Heidi Tweedie – England’s recovery colleges: an educational import for Scotland?
18th July 2012
A new initiative in England has seen a mini explosion in the development of ‘recovery colleges’ – new learning centres based on the principle that treatment approaches should be complemented by learning opportunities. Heidi Tweedie speaks to some of the people involved and asks if it’s time for a similar approach north of the border.
“I can’t describe how different a recovery college feels to walk in to. Watching people change, giving them the environment to grow,” enthuses Rachel Perkins, who supports England’s Recovery College Initiative as a member of the Implementing Recovery through Organisational Change Programme Project Team (ImROC) . ImROC is a programme created to help organisations to develop recovery-focused practice in England, commissioned by the Department of Health as a component of their mental health strategy, ‘No health without mental health’.
Rachel, previously a director at England’s first recovery college – South West London Recovery College, which opened in 2010 – was inspired by a visit to a recovery and peer-focused Arizona education centre and wanted to create a service that was based on a different way of working between professionals and service users. “Everything is co-produced, co-delivered, co-received, with personal experience given same value as professional experience,” explains ImROC colleague Dr Julie Repper, Recovery Lead at Nottingham Healthcare Trust and Associate Professor at University of Nottingham.
Working within mental health services but administered and managed as standard educational establishments, the colleges aim to provide education, not therapy, as a route to recovery by delivering co-led education and training programmes on topics such as mindfulness, understanding diagnosis and becoming a peer worker. “It’s college not outreach,” explains Rachel. “Its power is in being specific; if you offer therapy it could gradually morph in to an older style community mental health service. Staff who work there are committed and have completed extensive recovery training. Students choose what they want from a prospectus, they are not prescribed courses, and if they don’t like it they can leave. Certainly what we found was the rate of completing courses was about 70%, the same as local colleges.”
“Like WRAP the key to success is not losing sight of who owns it,” clarifies Waldo Roeg, peer trainer and support specialist at Central & North West London Recovery College, one of the four existing recovery colleges supported by ImROC. “It’s not a corporate tool. We differentiate clinical treatment from education and the effort made to make it truly co-produced has been huge. We are co-located with our trust’s learning and development department; it was a really good opportunity to embed even more of the co-production ethos as staff access courses through the trust training service. This integration means that more and more the staff are exposed as a matter of ‘normalcy’ to training alongside service users; breaking down so much of the ‘them and us’ power imbalance.”
Although recovery courses run and created by peers are not a new idea, recovery colleges take the concept one step further by functioning as a real college. “The biggest shift is that students’ self-identity is different; they are college students so they can hold their heads high, make friends, discuss their goals with others – everything changes because of this change in role and status,” explains Julie.
Additionally, creating a physical space where students can meet and support each other’s studies is key. Housing the college in its own venue, with a library and social space, provides a strong anti-stigma message and solidifies a student identity. “People can pop in and get a feel for the college,” elaborates Rachel. “This is especially useful for those who are suspicious of the courses by providing a safe first step. All colleges have satellite courses in the community too, and having a physical presence rather than a virtual one also makes it much harder to cut!”
Principally recovery colleges are available for everyone, but this brings an inevitable funding issue. As finance originates from mental health services, courses currently focus on applications from mental health service users, their carers and NHS staff. However some NHS trusts are looking to counter this by moving toward primary care contracts and exploring the possibility of offering paid places to those not currently eligible. For example, Central and North West London Recovery College has been inundated with requests from students from various disciplines requesting registration on Recovery College courses. Due to capacity service users and their supporters have been prioritised, but creative solutions are already on the table with potential partnerships being investigated with their local University.
At a time when funding for NHS services is frequently reassessed for savings new mental health initiatives may seem unlikely, but England’s Recovery College Initiative is proving the exception to the rule, providing evidence of ‘Better services, lower cost’. A recent survey of people who participated in courses at the South West London Recovery College showed a significant reduction in use of community mental health services. Additionally 70% became mainstream students, gained employment or became a volunteer. By enabling people to manage their own challenges and use professional services less, recovery colleges present a potential win-win situation for the NHS.
“Recovery colleges are absolutely the right direction to go, but I do have my reservations about whether they should be happening ‘under the wing’ of the NHS,” shares Mark Brown, editor of One in Four magazine, co-author of ‘Better Mental Health in a Bigger Society?‘, and originator of thenewmentalhealth.org. “Situating themselves within established NHS structures can on one hand challenge traditional perceptions of patient and professional, but on the other might continue them in more subtle ways. For the movement to be successful it needs to really challenge the ways in which things have been done in the past; avoid becoming ‘just another NHS mental health service’.”
One solution to this may be a partnership between NHS and voluntary sector organisations; developing in much the same way as the partnership between Dorset NHS Trust and peer led organisation the Dorset Mental Health Forum who deliver the Dorset Recovery Centre. Samantha Adkins, Recovery Education Co-ordinator, Dorset Recovery Centre, explains: “It’s a very even split of the work, 50% forum and 50% NHS trust. Neither organisation is better or more equipped. It’s certainly not tokenistic as together we can be more flexible.”
Indeed, the first Scottish mental health recovery college may be developing along similar lines. ‘Collaborate to Educate’, a group of agencies consisting of Health in Mind, CAPS and NHS Lothian, who organise and deliver training and workshops across Lothian with the Lothian Recovery Network (LRN), share common origins with recovery colleges. “The LRN have been doing peer-led recovery training for a while now. We listened to those with lived experience who felt collaborating with the voluntary sector was the best way forward, launching in March 2012,” explains Susan Pollock, Mental Health and Wellbeing Programme, NHS Lothian. Their success builds on NHS Lothian’s support of Realising Recovery and their peer worker programme; culminating in a solid base of trainers and NHS staff support.
But before Scotland considers importing this initiative fully we must ensure we have the foundations of organisational and societal change in place. “The idea is not just floated in,” warns Rachel. “It is vital to have a commitment to recovery ethos and achieving sustainable culture change in service planning and provision. Recovery colleges shouldn’t stand alone in changing a service.”
Mark agrees there is work to be done and feels the idea should be taken further: “There’s a hugely liberating possibility inherent in recovery colleges – people with mental health difficulties teaching or commissioning helpful stuff to support others to get on with life. That will be snuffed out by institutionalisation of the recovery college idea. It seems to me that the natural end point for this movement is that the colleges cease to be part of the NHS at all. If it’s going to work it needs to be a real partnership, involving pay parity as much as it involves mutual respect; an equal footing between people with mental health difficulties and those that do not.”
Further reading: ImROC briefing paper on recovery colleges