Establishing Recovery Colleges in mental healthcare services: A Royal Commission recommendation

Abstract

Recovery Colleges are an innovative education-based approach to support mental health recovery that, following the recent Royal Commission, will have to be established in every area mental health service within the state of Victoria. This paper describes the rationale, benefits and some of the key considerations to successfully establish Recovery Colleges. The establishment of Recovery Colleges has the potential to drive culture change within mental health services and embed recovery orientation within service provision as well as engaging service users in their own recovery journey. There are significant challenges, however, in implementing the collaborative, co-produced model within the constraints of a publicly funded mental health clinical service. This paper considers some of the practice implications for public mental health services in developing and integrating Recovery Colleges. The paper, like everything we do at the Recovery College, is co-produced and co-authored – in this case, by a lived experience expert, a medically trained expert and a research/writing expert.

Introduction – recommendations of the Royal Commission

Recovery Colleges offer a new way of working in psychiatric services. The recent Royal Commission into Victoria’s Mental Health System has indicated that all Youth, Adult and Older Adult Area Mental Health and Wellbeing Services will have a Recovery College, as well as specialist peer support from a lived experience workforce, comprising service users and family members/carers (State of Victoria, 2021). The rationale for establishing these new services rests on the understanding of the importance of self-management, self-determination and personal growth in supporting recovery for mental health consumers. The evidence base for recovery focus in mental health broadly (e.g., Byrne et al., 2015; Ridgway, 2001), and for Recovery Colleges in particular (e.g., Ebrahim et al., 2018; Meddings et al., 2015; Perkins et al., 2017; Thériault et al., 2020), is continuing to build.

Why have a Recovery College?

Recovery Colleges address the twin aims of supporting consumers through their own mental health journey and re-orientating mental health services towards a more consumer-first, recovery-focused model in line with national standards in healthcare (ACSQHS, 2017). The model responds to consumer demand for more information, control and choice over care (Meddings et al., 2015), as well as reducing stigma both broadly in the community and within health services. It breaks down communication barriers and reduces the power differential between service providers and consumers, which means that both are able to learn from the other’s perspective.

Emerging evidence supports the effectiveness of a recovery-based approach in the provision of mental healthcare, including through the use of peer support (Kessing, 2021), inclusion of lived experience perspectives (Scholz et al., 2016), co-produced education (Happell and Roper, 2009) and the development of more than 80 Recovery Colleges across the globe (Fortune et al., 2015; Meddings et al., 2015; Newman-Taylor et al., 2016; Thériault et al., 2020).

What is a Recovery College?

Recovery Colleges use an educational approach to mental healthcare, designed to complement rather than replace the therapeutic approach. It is a strongly held view in recovery circles that while

specialist assessment and treatment are important … they represent only a small part of what mental health services do and far more is required if people are to participate as equal citizens in economic, social and family life and do the things they value. (Perkins et al., 2012)

The core elements of a Recovery College involve the following:

• The process of co-production (an emerging space in healthcare which involves co-planning, co-designing, co-delivering, co-receiving and co-evaluating service design and delivery between people with personal experience of using mental healthcare services [patients/consumers and family/carers] and people with professional expertise in mental health [clinicians and other service providers]).

• Co-production is a feature of the college at every level from initial planning through to governance and decision-making about curriculum. As such, the college is not a day centre but a learning organisation where students make choices about the courses they wish to attend and things they would like to learn. Both service staff and service consumers, as well as interested others, can attend courses. Through this shared process, service users move from the role of ‘patient’ to the role of ‘student’, while service providers similarly shift from ‘the expert’ to ‘student’. The outcomes are increasingly being shown to be beneficial both for consumers and for service providers.

• People from any walk of life can attend, providing only that the person is interested in the topic and wishes to learn about it.

• The college is neither a substitute for other assessment and treatment approaches nor a stand-in for mainstream education, including other kinds of professional development, although it supports and complements other kinds of formal workplace learning. Instead, the Recovery College looks to exist in the gap that exists between the two, offering learning in ways and about things that otherwise would not be available.

• The culture in the college is one based on the principles of recovery-oriented practice and the strengths model, focusing on the potential for growth in everyone rather than on the more traditional approach of having service providers who do things ‘to’ and ‘for’ people, and consumers who have things done ‘to’ and ‘for’ them (ImROC, 2021).

Benefits of Recovery College

Development of person-centred approaches to recovery has been shown to empower individuals while also bringing a positive impact to clinical practice and in the longer term and broader context, having the power to change the culture of organisations and service systems (ImROC, 2021; Waks et al., 2017; Walker et al., 2012). Evaluation with college students has found a number of reasons why Recovery Colleges are effective in improving outcomes, including:

• Learning from other students (reducing social and workplace isolation and allowing for safe sharing of different perspectives);

• Co-production and the value of lived experience trainers as well as mental health service providers;

• Safe supportive environment to explore ‘what works’ rather than what is ‘right’ or ‘wrong’;

• Learning new knowledge (and skills);

• (Brings) Structure to the day;

• Offers choice – clinicians and consumers can learn about areas of interest, rather than what others recommend or mandate;

• Provides social opportunity;

• Allows for a sense of progression through the curriculum;

• Supported learning – professional development for service providers and new life skills for service users (Meddings et al., 2014).

Providing opportunities for consumers to feel empowered to take charge of their own care while supporting service delivery staff to improve their knowledge and skills is a powerful reason to undertake the establishment of local Recovery Colleges within public mental health services, in line with both state- and federal-level policy and standards in mental healthcare. Emerging research evidence suggests that when service providers attend Recovery College courses as students, alongside service users under the co-reception model, the benefits they accrue include learning new skills, improved empathy and recovery orientation in practice, increased enthusiasm and reduced burnout (Perkins et al., 2017). Auspicing a Recovery College within a public mental health service contributes towards state and national policy goals of increasing recovery-oriented service and person-centred care (National Mental Health Commission (NMHC), 2017).

How to implement a Recovery College

The expansion of the Recovery College model across the state represents significant reform of the current recovery model operating in Area Mental Health Services. Currently two Recovery Colleges operate in Victoria (as well as several others across other parts of Australia). One of these is located in a fully peer-run not-for-profit service, while the other (discovery college https://discovery.college/) was developed in a publicly funded clinical youth mental health service and has now expanded into adult community and inpatient settings. The learnings from the establishment of discovery college across these diverse service settings may provide a useful framework for the development of other Recovery Colleges in the future.

Implementing recovery-oriented practice across an organisation is an ongoing challenge, particularly as recovery focus is not commonly taught in universities during discipline training or in ongoing professional learning. As was noted by Williams et al. (2016), ‘enhancing employee motivation for enhanced recovery consistent practice’ by using a parallel model or process made the professional development a ‘safe’ space for mental health service providers to come and try their hand without the sense of it having a negative impact if they ‘got it wrong’. The Recovery College is designed to be an example of what that ‘parallel process’ can look like.

There is no single way of doing a Recovery College; however, key findings from the implementation of Melbourne’s discovery college concur with the published evidence base in indicating certain factors which support effective implementation, including:

• Leadership engagement: a key in successful implementation and establishment. While it may be that the college works in a ‘grassroots’ realm, top down input and engagement into the college is key if it is to be effective in having an influence on practice and organisational culture.

• Having a champion (or champions): someone who can carry the message, engage in various communication spaces and help staff engage with the idea, understand the model and have a go at it for themselves.

• Administration support: a key function in being able to build a curriculum that is dynamic and support students’ engagement and access to a multitude of courses and experiences. Insufficient administrative support may create situations where educational staff are required to undertake tasks outside their specific skill set, limiting the time and effort for more educationally focused activities.

• Clarity around the governance: identifying where the college sits at an early stage is helpful when addressing issues around sustainability, funding, programme oversight, policy setting and strategic direction.

In addition, it is clear from existing colleges that they do not function as effectively as an ‘add-on’, or side offering, but must integrate with the clinical and therapeutic service, to drive innovation and service change, through engaging clinical staff as well as consumers (Hopkins et al., 2018).

Conclusion

The recent Royal Commission into Victoria’s Mental Health System conducted exhaustive research into ways to improve what has previously been described as the ‘broken system’ (Premier of Victoria, 2020) of Victorian mental healthcare. Among other findings, the Commission has recommended the establishment of Recovery Colleges in all Adult and Older Adult Community Mental Health services. While Recovery Colleges are now being established across the world, serious challenges remain for many clinical services in achieving effective implementation. Requirements such as equal representation of lived experience (consumer) staff with clinical and other service delivery staff, commitment to genuine co-production at all levels of the college, risk management and duty of care to students, finding appropriate classroom spaces and provision of adequate administrative support are potential barriers to state-wide efforts to widen access to Recovery Colleges. Nonetheless, effective implementation has been achieved at various sites across Australia, including the innovative youth-focused discovery college in Melbourne, demonstrating that this new model can be developed in local contexts and has great potential to improve the way mental health services are delivered and received in this country.