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Mid West ARIES Project

A Report on the Development, Progress and Outcomes of a Pilot

Project to Provide a Recovery Education Service in the Mid West

Report by

Daniel Taylor, Aoife Boland and Niamh Wallace

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Acknowledgements

The Mid West ARIES Project wishes to acknowledge the following individuals and groups

who supported the planning, development and implementation of the project:

Firstly, the people of the Mid West (Clare, Limerick, and North Tipperary) who

volunteered, assisted, participated in and co-facilitated workshops, and without whom

the project would not have been possible.

The GENIO Trust who provided funding for the project.

The Mid West Mental Health Services Management Team who supported the project

from the outset.

Mental Health Ireland who were host employer for the Peer Educator and Education and

Development Officer and who provided invaluable support to the project.

Ennis and Limerick Mental Health Associations for their generous support and for use of

their facilities.

The Samaritans Limerick and Tipperary for their generous support and for use of their

facilities.

The staff of the Mid West Mental Health Services who participated in, facilitated

workshops and promoted the project.

The Graduate Entry Medical School, University of Limerick

The Faculty of Education and Health Sciences, University of Limerick

The staff at The Health Hub, Limerick

Edward Benn for design services.

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Core Project Team

Project Lead (PL): Niamh Wallace

Peer Educator (PE): Aoife Boland

Education & Development Officer (EDO): Dan Taylor

Project Advisory Group

Helen McAteer: Family Member Representative, Mid West ARI Project Group

Gerry Garry: Assistant Director of Nursing, Limerick Mental Health Services

John McElhinney: Mid West Area Development Officer, Mental Health Ireland

Margo O’Donnell-Roche: Manager, Aras Follain Peer Support Centre, Nenagh

Dr. Marie Oppeboen: Senior Registrar in Psychiatry, Dromin House, Nenagh

Sam O’Grady: Service User Representative, West Clare

Academic Review Group

Helen McAteer

Dr. Marie Oppeboen

Dr. Jennifer McMahon: Lecturer in Psychology, University of Limerick

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About this document

This document is in two parts.

Part One outlines the background, activity and outcomes of the Mid West ARIES (Advancing

Recovery in Ireland Education Service) Pilot Project.

Part Two presents an overview of course material coproduced during the project,

comprising seven workshops on Recovery and Well-being. This part of the document, online

resources and the appendices, is designed as a resource for anyone wishing to use

education as a means to promote Recovery in their own community.

It is requested that anyone wishing to reproduce the material contained in this document

and the accompanying electronic resources requests permission by contacting

[email protected].

No monetary gain should be sought from the use of these resources.

mailto:[email protected]

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Executive Summary

The Mid West ARIES Project was a 12-month Recovery Education pilot project which

commenced in April 2016, funded by GENIO and delivered in partnership by the HSE and

Mental Health Ireland. The project was initiated following the completion in 2014 of

Recovery Education Needs Analysis Research conducted in the Mid West region in

partnership between The University of Limerick and Mid West ARI1.

Mid West ARIES offered a range of courses, information and educational materials on

Recovery and Well-being in Mental Health which were coproduced and co-delivered by

people with lived experience of mental health challenges, family members and supporters,

and staff working in the mental health services in the Mid West region of Ireland. The

project utilised Recovery College principles while delivering courses in communities

throughout the region, without a physical base as is typical of most Recovery Colleges.

Oversight of the project was provided by the Mid West ARI Project group and an ARIES

Project Group which included Service User and Family Member representatives from Mid

West ARI, the HSE, Mental Health Ireland and Aras Follain Peer Support Centre, Nenagh.

Project activity included: the promotion of the project and the involvement of volunteers,

contact database development; the facilitation of co-production sessions; the cosynthesis of

workshop material and creation of workshop session plans and slides; the facilitation of

workshops, and the training and support of volunteer facilitators. Three-hundred and

eleven individual stakeholders were contacted directly during the initial project promotion

and capacity-building phase.

Seven coproduction workshops were held during the lifetime of the project, each focussing

on a different theme related to Recovery in mental health. A total of seventy-three

individuals from a range of backgrounds participated in the coproduction workshops. The

themes of the workshops developed were:

1 For more information on ARI visit:

http://www.hse.ie/eng/services/list/4/Mental_Health_Services/advancingrecoveryireland/

http://www.hse.ie/eng/services/list/4/Mental_Health_Services/advancingrecoveryireland/

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1. What is Recovery?

2. Understanding Mental Health Services

3. Advocacy and Empowerment

4. Diagnosis and Beyond

5. CHIME

6. After Recovery What Next?

7. Recovery Principles for Students

Feedback from participants in the coproduction workshops was positive, with a mean 96%

approval rating of their experience, based on responses collected in a broad feedback

instrument which incorporated a recovery process item checklist adapted from the CHIME

framework. The involvement of volunteers was central to the design of the project and

twenty-five volunteer recovery education facilitators completed training and went on to co-

facilitate workshops.

A total of twenty six workshops were delivered throughout the lifetime of the project in

three distinct phases: workshops for students of health, social care and allied sciences;

workshops co-facilitated by the core ARIES project team of Education and Development

Officer and Peer Educator (Pilot Phase); and, workshops co-facilitated by Volunteer

Recovery Education Facilitators (Main Phase). The workshops were educational in style and

content and were designed to be deliverable either as stand-alone, one-off workshops, or as

a series delivered usually weekly over a period of time. Across the three phases of

workshop delivery, a total of three-hundred and forty-seven individuals attended. Feedback

was positive, indicating a mean approval rating of 95% across all workshops. Qualitative

feedback indicated a range of benefits experienced by participants, and a number of salient

themes emerged, including safety, the benefits of working together, and an enhanced ability

to manage recovery. A number of recommendations are made based on lessons learned

from this project, to inform future recovery education initiatives in the region. These

include:

Continuation and development of wider curriculum content

Partnership with Higher Education Institutions to embed recovery education

Identification of income streams through partnerships

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Use of coproduction model of working to inform future collaborative project work in

mental health services

Mid West ARIES Project Summary of Outcomes

311 people involved during capacity-building

7 Coproduction Workshops involving 73 participants

7 Workshops developed

96% approval of experience of Coproduction

25 Volunteer Recovery Education Facilitators trained

26 Workshops delivered

347 individuals attended workshops

95% approval of experience of workshops

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Table of Contents

Acknowledgements ............................................................................................................................. 2

Core Project Team............................................................................................................................... 3

Project Advisory Group ....................................................................................................................... 3

Academic Review Group ..................................................................................................................... 3

About this document .......................................................................................................................... 4

Executive Summary ............................................................................................................................. 5

Section One: Background to the Project ............................................................................................... 11

Recovery............................................................................................................................................ 11

ARI ..................................................................................................................................................... 12

Coproduction .................................................................................................................................... 13

Core Project Team............................................................................................................................. 14

Recovery Colleges ............................................................................................................................. 15

Key Features of the ARIES Project..................................................................................................... 17

Section Two: Planning and Development ............................................................................................. 19

Development of Work Plan: April-May 2016 .................................................................................... 19

Work plan Pillar 1: People ................................................................................................................. 20

Work plan Pillar 2: Content ............................................................................................................... 21

Work plan Pillar 3: Partnership ......................................................................................................... 21

Work plan Pillar 4: Quality ................................................................................................................ 22

Project Promotion and Capacity Building: May-November 2016 ..................................................... 23

Involvement of Volunteers: April 2016 onwards .............................................................................. 24

Coproduction of Course Content: June 2016-January 2017 ............................................................. 24

Selection of Coproduction Workshop volunteers ............................................................................. 25

Coproduction Workshops ................................................................................................................. 25

‘Cosynthesis’ of Material by Core Project Team ............................................................................... 27

Involvement of Volunteer Facilitators: October-December 2016 .................................................... 28

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Volunteer Facilitators Training: November-December 2016............................................................ 29

The Use of Personal Narrative .......................................................................................................... 31

Section Three: Project Delivery Phase .................................................................................................. 33

Delivery of Workshops for Students: September 2016-April 2017 .................................................. 33

Delivery of workshops by EDO and PE (Pilot Phase): November-December 2016 ........................... 35

Delivery of workshops by Volunteer Recovery Education Facilitators (Main Phase): January- April

2017 .................................................................................................................................................. 36

Section Four: Evaluation and Recommendations ................................................................................. 38

Evaluation using CHIME .................................................................................................................... 38

UL Engage student placement: March-April 2017 ............................................................................ 39

Brief Thematic Analysis ..................................................................................................................... 39

Recommendations ............................................................................................................................ 40

Potential Areas for Research ............................................................................................................ 42

Conclusion ......................................................................................................................................... 43

References ........................................................................................................................................ 44

List of Appendices ............................................................................................................................. 45

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PART ONE- Summary Report of Mid West ARIES Project

Section One: Background to the Project

In 2013 the Mid West HSE Mental Health Management Team set up a local working group to

work with National Advancing Recovery in Ireland (ARI) to establish the Mid West as an ARI

site. The Mid West ARI group was then established in 2014 and its terms of reference

completed in 2015. The main purpose of the group is to achieve the advancement of

recovery through initiatives at both local systems and professional practice level. Mid West

ARIES (Advancing Recovery in Ireland Education Service) is an initiative which aims to

promote recovery through education.

Recovery

The Mental Health Commission (2008) states that the concept of recovery emerged

significantly in Ireland in the 1980’s, following the publication of a series of studies and

personal narratives that demonstrated that the course of mental illness was not one of

inevitable deterioration, but that people diagnosed with severe mental illness frequently

recovered and reclaimed meaningful lives. Approaches to understanding recovery

encompass both the personal internal processes by which an individual moves towards their

own recovery, and the external societal, organisational and/or clinical conditions that may

influence their recovery.

There are many definitions of recovery, including the following, by William Anthony (1993,

p.527):

“Recovery is a deeply personal, unique process of changing one’s attitudes, values,

feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and

contributing life even with limitations caused by the illness. Recovery involves the

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development of new meaning and purpose in one’s life as one grows beyond the

catastrophic effects of mental illness”.

The guiding principle of the ARIES project was not to prescribe or dictate any particular

definition of, or approach to recovery, but to provide opportunities through adult education

in safe and supportive settings for individuals to explore their own understanding of

recovery and the place it has in their lives.

ARI

Advancing Recovery in Ireland is a national HSE initiative aimed at bringing organisational

and cultural change in mental health services to support those services in becoming more

recovery-oriented. ARI recognises the reality that true partnership between those who use

and those who provide our services invariably provides better outcomes than care driven by

one party alone.

According to Collins (2016) there are four key steps in the process of developing recovery

oriented mental health services in Ireland:

1. Capacity Building

-Ensuring we have a critical mass of expert stakeholders, Service users, Family

members & Supporters, Service providers, voluntary & community sector

2. Recovery Planning

-Collaboratively develop practical plans for implementing change guided by the ARI

strategic approach and the ImROC challenges

3. Recovery Actions

-The organisation begins implementing the planned changes around new recovery

innovations and practice and seeks opportunities for further developments

4. Recovery Services.

-The organisation focuses on embedding the new change and ensuring the key

principles are institutionalised across all practices

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In 2014 the Mid West ARI group undertook an extensive needs analysis on Recovery

Education in the Mid West Region. This research2 found that there was a need for Recovery

education throughout the region and a willingness among communities to participate in the

establishment of a Recovery Education Service. This provided evidence to support an

application to GENIO in 2014, on foot of which funding to deliver a 12-month pilot project

was provided to Mid West ARI. Following planning, development and recruitment the Mid

West ARIES (Advancing Recovery in Ireland Education Service) pilot project was commenced

in April 2016, with the employment of a full-time Education and Development Officer (EDO),

with a background in psychiatric nursing, and a part-time Peer Educator (PE), with lived

experience of mental health challenges and of using the Mid West mental health services. A

member of the Mid West ARI Project Group, an Occupational Therapy Manager, was

appointed to lead the project. The ARIES Project was launched by Minister of State for

Mental Health and Older People, Helen McEntee, at the National ARI learning set in Limerick

on 16th November 2016 (see Appendix 1).

Coproduction

Coproduction means people with personal and professional experience of mental health

services working together from initial planning through delivery to evaluation.

Coproduction was a central methodology for the ARIES project. The key points about

Coproduction (adapted from Realpe and Wallace, 2010) are as follows:

• Co-production has historical roots in civil rights and social care in the USA.

• Collaborative co-production requires users to be experts in their own circumstances

and capable of making decisions, while professionals must move from being fixers to

facilitators.

• To be truly transformative, co-production requires a relocation of power towards

service users. This necessitates new relationships with front-line professionals who

need training to be empowered to take on these new roles.

2 Later published as: Joy Kelly, Stephen Gallagher & Jennifer McMahon (2016): Developing a recovery college: a

preliminary exercise in establishing regional readiness and community needs, Journal of Mental Health.

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• Patient centeredness describes the relationship between clinicians and patients as a

meeting of two experts, each with their respective knowledge and skills.

The following definition of Coproduction is offered by the UK Think Local Act Personal

partnership of more than fifty health and social care organisations (accessed May 13, 2016).

Coproduction is:

“When you as an individual are involved as an equal partner in designing the support

and services you receive. Co-production recognises that people who use social care

services (and their families) have knowledge and experience that can be used to help

make services better, not only for themselves but for other people who need social

care.”

For the purposes of the ARIES Project, Coproduction was defined simply as:

“A way for people who use mental health services (including their families and

carers) to work together with people who provide mental health services, to make

those services better”.

This principle was enacted through both the shared work of the Education & Development

Officer (a psychiatric nurse) and the Peer Educator (a person with lived experience of mental

health challenges, using mental health services, and Recovery) and the targeted

involvement of service users, staff and family members/carers throughout the project.

Core Project Team

The Core Project Team comprised Niamh Wallace (Occupational Therapy Manager and

Project Lead), Aoife Boland (Peer Educator) and Dan Taylor (Education and Development

Officer). From the outset, coproduction informed the project’s ethos. Partnership between

service provider (HSE), employer (Mental Health Ireland), and peer-led services (Aras

Follain) determined the recruitment process and appointment of project staff.

The core project team agreed to meet weekly for the duration of the project. The team

drew upon the breadth of their professional and personal experience to develop a shared

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vision and approach to the project. While fidelity to coproduction was manifest in the

collaboration between lived experience and professional experience, it is also important to

state that the project benefited from individual skill sets brought to bear by all three core

project team members. This meant that parity and equality of views and opinions were

explored and negotiated openly on an ongoing basis. Through these processes the core

project developed a strong bond through coproduction, which ultimately benefited the

project’s outcomes.

Recovery Colleges

Recovery Colleges are places where people who use mental health services, those who

support them and mental health professionals create (coproduce) and deliver (cofacilitate)

recovery-oriented educational courses and workshops. Anyone can choose to attend these

courses as part of their recovery journey. Courses offered by Recovery Colleges can include

understanding mental health difficulties, looking at treatment options and developing

practical life skills. The defining feature of Recovery Colleges is the way in which people who

have lived experience of mental health challenges, their supporters and mental health

professionals work together to provide the service. The first Recovery College opened in

South West London3 in 2009 and another opened in Nottingham in 2011, inspired by similar

initiatives in the U.S. In Ireland currently there are established Recovery Colleges in Mayo

and in Roscommon/East Galway, and several other sites in Ireland have Recovery Education

Centres in development, in addition to the current Mid West ARIES pilot project.

While there are many similarities, there are some features of the ARIES Project which

distinguish it from other Recovery Education Centres and Recovery Colleges. These features

may be considered alongside the eight defining features of Recovery Colleges as set out by

the Sainsbury Centre for Mental Health4, below:

3 A film about the Recovery College in South West London can be viewed at:

www.youtube.com/watch?V=VSOeQbkMVqc. 4 Rachel Perkins, Julie Repper, Miles Rinaldi & Helen Brown (2012): Recovery Colleges, London Sainsbury

Centre for Mental Health.

http://www.youtube.com/watch?V=VSOeQbkMVqc

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Recovery College Mid West ARIES

1. Coproduction between people with

personal and professional experience of

mental health problems

ARIES held coproduction workshops

involving people with personal, family and

professional experience to develop course

material and courses were co-delivered by

people with personal, family and

professional experience.

2. There is a physical base (building) with

classrooms and a library where people can

do their own research

There is no ARIES building with classrooms

and a library. Courses were delivered

throughout the region in e.g. community

centres, health centres and other

community-facing locations. Learning was

further supported by distribution of recovery

education materials from a central

administration office in St. Joseph’s Hospital,

Limerick.

3. It operates on college principles ARIES learners self-selected courses they

wished to participate in. Courses may be

signposted by mental health services, but as

with Recovery Colleges, there were no

referral or assessment procedures.

4. It is for everyone ARIES courses were open to all.

5. There is a Personal Tutor (or equivalent)

who offers information, advice and guidance

Information, advice and guidance were

provided by the Education and Development

Officer (EDO) and the Peer Educator (PE).

6. The College is not a substitute for

traditional assessment and treatment

ARIES operated in parallel to, and did not

seek to substitute or replace, traditional

assessment and treatment.

7. It is not a substitute for mainstream

colleges

ARIES was not a substitute for mainstream

colleges. ARIES initiated a partnership with

University of Limerick and provided

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Recovery Education to disciplines including

Nursing, Occupational Therapy, Medicine

and Psychiatry. This in-reaching approach to

Recovery Education for health professionals

in training exists only to a limited extent

among other Recovery Education Centres.

8. It must reflect recovery principles in all

aspects of its culture and operation

From the core partnership of EDO and PE, to

all aspects of course development and

delivery, ARIES reflected recovery principles

in all aspects of its culture and operation.

Key Features of the ARIES Project

Courses were co-delivered by volunteer recovery education facilitators trained by

ARIES. An original 2-day Training for Recovery Education Facilitators was co-

developed and co-delivered by the EDO and PE;

The volunteers trained were people with lived experience of mental health

challenges, mental health professionals, and family members/supporters;

An original questionnaire and brief version for all participants incorporating the

CHIME5 framework was developed and used to gather feedback on workshops,

courses and training (see Appendices 2 and 3);

Course material was reviewed by an external panel of three reviewers with

backgrounds in psychiatry, psychology, and adult education;

The project amassed a wide range of educational resources and materials on

recovery and sought to support learners and researchers throughout the region by

sharing these resources on request;

The project was supported by a Project Group with a range of backgrounds and

progress was reported on regularly to the Mid West ARI group.

5 Mary Leamy, Victoria Bird, Clair Le Boutillier, Julie Williams & Mike Slade (2011): Conceptual framework for

personal recovery in mental health: systematic review and narrative synthesis, The British Journal of Psychiatry.

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Section Two: Planning and Development

Development of Work Plan: April-May 2016

During the initial phase of the project the structure and content of the work plan was agreed by the

core project team and drafted by the EDO and PE, based on the priority areas highlighted in the

GENIO funding application. The work plan objectives were further informed by the ARI

Recovery Principles, the ImROC methodology, and specifically the 3 Key IMROC6

Organisational challenges highlighted in the 2014 Needs Analysis research conducted by the

Mid West ARI Project:

Supporting staff on their Recovery journey

Changing the culture of the organisation

Development of a Recovery education centre

The plan was then presented to the Project Advisory Group, including a tentative timeline

for the Project:

May Jun Jul Aug Sep Oct Nov Dec 2017

Develop work plan

Content production

Recruitment of

facilitators

Training volunteers

PilotPhase

RolloutPhase

ReviewEvaluation

ARIES Project Overview of the Year

6 ImROC: Implementing Recovery through Organisational Change. See www.ImROC.org for more information.

http://www.imroc.org/

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It was decided that the specific actions required to achieve the aims of the project would be

organised under four ‘pillars’, representing the substantive elements of the work required. Under

each pillar a series of tasks required to achieve the overall objective was established, and

each task was then further subdivided into the individual actions to be undertaken to

complete the task. For each action the person(s) responsible was identified, in addition to

the evidence required to show the action is completed, any potential blocks or challenges,

the expected time required to complete the action, and the planned completion date.

The four pillars are summarised as follows, including the overall objective for each:

Pillar Theme Overall Objective

1 People To identify, involve, and support Recovery education stakeholders throughout the Mid West region.

2 Content To co-produce and co-deliver a curriculum of material that meets the needs of and incorporates the strengths of all stakeholders.

3 Partnership To foster and maintain strong links with third-level academic institutions and others to jointly promote Recovery education.

4 Quality To ensure the project is completed to a high standard and that outcomes are measured and reported.

Work plan Pillar 1: People

Overall Objective: To identify, involve, and support Recovery education stakeholders

throughout the Mid West region.

The ARI Project HSE Mid West Genio application stated that: “There are a wide number of

stakeholders involved drawn from HSE staff, service users, service providers, carers,

family/friends and community organisations.” For the ARIES project to achieve its aims, it

was essential that all of the above individuals and groups be involved, or given the

opportunity to become involved at every stage. Due to the work already carried out by the

Mid West ARI Project, in particular the Needs Analysis Research (2014) and the FRIENDS

project, many stakeholders were already aware to some extent of the development and

possibly the initiation of the ARIES project. For these stakeholders, the work of the Project

Team was primarily to introduce themselves, bring the stakeholder up to date with the

21

project and invite them to become (re)involved. There were also many stakeholders in the

region who are unaware of the ARIES Project. For these stakeholders, the Project Team set

out to identify and contact them proactively and with sufficient knowledge of and

confidence in the project to interest them in becoming involved.

Work plan Pillar 2: Content

Overall Objective: To co-produce and co-deliver a curriculum of material that meets the

needs of and incorporates the strengths of all stakeholders.

The Centre for Mental Health (2012) states that most Recovery Colleges’ course content

clusters around five areas:

1. Understanding mental health issues and treatment options

2. Rebuilding life with mental health challenges

3. Developing life skills

4. Capacity building among the peer workforce

5. Family and friends

The Mid West ARI Needs Analysis Research (2014, p.63) identified three areas for

curriculum development which broadly reflect the five areas listed above: “Mental Health”

(area 1); “Personal Development” (areas 2 & 3); and “Practical Skills” (areas 3, 4 & 5). It was

planned that at least one or two workshops be developed under each heading to ensure

variety and broad appeal in the content.

Work plan Pillar 3: Partnership

Overall Objective: To foster and maintain strong links with third-level academic institutions

and others to jointly promote Recovery education.

The Needs Analysis Research (2014) was conducted in partnership with the University of

Limerick and it was planned that in the delivery of the ARIES Project this partnership (which

rests on other existing relationships through membership of the Project Group and the Mid

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West ARI Group) should be further strengthened and extended. There were a number of

anticipated benefits to this approach:

That the mental health professionals of the future would have access to

coproduced, codelivered education on recovery in mental health

Access for the ARIES Project to Educational expertise to assist in Curriculum

development

Opportunities for Recovery-based Workshops to be included in existing courses

in various departments

The possibility of an ‘embedded’ Recovery Education Centre arrangement like

that between Mayo RC and GMIT

Helping to improve the validity, credibility and sustainability of the ARIES Project

Practical benefits such as access to teaching venues and opportunities for

additional funding

The possible development of pathways for individuals through ARIES education

back to mainstream education

In addition to UL, it was planned that partnerships with other stakeholders also be

developed, including other academic institutions, relevant NGOs, Mental Health Teams,

GPs, Community Development organisations, and other providers.

Work plan Pillar 4: Quality

Overall Objective: To ensure the project is completed to a high standard and that outcomes

are measured and reported.

The core aims of the project were to co-produce and co-deliver Recovery-based Educational

materials throughout the Mid West region. In order for the value invested in the project to

be fully realised it was essential that the content and methods of delivery of Workshops be

of sufficiently high quality that they are sustainable into the future, based on the following

criteria:

The stated aims of the project are achieved as specified in the application;

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Fidelity to Adult Education principles;

Fidelity to Recovery principles;

Fidelity to Research principles, i.e. based on valid and verifiable data.

It was agreed that the CHIME7 framework should provide an overarching theoretical frame,

and a means to capture feedback on the project from a range of sources. CHIME was

selected because it has been used both in a UK and Irish context to facilitate the

‘measurement’ of Recovery outcomes8 and was also included as a core element in the

Recovery Principles training for community mental health teams rolled out by Mid West ARI

in 2015.

Project Promotion and Capacity Building: May-November 2016

An early priority was the establishment of a database of stakeholders including potential

volunteers. The local ARI group shared with the project a database of volunteers who had

expressed an interest in volunteering in ARI Projects. This provided an initial emailing list

which was added to throughout the project. A volunteer form was developed (Appendix 4)

and distributed to the network. This allowed a confidential database of service users, family

members and mental health professionals to be compiled and invited potential volunteers

to suggest topics for recovery education workshops.

A program of meetings with local stakeholders and attendance at local events was

established in the work plan with the aim of promoting the project throughout the Mid

West region. The national ARI Group provided a platform to promote the ARIES project at

national level through its regular ‘Learning Sets’. Meeting with representatives from other

ARI sites also allowed opportunities for sharing learning on Recovery education and

community involvement. In May 2016 the core project team met with the local HSE

communications department and agreed the content of a Staff Broadcast email to be sent

7 CHIME: Connectedness, Hope, Identity, Meaning and Empowerment. See Leamy et. al., (2011)

8 See for example Donnelly et al (2011) and the ‘Provisional Draft Recovery College Evaluation Framework’,

Dublin North, North East Recovery College (2016)

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to all HSE staff in the region, and a web page (Appendix 5) promoting the project and

providing links to information on ARI, on coproduction and recovery colleges. An associate

of the Peer Educator kindly donated time and expertise to design a logo for the project. This

was added to descriptive content and a leaflet advertising the project was produced and

printed. Approximately five hundred leaflets were distributed throughout the region via the

growing network of contacts, and leaflets were delivered to every community mental health

team in the region.

A summary of promotion and capacity building activities can be found at Appendix 6.

Three-hundred and eleven individual stakeholders and approximately twenty stakeholder

organisations were contacted directly (i.e. face-to-face) during this phase of the project, and

a larger number of individuals and organisations were made aware of the project indirectly

via electronic means and through word-of-mouth.

Involvement of Volunteers: April 2016 onwards

A core element of the ARIES Project design was to involve volunteers from communities

across the region at every stage of course development and delivery. The involvement,

training and support of volunteer recovery education facilitators reflected the intention that

as far as possible ownership of the project was held directly by the communities intended to

benefit from the project. In accordance with the ethos of coproduction, equal

representation was sought from those who self-described as service user/having lived

experience of mental health challenges, family member, and mental health professional.

Coproduction of Course Content: June 2016-January 2017

As described above, the topics for the workshops to be developed by the ARIES Project were

agreed by the Project Team, based on the findings of the local Needs Analysis Research, and

on core topics from the curricula of existing Recovery Colleges in Ireland (Mayo Recovery

College; REGARI Recovery College Roscommon/East Galway), and the UK It was

25

acknowledged that the process of curriculum development would be limited by the lifespan

of the project, therefore the topics selected were necessarily broad in scope.

Selection of Coproduction Workshop volunteers

For the first ARIES Coproduction workshop (What is Recovery? on 28th June 2016) the

participants were individually selected by the core project team from the Mid West ARI

volunteer database. Six individuals were selected, based on their self-identification as using

or having used a mental health service, as being a family member of a person experiencing

mental health difficulties, or being a mental health professional. The guiding principle in

selecting participants was to seek a balance between broad representation of views, and

manageability of inputs given a limited time and the limits inherent in facilitating discussion

while also recording (note-taking). As this was the first of the ARIES Coproduction

workshops the number of participants was limited to six in order to test the process.

Feedback from participants indicated the need for more structured facilitation, and

discussion with the project advisory group suggested the need for larger groups in

coproduction workshops. The planning and facilitation of subsequent coproduction

workshops reflected the learnings from this initial workshop, and so were more structured

and involved larger groups.

Coproduction Workshops

Seven coproduction workshops were held during the project. To support the process of

coproduction a discussion guide was developed by the EDO and PE based on a focus group

approach (see Appendix 7). The detail of these workshops i.e. date, theme, location,

participants and summary of feedback can be found at Appendix 8. Coproduction

workshops were two hours in length. The aim through facilitation was to provide a safe

space for participants to share their wisdom and expertise and so the first step in the first

coproduction workshop was to establish a group agreement. The participants in the first

workshop (What is Recovery? on 28th June 2016) drafted this agreement (see Appendix 9).

This was the group agreement that was taken forward to all subsequent coproductions and

26

workshops, with participants being given the opportunity to add to the guidelines at the

beginning of each session.

UK-based charity The New Economics foundation (2013)9 conducted a literature review on

coproduction in mental health, and highlighted six principles which are described as the

foundation stones of coproduction. “Blurring distinctions” is one of these six principles:

“Blurring distinctions: removing the distinction between professionals and

recipients, and between producers and consumers of services, by reconfiguring

the way services are developed and delivered”.

(NEF 2013, p.6)

The facilitators sought to promote this principle in the introduction of each coproduction

workshop by explaining that every participant was the authority in their own experience,

regardless of background. The phrase “There are no labels at the table” was used regularly

to illustrate this point. There was general approval for this approach from all coproduction

participants and a stated understanding of its value. However it was also observed by the

facilitators that, when invited to introduce themselves at the beginning of each

coproduction, participants almost invariably referenced their backgrounds directly, e.g. “I

have been a service user”, or “I am a psychiatrist”. This perhaps suggests the need to be

open about one’s background when meeting others for the first time in a group work

setting, while being allowed to let this aspect of identity recede into the background in

subsequent discussion. This speculative finding may have some support in the feedback

received from participants, which frequently acknowledged the value of people with

different backgrounds working together with a common aim. This was the dominant theme

in feedback when participants were asked what worked best. When asked what could be

improved, most participants stated that more time should have been allowed, and that

there should have been greater clarity on the purpose of the workshop.

Feedback from coproduction workshops was overwhelmingly positive. The question What

worked best in the session? elicited many times more responses than the question What

worked less well or could be improved? In order to reflect this, a selection of participants’

9 Slay, J. & Stephens, L. (2013). Co-production in mental health: A literature review. London: New Economics

Foundation

27

feedback from the coproduction workshops is presented below, reflecting the balance in the

feedback towards positive comments, while also including feedback which suggested

changes and improvements:

What worked best in the session?

What worked less well or could be improved?

‘Cosynthesis’ of Material by Core Project Team

The term ‘Cosynthesis’ was coined by the EDO and the PE to describe the process of

reviewing the material gathered in the coproduction workshops and formulating the

content gathered into individual session plans and accompanying PowerPoint presentations.

The term cosynthesis reflects the modelling of coproduction by the EDO and the PE. These

Everyone could speak freely,

all looked at as equals...

Friendly atmosphere. Good

facilitation. Different

perspectives.

People listened to each

other. Everyone’s point of

view was valued...

Open communication

between family members,

professionals and users of

services

Identifying the aim/goal of

today’s task- could be more

specific. Maybe ask more direct

questions.

28

two ostensibly different backgrounds were consciously and intentionally brought to bear

throughout the cosynthesis process, involving many hours of productive discussion on key

issues relating to mental health and service provision, focussing on the theme of each

workshop in development. This involved:

Initial reading of all notes, flipcharts and extant material from the coproduction

workshop by EDO and PE;

Collaborative discussion of themes arising;

Joint decision making about priority content for inclusion in workshop;

Collaborative drafting of initial session plan;

Substantive drafting of session plan and slide presentation by EDO;

Review and redrafting by PE

The completed session plan and slides was then submitted to the academic review group,

and their feedback jointly reviewed by the EDO and PE, and integrated into the session plan,

creating the final version to be delivered.

Involvement of Volunteer Facilitators: October-December 2016

The initial step in involving volunteer facilitators was an open call through the database of

contacts to any potential volunteers. An information day was held on 6th October, which 30

people attended. At this session potential volunteers were informed about the background

to the project, the rationale for recovery education, and specific features of the volunteer

facilitator role including payments for volunteers (via the system established by National ARI

and the HSE Service Improvement Unit), and Garda Vetting for volunteers, to be conducted

in partnership with Mental Health Ireland and pursuant to the HSE Policy on Safeguarding

Vulnerable Adults (see Appendix 10).

The information session also provided an opportunity for attendees to contribute to the

facilitator training to be provided. This was elicited by facilitated group work within the

information session guided by three questions:

29

“What do I want to gain from facilitator training?”

“What can I offer to facilitator training?”

“What supports would I want as a volunteer facilitator?”

The outputs from the group helped the EDO and PE establish the content of the Facilitator

Training for volunteers.

Volunteer Facilitators Training: November-December 2016

Following the information session, The EDO and PE developed a 2-day training program

designed to equip volunteers with the means to facilitate ARIES workshops by building on

existing strengths and drawing on expertise gained through lived experience, whether

service user, family member, or mental health professional. The Training Session Plan and

PowerPoint Slides for this training is included in the electronic resources which accompany

this report.

In order to maximise the effectiveness of the training, numbers were limited to 25, and to

maintain fidelity to coproduction, trainees were sought in equal numbers who self-

described as having lived experience of mental health challenges, being a family member, or

a mental health professional. Additionally, as the project was Region-wide, equal

representation was sought from the three counties in the Mid West Region: Clare, Limerick

and North Tipperary. As more than 25 people had expressed an interest in attending the

training, it was essential that the principle of fairness be adhered to in allocating places.

Since people were invited to self-select as facilitators, there was no interview or specific

qualification criteria. Instead, the allocation of places was made on a first-come basis. This

approach was followed to the extent that the call for trainee volunteers was made

simultaneously via email and text (for those not using email), and responses were logged as

they were received. The objectives of allocating places equally to those who self-described

as having lived experience of mental health challenges, being a family member, or a mental

health professional, and equally to the three counties, was not fully achieved, as illustrated

below:

Eight men and seventeen women were allocated places;

30

Five were from Clare, Eleven from Limerick, and Nine from Tipperary;

Thirteen people self-described as having lived experience, Four self-described as

being family members, and Five self-described as being mental health professionals.

Two people self-described as both having lived experience and being a family

member, and one person self-described as both having lived experience and being a

mental health professional.

On completion of the 2-Day training, feedback was sought from the 25 participants using

the ARIES Feedback form, and 23 feedback forms were completed. 95% of responses

indicated approval. A sample of the qualitative feedback received is presented below:



The lovely bond between

facilitators and the mix in the

room. Training was well

designed and structured.

Practical activities.

The two days were

empowering and emotional.

Listening to personal

experiences from

professionals, service users

and family members. The

group work and chats

Working on our facilitation skills

could have benefited from more

time. Greater participation from

mental health professionals.

31

In order to support the development of the project throughout the region, volunteer

facilitators were encouraged to form local groups based around the main population

centres: Ennis, Limerick, Nenagh and Thurles. Some guidance was offered by the EDO and

PE, but groups were not directed in this, instead being allowed to form groups themselves

according to location and their own availability.

All volunteers were invited to a training refresher day on 12th December, which 15

volunteers attended. This provided an opportunity for further facilitation practice, the

strengthening of collegiality among the group and the local area groups, and some specific

input based on the feedback from the training in November. Many people had requested

some guidance on maintaining boundaries in facilitation, and this was explored on the

refresher day through scenarios in facilitating workshops and advice on personal safety.

This discussion also highlighted the need for workshop participants to provide contact

details and a person to contact in case of emergency, and these details were included in a

workshop enrolment form which was being developed at the time (see Appendix 11). The

session plan and PowerPoint slides for this refresher training are included in the electronic

resources which accompany this report.

The Use of Personal Narrative

As highlighted earlier, stories of personal recovery from mental illness were one of the

significant emerging forces which brought the concept of recovery into the public’s

awareness, beginning in Ireland in the 1980’s (Mental Health Commission 2008). Since

then, the use of personal narratives of recovery has attracted increasing interest. Recovery

Southwest has published a guide entitled “Recovery Narrative Sharing Guidance”10 in which

it is stated:

“Personal stories can offer insight and hope to others struggling with difficulties as

well as helping the person whom has experienced mental distress to reclaim events

and their life stories. Also these narratives can help mental health professionals and

10

Available at: https://www.rcpsych.ac.uk/pdf/Story_sharing_guide.pdf

https://www.rcpsych.ac.uk/pdf/Story_sharing_guide.pdf

32

others working within health and social care gain greater understanding and

consider different approaches within their practice”.

The use of personal narrative was a central feature of ARIES training and workshops, and

this was first modelled directly by the PE in the training for volunteer facilitators. The PE

explained, through telling her own story, the circumstances surrounding and leading to her

accessing mental health services, being diagnosed, and ultimately finding recovery.

Volunteers were also invited, if they wished, to share parts of their own story or recovery

‘journey’. It was made abundantly clear to volunteers throughout the training that there

was never any obligation to tell their story, and this was supported structurally in the design

of workshop material: where reference was made to personal narrative in the workshop

session plans, there was also a link provided to another person’s recovery story from the

public domain, e.g. a piece of writing or a YouTube video. Volunteer facilitators were

encouraged and supported to include these stories rather than their own if that was their

preference.

33

Section Three: Project Delivery Phase

The following section outlines the delivery of ARIES Workshops, which is presented in three

phases:

Delivery of workshops for students of health, social care and allied sciences;

Delivery of workshops by EDO and PE (Pilot Phase)

Delivery of workshops by Volunteer Recovery Education Facilitators (Main Phase)

Delivery of Workshops for Students: September 2016-April 2017

In line with the objective of initiating partnerships with local 3rd level academic institutions,

and facilitated by some existing and new relationships established by the Project Lead with

key personnel in the University of Limerick, opportunities were sought to deliver Recovery

Education to students from a range of disciplines including medicine, particularly psychiatry,

clinical psychology, nursing, and occupational therapy. A significant development was the

inclusion of ARIES workshops in the schedule of psychiatric placement induction for final

year medical students in The University of Limerick’s Graduate Entry Medical School

(GEMS). Five such workshops were provided during the lifetime of the project, in addition

to a further workshop provided for Non Consultant Hospital Doctors on their induction. A

total of seventy-seven medics and trainees attended these workshops. Regular recovery

education for medical students of this kind (i.e. coproduced and cofacilitated) is thought to

be a new development nationally at the time of writing.

The workshop material provided to students was based on content sourced from ‘Recovery

Principles’, a coproduced program of training and capacity building in recovery which had

(prior to the inception of the ARIES Project) been delivered to Community Mental Health

Teams throughout the region, led by the Mid West ARI Group, as part of a national ARI

program of work. Since the original ‘Recovery Principles’ training program was developed

for practising mental health professionals, the program material was adapted for students.

This process of adaptation was guided by a small-scale coproduction workshop facilitated by

the EDO and PE, and attended by three post-graduate students- two studying occupational

34

therapy, and one studying psychology, on 19th September 2016. The adapted version of the

material was finalised jointly by the EDO and PE before being delivered to students.

A total of ten Recovery education workshops were delivered to University of Limerick

students of medicine, psychiatry, general nursing, psychiatric nursing, and occupational

therapy throughout the project, and a total of 147 students attended. The detail of these

workshops is at appendix 12. A sample of the qualitative feedback is presented below:



Despite 5 weeks of clinical

placement this was the first time I

got to hear a patient’s story in their

own words! The most valuable part

was the instructors’ narratives.

Mental illness does not

define a person...as a future

doctor I can tell people that

with the right support it will

be ok. Really liked the

personal aspect from both

carer and patient.

More info on Recovery

initiatives. Would be nice to get

some information on specific

techniques/goals to help

patients.

35

Delivery of workshops by EDO and PE (Pilot Phase): November-December

2016

Between 14th November and 7th December 2016, the Education and Development Officer

and the Peer Educator co-facilitated eight workshops in Limerick city, comprising each of the

four initially coproduced workshops, delivered twice in different venues. The purpose of

this was three-fold:

To deliver on the primary objective of providing Recovery Education;

To further promote the project to all stakeholders;

To gain learning on the material and its delivery to inform the main project phase in

which volunteer facilitators take over the facilitation of workshops.

Two venues were selected: The home of the Limerick Mental Health Association, and The

Health Hub, a community-based space in the City Centre developed by the University of

Limerick. Workshops were scheduled both during the daytime, and in the evening, in order

to allow as many people as possible to attend. A poster was drafted and used to promote

the workshops via the database of contacts (Appendix 13).

A summary of the workshops is at Appendix 14. A sample of the qualitative feedback is

presented below:


The use of personal narratives

throughout the session was very

beneficial. Very relaxed and open

to my opinions. Being heard,

listened to, understood.

It would be great if these

could run at all the day

hospitals. It was well

presented and there was

really good interaction

between us all. Very open

session.

36


Delivery of workshops by Volunteer Recovery Education Facilitators (Main

Phase): January- April 2017

In this phase the full project aims were realised: for coproduced workshops to be co-

delivered by volunteer recovery education facilitators representing service users, family

members, and mental health professionals, in their communities. Since eight workshops

had been delivered during the pilot phase in Limerick city, population centres in County

Clare and North Tipperary were prioritised. Two venues were secured, one in Ennis, and the

other in Nenagh. These venues were both multi use community centres with no specific

association to mental health services. Volunteer facilitators self-selected for these

workshops and this was negotiated informally based on the aim of allowing every volunteer

who wished to facilitate being given the opportunity to do so. A summary of the workshops

is at Appendix 15. A sample of the qualitative feedback is presented below:


Some of it was boring. Room

was a little cold. Bigger copy of

full slides. I found the room

exposed to noise from the room

beside.

Social element/co-operation,

meeting people who could help.

The ease and capability of the

facilitators’ approach to sharing

their knowledge.

Listening to psychiatrist very

informative, empowering, an

insight into their work.

Everyone got the chance to

speak openly about their

experiences.

37


The lack of discussion about our

family and how they react to us.

The info given about the

workshop could have been

more comprehensive.

38

Section Four: Evaluation and Recommendations

The following section gives an overview of the project outcomes in terms of self-reported

recovery processes for workshop participants. A brief analysis of themes emerging, and

summary recommendations for future recovery education developments in the Mid West

are offered.

Evaluation using CHIME

CHIME is an acronym describing five recovery processes (Connectedness, Hope, Identity,

Meaning and Empowerment) based on a wide-ranging narrative synthesis of published

research into accounts of the personal experience of recovery (Leamy et al 2011). CHIME

was incorporated into the feedback form used for ARIES Coproduction workshops, and

workshops delivered in communities in the Pilot and Main phases of the project, in order to

explore the usefulness of CHIME as a tool for self-reporting recovery outcomes (see

Appendix 1).

Participants’ CHIME feedback from the sixteen workshops delivered during the pilot and

main phases of the project were checked, and the percentages of each response calculated.

The five recovery process questions and five possible responses to each yielded a total of

eight-hundred and six individual responses, summarised below:

CHIME is a way of measuring individual or personal outcomes in Recovery oriented services.

CHIME stands for: Connectedness Hope Identity Meaning Empowerment

Please respond to the statements below, circling a number for each.

Statement: Participants’ responses (%):

Strongly

disagree

Disagree Neutral

Agree Strongly

agree

I felt connected to the activities and

processes in this session. 0% 1% 7% 34% 58%

I feel hopeful about Recovery after

taking part in this session. 0% 1% 13% 24% 62%

I feel my identity was recognised and

valued in this session. 0% 1% 6% 33% 60%

39

I feel that the material delivered in the

session is meaningful to me. 0% 0% 7% 32% 61%

I feel more empowered after taking part

in this session. 0% 1% 9% 28% 62%

An average (mean) of the total percentages for each of the five CHIME process shows that

91% either Agreed or Strongly Agreed with the indicative Recovery statements. These

findings should be taken with caution, since no controls were in place and a wide range of

factors may have influenced participant’s responses, however the encouraging suggestion is

that there is a perceived benefit among participants engaging in Recovery Education, and

that CHIME may be useful in the context of self-reporting recovery outcomes.

UL Engage student placement: March-April 2017

Established in September 2015, The University of Limerick (UL) Engage program’s stated aim

is: “to integrate civic engagement into the University's core missions in research, teaching

and internationalisation”. Through this program, in March 2017 two international students

were placed with the project, for approximately 4-6 hours per week. The priority during this

phase of the project was the completion of the final report, and an analysis of the project

outcomes. The UL Engage students assisted in this by drafting content on Coproduction and

Recovery Colleges, and by undertaking both statistical and thematic analysis of feedback.

The statistical outcomes have been presented in the earlier parts of the report and in the

appendices. The outcome of a brief thematic analysis is presented below.

Brief Thematic Analysis

Qualitative feedback was sought from participants at the end of each workshop using three

questions/prompts (see Appendices 1 and 2: ARIES feedback forms). A sample (of eight)

complete sets of feedback forms from the 26 sets collected were randomly selected and

analysed by the UL Engage placement students independently of each other. The approach

to identifying themes was based on Braun and Clarke’s (2006) method of thematic analysis.

40

This process identified twenty initial themes (see Appendix 16: initial themes). These

twenty themes were then reviewed jointly by the UL Engage placement students and the

Education & Development Officer, and six key themes were identified. These key themes

are presented below:

Safety: Being in an environment where everyone felt safe and free of judgement was

beneficial to the experience. Everyone in the room was able to contribute to the

conversation.

Personal experiences: Being able to listen to the experiences of others helped me in

understanding, sharing my own experiences

Equality: There was equality among the group no matter if you were a service user, family

member or service provider

Connection: There was a visible bond between facilitators and the group.

Support: Being in groups and being able to share your story and have everyone around you

understand what you went through.

Managing recovery: Working together we can learn from each other about practical ways to

manage recovery by putting ideas into practice.

Recommendations

The ARIES Pilot Project was an initial exercise in the development of a regional Recovery

Education Centre. Accordingly, a number of learnings were identified through discussion

among the core project team and project advisory group and informed by feedback given

from volunteers, workshop participants, and other stakeholders. The key recommendations

are presented below, along with some key potential areas for future research, to support

the ongoing development of Recovery Education in the region.

1. Parity in roles of Peer Educator & Education & Development Officer: During this project

the Education and Development Officer was employed full-time (37.5 hours per week) while

the Peer Educator was employed part-time (19 hours per week). This structural disparity

41

should be addressed in future developments to give equal standing in employment terms

and conditions between the two core personnel, in keeping with the ethos of coproduction.

2. Continuation & Development of wider Curriculum content: A total of seven workshops

were coproduced during the project; as mentioned earlier these were necessarily broad in

scope. In future developments it is anticipated that a curriculum with greater breadth and

depth be developed over an extended period.

3. Continuation & Development of wider Geographical reach throughout region: Due to

the constraints of time and resources during this pilot project, workshops were delivered in

only three main population centres in the Mid West Region (in addition to one coproduction

workshop in West Clare). The project should be rolled out on a wider geographical basis

including allowing rural communities to engage in Recovery Education.

4. Continuance of partnership with 3rd Level academic institutions towards embedment of

Recovery Education: Some positive initial steps were taken in developing partnerships in

academic settings and providing recovery education to future mental health professionals

and this should be further developed in the future.

5. Development through coproduction of a contract for volunteers: During the project no

formal agreement was drafted to record the relationship between volunteers and the

project. In order to protect the rights of volunteers and to maintain transparency and

accountability in future developments such an agreement or contract should be

coproduced.

6. Development of process for payments for volunteers: Experience of the process for

drawing down payments was that it was time-consuming and off-putting, based on a low

uptake from volunteers. Concerns about this process should be fully explored and changes

made to ensure it is as convenient as possible for volunteers.

42

7. Identification of income streams via partnerships: In order to protect future projects and

ensure sustainability revenue streams via academic institutions and/or the private sector

should be explored.

8. A social media presence (Facebook, Twitter): This project did not utilise popular social

media platforms to promote and extend its reach and this should be addressed as a priority

in future developments.

Potential Areas for Research

ARIES has commenced discussions with the Health Research Institute in The University of

Limerick to explore the experience of participation in recovery education and its

contribution to mental health and well-being. Recovery Education and Recovery Colleges

represent an emerging field in Ireland and this offers many opportunities for research to

inform future development and best practice. Some possible areas of focus are suggested

below:

A retrospective study of the development of the ARIES project in the context of

similar initiatives in other ARI sites and/or abroad;

A comparative analysis of outcomes from the ARIES project and other Recovery

Colleges and Recovery Education Centres in Ireland and/or abroad;

A qualitative investigation of the experiences of ARIES volunteers focussing on

Recovery Gains and Recovery Capital arising from involvement;

The development of a business case to support the sustainability and extension of

the existing pilot project;

Development of a validated means to measure recovery education outcomes;

Other potential avenues for research to be negotiated with the Health Research

Institute, UL, and interested researchers.

43

Conclusion

This report has outlined the development, activities and some of the outcomes of the Mid

West ARIES Pilot Recovery Education Project. The project has demonstrated considerable

interest in Recovery Education and Recovery Colleges in the Mid West Region, and

significantly, the capacity within communities across the region to support and play a

central role in the coproduction and delivery of Recovery-oriented education.

Participation and feedback suggest a willingness to engage in Recovery Education in the Mid

West region, and outcomes suggest the benefits of this approach. Learning gained from this

pilot project may be incorporated in future Recovery Education initiatives.

44

References

Anthony WA (1993) Recovery from mental illness: the guiding vision of the mental health

service system in the 1990s. Psychosocial Rehabilitation Journal, 16, 11-23.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in

Psychology, 3, 77–101.

Collins, P. (2016). 4 Steps to Recovery. National Office for Advancing Recovery in

Ireland. HSE: Mental Health Division. Dublin.

Donnelly M., Scott, D., McGilloway, S., O’Neill, D., Williams, J., Slade, M. (2011) Patient

outcomes: what are the best methods for measuring recovery from mental illness and

capturing feedback from patients in order to inform service improvement? Report

Commissioned by the Bamford Implementation Rapid Review Scheme.

Higgins, A. (2008). A Recovery Approach within the Irish Mental Health Services: A

Framework for Development. Mental Health Commission. Dublin

http://www.thinklocalactpersonal.org.uk/Browse/Informationandadvice/CareandSupportJa

rgonBuster/#Co-production accessed May 13, 2016

Kelly, J., Gallagher, S. and McMahon, J. (2016): Developing a recovery college: a preliminary

exercise in establishing regional readiness and community needs, Journal of Mental Health.

Perkins, R., Repper, J., Rinaldi, M. and Brown, H. (2012): Recovery Colleges, London

Sainsbury Centre for Mental Health.

Realpe, A. & Wallace, L.M. (2010) What is Coproduction? London: The Health Foundation

Slay, J. & Stephens, L. (2013). Co-production in mental health: A literature review.

London: New Economics Foundation.

45

List of Appendices

Appendix 1: Launch of ARIES Project

Appendix 2: ARIES Feedback form

Appendix 3: ARIES Brief Feedback form

Appendix 4: Mid West Aries Volunteer Form

Appendix 5: Mid West ARIES Web Page

Appendix 6: Mid West ARIES Project Promotion and Capacity

Building: April-December 2016

Appendix 7: Guide for Focus Group approach to Co-production

Appendix 8: Record of Coproduction Workshops

Appendix 9: ARIES Group Guidelines

Appendix 10: Mid West ARIES Volunteers Garda Vetting Process

Appendix 11: ARIES Workshop enrolment form

Appendix 12: Summary of Recovery Principles for Students

Workshops

Appendix 13: Sample Poster for ARIES Workshops

Appendix 14: Summary of Workshops delivered by EDO and PE (Pilot

Phase)

Appendix 15: Summary of Workshops Delivered by Volunteer

Facilitators (Main Phase)

Appendix 16: Initial themes from feedback from workshop

participants

46

Appendix 1: Launch of ARIES Project at the National ARI Learning Set officiated by Minister of State Helen McEntee, November 2016

From left to right: Mark Sparling (Head of Service), Dr. John O’Mahoney (Executive Clinical Director), Laura Thompson (Principal Social Worker), Michael Griffin (Business

Manager), Eamonn Butler (Principal Psychologist), Bernard Gloster (Chief Officer CHO3), Aoife Boland (ARIES Peer Educator), Dr. Marie Oppeboen (Senior Registrar and

ARIES Project Group Member), Helen McEntee (Minister of State for Mental Health and Older People), Niamh Wallace (Occupational Therapy Manager and ARIES Project

Lead), Ann O’Connor (National Director Mental Health), Dan Taylor (ARIES Education & Development Officer)

47

Appendix 2: ARIES Feedback form

Session Title:

Date of Session:

Facilitators:

Location:

Thank you very much for taking part in this session.

We would like your feedback to help us in planning for the future.

Please take a few moments to respond to the statements below, circling a number for each.

Statement: Please circle your response:

Strongly

disagree

Disagree Neutral

Agree Strongly

agree

The process of becoming involved in the

session was straightforward and trouble-

free.

1 2 3 4 5

I felt welcomed by the facilitators to the

session. 1 2 3 4 5

The venue was comfortable with

adequate facilities. 1 2 3 4 5

The aims and objectives of the session

were clearly explained. 1 2 3 4 5

My involvement and contributions were

supported and facilitated well. 1 2 3 4 5

The involvement and contributions of

other group members were supported

and facilitated well.

1 2 3 4 5

I felt respected and my opinions were

valued.

1 2 3 4 5

The facilitators were knowledgeable.

1 2 3 4 5

The facilitators communicated

effectively.

1 2 3 4 5

The structure of the session helped to

achieve the stated aims. 1 2 3 4 5

I would be happy to participate in a

future ARIES session. 1 2 3 4 5

Thank you. Please turn over.

48

CHIME is a way of measuring individual or personal outcomes in Recovery oriented services.

CHIME stands for:

Connectedness Hope Identity Meaning Empowerment

Please respond to the statements below, circling a number for each.


Strongly

disagree

Disagree Neutral

Agree Strongly

agree

I felt connected to the activities and

processes in this session. 1 2 3 4 5

I feel hopeful about Recovery after

taking part in this session. 1 2 3 4 5

I feel my identity was recognised and

valued in this session. 1 2 3 4 5

I feel that the material delivered in the

session is meaningful to me. 1 2 3 4 5

I feel more empowered after taking part

in this session. 1 2 3 4 5

Please answer the following questions based on your experience today:


___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________


___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Any other comments or suggestions?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Thank you!

49

Appendix 3: ARIES Brief Feedback form

Session Title: Date:

Facilitators: Location:

Thank you very much for taking part in this session.

We would like your feedback to help us in planning for the future.

Please take a few moments to respond to the statements below, circling a number for each.


Strongly

disagree

Disagree Neutral Agree Strongly

agree

The aims and objectives of the session were

clearly explained. 1 2 3 4 5

The facilitators communicated effectively.

1 2 3 4 5

The session gave me a better understanding

of Recovery in Mental Health. 1 2 3 4 5

I would be happy to participate in a future

ARIES session. 1 2 3 4 5

Please answer the following questions based on your experience today:


___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________


___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Any other comments or suggestions?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Thank you!

50

Appendix 4: Mid West Aries Volunteer Form

MID WEST ARIES PROJECT VOLUNTEER DATABASE

(This needs to be completed and signed on an individual basis)

The ARIES Project would like to maintain a database of volunteers who would like to be

involved in a volunteering capacity within the Mid West. If you would like your name to be

maintained on this database and be contacted when possible opportunities for involvement

arise, please complete the details below:

Name:

Address:

Telephone No.:

Email Address:

(Please Tick √)

Lived Experience Family Member Professional Experience

Other (please specify)

__________________________________________________________________________________________

Please specify the area(s) you might wish to be involved as a volunteer. (Please Tick √)

Developing Courses (Co-Production)

Delivering Courses (Co-Facilitation)

Assisting with Events and Activities

Other (please specify)

Any suggestions for courses? What would you like to see covered?

_________________________________________________________________________

Signed: Date:

Please return this form when completed to: Daniel Taylor, Education & Development Officer, Mid West ARI Project Office, St Joseph’s Hospital, Mulgrave St, Limerick T: 061 461226 E: [email protected]


51

Appendix 5: Mid West ARIES Web Page

52

Appendix 6: Mid West ARIES Project Promotion and Capacity Building: April-December 2016

Date Activity Venue Numbers attended

Service user Family Member Mental Health Professional

Student General/ unknown

Total

12/5/16 info Le Cheile, Limerick 4 1 5

12/5/16 info Employability Limerick 4 4

18/5/16 info Employability Nenagh 3 3

18/5/16 info Aras Follain, Nenagh 8 4 12

23-30/5/16 1:1 Meetings St. Joseph’s Hospital Limerick

6 2 2 10

13/6/16 info Le Cheile, Limerick 4 2 6

22/6/16 info Chapel Lane CC, Ennis 18 4 22

7/7/16 info Willowdale Day Hospital, Limerick

5 5

9/8/16 info Glentworth Hotel, Limerick 20 5 10 5 40

16/8/16 info Unit 5B, Limerick 5 1 6

19/8/16 info NLN Focus, Raheen 12 4 3 19

29/8/16 1:1 Meetings University of Limerick 3 3

7/9/16 info University of Limerick 3 3

19/9/16 info St. Mary’s HC, Thurles 5 5

21/9/16 info ARI Learning Set, Cavan 15 10 20 45

6/10/16 info St. Joseph’s Hospital, Limerick

20 6 6 2 34

11/10/16 info St. Anne’s Day Hospital, Limerick

8 4 12

13/10/16 info Mental Health Week, University of Limerick

5 5 5 15 30

17/10/16 info Southside DEPS, Limerick 5 5

1/11/16 info Ennis Mental Health Association, Chapel Lane

2 2

15/12/16 info HSE Staff Wellness Day, South Court Hotel, Limerick

5 5 30 40

Totals: 102 45 91 19 54 311

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Appendix 7: Guide for Focus Group approach to Co-production on Recovery

Welcome

Explanation

Introduction

Explain process

Outline parameters: mutual respect; if you see something on the board bring your

own angle; responsible for the energy you bring; use ‘I’ statements, speak from own

expertise; we’re here to create content that is useful to so many, we ask you to be

authentic: your voice is as valid and important as everyone else’s.

What is your understanding of Recovery?

How do you see Recovery happening?

What is the most important factor in Recovery?

In your opinion what is the best way to achieve Recovery?

What are the potential benefits of a person attaining Recovery?

What are the potential barriers to and difficulties in attaining Recovery?

How does the idea of Recovery make you feel?

Have you been involved with Recovery personally, or ‘held the hope’ of Recovery for

someone else?

What has been your learning from your involvement in Recovery?

If I was to ask you for one practical support in relation to Recovery what would you suggest?

Is there something that you have read, heard or seen that has had a positive impact on your

understanding of Recovery? What is it?

If you could put in one key topic to cover about Recovery what would it be?

In small groups, please discuss and write 6 critical/essential/fundamental topics for a

Recovery education programme which could stand alone and also be delivered as a

sequence.

If I was to ask you for 1 piece of advice, from your understanding of Recovery, what would

that piece of advice be?

54

Appendix 8: Record of Coproduction Workshops

Date Theme Venue Service User Family member

Mental Health Professional

Student Total Participants

Participants Feedback-

Approval %

28/6/16 What is Recovery?

St. Joseph’s Hospital Limerick

2 2 2 6 100%

27/7/16 Understanding Mental Health

Services


5 2 2 9 98%

9/8/16 Advocacy & Empowerment


4 4 3 11 99%

17/8/16 Diagnosis and Beyond

Kilrush Day Hospital Co. Clare

4 3 3 10 97%

19/9/16 Recovery Principles for

Students

St. Joseph’s Hospital, Limerick

3 3 not collected

12/12/16 CHIME St. Joseph’s Hospital, Limerick

11 4 4 19 88%

18/1/17 After Recovery What Next

St. Joseph’s Hospital, Limerick

8 3 3 1 15 94%

Totals: 34 18 17 4 73 Average (mean):

96%

55

Appendix 9: ARIES Group Guidelines

Please put your phone on silent

We practice mutual respect

We are all responsible for the energy we bring

to the group

Please speak one at a time

We speak from our own experience

We use ‘I’ statements

We are here to create content that is

invaluable to so many- Please be authentic

Your voice is as valid and important as anyone

else’s

What you hear here, who you see here, when

you leave here, let it stay here

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Appendix 10: Mid West ARIES Volunteers Garda Vetting Process

1. NVB1 form to be printed out and completed by all participants (except staff who are already Garda vetted)

2. In the section Role – please fill in “Recovery Education Facilitator”

3. In the section Name of Organisation – please fill in “ARIES Project”

4. Please ensure your eircode is included in the address

5. You will need to bring two pieces of identification with you – photographic ID (Passport, drivers licence, Irish public services card) AND proof of address. Please make sure your proof of address matches the address you have on the form. You need the originals and one photocopy of your identification and the proof of address.

6. The completed NVB1 form and your identification will be checked and signed off.

7. Your form will be sent to Mental Health Ireland for processing then it is sent to the Garda vetting unit.

8. You will receive and email to say it has been received and to complete the process on line.

57

Appendix 11: ARIES Workshop enrolment form

MID WEST ARIES PROJECT COURSE ENROLMENT FORM

Please complete below. If you require any assistance, please contact us.

Your Name: _________________________________________________________

Your Telephone Number and/or Email Address: ___________________________________

___________________________________________________________________________

Which course(s) would you like to attend? Please tick as many as you like:

“Understanding Mental Health Services” Tuesday 21st February, 2pm-5pm

“Advocacy and Empowerment” Monday 27th February, 6pm-9pm

“Diagnosis and Beyond” Monday 6th March, 6pm-9pm

Optional: Are you...?

Service User Family Member Professional Experience

Other: ___________________________________________________________________________________

Please give details of a person we can contact for you in case of emergency:

Emergency Contact Name: _____________________________________________

Emergency Contact Telephone: _____________________________________________

Any suggestions for future courses? ______________________________________

Thank you. You will receive a text or email confirming your place. We look forward to seeing you and hope you enjoy the course.

Your details will be kept on our confidential database and will not be shared with anyone without your permission. If you wish to remove your details from the database you can do so at any time by contacting Dan Taylor, as below.

Please return this form to: Dan Taylor, Education & Development Officer, Mid West ARI Project Office,

St Joseph’s Hospital, Mulgrave St, Limerick Tel: 061 461226 Mob: 085 876 8517 Email: [email protected]


58

Appendix 12: Summary of Recovery Principles for Students Workshops

Date Venue Audience Number attended

Approval rating

23/9/16 GEMS, University Hospital Limerick*

Medical Students 19 n/a

12/10/16 The Health Hub, Limerick Occupational Therapy Students

11 99%

19/10/16 The Health Hub, Limerick Mixed 14 93%

4/11/16 GEMS, University Hospital Limerick*

Medical Students 18 n/a

22/11/16 School of Nursing & Midwifery, University of

Limerick*

General Nursing Students

30 n/a

9/12/16 GEMS, University Hospital Limerick

Medical Students 16 90%

9/1/17 St. Joseph’s Hospital, Limerick

Psychiatric Trainees 5 95%





4/4/17 Health Sciences Building, University of Limerick

Psychiatric Nursing Students

15 100%

Total: 147 95% (mean)

* Feedback not collected

59

Appendix 13: Sample Poster for ARIES Workshops

Mid West ARIES

(Advancing Recovery in Ireland Education Service)

Recovery & Wellbeing Workshops

For those with lived experience of mental health challenges, their family

members/carers, healthcare professionals/students, and anyone with an interest in

mental health and Recovery.

Workshop Themes & Dates:

“What is Recovery?”

Tuesday 18th April, 2pm-5pm

“Understanding Mental Health Services”

Tuesday 25th April, 6pm-9pm

“Advocacy and Empowerment”

Tuesday 2nd May, 2pm-5pm

“Diagnosis and Beyond”

Tuesday 9th May, 6pm-9pm

Cost: No cost.

Where?: Samaritans Building, Barrington Street, Limerick

Interested?

Please contact Dan Taylor on 085 8768517 or at [email protected] for more

information, and to book a place.

Places are limited so booking is essential.


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Appendix 14: Summary of Workshops delivered by EDO and PE (Pilot Phase)

Date Workshop Theme

Venue Numbers attended

Service user

Family Member


Student Total Approval Rating


Le Cheile, Limerick 6 2 1 9 99%


The Health Hub, Limerick

2 2 4 94%

21/11/16 Advocacy and Empowerment


8 2 3 2 15

85%


Le Cheile, Limerick 5 1 1 7 100%


Services

Le Cheile, Limerick 6 2 1 1 10 97%


Services


13 2 4 19 97%



10 3 2 15 94%


Le Cheile, Limerick 4 1 5 100%

Totals: 54 13 12 5 84 96% (mean)

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Appendix 15: Summary of Workshops Delivered by Volunteer Facilitators (Main Phase): January-March 2017

Date Workshop Theme

Location Numbers attended

Service user

Family Member


Student Total Approval Rating


Ennis 13 5 3 3 24 97%


Services

Ennis 6 3 2 1 12 99%


Nenagh 8 3 1 2 14 88%


Ennis 7 3 1 2 13 87%


Services

Nenagh 5 3 2 2 12 96%


Ennis 5 4 2 2 13 97%


Nenagh 7 3 2 12 96%


Nenagh 8 4 2 2 16 94%

Totals: 59 28 15 14 116 94% (mean)

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Appendix 16: Initial themes from feedback from workshop participants

Personal experiences

Equality

Connection

Having support

Straying from topics

Safety

Time restraint

Take-away information

Contribution

Thankfulness

Refresher course

Managing recovery

Security

External input

Straight forward information

Vulnerability leading to openness

Held attention by Media

Need for more information

Involvement leading to productivity

Unpressured to get out of comfort zone

Organization of event Caring

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PART TWO- ARIES Workshops and Facilitator Resources

How to use this Resource

Please visit:

http://www.hse.ie/mwaries

Scroll down the page to the section marked “ARIES Workshops”.

In this section of the website you will find:

Workshop Session Plans including Facilitator Notes

PowerPoint Presentations

Handouts

For each of the following ARIES Workshops:

Workshop One: What is Recovery?

Workshop Two: Understanding Mental Health Services

Workshop Three: Advocacy and Empowerment

Workshop Four: Diagnosis and Beyond

Workshop Five: CHIME

Workshop Six: After Recovery What Next?

Workshop Seven: Recovery Principles for Students

Please contact Niamh Wallace, ARIES Project Lead, to request permission to use these

resources.

http://www.hse.ie/mwaries

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