Dorset Community Health Services

The Wellbeing and Recovery Partnership Dorset Community Health Services and the Dorset Mental Health Forum

Annual Report 2009/10

‘Transforming Experience… Unlocking Potential’ Completed by Phil Morgan and Becky Aldridge

Definitions of Recovery “[Recovery is] a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and contributing life, even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness...” (Anthony, 1993 – From the Sainsbury Centre (2008): Making Recovery a Reality) “Probably the most useful way of understanding recovery is linking it to our own experience because it is something that is common to all of us; it is not specific to mental health problems. Any of us, who have been through a divorce, being made unemployed, a major illness or bereavement, know that that changes us; there is no way to going back to how we were before that event. We have to incorporate that into our way of living and we learn from that and move on with that, which is exactly what we are talking about in terms of recovery from mental health problems. Very importantly, recovery is about taking back control over your own life and your own problems, about not seeing your problems as being uncontrollable, or that their control is just the province of experts. It is about understanding yourself what is possible and what you can do to help yourself.” By Dr Repper from An independent investigation into the care and treatment of Daniel Gonzales (January 2009) p. 124. Dr Repper is currently associate professor for Mental Health Nursing and Social Care at Nottingham University and is co-author of a book entitled Social Inclusion and Recovery. A model for Mental Health Practice (Baillere Tindall 2003).

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Contents Page Executive Summary .............................................................................................. 7

Introduction ........................................................................................................... 9

Future Directions for 2010/11.............................................................................. 11

Wellbeing and Recovery Strategy....................................................................... 13

Our Recovery Journey ........................................................................................ 15

Background ..................................................................................................... 15

The Principles of Recovery.............................................................................. 15

The Wellbeing and Recovery Partnership ....................................................... 16

The Development of the Strategy.................................................................... 17

The Development of Our Philosophical Approach .............................................. 19

10 Key Priorities Update on Progress ................................................................. 21

1. Communication..................................................................................... 21

2. Risk and Safety Planning...................................................................... 23

3. Recovery Co-ordination ........................................................................ 25

4. Workforce Culture................................................................................. 27

5. Acute Recovery Services...................................................................... 31

6. Outcome Measures .............................................................................. 33

7. Training................................................................................................. 37

8. Spirituality ............................................................................................. 39

9. Influence Wider Dorset population........................................................ 41

10. Develop Culture of Creativity and Participation .................................... 41

Conclusion .......................................................................................................... 43

APPENDICES APPENDIX ONE DORSET WaRP PROJECT PLAN APPENDIX TWO DORSET WaRP NEWSLETTERS APPENDIX THREE REFLECTIONS MAGAZINE APPENDIX FOUR COMMUNICATION STRATEGY ACTION PLAN

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Executive Summary Recovery is an internationally recognised conceptual framework which underpins developments in Mental Health. In England, Recovery features predominantly in the recent policy document New Horizons. (Department of Health, 2009) “If adopted successfully and comprehensively, the concept of recovery could transform mental health services and unlock the potential of thousands of people experiencing mental distress. Services should be designed to support this directly… This will mean substantial change for many organisations and individuals.” Future Vision Coalition (July 2009) The Dorset Wellbeing and Recovery Partnership (WaRP) was set up in April 2009 between NHS Dorset: Community Health Services (DCHS) and the Dorset Mental Health Forum (an independent third sector organisation run by people with lived experience), putting the expertise of people with lived experience at the centre of the transformation of mental health provision across the county. The Partnership’s aim was to embed the principles of Wellbeing and Recovery across all services within Dorset. In order for DCHS to put “recovery at the heart of everything it does” there remains a need for whole systems change, through casting a critical eye over current mental health service provision and addressing the health and wellbeing needs of local communities. Recovery involves moving away from traditional styles of service delivery to a more person-centred, strengths based approach, engaging with people who use services as partners on their individual journey of discovery. Mental health services can then become more flexible and responsive to the needs of individuals. The Dorset Wellbeing and Recovery Partnership see the principles of wellbeing as essential to understanding Recovery as a philosophy. There needs to be a shift of focus from an illness model to a wellness model. The importance of wellbeing recognises that a person’s overall health is influenced by them experiencing balance and meaning across a range of areas in their life (such as spiritual, physical, social and emotional health) as well as feeling connected to their community. Progress so far…

• Our main aim is culture change in Dorset, and this is happening: • Many staff have embraced the principles of recovery and feel hopeful,

motivated and inspired about their role in future service delivery. • People with lived experience are increasingly feeling that their expertise is

valued and that they have a lead part to play in the shaping of services. This is empowering, validating and rewarding; it gives individuals hope, meaning and purpose in their own recovery journeys.

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• Working in partnership with people with lived experience within mental health services is challenging stigma and raising everyone’s expectations of what we can achieve.

We have done this through robust project planning. Specific areas have been targeted, such as: communication; approaches to risk and safety planning; care co-ordination and individual self-management; workforce culture and the development of peer specialist posts; training; spirituality; recovery-focused acute services; outcome measures and recovery stories. This project plan was overseen by the WaRP steering group which was made up of people with lived experience, supporters of people with lived experience, clinicians, managers, and commissioners. This is all described in the WaRP annual report 2009/10. We are confident that we have now completed the groundwork and have exceeded our expectations in beginning to develop a “critical mass” of people passionate about recovery. This coming year we are looking to create a “tipping point” in order for the services to become truly recovery focused and transform the delivery of mental health services. Future Directions The WaRP strategy 2010/11 has been launched and it details how we are planning to build on our achievements. The strategy includes:

• The introduction of Recovery and Self-Management Training for both staff and people who access services (delivered by those with lived experience)

• Running Recovery Leadership Workshops for team leaders • The further development of peer specialist posts (people with lived

experience working in NHS teams modelling recovery) and accredited training

• Establishing locality based Learning from Lived Experience groups • Launching the Wellbeing toolkit and online resource • Developing partnership working with the supporters (carers) of those with

lived experience • Plans to evaluate our progress using the Sainsbury Centre for Mental

Health (2010): Methodology for Organisational Change. We feel that we have a clear way forward but the proof of the effectiveness of this approach is when we are successfully changing the experience of those who access services and their supporters, and more broadly changing people’s attitudes to how emotional wellbeing is addressed across the whole of Dorset. We would like to thank everyone who has supported us and worked with us on our recovery journey and who have contributed to our feeling of hope to give us inspiration for this project to move forward.

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Introduction This annual report summarises the progress of the Dorset Wellbeing and Recovery Partnership (WaRP) since its inception last year. The primary focus of this year has been to gain an understanding of the principles of wellbeing and recovery and how they apply in practice in order to fundamentally change the experience of how people engage with their wellbeing and with mental health services. In order to effect change there has been a particular focus on how we can achieve the cultural shift required to transform people’s experience. The WaRP has not focused on specific developments such as vocational opportunities or peer support as these are ongoing service developments. It has focused much more on how the WaRP principles should overarch all service developments. Members of the WaRP are participants in all major workforce development and strategy groups. The WaRP steering group is made up of people with lived experience, supporters of people with lived experience, clinicians, managers, and commissioners. The focus of the WaRP has predominantly been on partnership working between NHS Dorset: Community Health Services (DCHS) and Dorset Mental Health Forum (DMHF). Over the next year it is anticipated the focus will be much more pan-Dorset as the partnership working between Dorset Healthcare Foundation Trust (DHFT) and DMHF is strengthened and increasing opportunities for joint working across both NHS organisations are developed. In the steering group held on the 29th April 2010 we reviewed the progress made by the WaRP over the last year. It was agreed at the meeting that the following had been achieved:

• The development of a clear and coherent vision • Clear practical steps to achieve this vision • A way of not “doing recovery to people” • Strengthened existing good practice • Strengthened partnership working • Within DCHS completion of phase 1: development

This report summarises how we achieved this and focuses on two main areas, the first outlines the development of the WaRP and the evolution of our project and strategy planning processes, under the heading Our Recovery Journey. The second part outlines the progress made in each of the priority areas for development and also looks at how we are planning to take things forward. Preceding this is an outline of the future direction of the WaRP and a copy of the Strategy Plan 2010/11.

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Future Directions for 2010/11 We are now moving from a development phase to an implementation phase. The focus needs to be at locality level in order to implement the change. To support this process we are proposing that the meeting structure be realigned as follows. • The setting up of an overarching pan-Dorset stakeholders group with the

following membership: Commissioners, Directors of Mental Health Services from Dorset Community Health Services (DCHS) and Dorset Healthcare Foundation Trust (DHFT), Operational Manager or equivalent (DCHS and DHFT), Recovery leads (DCHS and DHFT), and Dorset Mental Health Forum (DMHF) Managers. This group would have strategic oversight of the strategic development of the pan-Dorset approach to Wellbeing and Recovery. (It is proposed this group would meet biannually.)

• The strategic implementation of Wellbeing and Recovery within DCHS would

then fall to the Operational Management Group (OMG) of DCHS. Once a quarter either the OMG or the Practice and Quality Meeting (PQ) would be replaced with a Wellbeing and Recovery Meeting which would focus on implementation. DMHF would attend this meeting as would any other key partners (such as carers, primary care representatives etc).

• On a locality level within DCHS, “Learning from Lived Experience” groups will

be established with a focus on creating a creative and critical culture which can influence day to day practice.

• The Team Leads programme was seen to be the key to supporting these

developments and in particular the Team Leaders Team Leads network. It was proposed that there be an extraordinary Team Leaders Team Leads day with a focus on the implementation of recovery.

We also feel the need to move away from using the project plan and 10 key priorities to a Wellbeing and Recovery Strategy which gives a broad overview of the key tasks in relation to implementation (see page 6, Wellbeing and Recovery Strategy). The rationale for this is that the project plan has outgrown its usefulness. It was effective at the start of the project to provide a framework and capture many ideas, but it is now unwieldy and of little practical use, particularly as our thinking has moved on significantly and recovery is embedded in many more areas. This is discussed further in the report. It is now necessary to establish a baseline of how recovery orientated our service is so that we can monitor the implementation process. We are proposing the Sainsbury Centre for Mental Health Methodology for Organisational Change. We are also looking at how we develop and monitor local plans and have developed a Locality Networks Service Managers Plan.

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Wellbeing and Recovery Strategy Goal What it means in Practice Action

To effectively communicate how and why the partnership is promoting recovery and wellbeing

For people in Dorset to be aware of the key concepts of Wellbeing and Recovery and to understand the importance of taking care of your physical and emotional health. There will be a visible commitment to Wellbeing and Recovery in every mental health unit and GP practice and an explanation of what recovery means in practice. All staff to be able to articulate the key principles of recovery and the changes required to service delivery. This will be supported by a Wellbeing and Recovery Partnership (WaRP) website.

Launch a poster campaign. Continue to meet with staff teams to “get the message out there”. Engage with local press and have articles in local newspapers and NHS publications. Develop a WaRP website.

To create a culture that provides the opportunity to be creative and promotes discussion on how to embed the principles of recovery in mental health service provision across Dorset

For every interaction to be characterized and underpinned by recovery principles using SCMH (2008) Ten Top Tips. Learning from lived experience workshops in each locality will embed the experience of individuals in the development and evaluation of services. These workshops will be where individuals share their experiences which enhance recovery and can influence service provision and delivery at a local level.

To set up learning from lived experience workshops in each locality. To develop local implementation plans which focus on how all people can be involved in the culture change required. To run recovery leadership workshops. To involve supporters in discussions about recovery at all levels.

To promote self management and develop a recovery co-ordination strategy to ensure the approaches of staff create a recovery enhancing environment

Wellbeing toolkits will be available to all (via the website – paper copies will also be available) and people will be encouraged to complete them to develop their ability to self manage. They can be completed by an individual on their own, with staff, a peer specialist or in a training group. People can decide to use the local tool or a tool of their own making or choosing to promote their self management. The importance is that they own it and that it is their personal plan. For those in secondary care, mental health care co-ordinators should encourage people to complete and share their toolkit to inform the CPA care plan using a coaching approach.

Wellbeing Toolkits under development (plus on-line resource) to be launched by end of summer. Training (people who use services, their supporters and staff). Supervision for staff to support the process; under development are the peer specialist roles to support this.

To change workforce culture so that recovery is the dominant approach

Peer Specialists will be supporting statutory staff in the delivery of services. Changes to be made to Human Resources process to support the implementation of recovery principles. Existing staff with lived experience will be supported as they utilise their experiences.

Development of peer specialist roles across all elements of the service. Development of Human Resources to support attitudinal shifts in relation to recovery principles.

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Goal What it means in Practice Action To ensure there is effective and consistent recovery training across Dorset

Training on the Wellbeing Toolkit, Recovery, and Peer Specialist training to be delivered by people with lived experience to people who use services and staff.

Recovery Education Centre (REC) to be established to develop and deliver training.

To ensure that spirituality is linked to recovery in a way that is meaningful to the whole community

That people’s spiritual understandings and needs will be taken into account at all stages of their recovery journey.

To raise awareness of the role spirituality plays in a person’s recovery through publishing recovery stories and to build this in to all elements of service design and delivery (wellbeing toolkits, acute care recovery strategy, locality implementation plans, learning from lived experience meetings).

To evaluate the experience of people who access the service through the use of recovery stories and robust recovery-based outcome measures

To use and develop measures that reflect people’s personal recovery journeys and their own goals. To move away from clinical outcomes to social inclusion outcomes and to evaluate the recovery orientation of service delivery.

To build into daily practice the development and rating of clients’ personal goals. To undertake an audit of staff and people who access the service on how “recovery orientated” the service is using SCMH (2010) Methodology for Organisational Change. To work with commissioners and engage with national projects on the development of recovery orientated service delivery.

To develop clear guidelines that integrate risk management, safety planning and recovery

Risk assessment and management will become an increasingly collaborative task with a sharing of responsibility. To support this process good practice guidelines and a safety planning and crisis management toolkit will be developed.

Staff to be supported by team leaders in supervision, and through training to develop more collaborative approaches to risk assessment and management. Once the good practice guidelines and toolkit are developed these will be launched to support the process.

To continue to develop the role that recovery plays in Acute Care Recovery Services – with a focus on development of alternatives to inpatient treatment for those in crisis

The Acute Care Recovery Service to work with people in crisis in ways that they would like, by increasing the use of Crisis Response and Home Treatment services. To work with people around crisis plans and advanced decisions about how they would like to be worked with when things start getting out of control. For people to have opportunities to give feedback and influence the experience to people admitted to hospital.

An acute care recovery strategy is under development which will build on the use of tidal model, star wards, motivational interviewing training, and opportunities to build people’s views on how they experience the service. To aspire to zero-restraint and develop peer specialist roles in crisis and acute services.

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Our Recovery Journey

Background The recovery partnership was established in April 2009, when Brian Goodrum (Mental & Prisons Health Services Director, Dorset Primary Care Trust, Community Health Services) and Shaun Byatt (Services Manager, DMHF) identified the need to strengthen the recovery philosophy in the delivery of mental health services. Phil Morgan (Lead Occupational Therapist, DCHS) was then appointed to the role of lead for recovery and to formally establish the partnership. The partnership was initially between DMHF and DCHS and Dorset County Council and jointly chaired by Phil Morgan and Becky Aldridge (Assistant Services Manager, DMHF). It now includes Dorset Healthcare NHS Foundation Trust and our working and networks span other organisations. The strength of the partnership is that it crosses the organisational boundaries and puts people with lived experience at the heart of service delivery and design. Dorset Mental Health Forum is an independent local 3rd Sector organisation which is led and run by people with lived experience of mental health problems. Through the partnership they are both strategic and operational partners in all elements of the delivery of mental health care. The first task of the partnership was to get a good understanding of what recovery was and what it looked like in practice. We were very keen to embed recovery principles in everything we did including how we approached the partnership. Initially we very much drew upon the work of Recovery Devon and are very grateful for the support of Laurie Davidson (Devon Recovery Partnership) who pointed us in the right direction, particularly stressing that it is a philosophical approach not a model. We used and continue to use the principles of recovery that he defined as our guiding statements and aspirations (see pp 32–3 in Appendix 1).

The Principles of Recovery

• Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems.

• Recovery represents a movement away from pathology, illness and symptoms to health, strengths and wellness.

• Hope is central to recovery and can be enhanced by each person seeing how they can have more active control over their lives (‘agency’) and by seeing how others have found a way forward.

• Self-management is encouraged and facilitated. The processes of self-management are similar, but what works may be very different for each individual. No ‘one size fits all’.

• The helping relationship between clinicians and patients moves away from being expert / patient to being ‘coaches’ or ‘partners’ on a journey of discovery. Clinicians are there to be ‘on tap, not on top’.

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• People do not recover in isolation. Recovery is closely associated with social inclusion and being able to take on meaningful and satisfying social roles within local communities, rather than in segregated services.

• Recovery is about discovering – or re-discovering – a sense of personal identity, separate from illness or disability.

• The language used and the stories and meanings that are constructed have great significance as mediators of the recovery process. These shared meanings either support a sense of hope and possibility, or invite pessimism and chronicity.

• The development of recovery-based services emphasises the personal qualities of staff as much as their formal qualifications. It seeks to cultivate their capacity for hope, creativity, care, compassion, realism and resilience.

• Family and other supporters are often crucial to recovery and they should be included as partners wherever possible. However, peer support is central for many people in their recovery.

Adapted from Recovery – Concepts and Application by Laurie Davidson, the Devon Recovery Group.

The Wellbeing and Recovery Partnership We were very keen to marry up the concepts of wellbeing and recovery. This was for three reasons:

1. the word recovery can be misleading as people can view it as clinical recovery getting better;

2. we wanted to have a wellness and wellbeing approach, which helps people pay attention to their physical and emotional health whether they access mental health services or not;

3. to acknowledge the huge health inequalities experienced by those with what is described as severe and enduring mental illness.

We had the first partnership meeting of all parties interested in recovery principles in May and started to identify “recovery champions”. We decided early on that we were going to take a strengths-based approach to create a critical mass of good practice rather than to try and engage with those who were not interested in recovery principles. We were also seeking to create a demand and a curiosity so that individuals and teams would contact us to find out more about the recovery approach. We set up the Wellbeing and Recovery Partnership Newsletter to support this. The newsletter tracks the development of our thinking and the practical steps we have made regarding implementation (see Appendix 2 for copies of the newsletter).

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The Development of the Strategy From that initial meeting we went on to develop a project plan. (As the project plan is over 30 pages it was felt that it was better to only include the introduction in Appendix 1. If you would like a copy of the full version please contact Denise Bilton on 01305 361 371 or denise.bilton@dorset-pct.nhs.uk.) Alongside the project plan we developed a meeting structure to support it. As far as possible we wanted to embed the recovery approach into existing meetings and then only have additional working groups where necessary. Due to this we have been continually reviewing and revisiting our structures in order to meet the changing stages of our development. Soon we found that the project plan, although useful for capturing all our ideas and giving us a way of measuring progress, was too long and unwieldy for practical use and effectively communicating our message. So we developed the 10 key priorities which were:

1. To effectively communicate how and why the partnership is promoting recovery and wellbeing

2. Develop clear guidelines that integrate risk management, safety planning and recovery

3. To develop a recovery co-ordination strategy and review all paperwork so that it supports a recovery approach

4. To change workforce culture so that recovery is the dominant approach 5. Continue to develop the role that recovery plays in acute (Enhanced

Recovery) services – with a focus on development of alternatives to inpatient treatment for those in crisis

6. Evaluate the experience of service users through the use of recovery stories and robust recovery-based outcome measures

7. To ensure there is effective and consistent recovery training across Dorset 8. Ensure that spirituality is linked to recovery in a way that is meaningful to

the whole community 9. To promote wellbeing and recovery throughout Dorset 10. Create a culture that provides the opportunity to be creative and promotes

discussion on how to embed the principles of recovery in mental health service provision across Dorset.

The progress made in line with these priorities is explained below. Due to the unwieldy nature of the project plan and the additional documents produced by the Sainsbury Centre for Mental Health regarding organisational change in line with recovery we have decided to condense the 10 key priorities and the project plan into a single strategy plan document with 9 work streams (see page 6). In order to communicate the message we have been meeting with teams and individuals, formally and informally, from a range of organisations, to get participation and engagement in the recovery agenda. These have included acute services, community services, drugs and alcohol services, universities, carers groups, and the NHS Dorset Best Practice event. In the vast majority of these forums the recovery approach has been met with enthusiasm and there appears to be a lot of excitement and a real will to take things forward.

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The Development of Our Philosophical Approach We have been developing our philosophy and our ability to effectively articulate what recovery is in practice and how it fits across mental health, physical, older persons, primary care. The concept of wellbeing provides a vehicle that allows the philosophy to be a really helpful unifying model which permits effective cross-boundary working and also seeks to maximise opportunities for individuals to self-manage their health and wellbeing whether or not they access services. We have been linking our developments to international and national best practice and we are part of the National Recovery Research Network. The following documents from the Sainsbury Centre for Mental Health have shaped our thinking:

• Making Recovery a Reality. A Policy Paper (2008) by Geoff Shepherd, Jed Boardman and Mike Slade

• Ten Top Tips for Recovery-Oriented Practice (2008) • Implementing Recovery: A new framework for organisational change.

Position Paper (2009) • Implementing Recovery: A methodology for organisational change. A

Policy Paper (2010) by Geoff Shepherd, Jed Boardman and Maurice Burns

In addition to the work of Laurie Davidson, the other key people who have been instrumental in giving us direction are:

• Mike Slade, Royal College of Physicians, and his book Personal Recovery and Mental Illness: A Guide for Mental Health Professionals (2009) Cambridge University Press)

• Eugene Johnson of Recovery Innovations (www.RecoveryInnovations.org) • Dr Julie Repper, Reader and Associate Professor of Mental Health

Nursing and Social Care, Faculty of Medicine & Health Sciences, University of Nottingham and Recovery Lead for Nottinghamshire Healthcare NHS Trust

• Dr Rachel Perkins, Director of Quality Assurance and User/Carer Experience, South West London and St George’s NHS Trust

• Becky Aldridge (Assistant Services Manager, DMHF) and Sue Forber (Development Worker, DMHF) have been completing a degree module in Recovery delivered by the Recovery Lead for Devon Partnership Trust at Exeter for Plymouth University. This has also shaped our thinking and practice.

Perhaps most importantly what has shaped our approaches and thinking is the lived experience of those people in Dorset, who use or avoid mental health services, who are committed to recovery principles and have the vision and passion to make change happen.

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10 Key Priorities Update on Progress

1. Communication Communication in the next year is perhaps the most important strand of our development. In some respects we have so far been a little tentative about communicating the fact that we are operating a recovery approach within the statutory services. The reason for this is because we want to ensure that when we say that a service is ‘recovery orientated’, that is what a person accessing the service experiences. We have also wanted to create a demand so that people become inquisitive and wish to find out about it for themselves rather than it being a corporate exercise where everywhere is flooded with recovery literature but practice remains the same and it becomes a paper exercise. Our target for this coming year is that we want to guarantee that all people who access services and staff can clearly articulate recovery principles and understand their practical application. We also want to raise awareness within the general population of the importance of taking care of one’s physical and emotional health needs. To communicate the message we have sent out a regular newsletter which has now become quarterly (see Appendix 2). So far, we have produced 5 editions. DMHF’s Reflections magazine has been focused on Recovery and Recovery Stories (see Appendix 3). DMHF has also had local press coverage in relation to a range of projects including the WaRP and an article will appeared in the May edition of the staff magazine Take Care. In addition we have given over 30 presentations about recovery and the WaRP to a range of people and organisations, including primary care services, secondary care, older adults mental health services, DCHS Best Practice event, substance misuse services, universities, and carers’ forums across Dorset. We have also offered an open door policy by arranging to talk to anyone who is interested in recovery. We have also communicated the message by embedding it in existing meetings such as the Acute Care Forum, CPA management meeting, and Team Leads Programme. In order to take our communications forward we have developed a communication strategy (see Appendix 4). Our key objectives for this year are

• To have a poster campaign across all services to give a visible presence and expectation that services will be working in a recovery orientated way and that people are fully aware of the recovery strategy.

• This will be supported by business cards with information about recovery.

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• We will be working directly with team leaders about how they can communicate to their teams and the people who access services about the local implementation of recovery and we will be setting up learning from lived experience groups to support that process.

• This year we are planning to launch the Wellbeing Toolkit, which is a locally developed personal recovery plan (this will be discussed on page 15: Recovery Co-ordination). We are also developing a web resource to support this initiative and have a local press launch celebrating recovery and the tool kit. It is being considered whether to coincide this with World Mental Health Day on 10 October 2010.

• To continue to do presentations, hold discussions, produce the newsletters, and Reflections magazine having a focus on recovery stories. (The use of recovery stories will be discussed further on page 22: Outcome Measures.)

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2. Risk and Safety Planning In order to successfully imbed recovery principles into service delivery we had to integrate the concepts of recovery and risk, particularly in the light of the recommendations following the Daniel Gonzales Enquiry (2009). We did this by developing a position statement and discussing and agreeing it at the Risk Team Leads Network. This was agreed upon and accepted by the operational management group, thereby demonstrating the organisational commitment to a change of approach. The statement is as follows: In order to delivery effective recovery orientated practice the Wellbeing and Recovery Partnership (WaRP) feel that it is important to make a statement on our approach to risk assessment and management. This is in line with the findings of the Gonzalez Enquiry (2009) and the recommendations from the Sainsbury Centre for Mental Health for Implementing Recovery (2009). We need to re-evaluate our approach to risk assessment and management to ensure recovery principles are embedded. Following the principles of recovery does not means that people are able to do as they please, rather they are encouraged to take responsibility and enter into shared agreements. The key elements of this are engagement, collaboration, transparency and the promotion of an individuals’ sense of control, sense of hope, and opportunities for the future (SCMH, 2009). A broad understanding of risk needs to form part of this with an awareness of not just physical harm to self or others but also emotional harm, this including an understanding of the emotional harm that limiting a person’s opportunities can have. We believe the key to effective risk assessment and management is achieved through effective engagement strategies and the development of relationships. The recovery principles give us a way to engage more effectively with people. We should be looking to connect with a person’s story and engage on an adult to adult basis to develop effective safety plans. The assessment and management of risk should be, where possible, a collaborative undertaking and a sharing of responsibility around the management of risk between the person, any supportive relationships that they have and the staff team and any other people or agencies involved with them. It is important that the views of the person and their supporters regarding risk are acknowledged, and that there is effective information sharing. There will be times that services may deem that a person is not able to make informed decisions around their own risk management. It is important that in these situations that any advanced decisions are taken into consideration. People should be encouraged to develop advanced decisions when they are not in crisis that outline how an individual would wish to be happen when they are in crisis. As a person becomes more able to make effective decisions about their risk management, that responsibility is shared. Even when people are unable or

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unwilling to make decisions about protecting their own safety or the safety of others it is important that services maintain engagement and proactively aim to maintain and develop relationships and offer relevant choices, where possible, and uphold the guiding principles of the Mental Health Act 2007 and Mental Capacity Act 2005. It is important to acknowledge that as part of the risk assessment and management process that conflict and disagreement may arise. When this occurs it is important to still maintain engagement and that our approaches are underpinned by the values of recovery. It is also important to be transparent as far as possible and that disagreements are noted and solutions, where possible, are worked towards. It is central that the staff are skilled in using conflict resolution techniques and motivational approach to support the more effective management and self-management of risk. The Department of Health (2007) acknowledges “the possibility of risk is an inevitable consequence of empowered people taking decisions about their own lives.” It is important the organisation and organisational structures (such as documentation) recognise and support the importance of positive risk taking. Following on from this the Risk Network is developing good practice guidelines around collaborative risk planning and the team leaders have been briefed around the relationship between risk and recovery. We have also begun to embed these principles into the Access and Transfer policy. Our plan for the coming year is to continue to use the Team Leads Risk Network to develop good practice and for team leaders to incorporate these new guidelines into their supervision and set up support structures that allow a more creative approach to risk taking. We will also look to develop self-management tools for individuals to be able increase their skills to self manage their own safety and the safety of others. The Team Leads Network will be reviewing the training and risk policies in order that they reflect service development. It is also planned to offer consultation, supervision and support for staff in undertaking effective risk assessment and management, particularly with complex presentations. This consultation should be a joint enterprise between DCHS and DMHF so that people with lived experience are at the heart of informing staff’s learning.

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3. Recovery Co-ordination We felt that this was a crucial area to get right, particularly in not “doing recovery to people”. We developed a statement to support the development of the Wellbeing Toolkit. (This has been referred to as Emotional Health and Wellbeing Plans and Personal Recovery Plans in other documents but we have now settled on the name Wellbeing Toolkit.) The Wellbeing Toolkit is a similar tool to a personal recovery plan or Wellness Recovery Action Plan. It is a self-management tool which draws an individual’s attention to the key areas in their life and how they can build the life that they want and receive the service that they want. We decided to develop our own tool because, although the WRAP (Wellness Recovery Action Plan) and Personal Recovery Plans are extremely useful we felt that we could develop a local tool designed by local people with lived experience which could be tailor-made to each individual that would enhance the opportunities for them and the staff working with them to use the tool effectively. We plan to have a web resource which supports the use of the Wellbeing Toolkit to give access to the general public. On the website we hope to have two versions: a standard version and a custom version which people can build so that they can address their individual needs. For example there may be pages which support people with communication difficulties; there may be pages which focus on specific condition managements, or substance misuse or offending behaviour. We also aim to have a multi-media approach so people can include pictures and music as part of their toolkit. There will also be a social networking element to the site. The other strength of the Wellbeing Toolkit is that it can be used by any person and provides an opportunity to bridge the care planning process between services – particularly primary and secondary care mental health. The statement is as follows: The relationship between Wellbeing and Recovery Plans and CPA care plans The WaRP are planning to develop the Wellbeing Toolkit (WT) for individuals. We would like to promote a tool that focuses on Wellness. The tools are both for the individual, to develop their self-management skills, and for the worker, as a vehicle to get to know the client and build a relationship where people can work in partnership. Staff should encourage all people who access services to complete a WT but these plans should be owned by the person themselves. We propose to complement the implementation of WT by offering people support by peer specialists on an individual basis or attendance at a recovery and self-management training group in addition to the support from NHS staff.

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The WTs should form the basis and guide the CPA care planning process. If a person has another form of plan e.g. a personal recovery plan or WRAP this could be used instead. They could even use pictures or photographs of anything that conveys what is important to them in their life. The crucial factor is that people have ownership of their own plans and that staff are skilled in facilitating people to be able to complete them. At times there may be disagreements regarding the plans of individuals and statutory responsibilities. These should be acknowledged and documented as part of the CPA care-planning process. In addition, the WTs could be developed to form part of NHS staff Job Development Reviews. Carers or people who are in supportive relationships could also be encouraged to complete WTs and people completing WTs should be encouraged to involve their supporters in their plans. The course of action for this year is

• to complete and launch the Wellbeing Toolkits and web resource to support it

• to roll out training packages to staff and people with lived experience to back up the implementation of the toolkit.

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4. Workforce Culture Over the past year, the most significant development has been in the area of understanding the importance of peer specialists in transforming an organisation into a recovery focused one. Their role is described in the document below. We have recruited our first peer professionals, working in NHS teams in the North Dorset CRT, and additional posts are in the process of being developed. By working in partnership together the NHS and DMHF now have a number of peer professionals working on strategic development so that peer relationships between NHS staff and people with lived experience are embedded at a managerial level. Likewise, this partnership work is being done closely with commissioners so lived experience is at the heart of service commissioning as well. We have also been able to get the message across of the importance of the shift in relationship between staff and clients – that it should form much more of a coaching relationship rather than a clinical one. So too we have been stressing the value of educational approaches to complement the clinical ones. In the coming year we will be working closely with team leaders to empower them to lead on recovery focus for each team, with recovery focused supervision and leadership skills to support this process. We are using the Sainsbury Centre for Mental Health 10 Top Tips for Recovery Oriented Practice to guide this. 10 Top Tips

After each interaction, ask yourself did I…

• actively listen to help the person make sense of their mental health problems?

• help the person identify and prioritise their personal goals for recovery – not my professional goals?

• demonstrate a belief in the person’s existing strengths and resources in relation to the pursuit of these goals?

• identify examples from my own ‘lived experience’, or that of other service users, which inspires and validates their hopes?

• pay particular attention to the importance of goals which take the person out of the ‘sick role’ and enable them actively to contribute to the lives of others?

• identify non-mental health resources – friends, contacts, organisations – relevant to the achievement of their goals?

• encourage self-management of mental health problems (by providing information, reinforcing existing coping strategies, etc.)?

• discuss what the person wants in terms of therapeutic interventions, e.g. psychological treatments, alternative therapies, joint crisis planning, etc., respecting their wishes wherever possible?

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• behave at all times so as to convey an attitude of respect for the person and a desire for an equal partnership in working together, indicating a willingness to ‘go the extra mile’?

• while accepting that the future is uncertain and setbacks will happen, continue to express support for the possibility of achieving these self-defined goals – maintaining hope and positive expectations?

We are also involved in the current workforce development review and will be focusing on the power dynamics at play within teams, particularly in relation to the role the medical model plays. We feel clearly the medical model can sit within the recovery approach, as it is about how issues such as medication are discussed with an individual, but that recovery approaches cannot sit within the medical model. Finally, we have submitted the following proposal to the DCHS Workforce Development group and are awaiting ratification. In addition next year we plan to develop workshops for statutory staff with lived experience to look at how they are supported on their recovery journey and how they can use their experiences to enhance their practice. Wellbeing and Recovery Partnership – Workforce Development Proposal 1. Purpose of the Report

1.1 The purpose of this report is to outline proposals for the development of Peer Specialist roles within DCHS and the organisational changes required to enable a more recovery focused culture.

2. Background and Summary

2.1 The Wellbeing and Recovery Partnership (WaRP) between NHS Dorset: Community Health Services (DCHS) and Dorset Mental Health Forum (DMHF) is tasked with influencing the delivery of mental health services by “putting recovery at the heart of what we do.” The New Horizons document (2009) outlines the Department of Health’s commitment to recovery principles. The Sainsbury Centre for Mental Health (2009; 2007) highlight the importance of organisational cultural change. They state the focus of services should be to increase personal control (‘agency’) of the people who access services, where non-professional expertise is acknowledged, that there are reduced power differentials, increased opportunities for a life ‘beyond mental illness’ and the validation of hope. A key part of this change is the transformation of the workforce through the employment of people with “lived experience” and the establishment of training programmes.

2.2 Peer specialists role model recovery and are pivotal in the organisational culture change offering “a beacon of hope and a living demonstration that people with mental health problems can make a direct contribution to their own and others’ recovery by using their experience in paid staff positions.” (SCMH, 2007, p. 11).

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2.3 The WaRP is would like the workforce development group to consider in two key areas: a) Agreement to commit to the development of Peer Specialist roles b) For Human Resources (HR) Business Partners to commit to and

support the practical and cultural shifts required, in regards to all HR processes, in order to enable the statutory services more recovery focused.

3. Recommendations

• For the Workforce development group to support in principle the development of Peer Specialist Roles and agree to support the piloting of peer specialists posts (in conjunction with the DMHF).

• The Workforce development group to advise on the tools to evaluate these roles (this work could be linked to National Recovery Research Network).

• For DCHS when recruiting to any post to add the additional consideration on whether the post could be a peer specialist role. With a view to build a career structure for peer specialists at all levels and the possibility of future consideration of setting percentage targets for employing peer specialists.

• For DCHS to support the establishment of a Recovery Education Centre (REC) to develop and deliver Peer Specialist Training. (The REC will operate pan-Dorset across Health, County Council and 3rd Sector Agencies)

• For HR Business Partners to guide the development of recruitment, selection, and staff management in order to embed recovery principles into the development of the workforce.

• To link the recovery developments with the wider initiatives and best practice regarding employing people with mental health problems.

4. Peer Specialists

4.1 The vision of the WaRP is that Peer Specialists are employed in a range of areas across mental health services and within communities. These areas would include: Acute Care, Community Services, Social Networking Activities, Peer Support, Delivering Recovery Training, as well as consultation and representation of people who use services and participation in the planning and design of services.

4.2 The available evidence on the efficacy of Peer Specialist workers indicates improved outcomes for people who use services, the organisations and also the individuals who undertake the Peer Employment Training. The key areas of potential benefit that are as follows (Scottish Recovery Network, 2006):

• Increased understanding of user perspective / user involvement culture

• Engaging hard to reach groups • Increasing choice within existing mental health system

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• Reducing workload for Statutory Services • Cost-effectiveness

4.3 The Scottish Government (2009) recently commissioned a review of a pilot which employed peer support workers in 5 Health Border areas. Their recommendations were as follows:

• The roll-out of peer support working across mental health services would be beneficial for people who use services, peer support workers and mental health teams.

• Peer support can be successfully implemented in a wide variety of service settings including acute inpatient care and community-based teams.

• On the whole, peer support workers were welcomed by people who use services, who reported high levels of satisfaction with the service.

• Peer support workers were able to give hope to people who use services, reduce feelings of fear and self-stigma amongst these people, enable life skills, and encourage people who use services to take on new strategies for recovery and have more control over their wellbeing.

• Peer support workers mostly grew in their own confidence and experienced enhanced recovery as a result of undertaking the role.

• Although some peer support workers became unwell during the pilot, they demonstrated the great potential of making constructive use of their experiences of recovery by integrating this further lived experience into the skills and knowledge they could offer in their role of peer support worker.

4.4 Sainsbury Centre for Mental Health describes the vision of the changes to service delivery: “Professionals will remain important, but they will have to recognise that their contribution needs to be made in a different way, acknowledging service users’ self-defined priorities. By contrast, we expect to see a greatly expanded role for ‘peer professionals’ in the mental health service workforce of the future. We recommend that organisations should consider a radical transformation of the workforce, aiming for perhaps 50% of care delivery by appropriately trained and supported ‘peer professionals’ (using the proposed local Recovery Education Centre to train and support these new staff)” (2009 p. 2,)

Phil Morgan Professional Head of OT and co-Chair of Dorset Wellbeing and Recovery Partnership Peter Richell General Manager – Adult Mental Health References: Department of Health (2009) New Horizons; Sainsbury Centre for Mental Health (2007): Making Recovery a Reality; Sainsbury Centre for Mental Health (2009): Implementing Recovery: A Framework for Organisational Change; Scottish Development Centre for Mental Health (2009) Evaluation of the Delivering for Mental Health Peer Support Pilot Scheme; Scottish Recovery Network (2006) Mental Health Delivery Plan: Development of Peer Specialist Roles: A Literature Scoping Exercise

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5. Acute Recovery Services It is crucial to get acute care and recovery principles aligned in order to best meet the needs of individuals in crisis or extreme emotional distress. It is also important to be able to answer the question of how we work in a recovery orientated way when people are being detained against their will or do not have the capacity to make informed decisions about their lives. The Acute Care Forum has been keen to embrace recovery principles within the structure of its meeting and increasingly these principles are being incorporated into all items that are discussed. These have included discussions and tentative agreement to aspiring to Zero Restraint as recommended by Recovery Innovations in Arizona. Dorset Community Health Services had already adopted the Tidal Model to use as a vehicle for the development of recovery approaches within acute settings, and all the units have undertaken a self-assessment audit which is due to be fed back to the Acute Care Forum in May 2010. The inpatient units are looking to build on this through the development of psychosocial interventions (in particular unusual experiences groups and motivational interviewing) and the Star Wards programme. There have been changes to home treatment with the development of teams in each of the localities, thus giving people the option to remain at home whist in crisis and to facilitate a speedier discharge. There have also been developments around Day Treatment with the Occupational Therapy led Recovery Pathway. The Access and Transfer Policy was reviewed by the Acute Care Forum and has been rewritten using recovery language and it provides an example of good practice which will influence the future writing of policies. In order to pull all the strands together in relation to acute care, an acute recovery strategy is under development.

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6. Outcome Measures Over the past 12 months the Joint Commissioning Outcomes (JCO) group has been meeting. It has been agreed that there is a need to move away from clinical outcomes towards recovery-based outcomes measures. The group has considered a range of papers and outcome measures (e.g. Outcome Framework for Mental Health, NSIP, 2009; Outcomes Compendium NIMHE, 2008) in seeking to explore which are the most useful in being able to serve the quadruple function of: informing commissioners; being relevant to clients; being user-friendly for staff to be able to implement; and being Recovery orientated. In trying to meet its objectives, the group has recognised the need to move away from measures of clinical recovery that look at symptom based and service usage outcomes, towards measures of personal recovery. The Report of the Standards and Outcomes Pilot Project 2008/9 Devon and Torbay Mental Health and Wellbeing Networks (Moores, 2009) highlights the complexity of attempting to measure personal recovery, as described here by Glenn Roberts (2008- in Moores (2009, p15): We are clear services cannot ‘recover someone’. “Services can offer treatment, support and access to opportunities but recovery is a personal journey, experience, hope and achievement. Services can stimulate, facilitate and promote recovery; they can also hinder recovery, but they cannot generate or create it. Services can in many ways provide the preconditions of recovery but not recovery itself which has to be discovered by the person. Personal recovery pivots around people becoming active and empowered in their own lives, self determining and self managing. They may continue to use and benefit from a wide range of services – but increasingly on their own terms… As we learn more about the limitations of ‘giving treatment’ to someone, we are learning that personal recovery is more related to personal variables such as hope, commitment, taking responsibility and control, and people developing self determination so that they actively use rather than passively receive services. A person may also be using a variety of services such that their experience of personal recovery is an outcome of a unique combination of experiences and commitments they make, which is very well portrayed in recovery stories, which also illustrate that there can be no ‘model of recovery’ or ‘recovery therapy’. One person may experience recovery from taking medication and attending psychotherapy, another by getting a job and finding a partner, another by leaving services altogether. It follows that if services can only provide the supports and preconditions of recovery but not recovery itself; then measures of the personal experience of recovery cannot easily or reliably be taken to be measures of services – so much as an expression of the life experience of the people using a service.”

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It is widely acknowledged that recovery stories are the most effective way of capturing a person’s unique and personal journey. These stories must play a role in the evaluation of services, but it is also recognised that it is not practicable for this to be the sole method to capture a wide set of data for commissioning purposes. However, the JCO is committed to exploring how recovery stories can be used to measure service outcomes. Initially the JCO focused on using the recovery star as a way of collecting recovery based data and this was piloted across the Community Resource Teams. Through this pilot and subsequent discussions with people who access services and their supporters through the WaRP partnership meeting it became clear that the recovery star neither adequately measured people’s personal recovery goals nor their more objective quality of life goals. However, the process was useful in being able to understand the complexities of the implementation of recovery-based outcome measures and for staff teams to start to look at a different set of priorities and then work in a more recovery focused way. It was acknowledged that for some people the recovery star is really helpful, but for others it was not. In looking at personal recovery goals it was thought that where possible we should seek to maximise individual choices around the use of measures but be able to try to standardise the outcomes. This lead the JCO to look other approaches to measuring recovery-based outcomes. This difficulty in trying to find a single measure is not a local problem; rather it is a national or international issue and is documented in the recovery literature. In the most recent National Recovery Research Network (April 2010) there were discussions about tools that were under development but as yet there is not a clear direction on this at a national level. In order to overcome the challenges posed by trying to measure personal recovery Mike Slade (2009: Personal Recovery for Mental Health Professionals) proposes the following:

“…an overall outcome evaluation strategy would measure two things; first, objective quality-of-life indicators, such as adequacy of housing, friendship, safety, employment, close relationships etc.; second, progress towards personal goals. A mental health service which can show it is increasing the attainment of valued social roles and increasing the proportion of personally valued goals being met by people on its caseload is likely to be a recovery-focused mental health service”

JCO discussed this and in addition added a third strand which would be to measure how recovery focused a service was. The plan is to develop a three-pronged approach to delivering outcomes.

1) Being able to evaluate personal recovery goals. The key principle behind this being that they are generated by an individual and are self-rated.

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2) Quality of Life Indicators: These would be objective measures that looked at social inclusion, employment etc.

3) Evaluating the organisational change in relation to recovery. The task now for the JCO is two-fold. One is to have this approach agreed as a pan-Dorset approach and the second is to identify the tools or specific outcomes that will be measured. In order to measure personal recovery goals it has been suggested that a simple 1-10 rating scale could be used by individuals in relation to the specific goals or goal that they have. Other options could be the goal attainment scale or similar measure. In relation to the quality of life indicators some of this data is already being collected; for example, around employment and housing. So it may be a matter of identifying which additional categories may be required. Mike Slade suggests the Los Angeles-based company MHA village: Quality of Life Outcomes measure. We have been in contact with MHA village and they are very supportive around sharing any information they have. At the last WaRP steering group in April it was proposed that the Sainsbury Centre for Mental Health (2010) A Methodology for Organisational Change be used to measure the recovery orientation of the service. In DCHS we now have plans to take this forward. We have also made informal contact with one of the co-ordinators of this project to see whether they might volunteer to pilot the tool in Dorset.

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7. Training The Sainsbury Centre for Mental Health Recommend the establishment of a Recovery Education Centre (REC) which is described as follows. This [‘Recovery Education Centre’] is staffed and run by ‘user trainers’ and delivers support and training for service users to train staff in recovery principles for teams and on wards. (It may or may not be delivered by an external, independent sector user/trainer organisation.) The Centre also runs programmes to train service users as ‘peer professionals’ to work alongside traditional mental health professionals as direct care staff. Arrangements for the management, supervision and support of these staff are co-ordinated by the Centre staff. The Centre offers courses to service users, their families and carers on recovery and the possibilities of self-management. There are a range of links to general educational classes in the community and pathways to courses and other learning opportunities. (SCMH, 2010, Implementing Recovery: A Methodology for Organisational Change) The WaRP has agreed in principle to establishing a pan-Dorset REC which will be led by DMHF. DMHF already provides mental health and recovery training for Dorset County Council and has begun design and delivery of training with DCHS. This has now been formalised into DMHF taking the lead on the following:

1) Recovery skills training for NHS staff, which will be core training 2) Recovery and self management training for people who access services

and their supporters 3) Peer Specialist training

A training package is under development for staff and people who access services in relation to the Wellbeing Toolkit. The development of peer specialist roles will support and be supported by this process. Ciaran Newell, Lead for service user and carer involvement (DHFT), has made some preliminary enquiries around having these course accredited by Bournemouth University on three levels. DMHF continues to contribute to the ongoing DCHS training programme with the training department. Over the next twelve months the focus will be on formally establishing the REC, developing, delivering and accrediting the training programmes and rolling them out pan-Dorset.

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8. Spirituality We have attempted to ensure that attention to people’s spirituality runs as a theme through all the developments, whether it be through collecting recovery stories, the acute care strategy, or the Wellbeing Toolkit. We view spirituality as essential to enable people to make sense of their lives and find purpose and meaning. In the most recent edition of reflections (see below) we outline how the WaRP views spirituality. Our task for the rest of this year is to communicate this more effectively and encourage staff to understand the clinical benefits of working alongside people and talking about what they find meaningful and how they view the world.

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9. Influence Wider Dorset population and

10. Develop Culture of Creativity and Participation For the purpose of this report we have grouped these two areas together as they are perhaps the areas that are least developed. We have also merged them on the Recovery Strategy document; hence there are only nine objectives. However, in the coming year it will be the initiatives that are under way which will support these areas, for example, the development of the Wellbeing Toolkit and the associated press release and website. As we are moving towards an implementation phase so we are changing our meeting structures to support participation on a local level, in particular with our learning from lived experience meetings. What we have achieved is a momentum and an increasing number of people telling us they are interested in recovery. We have seen demonstrated a shift in understanding the role recovery has in improving people’s lives. The recovery approaches have also influenced ongoing projects such as the wellbeing support programme and its links to public health and the Time for Change Campaign.

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Conclusion We feel that the WaRP has made good progress over the past twelve month and have experienced a constant process of review and revision as our understanding of how the principles of wellbeing and recovery have increased. We have organisational sign-up and buy-in from all the stakeholders across Dorset at all levels and a growing number of people who are keen to champion recovery. The focus in the first year has predominately been on Dorset Community Health Services. Our vision is for this work to take place pan-Dorset. We feel confident that we have now done the ground work in terms of how the ideology looks in practice. Now is the greater challenge which is the implementation. We feel that we have a clear way forward but the proof of the effectiveness of this approach is when we are changing the experience of those who access services and when there is a change in how people’s emotional wellbeing is addressed across the whole of Dorset. We would like to thank everyone who has supported us and worked with us on our recovery journey and who has contributed to our feeling of hope and given us inspiration for this project to move forward. Phil Morgan Becky Aldridge Lead Occupational Therapist Assistant Services Manager DCHS DMHF

Co-Chairs of Dorset Wellbeing and Recovery Partnership June 2010

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APPENDIX ONE

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The Dorset Wellbeing and Recovery Partnership Project Plan

Introduction

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The Dorset Wellbeing and Recovery Partnership Project Plan Introduction The Dorset Wellbeing and Recovery Partnership is primarily a partnership between NHS Dorset: Community Health Services (DCHS) and Dorset Mental Health Forum (DMHF). This partnership allows us to put the expertise and experience of service users at the heart of the development of mental health provision across the county. The Department of Health’s (2008; 2009) New Horizons documents outline the future direction for mental health service provision and emphasises the need for Mental Health Services to focus on the promotion of well-being of the whole community and for the underlying rationale for Mental Health Services being based on the principles of Recovery. Recovery involves moving away from traditional styles of service delivery to a more person centred approach, engaging with service users as partners on their individual journey of discovery. We believe that Recovery will improve the quality of services provided, as well as increase effectiveness and efficiency. Mental health services can become more responsive to the individual needs of people experiencing mental health problems, which will benefit existing service users, new service users and future service users. The partnership aims to provide leadership both a strategic level and influencing practice at the point of service delivery. We see the principles of wellbeing as essential to understanding recovery as a philosophy. That there needs to be a shift of focus from an illness model to a wellness model. Our understanding of wellbeing is that a person’s overall health is influenced by them experiencing balance and meaning across a range of areas in their life (for example: spiritual; physical; social; emotional health) as well as feeling connected to their community. People with mental health problems experience significant health inequalities and through the wellbeing and recovery partnership we seek to tackle these inequalities. In order to put “recovery at the heart of everything we do” there is a need for whole systems change, to cast a critical eye over current service provision and to address the mental health needs of local communities. Our aim is for the principles of Well-being and Recovery to be embedded across all services within Dorset and we are committed to collaborative working. The Dorset Wellbeing and Recovery Partnership Project Plan outlines how we aim to achieve this systems change. The plan is structured by eight headings which are influenced by the Devon Recovery Partnership headings for service development and were added to in the first Dorset Wellbeing and Recovery Partnership Project meeting. The headings are as follows.

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• Crisis Response, Inpatient Provision, and Community Alternatives to Hospital • Risk Assessment, Risk Taking and Safety Planning • Workforce Culture • Stigma, Discrimination and Language • Support from Peers and Staff Support in Assisting Recovery • Communication, Publications and Research • Promotion of Wellbeing and Strengths Based Approaches • Engagement with the Wider Community Aspirations The Dorset Wellbeing and Recovery Partnership Project Plan is underpinned by a number of aspirations for service provision. These aspirations are based upon the Principles of Recovery from the Devon Recovery Partnership (SCMH, 2008: Adapted from Recovery – Concepts and Application by Laurie Davidson, the Devon Recovery Group.)

• To improve the wellbeing of the people of Dorset: through influencing the community/communities that provide the opportunities for individuals and families to live meaningful and satisfying lives.

• For those people who use mental health services to experience it in a way that celebrates them as individuals and empowers

them by drawing on their strengths and their own wellbeing strategies. That they are encouraged to discover or rediscover a sense of identity separate from their diagnosis, illness or disability, and that their families and/or supporters are involved in this process where possible.

• For services and communities to promote feelings of “hope” through individuals having active control over their lives.

• Providing the resources for people to self-manage, to learn from others who have had similar experiences (peers support),

and/or offer “professional” support in ways that meet the needs of each individual. These resources should be organised in a way that provide ease of access, in environments that do not reinforce the stigma associated with mental illness, and be cost-effective.

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• To change the relationships between professionals and those who access services from expert/patient to partnerships and relationships that are more similar to coaching relationships, and that services are organised in a way where staff are available to people when they need them.

• That meaningful social roles are open to everyone in Dorset. All services and organisations should take an active role in

tackling social exclusion and break down the barriers between specific mental health services and the wider community.

• That there is a shared understanding across Dorset of the importance of using language that promotes hope and wellbeing and reduces stigma in relation to mental illness.

• That staff who work in all mental health services feel valued as individuals where personal qualities and experiences are as

important as their qualifications, and that staff development focuses on developing their capacity for hope, creativity, care, compassion, realism and resilience.

• When people experience high levels of distress, or are in crisis, which may compromise their own or the safety of others, to

provide a service that values them as individuals and promotes partnership working, enabling them to take responsibility for their recovery. If it is necessary to place restrictions on an individual (to maintain their safety or the safety of others) that this is done in the least restrictive way and that as far as possible their wishes and choices are respected.

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Summary of Wellbeing and Recovery Project Plan and 10 Priority Areas As the Wellbeing and Recovery Project Plan is a long document it is important to be able to communicate the key areas for service development. The table below outlines the ten priority areas. One of our key priorities is the integration of risk and recovery so that we can be clear to staff and service users about their responsibilities in terms of preventing harm to either themselves or the public whilst operating within the framework of recovery. Key Tasks Action Person/Group Responsible 1 To effectively communicate how and why the

partnership is promoting recovery and wellbeing Set up website, newsletters, magazines and meetings that support effective communication

Wellbeing and Recovery Partnership steering group and Communication working group

2 Develop clear guidelines that integrate risk management, safety planning and recovery

Set up working group to produce and share guidelines

Risk and Safety Planning working group

3 To develop a recovery co-ordination strategy and review all paperwork so that it supports a recovery approach

Set up working group to develop recovery co-ordination strategy

Recovery Co-ordination working group

4 To change workforce culture so that recovery is the dominant approach

Set up working group to examine all aspects of staff development (including recruitment, supervision, appraisal, practice and training)

Recovery Workforce Development working group

5 To ensure there is effective and consistent recovery training across Dorset

Set up working group to develop shared training strategy

Recovery Training working group

6 Continue to develop the role that recovery plays in acute (Enhanced Recovery) services – with a focus on development of alternatives to inpatient treatment for those in crisis

Set up working group to discuss opportunities to develop services

Enhanced Recovery working group

7 Ensure that spirituality is linked to recovery in a way that is meaningful to the whole community

Set up working group to develop recovery and spirituality strategy

Spirituality working group

8 Evaluate the experience of service users through the use of recovery stories and robust recovery-based outcome measures

Collect Develop, pilot and use recovery orientated outcome measures

JCB Outcomes meeting

9 Create a culture that provides the opportunity to be creative and promotes discussion on how to embed the principles of recovery in mental health service provision across Dorset

Set up open Wellbeing and Recovery Partnership meeting that promotes discussion and learning and operates as a consultation group for the Wellbeing and Recovery Partnership steering group

All people who are interested in Recovery in Dorset

10 To promote wellbeing and recovery throughout Dorset Engage with a wide range of partners and set up networks to promote wellbeing that look at the whole community

The Wellbeing and Recovery Partnership steering group

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Sainsbury Centre for Mental Health: Implementing Recovery: A New Framework for Organisational Change The Sainsbury Centre for Mental Health have produced a new guidance document to support organisation change. (It is available at www.scmh.org.uk/pdfs/implementing_recovery_paper.pdf.) At the steering group in October 2009 the importance of this document was discussed and it was decided to link it to our strategy to it. They highlight 10 key organisational changes required and in the table below we have outlined how we aim to address them and how they overlap with the WaRP 10 key priorities. These principles have been embedded into the project plan. Sainsbury Centre: Ten key organisational changes

What are we doing? Related area(s) in WaRP ten key priorities

1. Changing the nature of day-to-day interactions and quality of experience

Informing people about the principles of recovery and how this translates in practice, through meeting with individuals, groups, and teams and the newsletter. Celebrating good recovery orientated practice and looking to build a culture that challenges poor attitudes and practice

1) To effectively communicate how and why the partnership is promoting recovery and wellbeing

7) Ensure that spirituality is linked to recovery in a way that is meaningful to the whole community

2. Delivering comprehensive, service user-led education and training programmes

There is some user-led training but we are already looking to increase this and also to develop education-based programmes for people with lived experience

5) To ensure there is effective and consistent recovery training across Dorset

3. Establishing a “Recovery Education Centre” to drive the programmes forward

We have agreed to establishing a “Recovery Education Centre”, in principle and are looking to how this would work in practice

5) To ensure there is effective and consistent recovery training across Dorset

8) Evaluate the experience of service users through the use of recovery stories and robust recovery-based outcome measures

9) Supporting staff in their recovery journey 4. Ensuring organisational

commitment, creating the “culture

The commitment is present from the all the partnership organisations and the project plan has a whole systems approach to support a “cultural” change

3) To develop a recovery co-ordination strategy and review all paperwork so that it supports a recovery approach

4) To change workforce culture so that recovery is the dominant approach

5. Increasing “personalisation” and choice

We are increasing our understanding of how this links to recovery and how we can be more flexible and offer choice. People have been supported to access direct payments to purchase goods or services to support their recovery

6) Continue to develop the role that recovery plays in acute (Enhanced Recovery) services – with a focus on development of alternatives to inpatient treatment for those in crisis

7) Ensure that spirituality is linked to recovery in a way that is meaningful to the whole community

10) To promote wellbeing and recovery throughout Dorset

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Sain What are we doing? Related area(s) in WaRP ten key priorities sbury Centre: Ten key organisational changes 6. Changing the way we

approach risk assessment and management

NHS Dorset: Community Health Services, with Support from Dorset Mental Health Forum are reviewing their risk policies and will be redeveloping them in line with recovery principles

2) Develop clear guidelines that integrate risk management, safety planning and recovery

6) Continue to develop the role that recovery plays in acute (Enhanced Recovery) services – with a focus on development of alternatives to inpatient treatment for those in crisis

7) Ensure that spirituality is linked to recovery in a way that is meaningful to the whole community

7. Redefining service user involvement

Approach of the Forum has moved away from tokenistic user involvement to meaningful partnership working and consultation. The development of the WaRP is testament to this

3) To develop a recovery co-ordination strategy and review all paperwork so that it supports a recovery approach

8) Evaluate the experience of service users through the use of recovery stories and robust recovery-based outcome measures

9) Supporting staff in their recovery journey 8. Transforming the workforce The Wellbeing and Recovery Partnership Steering group

are in the process of developing a position paper that will outline the vision for the development of peer specialist roles

4) To change workforce culture so that recovery is the dominant approach

9. Supporting staff in their recovery journey

Members of the WaRP steering group will be meeting with Human Resources to look at how we can become more recovery orientated in how we support and develop our staff.

3) To develop a recovery co-ordination strategy and review all paperwork so that it supports a recovery approach

4) To change workforce culture so that recovery is the dominant approach

10. Increasing opportunities for building a life beyond illness

Continue to ensure service developments across the partnership aim for and meet this expectation

7) Ensure that spirituality is linked to recovery in a way that is meaningful to the whole community

10) To promote wellbeing and recovery throughout Dorset

7

Implementation of the Project Plan In order to implement the Wellbeing and Recovery Partnership Project Plan there needs to be involvement of a wide range of staff (from all sectors) and people with lived experience. For the approach, in keeping with recovery philosophy, the emphasis should be solution-focused and strengths-focused and therefore the emphasis should be on sharing and communicating existing good practice and celebrating our “Recovery Champions.” In order to provide a democratic approach and to be able to encompass a wide range of views it has been agreed that there will be quarterly open Wellbeing and Recovery Partnership meetings, open to anyone with an interest in Recovery in Dorset. This meeting will act as a creative think-tank and consultation group that the Wellbeing and Recovery Partnership steering group will feed into and learn from. Following the low attendance at the meeting in September and a discussion at the steering group, it was agreed that these would be replaced by locality based recovery networks. These networks will be responsive to local need and focus on implementation of recovery principles. There will be further definition and discussion about these at the next Steering group January 2010. In addition there will be an annual recovery event across all the localities which will celebrate any achievements and good practice. The Wellbeing and Recovery Partnership steering group will initially meet monthly in order to develop and implement the project plan, this was reviewed in October 2009 and it was agreed that the group would meet quarterly. The steering group is responsible and accountable to both Brian Goodrum and Shaun Byatt. Its membership should represent a range of staff from the NHS in terms of grade and location and members of Dorset Mental Health Forum. The proposed membership of the steering group is as follows:

Phil Morgan Becky Aldridge Peter Richell Davina Thorne Bernadette Waters Bev King

Peter Thorne Gary Cure Kate Antell Gary Hawker Mark Humphries

Paul Billen Claire Onions Ian Rodin Fran Abbott-Hawkins IAPT representative + 2 MHF

From the Wellbeing and Recovery Partnership steering group, interested parties in the open Wellbeing and Recovery Partnership meeting, and specifically identified individuals, a range of working parties will be identified. These working parties will have specific time-limited projects to complete. Where possible they will be linked into the existing Team Leads Networks or existing meetings. In addition, members of the steering group will meet with people from different parts of the service and other agencies when required.

8

Diagram of relationships between the different groups and meetings to aid implementation of project plan

Wellbeing and Recovery Locality Networks

Task Focused Recovery Working Groups

Operational Management Group Meetings Clinical

Governance Meetings

Enhanced Recovery Forum

Locality Management Meetings

Wellbeing and Recovery Steering Group

Team Leads Network

JCB Outcome Measures Meetings

Completed by: Phil Morgan12/6/09, amended 15/9/09, 11/11/09

9

10

APPENDIX TWO

WELLBEING AND RECOVERY You may be wondering why we have called it the Wellbeing and Recovery Partnership and not just Recovery. We see the principles of wellbeing as essential to understanding recovery as a philosophy. Our understanding of wellbeing is that a person’s overall health is influenced by them experiencing balance and meaning across a range of areas in their life (for example: spiritual; physical; social; emotional health) as well as feeling connected to their community. People with mental health problems experience significant levels of disadvantage and exclusion from their communities which, among other things, can stem from ignorance or a misguided desire to help. People who experience longstanding symptoms, which people describe as mental illness, experience disproportionate chronic and disabling physical health conditions and live shorter lives. It is therefore our task to support the wellbeing of individuals, to tackle discrimination and to reduce the impact of these health inequalities. Through the use of the Recovery principles to empower individuals and communities, we seek to ensure that health and wellbeing is within everyone’s reach.

Dorset Wellbeing and Recovery Partnership

Definition of Recovery “[Recovery is] a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and contributing life, even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness...” (Anthony, 1993 – From the Sainsbury Centre (2008): Making Recovery a Reality)

Initial Meeting of the Wellbeing and Recovery Partnership Programme On the 7th May the first meeting of the Recovery Partnership Board took place. The partnership board was jointly chaired by Phil Morgan from NHS Dorset Community Mental Services and Becky Aldridge from the Dorset Mental Health Forum. There were approximately 20 attendees with representatives from NHS Dorset, the Mental Health Forum and Rethink. The purpose of the meeting was to embed Recovery as the central approach to both the provision of mental health services and the promotion of mental wellbeing of the general population in this part of Dorset. This is to ensure we are able to offer the most effective mental health services possible.

The meeting aimed to establish a shared understanding and commitment to working in partnership and integrating recovery into practice. It was acknowledged that we have already made a good start and have some effective partnership working and recovery orientated practice and are keen to build on this.

The meeting was informal and lively and it was clear that there is a strong commitment to build on the excellent work that is already taking place. It is anticipated that the Dorset Wellbeing and Recovery Partnership will grow and evolve. This meeting should therefore be seen as a starting point rather than the finished article.

Recovery is not a model, it is a philosophy. To change services we need to embed this philosophy into everything we do.

Issue 1: July 2009

Principles of Recovery

• Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems.

• Recovery represents a movement away from pathology, illness and symptoms to health, strengths and wellness.

• Hope is central to recovery and can be enhanced by each person seeing how they can have more active control over their lives (‘agency’) and by seeing how others have found a way forward.

• Self-management is encouraged and facilitated. The processes of self-management are similar, but what works may be very different for each individual. No ‘one size fits all’.

• The helping relationship between clinicians and patients moves away from being expert / patient to being ‘coaches’ or ‘partners’ on a journey of discovery. Clinicians are there to be “on tap, not on top”.

• People do not recover in isolation. Recovery is closely associated with social inclusion and being able to take on meaningful and satisfying social roles within local communities, rather than in segregated services.

• Recovery is about discovering – or rediscovering – a sense of personal identity, separate from illness or disability.

• The language used and the stories and meanings that are constructed have great significance as mediators of the recovery process. These shared meanings either support a sense of hope and possibility, or invite pessimism and chronicity.

• The development of recovery-based services emphasises the personal qualities of staff as much as their formal qualifications. It seeks to cultivate their capacity for hope, creativity, care, compassion, realism and resilience.

• Family and other supporters are often crucial to recovery and they should be included as partners wherever possible. However, peer support is central for many people in their recovery.

SCMH (2008) Adapted from Recovery – Concepts and Application by Laurie Davidson, the Devon Recovery Group

.Getting Involved We are looking to set up a meeting to discuss the project plan, build on the initial ideas that have been generated. We are also looking to set up some working groups to address specific issues. If you would like to attend the meeting, participate in our working groups, be put on our mailing list or get involved in any other way please contact either: Phil Morgan – Philip.Morgan@dorset-pct.nhs.uk 01305 361371 or Becky Aldridge – beckyaldridge@dorsetmentalhealthforum.org.uk 01305 257172

Our services need to be shaped by the principles of Recovery. We all need to be thinking critically about our practice and asking the question, is what we are doing in line with these principles and if not what could we do to make it more Recovery focused?

All photos © Theresa Newton

THE WAY FORWARD A wellbeing and recovery project plan is currently under development and a summary of the key action points will be out for consultation shortly. The project plan will provide a framework within which further developments can take place and will address issues such as: Crisis Response, Inpatient Provision, and Community Alternatives to Hospital; Risk management and Safety Planning; Workforce Culture; Language and stigma; Support from Peers and Staff Support in Assisting Recovery; Spirituality; Promotion of Wellbeing and Strengths Based Approaches; Engagement with the Wider Community; and the development of a communications strategy.

“Probably the most useful way of understanding recovery is linking it to our own experience because it is something that is common to all of us; it is not specific to mental health problems. Any of us, who have been through a divorce, being made unemployed, a major illness or bereavement, know that that changes us; there is no way to going back to how we were before that event. We have to incorporate that into our way of living and we learn from that and move on with that, which is exactly what we are talking about in terms of recovery from mental health problems.

Very importantly, recovery is about taking back control over your own life and your own problems, about not seeing your problems as being uncontrollable, or that their control is just the province of experts. It is about understanding yourself what is possible and what you can do to help yourself.” By Dr Repper from An independent investigation into the care and treatment of Daniel Gonzales (January 2009) p. 124.

Dr Repper is currently associate professor for Mental Health Nursing and Social Care at Nottingham University and is co-author of a book entitled Social Inclusion and Recovery. A model for Mental Health Practice (Baillere Tindall 2003).

Dorset Wellbeing and Recovery Partnership

Next Meeting of the Dorset Wellbeing and Recovery Partnership September 22nd 10:00am – 12:00pm

Dorchester Corn Exchange

Issue 2: August 2009

Contact Details: Phil Morgan – Philip.Morgan@dorset-pct.nhs.uk 01305 361371 or Becky Aldridge – beckyaldridge@dorsetmentalhealthforum.org.uk 01305 257172

A Helpful Definition of Recovery

The second meeting of the Dorset Wellbeing and Recovery Partnership Programme will be held on the morning of 22nd September 2009 and is open to anyone who has an interest in mental health in Dorset and the promotion of wellbeing and recovery. The meeting aims to provide a creative space where ideas to promote the principles of recovery and wellbeing can be discussed. We are also looking for opportunities to develop meaningful partnership working between professionals and the people who experience mental health problems.

We are looking to discuss the Wellbeing and Recovery Project Plan which is in draft form. In particular, we wish to examine what we call the ten key priorities. These priorities are outlined on the reverse page of this newsletter. We are keen to receive feedback on this.

*** If you are interested in attending, or are unable to attend but would like to make some comments, please contact either Phil or Becky (see details below). We plan to have these meetings four times a year.

Dorset Wellbeing and Recovery Project Plan: 10 Key Priorities

1. To effectively communicate how and why the partnership is promoting wellbeing and recovery, through establishing an effective communication strategy, using a combination of different media: newsletters, internet, meetings etc.

2. To integrate the concepts of risk and recovery so that we can be clear to staff and service users about their responsibilities in terms of preventing harm to either themselves or the public whilst operating within the framework of recovery. We aim to develop clear guidelines that integrate risk management, safety planning and recovery.

3. To develop a recovery co-ordination strategy to develop meaningful partnership working between staff and service users in order to support a person on their recovery journey. This will include reviewing all procedures and administrative paperwork to ensure it supports a recovery approach.

4. To change workforce culture so that recovery is the dominant approach and philosophy across all mental health services.

5. To ensure there is effective and consistent recovery training across Dorset in both statutory and third sector services.

6. To continue to develop the role that recovery plays in acute services – with a particular focus on the development of alternatives to inpatient treatment for those in crisis.

7. To ensure that people’s sense of spirituality is linked to their recovery and that this is done in a way that is meaningful to the whole community.

8. To evaluate the experience of service users through listening to and recording their stories and through the use of robust recovery-based outcome measures.

9. To create a culture that provides the opportunity to be creative and promotes discussion on how to embed the principles of recovery in mental health service provision across Dorset, through the establishment of Wellbeing and Recovery Programme meetings.

10. To promote wellbeing and recovery throughout Dorset through engaging with a wide range of partners outside traditional health and social care settings and set up networks to promote wellbeing and recovery.

We will be looking to draw upon the experience and expertise from a wide range of people to support us in delivering these tasks, so if you feel you would like to contribute to any of these areas please contact either Becky or Phil. Photos © Peter Thomson

www.peter-thomson.co.uk

Since the last meeting interest has been growing in the Wellbeing and Recovery Partnership. We have been asked to do a number of talks and presentations to a range of people and teams and the feedback has been positive. The message we are receiving is that people value and support the project. We have completed a project plan, which we are looking to discuss at the next meeting and we have set up a steering group to co-ordinate its implementation. We have been speaking to Dorset Healthcare NHS Foundation Trust and they are interested in joining the partnership. We welcome their involvement so that the Partnership can cover Dorset County and there is an opportunity to share good practice. We have been exploring recovery-focused outcome measures and have been piloting the Recovery Star in a variety of teams across the whole county. We have also been engaged with South West Recovery Network and have agreed to host a regional recovery event on 16 October in Dorchester. More information about this will soon be available.

Progress since the Last Meeting

Dorset Wellbeing and Recovery Partnership

Issue 3: November 2009

Two exciting developments are informing our work: 1. The creation of Peer Specialist roles (people with

lived experience becoming an integral part of the workforce in delivering mental health services). Eugene Johnson from Recovery Innovations (previously Meta Services) in Arizona has been influential in developing these roles. Phil and Becky were fortunate enough to be able to attend a presentation he gave at an event in London in the Summer. More details to follow in the December Newsletter! If you cannot wait, visit www.recoveryinnovations.org to find out more about Peer Specialists.

2. The Sainsbury Centre for Mental Health document Implementing Recovery: A New Framework for Organisational Change which is described overleaf. Further details can be found at www.scmh.org.uk.

Both of these strands focus on the importance of an individual’s self-management, the role that other people with lived experience can have in each others’ recovery and how an educational approach can support all this. They also suggest that the role of services should be to provide suitable environments that facilitate these approaches, to support people on their individual recovery journeys.

Contact Details: Phil Morgan – Philip.Morgan@dorset-pct.nhs.uk 01305 361371 or Becky Aldridge – beckyaldridge@dorsetmentalhealthforum.org.uk 01305 257172

Key Recovery Developments

At the heart of Recovery “… is a set of values about a person’s right to build a meaningful life for themselves, with or without the continuing presence of mental health symptoms. Recovery is based on ideas of self-determination and self-management. … It emphasises the importance of hope in sustaining motivation and supporting expectations of an individually fulfilled life”. Shepard et al., 2008 Making Recovery a Reality. Sainsbury Centre

Welcome to the latest Wellbeing and Recovery Partnership (WaRP) Newsletter. We have been very busy since the last issue in August and will use this newsletter to update everyone and share our progress and thinking. We are keen to have your continued input and support. In particular, we want to use Recovery stories to illustrate Recovery orientated practice. If you have any stories you wish to share please contact Becky (see details at bottom of page). We will be discussing Recovery stories in the December newsletter.

We held our Wellbeing and Recovery Partnership meeting in September. Attendance at the meeting was low, but a lively discussion was had amongst a representative group of service users, carers and staff, particularly around outcome measures. It is really challenging to find an outcome measure that is useful both to individuals as part of their Recovery journey, as well as meaningful for practitioners and commissioners! Following the low turnout it was decided at the last Steering Group meeting to set up local implementation networks, which will focus on how we practically apply Recovery principles within each locality. In addition, we aim to hold an annual Recovery event to celebrate specific individual and service Recovery achievements. This is likely to be scheduled some time in the spring. In September we met with the Independent Mental Health Carer’s Forum. The group described some of their experiences and difficulties. In particular, that they would like services to be more responsive at early signs of crisis rather than when circumstances have escalated. This is something we are seeking to address as we review our approach to risk management and Recovery co-ordination (as highlighted in the August WaRP newsletter).

Sainsbury Centre for Mental Health Implementing Recovery: A New Framework for Organisational Change

The Sainsbury Centre for Mental Health have produced a new guidance document to support organisation change, which we feel is very relevant to our work. At the Wellbeing & Recovery Steering Group meeting in October, we discussed the importance of this document and we have incorporated it into our project plan. We believe we are already meeting some of these key changes. We are certainly attempting to redefine user involvement, and the role that the Dorset Mental Health Forum plays in the partnership is testament to this, and we do have an organisational commitment to changing the culture. We are determined to meet the other organisational changes, all of which overlap with the WaRP 10 key priorities (see August newsletter). Some items translate directly, for example Changing the way we approach risk assessment and management relates to our second key priority: Develop clear guidelines that integrate risk management, safety planning and recovery. Also our aim to provide consistent recovery training cross references Delivering service user led training programmes and Establishing a Recovery Education Centre (REC.) The steering group has agreed in principle to establish a REC and we are exploring how this would look in practice. The key to all of this is to ensure that the changes which are made influence practice on the ground and to ensure the services support people’s recovery journeys. It is also important to acknowledge that there is good recovery orientated practice happening all the time, so sometimes it is about highlighting that good practice rather than talking about things differently. We aim to highlight this good practice in our annual recovery event.

Progress Since the Last Newsletter

Sainsbury Centre for Mental Health Ten key organisational changes

• Changing the nature of day-to-day interactions and quality of experience

• Delivering comprehensive, service user led education and training programmes

• Establishing a ‘Recovery Education Centre’ to drive the programmes forward

• Ensuring organisational commitment, creating the ‘culture’

• Increasing ‘personalisation’ and choice • Changing the way we approach risk

assessment and management • Redefining service user involvement • Transforming the workforce • Supporting staff in their recovery journey • Increasing opportunities for building a life

‘beyond illness’

In September Becky and Phil went to hear Eugene Johnson of Recovery Innovations in Arizona speak. Eugene is a leading international figure in promoting recovery in mental health services. It is the work of Recovery Innovations which is helping shape our thinking as regards the role of peer specialists. Eugene used the Michelangelo quote across the page to illustrate how Recovery starts with a vision of hope and inspiration. The mission of Recovery Innovations is: “to create opportunities and environments that empower people to recover, to succeed in accomplishing their goals, and to reconnect to themselves, others, and meaning and purpose in life”. Recovery Innovations, through creating opportunities and giving people responsibilities, found that individuals not only improved but also flourished. They moved towards an educational model, training people in developing self-management skills and then on to employing people with lived experience. Eugene described a “snowball effect” where, as expectations were raised, people achieved more, hope increased and people’s lives improved. Recovery Innovations now have a comprehensive training package and career structure. 72% of the workforce are now peer specialists. Eugene described a “tipping point” where the organisation moved from one that reinforced disability, allowing people to be victims, looking for someone to fix them, to an organisation which empowered, allowing people to discover their gifts and strengths, which could be celebrated.

This has been compiled to raise awareness and promote the philosophies of Wellbeing and Recovery in a way that inspires hope, enables transformation and challenges stigma. The aim is to influence change within Dorset, particularly within mental health services and to provide a resource for people to access further information about wellbeing and recovery by: Establishing local recovery networks Developing methods of collecting and publishing recovery stories Making recovery stories available to Commissioners Creating the Dorset WaRP website Organising a

competition with local schools to design a WaRP poster to raise profile and publicise website Liaising with local press to raise profile, launch website and link with Time to Change campaign Involving Public Health to increase awareness of wellbeing and recovery outside mental health services.

Recovery Innovations – www.recoveryinnovations.org

Welcome to our winter newsletter. Apologies to those of you who were expecting a December edition. Following the last newsletter we decided to produce four newsletters a year, on a seasonal basis. The focus in this newsletter is: peer specialists and the role they can play in supporting both an individual’s recovery but also in helping organisations and teams to become more recovery centred; and to outline the communication strategy which we are in the process of launching.

Issue 4: Winter 2009/10

Dorset Wellbeing and Recovery Partnership

“The greater danger for most of us is not in setting our aim too high and

falling short, but in setting our aim too low and achieving our mark.” Michelangelo (Italian sculptor, painter,

architect & poet, considered the creator of the Renaissance, 1475-1564)

The Wellbeing and Recovery Partnership (WaRP) Communication Strategy

Peer Specialists and the Dorset WaRP

Contact Details: Phil Morgan – Philip.Morgan@dorset-pct.nhs.uk 01305 361371 or Becky Aldridge – beckyaldridge@dorsetmentalhealthforum.org.uk 01305 257172

Recovery Stories and Narratives

So having heard Eugene Johnston we asked ourselves, what does this mean for us and what is it that peer specialists actually do? Then we realised that we already have a number of paid and voluntary positions where people with lived experience contribute to both service delivery or service development. There are the Forum service user representatives who sit on various developmental and strategic groups for NHS Dorset: Community Health Services; there are a range of projects led by people with lived experience, for example the Sport and Leisure Activity Programme (SLAP) and there are volunteers who contribute to some of the activities and groups in the inpatient units. There are also peer support groups and development of training programmes led by people with lived experience. From this we know what peer specialists do: they inspire hope in others, they enable staff to think differently, they ensure that service delivery is focused on what the person wants rather than the organisation. We may not have called them peer specialists but that is what they are doing. So what do we need to do? Well, we need to build and develop this. We have just recruited our first formal peer specialist post in North Dorset to support people with mental health problems returning to work. We are currently developing a strategy that will propose the development of a comprehensive training programme for peer specialists and a career structure so that there are peer roles in all aspects of the services. Other areas in the UK have already started employing peer specialists and the feedback so far is encouraging, particularly in Scotland. If you want to find out more information on peer specialists please check out the Recovery Innovations website www.recoveryinnovations.org.

Recovery stories and narratives are an essential part of understanding recovery, what it means for people and what it looks like in reality. Not only can stories inform and inspire individuals on a personal level in their own recovery, but also mental health practitioners in their practice and the attitudes of communities and society as a whole. Stories can show people’s journeys, their recovery and achievements, in a unique and powerful way. They show journeys of discovery of people, tools, techniques and environments that have been helpful, hopeful and empowering.

A person’s narrative about their experience shows who they are as a person and is self actuated. It enables a shift away from a diagnosis focused account of where a person has been and facilitates engagement with the person themselves, in moving forward now.

Recovery stories can also be empowering and at times transforming for the author, helping people to

find meaning in their experience and discover strengths.

“I had lost total control over my life and was barely functioning. I had become a prisoner in my own home, staying in by choice all the time because I could not cope with the outside world. My occupational therapist was very determined to see my standard of life improved and was sympathetic but also very focused on that one aim. I certainly have never wanted sympathy or platitudes, only help in taking back control over my life. It was an impossible task on my own; no matter how hard I tried. And I tried so very, very hard.” MP

Becky plans to circulate and publish recovery stories and narratives from service users, carers, children and also staff in Dorset Mental Health Forum’s Reflections magazine at the end of March. Please send her your recovery stories, which can be in the form of writing, poetry, painting, film, or even photographs.

All photos © Judy Barrett

The WaRP has been discussing the role Wellbeing and Recovery Action Plans (WRAP) and personal recovery plans play in an individual’s recovery. It is well established that these plans are crucial in the development of self-management skills and a key tool in supporting a person’s recovery journey, enabling them to take control of their own wellbeing and recovery. WRAPs or personal recovery plans help an individual develop their self-awareness, thus promoting a sense of having control. They enable people to set goals and to monitor their own wellness. They also give people their own personal responsibility and empowerment to identify the help or support they require. We see these plans as tools which are crucial to the implementation of recovery principles in practice. We have been cautious until now about how to approach this as we were keen that these plans would be owned by the individuals and not be imposed on them or owned by statutory services. Over the next few months we aim to pilot a number of existing plans and look into the possibility of developing a local tool, with particular focus on wellness and wellbeing, using local people with lived experience (with an e-version). This could be used by people across Dorset and not just in mental health services. We are also looking to develop a training programme for people with lived experience and their supporters, and for staff to support the launch of these plans. Within mental health services we would expect professionals to use individuals’ personal recovery plans to shape the Care Programme Approach meetings. We would also like staff to offer to coach people in undertaking a personal recovery plan, or signpost people to where they can get further information or coaching on personal recovery plans. People should also be allowed the flexibility and choice to use whichever tool they feel is relevant to them and services should be able respond to this in a way where people can maximise their own self-management and control over the service they receive. We see the launch of the personal recovery plans and training as a major step in the culture change required in order to put recovery principles into practice. We plan to have them in place by the end of the summer.

Personal Recovery Plans

Issue 5: Spring 2010

Dorset Wellbeing and Recovery Partnership Welcome to the spring edition of the Newsletter and as it is the season of new growth it is a good opportunity to outline the developments that are taking place which should come to fruition over the summer. This edition focuses on three topics: our aims to implement personal recovery plans; the relationship that recovery has to older person’s mental health; and showing how we are shifting the culture in the NHS regarding the management of risk. We are also aiming to have our website up and running by the end of the summer to complement these developments.

The importance of language Language frames and constructs how we understand the world. Words are full of explicit and implicit meaning and power dynamics. By changing the terms we use we change how we describe the world. Obviously changes in words need to be accompanied by changes in practice or they can be hollow. The WaRP are proposing that we change the term Service User to Person who accesses services. Although it is a less concise term it puts the emphasis on the person. We would also suggest that the term Carer is replaced with Supportive Relationship (except in medico-legal circumstances) as it puts the person in control of their care. We would be interested to have your views on this.

© Peter Thomson (www.peter-thomson.co.uk)

Contact Details: Phil Morgan – Philip.Morgan@dorset-pct.nhs.uk 01305 361371 or Becky Aldridge – beckyaldridge@dorsetmentalhealthforum.org.uk 01305 257172

To complement the development of the personal recovery plans and culture shift within the NHS it is also important to review our approach to risk assessment and management. The WaRP has developed a position statement describing the key principles in recovery orientated risk and safety planning, its main points being: • The key elements are engagement, collaboration, transparency and the promotion of an individual’s

sense of control, sense of hope, and opportunities for the future (SCMH, 2009). • Following the principles of recovery does not mean that people are able to do as they please, rather

they are encouraged to take responsibility and enter into shared agreements. • A broad understanding of risk needs to form part of this with an awareness of not just physical harm to

self or others but also emotional harm. This includes an understanding of the emotional harm that can result by limiting a person’s opportunities.

• Establishing effective relationships are crucial to risk assessment, management and safety planning. Using recovery principles is a useful approach to engage with all people and particularly with those presenting with complex issues who may have found it difficult to engage with services.

• Where possible risk and safety assessment and planning should be a collaborative and shared process (including the involvement of a person’s supporters, friends and/or relations, and other agencies.) Skillful information sharing is a crucial part of this.

• When people are unable to make informed decisions about their care, then crisis plans and advanced decisions should be consulted. If advanced decisions or directives are not available as far as possible the known wishes of the individual should be considered. As a person becomes more able to make effective decisions about their risk management, that responsibility should be shared.

• Where possible individuals should be offered relevant choices. • When conflict and disagreement arise our approaches should still be underpinned by the values of

recovery and we should be transparent as far as possible. Disagreements should be noted and solutions, where possible, worked towards.

• Staff should be sufficiently skilled in conflict resolution and motivational approaches, and aim to maintain engagement.

To put this into practice the WaRP is in the process of developing good practice guidelines and a system of supervision and training for staff which will support a recovery orientated approach to risk assessment, management and safety planning. Alongside the development of personal recovery plans the WaRP will also be piloting and developing ‘crisis plans’ (which include advanced decisions) and ‘safety plans’ for people to develop to increase self-management when they are entering a period of crisis or emotional instability. We are seeking to develop a training programme for those with lived experience to be able to complete and for staff to be acting in a coaching role to support people in completing their own plans.

Risk, Safety Planning and Recovery

Older People’s Mental Health and Recovery

© Klaus Rytved

Is recovery relevant to older person’s mental health services? Of course it is! Recovery does not mean getting better; it is a set of principles that can guide people and services to support an individual to live the most meaningful and purposeful life they can. In many ways the older people’s mental health services think like this already, both with people with functional conditions (e.g. depression, psychosis) and organic conditions (e.g. dementia) particularly with work of Kitwood and the Person-Centred Care approach. So what happens next? We are looking to engage with staff and people who use the services to build on these principles to ensure that they guide, inform and develop service provision.

© Peter Thomson

APPENDIX THREE

SPRING 2010 FREE - please take a copy!

Included in this issue…

Personal Recovery Stories and Narratives What they are and what is their purpose.

Spirituality What is it and how does it fit with Recovery

Dorset Wellbeing and Recovery Partnership

Driving the work for Recovery orientated services in Dorset

Report from the Chair

Introducing the Forum’s new Chair, Hannah Walker

Full Contents on Page 2 Dorset Mental Health Forum 29—29a Durngate Street Dorchester Dorset DT1 1JP Tel: 01305 257172 Fax: 01305 261049 admin@dorsetmentalhealthforum,org.uk www.dorsetmentalhealthforum.org.uk

Editorial Hello and welcome to the new look Reflections magazine. The Forum has been very busy in the last few months and the recent changes to the Forum’s logo and image now reflect the essence of the Forum’s focus. Take a look at the new style website too, at www.dorsetmentalhealthforum.org.uk This edition has been compiled specifically to provide “Reflections on Recovery” and is dedicated to showing what recovery looks like. This is integral to the Forum’s work (see the Chair’s report on page 8) and also to the work of the Dorset Wellbeing and Recovery Partnership; read more on page 12. In this special edition contributors describe the essential ingredients of their recovery and their own personal recovery journeys. These narratives show that recovery is not the same as cure. “It is about living a valued and valuable life with difficulties and finding ways of coping with and understanding problems, as much as getting rid of them.” Anthony (1993) Recovery is a philosophy, an approach, which requires individuals to discover hope, find acceptance, have control over their lives, find meaning in their experiences and enjoy empowerment and personal responsibility. If you would like to make a contribution to Reflections, such as sharing your experiences, please contact the Forum. Other readers have told us that they find your views and experiences inspiring, supportive and profoundly helpful.

The Editorial Board

Recovery Stories ...

Recovery stories and narratives are increasingly recognised as vital, valuable tools on a number of levels. Not only can they inform and inspire individuals on a personal level in their recovery, but also mental health practitioners in their practice and the attitudes of society as a whole. Stories show people’s recovery and how they achieved it, in a unique and powerful way. They depict journeys of discovery of people, techniques, environments that have been helpful and empowering. Stories can support an individual’s recovery by • Challenging clinician’s illusion that people don’t recover (as they often

don’t see it happen!) • Enabling a person to find hope, to see what is possible - provide inspiration • Helping to make sense of experience and find different ways to manage distress • Finding meaning in experience, new meaning to life and ways to cope • Discovering ways to move forward – recovery is about wellbeing and living well • Learning about things that have worked for other people • Sharing of experience, reaching out and connecting with others with

similar experiences Stories make a difference on a broader level • They inspire and motivate others to change their approach to distress (living and working) • They challenge the mental health system (personal and political) • They challenge communities and society There is much to learn for everyone from recovery stories and narratives. In particular, research of stories reveals common recurrent themes for what has helped people in their recovery. • Building positive relationships – with oneself, with other people and

with medication • Self and symptom management techniques and tools • Education – learning how to gain control, confidence and life skills • Unexpected blessings – chance meetings, turning points, opportunities, perspectives Also, language is important when talking about and understanding mental illness and a person’s distress. Case histories written by clinician’s can objectify an individual’s life. They show where a person has been and are centred on the individual’s diagnosis. A person’s narrative about their experience shows who they are as a person and is self actuated. This can promote a caring response in the listener and facilitate empathy and connection with another human being. Other changes can occur too, when the need to break free from one’s diagnosis is recognised. Individual focus can shift from ‘moving away’ from where a person has come from, to ‘moving towards’ the future and goals. “I want to aim for more than managing…. I want to be living, thriving and fulfilling my dreams”.

Contents Recovery Stories and Narratives p.2/3 What is Spirituality? p.4 A quest for cosmic truth .. p.5 What Recovery and Spirituality means to me p.6/7 My Journey Back to Work p.7

Chair’s report p.8/9 More stories p.9 Membership Form p.9 Mindfulness p.10 Self Help p.11 Dorset Wellbeing & Recovery p.12 Recovery in a Group p.13 My Dance and Fight with Depression p.14 Hope … In the Here and Now p.15 Groups Information p.16

2

… And Narratives

Revisiting

from a

safe distance,

the narrator can

make choices

about the past,

the present

and the future.

Showing

the things

that hinder

and the details

that help.

3

A Gift of Stories. Discovering How to Deal with Mental Illness. Leibrich J. (1999) Dunedin, NZ, University of Otago Press / Mental Health Commission

‘Kia Mauri Tau!’ Narratives of Recovery from Disabling Mental Health Problems. Lapsley H, Nikora L. & Black R. (2002) New Zealand Mental Health Commission (available at recoverydevon.co.uk) Journeys of Recovery: Stories of Hope and Recovery from long term mental health problems. Scottish Recovery Network (2006) Glasgow: Scottish Recovery Network. Available in pdf from: http://www.scottishrecovery.net/content/mediaassets/doc/recovery_stories%20-%20final.pdf

Something inside so strong. Read J. (Ed) (2002) London: Mental Health Foundation

Beyond the Storms. Reflections on Personal Recovery in Devon. Devon Partnership NHS Trust Recovery stories: Cornish journeys of hope Cornwall Partnership

Recovery journeys: stories of coping with mental health problems South London & Maudsley

Sharing recovery stories, poems and narratives is not always easy. Often they are characterised by suffering, despair and confusion, as well as hope and determination. “When we tell our personal stories, they become powerful tools to explore experience. Revisiting from a safe distance, the narrator can make choices about the past, the present and the future. This reflection and reframing is empowering and potentially transformational. Others too, can look through these windows into worlds we have inhabited and travelled beyond. For those who take the time, these observations help show the things that hinder and the details that help.” Lynn. L. Beyond the Storms. Reflections on Personal Recovery in Devon. Page 7. Additional Source: Stories, Narrative and Self Management Presentation . Elina Baker, Linden Lynn and James Wooldridge. Thank you to all the contributors you will meet in the following pages, who speak not only for themselves, but for their fellow travellers. Each story, poem, narrative, is a celebration and tribute to the courage and endurance of their authors.

Collections of Recovery Stories .....

Every now and then go away, have a little relaxation, for when you come back to your work your judgement will be surer; since to remain constantly at work will cause you to lose power of judgement.

Go some distance away because the work seems smaller and more of it can be taken at a glance, and lack of harmony or proportion is more readily seen.

Leonardo De Vinci

4

Whatever makes you feel peaceful, joyful and content is spirituality. Anything that lifts you above and out of yourself and your thoughts is spirituality. Everyone is surrounded by spirituality every day. The definition of spirituality is that which relates to or affects the human spirit or soul, as opposed to material or physical things. Spirituality touches that part of you that is not dependant on material things or physical comforts. Spirituality is all around you – in everyone you meet, everywhere you go. “It is the breath of life, the innermost part of me. It is the space within my heart, my essence. It’s a kind of coming home, the space I go. My being, my spirit, my soul. Doctrine can be a divider, an excuse for war. Spirituality is a connector, a reason for peace.” Spirituality in everyday life: • Are there any things that particularly motivate you and that you enjoy? • Do you take time to reflect on life’s experiences? • What makes you smile? The simple sight and sound of a child’s laughter, the quiet

peaceful sight of a cat napping in the sun, that’s spirituality. • A quiet walk on a spring day, the gentle breeze, the sound of birds chirping, the smell

of flowers and freshly cut grass, it’s all the definition of spirituality. • Noticing acts of kindness and good you encounter throughout your day – that’s spirituality. • Devoting just a few minutes each day to sit still and quietly think about all the good

things in your life – that’s spirituality. • Reading books that inspire and touch your heart – they help to find your own

rings true “When everything seems so pointless and full of pain, I have to find some kind of comfort if I am to survive. Although I need to accept the illness, I also need hope. Sometimes I have a kind of miraculous experience, a kind of turning point, which involves spiritual in-sight. I know, deep within, that at these times, I am healing. That is why I have to reach the space within my heart to get well. There are many ways into that space for me – through reflecting with gratitude on the things I have, through focusing on the smallest point of here and now, through letting go of all the things I am trying to control. Almost always, though, the way in is through silence and solitude.” Leibrich, Dr J. Spirituality leaflet (June 2005), North Dorset Primary Care Trust

“Spirituality is an

experience,

not a religion.

Spirituality is

beyond doctrine,

beyond cultural

difference.

It is something

deep within

our core.”

Dr Julie Leibrich. World Assembly for Mental Health, Vancouver

personal definition of spirituality. Finding something that sparks your feelings and

A quest for cosmic truth …

the first chapter of my book!

All I wish to do

is to tell

my story …

Each therapy has

taught me

something

different ... 5

I will start at the beginning: reveal strange ideas I possessed even before my first major breakdown; describe what it's like to be gripped by psychosis, reality oscillating minute by minute and lastly my journey through recovery and beyond. Those not interested in what lies before, after and intertwined within this physical world need not stare too long at the larger canvas and simply appreciate this account of mental illness that is the essence of this work. Who am I? I'm a human being who sometimes thinks he's alien; the reincarnation of an evil soul that is seeking redemption; the Creator, Destroyer or Fixer depending on my mood. I can also be simply me - when I am well. Which fortunately, or unfortunately as the case may be (it can be comparatively dull after having attained such highs), is the majority of the time. There is a brief transitional period, however when I find myself on the threshold of something quite fascinating. This amazing sensory experience occurs in the early to mid stages of recovery as I slowly ease out of the mass confusion and complete loss of control that is psychosis. During this phase I exist in a state of heightened awareness which includes: the gaining of inexplicable knowledge and skills; the ability to detect subtle signs that would normally slip under my radar; plus an incredibly intense and narrow point of focus. I do not profess to be an expert in any field, all I wish to do is tell my story so perhaps one day, some smart kid might grow up to understand exactly what is going on inside and outside my mind. I'm far more intrigued by what is occurring externally. After all - it doesn't take a world renowned psychiatrist to see that the bulk of what I will tell you are symptoms of Bi-Polar Affective Disorder. Perhaps a physicist could help determine events on the outside somewhat better. Obviously it is very difficult to examine what I claim whilst psychotic objectively. However, if during other times only a half of one percent of what I believe may be happening can be validated, this would open the door to many more unanswered

Life is a steep learning curve. Happy climbing!” M

“My label is pretty much irrelevant. What you may find significant is mutual ex-periences we both share. This will hopefully bring clarity and demonstrate that certain thoughts and feelings are perfectly natural and not to be feared. We will take a trip through a magnificent multi-faceted world and gain valuable insights along the way. Those with no mental health background may find a lot of these concepts bizarre, indeed most of them are. However, you may find some strike a common chord with us all. Each time I mention a speculative idea, if it is most probably the product of delusion, I will highlight this.

“Looking after my health has been a long journey; at many points I believed life wasn’t worth living, but I have learnt it is. I also learnt that there is no shame in asking for help. I feel so much better and know that if I don’t work excessively over my paid hours, don’t get too little sleep and do talk through problems with friends, I am ok. I accept the need to take lots of prescribed medication but worry about the long-term effects. Each therapy has taught me something different and treated a bit of my depression each time. I knew that strong therapeutic relationships were important from my training but not how powerful they are in practice. Many staff gave me no hope of recovery physically and mentally but I am truly grateful for those that gave me hope at times when I needed it most.“ S

questions.

What Recovery and Spirituality ..

6

It was a

racing cert that …

I would turn to

religion as

a support

and relief …

My personal search

took me

far and wide …

looking for

an answer …

It was down to me

to put it all

into action.

“I had a brutal and miserable childhood, the sensitive son of a violently alcoholic father, brought up in poverty with none of the security or confidence that comes from a happy home life. I think it was a racing cert that at some stage in my life I would turn to religion as a support and welcome relief from personal mental suffering. I had joined the Royal Navy at 16 and used it as a way out of inner city Birmingham where I was living at the time. Whilst in training I was introduced to Christianity - it had high ideals and offered much in the way of succour and joy. For a while I was happy with my faith, I had friends who cared and an enjoyable social life. When I was approx 23 years old, I took an overdose of prescribed medication. It was the beginning of a lifetime of severe and enduring mental illness. I looked initially for support from my fellow church goers but quickly found that a friend in need was a pest and within six weeks my church membership was cancelled and I was effectively persona non grata. This was the beginning of my true understanding of religion, spirituality and the failings, weaknesses and hypocrisies of humanity and its personal beliefs. I think it is important to consider the supernatural, things other than the reality that we can see. Is this all there is? Why am I here? Is there a God? What is my purpose in life? These are difficult questions at the best of times, but when you are mentally unwell the times are difficult and the answers more important. My own personal search took me far and wide, I considered many of the major religions looking for an answer to the deep spiritual and philosophical solutions to the unhappiness that I recognised within me. Buddhism was attractive with its pacifism and deep spiritual peace, for a while the Japanese Shinto religion was considered because of its spiritual rigour, I was and still am enamoured with Wicca (witchcraft), not the fictitious sort that Christians and the low brow press have invented (true

witches don’t worship Satan they don’t even believe in his existence) but the sort that live in harmony with nature, accepting their place in the world and going by the creed “do what you will, but harm none”.

also found favour in that they believe that we don’t own the Earth but belong to it. All of the above eventually fell by the wayside when I realised that what I was actually looking for was a crutch, a support, somebody else to take responsibility for my illness and my suffering. This was my Damascus road experience, my burning bush, if I was to get well, to be content with my life to have a shot at happiness it was down to me I had to make it happen and I did. Luckily over the years I have met some exceptional members of staff within the local Primary Care Trusts who had given me encouragement and good advice. I put that into action. I realised that only I could make me well, staff helped, medication helped, therapy helped, my personal spiritual belief helped, but it was down to me to put it all into action. The first thing to do was to control or at least live with the hallucinations. I have had a relationship with three witches, I know they don’t exist to anybody else but they have been very real to me. With a combination of Cognitive Behavioural Therapy (CBT) and Mindfulness (meditation) I have not seen these three people for over four years. I have now, with the assistance of my GP given up Antipsychotics (don’t be tempted to just do this on a whim). I have also with slightly less success given up Antidepressants, also with the assistance of my GP. This was inordinately difficult to do not just because of the painful side effects but also because I had to leave the care of the PCT to achieve it. There are a great many staff within the PCT who are reluctant to encourage this sort of recovery and understandably so, we live in a risk adverse society and at the end of the day staff need to keep their jobs if something goes wrong.

(Continued on page 7)

Elements of Australian Aboriginal culture

... means to me

“I have had a period of 4 years of being on long term sick leave between 2003 and 2007, with my mental health prob-lems, during which time things were par-ticularly bad for me and I had no hope, dreams or aspirations. In fact I could see no future at all and many times wished my sad lonely existence would end. How-ever, my recovery has been a long slow process in which I have had much help and support. In 2007 I felt ‘ready’ to return to some form of work, which is when I was offered an opportunity of working alongside someone in Forston Clinic in her office. This was a massive step for me having been an inpatient there and it felt strange and even uncomfortable at times, but I persevered and gained confidence and self esteem. Unfortunately this position ended but I was lucky enough to be of-fered a role within another team, attend-ing their weekly meetings. Again this was challenging for me in a number of ways. Not only would I be within a team of pro-fessionals, taking minutes of meetings, something I’d never done before, but I

had to catch a train on my own. This might not sound like much to worry about but to me it was huge, because I often had thoughts of ‘walking in front of a train to end it all’. So, the first day that I stood on the platform waiting for the train was another massive step in my recovery. I think from then on I knew things could only improve for me, which they did. In fact within a few months I had returned to paid employment with two other employ-ers. This was such a boost to my self confidence, as I believed nobody would ever employ me again. Although since returning to work it has not all been plain sailing, having had problems with working tax credits, disability living allowance and housing benefit, but I never gave up and battled on. As a result I have gone from strength to strength. In fact I feel better now than I have for many, many years. I have found how satisfying returning to work has been and I feel strongly that social inclusion is vital to an individual’s recovery process, rather than isolation.” M.

A massive step …

strange and even

uncomfortable

at times,

but I persevered

and gained

confidence

and self esteem.

From then on

I knew things

could only

improve. 7

Be not the slave of your own past – plunge into the sublime seas,

dive deep, and swim far, so you will come back with self-respect, with new power, with an advanced experience,

that shall explain and overlook the old. Ralph Waldo Emerson

So where am I now I have achieved a level of recovery. When I went into the dark tunnel all those years ago the sun was shining brightly, I was in my early twenties and anything was possible. I have come out at the other end in my late forties into a milk white sun not quite as bright, not quite as warm and with less opportunities for life fulfillment. I am very definitely a different person, I am the captain of my own ship, there is no God to support me, no God to judge, I can be bloody rude and have strongly held opinions at times but I have a proven

history of great care for those who need it. I work within the mental health industry hoping to make a difference where ever I can. Some people cut me a little slack because of my past and my mental illness some others don’t but at the end of the day I am happy to stand on my own two feet comforted by the knowledge that I own my recovery. I had a lot of help from a lot of people but I overcame psychosis and depression and made my recovery happen. I believe others can do it to. I don’t believe in luck but if you do, I wish you lots of it.” B.

(Continued from page 6)

My Journey Back to Work ...

,

Report from the new Chair …

Hello and welcome to this edition of Reflections, which I hope you will find of interest. My own journey has been faltering, but has always been in the direction of the Recovery principles, even when I had never heard of Recovery.

I have always believed that the service user should be at the heart of his or her treatment, as we are the experts in our various conditions. That has not always been the case for me; I spent 16 years in the RAF, and was discharged in a way that was frankly punitive. I can only hope that the Services have moved on, with so many military people currently suffering in the war in Afghanistan. I had the first of many

breakdowns in 1990, whilst serving at the MOD. I have had a number since then and have been hospitalised 24 times, although I have never been Sectioned – largely due to the support of my CPN and psychiatrist. This was not always the case; initially, I went to a hospital that was both harsh and frightening, and I hardly ever saw a member of staff, let alone a psychiatrist. London is not a place to be mentally ill. When I was diagnosed with bipolar disorder, I felt that I was on the way to the end of the world; however, a diagnosis helped me to explore personally the facts and fictions of manic depression and somehow to accept mental illness. People with lived experience are in an ideal position to inform the service as to how they would like to be treated. It is

not for someone else to dictate terms. We need the input of professionals, for example to prescribe medication and to assist us when we are in need; however, the so called “medical model”, where service users had things done “to” them is no longer paramount in psychiatry. Recovery is our new paradigm; we need people with qualities, not necessarily qualifications, to serve our needs. The Forum employs people with lived experience to act, for example, as advocates and mentors; previously, only trained staff with no history of mental illness could act in this way. More and more people with lived experience are rejoining the country’s workforce without hiding the fact that they have a mental illness; however, there is a very long way to go before stigma and shame are eradicated. The Forum is committed to playing its part in this culture change. Service users, people with lived experience of mental health problems and Recovery are at the heart of everything the Forum does, in many different ways. In many cases staff are supported along their own personal journey of Recovery by the Forum, experiencing flexible, understanding and supportive employment, often utilising their own experiences to positive effect for others, enabling them to grow in confidence and to develop themselves. Since discovering the principles of Recovery, I have been better able to inform my own treatment. I look up the side effects of drugs and, along with my psychiatrist; I have choice in the matter of prescribing. My care plan, when I am admitted to hospital, is written in conjunction with me and discussed every week at ward round to see if there is anything I might like to change. For example, when I am high I find it impossible to stay asleep; in the past I would have been sent straight back to

(Continued on page 9)

We are the experts

in our conditions.

We need people

with qualities,

not necessarily

qualifications,

to serve our needs. 8

The Forum has a new Chair, following our Annual General Meeting in November 2009. We are delighted to have Hannah Walker at our helm, as she brings a wealth of experience and knowledge. In her first Chair’s report, Hannah shares her own perspective of Recovery.....

Hannah Walker

… Hannah Walker

Forum Membership: To get your FREE Membership card, please return this form to the Forum

Title Forename: Surname:

Address: Telephone Number:

Signature: …………………………………………………………………….. Date: …………………………………..

Would you like to be involved in th work of the Forum? Yes ………….

9

“After a gap of about six years I took up sport again in 2008. Over this time I have progressed in leaps and bounds, most physically and mentally. Several times I have filled in running the Badminton group. I would thoroughly recommend people with mental health difficulties to take up sport. I have even won a sporting award as I approach my 57th birthday. I’m looking forward to seeing new faces in 2010.” A.

bed had I got up, with the result that I used to lie awake until dawn. Now, after care planning, I watch TV until I have calmed down and then find it much easier to go back to sleep until the morning. Recovery should be our watchword in all that we do and say within mental health, whether as a person with lived experience or as a mental health worker. The service user should be put at the centre of care at every step of his or

her journey, and should be consulted at every stage. Where there is risk, it should be brought out into the open and talked about constructively by the service user and their key worker. Where there is anger or uncertainty, there should be discussion. We, as people with lived experience, should never again be done “to” – we should be equal partners in our journey of Recovery. I am excited to be part of the Forum’s work in these rapidly changing times. Hannah Walker

(Continued from page 8)

“I was diagnosed with bi-polar disorder over 2 ½ years ago after many years of undiagnosed illness. I used to feel very depressed and isolated. With the proper medication and a healthy amount of physical activity I have found an ideal way to treat my mental illness. On a bad day I still feel like not doing anything at all, I want to be alone and asleep in bed if possible. Fortunately, my job boosts me so that I only feel like this 1% of the time now. Doing the work that I do, has enabled me to avoid those days when I am depressed and feel unenthusiastic and unmotivated. My work helps me fill each day of the week. I find it enriching and rewarding especially when activities are well attended. I get to interact with many interesting people which again is rewarding in itself. It can be depressing when things don’t go so well, but I am able to deal with them by focussing on the successes. I have lots of friends and I never feel alone. I look upon life as a gift and I look forward to what each and every day will bring. Before my job, I was becoming self and socially isolated. Now I find myself no longer in that position and I am happy in what I do, doing work that is fulfilling and rewarding. Sometimes it can be hard, but I try to bring purpose and meaning to my life by enthusing others, which makes me feel good in myself.” D.

Presentation of the Best Sports Person in 2009 trophy at the SLAP & AOT Christmas Party, 2009

e

Mindfulness can help

You can become a member of the Dorset Mental Health Forum, free of charge. It is open to anyone who wishes to join. Members are entitled to take part fully and have voting rights. They are informed of meetings and relevant events taking place in and around Dorset. They also receive a copy of our Reflections newsletter regularly. A 24 hour telephone answering service is available when the office is not staffed. To apply for your free Membership card, cut out and complete the form on the back of this page and return it to the Forum. The information you send in will be completely confidential at all times and will be subject to the 1998 Data Protection Act.

To get your Free Membership Card please cut out and complete this form and return to the Forum at:

29-29A Durngate Street, Dorchester, Dorset DT1 1JP 10

Membership of the Forum

The Microscope To over-analyze the acute analogy. The flower will grow with simple food and water. An in-depth knowledge of cell division is not

To put lens upon lens is only to split hairs. The microscope does not show the whole picture. Mental illness can be rather obvious. A simple pair of specs can give better vision. Electron technology may split the atom. And explosions may occur. If you learn to live a little simpler, You may find peace with what you have. Without the need for over analogies. To learn that sight is a gift, That we can live life freely, Without the subjugation of many microscopes. What we have is already valued. Life is a gift. Possibly some binoculars might help. J.

What is Mindfulness? Being in control of your mind, instead of your mind being in control of you. Developing increased awareness of what is happening to you in the present moment. Observing what is happening to you without judging whether it is good or bad. Being in control of what you pay attention to and also being fully present in the current moment. How can Mindfulness help? When we are unable to control our attention, it is ex-tremely difficult to:

• Stop thinking about things (past, future, painful emotions, physical pain etc.)

• Concentrate on a task in the present, even when it is very important to do so.

• Give another person your full attention • Control urges to act in unhelpful ways

There are a few basic skills that can be learned to be-come more mindful, which require practice. These skills can have a life changing effect and be very helpful in an individual’s recovery . Source: Cooke, D. (2009). Recovery Rocks

Are you a mental health sufferer, a person who uses mental health services, a carer, or someone who is interested in mental health issues? Do you have views that you wish to share? Would you like your voice to be

heard? If you find yourself answering ‘Yes’ to any of these questions, why not think about offering your help to the Forum? There are a range of opportunities available and much work to be done.

You don’t need experience—we will help, train and advise you. Why not contact the Forum office to have a chat and find our more about how you can join in?

required.

11

Dorset Wellbeing and

Recovery Partnership

The Partnership’s aim is for the principles of Wellbeing and Recovery to be embedded across all services within Dorset. In order for NHS Dorset: Community Health Services (DCHS) to put “recovery at the heart of everything we do” there is a need for whole systems change, to cast a critical eye over current mental health service provision and to address the mental health needs of local communities. Recovery involves moving away from traditional styles of service delivery to a more person centred approach, engaging with people who use services as partners on their individual journey of discovery. Mental health services can become more responsive to the individual needs of people experiencing mental health problems, which will benefit existing people who use services, new people and future people. The Dorset Wellbeing and Recovery Partnership see the principles of wellbeing as essential to understanding Recovery as a philosophy. There needs to be a shift of focus from an illness model to a wellness model. The importance of wellbeing recognises that a person’s overall health is influenced by them experiencing balance and meaning across a range of areas in their life (such as spiritual, physical, social and emotional health) as well as feeling connected to their community. Promoting the concept and philosophy of Recovery is integral to the Partnership’s work. Recovery stories and narratives provide valuable evidence and guidance for person centred, recovery orientated practice in mental health services. Please send in your recovery stories - they can be in the form of words, painting, film, photography or artwork. We would very much like to gather stories from people with lived experience, service users, carers, children and also professionals.

“Recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings and goals, skills and/or roles. It is a way of living a satisfying, hopeful and contributing life even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” Anthony, W. (1993). Recovery from Mental Illness: The Guiding Vision of the Mental Health System in the 1990s. Psychosocial Rehabilitation Journal, Vol. 16, No 4, pp 11-23. “Probably the most useful way of understanding recovery is linking it to our own experience because it is something that is common to all of us; it is not specific to mental health problems. Any of us who have been through a divorce, unemployment, a major illness or bereavement, know that this changes us; there is no way to going back to how we were before that event. We have to incorporate that into our way of living and we learn from that and move on with that, which is exactly what we are talking about in terms of recovery from mental health problems. Very importantly, recovery is about taking back control over your own life and your own problems, about not seeing your problems as being uncontrollable, or that their control is just the province of experts. It is about understanding yourself what is possible and what you can do to help yourself.” Repper, J. (2009). An Independent Investigation into the Care and Treatment of Daniel Gonzales. Pg. 124

Recovery means

moving away

from

traditional styles

… a shift of focus

from an

illness model

to a

wellness model 12

The Dorset Wellbeing and Recovery Partnership is a partnership between NHS Dorset: Community Health Services (DCHS) and the Dorset Mental Health Forum, putting the expertise and experience of people who use services at the heart of the development of mental health provision across the county.

Hope sees the invisible,

Feels the intangible, But knows the possible.

Recovery in a Group

“I wouldn't be here if it wasn't for the group. I like the company. I can talk and explain without anybody spreading rumours.” C. “I look forward to a Tuesday to meet up with people with similar problems to myself. I enjoy the trips we have and the social aspect of it.” D. “I find the group is very sympathetic and good support from people I know. It is good to get together with people with a common interest. It buoys me up for the rest of the week.” D. The group helps people to develop confidence and can be a stepping stone to new experiences … “I think the group has given me confidence and I wouldn't have gone on the courses I have attended without being given the chance via the group; such as in Weymouth and Dorchester. These include 'more move' (keep fit), a place where I could have physiotherapy for a back problem (in Poundbury), talking through an exercise regime and other groups.” L. “I come for the company and would like to take part in the walking group.” J. For others simply having a place to meet for a chat hits the spot … “It is nice to know we have a place to get together and it is good that we can socialise and talk with each other when we feel the need.”” H.

“The group is somewhere to go. I have learnt a lot of things. I like the company and the outings.” N. The experience of the group is also appreciated by the volunteers and staff “I am one of the original members as I like to help the others, which in turn helps me to keep active and mentally stimulated.” P. “Being new to the group I am struck by the closeness and friendliness of the group members and helpers; this feels very nurturing. There’s a lot of willingness to make things work and to make it a positive experience for everyone. The atmosphere is one of openness and acceptance which allows people to be vulnerable if that is where they’re at. There is also a lot of good humour and laughter which is great to be around!” D.

Developing

confidence ..

A stepping stone for

new experiences ..

Meet for a chat ..

Willingness to make

things work .. 13

The Moving On group has a simple formula that works. The group was set up in response to a local need for people with long term mental health issues to have a non-judgmental place to meet and share, where they have a level of autonomy in what happens and can benefit from each other's support and understanding. In Recovery terms the Moving On group meets the criteria for an environment that empowers people and supports positive change. Group members describe how this fits in with their recovery.

The Moving On Group take a Healthy Lifestyles Course at Monkton Wyld Court

My Dance and fight

with depression ...

“Since I was a young child, I have danced, fought with depression. The dark fog shutting out all joy in my life, when I cannot see the blue sky of someone else’s ‘nice day’ nor feel the smile of a passer-by. Over the years, I have become very well acquainted with my enemy, my personal demon, which brings deadly apathy and lifelessness which enables me only to be in a state of frozen inaction, usually in bed, immobile, unable to read, to watch, to do, to think. I have researched and practised many antidotes and treatments and therapies. They each work to a degree and enable me to feel a small sense of control and the “I’ve got you, you swine” joy of momentarily beating my enemy down and out. I too complain. I too wrestle the dark angel. I too lose over and over again; but I have developed a secret weapon called Perspective and it’s fellow companion Sense of Humour. There are positive sides to clinical depression....it’s not all black, the light returns. It is wonder...ful when you have a day when you are not depressed, and you have appreciation for what others take for granted: you can now see the blue sky, the flowers, smell their perfumes, you can now hear those nice things people do say about you, you can appreciate the morning without dreading the coming of your demon who quashes all life from you in his darkness and weight. You feel joy that others cannot understand, at the smallest connection with something, someone outside yourself, after being shut inside yourself for so long. Still being here, against your previous wishes to not be, is now a real pleasure and you are very grateful to be here still. Mystics, saints and spiritual teachers have usually had deep depressions and have found their god, their sanctuary during those days when they felt furthest from all comfort and love, when they felt most alone and afraid. They have found genuine wisdom and enlightenment and strength. Creative people in the arts, the theatre, poets, comedians, musicians have

commonly experienced these dark suffocating times, and used those experiences to give quality to their offerings to the world, many qualities that can only come through the hell of living on this planet. Many people find that focusing outside themselves is a very good remedy for depression, so take up volunteering of some kind, and find their lives much more enriched by this, become less selfish. A new hobby can be taken up, a new interest...anything to take the focus off of their own navel. Life takes on new dimensions and friends. It’s a sport, a game: a person who approaches their depression from the perspective of a hunter tracking down their prey, needing to understand what is happening to them, can over time, gain a deep understanding of themselves, and can re-build themselves in a new mould. This needs the acceptance of this dark demon...as part of their own psyche and transforming it into a friend, recognising that in fact, it is there for a purpose which you need to understand, and communicate with it so that you can allow it some space, but not have it control your whole life. For example, say to it “Ok I’ll give you 10 minutes for a real wallow, and I’ll go along, but on the condition that I can enjoy the wallow. Then that’s it – go when I tell you!” By recognising the work it is trying to do for you, for example offering escape from the oppressing world, it is having a valuable function, which has to be accepted, but has to be controlled, to your limits. So allow, but in order to feel control. We can find out about our hidden needs and fulfil them. Our needs become our greatest assets. One of the best weapons to keep this demon under your control is the use of humour and keeping a pile of joke books where you will have to fall over them, like by the toilet, therefore notice, and read them. The devil hates laughter...especially at his expense. Laugh at his attempts to control you! One of the worst aspects of depression is it’s oppressive feeling of helplessness, so this feeling of some level of control, is releasing.” P.

Wonder …

Appreciate …

Connect …

Focus …

Recognise ...

Understand …

Purpose …

Control …

Laugh …

Release.

14

Hope … in the Here and Now.

Thirty-nine Pages This is my most recent poem I am trying to write. It came to my mind only last night. On a recent visit to my respite care home – in Dorchester, Dorset when I feel out on my own. I have a debilitating worry – and it makes me scared. But the staff of psychiatry are always prepared. As each of us patients, with forms to fill in. Simple general questions, such as your next of kin. It’s only a couple of pages – at least, it used to be. Now it’s become even worse. Thirty-nine pages it is you see. They want to know this and they want to know that. Yet for some of us we just want a chat – to someone who knows how ill we may feel. To fill out these forms though takes nerves of steel. Name, age, date of birth. Colour, creed, size of your girth. Red eyes, blue eyes, clothes size and all. If you are fat, short or tall. What you eat, what you drink, Do you wash up, or leave it in the sink? What shoe size you are and do you live on your own? Have you got children? (No, I only have a gnome). So now if that’s all – please leave me be. No wonder there are few trees left. They are all used up on these questions to me! R.

Love The time has come I am thinking, to stop my heart from sinking. The life I had, with OCD has torn me apart quite severely. My family and friends, over the last fifty years, have stood by me gallantly, throughout my tears.. I have caused constant worry, and much pain. I need to stop now, so I can begin again. Be that a strange statement, but completely meant. I want them to be safe, well and content. The ones I love and care about – they know I mean it, and I have no doubt. My way of protecting them, has been all wrong. After all this time, I want them to be strong. I do not deserve all the expertise I have had, I can only say, many thanks, and am so glad – to be given a second chance, to live my life without obsessions, compulsions, anguish and strife. From seven to fifty seven, I have been through hell. Those who have helped me, the whole world I would tell. We may all have times for example, as above. If only the world did go round, helped with love. R.

That’s what hope is. Reaching for, working for, fighting for what didn’t seem possible before. Barack Obama

Hope is both the earliest and the most indispensable virtue inherent in the state of being alive. If life is to be sustained hope must remain, even when confidence is wounded, trust impaired.

Erick Erikson 15

To be here and now To look back. The blackness Inside my heart, Dispelled by ruddy sunrise. The murmured madness Inside my head. Left slowly behind. One step at a time. Living in the hell of now. Getting back to normal. Living in the present moment. To be here and now. The warmth of home and the Pleasure of mental security. Neighbourly Neighbours, And the feelings of love. To enjoy life’s present. To be here, And now. J.

Recovery Feel the rage, trapped in a cage Peace so elusive, so hard to find Moments of clarity, fragments of sanity Transient thoughts of a recovering mind. Full of dread and apprehension Yet knowing one will eventually get well Dreading each second ‘til the time comes But once you’re there you can tell The psychosis fades, the anger lifts Bringing peace of mind and other gifts Renewed vigour and desire to progress Keep taking the tablets… you know it’s for the best. M.

Hope has two beautiful daughters – their names are anger and courage;

anger at the way things are, and courage to see that they do not remain

the way they are. St Augustine

REFLECTIONS is produced by the Dorset Mental Health Forum with funding kindly provided by Dorset Social Care & Health and NHS Dorset.All material © DMHF and Contributors

For copies of REFLECTIONS, and if you wish to be placed on our mailing list, contact:REFLECTIONS, 29-29A Durngate Street, Dorchester, Dorset, DT1 1JP. Tel: 01305 257172Design by www.herbertdesign.com. Artwork by Christine Partington. Printed by Remous 01963 250920

Bridport RETHINK Relatives and Carers SupportGroup 5 Downes St. Bridport.Meets 4th Mon (except Bank Holidays), 3 pm.Contact: 01308 459762

Independent Carers ForumMeets last Thurs. 3pm to 5 pm,

Contact: Karen Withers on 01308 459762 or Mobile: 07866 252046

SELF-HELP GROUPS, SOCIAL CLUBS + DROP-INS

CARERS + RELATIVES GROUPS

Willow Tree Group Castleman Bungalow, Blandford. Meets Wed.10am to 2pm (incl. lunch).Contact: Florence Spenceron 01747 825400. Mobile: 07979 437076

Hope Drop-In Centre1 Bimport, Toby’s Court, Shaftesbury. Tues. Wed. Thurs. 11am to 4.30pm.Fri. 2pm to 5pm.Contact: 01747 852224

Oak Tree ClubhouseCrossroads Centre, Weymouth.Meets weekly, Fri. 7pm to 9.30pm.Wed. 6pm monthly for outings.Sun. lunchtimes once a month.Contact: Andy Court on 01305 362094

Club 57. RETHINK Drop-In GroupThe Gallery, Durngate Street, Dorchester.Meets Mon. to Thurs. 10am to 2pm. Contact: Joan Evans on 07918 692120

Lyme Regis Social ClubWoodmead Hall, Lyme Regis. Meets every Wed. 10am to 1pm.Contact: 01308 459762

Bridport DBSA Support GroupWed. 6.30pm to 8pm. Centre for Local Food, Unit 17, St Michaels Trading Estate, Bridport. Contact: John on 07767 76595 (free phone)

Weymouth Peer Support Group Meets weekly, daytime and evenings Contact the group member onMobile: 07920 169002

Four Leaf Clover Club1 Abbey Road, Sherborne.Mon. to Thurs 10am - 4pm.Zest Café Fri/Sat. 9.30am to 3pm. WiFi available during opening hours. Contact: Liz McGaw on 01935 389192

The Lantern2 Ranelagh Rd, Weymouth. Open Mon. to Fri.

Advocacy and Counselling.Contact: Mick Branham on 01305 787940

First Tuesday Self-Help Group(Manic Depression Fellowship)Monthly, 1st Tues. at The Friends MeetingHouse, Holloway Rd, Dorchester. 7pm to 9 pm. Contact: 079 0555 0768 (NationalMDF, 08456 340543 or 020 7793 2630)

Variety of Groups5 Downes Street, Bridport.Open Tues. 10am to 3pmContact: Deborah Rodin on 01308 459762

Moving OnMeets weekly Tues a.m. and twice a month on Fridays (includes lunch) at Millennium Centre, North St, Bridport.Contact: Debbie on 07812 128085

Weymouth Carers GroupLeon Centre, Fernhill Rd, Weymouth.Meets 2nd Wed. 2 to 4 pm. Contact: Karen Withers on 01308 459762 or Mobile: 07866 252046

Shaftesbury & District Carers GroupHope Drop-In Centre, 1 Bimport, Toby’s Court,Shaftesbury. First Wed. 7pm.Contact: 01747 852224

Visit the Forum Website at www.dorsetmentalhealthfourm.org.uk

APPENDIX FOUR

Communication Strategy Action Plan The purpose of this action plan is to promote the philosophies of Wellbeing and Recovery in a way which creates opportunities for individual, groups, communities and services to understand mental health or emotional distress in a way that inspires hope and enables transformation (for individuals and services) and challenges stigma. This action plan seeks to communicate the messages to the general population, people with lived experience, and staff. The aim is to increase people’s awareness of wellbeing and the principles of recovery; to influence change within Dorset, and in particular within mental health services; and provide a resource for people to access further information about Wellbeing and Recovery.

Communication Task Action Timescale/Progress

Local Recovery Networks to develop methods of collecting recovery stories (and links and opportunities within clinical practice)

To feedback back in Spring Steering group

BS to be point of contact to collect recovery stories.

BA to speak to BS asap

DB to provide Admin support Ongoing BA to collate and put into Reflections (also to emphasise concept of spirituality and recovery)

With printers at present

BA and PM to make Recovery Stories available to Commissioners and Service Managers

Ongoing once stories become available

Develop Mechanism to Collect Recovery Stories and disseminate

PM and BA to link with wider SW recovery stories development

End of April

PM to speak to BG re: funding Done Develop WaRP Website- jointly hosted – independent but linked to Group to find domain name Asap

1

Communication Task Action Timescale/Progress

PM and BA establish Group to identify website content

Ongoing

Specification Guide for Website ASAP

both NHS and Forum Website.

DG and MM to implement design Once plan developed

PM and BA discuss brief for competition with local schools with BG (and establish budget for posters)

Asap

BS to get contact details

BS to arrange competition with local schools

Once agreement from BG is given

BS, MH, DB to organise launch event using Weymouth venue and gallery (involve local press)

Once competition has taken place

Develop Poster to raise profile of WaRP

BS and DB Distribute Posters Once poster design confirmed

PM to discuss with BG re: funding Asap PM and BA to agree content and design of business cards

Asap

Have visible and accessible WaRP information available across Dorset (Community locations, 3rd Sector, Primary care, Secondary Services- this is be graded as the WaRP develops with a focus on services for people with mental health problems initially)

Develop business cards with WaRP info

DB- Print and Distribute Once design complete

2

Communication Task Action Timescale/Progress

Develop A4 Posters based on Business Cards

DB- Print and Distribute Once design complete

All members of WaRP to take every opportunity to influence and inform others of the principles of Recovery and the need for them to influence service delivery and promote wellbeing in Dorset

All Ongoing

PM and BA to produce newsletter Quarterly PM to send to DG to put on the intranet

Quarterly To produce Newsletters to update on progress of the WaRP

Review newsletter August To contact Public Health to get wider Wellbeing and Recovery Message across outside of mental health services and promote Recovery principles in the role of prevention.

BA to meet with Dr David Philips re: public health agenda

June

Liaison local Press Forum press release- recovery story, definition of recovery, mention of WaRP- BA and MH

December 2009

3

4

Communication Task Action Timescale/Progress

Press to raise awareness of competition – BS and MH

Jan 2010

Press release with website development with the forum and WaRP

Apr 2010

Press involved in poster and website launch (link with T2C Dorset)- BS, PM, MM, MH

June 2010

Press involved in annual celebration event- PM, BA, MH

May 2010

Research and dissemination BA and PM – develop and participate in the development of local and national research projects

On going

Personal Recovery Plans PM and BA developing and launch date to be set

On going