If recovery colleges are the answer, what is the question?
24th August 2017
In this article SRN Director Frank Reilly asks what will help create and sustain communities that support recovery across Scotland? Are recovery colleges one of the answers?
Recovery is both a complex and simple process
The simplicity is in ‘what works for you is what works’. The complexity is in ‘what works for you might not work for everyone’. What is complex is:
- being connected to others
- being the hope for others as well as generating it for yourself
- recognising the identities that we all have at different points in our lives and our recovery
- creating and developing meaning in our everyday experiences and our lives
and through ALL of this, also being empowered.
For the Scottish Recovery Network (SRN) the next stage of developing recovery is to look to communities – communities of place and of interest – and help support the mechanisms that help people to connect, to recognise and make best use of their strengths and to take control of their own future.
The proliferation of colleges in England was funded primarily – but not exclusively – by CQUIN (Commissioning for Quality and Innovation payments framework). The colleges have not been without their critics who primarily focus on those sited in NHS premises, that emphasise the management of conditions and acceptance of diagnoses and the expected savings – and potential cut in services – to the health system. However this is not the full picture. Community focussed initiatives, Merseycare’s ‘LifeRooms’ for example, takes an asset based approach to community development, and the recovery college is only one part of what is on offer. Connection – to one another, to local businesses, to colleges and schools – is a central part of their model..
What are the drivers for recovery colleges in Scotland?
In England they aim to provide connection, hope, identity, meaning and empowerment. However the financial drivers can cloud these intentions, particularly when misinterpretations of coproduction are also included. ‘Do more for less’ is driving a lot of public sector change. However that imperative is changing the caring dialogue from ‘what can we do together’ to ‘you need to manage your condition more effectively’. This change in the mood music has a potential to derail peer led community development and empowerment initiatives and replace them with what might feel like additional responsibility for individuals and communities without the resources to support them.
What then do recovery colleges offer to Scotland? Perhaps the question is better put as: what can support mental health recovery in Scotland? First and foremost the parity of esteem between physical and mental health. Secondly but as important is the creation and support of non-stigmatising services. Thirdly and possibly most crucially, mainstreaming and normalising distress. People with mental health problems are you and me, not aliens. We all know someone who is experiencing distress and we are very likely to know someone whose distress has led them to approach a GP. A diagnosis can be a relief for many. For others it becomes both a comfort blanket and a trap, and our benefit system can and does keep people in that trap. In fact talking of recovery can have a direct impact on your income.
Recovery is about identity. How we see ourselves is a marker in our recovery journey. Recovery colleges have the potential to support people to move from an illness identity – ‘I am a depressive’, ‘I have schizophrenia’- to one that focuses on a pre-diagnosis identity as well as what the participants have overcome to be there. A system that reinforces that illness identity – ‘this is how to manage your illness’- without providing an opportunity to reconnect with a pre-diagnosis identity, or to create a wellness identity, is doing a disservice to the people they are trying to support.
So what model of recovery colleges suits the Scottish experience?
CQUIN supported developments in England are coming to an end: the money is drying up. A similar funding framework for recovery has never been available in Scotland so why is it now the thing to do?
A model that emphasises deficits and symptom management replicates a medicalised model of mental health that perhaps creates and sustains a view of health that is not compatible with recovery. A model that focuses on positive pre-diagnosis identities and is strengths based promotes adult thinking and ultimately independence. We can look to the citizenship approaches developed by Yale University and the uniquely Scottish version of this model developed by Turning Point Scotland as one of many models we should consider in this debate.
What drives the next stages in recovery should be what is right for the people of Scotland. Not a quick fix. Recovery is built on relationships primarily. Those relationships rely on individuals and those individuals will be different in each town or village. There is a danger in looking for and believing that you have found a magic bullet. What works or doesn’t work in England will not necessarily work or not work in Scotland.
Perhaps recovery is reaching a crossroads in Scotland. Efforts to transform statutory services underpinned by recovery principles have not succeeded, despite our efforts and those of the converted in those institutions. Recovery led by organisations that are not strengths based – and a diagnosis is not about strengths – will struggle to support strengths based recovery in the way that the majority of us are looking for. SRN’s stated intention is to focus on connection and communities as the place where recovery’s strengths based approach is most likely to flourish. The concept of a recovery college creates a connected community. If done well it is a community that lives by the strengths of the people who are part of it.
So what question does recovery colleges answer?
For those in service land it might look like a simple solution that is low cost and low maintenance. It is not. The initial investment in time and energy in developing and supporting the community takes significant resources. Coordinating courses and supporting a transition through the college to a form of independence takes significant skill. Over time any approach would look to take advantage of the strengths of participants to create roles filled by them. Transition from student/participant to presenter/lecturer to peer supporter/peer leader and beyond requires support at different levels. A model that generates the resources from within the community itself – the listeners, the advisors – and makes equitable connections with powerful bodies – such as the benefits agencies, health and social care as well as employers – has the greatest chance of forming sustainable change that challenges stigma and creates hope through purposeful activity.
We would love to hear your views on what will help create and sustain communities that support recovery across Scotland? Leave your comments below or join the conversation on Twitter using #recoverycolleges