Ringing the changes

At this time of the change of the year, it seems a good time to reflect on what we’ve done so far with Mental Snapp and the theory of change that we are proposing. I was asked over dinner before Christmas what our theory of change is, and came out with an answer that satisfied me at the time, I’ve since been post rationalising to see if I can make it work and make it measurable.

Without fully understanding what the question proposed, my instinct as to the change that we want to create with Mental Snapp is to make it so that the individuals who use the service feel more authentic, more self authenticating, and that they are in control of that process. I’m not aware of ‘authentic’ being used as a term in recovery literature, but I’d like to propose it as fundamental to a part of the recovery process that I have experienced, that of telling your story to yourself and to others in such a way as you feel true to yourself, unashamed to be yourself, and comfortable in your skin. I think that self authenticity goes further in that it encompasses an ability to look yourself in the mirror, to learn not to run away from yourself. Dorothy Rowe in her literature speaks of mental ill health as a misconceived attempt to escape from the threat of annihilation – the more I learn about and become reflective and reactive to my mental fluctuations, the more I realise that this is in fact the case. I have a very strong escape drive. Sitting with myself is something that I am learning, and learning to sit with my authentic self puts me in control.

So that is the proposal of our theory of change – self authentic, self authenticating, and in control. I took this proposal to Mike Slade of Nottingham University who researches recovery and we talked about how we might go about measuring this. Mike developed and published on the CHIME recovery framework, five measures of recovery which go beyond the clinical model of recovery and into personal recovery. At this point of the year, I think we could all, whether with or without a mental health diagnosis, look into incorporating them further into our lives for the following year. They are:

Connectedness

Hope and optimism

Identity

Meaning and purpose

Empowerment.

Unfortunately, though the CHIME model is measurable and robust, it takes a lower priority on the NHS agenda than measurable indices which indicate a cost saving to the public purse – the classic index being getting back into employment. Despite the scepticism and weariness on both sides of the service user/professional divide with the over use of this outcome measure, it continues to prevail. “I think the CHIME model of recovery and ones like it should be the core business of the NHS” said Mike “not on the periphery.” Surely this would save money in the long run.

To wait for the NHS to turn its enormous ship in our direction is to condemn ourselves to endless waiting. Just as I can see that Mike’s model adds value to the concept of recovery by including measures that have a qualitative element for the individual rather than a quantitive, mass, and economic approach, I hope we can add value by adding to people’s quality of life through using Mental Snapp. The thing to do is to get this off the ground, and to get some case studies, rather than a full research study. To be agile and to be responsive to service users and clinicians. These are our key touchstones. We’re waiting to find out if we have funding confirmed from a major funder, which will see us through to developing a prototype and then we can start to gather experiences of people using the app. We’ll be looking to research it as we go, using peer led techniques.

Mike elucidated two main avenues which we could use to measure our theory of change. We can look into the explanatory model of mental disorder, the extent to which our intervention of video diaries enables the individual to create a more coherent and meaningful sense of self and create meaning in experiences. The second avenue is to measure increased empowerment or agency; the ability to develop and make choices. Both these are measurable, though again not high on the spend list.

Like Mike’s CHIME model, our theory of change is likely to come low down on the list of NHS spending priorities. In order to bump it up the priority list, we have to demonstrate that we save the NHS time and money. Additional features will be necessary to do so, and we are considering what we will and will not countenance so that the model remains true to itself and doesn’t put the cart before the horse. We will not compromise by adding on additional features that take away from our core business, to enable people to live authentic lives where they are in control of their own narrative. To tell their stories, to others and to themselves and to be in control of that process. Would that ring the changes? In psychiatry, where someone else wields the pen over the service user life history, too right it would.