Induction Module October 2007

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The Ten Essential Shared Capabilities

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Induction ModuleWelcome to the Ten Essential Shared Capabilities (ESC) Induction Module. The aims of this

module are to:

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 exible learning resource. The module

can be used in the following ways:

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 .1 and . can then be completed at the induction event in a small group work

scenario.

You can end your induction programme here.

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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Page Induction Module: The Ten Essential Shared Capabilities


Contents

1. Introduction ......................................................................................................

. Meeting Phil - A Recovery Perspective............................................................4

. Working in Partnership .................................................................................... 9

4. Respecting Diversity & Challenging Inequality .............................................. 10

5. Challenging inequality ................................................................................... 11

6. Practicing Ethically ........................................................................................1

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

1. Personal Development and Learning .......................................................... 18

Acknowledgements ...........................................................................................19


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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 collaborationbetween 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:

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 conicts 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.

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 maintainingvalued social roles for people in the communities they come from.

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.

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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Providing Service User Centred Care. Negotiating achievable and

meaningful goals; primarily from the perspective of service users and their

families. Inuencing 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.

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.

Promoting Safety and Positive Risk Taking. Empowering the person to

decide the level of risk they are prepared to take with their health andsafety. 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.

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 reective 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 reect your current attitude and practice.

Based on our information from the pilot programme, we have evidence that by reecting 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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2. Meeting Phil - A Recovery Perspective

Phil is a real person and this is a real story...........

In February 004 I was employed in a senior post in the UK Merchant Navy. I wasearning a good salary. I was well qualied 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 004 I suffered a bi-polar episode.

As this wasnt my rst 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 rst, 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 lastresort of the frustrated mind in a unit I started scanning the rack of leaets.

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 itsnal 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

benets system we labour under meant that nancially 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 nd

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 timewith 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 shufed 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 benets agencies and a leaet which I had kept

when I left the acute unit.

Positive Assets. That word again, Positive! The one word that so many excluded peopleare 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 leaet 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 rst in a while and not the last. Yes I could get a job. You would like to be a

care worker? Denitely 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 positivetowards me as well.

Excellent, thats alright then, things are going ne, heres another job. Experience in the

care eld 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 eld 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 specically 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 lled 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 qualications 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 rmly 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

gure 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 rst 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 ll 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 ght against it.

And we are. Want to ght 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 .1

Write down or talk to your group colleagues about your inital thoughts after reading Phils

Story

Activity .

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 inuential, nor agree on the degree ofinuence.

How do you account for any differences between you and your colleagues?

Do your values and the way you would behave have inuences 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 inuence over the way you work?

Note to facilitators: you can end the session at this point.




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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 partner-

ship is characterised by developing and maintaining constructive relationships with serviceusers, carers, colleagues and the wider community.

Activity .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 .

Draw a diagram of the key people you work alongside.

Do you understand the roles of all these people and how these t 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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4. Respecting Diversity & Challenging Inequality

Activity 4.1

What barriers did Phil face from stigma and discrimination throughout his journey?

Activity 4.

Record an example of discrimination experienced by someone with whom you work or have

worked. Note: please consider issues of condentiality when writing and/or discussing this.

What did you do (or could you have done) to address this:




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6. Practicing Ethically

Activity 6.1

What does practicing ethically mean when considering Phils experience?

Activity 6.

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

LIST

Managers / Chief

Executives

LIST

Trainee Psychiatrists

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

Right and wrong

Belief systems

Ideals and priorities

Things that govern

behaviour and

decisions

Morals

Principles

Standards

Conscience

Fluid / changeable

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.

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 consider-

ing the effect of values on your behaviour)




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7. Promoting Recovery

Activity 7.1

What do you understand by the term recovery?

Activity 7.

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.

What do you think contributed to Phils recovery and what will continue to help his recovery?




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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.

How could Phils strengths and talents have been used to improve his recovery?




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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

Medication

Physical exercise

Religious and spiritual beliefs

Money

Personal strategies

Peace of mind

Thinking positively, taking control

Other activities

Hobbies and interests

Information

Home

Creative expression

(Faulkner and Layzell 000)

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.

How did Phils support differ from yours?




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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 004; see also ESC 4 Challenging Inequality). The followingthree denitions 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 00)

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 rst 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.

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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12. Personal Development and Learning

Activity 1.1

Write down your reections 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 rst three months of your new role.

discuss these with your line manager to be incorporated into your initial workplace induction

programme.


Induction Module October 2007

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