbury Centre for Mental Health, London