The Life Rooms: An Innovative Recovery Approach

Rotherham, Clare1

Raffay, Julian1

 

1Mersey Care NHS Foundation Trust

This work is licensed under a Creative Commons Attribution 4.0 International License.

KEYWORDS

Recovery, Mental Health, United Kingdom, Delivery of Health Care


The National Context

Mental health care in England has developed significantly. In the early 19th century and into the Victorian era, asylums were established for those suffering from mental distress. These were set up as self-contained establishments in rural areas with a strong focus on work and recreation.

Moving into the 1950s and beyond, greater acknowledgement of human rights and the creation of the National Health Service (NHS) led to the closure of many Victorian asylums and the movement towards a community-focused model of mental health care.

Alongside this, the development of psychiatric drugs further secured the establishment of the medical model as the frame of reference for mental health workers. Both the International Classification of Disease (ICD) and the Diagnostic and Statistical Manual for Mental Disorder (DSM) are utilized in the United Kingdom; the clinical language of diagnosis, disease, and drug treatment remain the main references for statutory mental health services.

Within this picture, policy initiatives have aimed to increase the effectiveness of mental health services. For example, the Care Programme Approach was developed in the 1990s to provide more intensive, co-ordinated support to those who need it. More recently, in 2011, the British Coalition government published a mental health strategy that aimed to support people with mental distress through aiding their physical health, challenging stigma, and supporting those caring for people experiencing mental distress.

Despite this, mental health outcomes have still been worsening in recent years.1 The current financial situation of the NHS warrants more creative approaches, exploring opportunities beyond what has already been tried.

Mersey Care NHS Foundation Trust (Mersey Care) is a secondary mental health Trust, providing specialist mental health services in North West England and beyond. Mersey Care provides specialist inpatient and community mental health, learning disability services, addiction services, and acquired brain injury services.

Although Mersey Care primarily provides secondary mental health services, it is reasonable to ask broader questions about mental health support. For example, what is the effectiveness of mental health support for those being discharged from secondary mental health care? What are the needs and support for those being managed by primary care, or indeed those not receiving any formalized clinical service at all?

These broader questions are the motivation for one of Mersey Care's latest ventures: The Life Rooms. The Life Rooms explores the contributions that Mersey Care can make towards supporting the recovery journey of those moving out of its services. It also aspires to strengthen the opportunities for support at a primary care level, thereby reducing the time spent with General Practitioners (GPs). Furthermore, the opportunities available at the Life Rooms aspire to work preventatively with those who may not yet have sought formalized help for their distress. It is with these broader aspirations in mind, and against the backdrop of an increasingly stretched health care system, that Mersey Care developed the Life Rooms', a 'community hub' model in response to mental distress. This hub houses the Recovery College, volunteering services and employment support under one roof in an inclusive and positive environment.

Development of Life Rooms

The Five Year Forward View for Mental Health document sets out the start of a ten- year transformation for NHS mental health care, specifically:

  • a shift towards prevention
  • recognizing the goals of people outside their mental health diagnosis
  • tackling the disproportionate way in which mental health problems affect those living with social deprivation1

Within the business case for the Life Rooms, there is a strong focus on recovery. It states that recovery is built upon four key foundation stones:

  • finding and maintaining hope
  • re-establishment of a positive identity
  • building a meaningful life
  • taking responsibility and control

The broad theme running throughout this literature is transforming mental health care delivery and the specific recognition of community approaches within this:

"Leaders across the system must take decisive steps to break down barriers in the way services are provided to reshape how care is delivered."1

The notion of recovery links with the prevention focus of the Five Year Forward View for Mental Health document and the recognition of people beyond their diagnosis. The goal to create a centre for recovery and social inclusion, designed to address the social determinants of mental distress, as detailed in the business case for the Life Rooms, is an attempt to respond to the need for a community offering that can provide a social support response.2

Within the literature, there is also recognition of the potential economic benefits of service transformation. Poor mental health costs £105 billion a year in England.1 Projects such as the Rotherham Social Prescribing Service give clear, independently evaluated examples of where Localized Clinical Commissioning Groups (CCGs) have implemented social responses to mental health and evidenced their wellbeing outcomes and economic effectiveness.3,4

A New Approach: The Life Rooms

The Life Rooms opened its doors on May 9, 2016 and has begun to work towards the aims and objectives outlined above. The Life Rooms houses Mersey Care's Social Inclusion and Participation Team, which comprises a number of Mersey Care services including a Recovery College, volunteering services, and employment support. In addition, The Life Rooms offers a safe and welcoming environment with access to a library service, computers, and a café. The Life Rooms provides a confidential advice area in which vocational pathways advisors provide individual support and community partners offer information and guidance on issues such as housing and employment.

In terms of raising the profile of mental wellbeing, the Life Rooms makes a statement by placing a mental health service in the heart of the community. The Life Rooms is offering a non-clinical space that is accessible by all members of the community, not just service users. The Life Rooms offers practical community resources, in addition to wellbeing support. This offers a new way of challenging stigma in the sense that it begins to demystify and provide some transparency to the concept of a 'mental health service.'

Promoting mental wellbeing through non-clinical opportunities aligns with the concept of 'social prescribing'. The Social Prescribing Network describes social prescribing and its potential in the following way:

By facilitating the patients' access to a whole range of voluntary and local services, including becoming volunteers themselves, there is much potential to nurture local social capital and catalyse health-creating communities that strengthen their ability to care for themselves and each other. Social prescribing recognizes that the third sector is a largely untapped asset that can deliver further integration between health and social care in the creation of a more responsive and efficient local health economy. Social prescribing can be used to empower the patient to look for solutions to social problems before a crisis occurs that might affect their physical or mental health.6

The Life Rooms offers a further contribution to the development of social prescribing in that it is operating within the framework of secondary mental health services. However, it also encompasses the need for the facilitation of third sector assets within the model. The Life Rooms brings together non-clinical opportunities for support, including those within the third sector, alongside local authority offerings, private sector workers, and Mersey Care's own services. The bringing together of such a wide range of opportunities for advice, support, learning, and self-development within a non-clinical, community-facing environment is an innovative approach to wellbeing support.

Improving access to meaningful occupation or employment opportunities becomes particularly significant when we consider that the employment rate for adults with mental health problems in the United Kingdom remains unacceptably low: 43% of all people with mental health problems are in employment, compared to 74% of the general population and 65% of people with other health conditions.1

Further, the recognition that meaningful activity is a key factor to recovery, as well as a strengthening factor for a community, informs one of the key aims for the Life Rooms. Employment is not appropriate for many people, but everybody should have the opportunity to explore what is meaningful activity for them.

Mersey Care has a significant history of holding service user and carer voices as central to service development via the provision of participation opportunities throughout the Trust. Central to Mersey Care's approach to participation is a commitment to the rights of service users and carers to be involved as equal citizens in decisions that affect their lives by everything that we do. Service users and carers are not involved in Mersey Care because it will be good for them, good for the Trust, or because it is the policy flavour of the government of the day. Service users and carers are involved because they are valued citizens with a human right to be involved. Working in this way results in many benefits for the Trust, society and ultimately the individual:5

  • Enabling service users and carers to participate as equal partners in all aspects of the Trust is an important way for Mersey Care to meet its legal obligation, to protect and promote the human rights of vulnerable people in its care.
  • An essential component of quality service development and delivery is the lived experience service users and carers have of those services. Service users and carers also have a wide range of valuable knowledge, skills, and experience in addition to their knowledge and experience of Trust services.
  • The participation of a diverse range of service users and carers who reflect the communities served by the Trust is essential if the Trust is to be a relevant and responsive organization.
  • Participation of service users and carers as equal partners in decision making is a means of tackling the power imbalance that often exists between professionals and lay people and is a means of achieving cultural change.
  • Participation of service users in decision making has good recovery and social inclusion outcomes for service users and carers, i.e., they move beyond an existence defined by illness to a life defined by themselves.

This ethos is central to the Life Rooms work. As such, there are many opportunities for participation within the Life Rooms, including service user steering groups and advisory panels. Volunteer services are also positioned within the Life Rooms, giving service users, carers, as well as the community opportunity to contribute towards Life Rooms service provision. Support is available to anyone interested in exploring volunteering opportunities within Mersey Care and beyond. There are a number of volunteers who work within the Life Rooms, all of whom are service user volunteers.

There are a number of opportunities to receive employment support in the Life Rooms. This can be provided by Mersey Care staff or external partners, or indeed, a combination of both depending on requirements. The Life Rooms facilitates support for individuals from a wide range of external organizations, as well as hosting events to showcase employers with appropriate employment opportunities.

The pathways advisor posts that have been developed as part of the Life Rooms service are key to this facilitation. They support visitors to navigate their way through the different Life Rooms offerings in accordance with their needs. They provide a point of contact for visitors, as well external organizations, and are therefore key to monitoring outcomes. The role is a brand new role within Mersey Care; in many ways it is similar to the social prescribing role outlined above. It offers the opportunity to work in a person-centred way with individuals as well as responding to community need via external provider offerings where necessary.

In terms of contributing to a stronger community through partnerships, the Life Rooms contributes to this agenda by forming partnerships with external organisations in order to create more effective service provision. The Life Rooms also provides resources for local community groups more generally. The library and computer access are examples of this, as well as hosting groups from the local Children's Centre, local interest groups, craft, and book clubs. Additionally, since opening, the Life Rooms has hosted a number of events, offering wellbeing opportunities for those within Mersey Care and the local community.

Working in this way is particularly significant. It is not about financial input, but a community-focused, asset-based approach. The joining up of private, public, and voluntary sectors has potential to improve outcomes for individuals., Remodelling community services in this way also presents opportunities in a broader sense, creating potentially less expensive, more effective ways of working.

Finally, in recognition that people in marginalized groups are at greater risk of mental distress,1 promoting diversity and access to mental health support for marginalized groups is an important aim of the Life Rooms work. Evaluation of our client base in respect of protected characteristics is on-going and will inform strategies within this area.

The Life Rooms: The Vision for the Future

As a service, the Life Rooms aims to contribute to the development of mental health services, prioritizing a community model. The Life Rooms explores the contributions that Mersey Care can make towards supporting the recovery journey of those moving out of its services. It also aspires to strengthen the opportunities for support at a primary care level, thereby reducing the time spent with GPs. Furthermore, the opportunities available at the Life Rooms aspire to work preventatively with those who may not yet have sought formalized help for their distress.

 

Current economic challenges faced by the United Kingdom Health system present mental health services with a considerable challenge. It is increasingly apparent that previously accepted models of community care are becoming unsustainable. It is also clear that demand for mental health services within the Trust is growing by between 4% to 5% each year. This reality challenges us to think differently around how we provide community care. The Life Rooms model seeks to respond to this challenge by taking a community asset-based approach involving cohesion between statutory, voluntary, and commercial sectors. Our aspiration is to develop an holistic social model that not only results in better outcomes for individuals and communities, but one that also enables us to switch off costs relating to traditional clinical models of care. A full econometric study will be required to robustly build the case in support of this aspiration.

 

Looking ahead, a second Life Rooms site has been identified. This represents the start of the process of replicating the Life Rooms model across the Mersey Care footprint.

Acknowledgements

The authors are grateful for contributions to the manuscript by Michael Crilly, Director, Social Inclusion and Participation Team, Mersey Care NHS Foundation Trust and Gary Thorpe, Head of Recovery College Development, Mersey Care NHS Foundation Trust.

 

Julian Raffay does not have any conflicts of interest to declare regarding the publication of this article or its content.

Clare Rotheram does not have any conflicts of interest to declare regarding the publication of this article or its content.

 

Corresponding Author: Clare Rotheram, Mersey Care NHS Foundation Trust, The Life Rooms, Evered Avenue, Walton Liverpool L92AF email: clare.rotheram@merseycare.nhs.uk

 

References

 

1.   Taggart, H. The five year forward view for mental health. 2016 [cited 2017 January 16]; Available from: https://pdfs.semanticscholar.org/59f4/8ef5ec2914966d19798c98888a51707f0d2e.pdf.

2.   Crilly, M., Business case 2015, Centre for Recovery and Social Inclusion: Cork, Ireland.

3.   Dayson, C., N. Bashir, and S. Pearson. From dependence to independence: emerging lessons from the Rotherham social prescribing pilot. 2013 [cited 2017 January 16]; Available from: http://www4.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/rotherham-social-prescribing-final.pdf.

4.   Dayson, C. and N. Bashir. The social and economic impact of the Rotherham social prescribing pilot. 2014 [cited 2017 January 16]; Available from: http://www4.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/social-economic-impact-rotherham.pdf.

5.   Mersey Care NHS Foundation Trust. Operational plan 2016/17. 2016 [cited 2017 January 16]; Available from: http://www.merseycare.nhs.uk/media/2997/operational-plan-public-summary-word-version-v3-04-08-16.pdf.

6.   Report of the annual Social Prescribing Network conference. Jan 2016. London. 2016 [cited 2017 January 16]; Available from: https://www.westminster.ac.uk/patient-outcomes-in-health-research-group/projects/social-prescribing-network.

 

 

 



Copyright (c) 2017 Clare Rotheram, Julian Raffay

Journal of Recovery in Mental Health ISSN 2371-2376