Enhancing social inclusion of mental health service users

An innovative approach to social inclusion in Europe has succeeded in increasing the rate of employment among users of mental health services (patients). The researchers who developed the approach suggest it could also be used to help other disadvantaged groups. EMILIA, a European research project financed by the European Commission, showed that lifelong learning educational courses designed with input from the service users themselves can offer significant benefits for those users: it can aid their recovery, facilitate their social inclusion and promote their return to work.

EMILIA (Empowerment of Mental Illness Service Users: Lifelong Learning, Integration and Action) focused on mental health service users who suffered from severe mental illness and had a minimum of three years’ experience of mental health services. These participants were employed as lifelong learning trainers in their local community, using training material designed and developed by mental health service users themselves.

The project involved seven mental health services and one university. In some cases, training was carried out entirely by service user trainers; in others it was undertaken alongside professional trainers. The project designed 11 educational programmes in all, covering such topics as recovery, service user leadership, building on personal strengths etc. (Details of the programmes are available at: http://www.emiliatraining.net). The field work was conducted in a variety of cultural contexts in eight different countries: Bosnia-Herzegovina, Denmark, France, Greece, Norway, Poland, Spain and the United Kingdom.

EMILIA’s research utilised the five-step process anchored in the European Union’s lifelong learning policy:

  • Stage 1 of this process identifies partnership working across the learning spectrum as “the first building block, in which all actors inside and outside the formal systems must collaborate in the development of learning organisations for strategies to work.”
  • Stage 2 is concerned with insight into demand for learning, which EMILIA operationalised by carrying out systematic lifelong learning needs assessments of the mental health service users.
  • Stage 3 identifies analysis, generation and development of adequate financial and learning resources for the task. This is concerned with the institutional resourcing of the lifelong learning assessed as needed in the previous stage.
  • Stage 4 is entitled facilitating user access to learning and work opportunities. This stage proceeds to match learning opportunities to learners' needs and to facilitate access to the learning opportunities the users themselves have selected locally.
  • Finally, stage 5 - striving for excellence through service improvement - ensures that a comprehensive integrated approach to lifelong learning (and social inclusion) is in place in the institutions concerned.

The service users in EMILIA were paid to perform a number of social inclusion roles. These included assistant researchers, health service workers, peer support workers, part-time teachers, and university social work and nursing course assessors.

The researchers found that employing mental health service users as trainers made the training more credible in the eyes of the students and benefited service user trainers by empowering them and aiding their recovery. It also constituted a first step toward preparing them to teach health care professionals and student nurses. Enabling mental health service users to act in a professional training role helped overcome the feeling of difference between ‘them and us’.

The study produced evidence that these approaches led to significant reductions among the sample group in hospital admissions. Beyond that it increased levels of employment, the number of hours worked per week, the amount of disposable income, as well as the degree of social inclusion, empowerment and employability. The project employed quantitative and qualitative methods to assess the project at two follow-up points.

The researchers found clear evidence of the positive impact of the project after it had been in operation for 20 months. This included: a doubling of paid employment from 7.3 to 14.6 per cent and a similar increase for voluntary employment; significant increases in disposable income and quality of life; an increase in the average number of hours per week worked from 0.3 to 3.23; an average reduction of days in psychiatric hospital from 14 to 7; self-reported increase in levels of self-confidence, efficacy and hope, and increased skills and knowledge leading to increased employability.

The project also found that universities and health care centres involved in the study benefited from the knowledge and experience of mental health service users. Moreover, it found that consulting them made programmes on health care management and education more valid and meaningful.

The EMILIA project has developed a suite of innovative tools to help achieve goals of increased employment and social inclusion among disadvantaged groups. These include:

  • A confidential lifelong learning planning development profile (PDP) for mental-health service users.
  • Eleven lifelong learning training programmes designed by the service users themselves, available free to all via the EMILIA training website: http://www.emiliatraining.net.
  • New roles for mental health service users to use their experiences by working as lifelong learning trainers and personal medicine coaches.
  • A tool to enable organisations to identify obstacles and solutions to successfully deliver lifelong learning to excluded groups.

Recommendations for improving inclusion for all disadvantaged, socially excluded and disempowered groups:

  • European countries with a strong tradition of strong welfare benefit support (for example, Scandinavia, the UK, and France) should reduce the impact of the ‘benefit trap’, where disadvantaged individuals fear that new learning and occupational opportunities could mean they lose welfare benefits.
  • European countries with a less well established tradition of welfare support, such as Bosnia-Herzegovina, Greece, Poland or South Eastern Europe should consider establishing and promoting government bodies and/or NGOs specialising in providing lifelong learning to disadvantaged groups.
  • Provide free lifelong learning for all disadvantaged groups, for example those with physical disabilities or drugs/alcohol dependencies, accessing for example http://www.emiliatraining.net, which is downloadable for free.
  • Develop, in collaboration with disadvantaged groups themselves, lifelong learning opportunities relevant to the lives of recipients, highlighting the valuable connections between recovery and lifelong learning.
  • Collaborate actively with European Commission's Directorate-General for Health and Consumers regarding the project PROMISE1 for broader dissemination of EMILIA results.
  • Actively promote the employment of disadvantaged individuals by engaging with employers.

Recommendations specifically for improving inclusion of mental health service users:

  • Disseminate and make permanently available lifelong learning packages, training-the-trainers packages and PDP tool, currently available at http://www.emiliatraining.net
  • Establish a permanent EU network, in conjunction with the World Health Organization (WHO), of mental health service providers to enable widest spread of lifelong learning programmes.
  • Create an EU network of mental health service user groups in collaboration with WHO to encourage setting up the innovatory use of mental health service user trainers.
  • Encourage collaboration between lifelong learning providers, mental health services, employers and job information centres.
  • Ensure updating of training material produced during EMILIA and permanent EU funding to host these materials.
  • Ensure a balance between medical approach and recovery (psychosocial) approach to manage and deliver health care which will help the EU face the structural challenge posed by an ageing population.


1 See: http://www.promise-mental-health.com/

EMILIA – Empowerment of Mental Illness Service Users: Life Long Learning, Integration and Action (duration:1/9/2005 - 28/4/2010) was an Integrated Project funded under the 6th Framework Programme for Research of the European Union, Thematic Priority 7 – Citizens and governance in a knowledge-based society.

See: http://www.emiliaproject.net/

Contact: Peter Ryan, p.ryan@mdx.ac.uk