Recovery Colleges: supporting recovery and living well in local communities
Intended for healthcare professionals
Evidence and practice    

Recovery Colleges: supporting recovery and living well in local communities

Matthew Jonathan Ellis Principal, Calderdale and Kirklees Recovery and Wellbeing College, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, England
Jane Rennison Senior ImROC consultant and trainer, ImROC, Nottingham, England

Why you should read this article:
  • To acknowledge the need for the NHS to shift from managing symptoms to promoting recovery

  • To learn more about the development, principles and ways of working of Recovery Colleges

  • To understand how you can incorporate elements of a ‘recovery and living well’ approach into your practice

With increasing pressure on health and social care services, there needs to be a shift away from treating illness as it arises towards preventing it and supporting people to live well with it. In this article, the authors describe the ‘recovery and living well’ approach and the role of Recovery Colleges in that approach. A fundamental aspect of Recovery College is that people are supported and enabled to take control of their condition and live the lives they want to live through courses delivered in the local community and co-produced and co-facilitated by people with lived experience and professionals. Nurses can support the people they care for to understand their health condition and well-being needs and learn how to live well by introducing elements of a ‘recovery and living well’ approach in their practice.

Primary Health Care. doi: 10.7748/phc.2023.e1818

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

@ImROC_comms

Correspondence

jane@imroc.org

Conflict of interest

None declared

Ellis MJ, Rennison J (2023) Recovery Colleges: supporting recovery and living well in local communities. Primary Health Care. doi: 10.7748/phc.2023.e1818

Published online: 13 December 2023

Recovery Colleges, as a component of a ‘recovery and living well’ approach, align with the NHS (2019) Long Term Plan and the review of Integrated Care Systems (Department of Health and Social Care 2023) in terms of their focus on the importance of enabling people to take greater control of their well-being, live the lives they want to live and access services in a more informed way. The Recovery College model drives a new healthcare paradigm where people are fully aware of their rights; understand their health condition and well-being needs and how these interact with their social circumstances; and know where, when and how to access support. Through the work of Recovery Colleges, local communities can become more engaged, confident and capable in accommodating, supporting and building on their population’s diverse needs and strengths. Within the Recovery College model, healthcare professionals can recognise the expertise of service users as having equal value to their own and engage in collaborative decision-making about well-being, care and treatment.

Key points

  • Government policy emphasises the importance of shifting the focus from treatment to prevention and recovery

  • Improving outcomes is not only achieved by treating people’s symptoms but also by addressing their social circumstances and personal goals

  • For an individual, recovery means gaining hope, understanding one’s abilities and disabilities, engaging in an active life, and having autonomy, identity, purpose and a positive sense of self

  • The Recovery College model is a natural extension of a ‘recovery and living well’ approach

  • Recovery Colleges are educational, collaborative, progressive, inclusive, strengths-based and community-facing

Need for a new model of care

The NHS is under extensive pressure fuelled by factors such as an ageing population with multiple long-term conditions, an expanding range of treatments and interventions, and a more informed population seeking the best treatment and support, alongside an increased reliance on health services to provide these (NHS England 2023). This is compounded by high vacancy rates, the ongoing effects of the coronavirus disease 2019 pandemic and delayed discharges from acute services due to lack of resources in social services. Additionally, the UK is experiencing a cost-of-living crisis which is deepening healthcare inequalities and increasing demand on health services (Care Quality Commission 2023).

Some commentators have questioned the sustainability of the current NHS model if it does not move away from an ethos of treating illness as it arises to an ethos of preventing it (Lent et al 2022). Logically and economically, there comes a point where the NHS can grow no further. Government policy emphasises the importance of shifting the focus from treatment to prevention and recovery, of removing barriers between acute and community care, and of enhancing collaboration between health and social care services (NHS 2019, DHSC 2023). At this point in the NHS’s existence, there is an opportunity to explore alternative models of support and alternative ways in which health and social care professionals can deliver that support.

Moving from service dependency to community engagement

There are resources within local communities that often go unnoticed. For example, in 2021 there were an estimated 5 million unpaid carers in England and Wales, 1.5 million of whom spent more than 50 hours a week providing care (Office for National Statistics 2023). This figure roughly equates to the number of people employed in NHS hospital and community health services, which was just over 1.4 million in January 2023 (NHS Digital 2023). Given the size, experience and potential expertise of this ‘core’ or ‘love’ economy (Stephens et al 2008), health and social care services need to consider how to connect with, value, nurture and work alongside unpaid carers.

Around 70% of NHS expenditure goes to the treatment of people with long-term conditions (House of Commons 2014). Furthermore, it has been estimated that 20-50% of patients consult their GP for what is primarily a social problem (Malby et al 2019). Support from healthcare professionals and prescribed medicines have a limited, albeit important, effect on people’s outcomes and quality of life. Evidence suggests, for example, that clinical care explains 20% of health outcomes while the combination of social, environmental and economic factors such as housing, unemployment and loneliness explains 50% of them (Moriarty 2023).

This infers that improving patient outcomes is achieved not only by treating people’s symptoms but also by addressing their social circumstances, personal goals and what makes life meaningful for them. While health services might address a health condition, the person needs support to recognise that their condition does not define them and that they can continue to live well if they have the practical and emotional support to do so.

Moving from managing symptoms to promoting living well

Being a service user is a transient role, maybe the length of a brief weekly healthcare appointment. For the rest of the time, a service user is a person living their life, and it is in that context that they need support in terms of choices and opportunities to manage their health condition and live well. Finding a balance between managing a health condition and living well often requires a change in the person’s behaviours within a supportive culture. This can assist them in ‘rebuilding a meaningful, valued and satisfying life’ (Sanati 2022). The focus of health services and healthcare professionals therefore needs to shift from managing symptoms to promoting living well.

Moving towards a model of community-led support that draws on local resources, where the individual is regarded as a ‘person living their life’ rather than a consumer of health services and where social factors are recognised and addressed, can enable people to take greater control of their well-being and facilitate illness prevention (Public Health England 2015). Good health is not made or managed in institutions but in communities (Marmot et al 2020).

As well as moving towards working more closely with local communities, health services and healthcare professionals also need to change their perceptions of what constitutes successful outcomes. Healthcare is not solely about prognosis and clinical outcomes, but about the meaning life has for people. This was illustrated by the British entrepreneur Nick Hungerford, who while living with terminal bone cancer set up a charity for children bereaved by the loss of a parent.

In a radio interview in June 2023, shortly before his death, Mr Hungerford stated that ‘dying makes you privileged’ and described how he used the terminal phase of his illness to reflect on what he valued in his life, the time he had left and who he wanted to spend it with, as well as to plan for his death (BBC Radio 4 2023). These are valid outcomes and healthcare professionals can support people to attain such outcomes by considering that their role is partly to protect, as far as possible, people’s ability to pursue their highest priorities in life, which is ultimately about sustaining the reasons one wishes to be alive (Gawande 2014).

Concept of recovery

For people living with long-term conditions, symptoms can, over time, worsen and become more challenging to manage, even with medical treatment. However, it is still possible for them to find meaning and purpose and live a valuable life. The contemporary concept of recovery emerged in the US in the 1970s and 1980s, when people with personal experience of severe mental illness challenged the notion that their symptoms defined them and would prevent them from achieving their life goals, and demonstrated that it is possible to live life with such symptoms (Roberts and Boardman 2013).

Recovery has been described as ‘the process of rebuilding your life following devastating and life changing events: finding a satisfying and valued life, doing the things that matter to you and pursuing your priorities in life. The process of grieving what you have lost, finding meaning in what has happened, rebuilding a sense of self and purpose in life and growing beyond what has happened’ (Anthony 1993).

Recovery is an ongoing process defined by the individual. It is not synonymous with cure (World Health Organization 2013). From the perspective of the individual, recovery means gaining and retaining hope; understanding one’s abilities and disabilities; engaging in an active life; and having personal autonomy, social identity, meaning and purpose in life and a positive sense of self. Box 1 lists principles underpinning the concept of recovery.

Box 1.

Principles underpinning the concept of recovery

  • Making sense of our condition(s), understanding what it means for us and our lives and for our significant others

  • Working with relevant people to learn how we can keep ourselves as well as possible

  • Recognising our personal strengths and talents and the resources available to us, such as family, friends and communities

  • Making use of the support in our local communities

  • Identifying and working towards new possibilities and priorities

  • Discovering ways of doing things that are valuable to us

  • Recognising our rights, self-advocating and overcoming stigma and discrimination associated with our condition and life experiences

  • Understanding our needs and knowing when, where and how to access the support we need

(Adapted from ImROC 2020)

Healthcare professionals who adopt a recovery-focused approach re-conceptualise their role as enablers, supporters and informers rather than ‘fixers’. This changes what they do, how they do it and the nature of their relationships with the people they support (Till 2007). Table 1 shows the difference between a clinically focused approach and a recovery-focused approach to supporting service users.

Table 1.

Clinically focused approach and recovery-focused approach to supporting service users

Clinically focused approachRecovery-focused approach
The person requiring support is regarded as a service userThe person requiring support is regarded as a ‘person living their life’
The focus is on:
  • ‘What is the matter with you?’

  • Symptoms and problems

  • Diagnosis

  • Assessment

  • Treatment

  • Prognosis

  • Health-defined outcomes

The focus is on:
  • ‘What matters to you?’

  • Values and beliefs

  • Relationships

  • Abilities and strengths

  • Interests and aspirations

  • Purpose and meaning

  • Roles and occupation

  • Person-defined outcomes

The relationships between the professional and the service user is one of dependency and ‘doing to’The relationship between the professional and the person is enabling and collaborative
History, social circumstances, activities, beliefs, values and strengths are used to inform decisions about diagnosis, treatment and supportDiagnosis, treatment and support are considered in terms of the extent to which they help the person do the things they value and want to do

(Adapted from Perkins 2012)

Recovery Colleges

The Recovery College model is a natural extension of a ‘recovery and living well’ approach. Recovery Colleges started in mental health services, but have gradually developed for all health conditions and settings and are now situated in primary care and in public health and mainstream community venues such as libraries and sports centres (Hayes et al 2023). The first Recovery College was set up in south London in 2009 (Rinaldi and Wybourn 2011). Since then, a further 221 Recovery Colleges have opened in 28 countries across five continents (Hayes et al 2023). There are Recovery Colleges in all four countries of the UK.

Principles of Recovery Colleges

Recovery Colleges are defined by the following principles (Perkins et al 2018):

  • Educational – Recovery Colleges provide places for people to learn and their users are considered students, not patients. They offer courses focused on how to recover from, and/or live well with, a wide range of physical and mental health conditions. They provide students with information and advice about their condition, the available treatments and therapies, and how to keep themselves well – for example by adjusting to changes in their lives, getting back into work and/or education or becoming involved in volunteering. Students enrol on whichever course they are interested in.

  • Collaborative – all aspects of Recovery Colleges are co-produced by people with lived experience, professionals and subject experts who work together as equals to develop and facilitate courses and ensure their quality.

  • Progressive – Recovery Colleges enable students to identify their goals and explore ways of achieving those goals outside health and social care services. They support students to move through and out of the college and through and out of health and social care services towards what they want to achieve in their lives.

  • Inclusive – Recovery Colleges are open to everyone, are free and do not require referral from health or social care services. There are no diagnostic requirements or formal risk assessments, such as in the context of mental health issues.

  • Strengths-based and person-centred – the strengths, skills, qualities and abilities of each individual member of staff and student are identified, built on, celebrated and rewarded.

  • Community-facing – the Recovery College model involves active engagement and partnership working with local community organisations such as libraries, faith centres, leisure and social facilities, support groups, further education colleges and universities.

How Recovery Colleges function

Typically, a Recovery College employs a small team comprising people with lived experience and professionals (such as social workers, occupational therapists, nurses and administrative staff) supplemented by a larger pool of sessional peer and professional trainers and subject experts (such as medical staff, housing officers, social prescribers and community link workers drawn from local health and social care services and community organisations). A Recovery College runs in the same way as a mainstream college, with a prospectus and the provision of courses during academic terms. Courses may be a one-off session or run over several weeks with one session per week. Some Recovery Colleges are funded directly through integrated care boards; some are partly funded by local authorities and/or charities; and some received funding from a mix of health, social care and third-sector organisations. Many also rely on local partnerships, including through Community Learning projects.

An example of a course offered in a Recovery College would be a wellness planning course. Such a course would be co-designed and co-facilitated by people with lived experience and professionals with expertise in that area, creating an empathetic and sensitive learning environment. Students on a wellness planning course would be encouraged to develop and build on their ‘wellness tools’, for example self-compassion, supportive relationships or hobbies. A core element of Recovery Colleges is encouraging people to take control of their health condition, their treatment and the way they live their life, so students on a wellness course would also be provided with information about their health condition to assist them to make informed decisions about their treatment and care.

Recovery Colleges are not a substitute for the specialist assessment, treatment and therapy provided by healthcare professionals working in health services. However, by blending lived experience and professional expertise, Recovery College courses can increase people’s understanding of the challenges they are experiencing and how to manage them. This helps them to move from being passive recipients of care, who expect others to ‘do for them’, to becoming active agents in managing their health and well-being.

Recovery Colleges demonstrate the power of peer support. Students are likely to meet others with similar issues to theirs and learn about how they are managing these issues. They may build circles of support and make lasting friendships, in a similar way to students attending mainstream educational facilities. The experiential nature of the learning creates an empathetic and understanding environment that demonstrates that change is possible, which can inspire and motivate students to make changes in their life. Furthermore, observing how trainers co-facilitate courses can help students recognise their own potential. For example, seeing someone with a mental health condition working as a respected equal with a professional can raise a student’s hope and expectations for themselves and reduce self-stigmatisation (Repper and Eve 2023).

Students who have attended Recovery Colleges often go on to become volunteers, using their unique set of skills to provide peer support to others. This is important in terms of personal value – being able to use one’s skills and feeling competent can support recovery and living well – and benefits Recovery Colleges in terms of resources, productivity and strengthening connections with the local community. This idea of mutual benefit is not present in services constructed on a clinically focused paradigm.

Benefits of Recovery Colleges

Emerging evidence such as annual reports and published articles shows that Recovery Colleges are popular with students, who derive a range of benefits from attending courses including skills and knowledge development, reduced feelings of internalised stigma, belief that recovery is possible, increased sense of social inclusion and empowerment (Lucchi et al 2018, Toney et al 2018, Jersey Recovery College 2021, Doroud et al 2023). In addition, students have reported benefits from the ‘hidden curriculum’ provided by Recovery Colleges, such as a sense of belonging and peer support (Yoeli et al 2022). An ongoing programme of research, Recovery Colleges Characterisation and Testing (RECOLLECT), is investigating the effectiveness of Recovery Colleges in England and can be accessed at: www.researchintorecovery.com/research/recollect

Implications for practice

The authors of this article have described an alternative paradigm of healthcare that requires re-envisaging the role of healthcare professionals and shifting the focus from achieving clinical outcomes to gaining a wider understanding of people’s lives and what matters to them. The authors argue that, to help people under their care take control of their health and lives, nurses and other healthcare professionals need to look beyond treatment and care plans to focus on recovery and living well.

Nurses interested in incorporating ‘recovery and living well’ approaches in their practice may want to consider:

  • Broadening their understanding of healthcare outcomes to incorporate people’s personally defined outcomes.

  • Tapping into the expertise of the people they support, their families and their wider networks.

  • Developing and strengthening their connections with, and involvement in, local community organisations.

  • Sharing their expertise by co-producing or co-facilitating courses at their local Recovery College.

Conclusion

The sustainability of the current model of health and social care services in the UK is doubtful if services do not move away from treating illness as it arises towards prevention, recovery and living well. Recovery Colleges, which are a natural extension of the ‘recovery and living well’ model, can support this shift by delivering courses within local communities using local resources. The Recovery College model, which is based on co-production between professionals and people with lived experience, can support people to understand their condition and well-being needs and learn how to live well. Nurses can use elements of the ‘recovery and living well’ approach to support the people they care for in their area of practice.

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