Advancing Recovery in Ireland: A guidance paper on implementing organisational and cultural change in mental health services in Ireland

Recovery is important to everyone. Individuals presenting at our mental health services seek support both for managing ongoing distress but also with building a future that is better a future that involves 'recovery' both personal and clinical. The acknowledgement of this, along with recognising the immense expertise with which service users present (and those who support them) has driven the momentum towards developing "recovery oriented mental health services" Advancing Recovery in Ireland is the HSE national initiative aimed at bringing about the organisational and cultural change necessary to support our mental health services in becoming more "Recovery oriented" This recognises the reality that true partnership between those who provide our services, those who use them, and those who provide support, invariably provides better outcomes than care driven by one party alone. Utilising the best international models of organisational change the initiative has applied Kotter's (2007) widely used model on "Leading Change" in organisations, in conjunction with the HSE's own bespoke organisational change model "Improving Services" 2008) The HSE model resulted from an extensive process of reviewing organisational models internationally and identifying the key elements of a successful change initiative. The HSE Systems Reform Group similarly promotes successful organisational change through a methodology "Benefits Realisation" that dovetails closely with the HSE model. The ARI model for organisational change is laid out in detail in this document and diagrammatically  While internationally recognised models of organisational change provide a helpful overarching structure for a successful change initiative, the "how we should do it" of organisational change, the content of the process is invariably specific to the initiative itself. In terms of promoting a Recovery focus, the ImROC methodology is a widely used model of cultural and organisational change for mental health services, with over half of all UK mental health trusts utilising this model. Consequently the ImROC 10 Organisational Challenges provide a helpful guide to "what we should do" when it comes to achieving successful change in these areas. These 10 challenges are described and interwoven into each phase of the organisational change process. The ARI approach has sought to utilise the best of these models to design a programme that is pragmatic, bespoke to Irish services, and in keeping with best practice in organisational change. The four phases of this process are: (1) Building  This involves ensuring we have a critical mass of key stakeholders committed to working in partnership to promote recovery oriented practices. (2) Recovery Planning: This is where, in each area, a guiding coalition of committed stakeholders collaboratively develop a practical plan for implementing change as guided by the ImROC challenges. (3) Recovery Actions: At this stage the organisation begins implementing the planned changes and seeks opportunities for further developments. (4) Recovery Services: At this point the organisation focuses on embedding the new change and ensuring the key principles are institutionalised across all practices. Furthermore, the ARI initiative is committed to undertaking an ongoing evaluation of its work in a way that helps continuously inform the process to maximise positive outcomes. We actively seek open dialogue and feedback from all our partners, as we work together to collectively make our mental health services more Recovery oriented. Finally, this document re states the key principles which we feel lie at the centre of all good Recovery focused services. This is to ensure that in the challenging process of organisational change we do not lose sight of the key values that drive this work.