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Discovery Partners: Facilitating and Enabling the Persons Whole Life Discovery Journey

We work in partnership with individuals who have used mental health services for long periods of time and want to make significant improvements to their mental health and their lives.

We provide the essential time and space required for people to embark on their discovery journey.
The Discovery Partnership achieves this by focussing on peoples unique assets and circumstances and breaking the cycle of hopelessness, dependency and maintenance.
We call it discovery, because “recovery” is misunderstood and presumes getting something back that has been lost, whereas “discovery” means finding new ways to fulfil a better life for yourself and equipping you to do that.

Introduction
Many people are using mental health services for long periods of time.

These are people who can take up a lot of time and resources including:
requiring the support of emergency services (police, ambulance, accident and emergency)
frequent readmissions to acute hospital services
requiring placements in specialist residential services (including out of area)
are a significant proportion of the clients of community mental health teams
are often subject to repeated sectioning under the mental health act
are often seen to be at risk and not in receipt of appropriate support

This program is specifically designed for these people.

Further, it is the social, economic, and physical environments in which people live that to a great extent influence peoples mental health and many common mental disorders. It is well evidenced that social inequalities are associated with increased risk of many common mental disorders. Taking action to improve the conditions of daily life from before birth, during early childhood, at school age, during family building and working ages, and at older ages provides opportunities both to improve population mental health and to reduce the risk of those mental disorders that are associated with social inequalities. This is why we are focussing on the whole life needs of people and the communities they live in.

The services invest a great deal of time and resources in finding ways to provide a better, individualised package of care and support for these people. However, the focus of the care is often on addressing peoples immediate and short term needs. The Whole Life issues that very often led them to require services in the first place are not fully understood or resolved. Further, the nature of the service can create a cycle of dependency and maintenance for the individual. This is sometimes described as people being “stuck”. In spite of significant resources being used for these individuals, it is questionable as to whether we have found the most effective response, in terms of cost and positive outcomes.

The needs of the individuals require a completely different approach. This approach should be based on identifying and working toward meeting the whole life needs and goals of people. We achieve this by working on a one to one basis and setting achievable shared objectives and outcomes. This way of working with people is not easy to realise in many places because of the immense pressure on services and mental health workers . Therefore very often they do not have the time and space to do this work. The IMHCN team has developed a way of meeting this need called Discovery Partners.

2. Discovery Partners
Discovery Partners forge and facilitate a partnership between identified service users, their social networks and their mental health workers. They use their professional skills and expertise in a collaborative partnership with the service user. This involves the willingness and ability to shape a journey based on the discovered needs and preferences of the individual.

Very often people have difficulties that are as much to do with their social and economic circumstances as well as the mental health issues they are facing. In fact the two are often intertwined and need to be addressed together. Therefore our approach addresses directly the specific circumstances of a person. We seek solutions to the difficulties they are facing, to their family relationships, their social network, their housing and other social and economic circumstances.

3. Our way of working: Creating and Developing a Partnership
The evidence base demonstrates that the most important factor in developing an effective therapeutic alliance is founded in the trust forged between the people working in services and the people using the services. Further, these successful relationships are mutual, reciprocal and founded on good rapport and shared responsibility.

The key principle is that those involved are equal and full partners in developing the conditions for positive change and moving forward in the persons life. The work commences with sharing and understanding the persons clinical story and the significant mile stones in their life so far. They then create their Whole Life Pathway as a discovery journey. This is based on their identified whole life needs, wants, dreams and goals.

The process begins with an introductory workshop where we set out the purpose, aims and content of the discovery partnership and ensure ownership by all concerned. The workshop is for people within the service who are interested in participating, including service users, family members and friends, managers, mental health workers and community representatives. Following this meeting we agree that the program will commence. We then invite service users and their families to indicate if they would like to take part. Their participation is then negotiated and agreed with the discovery partner.

From this foundation we work with the person to realise their Discovery Journey in a continuous and supportive way. The service user and the Discovery Partner, work to connect with their social network and the services they use. This requires the appropriate amount of the time and space that is required to make a tangible difference in their circumstances and lives. This should continue until the person has the opportunities and confidence to move on in their lives.

The Discovery Partner works alongside the person for a six month period, if required this can be on a 24 hour basis.

We can partner up to 8 people within a local service.

This process is both an individual and shared experience. The importance of having a group of people with the opportunity to work together as peers is an essential part of the program and addresses issues of togetherness, empowerment and responsibility.

A weekly schedule is mutually negotiated to ensure the right times and places are acceptable and comfortable within a flexible timetable.

On regular occasions the partners will meet together in a Discovery Learning Community to share experiences and reflections. This is an opportunity for other people from the social networks and services to share in the learning and extend this new thinking and practice.

The Discovery partners work closely with the persons care coordinator and other key workers to ensure their full involvement in the persons journey.

We work in the following ways:

Knowing the Person
Creating the opportunity for the maximum time and space
Building a trusting relationship by adopting a personal approach from the start of the Discovery Journey
Believing absolutely that the person can move forward in their lives
Being able and comfortable to share together life stories
Fostering self determination, self belief, hope and shared responsibility for embarking on the Discovery Journey
Discovering their personal strengths, assets and resources
Exploring Whole life in all respects; what you have now, what you need and want and where you want to be, including hopes and dreams
Reviewing the clinical story, negotiate about it and come to a mutual agreement on its meaning and value
Exploring the difficulties people have with the subjective experiences of hearing voices, self injury and self harm, paranoia etc.

Working alongside the person
Acknowledging the service user as the expert who has the capacity to deal with their emotions
Guiding the person on their journey
Giving and sharing knowledge and information of best evidence in recovery practice and resources, tools and instruments for the person and their discovery learning group
Developing pathways, coping skills and strategies and finding the resources and allies to assist in addressing difficulties and experiences in their life through creating a Discovery Map
Encouraging a healthy life style including physical health checks
Self management, including looking after their own physical and psychological health needs.
The proper and effective use of medication
Working alongside families and friends to understand their perspective, their needs, roles and responsibilities
Ensuring informed choice of treatments/clinical interventions and therapies providing knowledge
Agreeing and jointly owning common attainable goals
Working toward the goal of no longer requiring services

A Whole Life for the Person
Developing and extending friendship and peer support networks
Accessing local whole life resources available including art and culture, sport and leisure, occupation, employment, volunteering, housing, learning and education, welfare benefit advice, self help opportunities, groups, clubs
Creating and sustaining a discovery learning support group with the person in the centre

Celebration
Celebrating progress so far made in the Discovery Journey
Sharing progress with their family and friends
Together reviewing whats worked and what hasn’t worked
Deciding on what the next goals are

This individualised way of working with people of is not always easy to realise in services because of the current pressures on services and mental health workers. However we believe that this discovery partnership offers a solution to service providers facing the challenge of addressing the whole life needs of people stuck in their lives.

4. Our Discovery Partner Team
The IMHCN has experienced workers who include people who have experience of using services and family members.

Each IMHCN Discovery Partner has worked in innovative services and practices.

This includes:
Developing and supporting recovery communities and recovery houses in Trieste, Italy
Designing and facilitating Whole Life Whole System Action Learning Sets in the UK and other countries
Practicing the hearing voices approach, open dialogue, whole life planning and peer to peer work

Their approach is holistic and includes psychological therapies that recognise the key importance of trust, reciprocity and shared responsibility.

The experience that these partners have gained has led to our firm belief that this way of working should more widely available for service users and family members as well as services.

Therefore we have brought together this expertise to create this Discovery Partnership scheme.

The IMHCN team will lead the development in a local area and this will include the training and mentoring of other local Discovery Partners.

5. Agreement
1. The IMHCN, the local Mental Health Organisation together with the identified service users and their families will form a clear agreement to work together on moving forward the person in their life based on the goals outlined above.
2. A stakeholder group will be formed to manage the program.
3. A monthly Recovery Learning Community meeting will be held to review the progress of the program and to plan for the future.
4. Regular Family Support Meetings will be held.
5. Weekly meetings of the service users will be held.
6. Monthly Individual Progress Review Meetings will be held with each service user participant.
7. The Program, the outcomes and what has been achieved by the participants will be externally evaluated
Costs

The indicative costs for each service user will be between £12,000 and £15,000 for six months.

This is for the cost of providing the Discovery Partner, their fee and expenses.

The IMHCN will be responsible for overseeing the program and providing the necessary supervision and support.

6. Recovery House, Trieste Italy

 

7. Evidence Base

 

John Jenkins (CEO)

Paul Baker (Secretary)

August 2016

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