The Scottish Government

« Previous | Contents | Next »

Listen

CHAPTER ONE: INTRODUCTION

1.1 The Scottish Development Centre for Mental Health were commissioned by the Scottish Government to undertake this evaluation, entitled 'Evaluation of the Scottish Recovery Indicator Pilot in five Health Board Areas in Scotland'.

Background

1.2 Delivering for Mental Health ( DfMH) was produced in December 2006 by the Scottish Executive's Mental Health Division to build on recent service shifts towards a community-based service model. The guidance in DfMH is based on evidence of what works in terms of achieving better outcomes for individuals through using appropriate services that meet their needs. It promotes a functional model of service design and requires local partners to ensure that services aim to perform well and achieve good standards in response to local needs. There are 3 main targets:

• To reduce the annual rate of increase in anti-depressant prescribing to zero by 2009/10
• To reduce suicides in Scotland by 20% by 2013
• To reduce re-admissions (within one year) to hospital by 10% by the end of 2009

1.3 Central to DfMH is the promotion of a well-being and recovery-based mental health service model. This is combined with a population-based approach to social inclusion to prevent mental illness and inequalities in mental health and highlight the link between mental and physical health.

1.4 The targets are supported by 14 commitments. This evaluation is concerned with the Scottish Recovery Indicator ( SRI), the tool that is hoped will assist the successful implementation of Commitment One. Commitment One states:

'We will develop a tool to assess the degree to which organisations and programmes meet our expectations in respect of equality, social inclusion, recovery and rights. The tool will be piloted in 2007 and be in general use by 2010.'

Scottish Recovery Indicator

1.5 In response to Commitment One of DfMH, the Mental Health Division set up a working group to develop a tool to measure practice in relation to recovery-promoting values. The Scottish Recovery Indicator is the result of adaptations made to the Recovery-Oriented Practices Index ( ROPI) which was originally created and subjected to research and testing by the New York State Office of Mental Health (Mancini & Finnerty, 2005). The adaptations were primarily to ensure that the tool was relevant within the Scottish mental health practice arena whilst maintaining those components of the tool that are known to measure those aspects of service that are known to promote recovery.

1.6 The suggestion that 'a recovery environmental audit tool' be developed for Scotland was first made in Rights, Relationships and Recovery: The Report of the National Review of Mental Health Nursing in Scotland (2006). Following discussion, this action was later subsumed as a commitment in DfMH.

1.7 The SRI covers a wide range of issues, with the key elements being:

• Meeting basic needs; personalisation and choice
• Strengths-based approach ( e.g. care plan format integrates strengths into goals)
• Comprehensive service
• Service user involvement/participation ( e.g. service users employed in professional and/or support staff positions at equal pay and with equal responsibility)
• Involving support networks and promoting social inclusion and community integration ( e.g. service makes active efforts to involve service-users' support system in care and treatment)
• Service user in control and active participant even when subject to compulsion ( e.g. services should encourage service users to plan in advance for periods of incapacity)
• Recovery.

1.8 The SRI data is collected from a range of sources, including: assessments and care plans, service information, policies and procedures and interviews with service providers and service users. A summary version of the SRI tool under evaluation can be found in Appendix 1.

1.9 The SRI enables the assessment of whether and how organisations, and those who work in them, are ensuring that individuals who use their services and their carers' needs, are met in terms of their rights to equality, social inclusion and support to recover. It is primarily a developmental tool which engages the tool-user in a process of:

• Assessing the extent to which services, and those who work in them, meet the expectations of Commitment One of DfMH
• Identifying gaps in service provision, processes and policies
• Creating an action plan to improve the service
• Reassessing to identify progress.

Need for evaluation

1.10 To inform the success of local processes, policies and staff in promoting respect for equality, social inclusion, recovery and rights within mental health services, knowledge is required about the practical utility and validity of SRI as a development tool for this purpose.

1.11 In response to this, the Scottish Executive's Mental Health Division piloted the SRI in five health board areas in Scotland and commissioned an evaluation of the pilot.

SRI pilot sites

1.12 Under the DfMH Leadership Programme Leading Change, 5 health board areas have included recovery and social-inclusion focused elements within their Leading Change projects and agreed to pilot the SRI in different ways that matched with their wider change projects. The pilot areas and their proposed approaches to using SRI were:

• Ayrshire and Arran used the SRI to measure the impact of system-wide cultural change in a number of wards in different hospitals. All of the pilot sites in Ayrshire and Arran were inpatient units, with one being adult acute admission wards (Ward 1D & 1E at Crosshouse Hospital, Kilmarnock), one a ward for adults with continuing care needs/rehabilitation (Ballantrae Ward, Ailsa Hospital in Ayr) and another acute admissions in old age psychiatry (Pavilion 2 in Ayrshire Central Hospital, Irvine and Croy House in Ailsa Hospital, Ayr).
• Greater Glasgow and Clyde explored the application and relevance of SRI within diverse communities, with particular reference to black and minority ethnic ( BME) and deaf communities in a variety of mental health settings (involving some BME and deaf groups in the review of the tool). Greater Glasgow and Clyde had numerous pilot sites of which only three were selected for inclusion in the evaluation. One pilot site in North Glasgow was a linked acute inpatient ward (Armadale Ward in Stobhill Hospital) and community-based adult mental health service (Springpark Resource Centre). Another was the Crisis Team, a community-based service in South East Glasgow and the remaining pilot site was the continuing care/rehabilitation Ward 15 in Dykebar Hospital in Paisley.
• Forth Valley used the SRI to benchmark and audit change resulting from their culture change exercise, particularly acute in-patient and intensive home treatment teams and older people's services. Three pilot sites participated, all in adult inpatient services based in Falkirk and District Royal Infirmary. The wards that participated in the pilot were: ward 1 (acute inpatients), ward 18 (acute inpatients) and ward 19 (intensive psychiatric care unit). All pilot sites in Forth Valley were project managed by the local lead, the Project Manager (recovery).
• Tayside (Angus area) used the SRI to benchmark and inform redesign in relation to the reconfiguration of day services, focusing on community integration, potentially in wards and community services, but mainly in statutory day services operating from multiple sites. There were three pilot sites in Angus, one in an inpatient ward (general adult psychiatry) in Sunnyside Royal Hospital in Montrose, one in day-treatment services (general adult psychiatry) in Whitehills Health and Community Care Centre in Forfar and one in day services (adult community social work and health) within Angus Council's social work department at Gowanlea in Arbroath. Angus pilot sites also involved the service user-led voluntary organisation Augment (Scotland) Ltd to conduct the service user interviews for the SRI.
• Two further areas asked to be included, Grampian (Moray) and Lanarkshire. Unfortunately, due to sickness, Lanarkshire was not able to proceed with their pilot within the time scales of the evaluation which would have seen 2 further pilot sites, one in an adult inpatient ward (Ward 24, Monklands Hospital in Airdrie) and one in the community-based Cumbernauld Mental Health Outreach Team (a joint social work and health team).
• Grampian (Moray) used the SRI to monitor their independent sector community mental health services. Two SRI pilots were carried out in Moray, one in the community-based Adult Day Services in Dr Gray's Hospital ( NHS Grampian) and another in the voluntary sector in Horizons with Moray Anchor Projects, a drop-in centre for adults experiencing or recovering from mental health problems or distress. Both pilot sites were based in Elgin and were led by the same local leads.

Objectives

1.13 The overarching aim of the evaluation was to assess, at this early stage, if the SRI results in real impacts in terms of the implementation of the Mental Health Delivery Plan.

1.14 The specific objectives of this evaluation were to:

• Assess the relevance and appropriateness of the tool to a variety of settings
• Identify what preparation organisations and individuals need before using the tool
• Identify how best the tool should be used ( e.g. who to involve in gathering and providing information)
• Identify whether the tool may be able to measure changes in services
• Identify the potential for the use of SRI as a means of promoting change
• Assess whether service users and carers feel added benefit from being involved in the piloting of SRI.

1.15 The evaluation also offers clear recommendations in relation to:

• Whether any amendments or additions are required to the tool
• Preparation required to use the tool
• Advice and guidance on how to use SRI as a developmental tool to effect improvement in services.

Approach

1.16 In line with the principle that services should be delivered in a person-centred way, recognising the uniqueness of each individual's experience, the evaluation examines the extent to which the tool identifies how well the services are identifying and then responding where there are inequalities, e.g. poverty, marginalized groups, stigma.

1.17 In order to meet the evaluation objectives, the primary focus of this report is the utility of the SRI as a development tool within the different pilot settings. The evaluation examines each stage of the ' SRI development process' individually (as detailed in Figure 1.1 below) and the development process as a whole.

1.18 Viewing the process as a whole, the evaluation explores the extent to which SRI enables practitioners and managers to apply individual-level factors that promote equality, social inclusion and recovery to system-level change.

Figure 1.1 SRI Development Process

« Previous | Contents | Next »