Rebuilding lives in the Recovery College

Eloise Stark on a promising addition to the mental health landscape.

In April 2018, I enrolled on a tutor training course with the Oxfordshire Recovery College. Could I use my experiences of mental ill health, time within ‘the system’ and eventual recovery in order to benefit others on similar journeys?

Ralph Waldo Emerson once said that ‘it is one of the most beautiful compensations of this life that no man can sincerely try to help another without helping himself’. Through helping others, I feel I am turning the worst experiences of my life into something positive. If I can help one person by talking about my own experiences, then I can forgive my mind for turning against me briefly during the years spent unwell.

The concept of a Recovery College was borne out of the growing movement for recovery-oriented services, which promote the rebuilding of lives rather than the more narrow reduction of symptoms. Building resilience, supporting self-esteem and identity, focusing on strengths and finding meaning and purpose in one’s life are all important aspects. The Recovery College is founded on an educational approach, in contrast to a therapeutic or medical approach. There is no single definition of ‘recovery’ which fits with the ambitions of every individual, because it is a highly personal journey. In the dictionary, recovery is defined as ‘a return to a normal state of health, mind, or strength’, but we can’t ‘return’ to who we were before illness took hold… our experiences irrevocably change us and how we experience the world.

Recovery Colleges are inclusive and for everyone – people experiencing mental health challenges, carers, friends and family, and staff and volunteers from mental health services. The Recovery College is not a substitute for traditional assessment and treatment, such as from NHS mental health teams or GPs, or for mainstream education such as college or university courses. It is an adjunct to whatever help, support, education or training the individual is already receiving.

Importantly, attending the Recovery College is a choice, not a ‘prescription’ or a necessary ‘treatment’. Students have to ‘opt in’. While there, students choose the courses they are interested in. When students leave, they ‘graduate’, they are not ‘discharged’. From my experience, students often come because they feel that there is something missing in their care.

Everything that happens in the Recovery College, from designing and delivering the courses to strategic decisions, is done through the principle of co-production. This means that every action takes into account the views of multiple people, such as professional experts and particularly the voices of those with lived experience of mental health challenges. I am similar to many others in the College in wearing both the Expert by Experience (EbE) hat, by virtue of lived experience of mental ill health, and the Expert by Training (EbT) hat. I have a BA in Experimental Psychology, and as a current PhD student in Psychiatry, I have academic knowledge about mental health. Wearing the two hats can be a huge advantage. I know what is happening in the brain and to the mnemonic and cognitive systems during ‘flashbacks’ for example, but I also know how it feels to be incapacitated by a sudden, deeply traumatic memory that seems to come out of the blue.

Language supports the concept
Language is incredibly important for how people perceive themselves and others, and how they relate to the world. Philosopher Ludwig Wittgenstein mused upon the power of language to influence thought, saying ‘the limits of my language means the limits of my world’. In the context of mental health, negative language can be incredibly stigmatising and isolating, while positive words can convey principles of dignity, empathy and hope (Richards, 2018).

The Recovery College model attempts to use language to empower. All those who attend courses are known as ‘students’, not ‘patients’ or ‘service users’. This is a great leveller for the mixture of mental health services users, carers, family, friends, and mental health professionals who attend. All students complete the same registration process (not ‘referral’) and an individual learning plan which takes their individual needs into consideration. No student is distinguished based upon their role during the courses. Indeed, the boundaries between these roles are not always clear-cut, and it is common to have students who identify as mental health professionals or carers as well as having mental health needs themselves.

All individuals leading courses are known as ‘tutors’, not ‘therapists’ or ‘clinicians’. There are always two tutors for each course, one with lived experience (the EbE) and one with professional experience (the EbT). Again, unless asked or apparent through discourse, neither tutor distinguishes themselves by their role. They are simply the tutors, here to help and equally to learn alongside the students.

Learning more than course content
Courses at the Oxfordshire Recovery College include understanding the principles of recovery and exploring one’s own personal recovery journey. Some courses cover common mental health experiences, such as depression, anxiety, psychosis, personality disorders, self harm, and eating disorders. Other courses invite students to engage in meaningful activity, such as Tai Chi, creative writing, art or music. Some courses consider specific perspectives, such as the caring role, or parenting in recovery.

But students learn more than course content at the Recovery College. Students may learn that they are not alone, that other people experience similar things to themselves; that they have shown considerable strength in just getting themselves to a course, and that their determination is commendable; that they can enjoy education again, that they have skills and strengths they didn’t realise. They may learn interpersonal skills and how to manage in groups. Carers may learn to see mental health from different perspectives, helping them relate to their loved one. Professionals may learn greater empathy or understanding.

A promising model
Evaluation of the Recovery College model is still in its infancy, as the first UK College began only a decade ago. Yet there is a smattering of peer-reviewed research, and the results are promising. In one study, students used mental health services less and showed significant reductions in occupied hospital bed days and admissions following attendance at a Recovery College (Bourne et al., 2017). The authors calculated NHS savings generated by reduced service use of £1,760 per student who completed a Recovery College course. In a further exploration of arts-based courses, self-reported mental wellbeing and involvement in arts activities increased following course attendance over nine months (Stevens et al., 2018). Some students spoke of increased social inclusion, and of continuing to use skills learned in the course to maintain their wellbeing.

Effective collaboration between EbT and EbE tutors is key to Recovery College course success. Meeting tutors with lived experience appears to be especially beneficial for students overcoming feelings of isolation and self-stigma and for endorsing peer support (Cameron et al., 2018). A study of clinicians in the EbT role found that the experience of co-production can transform professional practice, since working with individuals with lived experience can lead to shifts in perceptions of professional power and authority, sometimes resulting in personal disclosures concerning mental health (Delgarno & Oates, 2018).

My personal perspective is that Recovery Colleges fill an important gap in the current mental health system. Many mental health services are so stretched that waiting lists for assessment or treatment reach the hundreds, clinicians are at risk of burnout and those accessing these services are naturally disgruntled. Recovery Colleges often help students overcome some of the social difficulties that lead to mental ill health, such as isolation. Through offering volunteering positions they help people find meaning and purpose. And they engender a sense of autonomy, since individuals choose to learn about their recovery, that of their loved ones, or the people that they work with. To be able to say, ‘I want to recover and I am going to go out there and learn about how I can do so’ is incredibly empowering.

One of the founding principles of the Recovery College model is hope, and this is something that I see every single time I teach a course. In one course, we tutors check in with students at the end, asking them to give a single word which describes how they are feeling right there and then. The words we hear – ‘empowered’, ‘positive’, ‘optimistic’, ‘persistent’, ‘hopeful’, ‘not alone’ – are enough to make me return after even the most triggering or difficult of courses.

BOX: A memorable moment

During one of my first courses as a tutor, I was exceedingly nervous. One of the students, a young man, was visibly nervous throughout and I felt real solidarity with him. Halfway through the course, in our break, he came up to me and asked if he could leave as he was feeling very anxious. I told him that he was welcome to leave if he felt he needed to, but that maybe we could talk about what was difficult for him and see if we could resolve it. I told him that I was feeling anxious too, and shared some of my coping strategies. We came up with a plan for him to doodle on handouts for the second half, and to focus on breathing to stay calm. He managed to stay until the end, when we did a ‘check-in’ to see how everyone was feeling after an afternoon of learning. He said that he felt huge pride in his ability to persevere, and the smile on his face as said goodbye was enormously rewarding.

 -   Eloise Stark is a PhD student in Psychiatry at the University of Oxford

[email protected]

Revisit our January 2019 interview with Thea Fitch who works at a Recovery and Wellbeing College.

Key sources
Bourne, P., Meddings, S. & Whittington, A. (2017). An evaluation of service use outcomes in a Recovery College. Journal of Mental Health, 27(4), 359-366.
Cameron, J., Hart, A., Brooker, S. et al. (2018). Collaboration in the design and delivery of a mental health Recovery College course. Journal of Mental Health, 27(4), 374-381.
Delgarno, M. & Oates, J. (2018). The meaning of co-production for clinicians. Journal of Psychiatric and Mental Health Nursing, 25, 349-357.
Richards, V. (2018). The importance of language in mental health care. The Lancet Psychiatry, 5(6), 460-461.
Stevens, J., Butterfield, C., Whittington, A. & Holttum, S. (2018). Evaluation of arts based courses within a UK Recovery College for people with mental health challenges. International Journal of Environmental Research and Public Health, 15, E1170.

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