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The SESRC embeds the lived experience of the consumer voice
within every aspect of the College, from initiation, planning,
course development, course facilitation, the day-to-day running
of the College, the governance structures through to the
outcomes evaluation research. Staff interviews and course
evaluations highlight the value of co-production within the
Recovery College setting.
The overarching themes identified through the establishment
stages of the College, were that the lived experience within
the co-production framework was ‘transformational’ and
‘life changing’ in the mental health setting. Furthermore, co-
production was not without ‘challenges’ and we experiences
many ‘learning experiences’ during the initial stages of setting
up the College and developing the courses. Students attending
the College indicated that the inclusion of the lived experience
along with professional experience was ‘powerful’ and ‘inspiring’.
South Eastern Sydney Local Health District in partnership with
the St. George and Sutherland and City East Community Colleges
(local registered training organisations) was awarded a NSW
Health Innovations in Integrated Care Project Grant (2014-15) to
pilot the mental health Recovery College as a new and innovative
approach for delivery of recovery-oriented services.
The Recovery College initiative aligns with The National
Framework for Recovery-oriented Mental Health Services
(Commonwealth of Australia, 2013) and Australia’s National
Recovery Colleges. Co-Production in Action:
The value of the lived experience in “Learning
and Growth for Mental Health”
KATHERINE H GILL
This paper explores the value of co-production, in the context of the recently established South Eastern Sydney
Recovery College (SESRC). The SESRC is a pioneering educational initiative in Australia, focused on learning and
growth for better mental health, and demonstrating advances in recovery-oriented public mental health service
practice.
Feature...

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Standards for Mental Health Services 2010 which draw on
national and international research to provide a consistent
approach to recovery-oriented mental health practice and
service delivery.
The National Framework specifies that recovery-oriented mental
health services have a responsibility to work in partnership with
a broad cross section of services and community groups, and
to embrace and support the development of new models of
peer-run programs and services. Recovery-oriented approaches
recognise the value of the lived experience and bring this
together with the expertise, knowledge and skills of mental
health practitioners. Recovery approaches challenge traditional
notions of professional power and expertise by helping to break
down the conventional divide between consumers and staff
(Australian Health Ministers Advisory Council, 2013). Within
recovery paradigms all people are respected for the experience,
expertise and strengths they contribute.
Personal recovery has been described as a journey of discovery,
making sense and finding meaning in one’s life journey (Repper
and Perkins 2012). In recovery a person becomes an expert
in managing his/her own self-care, identifying and building on
unique strengths and resourcefulness to build a new sense
of self to pursue personal aspirations and life goals (Perkins,
Repper et al. 2012). Principles identified as important in
facilitating recovery include having a sense of hope, a locus of
control, and opportunities to build a life beyond mental illness
(Boardman and Shepherd 2009).
The Recovery College concept
The Recovery College approach, whilst new to Australia, is
recognised internationally as a key feature of contemporary,
recovery-oriented mental health services. The Recovery College
model used in South Eastern Sydney is based on the highly
regarded Recovery Colleges in the United Kingdom (Perkins
and Repper, 2012), a model that evolved from the Recovery
Education Centres in the USA (Recovery Innovations in Arizona,
Boston University Centre for Psychiatric Rehabilitation).
The Recovery College is an innovative model that converts
traditional treatment approaches into educational opportunities
to develop consumers’ self-management skills, to enhance
recovery and reduce dependence on mental health services.
The College offers comprehensive education and training
programs, co-developed and co-delivered by people with lived
experience of mental health concerns and health professionals.
The College is open to mental health consumers, their carers,
families and friends; as well as mental health staff, volunteers,
and staff of College partner organisations. For carers, families,
friends and health professionals, the College is an opportunity
to better understand mental health challenges and to support
people in their journey of recovery. All of the courses come from
a recovery perspective to inspire people to have hopeful and
meaningful lives.
Co-Production and the Recovery Colleges
Co-production frameworks involve an equal
partnership between professionals and service users,
working collaboratively to plan and deliver services.
Co-production frameworks recognise that both
partners have vital contributions to make, and both
partners bring vital expertise and knowledge which
can be harnessed and synthesised to improve the
quality of services.
The principles of co-production are a fundamental component
of the Recovery College model, whereby people with lived
experience of mental health concerns (otherwise known as
consumers or service users) are brought together with health
professionals as equal partners to plan and deliver new
educational programs. Co-production has been fundamental
to the establishment and implementation of the SESRC and
is incorporated into all facets including planning and course
development, governance, administration and the day-to-day
running of the College, course facilitation and research and
evaluation. Within the Recovery College setting those who
attend the courses are regarded as ‘students’, whether they are
clinicians, clinical students, corporate staff, carers or consumers.
Those facilitating the courses are ‘educators’, with each course
facilitated by both a clinical and a peer educator.
Co-production is recognised as having the potential to transform
the way services are delivered and systems are structured.
It creates new relationships between those who use services
and the professional staff and goes well beyond traditional
consultation or tokenistic participation (Slay and Stephens 2013).
Within the co-production framework both partners contribute
equally and both are valued for the vital contributions that their
professional and/or lived experience brings to planning and
delivery of programs.
Co-production requires a shift in the organisational structure
and culture. Professionals need to be prepared to take on
the feedback, advice and decisions made by those with lived
experiences. New structures of management and governance
that incorporate the lived experience of service users at every
level need to be developed and new risk management policies
need to be identified and implemented (Needham and Carr
2012).
Recovery-Oriented Mental Health Practice
Recovery-oriented mental health practice supports
people to recognise and take responsibility for
their own recovery and wellbeing; to define their
unique goals, wishes and aspirations. The recovery
framework sees recovery as a personal and
individual journey and a process in which people with
mental health concerns develop a meaningful and
contributing life with or without ongoing symptoms of
the mental illness.

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Co-production requires a redefining of the way the ‘experts’
view service users. Instead of being people who have needs and
are dependent on and/or passive recipients of the professional
‘expert’ advice and opinion, service users are now seen as the
‘expert’ in their personal recovery journey. The expertise, assets
and value of the lived experience of the consumer worker is
recognised and harnessed within the health system in order to
improve the quality of services delivered.
Outcomes to date
The Recovery College commenced delivery of courses in July
2014. As of September 2014, eleven courses have been
delivered through three streams:
1. Understanding Mental Health Conditions and Treatment
Options
2. Rebuilding Your Life: Developing Knowledge and Skills
3. Getting Involved in Mental Health Services and Making a
Difference
To date, 107 students have enrolled with the College, all courses
had the maximum number of enrolments and all had waiting
lists. Service users of the South East Sydney Local Health
District mental health services are eligible to attend the Colleges
free of charge. Students attending the courses have included
consumers (43%), carers (11%), clinicians (25%) clinical
students (18%) and corporate staff (4%). On completion of each
course, student feedback and course evaluation is undertaken.
In September 2014 staff interviews were undertaken to review
and reflect on the process of co-production within the Recovery
College setting. Those interviewed included peer support
educators, consumer workers, clinician educators, and members
of the Recovery College management team (n=6). Staff were
asked to consider the strengths, benefits and challenges of
co-production and were given an opportunity to reflect on the
co-production process in their specific capacity within the
College, the lessons learned and what could be done to improve
and refine the process. All interviews identified consistent and
common themes which are discussed below.
Co-production – The peer educator
experience
Interviews with peer educators with lived experience highlighted
the value of co-production both personally and for transformation
of the mental health system.
Benefits to the consumer worker included enhanced self-
esteem, personal and professional growth, development
of a sense of purpose, hope and meaning in life, feeling
valued, improved networks, connections and skills for future
employability.
Peer educators involved in co-development of courses indicated
that the experience of co-development was highly dependent on
the particular clinician they were working with. Peer educators
indicated that sometimes the process was very positive,
rewarding and empowering.
I felt I was respected, there were no power dynamics,
we communicated well, shared equally and we both felt
comfortable and safe in saying what we thought.
But in other cases, the experience was different:
It wasn’t an equal experience, I felt my opinion was over
ridden, and I wasn’t able to vocalise… On one occasion
the clinician put a line through my work. This made me feel
disempowered and I lost self-esteem. On this occasion it
was not a safe and equal experience.
The peer educators indicated that at times there was uncertainty
over expectations and who does what.
I felt I was left to do everything, that I had to always take the
lead, on this occasion the clinician stepped back too much,
like [they] didn’t understand the collaborative process of co-
production… [they] left everything to the last minute, when I
like to be prepared and organised.
The peer educators found course delivery to be a positive and
rewarding experience.
I felt empowered with the delivery …it was so moving and
powerful for all.
I could see the amazing benefits for the students as they
began to talk, write and reflect in a recovery based way.
The students wanted to keep coming back…they found
meaning and purpose in life and realised they were more
than their illness.
[The course delivery helped to] break down barriers, we had
directors sitting next to consumers who were inpatients at the
time… they were chatting like they were equal… It’s a new
paradigm, transformational and so beneficial to the recovery
movement.
Consumers employed by the Recovery College have indicated
that they felt valued and respected. They appreciated the
openness and safety of disclosure, and found the experience
to be rewarding for both personal and professional growth.
It was challenging, but I learned a lot, I was taken to another
level…made to think in a new way, made to think more
deeply. I have learned such wisdom from the Recovery
College staff.

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Co-production – The clinician experience
All clinicians interviewed spoke positively about the benefits of
co-production. The clinicians identified that they were able to
learn and better understand the consumers’ perspectives.
Testimonials collected through the evaluation process include:
I learned things that I would never get from a text book…the
sharing of experiences was so important, I could understand
the other point of view…the consumer voice is authentic, it
addresses things at a deeper level and has more impact…
it is really life changing for people to be able to listen and
talk openly about experiences…it helps to break down the
barriers in a practical way. The more people are exposed
to this the more we will get changes in the culture and
community.
I saw that the clinician is not always the person with all the
answers, instead clinicians need to be creative and open
minded… co-production opens up new possibilities, it’s a
real challenge for the system…to be comfortable with not
knowing all the answers, to be doing ‘with’ instead of doing
‘to’…so empowering for the consumer… it is how services
need to be moving.
Consumers bring a variety of backgrounds to the mental
health service, whereas mental health clinicians are often
(but not always) career health professionals with training in
one of five disciplines. Consumer workers bring so many
skills and knowledge bases, as well as lived experience e.g.
teaching, research, education, arts, accounting, business,
community work, law, engineering, linguistics, sociology,
construction, science, hospitality [examples from consumer
workers at SESRC].
Some clinicians found the experience more challenging than
others. Clinician feedback included:
It was a positive experience, but challenging, a huge change
to go from the clinical setting to an educational setting and
managing a class…
In course development it was hard to move away from a clinician
mindset to working with a consumer educator with a different
perspective…
I had to develop new ways of interacting and listening, I had
to be open-minded and take a step back …
While it is helpful to combine the different perspectives it needs
to be acknowledged that clinicians also need support and
training…
It is such a different way of doing things and can be a bit
destabilising…
I know it is good but I needed to go away and process, it is
not that easy to change…
It was a bit of a culture shock at first, a steep learning
curve…
Sometimes I felt a bit alienated and out of my depth.
Co-production – The student experience
Student feedback and course evaluation indicated that the
sharing of lived experiences was inspirational and empowering.
All students indicated that they gained valuable knowledge,
greater awareness and understanding of recovery. The
students valued the lived experience recounts where they could
learn from other people’s experience; they appreciated the
openness of the discussions, the authentic consumer voice and
the practical examples and experiences of people who have
successfully recovered. Students commented that the Recovery
College was so different to anything experienced before and took
them to another level in their understanding of recovery.
Students valued the safe environment to share experiences.
They appreciated the strengths based approach and the positive
outlook on recovery. 100% of students indicated that their
expectations had been met or exceeded, and 100% of students
indicated they would recommend the course to others.
The clinicians and clinical students attending the courses valued
the input of consumers:
Professionals can learn a lot by working together with
consumers and understanding their point of view…
Continue with the consumer perspective – very interesting…
Hopefully this recovery College concept and involvement of
consumers will continue to grow – Great Start!!”
Co-production – The Recovery College team
experience
Prior to the establishment of the Recovery College, the mental
health service had increasingly been working in partnership with
consumers in an educational capacity through various projects.
This experience was essential to the successful implementation
of the Recovery College co-production model, as the Recovery
Colleges required clinicians and consumers to “take a leap
forward towards a truly equal relationship”(Recovery College
Management).
Interviews with the Recovery College team highlighted some
challenges in setting up this new co-production model. For
example, in order to meet the time and budget constraints of the
project, the processes were rushed and a bit ad-hoc. One of the
team members said: “We tried to run before we could walk“.

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Other challenges emerged because of the staging of some of
the project processes. For example, the peer educators were
employed prior to the clinical educators which meant that they
had already completed a large amount of work before the two
came together. This fact, together with separate meetings
between peer and clinical educators resulted in some tensions in
the initial stages.
Another lesson the team learned was underestimating the
amount of support and training that all the educators required.
One of the team members said: “…people needed to do training
on co-production, recovery and purposeful story telling prior to
developing courses”.
A number of strategies have now been put in place to address
these issues, including a comprehensive train-the-trainer
program, joint consumer/clinician educator meetings and clearer
guidelines for course development.
Summary
The Recovery College concept is regarded as ‘transformational’
in the delivery of recovery-oriented services. The College has
the potential to break down barriers and stigma thus creating
openness and understanding of recovery-oriented practice, with
the authentic human voice encapsulating the lived experience.
The co-production process challenges the way service users
and the mental health profession view recovery. While some
clinicians have fully embraced the co-production process, others
have found the process more challenging. In having to adapt
their thinking and language use, some clinicians began to doubt
their expertise and what they had done before.
It was identified that all involved needed training and support
as this process was so revolutionary and different. To promote
equality and develop a safe and collaborative relationship,
combined training with both peers and clinical educators was
identified as important.
About the Author
Dr. Katherine Gill is a Registered Occupational Therapist and is
undertaking the Research and Evaluation for the South Eastern
Sydney Recovery Colleges. Katherine has a background in
medical and mental research, and also works in the health
industry.
References
Australian Health Ministers Advisory Council. 2013 The National Framework
for Recovery-oriented Mental Health Services: A Guide for Practitioners and
Providers, Commonwealth of Australia.
J. Boardman, and G. Shepherd. 2009 Implementing Recovery: A new
framework for organisational change. Centre for Mental Health.
C. Needham and S. Carr. 2012. Co-production: an emerging evidence base
for adult social care transformation. Social Care Institute for Excellence.
London.
R. Perkins and J. Repper. 2012. Implementing Recovery through
Organisation Change: Recovery Colleges. Centre for Mental Health. London.
J. Repper, R. Perkins, M. Rinaldi and H. Brown. 2012. A journey of discovery
for individuals and services. In Working in Mental Health: Practice and policy
in a changing environment. P. Phillips, T. Sandford and C. Johnston (eds.).
Routledge. Oxford
J. Slay and L. Stephens. 2013 Co-production in mental health: A literature
review. new economics foundation. London.