My shared pathway – involving service users of secure mental health services

Rethink Mental Illness is a charity that supports almost 60,000 people every year across England to get through crises, to live independently and to realise they are not alone. Ian Callaghan is the Recovery and Outcomes Manager at Rethink Mental Illness and is National Service User Lead for ‘My Shared Pathway’ (which started as Department of Health-led initiative) he is also a former service user of secure mental health services.

Ian shared his experience of involving secure mental health service users in the development of ‘My Shared Pathway’ with NHS England.

What was the reason for involving service users, what were the issues you wanted to address?

Service users were not satisfied with the services they were receiving. This was because services provided at the time were not focused on recovery. People with mental health problems did not know what they needed to do to move on and get better. They were not as involved in their care as they wanted to be, which made it difficult for them to understand their care pathway.

From a commissioner’s perspective the involvement of service users and their feedback helps to provide valuable information that can be used to measure and manage service performance.

How did you do it and who did you need to involve?

My involvement started at a ward level, while I was a service user myself. It involved speaking to staff and other service users about our shared experiences of services. The networks grew and we started making regional connections and encouraging involvement through local and regional Recovery and Outcomes groups.

In the Yorkshire and Humber region, where the project initially developed, there was already a strong focus on involving service users and on recovery, so this provided an excellent starting point. The key to the success of developing ‘My Shared Pathway’ was bringing everyone together – service users, staff, service providers and commissioners. You need to involve everyone to develop a joint approach and sign-up at all levels. This helps to make service users and staff feel their involvement is valued. It creates an open forum, where everybody is equal and collectively focused on finding solutions.

What has changed?

From a service user perspective ‘My Shared Pathway’ means that they are involved in decisions about their own treatment and care. Recovery is person-centred and can involve family and carers too – this is a positive shift in culture.

Service users are involved in decisions about their care and things are explained and discussed, for example risk and safety planning. Care plans are co-produced between service users and staff and there are regular review meetings.

Service users have clear targets to achieve their desired health and wellbeing outcomes. They understand the steps they need to follow to get well and work together with staff to meet these targets.

What has been the impact?

The shift in culture has been empowering for service users and staff. Service users are more confident in saying what they want and need from their care. Surveys and anecdotal evidence tells us that communication and relationships between staff and service-users have significantly improved – they are working together towards a common goal.

Service users feel more in control of their lives and able to get better quicker. Feedback we have had suggests that there are reductions in length of hospital stays and time spent in hospital is much more productive.

How has it helped to shape services longer term?

Being listened to has empowered service users and staff and encouraged them to input to the development of services and continue to be involved.

By bringing people together locally, regionally and nationally we have opportunities to share best practice and learn from each other on an ongoing basis to continue improving.

Our initial work on ‘My Shared Pathway’ has also opened up opportunities to have a voice nationally, for example through the Mental Health Taskforce. We work with NHS England and give our perspective on the development of services and what is important to people with mental health issues who are in secure units. Through these networks we hope to have a lasting impact on meeting the treatment and care needs of service users.