Developing Technologically Enabled Remote Access to Recovery Colleges: A Co-Production Workshop.

On Thursday 16th of March at the Digital Exchange in Little Germany, Bradford, the  Digital Health Exterprise Zone (@DHEZ) hosted a workshop that brought together clinicians, recovery college students, users of services and technology innovators to consider the challenges of making recovery college sessions available for ‘remote participation’.

Professor Allan Kellehear, Academic Director @DHEZ, welcomes the delegates and introduces them to the challenge in hand.

Recovery colleges are meant to be health education communities where people can learn together, from each other and with educators developing personalised ways of improving their mental health, well-being and ability to work with distress. They should also offer opportunities to reforge identity, gain purpose and hope, hone life-skills and as desired work-skills without the latter being the necessary main focus of attention.

Steve Williams (@mhnurselecturer) and the lead for the @UoBRecoveryColl introduces what Recovery Colleges are and what the simulated college workshop will entail.

So why ‘remote participation’? The idea here is to consider developing technologies that enable people attending recovery education or psychological health sessions to join in from home if on that day they simply can’t get into college because they haven’t got enough money for travel, or they feel too distressed mentally or physically or for whatever reason that comes along with what health services typically refer to as ‘drop-out’ or reasons for non-attendance. Lots of advantages and lots of problems come along with this idea of remote participation. We feel it’s worth addressing these to help tackle, amongst other things, the ‘drop-out’ issue.

Drop-out is a massive problem in all forms of psychological health care, whether that’s situated in health or education. For example the most recent IAPT (Improving Access to Psychological Therapies) figures for 2015-2016 (from April 2015 to March 2016)  indicate that 33.9% of referrals end before entering treatment and of those referrals 92.1% did not attend any type of appointment. IAPT is the service aimed at providing psychological therapies for people with anxiety and depression. There were in total 1,399,088 referrals which equates to 1, 179, 328 people because there are sometimes multiple referrals, people being referred from one IAPT service to another and also people being stepped up from a lower intensity to a higher intensity service. 58.7% of referrals did not complete the course of treatment and ended participation for a variety of reasons and what ‘ending the referral’ means in IAPT terms  includes- declining to start, being deemed not suitable for IAPT or starting but not continuing. Given that IAPT aims to reach as an initial goal only 15% of those with anxiety and depression who need ‘evidence-based treatment’ and has a target of 50% reaching ‘recovery’ multiple approaches to addressing the reasons why treatment ends or is patchy are clearly urgently required. Using technology is one possible approach that we are exploring at Bradford.

Our delegates view, in another room, what is going on in the College Simulation and grasp the difficulties of current technology in providing ‘remote participation’ first hand.

Having run the workshop on the day our delegates left having worked together to form the skeleton framework of potential solutions. Problems were identified and discussed and ways to overcome them from an operational and technical perspective were raised. We now have potential partners who encompass user-experience, clinical and educator experience and technology expertise. We are looking forward to them joining with us on the next step to exploring how feasible, safe, and effective remote participation can be as a strand of delivering mental health care and to those struggling to find it and attend in our current education and care provision.

And here’s an interesting 360 degree image from one of our technology colleagues (David Renton) who participated on the day:

Interesting workshop in Bradford on Innovative tech to support Mental Health #MVPBuzz #MIEExpert #theta360 – Spherical Image – RICOH THETA

Critical Mental Health Nursing

I published Recovering from Psychosis: Empirical Evidence and Lived Experience in 2016 and having done that you would think that was enough and I should get on with business as usual. But no. I had already started working on a second book idea which was originally going to be a book on Recovery Oriented Nursing – a sort of how-to guide combined with a critical perspective on it. And then everything went pear-shaped. Well, no not really. I started approaching people and talking about the book looking for contributors because another solo effort seemed to be a bridge too far and one that I’ll revisit later (yes there is a Book III idea wanting to get out). Instead surely editing a book and having others write the chapters was easier? The astonishing naivete.

Now we are some 3 months into the writing process for book two. It’s not a Recovery Oriented Nursing book as you may have gathered as the conversations with contributors and gathering co-editors took shape. That and the fact that another book exactly on that topic turned out to already be in press. Instead we have a completely different animal – Critical Mental Health Nursing. Offered up in conjunction with the Critical Mental Health Nursing Network.

CMHN is a vehicle. For multiple perspectives from nurses being critical of nursing, from people who have had experience of being cared for by mental health nurses, from professionals of other disciplines working alongside nursing to be heard. It will have a strong applied to practice focus, an ethnographic and autoethnographic flavour along with empirical evidence, multiple-theoretical-analytical approaches, and is driven by the authors and not the editors. At least that’s the plan! More to come as I have it. We are looking to see it published in 2018 by PCCS.

Against ‘Involvement’ and Towards ‘Co-Production’.

Several weeks ago whilst taking part in some discussions on service-user involvement on Twitter that were, in fact, generally positive about this idea I had to profess that lately I have become ‘against involvement’. It’s tricky when you are limited to 140 characters to express nuanced ideas without oversimplifying what it is that you are endeavouring to express. I don’t wish to sound as if I am against ‘inclusion’ or embracing the ideas of service users. As an ex-service user myself that would be somewhat strange – I would have to censor and exclude myself!  So I’ve resorted to expressing these ideas at more length here in this blog post. It’s particularly pertinent I think to reflect on this now given the recent thought provoking Guardian article by Peter Beresford in the wake of the DOH’s (Department of Health’s, 2014) project to extend user involvement and live up to the policy pledge (rhetoric?) of “nothing about me without me”.

My problems with ‘involvement’ are that it is an ill-considered idea in the first place. It seems like something initially that is highly laudible and worthwhile. However my difficulties with it stem from what is implicit in setting up programmes with an ‘involvement’ agenda and from having being ‘involved’ in the running of such programmes in organisations in the past.  My experience as a professional in educational, healthcare and research organisations is that when ‘involvement’ is raised it’s at the point when most of the work in developing the educational, service or research project has already been done within the organisation itself.  “Involvement” can all too typically devolve down to inviting a service-user or outsider of the host organisation to participate in some pre-determined aspect or element of the service or programme that has already been committed to. They might have their expenses provided or receive some form of token payment for their activity. They might participate in the evaluation of a project as participants in a focus-group. My point here is that this is very much a form of “involvement” that stands to maintain the status-quo of the user as an “outsider” to the programme, project and host organisation. To put it in a nutshell “involvement” as has initially been developed is at risk of being “othering”.

If not “involvement” then, because of this “othering” risk, what instead? I would like to see the development of projects that aim instead from the outset to be collaborative and co-productive. Seek out and employ service users on an equal footing as participants in developing, designing, implementing and evaluating programmes across organisational settings as co-producers. Developing from this co-production I would then envisage programmes that head towards service-users leading and developing services/programmes in their own right.

The potential advantages of co-production and service-user leadership are, amongst other things, in the expressed values and diversity of the project. This is reflected in the Writing for Recovery research project of Taylor et al. (2014) who employed a service-user/writer to lead their project group.  Group members in this project reflected on the difference this made, and one reflected that:

‘Undertaking a service user led group gave me the courage to speak out, as I knew we had all faced major life challenges at some stage’ (WfR member). (Taylor et al., 2014, p 6).

References

Beresford, P. (2014), How Can Social Care Providers Involve Service-Users?, http://www.theguardian.com/social-care-network/2014/may/22/social-care-providers-involve-service-users [Accessed 28/05/2014].

Taylor, S. , Leigh-Pippard, H. and Grant, A. (2014), Writing for recovery: a practice development project for mental health service users, carers and survivors, International Practice Development Journal, 4(1) , pp. 1-13.

Further Reading and Watching

Check out the SCIE’s (Social Care’s Institute for Excellence) guide to co-production: http://www.scie.org.uk/publications/guides/guide51/

And a great little explanatory video: http://www.scie.org.uk/publications/guides/guide51/resources.asp