What do we want ‘recovery colleges’ in Scotland to be?
24th August 2017
Speaking to people from a range of initiatives, health writer Jennifer Trueland explores different approaches and thinking around ‘recovery colleges’.
The idea of a recovery ‘college’ is seductive. As Scotland’s schools and universities go back and autumn approaches, there’s a certain charm about the idea of packing your pencil case and heading for the classroom – and with ‘recovery’ thrown in as well, what’s not to like.
But is it as simple as that? Should they just be about recovery in mental health – or should they be for everyone? What do we gain by encouraging the growth of recovery colleges in Scotland?
It’s actually remarkably hard to come up with any concrete conclusions about recovery colleges; defining the concept is difficult, and there isn’t even any consistency on naming. According to ImROC (Implementing Recovery Through Organisational Change), recovery colleges ‘can revolutionise mental health services and help people to fulfill their potential’ by delivering comprehensive, peer-led education and training programmes within mental health services. The ImRoc website says:
They should be run by any other college, providing education as a route to Recovery, not as a form of therapy, with courses co-devised and co-delivered by people with lived experiences of mental illness and by mental health professionals
ImROC’s focus on mental health services is understandable: the organisation was originally established by the Department of Health in England to champion its ‘Supporting Recovery’ initiative, and is now hosted through Nottinghamshire Healthcare NHS Foundation Trust – it is therefore embedded in services, and aimed at service-users. There is also a financial tie-in: where recovery colleges have been set up south of the border, they have largely been funded via NHS England’s Commissioning for Quality and Innovation (CQUIN) payment framework, further entrenching the association with health services. But are mental health services the right model for what is actually supposed to be ‘like any other college’, to quote ImROC again?
The picture in Scotland is very different; there are very few organisations actually calling themselves recovery colleges and, unlike England, there is no single income stream to tap. This means that funding can be – and is – a major issue – as at least one college can attest.
The Dumfries and Galloway Wellness and Recovery College was an early pioneer of the concept in Scotland. Attached to the University of the West of Scotland, which has a campus in Dumfries, it launched in 2013, and has delivered 86 courses to some 600 students, covering issues such as reading for recovery, the menopause, and wellbeing through Tai Chi.
Unfortunately, a lack of funding put a stop to the initiative – at least in its original form – in July of this year. ‘I feel as if we’re leaving the party as everyone else arrives,’ says Marie McCaig, a lecturer in mental health nursing at the University of the West of Scotland, who was instrumental in developing the college. ‘But I feel that we have achieved a lot in the four years, and hope that a way forward will be found.’
She feels that the Dumfries and Galloway model – believed to be the first in the UK to be attached to a university – has benefits and disadvantages. On the one hand, the university setting makes it much easier to create a college ethos – everyone taking part is called a ‘student’, for example, with less temptation to label people as patients or service users. Being part of a University, nevertheless, can limit what sources of funding are available.
Arguably one of the most exciting things to grow out of the college, however, is the strong network of peer trainers that has been central to the initiative since it started. Importantly, this group has decided to seek funding to take the concept further and ensure that classes continue for the population of Dumfries and Galloway.
Jacquie Jamieson, one of the peer trainers, says that the third sector does not get proper finance and support, but that it’s time for funders to be more imaginative. ‘We want to get our own funding – what we want is to take it to the next level,’ she says. ‘There is so much that we can do if only people let us.’ They are planning a meeting in September to discuss the way forward – and whatever happens, the aim is that it will be peer-led, based on strengths, and working to reduce stigma and break down barriers.
Another issue is whether recovery is solely a concept of mental health, or whether recovery colleges could and should be applied to other areas, such as long term conditions or addictions. Turning Point Scotland (TPS), for example, is running an initiative that sounds very similar to recovery colleges in some respects, but has a refreshingly broad view of who might benefit. The TPS Connecting Citizens project involves a six-month programme with twice-weekly classes geared towards rights, responsibilities, roles, relationships and resources of those taking part. Like recovery colleges, participants are called students, never service users. ‘It’s moving away from the identity that brought them into services,’ explains Karen Black, Citizenship Development Co-ordinator.
People fill in an application form in the same way as they would to go to college, she says, and everyone who takes part is treated equally. Participants come with complex issues, she says, but one of the key things about the programme is moving beyond these issues and working on citizenship – that is, achieving a sense of belonging an inclusion in the community.
Citizenship (based on the Yale University idea of ‘an innovative and holistic model for community integration and social inclusion) is being integrated into TPS’s overall programme, working alongside the support already being offered.
So far, she has been particularly impressed by the peer support that students offer each other, and says that participants have the opportunity to become peer mentors. ‘It’s really about improving somebody’s ability to integrate into communities, and improve their resilience,’ she adds.
Of course, these are also the aims of the better recovery colleges in England, many of which can show impressive results and a fantastic range of activities. For example, the wonderfully named SLaM (South London and Maudsley) Recovery College, part of the SLaM NHS Foundation Trust, runs courses under a variety of headings, from understanding mental health difficulties and treatment (sample workshop: understanding bipolar disorder); rebuilding your life (sample courses: a half-day workshop on how to get a good night’s sleep, and a six-week course on ‘creating the happiness habit’); developing knowledge and skills (sample course: using social media to find a job); and getting involved, which includes a workshop on getting involved in peer support. But as well as the classroom courses and workshops, the college also has innovative partnerships with, for example, The Comedy School, which has been working with students on comedy improvisation to help develop confidence.
According to manager Kirsty Giles, one of the benefits of the college is that it engages with the voluntary sector – which in itself opens up opportunities for students. It’s important to make sure that the people who come on board understand co-production she adds, so that everyone is coming from the same standpoint. Setting realistic expectations of what the college can achieve is also key. ‘We can’t be all things to all people; we’re a bridge for people to find opportunities.’
SLaM recovery lead Gabrielle Richards adds that the college has been lucky to win funding from the Maudsley Charity, and points to positive outcomes from a recent evaluation. Among other things, students reported feeling a ‘sense of hope’ after attending the college, and said they had taken advantage of new opportunities and developed their knowledge about mental health and recovery and new skills for self-management.
One of the benefits of the SLaM college is that many of its courses are run in the community, meaning is it less perceived as part of mental health services than if it was all taking place in NHS facilities.
Being apart from statutory services is also something that is valued by similar initiatives in Scotland (although there is acknowledgement that this can make funding tricky, as Dumfries and Galloway have found out). In the north of Scotland, a different approach is showing good results, and perhaps offers one way forward. Heidi Tweedie is director/champion of Moray Wellbeing Hub CIC, which aims to support people to live more mentally healthy lives. Essentially peer-led, it is moving away from labels such as service user (and even peer) in favour of ‘champion’, and encourages individuals to use their life experiences to better understand and self-manage their wellbeing.
A large part of it is about mutuality and partnership, explains Heidi, who describes the hub as an ‘umbrella’ organisation that makes it easier for other groups and individuals to run – or try out – activities. ‘Just as you might go to the gym if you wanted to try yoga or a spinning class, we hope people who want something on emotional wellbeing will come to the hub,’ she says.
Like Karen, Heidi is keen that the focus is on strengths and assets, and she believes strongly that unleashing the positive creativity in communities is good for wellbeing. She acknowledges that it can be tough to access funding, but also believes that people should be prepared to pay a small sum to take part in activities that benefit their emotional health.
She also says it’s not just about mental health. ‘We should be talking about wellness colleges,’ she smiles. ‘We should be looking at long term conditions, across the board, working with people through life changes and retirement. We should be promoting wellness for everyone. We’re all human beings.’
Perhaps that is the way forward for Scotland – a focus on ‘wellness’ rather than ‘recovery’, or at least broadening the notion so that it goes beyond mental health. This could include the community hub approach such as in Moray, or the citizenship focus of Turning Point Scotland. What does seem clear is that a services-embedded ‘recovery college’ model has had little traction in Scotland so far, no matter what the future may hold.