Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK.
King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Epidemiol Psychiatr Sci. 2019 Oct;28(5):481-488. doi: 10.1017/S204579601800063X. Epub 2018 Oct 23.
Recovery Colleges are opening internationally. The evaluation focus has been on outcomes for Recovery College students who use mental health services. However, benefits may also arise for: staff who attend or co-deliver courses; the mental health and social care service hosting the Recovery College; and wider society. A theory-based change model characterising how Recovery Colleges impact at these higher levels is needed for formal evaluation of their impact, and to inform future Recovery College development. The aim of this study was to develop a stratified theory identifying candidate mechanisms of action and outcomes (impact) for Recovery Colleges at staff, services and societal levels.
Inductive thematic analysis of 44 publications identified in a systematised review was supplemented by collaborative analysis involving a lived experience advisory panel to develop a preliminary theoretical framework. This was refined through semi-structured interviews with 33 Recovery College stakeholders (service user students, peer/non-peer trainers, managers, community partners, clinicians) in three sites in England.
Candidate mechanisms of action and outcomes were identified at staff, services and societal levels. At the staff level, experiencing new relationships may change attitudes and associated professional practice. Identified outcomes for staff included: experiencing and valuing co-production; changed perceptions of service users; and increased passion and job motivation. At the services level, Recovery Colleges often develop somewhat separately from their host system, reducing the reach of the college into the host organisation but allowing development of an alternative culture giving experiential learning opportunities to staff around co-production and the role of a peer workforce. At the societal level, partnering with community-based agencies gave other members of the public opportunities for learning alongside people with mental health problems and enabled community agencies to work with people they might not have otherwise. Recovery Colleges also gave opportunities to beneficially impact on community attitudes.
This study is the first to characterise the mechanisms of action and impact of Recovery Colleges on mental health staff, mental health and social care services, and wider society. The findings suggest that a certain distance is needed in the relationship between the Recovery College and its host organisation if a genuine cultural alternative is to be created. Different strategies are needed depending on what level of impact is intended, and this study can inform decision-making about mechanisms to prioritise. Future research into Recovery Colleges should include contextual evaluation of these higher level impacts, and investigate effectiveness and harms.
康复学院正在国际上开办。评估的重点一直是使用心理健康服务的康复学院学生的成果。然而，员工参加或共同提供课程、提供康复学院的心理健康和社会保健服务机构以及更广泛的社会也可能从中受益。需要一个基于理论的变革模型来描述康复学院在这些更高层次上的影响，以便对其影响进行正式评估，并为未来的康复学院发展提供信息。本研究的目的是制定一个分层理论，确定康复学院在员工、服务和社会层面的作用机制和结果（影响）。
通过系统综述确定的 44 篇出版物进行归纳主题分析，并通过有生活经验的咨询小组的合作分析进行补充，以制定初步的理论框架。然后，通过对英格兰三个地点的 33 名康复学院利益相关者（服务使用者学生、同行/非同行培训师、管理人员、社区合作伙伴、临床医生）进行半结构化访谈对该框架进行了细化。
在员工、服务和社会层面确定了作用机制和结果的候选者。在员工层面，建立新的关系可能会改变态度和相关的专业实践。员工的预期成果包括：体验和重视共同创作；改变对服务使用者的看法；以及增加热情和工作动力。在服务层面，康复学院通常与宿主系统相对独立发展，减少了学院进入宿主组织的范围，但允许发展一种替代文化，为员工提供围绕共同创作和同伴劳动力角色的体验式学习机会。在社会层面，与社区机构合作使其他公众有机会与有心理健康问题的人一起学习，并使社区机构能够与他们原本可能不会接触的人合作。康复学院还为有益地影响社区态度提供了机会。
本研究首次描述了康复学院对心理健康工作人员、心理健康和社会保健服务以及更广泛的社会的作用机制和影响。研究结果表明，如果要创建真正的文化替代，康复学院与其主办组织之间需要保持一定的距离。根据预期的影响程度，需要采取不同的策略，本研究可以为优先考虑作用机制的决策提供信息。未来对康复学院的研究应包括对这些更高层次影响的背景评估，并调查有效性和危害。
