Public involvement policy and strategy
Policy and Research Context
"Involvement is intended to refer to principles and approaches that lead to individuals having real choices ... and their voices heard and heeded both individually and collectively" (BPS, 2010).
"If the traditional division between 'us' (the professionals) and 'them' (the service users and carers) is to be challenged, practitioners require opportunities to learn in a variety of ways from the experience of those who have personally lived with mental distress and disability." (BPS, 2008).
Department of Health policy emphasises the importance of involving the public, including service users and carers, in all aspects of health care planning and delivery (DoH 1999, 2000). The NHS Act (2006) requires that service users and the public are involved and consulted around the planning and provision of NHS, and the NHS Constitution (2010) establishes the right for service users or their representatives to be involved in the planning and development of services.
Service user involvement in clinical psychology training is enshrined in current policy. The HCPC Standards of Education and Training (2017) require clinical psychology training programmes to demonstrate evidence of the involvement of service users and carers. Good practice guidelines for the involvement of service users and carers in clinical psychology training programmes are published by the BPS (2008).
1. Service User and Carer Vision Statement
The programme philosophy and vision states that: we have a commitment to building a genuine partnership between service users and those involved in the programme.
The following vision statement was jointly developed by the programme and service users:
Service user involvement in the Lancaster DClinPsy programme aims to break down barriers between service users, trainees and professionals involved in the work of the programme. Our work together aims to build partnerships and trust, and help us learn from each other to reduce a sense of "us and them".
We want service user involvement to be a key part of the ethos of the course, so that trainees can take forward the importance of public and service user involvement into their practice. We want to improve trainees' and professionals' knowledge around service user involvement, and to improve the quality of their practice as a result. We aim for trainees and professionals to view service user involvement as an integral part of their work
2. Principles Underpinning Service User Involvement on the Lancaster DClinPsy Programme
Research suggests that embedded participation based on a partnership approach is most effective at achieving lasting change. We intend for service users to be key players or partners in the achievement of the vision and aims jointly developed by the programme and service users. We will actively promote the involvement and participation of service users in as many aspects of the programme's work as appropriate.
Intention to Change
The Lancaster programme has a fundamental intention and commitment to adapt and evolve as a result of service user participation.
We acknowledge that research has indicated that many service user involvement initiatives have not achieved their stated aims, due to a failure to truly involve users, or through limited or tokenistic involvement, or through professional and organisational resistance. We will seek to minimise, where possible, the effects of power relationships between service users and trainees and members of programme staff.
We will aim for service users and carers to be active partners, and for initiatives and the achievement of aims to be as participative and user-led as possible. We acknowledge that this involvement needs to take place within certain constraints (e.g. finance, organisational policy and HCPC & BPS standards and guidance).
The programme will recognise the validity and worth of the unique expertise that service users have developed through experience, and will aim to treat service users and carers as 'experts by experience'.
Service users and carers are often asked to be more 'representative' than any other group of stakeholders in the change management process (SCIE, 2004), and service users who are marginalised from mainstream services can also be found to be under or unrepresented in the participation intended to develop those services.
The Lancaster DClinPsy programme aims to promote the representation of as wide a range of users of services as practical. Service users from a range of services will be invited to be involved in the work of the programme.
The programme and service users will aim to be as clear as possible about their expectations and limits of the partnership. The process and impact of service user involvement will be monitored and evaluated on an ongoing basis through trainee, staff and service users' feedback.
The programme welcomes the involvement of people regardless of age, gender, ethnicity, faith, sexual orientation, or ability. Service users who currently work with the course are a diverse group, and include people who have used mental health services, care for those who use services, or have an interest in mental health professional training.
3. Structure, Processes and Methods of Involvement
Service user and carer involvement on the programme is supported by a reference group known as LUPIN (Lancaster University Public Involvement Network). Members of the public who have an interest in clinical psychology training, trainees, and programme staff are all welcome to be part of LUPIN.
LUPIN meets as a steering group, which aims to guide the overall strategy, and several subgroups, which meet periodically to focus on specific developments within the programme. Service users have been involved in several aspects of the work of the programme:
Service users (including, but not restricted to, LUPIN members) have contributed to the planning and delivery of teaching sessions and workshops with trainees and clinical psychologists external to the programme. LUPIN members have contributed to the peer observation of teaching sessions to trainees.
Members of service user groups representing other specialties (such as people with learning disabilities) also regularly contribute to teaching on the programme.
Selections and Admissions
LUPIN members are members of the interview panels which select each new intake of trainees. A variety of other service users are also involved in the "tower task", one of the four elements of the recruitment process during selection week.
LUPIN members have been involved in the planning of trainee research projects.
LUPIN members contribute to the programme policy group meetings and the Programme Board.
Fitness to Practice
LUPIN members form part of the fitness to practice committee.
4. Service User Involvement Monitoring, Evaluation and Benefits of Involvement
The evidence base for the effectiveness of service user involvement in training health care professionals is limited but increasing. Benefits have been reported by both service users involved in the educational process (Forrest et al., 2000; Master et al., 2002) and students (Wood & Wilson-Barnett, 1999; Khoo et al., 2004).
Service user involvement in clinical psychology training can:
- provide positive contact with people who have experienced mental health problems and/or used psychological services
- give trainees a different understanding of what is important in clinical encounters with clients
- emphasise the importance of collaborative ways of working
- emphasise a community psychology perspective and a holistic view of mental health
- help trainees to see user-run groups as legitimate community resources
However, research to date on the relationship between involvement processes and the achievement of tangible user-led change is limited. Although individual and group experiences of involvement have been reported, there is sparse evidence of improvement in service quality or service user outcomes as a result (SCIE, 2004).
The Lancaster DClinPsy programme will monitor both service user and trainee views of the processes in place (and planned) for involvement, via a range of methods. We also aim to evaluate the impact of involvement on trainee knowledge and competence, and on views of the quality of training (both in terms of the experience of trainees and the perceptions of outside stakeholders).
Monitoring and evaluation will take place via regular updates from programme staff and LUPIN members to programme committees, feedback from participants in teaching and workshop sessions, and an annual survey of trainees and LUPIN members on the impact of the work.
The programme has a LUPIN development worker whose responsibilities include:
- Being a first point of contact between the programme and LUPIN members
- Supporting LUPIN members’ involvement in different activities on the programme, ensuring that members are happy with their level of involvement e.g. through individual review meetings
- Being a point of contact for advice or concerns about any aspect of involvement and, where necessary, raising issues on behalf of LUPIN members with programme staff
- Advising the programme staff on ways of improving LUPIN’s involvement in the programme
- Working with the LUPIN staff team to develop effective processes for supporting the LUPIN Steering Group
- Implementing and further developing an already existing buddy system
The programme will also ensure that dedicated time from programme staff is available to support service user involvement in all its aspects. This will include members of the clinical, research and administrative staff. The programme will provide suitable meeting venues, travel expenses, and payment for activities when appropriate.
Programme staff will take responsibility for chairing LUPIN steering group and subgroup meetings. Programme administrative staff will be responsible for keeping and circulating meeting minutes.
Payment for Service User Involvement
Service users and carers will be eligible to claim travel expenses at public transport rates for attendance at most meetings and teaching sessions they contribute to or observe. Fees are also paid for some activities. More details are given in the LUPIN Policy for payment.
Support, Training and Development
Reasonable adjustment will be made for those who are disabled in any way by society in order for service users to participate in programme activities. This includes, for example, accessible meeting venues, and aids and adjustments for visual, cognitive or hearing impairments.
The level of involvement by service users in programme activities is dependent on personal choice, and the programme does not have specific expectations of how much time people need to commit.
Through discussion at LUPIN steering group meetings the programme aims to meet any specific and relevant training and development needs that are highlighted through the work. For example, to date, this has led to arranging a training session for LUPIN members to understand policy and legislation on Equality and Diversity.
British Psychological Society (2008). Good Practice Guide: Service User and Carer Involvement within Clinical Psychology Training. Leicester: BPS.
British Psychological Society (2008). Good Practice Guidelines to Support the Involvement of Service Users and Carers in Clinical Psychology Services. Leicester: BPS.
Crawford, M., Rutter, D. and Thelwall, S. (2003) User involvement in change management: A review of the literature, Report to NHS Service Delivery and Organisation Research and Development Programme (NHS SDO).
Department of Health. (1999). National service framework for mental health. London: HMSO.
Department of Health. (2000). The NHS plan. London: HMSO
Department of Health (2003). Strengthening Accountability: Involving Patients and the Public. London: HMSO.
Department of Health (2010). The NHS Constitution for England. London: HMSO.
Forrest, S., Risk, I., Masters, H., & Brown, N. (2000). Mental health service user involvement in nurse education: Exploring the issues. Journal of Psychiatric and Mental Health Nursing, 7, 51-57.
Harper, D., Goodbody, L., & Steen, L. (2003). Involving users of services in clinical psychology training. Clinical Psychology, 21, 14-19.
Heath and Care Professions Council (2012). Standards of Education and Training Guidance. London: Health and Care Professions Council.
Khoo, R., McVicar, A., & Brandon, D. (2004). Service user involvement in postgraduate mental health education: Does it benefit practice? Journal of Mental Health, 13, 481-492.
Masters, H., Forrest, S., Harley, A., Hunter, M., Brown, N., & Risk, I. (2002). Involving mental health service users and carers in curriculum development: Moving beyond classroom involvement. Journal of Psychiatric and Mental Health Nursing, 9, 309-316.
Rose, D., Fleischmann, P., Tonkiss, F.,Campbell, P. and Wykes, T. (2003) Review of the literature: User and carer involvement in change management in a mental health context: Report to NHS Service Delivery and Organisation Research and Development Programme (NHS SDO).
Social Care Institute for Excellence (2004) Has service user participation made a difference to social care services? London: SCIE.
Wood, J., & Wilson-Barnett, J. (1999). The influence of user involvement on the learning of mental health nursing students. Nursing Times Research, 4, 257-270.