How can ImROC help?

ImROC has previously commented on the media exposure of appalling practice in inpatient units (Response to Dispatches – ImROC – Implementing Recovery through Organisational Change); coverage that vindicated the personal reports and cries for help from people in those services, patients, their families and staff.  The Independent Inquiry into events at Edenfield that were exposed by Panoram in February 2023 digs deeper and finds little to reassure any of us that we can feel confident that if we reach a point of crisis we can look forward to a safe, therapeutic or compassionate response. Whilst the report focuses specifically on one Trust, the experiences that we hear daily from ImROC’s staff and students who have themselves spent time in inpatient settings closely and alarmingly echo the findings.

What is clear is the extent to which staff members who are committed to developing respectful and empowering relationships, creating safe spaces for those in distress to make sense of their experiences and find ways forward in a supportive and understanding environment have little opportunity to do so.  More worrying is their powerlessness in making their concerns heard, their inability to positively influence culture and practice when there is systemic resistance to hearing ‘bad news’ and responding appropriately.

Even worse is the finding that people from black and minority ethnic groups and those with protected characteristics (both patients and staff)  appear to fare worst; not merely in not being heard but in being treated coercively and disrespectfully with no understanding of their experience, their culture or what drives their behaviour.

It is somewhat reassuring to see NHSE commitment to shifting the culture of practice in inpatient settings through significant investment in values based, lived experience led training, coaching, leadership development, supervision and quality improvement.  (Culture of Care Programme (rcpsych.ac.uk).  But this will inevitably be slow to implement, time limited and cannot possibly address the widespread systemic problems relating to lack of funding, workforce shortages, inadequate social care and support and worsening inequalities in all domains of life. Indeed no single intervention or approach will provide all the answers.

So what can ImROC offer that might support current endeavours to improve the experience of people in crisis?

1. A briefing paper

We have coproduced our own response to inform the recovery of acute inpatient care.   This carefully cocreated paper builds on the experience of people who have a range of different experiences in acute care  – people who have spent time in wards and family members, people from different minority and ethnic groups, people with different professional roles.  The result is lengthy but that is because it is not a set of directions, guidelines and checklists.  It goes back to basics and focuses on the importance of human connections: the relationships that underpin safe and supportive care.  It discusses ways of offering trauma informed  and neuro-inclusive environments and conversations; and emphasises the need for appreciative and collaborative decision making whether developing collaborative care plans, joint safety plans or  preparing to move on.

This paper is available to view here (24. Recovering Adult Acute Psychiatric Inpatient Wards – ImROC – Implementing Recovery through Organisational Change) and we will be running a webinar to offer a visual/verbal and accessible summary of the paper.  This will be followed by a series of lived experience led podcasts that focus on different elements of the paper.  Follow us on Linked in to find out when these will be happening

2. Companion Guides

Alongside this briefing paper, we have coproduced two companion guides .  The first (Thinking about Recovery Together – ImROC – Implementing Recovery through Organisational Change) is a conversational tool loosely based on a personal recovery plan – adapted for use in acute care settings. We heard from people who have been in acute wards that  it can be hard to focus on completing a full recovery plan in times of acute distress.  There are so many immediate fears, worries and priorities.  However, some people, staff and patients find it helpful to have a structure to work with, some key questions to focus on, questions that validate a persons strengths, resources, experience and emphasise possibility, hope and aspirations.

The second is a benchmarking tool: Team Recovery Implementation Plan for Acute Inpatient Wards

Designed for whole teams, including those using their support and family members, to use to assess their strengths and achievements, the gaps and potential areas that need improvement against evidence based good practice benchmarks.  This is specifically adapted for inpatient settings and provides a tried and tested basis for self assessment, priority setting and quality improvement.  ImROC has long experience of working with teams utilising this tool to identify bespoke goals, supporting action planning and implementation.

3. Co-facilitated learning spaces for inpatient staff

We offer co-facilitated learning spaces for inpatient staff which are developed with organisations/teams to meet their particular needs.  These take the form of action learning sets for key members of staff to learn, reflect and share in a safe group away from their place of work.

4. Culture of Care

We have already written a paper that focuses on the culture of care (19. Creating a Recovery Focused Culture: changing the nature of conversations from the bottom up – ImROC – Implementing Recovery through Organisational Change). As always we start with people using services and the staff who work with them. Both groups are frequently disempowered with minimal influence, receiving little appreciation and little support. This paper offers examples, ideas and approaches to change the nature of conversations at every level of organisations.

5. Coproduced recovery focused learning spaces

It is interesting to see that the Independent Inquiry found that the Recovery Academy was a beacon of light for those using the Edenfield Unit.  ImROC developed the first Recovery College in England in 2009 and has supported their development ever since.  All research demonstrates the benefit of coproduced recovery focused learning spaces where people learn alongside others who share their experiences and their stories of hope and achievement.  ImROC continues to offer support for any service wishing to develop their Recovery College offer into inpatient areas, this can be offered to individual teams or services, or through membership of our Learning Set. International Recovery College Learning Set – ImROC – Implementing Recovery through Organisational Change

6. Peer Support Workers

There is no mention of peer support workers in the Edenfield inquiry, yet research demonstrates that the employment of peer workers in acute care correlates with an improvement in staff attitudes and a reduction in the use of restraint and coercion.  We believe that peer support is an essential and complementary role in any multidisciplinary care team.  Research suggests that peer workers offer hope, validation, time, practical and emotional support that is not bound up with treatment and regulation.  In addition peer support workers can offer advocacy and bring alternative perspectives in team practices and decisions.  Whilst imROC offers a whole pathway of accredited training and development for peer support workers ( Training Courses – ImROC – Implementing Recovery through Organisational Change) , we do not recommend their employment in teams without careful training and preparation of the team.  We offer workshops with mental health teams to prepare them for peer support workers (Team Recovery Implementation Plan for Acute Inpatient Wards – ImROC – Implementing Recovery through Organisational Change) and these are a helpful way of identifying strengths and challenges existing in the team. 

Get in touch

If you are interested in finding out how we could support you, your team or your organisation to improve the experience of inpatient care, please do get in touch. We always start where you are at, working with you to provide coproduced and cofacilitated support to meet your needs.