induction module october 2007
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The Ten Essential Shared Capabilities
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The Ten Essential Shared Capabilities
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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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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.
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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.
The Ten Essential Shared Capabilities