Vision for change in practice: a pilot study of recovery oriented mental health services

Abstract

Managing the integrated delivery of better public health services and working with community assets to improve health outcomes Introduction: Policy dictates a move toward recovery oriented services for people with severe mental health difficulties, yet there is a lack of analysis regarding facilitation of this type of support in Ireland. Practice change: REFOCUS was a pilot project implementing recovery oriented services within the Irish mental health day services. It utilised peer support and individualized care planning to encourage and foster engagement with the community and to guide the service user (SU) towards adopting a positive and forward looking perspective to their lives. SU’s were facilitated to access mainstream employment and social and leisure opportunities. Participating SU and staff availed of co designed recovery led training programme. Some staff were reconfigured to become Individualised Planning Facilitators, Community Connectors and Individual Placement and Support Employment specialists. Aim and theory of change: The evaluation aimed to appraise the impact of implementing recovery focused day services by exploring and measuring the experiences of service users, peer support workers and mental health staff participating in the initiative. SU outcomes were measured qualitatively and quantitatively against CHIME (connectedness, hope and optimism about the future, identity, meaning in life and empowerment) domains of recovery at two time points. Staff beliefs, attitudes and judgements as well as PSW’s experiences were also explored. Population & stakeholders: The evaluation included 35 SU with serious mental health difficulties, 14 health service staff and 7 peer support workers. REFOCUS was a 3 year Genio Trust funded joint initiative between the Irish Health Service Executive and RehabCare. Timeline: This longitudinal study measured outcomes at two time points over a 3 year period. Highlights: At T2 93% of SU judgements measured by INSPIRE agreed peer support workers aided their recovery and SUs agreed they had experienced 82% of the positive personal recovery aspects measured by the QPR. SU met needs as measured by CANSAS remained constant from T1 to T2. At time 2 majority of staff (83%) believed that REFOCUS offered a good way to provide mental health services and 61% felt supported by the HSE in implementing recovery oriented changes Both staff and service user’s identified peer support to be uniquely supportive of a service user’s individual recovery, helping service user’s to feel more positive, confident and independent. Sustainability: Although many staff felt recovery orientated services involved more of a struggle in the short term, long term gains in service user independence, they felt, were worth the extra effort. Some mentioned an increase in job satisfaction from watching service user’s gain hope, confidence and independence from their experiences. Transferability: Staff and service user’s both found peer support to be a positive aspect of REFOCUS and felt with the development of training and guidelines for the role, could be an important improvement to service provider practice. This evaluation has demonstrated that a day service that supports recovery could continue to meet the needs of a service user while also improving their functioning and quality of life which could potentially reduce the level of dependency on health service resources. Results may aid understanding and guide future recovery oriented practices