The development, outcomes, and evaluation of the co-produced, EACEA funded Master
of Science Mental Health Recovery and Social Inclusion (MHRSI) programme
February 2015
(NB This programme was made possible by the support of the European Union’s Education,
Audiovisual and Culture Executive Agency (EACEA) ec.europa.eu/dgs/education_culture/
index_en.htm)
Introduction
This article sets out the rationale for the development, results and outcomes, of the EACEA
funded Master of Science Mental Health Recovery Social Inclusion (MHRSI) programme,
including independent evaluations of the programme.
The Master of Science Mental Health Recovery Social Inclusion has been
co-produced by experts by experience, agency professionals and academics in Italy, Poland,
Portugal, USA and the UK. Its aim was to develop the world’s first online Master programme
that addresses the key concepts of Recovery and social inclusion and how they are delivered,
researched, and disseminated within mental health agencies and practices. The online Master
Programme, available to anyone eligible to register for the Master programme, anywhere in
the
world,
is
thus
easily
accessible.
(Please
see
our
website,
http://www.raiseinrecovery.com/info.html)
The Programme offers the following modules:
Module 1: Innovation in Recovery and Social Inclusion Theory and Practice (developed by
the New University Lisbon, Portugal; University of Turin, Italy; Azienda Sanitaria Locale
ASL AT, mental health agency, Asti, Italy; University of Hertfordshire, UK; The Maria
Grzegorzewska Academy of Special Education; National Advisory Groups)
Module 2: Recovery and Social Inclusion Research (developed by the University of
Hertfordshire; the New University Lisbon, Portugal; National Advisory Groups)
Module 3: Leadership and organisational change (developed by the Azienda Sanitaria Locale
ASL AT, mental health agency, Asti, Italy; University of Hertfordshire, UK; The Maria
Grzegorzewska Academy of Special Education; National Advisory Groups)
Module 4: Recovery and Social Inclusion Policy and Legislation (developed by the New
University Lisbon, Portugal; University of Turin, Italy; University of Hertfordshire, UK;
National Advisory Groups)
Module 5- Dissertation/project module (developed by the University of Hertfordshire, UK;
National Advisory Groups)
Background to the development
The partners in this development have looked at the curricula on offer in each of the partner
countries/across Europe, in relation to recovery and social inclusion. We had also
investigated the educational programmes on offer in the USA, Canada, Australia and New
Zealand, where a number of the innovations in recovery and social inclusion have taken place
(e.g. our partner the Yale Recovery Centre, and the ReFocus research project that has an
international advisory board with experts from the US, Australia and the UK).
There appeared to be many in-service training programmes on recovery for service providers,
and some optional one semester modules in university courses for nurses and social workers,
and in-depth educational programmes focused on recovery in Yale University, Boston
University and Nottingham University. However, these are not based on online learning and
teaching, do not have the systematic involvement of professional, service users and carers’
organisations in their development as in this project, and lack a European dimension.
There are no European partnership educational programmes focused on recovery and social
inclusion. In addition, there was little or no focus on leadership, social inclusion and
organisational change, on involving service user and carers and professional organisations,
and of projects undertaken as part of training and education that require application to the
field at the Masters level and beyond. We were only able to provide this Programme as we
have been very fortunate to have had the resources of our Educational Technologists in the
School of Health and Social Work at the University of Hertfordshire, their equivalents in our
partner universities and agencies, and the input of staff and Educational Technologists in the
University of Hertfordshire’s UHOnline Department.
The new components to be developed in this multilateral curriculum development project
included:
- an online programme in the English language with virtual classrooms and tutorials
- Combining input on recovery with that of social inclusion in mental health
- Focus on leadership and organisational change in recovery and social inclusion work
- Focus on applied research in an area where research is at its beginning
- Introducing policy and legislation as core subjects
- Involving service users, carers and professional practitioners organisations in the
development of the curriculum and in contributing to the teaching on the programme
- Aiming to attract course participants who are practising in/leading/participating in
mental health services
- Consulting professional and service users organisations in each partner country
throughout the project
- Ensuring the multidisciplinary contributions to the development of the curriculum
- Developing an online system/strategy suitable for the programme with input of
blended learning specialists in each partner institution
- Evaluating and further develop the delivery/content of the modules based on
systematic internal QA procedures, and independent evaluation
- Training teachers in online delivery
- Developing and implementing dissemination, exploitation of the results, sustainability
and promotion strategies.
The partners had originally planned a jointly validated programme, but due to the impact of
the economic crisis not all partner higher education establishments were permitted to do this
in their own countries. However, the materials and first delivery of the taught modules were
fully jointly produced, reviewed and reworked by our academic partners, agency
professionals and agency partners and experts by experience, in Italy, Poland, Portugal, USA
and the UK.
The inclusion of users- expert in experience- and carers of mental health services
The inclusion of users of mental health services in terms of policy, practice and their own
treatment has been a key area of debate and development in recent years. This project set out
this inclusionary process within the recovery based approach set of developments and
brought it to a new level- both in terms of the level of learning for professionals to take this
agenda forward in their management and practice, in an open online learning Master of
Science Mental Health Recovery and Social Inclusion (MHRSI) programme, but also for
service users to be part of this as students, and as co-producers of it.
We perhaps did not fully predict the level of benefits of this component for students on
programme with expertise by experience sharing with mental health professionals. (Please
see evaluations of the Programme that will be placed on our website).
In addition, the Programme was awarded a University of Hertfordshire Vice-Chancellor
Award for Excellence for International Engagement in 2014.
In particular, areas of recovery-based practice developments, and the concept of leadership in
recovery based services that have emerged in the first phase of the programme have been
further developed in the modules, based on feedback from students on their experiences of
the first delivery of the modules.
Recovery research is central to this MSc, due to our commitment to enhance students’
knowledge of existing good quality recovery and social inclusion research evidence.
Moreover, we are focusing on enabling the students to become researchers of recovery issues
and the adoption of a participatory approach to such research in including service users, their
carers, and practitioners as partners to students’ research projects.
Recovery based programmes
The relatively new concept of recovery in mental health as the underlying philosophy of our
approach to people experiencing mental health problems has been adopted as a policy and
practice framework in mental health services in Europe in recent years. Despite some
examples of good practice, its application in everyday practice has emerged at a slower pace.
Unlike the traditional clinical meaning of recovery that perceives lack of symptom and return
to ordinary functioning as recovery from mental illness, the new meaning of recovery
measures recovery by the ability to live well with the illness, often with some of the
symptoms, and living beyond the illness in terms of enhanced social inclusion, activities
taken up and control over one’s life.
In addition, the concept of social inclusion has emerged as a key dimension of the new
meaning of recovery (Repper and Perkins, 2003) in response to the high degree of social
exclusion that characterises social and sometimes agency reactions to people experiencing
severe mental illness world-wide, including Europe (MHE 2007), and their informal carers.
The new meaning of recovery has already motivated initiatives of inclusion of mental health
service users in a number of ways in vocational training, paid and unpaid employment,
formal education and in research in a number of European countries such as Denmark,
Finland, France, Ireland, Italy, Poland, Portugal, Spain and the UK (Mezzina et al, 2006,
Ramon et al, 2010), as well as in the US, Australia, Canada and New Zealand (Davidson,
2010). However, it cannot be argued that for these initiatives to become the norm as a social
and service agency response, they need not only to be more wide spread, but also that they
need to be accompanied by educational programmes that clearly demonstrate
social
inclusion in higher education and learning from the recent contributions of service users and
carers to running programmes, training and research.
Moreover, the introduction of a new way of approaching people with the lived experience of
mental ill health has also led to re-consideration of service content, service organisation, and
leadership focus, which have highlighted the need for service providers to acquire new
knowledge and skills, as well as unlearning of some taken-for-granted past attitudes. This
dimension highlights the need for leadership that embraces the challenges which the recovery
and social inclusion approach brings with it for practitioners and policy makers, and the need
for them to take into account knowledge and input based on service users and informal
carers’ experiences.
Both recovery and social inclusion are recognised by the EU as key principles of its mental
health policy (e.g. MHE, 2007), as well as by the World Psychiatric Association, which has
recently set up a special task force to encourage user involvement (Herrman, 2010).
Higher education is an arena in which there have been recent attempts at widening
participation of access and retention, but these are neither specifically aimed at people with
mental health difficulties, nor are they focused on leadership in recovery and social inclusion
in the field of mental health.
The advantage of locating this initiative in higher education with Europe wide universities’
input, and service agency input, is that it enables to offer a more comprehensive, in-depth
context for learners, and an arena where the power differentials between professionals,
service users and carers are significantly diminished as they collaborate in developing this
programme.
Consortium members
The consortium has members from four EU member states, covering Southern and Northern
Europe, old and relatively new member states, varied of socio-economic and cultural
contexts.
Each partner brings specific expertise and skills that will enhance the project. These include
skills in:
- online programming at masters level
- recovery and social inclusion research
- working closely with service managers, users and carers
- working closely with policy makers
- multidisciplinary and disciplinary in-depth knowledge (nursing (Hertfordshire);
pedagogy (Poland); psychiatry (Portugal; Poland; Asti, Italy; Yale); psychology
(Yale, Turin, Italy),social work (Hertfordshire).
Having three partners who are also service providers in mental health (Asti, Poland, Portugal)
has ensured that everyday practice concerns are highlighted and addressed within the
programme, as has the input from service users and carers’ organisations, professionals, and
agency managers as part of the learning material development as well as part of the National
Advisory Groups, which will be in-built into this curriculum development project.
This successful curriculum development project, as evidenced by its recruitment beyond the
EACEA funding, student feedback, the robust Quality Assurance methods at UH, and
independent evaluations undertaken by Dr Charles Simpson, and Prof Larry Davidson, has
responded to several identified gaps in European higher education, including lack of
dedicated training programmes that focus on recovery and social inclusion in mental health,
educational programmes that enable professionals, consortium has service users and carers’
members to benefit from each other’s experience and knowledge, training in recovery and
social inclusion for leaders of mental health services.
Quality Assurance
The MSc became a UH programme as agreed by partners, and UH took on responsibility for
the QA processes, by way of regular meetings with partners, NAGs, contained within the
robust Quality Assurance methods and processes at UH. This includes not only the process
programme validation, but also in terms of the annual programme management and review
processes.
Partner meetings to develop and review the piloted modules took place in and May 2014 (in
addition to other partner meetings throughout the project), as the first modules were finishing.
National Advisory Groups (NAGs) contribution
The National Advisory Groups (NAGs) were constructed to enable viable representation of
the wider community engaged with recovery and social inclusion. Members included people
with the lived experience of mental ill health (service users), family members who became
carers and professionals representing the multidisciplinary range.
The NAGs were consulted about the content and format of the newly developed modules,
dissemination and marketing, and some members were included in the development of
learning units within the modules. Their contribution of their in-depth experience is
invaluable.
The NAGs are represented also in the final programme meeting and video conference.
Development of the Programme
Having completed the European Union (EU) pilot project, meant that the Masters programme
moved more completely under the auspices of University of Hertfordshire (UH) concerning
its delivery with EU partners less involved in the review of modules and in taking the
responsibility for the online teaching due to the changing nature of the programme from
jointly delivered pilot to a more standard UH programme. It was important for all who had
been involved in the production of the Masters programme to preserve the integrity of the
international focus and co-produced content and each module leader had to review the
module content based on the feedback from students and their own educational and subject
expertise to best achieve a consistent level of effort across modules. There was also a need to
ensure that the whole programme functioned coherently and to take an overview of what
might improve it.
Prior to and during the project delivery there was a meeting in the UK between all the EU
partners to review progress so far. Information from students was discussed and collated and
several changes were decided upon at this point. Changes were then immediately
implemented where possible or incorporated into what became an ongoing review process
prior to next time that the module was to be delivered. The changes were reflected in the
ongoing quality improvement processes at the University of Hertfordshire and an Annual
Monitoring Report was created based on meetings, programme committees, the EU project
evaluation, the Postgraduate Taught Experience Survey and Module Feedback
Questionnaires. Much of the work identified in this report was already well underway prior to
the start of the academic year for the second run of two modules for our first paying
customers.
Following the feedback from the first cohort of students, the main changes discussed and then
implemented were:
 To review student effort which had been the subject of some concern in the feedback.
Modules were reviewed to identify core and supporting activities and it was
suggested to the students that they can be discriminating in their use of their time to
best effect in line with their personal interests and needs.
 More individual and group tutorials were instituted in order that students would be
able to see and interact with their tutors, as well as with each other at the beginning of
each module and nearer the point of assignment submission.


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Circulation of email contacts to all students who agreed to this to facilitate easy
communication offline.
Use of Skype rather than Adobe Connect which we had found a less than congenial
online environment.
Consideration of workload across the units and identified where some units needed
editing and adding to
Creation of a list of areas of EU partners’ expertise to be captured for keynote
lectures to be video recorded as a resource library for the course. Several of these are
now in place and all contributions to the final conference in Lisbon will be recorded
to add to this resource.
Consideration of the modules where two summative assignments was a useful
strategy and those where it was a less positive component. Applications were made to
reduce summative assignments to one submission in three out of five of the modules
Identification of a need for more practice links within the course and a decision to reorganise and change the focus of the leadership module to achieve a new emphasis on
partnership in care and co-production to reflect the wider recovery agenda more fully
Following due consideration of the potential for expanding the links to practice, the most
comprehensive review was of the Leadership for Innovation module where we considered it
to be best situated.. It would be the final module to be delivered as students were concurrently
working on their project module which has an innovative practice change at its core. Whilst
already recovery focused we were keen to pick up on practice developments within this
module to offer students the chance to think about leadership as collaboration, partnership
and co-production. This was in recognition of the embedded philosophy that it was not
professionals who should be leading care but people who use the services themselves, the
experts in their own personal experience.
We gathered a group of people who delivered a variety of practice approaches together and
began to compile a set of learning packages around a selection of approaches to mental health
care that could help students think differently about managing care (this was to include those
people using services and carers managing care as well as professionals). We intended that
students would consider the management of and colleagues, looking for where innovative
change might occur in practice. Sitting within a module that perceived leadership in recovery
services as of necessity having a strengths focus instead of a deficit focus - these approaches
could be utilised to consider innovation in services with people who are active partners in
designing their own journey of recovery. To begin with, we are beginning to create learning
packages in Systemic Family Therapy (using an example of where it had been used
innovatively with adults to good effect), Solution Focused Therapy, Hearing Voices and Peer
Support/Peer Listening. Carers’ involvement will be one of the next packages to be
considered. We work with people who use services and a network of professionals to devise
these new learning packages. Appropriate changes to assignments were made to reflect the
new structure of the unit.
In the spirit of co-production, collaboration and partnerships in learning we hope to gather the
innovative working experiences of our students that will be drawn out in Module 4 and 5 to
create new learning that is brought back into the programme. This will keep the course up to
date with practice but also enable more exchange between students about what is working for
them out in the field. This will be an ongoing piece of work with a long list of potential
learning packages to be created that can influence perception and change ways of working
but more importantly so that the unit will fit more effectively into the overarching aim of the
programme, which is to help change thinking about mental health services and most
importantly implement changes to practice.
Thank you for your interest in this Programme.
If you have any queries re the Programme, please contact:
Dr Audrey Kempson - Programme Tutor
University of Hertfordshire, College Lane, Hatfield, AL10 9AB, UK
Phone: 44(0)1707 286304
Email: A.Kempson@herts.ac.uk
Internet site address: www.herts.ac.uk
Professors Brian Littlechild/Shula Ramon - Co-ordinatorsUniversity of Hertfordshire,
College Lane, Hatfield, AL10 9AB, UK
Phone: 44(0)1707 284423
Email: B.Littlechild@herts.ac.uk / s.ramon@herts.ac.uk
References
Davidson, L., Rakfeldt, J., Strauss, J. (2010) The Roots of the Recovery Movement in
Psychiatry: Lessons Learned. Chichester: Wiley and Blackwell Publishers.
Herrman, H. (2010) WPA project on partnerships for best practice in working with service
users and carers. World Psychiatry 9 (2) 127-8.
Mezzina, R., Borg, M., Marin, I. Sells, D. Topor, A., Davidson, L.(2006)From participation
to citizenship: how to regain a role, a status and a life in the process of recovery. American
Journal of Psychiatric Rehabilitation, 9(1), 39-61.
MHE (2007) Social Inclusion in Mental Health. Brussels.
Ramon, S. Griffith, C.A., Nieminen, I., Pedersen, ML, Dawson, I. (2010) Towards social
inclusion through lifelong learning in mental health: analysis of change in the lives of the
Emilia project service users. International Journal of Social Psychiatry, 57, 3, January, online.
Repper, J., Perkins, R. (2003) Social Inclusion and Recovery: A Model for Mental Health
Practice. Edinburgh: Balliere Tindal.