Occupational therapy evidence in paratice for mental health

2 Service User and Carer Involvement: Co‐production 17Nashiru Momori and Gabrielle Richards 3 Creativity as a Transformative Process 35 Diane Cotterill and Lucy Coleman 4 Group Work in

in Practice for Mental Health

Occupational Therapy Evidence

in Practice for Mental Health

Second Edition

Edited by

Cathy Long

Former senior lecturer

York St John University

First edition published 2006 by John Wiley & Sons Ltd

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Names: Long, C (Cathy), editor | Cronin-Davis, J (Jane), editor | Cotterill, Diane, editor Title: Occupational therapy evidence in practice for mental health / [edited by] Cathy Long, Jane Cronin-Davis, Diane Cotterill.

Description: Second edition | Chichester, West Sussex ; Hoboken, NJ : John Wiley & Sons, Inc.,

2017 | Includes bibliographical references and index.

Identifiers: LCCN 2016055401 (print) | LCCN 2016056140 (ebook) | ISBN 9781118990469 (pbk.) | ISBN 9781118990551 (pdf) | ISBN 9781118990544 (epub)

Subjects: | MESH: Mental Disorders–therapy | Occupational Therapy–methods | Evidence-Based Medicine

Classification: LCC RC439.5 (print) | LCC RC439.5 (ebook) | NLM WM 450.5.O2 |

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Set in 10/12pt Warnock by SPi Global, Pondicherry, India

1 2017

occupational therapy in mental health.

2 Service User and Carer Involvement: Co‐production 17

Nashiru Momori and Gabrielle Richards

3 Creativity as a Transformative Process 35

Diane Cotterill and Lucy Coleman

4 Group Work in Occupational Therapy: Generic

Versus Specialist Practice 59

Catherine Benyon‐Pindar

5 Working with Alice Smith: Services for Older People 87

Caroline Wolverson and Alison Williams

6 Occupational Therapy Interventions for Someone

Experiencing Severe and Enduring Mental Illness 109

Lindsay Rigby and Ian Wilson

7 Forensic Mental Health: Creating Occupational

Opportunities 139

Jane Cronin‐Davis

Contents

8 Promoting Self‐Efficacy in Managing Major Depression 165

Gill Richmond

9 Veterans: Understanding Military Culture and

the Possible Effects on Engagement 191

Nick Wood, Diane Cotterill and Jane Cronin-Davis

Index 223

Catherine Benyon‐Pindar, BSc(Hons), BHSc (Hons) After 4 years of

medical school and a BSc in Psychology with relation to Medicine, Catherine decided medicine was not for her However, she discovered

a passion for occupational therapy and qualified in 2005 She ised in mental health immediately, initially working in forensic mental health She moved to a specialist post at The Retreat in York in 2007 and has worked for 9 years on the Acorn Programme, an intensive group work programme and an accredited therapeutic community for women who predominantly meet the criteria for Borderline Personality Disorder, Complex Post Traumatic Stress Disorder and/or Dissociative Identity Disorder She has facilitated a wide range of groups including psychoeducational, occupation‐based and psychotherapeutic She regularly presents at national conferences and in 2014 completed the Institute of Group Analysis’ National Foundation Course in Group Analysis She is passionate about student education, group work, trauma and mindfulness

special-Lucy Coleman BA(Hons), BHSc(Hons), PGCE special-Lucy first became

involved with Converge Communitas choir in 2010 when she was an occupational therapy student at York St John University Before starting her occupational therapy programme, she taught music and sang pro-fessionally Lucy qualified in 2013, and was offered the post of Support and Progression Worker with Converge at the university One of her main roles at Converge is to co‐ordinate support for anyone enrolled on courses who may need this by liaising with course tutors, York St John student buddies and peer mentors Lucy also works with people to help them achieve their creative goals in different ways This could mean

List of Contributors

offering them people to progress in our courses, with application for university places and finding employment opportunities.

Diane Cotterill, Dip COT, Bsc(Hons), MSc, PGAP, PGCHR, FHEA Diane is an occupational therapist who graduated in 1990 Following this Diane worked in a range of psychosocial settings, both inpatient and community, predominantly with working age adults but she also has experience of working alongside older people with complex needs Diane now teaches on the undergraduate occupational therapy pro-gramme and contributes to teaching at postgraduate level at York St John University Diane maintains a keen interest in mental health ser-vices, the care provided for older people in care homes and also from

a professional perspective, ethical practice and professionalism

Jane Cronin‐Davis, PhD, MSc (Crim Psych), BHSc (Hons), BA

(Hons), BA, PGCAP, FHEA Jane graduated as an occupational pist in 1994 from what was then the College of Ripon and York St John (now York St John University) Much of her clinical experience is in mental health, specialising in forensic mental health She has worked

thera-in high and medium secure hospitals Her last post before movthera-ing to work in a university was Head of Occupational Therapy at Broadmoor Hospital in the UK Her specialist interest is in occupational therapy occupation‐focused assessment and treatment interventions; risk assessment and management; and working with people diagnosed with personality disorder in forensic settings She currently offers supervision and practice development to practitioners working in secure services Jane focuses on research related to forensic practice She was a lead for the College of Occupational Therapists (2012) prac-tice guidelines ‘Occupational Therapists use of occupation‐focused practice in secure settings’ She has worked for National Institute of Clinical Excellence and other national organisations representing occupational therapy Jane was previously the Chair of the College of Occupational Therapists Specialist Section for Mental and the Forensic Forum

Cathy Long, SROT, DipCOT, MSc (Applied Psychology), CertHE

Until recently Cathy taught at York St John University She qualified

as an occupational therapist in 1982 and has worked in Birmingham and Manchester as a mental health occupational therapist She has worked in adult community mental health teams, resource centres,

acute inpatient services and a unit for group and individual therapy Immediately prior to teaching she worked within an NHS funded arts and activities centre for people experiencing mental health illnesses.

psycho-Cheryl McMorris, BSc(Hons) psycho-Cheryl qualified as an occupational

therapist in 1997 from the University of Derby Cheryl’s first post was working in adult mental health in patient services in Gloucestershire, before moving to Scotland where she worked for a year in a Social Work Department for Glasgow City Council Since then Cheryl has specialised in working in mental health primarily forensic services She has worked across high, medium and low secure services In 2004, she took up post as a Clinical Specialist Occupational Therapist for discharge liaison at The State Hospital, Carstairs before taking on her current role as Forensic Care Group OT Lead for the Directorate of Forensic Mental Health & Learning Disabilities in NHS Greater Glasgow & Clyde in 2007 Cheryl has a special interest in vocational rehabilitation and employability in mental health specifically for forensic service users She has an enthusiasm for the development of others particularly leadership skill developments for occupational therapists and support staff Cheryl chaired the Scottish subgroup of College of Occupational Therapists Specialist Section Mental Health (COTSSMH) for 4 years before becoming Vice Chair in 2014 and the Chair of COTSSMH in 2015

Nashiru Momori Nashiru is Founder and Director of Real INSIGHT – an

organisation aiming to transform services through user involvement

He has extensive experience of inpatient and community services, drug dependency and the criminal justice system His experience of his recovery journey has enabled him to recognise the importance of a holistic approach to recovery and the need for meaningful involve-ment Since 2011, Nash has been an Expert User Consultant for West London Mental Health Trust providing insight to Senior Management Teams working directly with frontline staff and peers in a recovery oriented practices, and enhancing relationships From 2013 to 2015, Nash worked with Resolving Chaos to help create and implement the Fulfilling Lives programme in Lambeth, Southwark & Lewisham He was the National Expert Citizen Group Coordinator for the pro-gramme funded by the Big Lottery Fund from 2014 to 2015 He was founder and Chair of the Expert Service User Reference Group, which

enables individuals currently using support services, or at the ery, to participate in the development, management, delivery, moni-toring and evaluation of their projects Nash is a Governor of South London and Maudsley NHS Trust, and part of the development team for its Recovery College, vice chair of their Social Inclusion and Recovery Board, and a regional Ambassador for the Equalities National Council Currently, Nash is a Trustee for the Blackfriars Settlement and West London Collaborative.

periph-Gabrielle Richards, BAS (OT), MSc, FCOT periph-Gabrielle has worked in

mental health all of her career She is passionate about tion and promotes a collaborative and recovery based approach to all her work from practice, organisational and strategic levels work-ing alongside people with lived experience Gabrielle chairs the Board for the Social Inclusion and Recovery Strategy work of the Trust and leads on several Trust wide projects and initiatives includ-ing volunteering and the Recovery College Gabrielle has been involved in working parties and Boards of the College of Occupational Therapists focusing on mental health She was the chair of the Colleges Specialist Section for Mental Health During this time the profile of mental health was raised significantly most notably with the development of the Colleges Strategy for Mental health

co‐produc-‘Recovering Ordinary Lives’ She has contributed to publications and presented at national and international conferences She is currently Chair of the London Mental Health Occupational Therapy manag-ers group and Professional Head of Occupational Therapy and Lead for Social Inclusion and Recovery at South London & Maudsley NHS Foundation Trust, King’s Health Partners In 2008 she was awarded the British College of Occupational Therapists Fellowship in recog-nition of her outstanding contribution to the work of the Specialist Section in mental health and to the profession of occupational therapy

Gill Richmond DipCot, Grad Dip Counselling, PGDip Cognitive

Therapy, BACP accredited CBT practitioner, Gill trained and fied as an occupational therapist in 1991 at the University College of York St John She has worked in a range of mental health settings and has primarily worked with adults with complex mental health needs in

quali-an NHS setting using CBT for individuals quali-and groups Gill is BABCP accredited, a CBT practitioner, Supervisor and Trainer

Lindsay Rigby, SROT, Dip COT, BSc (Hons), MSc Lindsay was

employed as a teaching fellow at Manchester University and Manchester Mental Health & Social Care Trust as a practice develop-ment practitioner With over 20 years’ experience in occupational therapy in acute mental health, she spent over 8 years in a Home Treatment Team offering alternatives to hopital admission She spe-cialised in the development of clinical pathways to provide cognitive‐behavioural therapy and family interventions alongside specific occupational therapy interventions Her area of specialist interest was with those who experience a first episode of psychosis and the super-vision of clinicians

Alison Williams, BA (Hons) Social Policy with Social Work, BHSc

(Hons) Occupational Therapy, Post Graduate Diploma in Management Studies Alison has over 15 years’ experience working as an occupa-tional therapist in older people’s mental health services in a variety of areas including memory clinic, community mental health teams for older people and inpatient care Her particular areas of interest are working with people with dementia and their carers, dementia‐friendly design/environments and assistive technology

Ian Wilson, RMN, Dip PSI (Thorn), BSc (Hons), MSc (COPE) Ian

works as a Dual Diagnosis Trainer and Clinical Specialist in Dual Diagnosis for Manchester Mental Health & Social Care Trust He has worked in mental health services in Manchester for 25 years During that time he has offered evidence‐based psychosocial interventions to many clients, including CBT for individuals and their families He has trained staff from a wide variety of backgrounds and professions in the delivery of psychosocial interventions, locally, nationally and abroad

He has a particular interest in working with young people ing a recent onset of psychosis and their families, and patients with complex ‘dual diagnosis’ presentations He is currently also a Teaching Fellow at the University of Manchester

experienc-Caroline Wolverson, Dip COT, Dip Therapeutic Horticulture, MSc

Professional Practice, Fellow of the Higher Education Academy Caroline is a senior lecturer in the Faculty of Health and Life Sciences

at York St John University An occupational therapist by background, she now teaches on the undergraduate occupational therapy programme and MSc Professional Health and Social Care studies programme Her

particular areas of interest are working with older people, people with dementia and their carers and maintaining well‐being through activity

in the care home setting

Nick Wood, MSc, Fellow of the Higher Education Academy After

serving in the Royal Navy and seeing active service (Falklands 1982), Nick joined HM Prison Service in 1986 Working in numerous roles including substance misuse teams and offender management, he cre-ated the Veterans In Custody Support model becoming the coordina-

tor for Prisons in England and Wales He co‐authored the Working

with Veterans guide and received the HRH Princess Royal Butler Trust

Award for his veterans’ support work in 2010 In his current role, Education and Development Lead (Military Culture & Interventions), Nick delivers the YSJU Veterans (Military Culture) Awareness CPD and is collaborating with colleagues to introduce ‘military culture’ into student’s studies He sits on local authority and national boards including COBSEO Veterans in the CJS, SSAFA Prison In Reach and NHS Armed Forces Networks in Yorkshire & Humber and the North East He contributed to the government Phillips Inquiry into Veterans

in the CJS and has co‐authored academic publications into veterans in the CJS Nick’s current projects include a research study to assess the impact on veteran identification and engagement within community support services

This, the second edition of Occupational Therapy Evidence in Practice

for Mental Health, provides a contemporary perspective of

occupa-tional therapy practice We are proud to welcome both new contributions

to the text and updated chapters from the previous edition We sider all of these to be relevant to current practice, providing clear examples of implementing evidence in practice All authors have a strong interest in how occupational therapy interventions benefit people who use (or have used) mental health services, and have exper-tise relevant to the focus of their chapters Diane Cotterill is welcomed

con-as the third editor As with the first edition, this text is written for students and new graduates who seek to underpin their practice with the relevant evidence and theory base, consider how to develop skills for practice and question how to move practice forward

Since the first edition of the book in 2006, the evidence base for occupational therapy has grown, thereby demonstrating how it can address the occupational strengths and needs of the wide range of peo-ple using mental health services Evidence‐based practice is no longer

a new phenomenon; it is a routine, everyday component of tional therapy practice Studies have shown that occupational thera-pists have positive attitudes towards evidence‐based practice [1] and the increasing drive for effective practices in the NHS makes a scien-tific approach to service delivery a continued requirement – whether practising in England, Scotland, Wales or Northern Ireland [2–5]

occupa-However, the authors in this book have deliberately and judiciously taken a broad perspective of what constitutes evidence‐based prac-tice In order to be true to our person‐centred practice, there are no definitive or manualised answers in the chapters; rather, by drawing on

a wide range of evidence, the authors have shown how occupational

Preface

therapy or an occupational perspective makes a difference to individuals who use mental health services Each contributor has proffered clinical reasoning, service contexts, national policy and legislation

in addition to their mental health experience and their unique tributions to mental health occupational therapy Thus, we hope that each chapter provides not only evidence, but also stimulates readers to consider how they might provide occupational therapy interventions, given that clinical reasoning is influenced by factors such as personal preference, team dynamics, professional experience and training

How to Use This Book

Each chapter focuses on a different practice setting or approach, but each is based on an individual or individuals with whom the author has worked Pseudonyms have been used and some relevant detail and infor-mation has been altered to prevent the possibility of identification.Each chapter includes tasks: reflective questions or suggested read-ing to prompt the reader to look beyond the confines of the book and develop their reasoning skills

Briefly, the content of each chapter is as follows

Chapter  1 by Cheryl McMorris sets the scene for the book as a whole, giving a synopsis of current mental health policy and what this means for occupational therapy practice Cheryl writes with passion

of the important of using evidence in our practice and urges us to undertake research in order to demonstrate our effectiveness and to ensure the best quality services

Gabrielle Richards and Nashiru Momori have worked together for some time as occupational therapist and service user In Chapter 2 they help us to appreciate the concept of service user involvement in mental health, and moreover, the importance of co‐production They provide an example of their successful strategic collaboration and offer readers their individual perspectives Nash outlines his unique model for co‐production

Chapter 3 explores the impact that engaging in creative occupations can have upon mental well‐being, and how an occupational therapist might facilitate this process The first half of the chapter highlights the importance of supportive environments and how these can promote engagement and participation and how the Model of Creative Ability

contributes to enabling individuals to access their inner resources It then provides an example of a collaborative community arts project called Converge which is based at York St John University.

Catherine Benyon‐Pindar explores the generic versus specialist practitioner roles in the context of a therapeutic community for women with a variety of self‐defeating behaviours She writes about the complexity and value of group work in occupational therapy, and describes the stages of group development within the Relational Model of Group Work Catherine discusses the therapeutic use of self with the women on the residential group therapy programme She emphasises the use of occupation‐focused, occupation‐based and occupation‐centred practice within both generic and occupational therapy group work Reference is made to Dialectical Behaviour Therapy (often referred to as DBT), NICE clinical guidance and occu-pational therapy models of practice and process

Alice Smith has a recent diagnosis of Alzheimer‐type dementia and lives on her own In Chapter  5 Caroline Wolverson and Alison Williams discuss the steps involved in working as an occupational therapist with Alice and her family, while remaining closely faithful to the principles of person‐centred practice and multi‐agency working Consideration of her physical needs (Alice also has osteoarthritis) and what it is like to live with a diagnosis of dementia are explored within the chapter References to evidence to support suggested interven-tions are presented with a particular focus on meal preparation, com-munity engagement and carers’ support

Adhering closely to principles of evidence‐based practice, Chapter 6 gives a detailed account of psychosocial interventions (PSI) for schiz-ophrenia Training in PSI is usually at the postgraduate level and multi‐disciplinary, and it is becoming increasingly recognised as treat-ment of choice  –  hence its inclusion here Using the Canadian Occupational Performance Measure [6] as a starting point, Lindsay Rigby and Ian Wilson show how the symptoms of schizophrenia affect Bob’s ability to engage with his previous occupations and with his family They then describe detailed and clearly defined interventions

to help Bob and his family meet their goals

Occupational therapy has now come of age in secure environments

in the UK Chapter 7 considers specifically occupation‐focused tice in a secure setting with reference to national guidance Jane Cronin‐Davis takes us through the process and considerations of Will,

prac-an occupational therapist working with Nathprac-an, a service user in a

medium secure unit in the UK There is an opportunity for readers to recognise the challenges and opportunities which co‐exist for occupa-tional therapy staff in secure environments, and to identify the need and potential for occupation‐focused practice with service users despite the security and environmental restrictions There is a strong emphasis on the possible evidence‐base for occupational therapy interventions in secure environments.

Occupational therapy in mental health integrates evidence‐based strategies to facilitate a clear understanding of the individual environ-mental, socio‐cultural, cognitive, emotional and behavioural factors leading to the development and maintenance of depression This case study in Chapter 8 by Gill Richmond provides opportunity for reflec-tion on strategies that guide the therapist’s clinical reasoning and will assist collaborative implementation of the most suitable and effective therapeutic interventions for the person experiencing depression Reference is made to guidelines on the treatment of depression for-mulated by NICE [7]

Since 2008, mental health services have been required to address the mental health needs of veterans living in their area Chapter 9 gives a detailed background to military culture and armed combat, and their possible impact on health A key issue is the transition from army to civilian life and the difficulties this poses, in part resulting from social stigma and barriers to seeking help Nick Wood does not present occupational therapy processes, but encour-ages the reader to consider these in the light of evidence, policy and guidelines

In this second edition there are some clear and purposeful sions from the first edition We felt that learning disability, and child and adolescent mental health services warranted greater considera-tion than could be afforded here

References

Occupational therapists’ attitudes, knowledge, and implementation of evidence‐based practice: a systematic review of published research

British Journal of Occupational Therapy, 77 (1), 24–38.

2 Department of Health (2011) No Health without Mental Health:

A cross‐government mental health outcomes strategy for people of all ages, https://www.gov.uk/government/uploads/system/uploads/

attachment_data/file/213761/dh_124058.pdf (accessed 28 October 2016)

2012–15, http://www.gov.scot/Resource/0039/00398762.pdf (accessed

28 October 2016)

Mental Health and Wellbeing in Wales, http://gov.wales/docs/dhss/

publications/121031tmhfinalen.pdf (accessed 28 October 2016)

Delivering the Bamford Vision: The Response of the Northern Ireland Executive to the Bamford Review of Mental Health and Learning

Disability Action Plan 2012–15, https://www.health‐ni.gov.uk/sites/

default/files/publications/dhssps/bamford‐action‐plan‐2012‐15.pdf (accessed 28 October 2016)

Pollock, N (1994) Canadian Occupational Performance Measure,

2nd edn, CAOT Publications, Montreal

recognition and management Clinical Guideline 90, NICE, London.

Occupational Therapy Evidence in Practice for Mental Health, Second Edition

Edited by Cathy Long, Jane Cronin-Davis and Diane Cotterill

© 2017 John Wiley & Sons Ltd Published 2017 by John Wiley & Sons Ltd.

1

Historically, there has been much debate and discussion about the ficulty in defining occupational therapy Personally, occupational therapy is a passion A passion to enable people to achieve their full potential, to work towards their goals and be all they can and want to

dif-be and more The true aspiration of the occupational therapist is no different in mental or physical health – occupational therapy supports people to develop skills to overcome the challenges that restrict them and to utilise their strengths to enable them to live the lives they want

to live

Despite the significant changes in health and social care systems over the last decade and the current financial challenges we face, I am inspired by the creativity and adaptability of our profession We actively seek out new scopes of practice, identifying the need for and highlighting the benefit of occupational therapy We have outstanding clinicians, researchers, educators and managers, all of whom are exceptional leaders  –  determinedly working to develop, deliver and evidence the best of what occupational therapy can offer in mental health

We are beginning to embrace the requirements to develop and apply evidence that demonstrates our unique contribution to mental health service delivery and show the effectiveness of our interventions

Occupational therapy in mental health has commenced its journey

to adopt an evidence and values‐based approach The chapters within this book reflect the initiatives, developments and evidence of our profession in mental health practice; however, we have not yet arrived

at our destination To ensure we deliver high quality care, cost effective

An Introduction: Tracking Developments

in Mental Health Practice

Cheryl McMorris

interventions and that our profession continues to flourish we need to evidence what we know in our hearts: occupational therapy makes a positive contribution to high quality, effective mental health care.

Mental Health Legislation, Policy

and Developments Influencing Occupational

Therapy in Mental Health

The four countries of the UK, England, Northern Ireland, Scotland and Wales, each have their own mental health legislation and concur-rent policies, which are significant in determining the key priorities and agendas for mental health services Such variations in legislation and mental health policies result in both subtle and major differences

in role remit, commissioning and delivery of mental health services across the UK

The introduction of Chief Allied Health Profession (AHP) Officers

or Lead AHP Officers within government departments has had a nificant impact upon occupational therapists working in mental health These roles have instigated the production of key AHP policy and strategic drivers, which have been utilised to influence, evidence and support the work of occupational therapists employed in mental health in driving service change, improving service delivery and dem-onstrating our vital role within the mental health workforce

sig-A brief overview of the most recent mental health legislation, policy and AHP policy across the UK is given in Table  1.1 and Box  1.1 Throughout the book there is reference to relevant policy related to the specific area of practice and all efforts have been made to include

a UK‐wide perspective

Over the last 10 years, within the UK there have been leading opments influencing and enhancing the evidence for occupational therapy in mental health services The Research Centre for Occupation and Mental Health (RCOMH) which until recently was at York St John University set out to develop world class research in occupational therapy and mental health to influence best practice This was achieved through the core work within the coordinated research programmes: arts and creativity, children and young people’s occupations, occupa-tional and mental health in forensic and prison services, occupation and older people’s mental health and participation and mental health

Box 1.1 The policy context for evidence‐based practice in the UK

Department of Health (2009) Living Well With Dementia: a national

dementia strategy, https://www.gov.uk/government/publications/

living‐well‐with‐dementia‐a‐national‐dementia‐strategy (accessed

28 October 2016)

Department of Health (2011) No health without mental health: a

cross‐government mental health outcomes strategy for people of all ages, https://www.gov.uk/government/uploads/system/uploads/

attachment_data/file/213761/dh_124058.pdf (accessed 28 October 2016)

Department of Health (2014) Closing the Gap: priorities for essential

change in mental health, https://www.gov.uk/government/uploads/

system/uploads/attachment_data/file/281250/Closing_the_gap_ V2_‐_17_Feb_2014.pdf (accessed 28 October 2016)

Department of Health, Social Services and Public Safety (2011)

Service Framework for Mental Health and Wellbeing http://www.scie.

org.uk/publications/guides/guide30/files/northern_ireland_mental_ health_and_wellbeing_service_framework.pdf?res=true (accessed

28 October 2016)

Great Britain Parliament Mental Health Act 2007, http://www.

legislation.gov.uk/ukpga/2007/12/contents (accessed 28 October 2016)

Great Britain Parliament The Mental Health (Northern Ireland) Order

1986 (No 595) (NI 4), http://www.legislation.gov.uk/nisi/1986/595/

contents (accessed 28 October 2016)

Northern Ireland Association for Mental Health (2009) A Flourishing

Society: Aspirations for Emotional Health and Wellbeing in Northern Ireland, http://www.niamhwellbeing.org/SiteDocuments/compass_

flourishing.pdf (accessed 28 October 2016)

Public Health Agency (2012) Allied Health Professionals Strategy

2012–2017: Improving health and well‐being trough positive nerships, http://www.publichealth.hscni.net/ahp‐strategy‐2012‐2017

part-(accessed 28 October 2016)

Public Health England (2015) The role of allied health professionals in

public health: examples of interventions delivered by allied health sionals that improve the publics’ health, https://www.gov.uk/government/

profes-uploads/system/uploads/attachment_data/file/483038/Mapping_ the_Evidence_of_impact_of_allied_health_professionals_on_public_ health.pdf (accessed 28 October 2016)

(Continued )

The National Institute for Health and Care Excellence (NICE) accredited the College of Occupational Therapists (COT) practice guidelines for occupational therapists’ use of occupation‐focused prac-tice in secure hospitals As the first practice guidelines for occupational therapists in mental health in the UK, they utilise the evidence to sup-port and inform clinical practice It is hoped that this will be the foun-dation for the development of more practice guidelines for occupational therapists in mental health, setting standards for best practice and demonstrating the role of occupational therapy within different clinical areas for other healthcare professionals and service users.

Mental Health Occupational Therapy Roles

and Diversity of Clinical Practice

Occupational therapists have become well established as integral members of core teams in mental health services including specialist areas of practice As a consequence of the changes in health and social

Scotland Parliament (2015) Mental Health (Care and Treatment)

(Scotland) Act 2015, http://www.legislation.gov.uk/asp/2015/9/

contents/enacted (accessed 28 October 2016)

Scottish Government (2010) Realising potential: an action plan for

allied health professionals in mental health, http://www.gov.scot/

Resource/Doc/314891/0100066.pdf (accessed 28 October 2016)

Scottish Government (2012) AHPs as agents of change in health and

social care: The National Delivery Plan for the Allied Health Professions in Scotland, 2012–2015, http://www.gov.scot/Resource/0039/00395491.

pdf (accessed 28 October 2016)

Scottish Government (2013) Allied Health Professions Scotland

Consensus Statement on Quality Services Values, http://www.gov.scot/

Resource/0043/00438291.pdf (accessed 28 October 2016)

Welsh Government (2010) Mental Health (Wales) Measure 2010,

http://www.legislation.gov.uk/mwa/2010/7/contents (accessed

28 October 2016)

Welsh Government (2012) Together for Mental Health: a

cross‐govern-ment strategy to improve cross‐govern-mental health and wellbeing for all ages, http://

gov.wales/consultations/healthsocialcare/mhealth/?lang=en (accessed 22 January 2016)

Box 1.1 (Continued)

care systems, we have begun to develop evidence together with establishing the value of the profession within new clinical areas; as a result the scope of our practice is broadening and our roles are becoming more diverse.

The benefit of role emerging placements for students as well as practitioners moving into non‐traditional areas of practice is well documented Examples include working with veterans, cooperative developments with third sector and community services including residential and nursing homes, day centres and charities as well as organisations such as schools, youth offending teams and within prison healthcare [1–3] Emerging areas of practice include occu-pational therapists working in primary care, linking with general practitioners, utilising short‐term interventions [1] in early access and crisis interventions, recognised as crucial in admission avoidance

Vocational rehabilitation has been identified as a key practice opment area As a profession occupational therapists are fully aware

devel-of the benefits devel-of this intervention; there is strong evidence identifying that work or employment has a positive impact on mental health, promoting recovery, leading to better health, quality of life and well‐being and reducing social exclusion and poverty [4] There are many current examples of occupational therapists developing vocational rehabilitation roles with employment agencies, individual placement supported employment and within services such as Jobcentre Plus

Williams et al [5] describe occupational therapists being best placed

to provide strong leadership in supporting the introduction of evidence‐based practices in supported employment

A key priority across the UK is the provision of care and support for people with dementia and their families Evidence suggests that occu-pational therapists working within dementia services are delivering improved quality of care and achieving cost savings through the devel-opment and evidencing of non‐pharmacological management of symptoms and use of technology [1]

The impact of mental illness on physical health, and the recognition that many people with physical illness experience mental health prob-lems [6], supports the need for experienced mental health practition-ers to be involved in other clinical areas such as physical rehabilitation, trauma, cancer care, palliative care and supporting the older people.Identifying and utilising current evidence highlighting the impact of occupational therapy in developing these emerging roles allows us the opportunity to focus on our core competencies, the exclusive skills we

have to offer and to avoid the hazard of occupational therapists taking

on generic roles and remits Creating the evidence to support the development and demonstrate the efficacy of occupational therapy within these emerging settings is key to the expansion in our scope of practice We need to take advantage of these opportunities, utilising our existing evidence as the foundation to promote what we can con-tribute [7,8]

The Importance of Using and

Applying Evidence

Within the rapidly changing world of health and social care, service reconfiguration, financial challenges and pressure on resources it is essential that we evidence our impact and our unique contribution to recovery if we want occupational therapy to remain a core profession

in mental health services It is imperative that we evaluate the tiveness of what we deliver as a priority in order to demonstrate clini-cal and cost effectiveness in comparison to other services and interventions [9]

effec-Occupational therapists working in mental health services have a professional responsibility to establish the effectiveness of interven-tions, ensure work is based on the best available evidence [10] and validate the quality of our input to mental health service provision It

is essential that, as a minimum, we apply the best available evidence to inform our practice and ensure we are delivering the highest quality service possible

Hierarchies of evidence are classed in relation to methodological rigour and can be applied within practice: systematic reviews, ran-domised control trials, non‐randomised intervention/observational/non‐experimental studies and expert clinical opinion It is important that we have an understanding of what is the best evidence in relation to the clinical questions we are asking and that we are comfortable in locat-ing the evidence, critically appraising it and applying the findings to our everyday practice Central to this is ensuring that people who have used services are actively participating in research programmes and that these data are integrated with clinical experience so that we always keep the occupational needs and well‐being of our clients as our primary focus and that the research evidence is matched to these needs [11]

The evidence base for the profession has grown over the last

10 years, providing more robust research [12] While this is a step ward, there are still gaps in the evidence [13] and there is a need for more rigorous methodological research, such as systematic reviews [14,15], to guide clinical decision making and influence best occupa-tional mental health practice

for-To implement research, robust evidence outcomes are required to demonstrate the impact of interventions Choosing the right outcome measure is important We need to develop measures that are valid, measuring what we are trying to achieve within our interventions and practice We should use a variety of outcome measures and, where possible, use occupational therapy assessments that have been tested

to ensure reliability and clinical utility, as it is these assessment tools that reflect our unique focus upon occupation There is a requirement for the profession to build research capacity and capability, utilise evi-dence‐based occupational therapy assessments in order to demon-strate the economic impact of interventions as well as maintaining and ensuring the highest quality of care for service users

Overcoming Barriers to Using

● Presentation and accessibility to research: relevant literature not

being compiled in one place and implications for practice not being clear [16]

Within our organisations we need to develop strategies to overcome these barriers, utilising factors that have been identified as supporting the integration of evidence into practice [17] We need to challenge ourselves to develop our competence in research processes, prioritis-ing practice development alongside service delivery [18] There is an expectation within our clinical areas that we will utilise the best available evidence for our clinical interventions This should be pro-moted to new graduates as they enter the service and link them to

more experienced clinicians as well as library and database resources

to establish evidence‐based practice habits at the start of their careers [19] Finally, we need to understand as managers, organisations and as individuals that protecting time for ourselves and our teams to take action towards evidence‐based practice is invaluable if we want to deliver high quality care

Values‐Based Practice

Occupational therapists should relate easily and readily to values‐based practice but its inclusion is important here in order to create a balanced approach to mental health practice Evidence‐based prac-tice, by its very nature, is scientific  –  often involving generalising research findings across relevant ‘cases’ [20] Fulford suggests values‐based practice links this evidence with an individual’s unique set of values, needs, preferences and personal circumstances It is based on mutual respect between health professional and service user, and sup-ports the process of good decision making by allowing for differing values and outcomes, rather than reaching a pre‐set outcome as dic-tated by evidence [21] Evidence is incorporated into this process but

a values‐based practitioner will allow for different possibilities Hence, values‐based practice sits alongside evidence‐based practice and is an integral part of being client centred – it should sit comfortably with occupational therapy given our emphasis on choice, self‐management, respect [22] and person‐centred practice [23] The government’s recent vision for all health and social care practitioners to practice the

6 Cs further emphasises the need for a compassionate, caring and committed workforce [24] In our quest to become evidence‐based occupational therapists it is beholden upon us not to forget our vital professional values

Value of Leadership

It is important to recognise the value of leadership in influencing the adoption of evidence‐based practice Everett and Sitterding [25] sug-gest that transformational leadership is required to create an infra-structure that influences organisational factors, processes and expectations to enable the sustainability of evidence‐based practice]

Aarons [26] described leadership geared toward promoting innovation and change to be critical to the successful implementation of applying the evidence base All practitioners have leadership capabilities, but occupational therapists are consistently creating change as part of everyday core business In order to empower the profession, we need

to provide training and development for effective leadership for all grades of staff This will result in a profession confident to influence change, embrace the evidence that is produced and use it to its full advantage to secure quality services

The benefits of maintaining our focus on evidence‐based practice will result in improvements to care, a positive economic impact on service delivery, the ability to influence policy and guidelines and build a secure future for our profession

The Future for Occupational Therapists

The political strategy to improve mental health is clearly identified across the UK As a priority area within health and social care, the profession needs to embrace the changes occurring within these systems, while ensuring that we remain true to our philosophy By continuing to seek out the evidence for the requirement of our exper-tise in new and diverse clinical areas, as well as utilising and expanding the evidence in roles already established, we can improve the patient experience and enhance service delivery, and be seen as leaders within mental health care

I believe occupational therapists have the required skill set to be strong, inspirational leaders We possess the skills and capabilities to engage with the potential of the people we lead and link these to our organisations and professions purpose, while keeping quality care at the forefront of our practice To face the challenges of the shifting environments and demands of health and social care, I think our

future lies with ensuring our workforce believes in themselves as ers, upskilling staff with leadership abilities so we can truly influence the impact that occupational therapy can make.

lead-Clinicians need to feel comfortable and confident with evidence‐based occupational therapy and the skills required to engage actively

in this This evidence is vital for our discussions with service users about the positive benefits of our interventions and conversations that influence commissioners when we are advocating what the profession has to offer

There are many studies that do not currently have a sufficient research base to give the strength of evidence required [12,28] If the profession is to continue to grow we need to utilise this information where increased strength of evidence is required and focus on those areas for research development We need to look outside of our local remits and identify areas where we can conduct multi‐site research or data sharing to global research We need to answer the calls from pro-fessional bodies such as COT, the World Federation of Occupational Therapists and the American Association of Occupational Therapists

to take action towards a united goal of increasing research within occupational therapy internationally, demonstrating our effectiveness and providing the best quality of service for the people who access our services

It would be remiss not to mention that we need to engage with nology and recognise the impact of the use of social media for pro-moting our work, research and evidence and communicating globally [29,30] If we want to network at an international level and promote our developments and contributions to mental health care, we need to embrace social media (in a professional manner) utilising blogs, Twitter, Facebook and so on

tech-The second edition of this book, along with other relevant mental health publications, is invaluable It demonstrates the use of evidence

in clinical practice, promoting the evidence available in a variety of clinical areas; it is constructive as a teaching tool and as a support in encouraging the use and application of our evidence

I believe that occupational therapy can lead the way in future ments for mental health service users We should be proud of the sig-nificant achievements that we have made over the last decade We now need to appreciate and demonstrate the value and unique contribution

develop-of our prdevelop-ofession within all the diverse clinical areas in mental health This will allow us to integrate into services and systems while keeping

our core skills at the fore and take up the call to apply and produce dence to embed and secure our profession successfully within the men-tal health services of the future To achieve this we each need to take responsibility for our own contribution It requires action, from you.

References

Occupational Therapy (England), https://www.cot.co.uk/sites/default/

files/general/public/Urgent‐Care‐report‐2015.pdf (accessed

28 October 2016)

nature of occupational therapy, http://www.theguardian.com/social‐care‐network/social‐life‐blog/2015/may/27/occupational‐therapy‐

training‐work‐location‐unusual‐creative‐thinking (accessed

28 October 2016)

A Consultation Response from the College of Occupational Therapy,

COT, London

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Occupational Therapy Journal, 62 (5), 316–325.

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competencies for emerging practice in occupational therapy Journal of

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to promote the distinct value of occupational therapy American

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effective? British Journal of Occupational Therapy, 76 (10), 470–473.

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Professional Conduct, COT, London.

practice in Occupational Therapy: informing clinical decisions

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occupational therapy: a study of clinician perspectives Australian

Occupational Therapy Journal, 62 (5), 326–332.

evidence in the American Journal of Occupational Therapy

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interventions for employment and education for adults with serious

mental illness: a systematic review American Journal of

Occupational Therapy, 65 (3), 238–246.

occupational therapy in mental health: more systematic reviews are

needed Occupational Therapy in Mental Health, 28 (4), 321.

practice: barriers to research use among occupational therapists

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among Canadian occupational therapists Canadian Journal of

Occupational Therapy, 81 (2), 79–92.

learning as a strategy to embed evidence within occupational therapy

practice Journal of Evaluation in Clinical Practice, 12, 227–238.

evidence‐based practice: an action research study British Journal of

Occupational Therapy, 79 (1), 42–48.

Stories Linking Science with People, Cambridge University Press,

Cambridge

Care, http://valuesbasedpractice.org/(accessed 28 October 2016)

of occupational therapy and its contribution to adult social service users and their carers, http://www.cot.co.uk/sites/default/files/

position_statements/public/position‐statement‐value‐of‐ot.pdf (accessed 28 October 2016)

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Professional Conduct for Occupational Therapists, COT, London.

england.nhs.uk/wp‐content/uploads/2012/12/compassion‐in‐

practice.pdf (accessed 6 November 2016)

required to design and sustain evidence‐based practice: a system

exemplar Western Journal of Nursing Research, 33 (3), 398–426.

association with attitudes toward evidence based practice

Psychiatric Services, 57 (8), 1162–1169.

for Occupational Therapists, COT, London.

opportunities in the area of adults with serious mental illness

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occupational therapy knowledge sharing and creation using the

internet Canadian Journal of Occupational Therapy, 82 (3),

144–149

Occupational Therapy News, 24 (1), 24–25.

Occupational Therapy Evidence in Practice for Mental Health, Second Edition

Edited by Cathy Long, Jane Cronin-Davis and Diane Cotterill

© 2017 John Wiley & Sons Ltd Published 2017 by John Wiley & Sons Ltd.

2

Service user and carer involvement in mental health services has grown significantly in recent years As Philip Kemp [1] wrote, user involvement has now established itself as a significant feature in the landscape of mental health service provision He highlights that ser-vice users are increasingly involved in the whole range of activities in mental health: policy development, service planning and commis-sioning, individual care planning, research and evaluation and educa-tion and training But what does this look like in practice? To what extent do service users and carers really feel involved? Julie Gosling [2] argues that because government policies dictate that there has to be service user involvement, many organisations take on only the ‘outer wrappings’ That is, they use the language and processes of involve-ment which can be a very top‐down approach to ‘tick the boxes’

Service User and Carer

Involvement: Co‐production

Nashiru Momori and Gabrielle Richards

LEARNING OUTCOMES

By the end of this chapter you will be able to:

● Understand the concept of service user and carer involvement in mental health services

● Understand the value of service user involvement and strategic approach to occupational therapy practice in mental health and the complexity of this agenda

● Develop a good understanding of co‐production

● Read an example of a successful strategic collaboration between a senior occupational therapist and a service user consultant

● Review your own approach to your collaborations as a student or tional therapist

occupa-Little consideration is given to real empowerment in order to make a genuine contribution She goes on to propose that service providers have hijacked involvement so it means compliance, containment,

coercion and incorporation Tondora et al [3] suggest people using

mental health services essentially want the same things out of life as practitioners – a home, family, faith, a sense of purpose, health and other such things (module 1, p 4) They indicate that ‘systems are structured in such a way that practitioners are seldom promoted to think of it in this manner’ Additionally, they state that ‘recovery‐ oriented and person centred care is, at its core, about getting past the

“us/them” dynamic to truly partner with people in recovery in their effort to attain their personally defined and valued goals.’

So, how do we build meaningful and trusting relationships, both organisationally and personally, with service users and carers that embody honesty and openness? This chapter proposes a framework of service user involvement to illustrate the steps needed for meaningful participation

Recovering Ordinary Lives: The Strategy for Occupational Therapy

in Mental Health Services 2007–2017 [4] proposed that occupation

was important to health and well‐being Moreover, it reaffirmed that

a commitment to working in partnership with service users and carers

in all areas of occupational therapy practice was fundamental to ensuring services are accessible and timely to meet people’s needs It recommended the following guiding principles for mental health occupational therapy practice:

● Occupational therapy is equally available to everyone on the basis of need, irrespective of age, gender, sexuality, race, religion, disability, place of abode, social class or other personal or cultural characteristic

● The therapist works in collaboration with the client to collect mation, identify problems or needs, set goals, formulate plans for action, implement intervention, evaluate outcomes and end the intervention

infor-● Interventions involve the client in activity

● Interventions support the client in developing or maintaining a isfying personal and social identity

sat-● Interventions move the client in the direction of fuller participation

in society through the performance of occupations that are priate to her or his age, social and cultural background, interests and aspirations

appro-● Interventions are designed to overcome physical, psychological, social and environmental barriers to participation.

● Interventions assist the client to achieve greater autonomy of thought, will and action

● Interventions are appropriate to the client’s lifeworld context and the treatment environment

● The therapist evaluates the effect of every intervention on the ent’s skills, task performance, activities and occupations

cli-● People who use occupational therapy service play a part in ing, monitoring and evaluation those services

develop-While these principles are well set out, Deborah Harrison [5] says the profession needs a political and social awareness in order to build partner-ships and engage with a broadening role so to enable access to occupation The Department of Health described occupational therapy as ‘promoting self‐reliance and resourcefulness via a person centred approach’ [6] However, there are still many challenges to this in practice

The Policy Context

Since the implementation of the NHS Plan 2000 [7] there have been a number of policies and strategies set out by the government, National Health Service England (NHSE) and National Institute for Health and Care Excellence (NICE) to ensure the service user and carer voice experience and engagement is at the centre of everything the NHS does

In 2011, the government published its mental health strategy ‘No Health without Mental Health’ [8] The strategy was built around six objectives:1) More people will have good mental health

2) More people with mental health problems will recover

3) More people with mental health problems will have good physical health (statistics say people with schizophrenia die 15–20 years earlier than the general population)

4) More people will have a positive experience of care and support

Task Box 2.1

includes the service user perspective?

5) Fewer people will suffer avoidable harm

6) Fewer people will experience stigma and discrimination

Implicit in these ambitions was making sure that the involvement of service users and their families was crucial to realising these ambitions

In other words, being involved in reviewing services, developing services and running services

Similarly, the Scottish Government’s Mental Health Strategy 2012–

2015 [9] set out a range of key commitments across the full spectrum

of mental health improvement, services and recovery to ensure ery of effective, quality care and treatment for people with a mental illness, their carers and families The strategy supported and adopted the three Quality Ambitions for Scotland that health and care is per-son‐centred, safe and effective

deliv-In Wales, Together for Mental Health: A Cross‐Government Strategy

for Mental Health and Well‐being in Wales [10] reinforces the need to

promote better mental well‐being among the whole population but again underlines the importance of people being fully involved in the decisions that affect their lives and the care, support and treatment they get It emphasises that the voices of service users, their carers and families must be heard at individual, operational and strategic levels.Northern Ireland in their review of mental health and learning dis-ability services in 2005 had at its heart the importance of sensitive and

person‐centred provision More recent publications, the Bamford

Review [11] and an evaluation on mental health service provision in

Northern Ireland [12], concluded that while mental health is a major public health issue there are still many challenges to improve funding, provide a new vision and leadership in mental health One of the rec-ommendations from the 2005 evaluation highlighted the need for ser-vices to ‘strive to promote a person‐centred and relationship‐based approach to service delivery’ [12, p 6]

The NHS Constitution for England [13] sums up the position and policy of the countries’ governments having similar ambitions, when

it states: ‘The NHS aspires to put patients at the heart of everything it does.’ With regard to involvement in services, it states ‘you have the right to be involved, directly or through representatives, in the plan-ning of health care services commissioned by NHS bodies, the devel-opment and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the opera-tions of those services’ [13, Section 3a, p 9]

So, how might all this be done?

Co‐production in Mental Health

The term ‘nothing about us without us’ is commonly used in relation

to service user and carer involvement It is used to communicate the idea that no policy or service design should be decided without the participation of people affected by the development

Given the importance of making sure service users and their carers contribute to services, what is the way forward with involvement without it being tokenistic or a ‘tick box exercise’? Many commenta-tors in mental health recommend it is with co‐production

What is co‐production? It was first conceptualised in America in

1980 by a civil rights law professor, Edgar Cahn, who created Time Banks, a system which was a reciprocity‐based work trading system in which hours are the currency With Time Banking a person with one skill set can bank and trade hours of work for equal hours of work in another skill set instead of paying or being paid for services He showed that successful collaboration involved people who used those services contributing to improving them Following this, in the UK, the concept

of co‐production started to be used in trying to understand the ship between clinicians and patients in health services In the 1990s there continued to be a recognition that services needed to change and policy makers have wanted to find more participatory ways of service delivery to promote social capital and consumer involvement

relation-The New Economics Foundation [14, p 3] have usefully defined co‐production as ‘a relationship where professionals and citizens share power to plan and deliver support together, recognising that both partners have vital contributions to make in order to improve quality of life for people and communities’

There is no single formula for co‐production; however, there are some common key features that are present in co‐production initiatives:

● Define people who use services as assets with skills

● Break down barriers between people who use services and professionals

● Build on people’s existing skills

● Includes reciprocity (where people get something back for having done something for others) and mutuality (people working together

to achieve their shared interests)

● Work with peer and personal support networks alongside professional networks

● Facilitate services by helping organisations to become agents of change rather than just service providers

NICE guidance on person‐centred care [15] recommends that ple who use mental health services should have the opportunity to make informed decisions about their care and treatment in partner-ship with their health and social care practitioners More recently, the National Survivor User Network (NSUN), a network of individuals and groups who have direct experience of mental distress and/or using mental health services, produced guidance on service user

peo-involvement The document, 4Pi National Involvement Standards

[16], was formally launched in January 2015 It sets out how to enable services, organisations and individuals to think about how to make involvement work well It outlines the principles of involvement, the purpose, the presence, the process and the impact and suggests that every element of the framework needs to be in place for involvement

to be successful, meaningful and effective

So, in reality, co‐production is not just a word, not just a concept, it is

a meeting of minds coming together to find a shared solution It is a tionship where professionals and people who use services share power to plan and deliver a project together It is not just participation where people are consulted, it means being equal partners and co‐creators to build and deliver services or individual care

rela-Many occupational therapists would argue that they are very familiar with co‐production as it aligns very closely with occupational therapy core values of working alongside their service users It is not that occu-pational therapy philosophy and underpinning values do not fit well with the notion of co‐production, they do However, if you look at a definition of occupational therapy it will invariably infer something like

‘occupational therapy is the use of treatments to develop, recover or maintain daily living and work skills… It is a client‐centred practice…it provides practical support to enable people to facilitate recovery.’The World Federation of Occupational Therapists [17] defines occupational therapy as a client‐centred health profession concerned with promoting health and well‐being through occupation Its pri-mary goal is to enable people to participate in the activities of every-day life Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modi-fying the occupation or the environment to better support their occu-pational engagement

The Canadian Association of Occupational Therapists [18] state that occupational therapists are highly trained health‐care professionals

who use a systematic approach based on evidence and professional reasoning to enable individuals, families groups, communities, organ-isations or populations to develop the means and opportunities to identify and engage in the occupations of life Although talking about collaboration, they go on to say the collaborative process involves assessing, planning, implementing, monitoring, modifying and evalu-ating the client in relation to occupational engagement in self‐care, work, study, volunteerism and leisure.

The British Association of Occupational Therapists [19] define occupational therapy as providing practical support to enable peo-ple to facilitate recovery and overcome any barriers that prevent them from doing the activities (occupations) that matter to them This helps to increase people’s independence and satisfaction in all aspects of life

These definitions describe occupational therapy really well but they

remain the language of therapy and not of co‐production In Practical

Approaches to Co‐production [20] the four steps identified to achieve

more influence and choice in terms of co‐production are as follow:

1) Target it – focus on the services and issues where a move to greater

co‐production is likely to produce the greatest benefits in relation

to costs

2) People it – focus on co‐producing with those people who are most

likely to achieve high priority benefits at low cost to the public tor, especially where those benefits go to those members of the community in most need

sec-3) Incentivise it – focus on finding ways to ensure win–win outcomes

for all users and members of the community who co‐produce with public services

4) Grow it – focus on finding ways to scale up the co‐production

ini-tiatives by getting those involved to bring in other people and by promoting its imitation elsewhere

For professionals to have a successful experience of co‐production they have to make a shift in their thinking and working relationships and as a result will have a more powerful outcome in terms of a more meaningful involvement with the people who use their services However, the same has to apply for service users or carers to have the same positive outcome

The following model was developed by one of the authors, Nash Morori, drawing on his experiences of being someone who has used

services and contributed to service development The model is called the Insight Service User Involvement Framework [21] The frame-work aims to give both service users and professionals a model by which to develop a democratic approach to involvement to give people more control over their health and care He proposes that ‘Insight aims to make service user involvement an intrinsic and essential component

of service design, decision making and delivery’ The aim is to use people’s lived experience to engage, empower and enable service pro-viders and users to develop a sustainable and meaningful model of service involvement The framework outlines seven levels of service user involvement underlined by several key principles

Key principles in service user involvement:

● Recognising people as assets

● Building on people’s existing capabilities

● Promoting mutuality and reciprocity

● Breaking down barriers between professionals and recipients

● Facilitating rather than delivering

The seven levels of service user involvement:

1) Trust and Relationship – Effective relationships built with deeper

qualities of human bond at an individual level that allows ised interactions between service users and service providers

personal-2) Mutual Acceptance – Non‐judgemental and unconditional

engage-ment between service users and providers enabling mutual acknowledgement and validation of each other’s opinions

3) Self‐Belief and Hopefulness – A proactive involvement of service

users due to a sense of hopefulness built upon a core belief in vice users’ ability to make positive and meaningful contributions

ser-4) Learning and Discovery – A genuine openness to learning from the

experience of service user involvement via sharing of skills, assets and knowledge development

Task Box 2.2

on these definitions?

experience for the people you work with?