The Ten Essential Shared Capabilities
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The Ten Essential Shared Capabilities Induction Module
Welcome to the Ten Essential Shared Capabilities (ESC) Induction Module. The aims of this module are to: 1. Provide background on why the Ten ESC were developed . Introduce you to the Ten Essential Shared Capabilities . Provide the opportunity to consider how the Ten ESC can be used to support Service User centred mental health services.
About this module
This module is set out to provide facilitators with a flexible learning resource. The module can be used in the following ways: 1. The ESC descriptions (pages 4-5) and Phils story (pages 6-9) can be handed/posted to induction participants prior to attending the training event. . Acitivity 2.1 and 2.2 can then be completed at the induction event in a small group work scenario. . You can end your induction programme here. 4. If you have more time available you can complete the full review of some or all of the ESCs (pages 11 onwards) Note: We intend to provide a range of personal experience stories in the near future which can be used as substitute examples.
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The Ten Essential Shared Capabilities Contents
1. Introduction. ......................................................................................................2 2. Meeting Phil - A Recovery Perspective............................................................ 4 3. Working in Partnership..................................................................................... 9 4. Respecting Diversity & Challenging Inequality............................................... 10 5. Challenging inequality.................................................................................... 11 6. Practicing Ethically.........................................................................................12 7. Promoting Recovery.......................................................................................14 8. Identifying Peoples Needs and Strengths. ..................................................... 14 9. Providing Service User Centred Care............................................................ 15 10. Making a Difference. .....................................................................................16 11. Promoting Safety and Positive Risk Taking.................................................. 17 12. Personal Development and Learning........................................................... 18 Acknowledgements............................................................................................19
Induction Module: The Ten Essential Shared Capabilities
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The Ten Essential Shared Capabilities 1. Introduction
The Ten Essential Shared Capabilities (ESC) framework provides the basic building blocks for your work in mental health. They are value and practice based and as such apply to all workers in mental health services. The Ten ESC were developed through close collaboration between service users, carers, academics, managers and practitioners. They are an attempt to distill the core attitudes and behaviours associated with high quality mental health services. If you want to know more about the Ten Essential Shared Capabilities go to www.lincoln. ac.uk/ccawi, where you can download learning materials and updates. The Ten Essential Shared Capabilities are: 1. Working in Partnership. Developing and maintaining constructive working
relationships with service users, carers, families, colleagues, lay people and wider community networks. Working positively with any tensions created by conflicts of interest or aspiration that may arise between the partners in care.
. Respecting Diversity. Working in partnership with service users, carers,
families and colleagues to provide care and interventions that not only make a positive difference but also do so in ways that respect and value diversity including age, race, culture, disability, gender, spirituality and sexuality.
. Practising Ethically. Recognising the rights and aspirations of service
users and their families, acknowledging power differentials and minimising them whenever possible. Providing treatment and care that is accountable to service users and carers within the boundaries prescribed by national (professional), legal and local codes of ethical practice.
4. Challenging Inequality. Addressing the causes and consequences of
stigma, discrimination, social inequality and exclusion on service users, carers and mental health services. Creating, developing or maintaining valued social roles for people in the communities they come from.
5. Promoting Recovery. Working in partnership to provide care and treatment
that enables service users and carers to tackle mental health problems with hope and optimism and to work towards a valued lifestyle within and beyond the limits of any mental health problem.
6. Identifying Peoples Needs and Strengths. Working in partnership to gather
information to agree health and social care needs in the context of the preferred lifestyle and aspirations of service users their families, carers and friends.
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7. Providing Service User Centred Care. Negotiating achievable and
meaningful goals; primarily from the perspective of service users and their families. Influencing and seeking the means to achieve these goals and clarifying the responsibilities of the people who will provide any help that is needed, including systematically evaluating outcomes and achievements.
8. Making a Difference. Facilitating access to and delivering the best quality,
evidence-based, values-based health and social care interventions to meet the needs and aspirations of service users and their families and carers.
9. Promoting Safety and Positive Risk Taking. Empowering the person to
decide the level of risk they are prepared to take with their health and safety. This includes working with the tension between promoting safety and positive risk taking, including assessing and dealing with possible risks for service users, carers, family members, and the wider public.
10. Personal Development and Learning. Keeping up-to-date with changes in
practice and participating in life-long learning, personal and professional development for ones self and colleagues through supervision, appraisal and reflective practice.
As you work through this module you will look at each of these capabilities in turn and think about how they apply to the work you do.
Please note:
The 10 ESC are the foundation on which good mental health practice is set. On a surface reading all capabilities may seem sensible and reflect your current attitude and practice. Based on our information from the pilot programme, we have evidence that by reflecting on your role and practice, the ESC can be challenging and provide a greater insight into mental health work and fundamentally challenge the basis of care. *We use the word care in its widest application. We care for each other as persons whatever role we perform either in work or at home and in social settings.
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The Ten Essential Shared Capabilities 2. Meeting Phil - A Recovery Perspective
Phil is a real person and this is a real story...........
In February 2004 I was employed in a senior post in the UK Merchant Navy. I was earning a good salary. I was well qualified and considered good at my job. I lived a secure middle class existence in an almost paid for semi in a popular area. While my relationship had been in a poor state for some time I doted on my eight year old son. In March 2004 I suffered a bi-polar episode. As this wasnt my first such episode I was aware of my deteriorating condition and contacted my GP hoping to initiate an early intervention. My GP arranged a visit from locally based CPNs who arrived within a day to make an assessment. As a result of this assessment I was given support from Crisis Resolution Services and it was my stated conviction that I believed I had acted in time to forestall this episode becoming a major risk. Unfortunately this was misplaced optimism and three days later I suffered a manic attack which led inevitably to my admission into an acute psychiatric unit. As the alternative was possibly death it wasnt a bad result. With hindsight I hadnt been failed in anyway by the system, rather my perceptions of my mental health were skewed. This admission, not my first, was to have results which were previously unforeseeable. While in this unit, which was a temporary stay as I awaited a move to a unit nearer home, I had a brief period of lucidity and felt the need to read. The magazines appeared mundane and the books offered nothing either. I took to the last resort of the frustrated mind in a unit I started scanning the rack of leaflets. In amongst the womens groups, mens groups, schizophrenic support groups and countless copies of Hulls own New Dawn the title of one small pamphlet caught my eye. It wasnt a gaudy colour, nor was the writing in an unusual font or super large. Rather the heading represented something. Positive Assets? I wasnt one at this time, in fact I was anything but, in my mind the self cancelling negative asset leaving a nice round zero was more appropriate. Within two weeks I had lost my job and my relationship had shuddered through its final death throws. I hadnt seen my son since my admission. Seven more weeks saw me discharged into the community, into a MIND hostel as I was technically homeless. It was also technically an improvement. Although the benefits system we labour under meant that financially I couldnt live as well as I had been in the acute unit! After I had paid rent to MIND who were doing a fantastic job I had about 30.00 to live on. This was socially and economically an unusual situation for me to find myself in to say the least. I had some good friends but I couldnt afford to socialise with them. I had hobbies but I couldnt afford to carry them out. I had a lot of money
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invested in a house but couldnt touch it. Anyway, I had already made the decision that whatever happened to me there would be the minimum disruption to my sons life, so asking my now ex wife to help was out of the question. Contact with my son was limited as my ex partner would not allow him to spend time with me where I was because she didnt want him in a house full of mad men although to give credit where its due she wouldnt have allowed him to spend time in a house full of mad women either! To travel to his location was expensive, as was doing ANY of the activities young boys expect from their dads. Movies, football matches, burgers, shopping expeditions, music, bmx parks, especially bmx parks at which we had previously spent hours together, ALL beyond my reach. I dont care dad I just love you brought tears to my eyes and allowed me to feel proud of something I was a part of, but didnt alleviate the sense of failure as a provider. Anyway I just wanted to spend time with him and even that was problematic. People use the phrase rock bottom. That was also the phrase I applied to myself as I took stock of my situation. Of course rock bottom is subjective and in reality things could have been much worse for me. However for me, I was reliant on other people for everything, I had no job and couldnt go back to my previous employment on my consultants advice, I could afford none of the social activities everyone, myself included take for granted. I am held by drugs in my system which in reality are keeping me socially viable, I had debts which I couldnt afford to pay off and which were catching up with me fast, I felt a failure and looked a failure, in my own eyes I shuffled and hung my head like a dog. Smiling happy people began to annoy me. Rock bottom? The correct phrase is socially excluded but that hardly seems to be the correct language to use for oneself. Rock bottom thats more descriptive. I took stock of my possessions. My beloved Apple lap top, my books at my old address, some expensive toys and my clothes. And my mind which was now functioning in a fashion I could recognise. What else? A mounting pile of angry letters from banks, a growing pile of communication with benefits agencies and a leaflet which I had kept when I left the acute unit. Positive Assets. That word again, Positive! The one word that so many excluded people are unable to associate with! I am in debt but I am positive about it? I cant get a job but its quite positive really? I cant see my friends but thats a positive? I cant function as a father but thats another positive? Here was a leaflet telling me I could be positive about something, not only job opportunities but the suggestion of understanding! I made a telephone call. This very quickly led to a meeting, the meeting with the positive assets coordinator was positive. A first in a while and not the last. Yes I could get a job. You would like to be a care worker? Definitely something to be positive about and achievable. Lets try and sort that now. Need a bit of positive encouragement to go for that? Here it is. Excellent, lets see whats available, well send you letters telling you when posts
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become available. Yeah about one a month? Bloody hell not another one falling through the letter box. Need help with your CV? Need help with the application? No? You can do it yourself? Thats fantastic thats positive. You can do this. The Positive Assets Coordinator was so positive towards me I began to feel positive towards me as well. Excellent, thats alright then, things are going fine, heres another job. Experience in the care field required, at least one year suggested, all is not that rosy in the garden then? What about past experience as a service user, other people in the care field tell me to be very careful about mentioning that. Social inclusion is still a lip service for some. It may hold you back. Or it may not. So thats a dont know then? Thanks for the advice. Hey heres one. Have you heard of a new post called STR Worker? Yeah but I dont have a years experience of care work. Not a problem. But I have been a service user. Thats two not a problems. This post specifically offers the opportunity for employment in the local Trust to service users. You mean service users as in the socially excluded? As in the rock bottomed? The application form came and was filled out. The job description had appealed immediately. It seemed a little like they wanted people like me to support people like me. There was a lot of humming and hah-ing around that. Transferable life skills and a lot of experience of not feeling very well mentally. None of my qualifications seemed relevant, the removal and realigning of a ships tail-shaft with adjustments to the OD box and recalibration of the closed loop feedback systems while setting the cpp to the relevant K mark? Excellent, heres a job in mental health its yours. However life skills, values, experience of multi cultural working and living, a firmly held belief system that has never been discriminatory. A willingness to be educated in new skills and an empathy for fellow travellers, how could you not have that. It was as if the STR role was made with people like me in mind. And there are many mes in the mental health system. How to mention my being a service user without making it sound like a plea for employment? How to mention this fact and maintain dignity? Will this job come because you are the best for the job or because you have a mental illness and someone wants to tick a box? Yes weve employed one. On the surface everything appears supportive, will it be? In the end I opt for as a previous user of services I have gained a limited understanding of the operating of the mental health systems. I left it at that. I get an interview. I am not nervous in interviews, some are and its a great shame that this has held some excellent people back. This interview was different; it seemed designed to give the nervous an opportunity to overcome some of the stumbling blocks. Whilst not nervous in interviews I actually found myself enjoying this one. The questions required answers based upon honesty, common sense and values. As usual I assessed my chances. Everyone I talked to seemed to have some degree of experience in care work and seemed relieved to hear I didnt. Perhaps mentally eliminating me.
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We are promised calls at 1600 informing us of our success or lack of. By 1800 I figure it had been worth a punt but therell be another chance. So positively had positive assets changed my thinking. The phone rings, the usual moment of high tension, Ive got the job! You mean I am advancing to the next stage of the interview process? No, youve got the job. Ive got the job!! Flip Me. Its that dramatic. Socially excluded, rock bottom, to employed. The first step has been taken; social exclusion is beginning its rotation. Now begins the usual world of bumf. Forms for this, forms for that, lets inject you in the arm, lets change the insurance on your car, sure as soon as I get one you can. Have you got a telephone number? An email address? A mobile number? No but I bloody well will have because now social exclusion is rotating and I can feel the centrifugal effect, phones, emails and mobiles. Injections, forms to fill in, want me to have a car? I can because I will be employed. Ill be included. Do you have a bank account number? Do I ever, I get a letter reminding me of it every day from an irate manager, hell be very pleased at my move into the world of social inclusion. Mentally the pace picks up and with it goes my stature and head, it no longer hangs. Im going to be an STR worker, employed, included, Ill see my son and well go to the bmx park. We might even go to the good one in Leeds, because being socially included these activities are open to me. I start work, I receive training, the STR leadership is exemplary, enthusiastic and inclusive. I know thats bad grammar but I love the word inclusion. The training is excellent. Lifelong learning I think its called. How inclusive is that! And this is because someone somewhere thought of having a new role that would be open to service users. Someone said lets call it STR worker. Someone in the Humber area said that looks good and lets put someone with enthusiasm in charge of the initiative, someone who believes in the role and its values. As a result, myself, and, I know, a large number of other service users are now back in the world so to speak. And you know what? We all have suffered some form of social exclusion at one time or another so we should all be able to fight against it. And we are. Want to fight social exclusion? Employ someone whos suffered from it! I myself am now back in the world of the included, please, never let me forget where I was last year, for my sins I get to look back into the dark world of the excluded and sometimes reach far enough into it to help someone pull themselves a bit of the way back from the underworld of exclusion. That is the great privilege that the STR role has bestowed upon me and others like me. Id change one thing. Id call it Support Time and Inclusion worker!
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Activity 2.1
Write down or talk to your group colleagues about your inital thoughts after reading Phils Story
Activity 2.2
In your groups discuss which ESC value descriptors played a role in Phils story? Note you may not all agree on which ESC descriptors were influential, nor agree on the degree of influence. How do you account for any differences between you and your colleagues?
Do your values and the way you would behave have influences on how you view Phils experience?
Did you and your group colleagues negotiate a common agreement on the key issues?
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Do your values and behaviours have influence over the way you work?
Note to facilitators: you can end the session at this point.
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The Ten Essential Shared Capabilities 3. Working in Partnership
In this section we are asking you to consider the people and services who needed to Work in Partnership in order to offer Phil the support he needed. Remember working in partnership is characterised by developing and maintaining constructive relationships with service users, carers, colleagues and the wider community.
Activity 3.1
Draw a diagram that represents the people and services that were/should or could have been there for Phil in his recovery.
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Activity 3.2
Draw a diagram of the key people you work alongside.
Do you understand the roles of all these people and how these fit with your role? If not, arrange to talk to them about this. Use this opportunity to check that they understand your role.
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The Ten Essential Shared Capabilities 4. Respecting Diversity & Challenging Inequality
Activity 4.1
What barriers did Phil face from stigma and discrimination throughout his journey?
Activity 4.2
Record an example of discrimination experienced by someone with whom you work or have worked. Note: please consider issues of confidentiality when writing and/or discussing this.
What did you do (or could you have done) to address this:
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The Ten Essential Shared Capabilities 5. Challenging inequality
The Social Exclusion Unit, in their report Mental Health and Social Exclusion (2004) presented the problem as: 1. Adults with long-term mental health problems are one of the most excluded groups in society. Fewer than 25% of adults with long-term mental health problems are employed. . Mental health problems cost the country over 77 billion a year. . Social isolation is an important risk factor for deteriorating mental health and suicide. 4. Severe mental health problems affect 1 in 200 adults a year. 5. More common mental health problems affect 1 in 6 people, with the highest rates in deprived neighbourhoods. GPs spend a third of their time on mental health issues. Costs for anti-depressants have risen and there are variations in access to talking therapies. 6. Over 900,000 adults in England claim sickness and disability benefits for mental health conditions. 7. Mental health problems can have a strong impact on families both financially and emotionally. 8. Creating sustainable, inclusive communities is about everyone having a stake. Being in work and having social contacts is strongly associated with improved health and well-being. People with mental health problems have much to offer. If they can fulfil their potential, the impact of mental health problems can be significantly reduced.
The report presented the causes of the problem: Stigma and discrimination against people with mental health problems is pervasive throughout society. Professionals often have low expectations of what people with mental health problems can achieve. Lack of clear responsibility for promoting vocational and social outcomes for adults with mental health problems. Lack of ongoing support to enable people to work. People face barriers to engaging in the community. Groups that face particular barriers are ethnic minorities, young men, parents with mental health problems and adults with complex needs.
Activity 5.10
Think of a service user (or another person you know). What barriers does this person face from stigma and discrimination in trying to fulfil their potential?
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The Ten Essential Shared Capabilities 6. Practicing Ethically
Activity 6.1
What does practicing ethically mean when considering Phils experience?
Activity 6.2
Please answer the following questions. This activity will help you to identify what values mean to you. There are no right or wrong answers. What are your values?
Compare your answers with what other people said:
What are values?
LIST 1 Delegates at a recovery conference Core beliefs Principles cultural, individual Anything thats valued Quality of life Right to be heard Social values Self respect Valuing neighbours Your perspective on the world LIST 2 Managers / Chief Executives Right and wrong Belief systems Ideals and priorities Things that govern behaviour and decisions Morals Principles Standards Conscience Fluid / changeable LIST 3 Trainee Psychiatrists What you believe in Self esteem Principles Integrity Openness/honesty Personal motivating force Primary reference points Ethics Virtues
In completing this activity you have thought about what you mean by values. You are also aware that other people may mean something different.
Activity 6.3
Did Values have anything to do with Phils recovery? If so what values? Whose Values?
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Activity 5.4
What effect did the expression of these values have on Phils recovery? and how might they affect other people? (Think about colleagues, family, Service Users, Carers when considering the effect of values on your behaviour)
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The Ten Essential Shared Capabilities 7. Promoting Recovery
Activity 7.1
What do you understand by the term recovery?
Activity 7.2
Discuss recovery as a group to ensure everyone has a clear understanding of the term. (It may be useful to consider the NIMHE guiding statement on Recovery to help here.)
Activity 7.3
What do you think contributed to Phils recovery and what will continue to help his recovery?
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The Ten Essential Shared Capabilities 8. Identifying Peoples Needs and Strengths
Activity 8.1
Think about your own strengths and talents and list the three or four that you are most proud of:
Activity 8.2
How could Phils strengths and talents have been used to improve his recovery?
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The Ten Essential Shared Capabilities 9. Providing Service User Centred Care
Activity 9.1
Make a list of anything or anybody that you found helpful or supportive at a time in your own life when you were distressed: 1.
.
.
4.
5.
The Strategies for Living team at the Mental Health Foundation asked a similar question to service users to find out about their strategies for living with mental distress. (Faulkner and Layzell 2000) Compare your list with the table below. This gives an overall picture of the different strategies and supports people found to be most helpful. Many people identified two or three supports (people or activities), whilst a few found that one factor - or person stood out for them.
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Most helpful strategies and supports
Relationships with others Friends, partners, family Other service users/people with similar problems Mental health professionals Counsellors/therapists People encountered in day centres, drop-ins, voluntary sector projects Personal strategies Peace of mind Thinking positively, taking control Medication Physical exercise Religious and spiritual beliefs Money Other activities Hobbies and interests Information Home Creative expression
(Faulkner and Layzell 2000) From this table you can see the variety of people, activities and strategies that were seen to be helpful. Some are offered by mental health services but very many are much wider than that. Remember to think broadly when working with a service user to help them to describe their goals, identify their strengths and develop their own recovery strategy.
Activity 9.2
How did Phils support differ from yours?
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The Ten Essential Shared Capabilities 10. Making a Difference
The processes and power of exclusion
In order to combat social exclusion, we need a good understanding of how it works in society and affects individuals (SEU 2004; see also ESC 4 Challenging Inequality). The following three definitions describe distinct but inter-related elements. Inclusion as access. People using mental health services should have access to the decision-making places where their personal care is reviewed and planned; where services are designed, managed and audited; and where jobs and promotions are offered. Inclusion as standard of living. People using mental health services should have the same opportunities as other citizens to enjoy employment and income, healthcare, housing and community safety, civic and legal rights. Inclusion as relationships. People using mental health services should have the same opportunities to establish and maintain respectful connections and friendships with a diverse array of other citizens. (Bates 2002)
Consider the following case examples in turn and build up a detailed story of a typical journey into an excluded life that might be experienced by a person from the first onset of mental distress (Mind 1999).
Activity 10.1
Consider how the three aspects of inclusion listed above impact on the persons life and become mutually reinforcing. 1. Do factors such as age, gender or ethnicity affect Phils journey?
. Do mental health services sometimes make exclusion worse?
. What do these services do to help the recovery journey?
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11. Promoting Safety and Positive Risk Taking
Activity 11.1
Write down what you think the risks faced by Phil, his carers and services were. How might these risks be positively addressed?
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The Ten Essential Shared Capabilities 12. Personal Development and Learning
Activity 12.1
Write down your reflections on what you have learned from studying Phils story?
How might this be translated into your role within mental health services? Remember the Ten ESC apply to you, as well Service Users/ Cares and colleagues.
Identify two actions to take away and work on during the first three months of your new role. discuss these with your line manager to be incorporated into your initial workplace induction programme.
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