The growth of recovery colleges in recent years is helping to fill the gap in mental health service provision between in-patient care and outpatients’ recovery within the community.
For people recovering from a period of mental ill health, getting involved in the local community can be an important part of their recovery, but finding services that fit with their lives can be difficult. But an increasingly popular option is to enrol at a recovery college, where they can study in an environment geared towards helping people in their ongoing recovery from mental illness.
The first recovery colleges were established in the UK more than six years ago and The Centre for Mental Health and NHS Confederation Mental Health Network say they are transforming mental health services. There are now almost 40 recovery colleges in operation, mainly in England, but also in Scotland, Ireland, Italy, Australia and Japan.
Many UK recovery colleges are members of Implementing Recovery through Organisational Change (ImROC) [www.imroc.org/]. They meet regularly to share good practice and improve their own practice.
Recovery colleges enable people to become experts in self-care and develop the skills they need for their life and work. At a recovery college, students develop their own understanding of their difficulties as well as other skills and resources such as self-management. They widen the focus from a narrow perspective of simply symptom reduction to a more meaningful, enriched overview of recovery and skill development. Colleges are run on mainstream college term times and provide education as a route to recovery, not as a form of therapy.
Peer trainers – people with lived experience of mental health issues – and mental health professionals co-devise and co-deliver the courses. The colleges’ inclusive nature mean that students require no educational qualifications and all contributions are recognised and valued. Courses are available to people with mental health issues, their families, carers and professionals.
Rinaldi and Wybourn (2011) reported that 18 months after first attending college, almost 70% of students surveyed had become mainstream students, gained employment or started volunteering. In two studies, students’ quality of life and wellbeing significantly improved after attending recovery colleges as measured by Warwick Edinburgh Wellbeing Scale and MANSA (Meddings et al, 2015; North Essex Research Network, 2014).
Recovery College Greenwich
Mental health trusts run most recovery colleges, although some are partnerships with voluntary sector organisations and others run from educational establishments. All have a common core ethos, but differ in the way they are run.
One example is Recovery College Greenwich, based in Woolwich, southeast London, and hosted by mental health charity Bridge Mental Health. When Greenwich Clinical Commissioning Group commissioned the service in 2013, they placed the college within the community. Currently, more than 1,000 students are enrolled there. The location at a new site which also hosts a café, is developing into a local mental health and wellbeing hub under an umbrella of service provision, called The Recovery Place.
Students are not asked for details of their diagnosis on enrolment at the college. Many students say that enrolling is the first time someone has focused on their life and what they want to achieve rather than their diagnosis and report the positive impact this has had on their mental health and wellbeing. For example, one student, Jacqui Collins, says: “Coming to Recovery College Greenwich has been my saviour and has helped my recovery tremendously. If I’ve had a bad day the amazing staff and students give me a boost. I’ve made nice friends, which has really helped and we all support each other.
“Last year I ended up in a local psychiatric ward. It was there I found out about Recovery College Greenwich. [I met] a lovely lady, Gemma, on the ward and I had an idea of setting up a coffee morning for people with mental health issues in the local community. But it wasn’t until I’d spent time at the recovery college where staff encouraged me to believe I could achieve this, that I took action. I’ve now set up a regular coffee morning and it’s a success. I couldn’t have done it without Recovery College Greenwich to come to and I still attend the college every week as my recovery continues.”
Respect and trust are at the heart of the college approach and underpin the range of courses, seminars and workshops, which are co-designed and co-delivered by peer trainers, mental health practitioners and college partners. A steering group of people with lived experience, mental health practitioners and education providers lead the college’s development.
Partnership working and co-production
Partnership working lies at the heart of the success of this and other recovery colleges. Recovery College Greenwich envisages that this will improve what the college can offer, support integration across the borough and ensure longer-term sustainability.
Another recovery college with partnership working at its heart – all aspects of the college are co-produced – is Sussex Recovery College, a partnership between Sussex Partnership NHS Foundation Trust, Southdown and other voluntary sector organisations. It is part of the national ImROC Recovery College Learning Network.
The college held its first courses in spring 2013 and more than 1,000 students have since attended. The college has shown positive outcomes: more than 95% of students say they would recommend the course they did to others. Students have also progressed in terms of personal goals, subjective measures of recovery (CHOICE and Process of Recovery), quality of life (MANSA) and wellbeing (SWEMWBS) (Meddings et al, 2015).
Students have suggested that the centrality of co-production is what makes the college helpful. As a report noted: “It was the equality, learning from peer trainers’ lived experience and professionals that helped.” The safe environment created by the college and the knowledge they learned from the combined expertise of peers and mental health professionals also helped: “The combination of professional and research evidence knowledge coupled with real life knowledge made it come alive,” (Meddings et al, 2014).
Meanwhile, at SLaM Recovery College, run by South London and Maudsley NHS Foundation Trust, choice is an important quality. There, students – who may be taking part in education for the first time in years – are able to make choices about the courses they study, where and when they take part. People have the opportunity to learn in a safe and welcoming environment, which they may not have experienced previously. In turn, students say that they feel more confident and have learned coping strategies to manage the challenges they experience, and are moving onto formal learning, peer support, befriending, volunteering and work, including joining the college as peer recovery trainers.
At the end of each session, students are asked to fill out a short evaluation form about their experience. One question asks if people feel more hopeful as the result of attending. Usually, the response is “I feel more hopeful”, which, for many students, is a shift in their outlook.
Location can also be important. For example, Solent Recovery College – a partnership between the local adult mental health services, Highbury Further Education College and Solent Mind – is hosted in an existing educational facility. This means students attend a mainstream environment, and are able to join the student union, use the library, IT suite and access discounted activities.
As a result, students have reported positive outcomes. For instance: “My communication skills have improved. I am going out much more (remembering things I have learnt). It has improved my confidence.”
Another student said: “[It] has given me more hope for the future. Has made me realise that I'm not unusual and given me permission to allow myself time.”
A third said: “I've made a lot of changes in my life since starting at the Recovery College. I see growth in myself and so do my friends. They're amazed at the progress that I have made.”
The Central & North West London NHS Foundation Trust Recovery & Wellbeing College recognises the co-production ethos of their college as a fundamental principle. College manager, Syena Skinner, says: “The college’s commitment to the principles of ‘true’ co-production, the recognition of the commonality that everyone’s a student and considered a recovering human being continues to offer a positive model for this approach within the organisation. It opens up discussions that break down stigma and discrimination at all levels. Feedback demonstrates that personal recovery is an individual journey.
“Students and their supporters repeatedly report that attendance at the College has opened up possibilities to recover and discover a life, living with and beyond symptoms and their diagnosis. Staff and students report the positive influence the College has had on their practice, realising their impact on an individual’s use of services and their journey out of services, as well as on their own wellbeing.”
Building on recovery
But it is the outcomes for people who attend recovery colleges that is most important. For instance, students at the Recovery College at South West London & St. George’s comment regularly about feeling the courses have been the first step in their recovery or have helped them build on their recovery. Every term students leave courses as they have been successful in securing paid work. Co-production is also a founding ethos of this college and they run a trainee peer trainer programme to encourage students to become peer trainers. There are also voluntary opportunities for students to work at the college, which has been a successful addition.
It has also been valuable for the college to update its existing courses and develop new ones. This has allowed a deeper understanding of how and why the courses are successful enabling the steering group to replicate and develop what has worked. They have also co-produced a document underlining the core competencies of their trainers in order to recognise and support their development.
There is a need for research to examine possible mechanisms of change in recovery colleges. It seems likely that their success is not only due to the recovery education students learn in class but the co-production, genuine valuing of lived experience and being treated as adult learners who choose what might help them in their recovery.
Recovery colleges provide a safe environment in which a person with mental health issues can recover and develop within an educational environment in the community, something that was lacking prior to their development. Raymond Sheehy, CEO of Bridge Mental Health, that runs the Recovery College Greenwich, says: "Experience is showing us that recovery colleges are a place for all of us to come together to engage in educational activities that support our health and wellbeing: enabling us to flourish.”
Raymond Sheehy, CEO, Bridge Mental Health: www.recoverycollegegreenwich.org
Sara Meddings, consultant clinical psychologist working with Sussex Partnership NHS Foundation Trust and a consultant with ImROC: www.sussexrecoverycollege.org.uk
Kirsty Giles, manager, SLaM Recovery College: www.slamrecoverycollege.co.uk/
Syena Skinner, recovery and wellbeing college manager, CNWL Recovery & Wellbeing College: www.cnwl.nhs.uk/recovery-college/
Toni King, OT and recovery lead, Solent Recovery College: www.highbury.ac.uk/student-life/advice-and-support/solent-recovery-college/
Meddings S, Byrne D, Barnicoat S, Campbell E & Locks L (2014) Co-Delivered and Co–Produced: Creating a Recovery College in Partnership. Journal of Mental Health Training, Education and Practice 9 16-25.
Meddings S, Campbell E, Guglietti S, Lambe H, Locks L, Byrne D & Whittington A (2015) From Service User to Student – The Benefits of Recovery College. Clinical Psychology Forum 268 32-37.
Meddings S, Guglietti S, Lambe H and Byrne D (2014b) Student perspectives: recovery college experience. Mental Health and Social Inclusion 18 142-150.
North Essex Research Network with South Essex Service User Research Group (2014). Evaluation of the Mid Essex Recovery College October-December 2013. Anglia Ruskin University.
Perkins R, Repper J, Rinaldi M & Brown H (2012) Recovery Colleges, ImROC, Briefing 1. Centre for Mental Health (online).
Rinaldi M & Wybourn S (2011) The Recovery College Pilot in Merton and Sutton: longer term individual and service level outcomes. South West London and St. Georges Mental Health NHS Trust.