How Recovery offers ‘more for less’:

the business case for creating a

recovery-focused organisation

Julie Repper

Director – ImROC

Recovery Lead – Nottinghamshire Healthcare Trust

Vision for Change

“…maximising recovery from mental illness, and

building on the resources within service users and

within their immediate social networks to allow

them to achieve meaningful integration and

participation in community life”

Advancing Recovery in Ireland - goals

To improve the experience and wellbeing of people with mental health conditions

To support people who use services to achieve their goals and ambitions

To improve the experience and wellbeing of family and friends

To improve the working lives of staff

To improve the quality of services and to do this in a cost effective manner

How to effect change: 10 ImROC - Challenges

Creating the organisational culture for Recovery focused change by –

Changing the nature of day-to-day interactions

Delivering comprehensive, coproduced staff training programmes

Ensuring organisational commitment at all levels

Shifting understanding of involvement to co-production

Improving experience, outcomes and cost effectiveness of

services by -

Establishing a ‘Recovery College’

Increasing ‘personalisation’ and choice

Transforming the workforce (‘peer support workers’)

Changing the way we approach risk assessment/management

Redefining user involvement as ‘partnerships-between-experts’

Supporting staff wellbeing and resilience

Increasing opportunities for building ‘a life beyond illness’

Valuing, including and supporting family members and friends

Evidence that Recovery focused services

can both improve outcomes and reduce cost

“People who see themselves solely as a mental patient may feel driven to conform to an image of incapacity and worthlessness, becoming

more socially withdrawn and adopting a disabled role. As a result, their symptoms may persist and they may become dependent on treatment

providers and others” (Warner et al. 1989)

“Recovery focused services are all about enabling folk to recognise their own potential to manage their condition so that they can live a life that

they value and in doing so move away from services towards the interdependent network of community and social support that all of us

need” (Lysaker et al, 2007)

Offering coproduced Recovery Education – developing a Recovery College

Health education increases self management, reduces crises and reduces service use (Lawn et al. 2011)

“Shift from treatment to prevention and promotion generates significant efficiency gains” (Knapp et al, 2011)

SW London Recovery college - 70% students go on to mainstream education, employment or volunteering; a mean reduction of 14.6 days pa (saving approx £800 per student - (Rinaldi, 2010)

Nottingham Recovery college reports over 100% increase in social contacts and social roles (Brown, 2013)

SWYFT Recovery colleges reported 14% reduction in services used. £600 ppa cost reduction in service use

Essex Recovery college reports 80% of student group reduced their use of secondary care services (12% discharged) with estimated saving of £300,000

Increasing Personalisation, Choice and Control

Research into shared decision making demonstrates:

to less restraint, less use of PRN medication, fewer crises and fewer serious

incidents (Closing the Gap, THF, 2013)

Research into Personal Recovery Planning demonstrates Reduction in depression and anxiety symptoms

Significantly greater improvement over time in total Recovery Assessment

Improved personal confidence and achievement of personal goals.

In addition, the greater the number of WRAP sessions attended, the more

participants’ outcomes improved (Cooke, 2014).

Research into Personal Health budgets demonstrates improved

outcomes and cost savings (Forder et al, 2012).

Where people had a higher budget, savings were made for the NHS as well

as people's quality of life improving.

In-patient costs fell for people with a personal health budget, suggesting that

people receiving personal health budgets had fewer stays in hospital.

Joint crisis planning leads to less compulsory treatment (Henderson et al, 2004)

SAMSHA (2012) have reviewed evidence and provide the business case for

eliminating unnecessary restraint:

Benefits for staff include: improved job satisfaction; reduced absenteeism,

reduced injuries, reduced compensation claims, reduced workforce

replacement costs and reduced staff turnover.

Benefits to people using service include: fewer injuries; shorter lengths of

stay; decreased re-hospitalization; less medication use; increased positive

outcomes/discharges; and higher level of functioning at the time of discharge.

Merseycare introduced ‘No Force First’ on 18 acute inpatient wards and found:

Use of restraint reduced by 80%

Staff sickness reduced by 85%

Changing the way we approach risk assessment and management

Staff mental health problems cost UK employers an estimated £26billion per annum equating to approximately £1,000 per employee p.a.

Working in Recovery focused ways reduce sickness absence (eg evidence related to restraint, peer workers), improve job satisfaction (eg evidence related to Team Recovery Implementation Planning).

We are building a repertoire of HR, OH and workforce approaches to raise job satisfaction, morale and support for staff. These draw on research evidence from CMH, Shaw Trust, Mental Health at Work, Richmond PRA in Sydney ….)

Supporting staff well-being and resilience

Recovering a ‘Life Beyond Illness’

Employment Individual placement and support has demonstrated effectiveness in helping people obtain work. Paid employment is associated with reduced admissions, reduced service use, reduced symptoms, improved quality of life, enhanced social networks (e.g. Bond, 2008).

Housing Decent housing is essential for mental health; Housing provides the basis for individuals to recover, receive support and return to work or training. Housing support provides a three fold return on investment through savings on health, social and criminal justice service costs

(NHS Confed, 2012).

provide 97% of the support received by people with mh problems

save the UK economy £87bn

twice as likely as others to be permanently sick/ disabled

20% of those caring for person with mh problems themselves have mh problems which they attribute to their caring role.

If we can support them to access appropriate services in a timely manner, keep them informed and help them to care for themselves, they will feel better, the person they care for will be more settled and they will need less support in the long term -reducing demands on services (Mayhew, 2013).

Valuing and Supporting Family Members

If we support people in their recovery we give them greater control over their own lives, reduce their reliance on services, create more accommodating communities, find our own work more rewarding.

In short, a Recovery focused organisation can offer more for less!

Developing a genuinely Recovery focused service achieves better outcomes at lower cost

We need to emphasise our commitment to coproduction in our approach and in the skills/experience of our consultants.

Our current move towards community development and engagement. Although absolutely fundamental to Recovery, third sector groups and community facilities and organisations do not have sufficient funding to pay for our support ….

A price tag on ImROC products?

Dissemination of our learning through briefing papers, films, website ….All currently offered free of charge despite having a cost to us.

Do we have any figures on downloading of briefing papers so we can demonstrate their popularity and potential impact?

We can then ask about how to achieve funding for this – membership options, availability of core funding etc.