Jon Fieldhouse

Community participation and recovery for mental health service users: an action research inquiry

Introduction: The social inclusion of individuals with mental health problems is an issue for mental health services, for the individuals who experience stigma, discrimination and exclusion, and for society at large. To develop community-orientated services that are capable of promoting inclusion it will, therefore, be advantageous to all parties to understand what service users find most helpful. Method: A 2-year action research project explored the recovery journeys of a group of assertive outreach service users who had progressed from being socially excluded and occupationally deprived to being participants in their local communities. The research aimed to understand how these outcomes were produced and to use this knowledge to inform local service development. Findings: This paper focuses on eight qualitative interviews, where service users recounted their stories of community participation and inclusion. The findings show how assertive outreach practitioners harnessed occupation as a basis for building relationships between practitioners and service users, and how this became a conduit towards participation in the mainstream community. Conclusion: Facilitating engagement in community-based occupations through creative collaboration helped participants reconnect with cherished roles, achieve long-standing goals and develop feelings of self-efficacy, belonging and wellbeing.

Community mental health and social exclusion: Working appreciatively towards inclusion:

A central feature of community mental health practice is the social inclusion of its service users. This involves opening up life opportunities in the mainstream community, requiring collaboration with community partners. A group of mental health service managers, practitioners, service users and representatives from the Further Education community worked together for 18 months to promote social inclusion for local service users and used appreciative inquiry and co-operative inquiry methods to explore and enhance this work. This article discusses the methodological nuances of this fusion of approaches. It underlines the benefits of an appreciative approach for addressing historically rooted patterns of practice within statutory mental health services, and highlights how harnessing an extended epistemology can bring together impetus from ‘top down’ and ‘bottom up’ to create actionable plans. The article describes what was learned about optimal inter-agency working and about trying to be a change agent in a large organization. It concludes with reflections on the suitability of participatory action research methods for developing community-orientated mental health services.

‘Gardening without Borders’: Reflections on the Results of a Survey of Practitioners of an ‘Unstructured’ Profession:

For several years, the social and therapeutic horticulture (STH) movement has been considering its own gradual professionalisation, as a way of raising its profile and ensuring standards of training and practice. A survey of 119 STH practitioners showed that the vast majority of respondents wanted a national body and the registration of projects and/or practitioners; over half wanted a protected job title; and there was a wish for more research-based evidence. The implications of this survey for the STH movement are discussed and issues of potential interest for occupational therapists are highlighted.

Vocational rehabilitation in mental health services: evaluating the work of a social and therapeutic horticulture community interest company

Purpose – The purpose of this paper is to report on an action inquiry (AI) evaluation of the Natureways project, a time-limited collaboration between an NHS Trust Vocational Service and a voluntary sector horticulture-based community interest company (CIC). Design/methodology/approach – Natureways produced positive employment outcomes and an AI process – based on co-operative inquiry with trainees, staff, and managers – explored how these had been achieved. Findings – Natureways’ efficacy was based on features of the setting (its supportiveness, rural location, and workplace authenticity), on its embeddedness (within local care-planning pathways, the horticultural industry, and the local community), and on effective intersectoral working. The inquiry also generated actionable learning about creative leadership and adaptability in the changing landscape of service provision, about the benefits of the CICs small scale and business ethos, about the links between trainees’ employability, social inclusion and...

What helps successful community groups (involving peers support workers) to develop

Purpose – The purpose of this paper is to explore features of successful peer supported community support groups hosted by St Mungo’s and partners. Design/methodology/approach – Literature review and theme construction. Findings – Overall the review confirmed existing findings that successful support groups foster mutually supportive, reciprocal relationships capable of inspiring hope among group members. This paper will concentrate on findings that co-production was indicative of successful groups in terms of shared aims, negotiated agendas, clear communication, and engagement with the wider community. Research limitations/implications – A group’s success was seen in terms of growth in members’ self-esteem, empowerment, and optimism, which this paper proposes could become part of a conceptual framework of a learning organisational culture. Originality/value – Developing understanding of a rapidly growing phenomenon in community-based mental health care and presenting this in terms of a particular organis...

What works for peer support groups: learning from mental health and wellbeing groups in Bath and North East Somerset

Purpose The purpose of this paper is to explore what worked well in terms of peer involvement in a diverse network of community groups for people affected by mental health problems in Bath and North East Somerset (BANES), UK. Design/methodology/approach A participatory action inquiry approach engaged the network’s key stakeholders (group members, facilitators, and commissioners) in critical reflection on what supported successful groups. Findings Successful groups have six characteristics: mutual support, a positive shared identity, opportunities for taking on roles, negotiated ground rules, skilled facilitation, and a conducive physical environment. Additionally, each group achieved a balance between the following areas of tension: needing ground rules but wanting to avoid bureaucracy, needing internal structure whilst also committing to group activities, balancing leadership with accountability, wanting peer leadership whilst acknowledging the burden of this responsibility, and lobbying for change in mental health services whilst acknowledging the need for support from them. Research limitations/implications The evaluation shows a group’s success is about adaptability and group facilitation is the art of navigating a course through these competing demands above. These insights have informed plans for a practical guide for developing peer led groups and for training of peer leaders in BANES. Originality/value This evaluation focuses on self-efficacy. It draws on group members’ own perceptions of what worked best for them to provide transferable learning about how peer led support groups might develop more generally. It can thus inform the growth of a comparatively new kind of community-based support for people with mental health problems and for their carers.

Community participation and social inclusion in Bristol

Purpose – This paper reports on action research which explored assertive outreach service users’ experiences of community participation and then fed this learning into a multi‐agency forum – where it was used in joint‐planning between mental health services and community partners, aiming to maximise social inclusion locally.Design/methodology/approach – Action research methodology was chosen to examine the forums work because it brings together different perspectives to reveal an issue in its entirety and effect change in practice. Service users’ experiences were explored using semi‐structured qualitative interviews.Findings – Engagement in mainstream community‐based activities re‐connected service users with cherished life roles and developed feelings of self‐efficacy, belonging, and wellbeing. Effective inter‐sectoral working in the forum was based on a shared agenda and collective action planning.Research limitations/implications – Whilst every effort was made to ensure an authentic service user voice...