Change and mental health services:
a local experience in Brescia
Fabio Lucchi
Centro Psicosociale Brescia Sud
Daniela Sangiorgi
Politecnico di Milano
Il territorio di riferimento della Unità Operativa di Psichiatria 23‐ASST Brescia
“E’ un processo profondamente
personale ed unico che porta
a modificare i propri comportamenti,
valori, sentimenti, capacità,
obiettivi e ruoli.
E’ un modo di vivere con soddisfazione
la vita partecipando ad attività e relazioni
significative anche
con le limitazioni dovute alla malattia.”
(W. Anthony, 1993)
Transforming people who use services
From passive recipients of services and burdens on the system into one where
they are equal partners in designing
and delivering services
(C. Needham, 2009)
How should we think
about value in health
and care?
Discussion pa per
September 2015
Positio P aper: Are mainstream mental health services ready to progress n
transformative co‐productio?
I Servizi sanitari ed i loro utenti:
diversi livelli di collaborazione
Involving patients and carers.
NHS Modernising agency, 2003
Il colloquio con l’utente
per la compilazione della stella
Incontro
fra due
«esperti»
Esperto per esperienza
chi la malattia la conosce perché
l’ha provata direttamente
Esperto per professione
chi la malattia l’ha studiata
e l’ha conosciuta nel lavoro
expert by living
expert by learning
Learning
for Life
Adult learning,
mental health and
wellbeing
“..a place where we can be students of our own wellbeing”
Julie Repper, Nottingham Recovery College
Creative
Citizens
A meeting space
between designers,
citizens, local
stakeholders and
institutions.
Politecnico di Milano
Polimi DESIS Lab
Italy
Towards services and care pathways
redesigned using patient and staff experience
Why co-design
“transformation of power and control, and the active involvement of citizens in many aspects of designing, commissioning, and delivering services.” (Nef, 2013)
Strenghtening co‐production in mental
health services requires a collaborative
process for redesigning services and
for the transformation of established
practices that brings togheter staff
members, users and communities.
Recovery Co Lab: an experimental space
Physical spaces or
units in
organisations where
creativity,
experimentations
and knowledgesharing are allowed
and promoted.
Flexible, collaborative,
experimental
http://mind-lab.dk
Focus
Rehabilitation and care pathways
Methods:
-
practices
roles
experiences
What helps and what hinders coproduction
Spaces and their use
Observation, interviews, focus-groups,
diaries,generative tecniques…
Methodology
Service Design
& Co-production
Collaborative Services
Co-design
Service Design
& Evaluation
Service experiences
evaluation
Integrative approach
Co‐production
Service Design
& Change
Organisational
process
Evaluation
Progetto Core
& Recovery
Assessing orientation
toward Recovery and
Coproduction
Project timeline
GIU
LUG
AGO
SET
OTT
NOV
DIC
GEN
FEB
MAR
APR
Recovery STAR
Approccio Progettuale integrato
CORE working groups
Applicazione co‐produzione in UOP23
Formalizzazione & condivisione
Recovery & co‐production Group
National and international conferences
Final
Event
MAG
Expected Outcomes
1. Setting-up of the Co-Lab UOP23:
2. Identification of ingredients for cocoproduction
3. Ideas and proposals for change and service
development
“When changes driven by desire meet
those driven by need, innovative social trasformations
take place.”
(Manuel Castells, 2012)
Thanks for your attention.
Metamorfosi Festival: Scena mentale in cambiamento.
(Brescia, 2016)
Supporting people
to manage
their health
An introduction to
patient activation
Authors
Judith Hibbard
Helen Gilburt
May 2014
“Students choose their own courses, work out ways of making sense of (and finding meaning in) what has happened and become experts in managing their own lives” Recovery Empowerment Continuum Characteristics Perspective
Motto
Level 1
Level 2
Level 3
Traditional Psychosocial Rehabilitation Philosophy/Continuum
Done to
Done for
Done with
Clinical team identifies goals and develops service Characteristics plans. Compliance with directives is focal point activities.
Clinically sound professional services Core Value
& stability
Compliant
Person(s)
Subservient Prescriptive
Staff Member
Directive
Clinically driven
Organization
Provider is expert
Discouraged
Risk Taking
1950
1980
Compliance/
2010 Directive
Present
Future
Level 4
Level 5
Peer‐Driven Peer‐Driven Care
System
Done by
Strong dependence Genuine voice and Self‐directed care is a Many roles in the on system & artificial participation with core value with peers system are filled by (paid) supports with some support for peers, including holding some no individual risk individual risk taking leadership and workforce, & engagement in advocacy positions governance, etc. Not taking or family natural supports.
engagement.
a token gesture.
within the system. Safety and security Personal recovery Personal recovery Culture change with a goal of through through self‐directed through peer collaboration
care leaders and staffing stability
Dependent
Respected (Voice)
Leader
Empowered
Institutionalized
Involved
Advocate
Leaders
Caretaker
Partner
Consultant
Peers
Protector
Guide
Support
Advocate
Protective
Collaborative
Recovery driven
Peer‐driven Risk Averse
Engaging
Person is expert
Peer‐staffed
Blocked
Supported
Encouraged
Expected
Dependent/
Care Taker
Voice & Participation
Action & Leadership
Peer‐Driven System
Sette messaggi basati sulle evidenze:
1) La recovery è valutata meglio da persone esperte per esperienza.
2) Molte persone che hanno disturbi mentali guariscono.
3) Se una persona non soddisfa i criteri diagnostici per un disturbo mentale non lo ha.
1) Le diagnosi non hanno fondamenti robusti.
2) I trattamenti sono una delle molte vie verso la recovery.
1) Alcune persone scelgono di non rivolgersi ai servizi.
2) L’impatto dei disturbi mentali non è univoco.
Why design…
Users assets
Design for co‐production in mental health
care means to identify togheter
the conditions promoting users engagement For a meaningful users engagement in service delivery and planning.
Mental health
Professional knowledge
values
Physical spaces
information
rules
Care pathways
timing
1. Attendees were invited to share personal experiences
of psychosis which highlight areas for improvement and
development
2. We clustered these postcards to identify some key
themes and opportunity areas
3. The teams then identify specific opportunities they
wanted to work on during the afternoon – each team
chose two opportunities.
4. Each team worked on a template to ensure they
captured all relevant aspects of their proposed solution
Come: Co Lab _ spazio sperimentale
Spazio fisso
Spazio pop-up
Esempi:
Lambeth Living Well Collaborative is a collaborative of those with a stake in mental health care in Lambeth. Commissioning and service approach informed by
‐ co‐production
‐ Recovery
‐ Total place principles
Perché co-produzione
“La più semplice definizione di co‐produzione : le persone che usano i
servizi contribuiscono a produrli” (Needham, 2012)
Nel caso dei servizi per la salute mentale, la co‐produzione dei servizi ha un potenziale trasformativo per l’utente nello sviluppo delle relazioni sociali e delle capacità personali, nella riduzione dello stigma, nel miglioramento del senso di appartenenza, e nella capacità di gestione e controllo della propria condizione (NEF, 2013)
Esempi:
Ambito
1. Esplorazione generale:
Attività e percorsi riabilitativi
(attività espressive, sportive, formative, risocializzanti, culturali, ecc.)
2. Fuoco valutazione
Attività / spazi propedeutici alla co-produzione
(sportello SPDC, consiglio di comunità, piani di trattamento
individualizzati, gruppo utenti, ecc.)
Ambito
2. Fuoco valutazione
Attività / spazi propedeutici alla co-produzione
(sportello SPDC, consiglio di comunità, piani di trattamento
individualizzati, ecc.)
Valutazione specifica:
Quanto queste attività, spazi, strumenti
o persone favoriscono..
- Parità (fiducia)
- Responsabilità (abilitazione)
- Informalità
- Negoziazione
Interviste, osservazione
Come: Designer in Residence
Marta Carrero
Service Designer
http://www.la27eregion.fr/residence/
Forma immersiva di
progettazione in una
specifica comunità /
entità portando nuovi
approcci creativi e
collaborativi
all’innovazione
Piano attività
2 cicli di co-design su diverse strutture:
