When the concept of recovery colleges first emerged in the UK a decade ago it is unlikely anyone anticipated how quickly they would be embraced within mental health services, or how rapidly they would grow.
From the first pilot in two London boroughs in 2009, which soon spread to colleges serving five by 2010, there are now dozens across the UK and Ireland.
The colleges, which tend to be based at hospitals or community locations, offer educational courses and workshops focused on mental health and recovery that are co-designed and delivered by people with lived experience – peer support workers – alongside mental health professionals. Overcoming the stigma and discrimination associated with mental health difficulties is central to their programmes.
People with experience of mental health difficulties, their families, clinical staff – and even sometimes the wider community – can sign up to a diverse range of courses. These might include offerings as varied as dealing with difficult emotions, mindfulness, setting goals, interview skills and healthy living.
David Wilmott is director of nursing at Cygnet Healthcare, which has been delivering recovery college courses in its hospitals for the past three years and has 13 colleges currently in operation, with more planned. He says the fact that courses are designed and delivered based on the “wishes and needs” of people with lived experience of mental health problems is central to their success. An “inclusive” learning environment means peer support workers and students alike gain confidence and “become experts in their own recovery”, he says.
While there are no central statistics for the number of people who have been on courses or taught at the colleges, there is evidence of their popularity. “Since we opened our doors in January 2012 we have had over 5,500 individual students enrolled, totalling over 13,000 attendances on workshops and/or courses,” says Syena Skinner, manager of the Central and North West London NHS foundation trust Recovery and Wellbeing College. More than 1,200 workshops or courses have been delivered to date.
Bernadette Donaghey has been a peer trainer at the Western health and social care trust Recovery College in Northern Ireland for four years. The trust, which launched its first pilot in Omagh in 2014, now offers 26 courses and workshops at community-based locations across five towns.
Donaghey says that being involved in co-production “at every level” from design to implementation sets recovery colleges apart. They are not a substitute for therapy and other interventions, she says, but in her experience the inclusive, co-production model “is therapeutic”.
Research suggests the recovery college model is effective; students surveyed report high levels of satisfaction and improved skills and knowledge. There is also evidence that people attending feel less stigma and greater wellbeing.
As a peer trainer Donaghey’s reflections on the programme and its role in recovery remain positive: “[It’s] given me hope that I could move on,” she says.
Living proof: The role of former patients in recovery
Peer support workers bring crucial lived experience for those new to the system
Mel Ball spent time in a long-term residential unit receiving treatment for experience of complicated trauma before she went on to apply to work as a paid peer support worker (PSW) on a mental health acute ward. “I felt it necessary for me to be part of change,” she says of her decision to go for the job.
Ball is now peer support lead at the Central and North West London NHS foundation trust (CNWL), with responsibility for overseeing its peer support programme.
She works alongside clinical staff in fully integrated teams, including on acute wards and in the community; peer support work has come a long way since the trust first dipped its toes in the water a decade ago, with only four part-time PSW’s, says Syena Skinner, manager of CNWL’s Recovery and Wellbeing College.
Skinner explains that the current peer support programme was triggered by the then Department of Health’s Implementing Recovery through Organisational Change (ImROC) initiative in 2009.
PSWs at the trust are an integral part of the teams, according to Skinner. They work with clinical staff and often carry out roles beyond peer support, including as healthcare assistants. In acute settings, PSWs are either based on wards with clinical teams or with inpatient occupational therapy services.
After being recruited, all trust PSWs complete a 10-day peer worker accredited training course. The course focuses on connecting theory with practice, while also developing skills in areas spanning ethics, active listening, and dealing with challenges in the role.
Because of their direct experience of mental health problems and services, PSWs bring added value in a multitude of ways, according to Skinner and Ball. A peer support worker might, for example, spend time with a newly admitted person or first-time in-patient and drawing on their own experience – sometimes of the same ward – help outline how the system works, thereby easing the transition.
For many people, navigating mental health services can be daunting, but PSWs can provide crucial first-person insights on how to better understand and engage with the system, including as in-patients, says Ball.
In the area of control and restraint, which can be among the most challenging aspects of in-patient care on acute wards, PSWs have provided valuable input, including redesigning physical intervention training, according to the trust.
Ball says her own experience of being a peer worker has been “life-affirming” and that the presence of PSWs can break down barriers between clinical staff and service users.
That peer support working “can help reduce stigma” is encouraging, and the emphasis on recovery within services, as the foundation of peer support work, is central, she says.