Guidelines for Higher Education Institutions on involving Service Users in the training of Graduate Primary Care Mental Health Workers.
Colin Gell - User Consultant
These guidelines are published on the Knowledge Community Nimhe website in advance of official publication. They have informed the good practice guide on service user and carer involvement in mental health education and training, “Learning from Experience” -
produced by the Mental Health in Higher Education project in conjunction with NIMHE West Midlands and Trent Workforce Development Confederation.
The guidance addresses a wide range of issues specific to user involvement in Higher Education training and asks the right questions to assist inclusive decision-making and working towards local solutions. The user voice is central to this process and Colin Gell, in his capacity as User Consultant to the Nottingham Advocacy Group, has consulted widely amongst user organizations to ensure their views are heard. The scope of the acknowledgements bears witness to his commitment to build an informed consensus from a wide range of agencies.
This guidance provides a useful resource to the key partners in Higher Education, Regional Development Centres, local Workforce Development Confederations and Primary Care Trust employers in working with Users towards enhance their training role. Importantly, these guidelines address key points of direct relevance to the planning, delivery and evaluation of the Graduate Worker training programme and will assist in completion of the user involvement questions within the National Continuous Quality Improvement Tool for Mental Health Education published by the Northern Centre for Mental Health in July 2003.
Colin currently works for the National Institute for Mental Health at the East Midlands Development Centre.
David Rushforth Project manager, Graduate Primary Care Mental Health Worker
The Trent Workforce Development Confederation (WDC) has commissioned twelve Higher Education collaborations in England to train graduates to work with mental health users in primary care settings. Trent WDC intend for this training to be provided in a consistent way nationally with scope for local interpretation of the role. The involvement of service users in the provision of training is vital to its success and Trent WDC is keen to see their involvement in all aspects of the training, design, delivery and evaluation. Discussions with the collaborations have highlighted the need for guidance on how service user involvement might best be taken forward. Valuable comments have been forthcoming from a large number of individual service users and user involvement workers from informal visits, individual interviews and during conference workshop discussion groups. Additional contributors include the User Reference Group at Kings College, London and academic staff from the Higher Education collaborations. Three key questions were posed:
1. If service users are to be meaningfully involved what would that look
like? Where do we start?
2. Regarding the content of courses, what are the areas that service users feel are
vital to be included?
3. How can service users be best involved in the provision of the training?
1. Service User Involvement
• Open Event
It is recommended that each Higher Education training centre invite service users to an open event, to share information and listen to their views on what they think Graduate Primary Care Mental Health Workers need to be able to offer to users of primary care mental health services. Every effort should be made to involve people who have only used primary care as well as people who have used both primary and secondary services. At such open events, time should be set aside to explore with service users how they can be involved in training graduate workers.
• User Reference Group
The open event should actively seek nominations for service users to sit on a user reference group that will be involved in many aspects of graduate worker training, including both design and delivery decisions.
It is vital that the reference group is inclusive of the diversity of people using services, with regard to race, gender etc. Some sites are intending to employ a service user as member of the university team, in order to facilitate the user reference group and support its members. This is viewed as an essential step to ensure adequate support for service user trainers. Funding will be needed to pay people for their involvement. Consideration will need to be given as to how people can be paid.
Attention should be given to preparing service users to be trainers. Anglia Polytechnic University put on a regular day for people to learn about training. Consideration should be given to how this training can be accredited.
• Planning Group
Service users should be represented on the group that plans the curriculum. Service users can be involved in designing material for individual training sessions e.g. case studies through to advising on the assignments learners are asked to submit.
• Advisory / Steering Group
Service users should be on the Steering Group that oversees the course of study and attend all audit and quality assurance meetings relating to the course. Members of the user reference group should be fully involved in the on-going monitoring of the course. • Selection of workers
Service users should be involved in the recruitment, interviewing and selection process, working alongside the employing Primary Care Trusts and Universities to ensure appropriate people are employed as graduate workers.
It might well be interesting to develop informal support networks whereby a student and service user meet over the length of the training. They might also look at how the training needs might change over the course of the Graduate Worker experience. Joint visits with users and placements in user agencies will also assist with involving users in the delivery of the course.
• Support for Trainers
A clearly thought-out plan to ensure that service user trainers are well supported will need to be agreed before the start of the training. Users will welcome on-going feedback on their contributions through regular meetings with course leaders.
Higher education collaborations will need to think through how service users can be involved in assessing students‟ work. Some universities are already looking at this e.g. Bristol and Birmingham where a panel of users are involved with the RECOVER course to provide feedback on student‟s portfolios about user participation and recovery.
Research activity related to training and its impact on service users should actively seek to engage user involvement in the Project Steering Group which overviews the research project from an early stage. There is scope for user involvement into research design and delivery, most notably where user interviews are anticipated. User involvement can extend to commentary on questionnaire design and wording, conducting interviews, running focus groups etc. Research training for users is an essential part of their wider training development needs.
2. Content of course
People contributing to the consultation suggested that the following important areas should be included in the course with opportunities for joint learning for students and service users on a regular basis. There is no order of importance or priority indicated. • Personal Experiences/testimonies
• Pathways to help - Where do people go to get support?
• Understanding of Advocacy
• User Involvement in Practice - Individual and collective involvement/empowerment • Local Knowledge – knowing about support and user groups
• Interventions - What works from the service user point of view?
• Importance of self-help - Providing clear information and to check understanding
• User link to Primary Care - How can these workers be the main link with service users?
• Developing Relationships - Building up an understanding with users. Good people
skills and listening skills
• Ordinariness - Providing links to mainstream education, housing, benefits, work etc
• Understanding of Mental Health and Primary Care policy and culture • Clinical Governance / Audit / Needs Assessment
• Testimonies by Service Users from minority ethnic groups • Understanding of the Mental Health Act
• Discrimination / Stigma
• Social Inclusion
• Issues for Service Users around employment
• Understanding use of direct payments
• Recovery / self-management
• History-models of madness
• Mental health promotion v medical model
• Influencing other primary care workers (receptionists etc)
• Use of medication
• Values in mental health
• An understanding of how primary & secondary services work and interface
3. Involving service users in training
The general consensus amongst the contributors viewed „stand-alone‟ or „one-off‟ user
teaching as insufficient. Service users should be involved in a whole range of ways to ensure there is a user perspective integrated into all elements of the course. This inclusive approach aims to draw upon the full depth of the user‟s expertise, in addition to their presentation skills.
A review of external teaching budgets is strongly advised to ensure sufficient funding is identified exclusively for payment of service user trainers. The established norm is to pay service user trainers at standard rates. Before the commencement of any involvement, full discussion and agreement is required to establish the best way for them to receive payment. There is a need for a very flexible approach to this very important area. A sizeable pool of trained service users will be needed. It is important to note that, alongside the commitment from universities to recruit and train people, Regional Development Centres of the National Institute for Mental Health England should provide training for service users to enable them to be better prepared for involvement in both training and service delivery issues. For example, the East Midlands Development Centre has already committed funding for an initial two-year programme of training for around two hundred service users across the five counties. Advice is available from the Regional Development Centre on promoting User Involvement in training.
It has also been suggested that there needs to be ways for service users to come together across collaborations to share their experiences. A national 'network' bringing service user trainers together has also been suggested.
User involvement perspective - Nottingham Advocacy Group
ColGl@aol.com - contact Colin Gell at
User reference Group - University of Southampton - contact Steve Tee at email@example.com
Preparation for training - Anglia Polytechnic University - contact Tim Schafer at firstname.lastname@example.org
Users as Assessors - University of Birmingham - contact Diane Bailey at D.E.Bailey@bham.ac.uk
Paying users for training - University of West England - contact Stewart Dewer at Stewart.Dewer@uwe.ac.uk
User involvement in assessing pre-registration mental health nurse practice - Oxford
- contact Bill Spence at email@example.com
I wish to thank the many anonymous users and user involvement workers who freely gave of their time and expertise. I also acknowledge the valuable contributions from the following people and organizations.
Alan Kitt, West Lincolnshire Primary Care Trust
Ann Davis, University of Birmingham
Annette Donovan and colleagues, User Voice, Derbyshire
Anni Telford, University of Derby
Barbara Crosland, Nimhe West Midlands user development worker Bernie Martins and colleagues, Open Assembly, Leicester
Bill Davidson, Impact
City-wide Council, Nottingham
Delegates attending the Graduate Primary Care Mental Health Worker Conference, Nottingham
Delegates attending the Mental Health in Higher Education Conference, Derby Delegates attending the Mental Health Training and Education Conference, Nottingham Delegates attending the Nimhe West Midlands Conference, Stafford Diane Bailey, University of Birmingham
East Midlands Development Centre- Training Group
Heather Raistrick, Northern Centre for Mental Health
Joel McCann, Peoples Forum, Leicester
John Cairney, Moving On, West Midlands
John Playle, University of Manchester
Kay Macdonald, Salomons, Christ Church College
Liz Salisbury, User and Carer support worker, Lincolnshire Manjit Rostom and Soo Lee, University of Hertfordshire
Nottingham Advocacy Group
Piers Allott, Nimhe Recovery Fellow, University of Wolverhampton Sara Owen, University of Nottingham
Steve Tee and the External Reference Group, University of Southampton Stewart Dewar, University of Western England
Theo Stickley, University of Nottingham
Tim Schafer, Mohammed Abuel-Ealeh and colleagues, Anglia Polytechnic University Tina Coldham, User consultant, University of Southampton Tony Riley, Having a Voice, Manchester
Unblocking Potential Project, Sheffield
User Reference Group, Kings College, London
Our apologies to anyone we have inadvertently omitted from our list of contributors.