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"Standing On the Shoulders of Understanding Mental Health Promotion and Social Inclusion through Work Based Experiences and Patient and Public Partnership Stephen P Young Ph.D. Thesis 2009 ii Standing On the Shoulders of Understanding Mental Health Promotion and Social Inclusion through Work Based Experiences and Patient and Public Partnership Stephen P Young Faculty of Health and Social Care School of Nursing and Midwifery University of Salford Salford, UK Submitted in Partial Fulfilment of the Requirements of the Degree of Doctor of Philosophy, November 2009 Contents Page Tables and Illustrations vi Acknowledgements viii Abbreviations x Preface xii Abstract xiii Section 1 1 Chapter 1 Introduction 2 Why is this Important? 4 Structure of the Thesis 7 Summary of Chapters 8 Chapter 2 Personal and Professional Background 16 Professional Background 18 Why mental health? 19 My Experience of the Institution 20 I am Not Alone 22 So why did I continue? 24 A Profile of My Roles in the NHS 25 What Next 30 Section 2 37 Chapter 3 A New Understanding in Practice 38 The Creative Living Centre 40 Action Learning and Research 46 Web House, Democratic Therapeutic Community 48 Angel Healthy Living Project 50 Mental Health Promoting Communities 53 Manchester, Salford and Trafford Health Action Zone 55 Social Action Research Programme 56 Real Lives Real People 58 Chapter 4 Learning in the Context of Mental Health and Social Care Policy Context Introduction 62 Policy Context 64 The National Service Framework for Mental Health. 64 Social Exclusion 65 Health Act 66 NHS Plan, A plan for investment, a plan for reform 67 Neighbourhood Renewal, Strategy Action Plan 67 Making it Happen - National Strategy for Mental Health Promotion 67 Learning from Practice and Experience 69 Mental Health and Mental Illness 69 Mental Health Promotion 71 Regeneration 72 Working in Partnership 73 Involving Service Users 75 Citizenship 77 CHOICE-Responsiveness and Equity in NHS and Social Care 77 A Community Development Approach 78 Discussion 80 Chapter 5 My New Role Develops 83 Centre for Community Learning 93 Challenges to my Practice 94 Summary of the Rationale for My Research 96 My Research Question 98 Section 3 99 Chapter 6 Research Design-Approaches to Understanding My Practice Introduction 100 The Research 101 Ensuring Anonymity 102 Methodology 109 Why Action Learning 110 Action Learning & Research - A Framework 112 Making sense of the Information 122 Why Stories 123 Methodology - List of Inputs 129 Chapter 7 The Salford Social Entrepreneurs Programme 130 Introduction 130 Background 131 First Salford Entrepreneur Programme 133 The Set Commences 133 The People - The First Set 137 Reflection on the First SSE Action Learning Set 156 Second Salford Entrepreneur Programme 159 The People - The Second Set 160 Chapter 8 Action Learning as a Way of Learning to Learn by Doing Background 176 Why Action learning 177 My Education, Learning from the Memory of my Experience 178 My Education, My Work Experience 180 Learning from the Present Experience 182 Action Learning - Developing my Understanding as a Researcher 185 The Doctoral Programme Commences 185 The Research Set 187 What is a PhD 192 Presenting My Problem to the Set 194 Transfer from MPhil to PhD 197 Supporting Local People with Action Learning 198 Set Advisor or Facilitator 199 Chapter 9 Findings and Conclusions 202 The Further Understanding of Engaging with Patients and the Public - A Case for Change 203 From Responsive to Participatory Working - Some Challenges 206 Six Critical Ingredients for Patient and Public Involvement 215 The Further Understanding of Autonomous Learning in the Promotion of Mental Health and Well-Being 221 Action Learning as a Process for Change 222 Salford - The Local Authority Context 223 Mental Health and Well-Being 224 Individual Benefit 226 Community Benefit 226 Social Inclusion 227 Health Inequalities 230 Section 4 243 Chapter 10 The Relevance and Application of My Experience 244 Conclusions the Wider Context 244 Statutory Requirements 246 Health Service Requirements 250 People Requirements 253 Six Critical Ingredients for Developing an Empowering Organisational Culture 256 Chapter 11 Making Sense of My Research 257 Introduction 257 The Central Picture Model 257 What was the Situation? 262 What Did I Know about the Situation? 265 Why was I concerned? 266 What Did I do About it? 267 How Did I Do This? 268 What Did I Achieve? 268 What Did I Learn Specific to the Issue and Wider? 270 How Did I Evaluate the Experience? 271 How Does My Contribution Compare With Others? 272 What Does this Add to My Learning/Abilities? 277 What Have I Added to General Understanding/Abilities In this Field? 279 What Can I Add Further? 279 What Can Others Add Further? 281 Chapter 12 Life After the Social Entrepreneur Programme 282 NHSU 283 Mersey Care Mental Health and Learning Disabilities NHS Trust 286 North West Mental Health Chief Executives Partnership 286 Health Promoting Mental Health Services 287 Liverpool European Capital of Culture 289 Your Health, Your Care, Your Say 289 Making it Possible - A National Strategy for Mental Health and Well-Being 291 Developing a Learning Framework for Active Citizenship 291 New Opportunities - New Horizons 292 Work Undertaken to Date 294 Active Citizenship 294 National Institute for Mental Health England 294 Modernising Pathology Services - Through Action Learning 295 Trustee Mind 295 Together We Can 296 Chapter 13 Making Sense of the Action and Learning - A Meta Position Introduction 297 Purpose of the Inquiry 300 Methodology 302 The Use of Literature 309 The Character of Action Learning 315 Limitations of the Research 319 Findings 321 The key Ideas and their Origins in Resourceful Collaborative Practice 321 Outcomes Arising from Practice 322 Contribution to Knowledge 328 The Original Contribution to Knowledge and Practice 332 Autonomous Learning 336 Contribution to Method 338 Opportunities for Further Research, Development and Direction 339 Further Research 339 Potential for Published Papers 340 Personal Development and Practice 342 Critical Review of How the Final Chapter was Written 343 Appendices Appendix 1 Employment Profile 348 Appendix 2 Trust Board Paper-Mental Health & Community Strategy 350 Appendix 3 Job Description - Service Director (Developments) 354 Appendix 4 First Proposal to Chief Executive 357 Appendix 5 Trust Board paper-Centre for Community Learning Proposal 360 Appendix 6 Publications 364 Appendix 7 Conference and Workshop Presentations 366 Appendix 8 The Salford Social Entrepreneur Programme 368 Appendix 9 Letter of Support for the SSE from Trust 371 IV Appendix 10 Action Learning Set Colleagues 372 Appendix 11 Salford City Council's Community Strategy - SSE Participants Community Profiles 374 Appendix 12 Regional Statistics - NHS Users-the Silent Majority 379 Appendix 13 References 381 Appendix 14 Bibliography 396 Tables and Illustrations Page Figure 1 Evolution of My Personal Journey 36 Figure 2 A Journey of Discovery and Influence 61 Figure 3 Triangulation of Experiences 96 Figure 4 Ensuring Anonymity 106 Figure 5 Botham and Morris Triangle 112 Figure 6 Methodology - List of Inputs 129 Figure 7 Developing a Relationship - A Pathway to Patient and Public Involvement 214 Figure 8 Autonomous Learning as a Model for Health Promotion 221 Figure 9 Salford Index of Deprivation 224 Figure 10 Salford Social Entrepreneur Programme-Participants Employment Profile 229 Figure 11a Individual Participants Outcomes 232 Figure 11b Individual Participants Outcomes 233 Figure 11c Individual Participants Outcomes 234 Figure 11d Individual Participants Outcomes 235 Figure 11e Individual Participants Outcomes 236 Figure 11f Individual Participants Outcomes 237 Figure 11g Individual Participants Outcomes 238 Figure 11h Individual Participants Outcomes 239 Figure 11i Individual Participants Outcomes 240 Figure 11j Individual Participants Outcomes 241 Figure 12 Learning to Learn - Milestones of Influence 242 VI Figure 13 Three Levels of Patient and Public Involvement and Three Levels of Involvement for Active Citizenship 255 Figure 14 Central Picture Model 258 Figure 15 The Outline of a Projects Life 261 Figure 16 Factors Influencing Health Outcomes 275 Figure 17 The Process of Inquiry through Action Learning Processes 304 Figure 18 Learning with and from Others - Considered Data 314 Figure 19 The Process of Discovery and learning 329 Figure 20 Young's Framework for Patient and Public Involvement 334 Vll Acknowledgements This thesis would not have been possible if it wasn't for the help and support of a number of people. I would like to acknowledge and thank those people who have been supportive to me throughout the years I have undertaken this research. My first thanks are to the participants of the Salford Social Entrepreneur Programme. This research would not have been possible if it wasn't for their motivation and commitment in making a difference to their community. They embraced me and my research with open arms and were always willing to share with me their individual and collective experiences. I am also indebted to my colleague and friend Chris Dabbs whose continued drive to support others resulted in the development of the now nationally recognised Social Entrepreneur Programme. The Revans Centre holds a special place in my life and it is here where I learnt from the many special people who made the Centre possible. The Centre provided the opportunity for me to realise more of my potential. I discovered the value of action learning and research and was able to integrate this into my work as an approach to solving work based problems. I would specifically like to mention Professor David Botham, Professor John Morris, and Professor Bryan Allison. A particular thanks go to my research action learning set colleagues Steve Grainger, Caroline Altounyan, Linda Dack and our Set Advisor Dr Donna Vick. I Vlll also thank them for coping with my enthusiasm which I know could be overbearing as I pursued answers to the many problems I encountered. We shared many experiences in our set meetings and developed a special understanding of each other.
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