The power of co-production: Building service user research skills with the Recovery College

Rachel Holden, Clinical Psychologist at the Institute of Psychiatry, Psychology & Neuroscience, and Nick Hunter, Peer Recovery Trainer at the Recovery College, have been working with clinicians, researchers and service users to develop a novel approach to co-produced research in collaboration with the Recovery College at South London and Maudsley NHS Foundation Trust.

In this blog, Rachel and Nick discuss how by creating and conducting their own piece of research they developed a course to help service users understand and participate in research. The results have helped to transform service user views not only on research, but also about their own mental health recovery.

Over the past months, a collaboration has taken place between King’s College London and South London and Maudsley NHS Foundation Trust’s Recovery College, which offers free mental health and wellbeing education. Over 12 weeks we have delivered a Recovery College course on understanding research though conducting a piece of research. The College is an education service at the Trust, providing free mental health and well-being courses to support recovery. It is open to all service users, their family and friends, as well as volunteers and staff. A wide range of workshops are offered throughout the year, developed and delivered by those with lived experienced and/or professional expertise. 

The project was set in the River House Campus of the Recovery College, and our students were a group of staff and service users within forensic services. Forensic mental health services provide treatment, rehabilitation and aftercare for people who are mentally unwell and who are in the criminal justice system. River House is at Bethlem Royal Hospital and is for people, aged 18-65, with mental health problems and a history of offending behaviour, and who are acutely unwell or have challenging behaviour.

Our facilitators were comprised of a number of staff members, the majority with lived experience of mental illness.

Getting started

The team met regularly over the course of six months to develop materials for the group. With support from the Trust’s Service User Research Ambassadors Lily Kpodo and Jemma Venables along with guidance from Caroline da Cunha-Lewin of the Consent 4 Contact (C4C) research register, we spent several months outlining what the purpose would be, how it was to be delivered, and if there were any potential stumbling blocks which could have been anticipated along the way.

Despite our team’s concerns about potential resistance or anxiety from senior management, because we were asking for the freedom to research whatever our service users suggested, we were instead met with overwhelming support and ideas to develop the course further.

Various aspects of the course ensured we met the quality assurance process within the Recovery College: the psycho-educational element and the involvement and co-production with our students. The ROSE (ethics) committee was helpful in guiding us along the path of service evaluation. Students could decide on and discuss any research topics (nothing was considered off limits) as part of the course development.

Originally set to be held in person, COVID-19 restrictions shifted the course development and delivery online. This allowed us to work closely with many members of the team including psychologists, occupational therapists, and activity practitioners within the unit. This enabled us to identify multidisciplinary team (MDT) support for the project and an openness to working with the findings of our research.

Recruiting student researchers

Recruiting students to commit to a 12 week course with a title as dry as “Research Skills”, was always going to be a challenge. A lot of effort went into creating a presence and swell of enthusiasm within the River House unit. We organised and developed a River House wide vote on potential research questions. This was promoted at community meetings, patient rep meetings, roadshows, and general awareness on the wards. Not only did this give us topics to work with in our course but also it identified an interest within the service users (and staff) on signing up for the course. The results of the vote were fed into the course, with student ultimately choosing one to focus on.

Research topics put to a River House vote, included:

Taught content

The course eased our students into the realms of research, with weeks one to four exploring what research means to our students, and looking at everyday, practical examples of research skills that we all utilise.

Topics covered each week: 

Choosing a topic and a methodology

A week was spent deciding what theme the group would ultimately decide upon. As well as considering the topics suggested by the wider River House community from the vote (above), students were invited to write their own. After a very close vote, the most popular topic was “How to get out of hospital quicker and to achieve successful discharge in the community”. We hope that subsequent iterations of the group might address other suggested topics such as race and diagnosis.

The group decided that semi-structured interviews and thematic analysis would allow us to gather the richest information, so they developed a questionnaire and began practicing interview skills. In addition, we completed a ROSE ethical approval form and prepared to present our proposal to the ROSE committee. The committee was very supportive, we talked through the positives and negatives of different approaches to data collection and recruitment.

Recruiting participants

The group decided that they specifically wanted to recruit service users who had been discharged and then come back to forensic hospital. They were curious about why people come back into hospital, perhaps because many of our student researchers had experienced readmission.

An information sheet was read out by student researchers in ward community meetings. This information sheet made it clear that the research group consisted of current inpatients from the same hospital and was clear that participants should not share information that they did not want these people to know. Potential participants were approved by their MDT, with discussions about the interviewer/interviewee pairings.

Ultimately, we recruited 5 participants; we would have liked to recruit more people, but it was at this stage in the project that we discovered what a short space of time twelve weeks is.

Interviews were conducted by student researchers and transcribed by facilitators. The results were analysed using thematic analysis by the group in the teaching sessions.

Results and Impact

Our key themes were: barriers to getting out and staying out of hospital; what helps people to stay out of hospital; and the impact of readmission. A novel aspect of this piece of work was analysing our results when so many in our group had direct experience of what participants were talking about.

We decided to record our student researchers’ own responses to the semi-structured interview questions as a way of capturing their testimony and resonance to our findings. Quotes from these interviews have been included in the write up of our study, although they were not included in the main analysis.

A student researcher spoke in the final session of the course about the importance of meaningful occupation, and how contributing to the course gave him a sense of purpose. He said that the group had made him more aware of the importance of employment and being part of something wider as an alternative to addiction. This feedback left our group feeling the impact of our work had been deeply validated.

We were invited to share our findings on a Trust-wide broadcast, and to present our findings to the South London and Mental Health Community Partnership at their Friday morning teaching for forensic clinicians across South London. In addition, we have been invited to share our work at the European Congress of Psychiatry in Paris next March 2023. We are delighted to be able to offer student researchers these exciting opportunities to share the work they have done.

We now have a group of research literate service users who are eager to become involved in more opportunities for research. These service users have developed the ability to understand the methodology of the research they are being asked to contribute to, and we hope they will be invited to take part in further co-production initiatives.

With thanks to the team: Lily Kpodo – Service User Research Ambassador; Jemma Venables - Lived Experience Research Ambassador; Zoe Middleton - Forensic Mental Health MSc student

This course is not currently enrolling new students, but if you would like to find out more about research at the Trust and how to get involved, a Research Club is being hosted by the Recovery College this September and October.

Visit the Recovery College website to join the Research Club.