Strategic Partnership Guide - nda.ie

Strategic Partnership Guide: Good Practice in Working with People with Experience of Mental Health Difficulties

Strategic Partnership Guide: Good Practice in Working with People with Experience of Mental Health Difficulties

National Disability Authority

25 Clyde Road

Dublin 4

Tel: 01 608 0400

Fax: 01 660 9935

Email: [email protected]

2005

Acknowledgements

The Strategic Partnership Guide: Good Practice in Working with People with Experience

of Mental Health Difficulties was commissioned by the National Disability Authority (NDA)

in response to the recommendation of a NDA statutory committee, the Mental Health

Advisory Committee (MHAC). The Guide is based on research and review of good

practice undertaken by Chris Stevenson, Sue Jackson and Jean Davison (Teesside

Centre for Rehabilitation Sciences, England) and Kieran Crowe and Paddy McGowan

(Institute for Mental Health Recovery, Ireland).

The team, with the NDA, would like to thank the following representatives from a number

of voluntary, community and statutory organisations who provided input and feedback

during the research and consultation stages of developing the Guide:

Frank Flannery Chair, Mental Health Advisory Committee

Mary Clarke-Finnegan Mental Health Advisory Committee

Phil Cotter Mental Health Advisory Committee

Patsy Doolin Mental Health Advisory Committee

Frances Harvey Mental Health Advisory Committee

Paul Howard Mental Health Advisory Committee

Seamus Hoye Mental Health Advisory Committee

Mark Logan Mental Health Advisory Committee

Verena Keane Mental Health Advisory Committee

Brendan Kenny Mental Health Advisory Committee

Mary Keys Mental Health Advisory Committee

Andrew Logue Mental Health Advisory Committee

Hugo Magee Mental Health Advisory Committee

Louis McGuire Mental Health Advisory Committee

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Tom Moran Mental Health Advisory Committee

Tom Noonen Mental Health Advisory Committee

Dan O’Connor Mental Health Advisory Committee

Winifred O’Hanrahan Mental Health Advisory Committee

Laura Thompson Mental Health Advisory Committee

Margaret Webb Mental Health Advisory Committee

Laurie Ahern Mental Disability Rights International, US

Liz Brosnan Western Mental Health Alliance

Deirdre de Burca Green Party

Will Hall Freedom Centre, US

Professor Alec Jenner Asylum, UK

Paul Johnson National Institute for Mental Health England

Limerick focus group members

Terry Lynch Private psychotherapy practice

Donal McAnaney Rehab Group

Anne O’Donnell Edinburgh Users Forum

Mary O’Hagan Mental Health Commission, New Zealand

John Redican Irish Advocacy Network

Dr Alex Reed University of Northumbria, UK

Jan Wallcroft EbyE, National Institute for Mental Health England

Aisling White North Dublin Psychology Service

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Strategic Partnership Guide

ForewordThe National Disability Authority’s Strategic Plan 2004-2006 states that working in

partnership is one of our core values and that, in particular, the Authority will work to

‘maintain and strengthen existing partnerships, and initiate and contribute to the

development of strong partnerships and constructive working relationships… as a basis

for effecting change’.

This Strategic Partnership Guide builds on earlier guidance in the NDA’s Ask Me:

Guidelines for Effective Consultation with People with Disabilities and on our investment

in promoting the rights of people with experience of mental health difficulties, for example

through the establishment of the statutory Mental Health Advisory Committee and

publication of an issue in the Disability Agenda series, entitled Promoting Positive

Attitudes to Mental Health. Through the publication of this Guide, the NDA signals the

importance of including people with disabilities in strategic partnership, i.e. moving

beyond consultation.

This Guide represents an authoritative international and national consensus on forming

and maintaining such successful strategic partnerships. The University of Teeside,

England and the Institute for Mental Health Recovery, Ireland have been commissioned

by the Authority to develop the Guide and have done so using evidence from a number of

sources including an international Delphi exercise with a wide range of stakeholders, a

digest of selected national and international research and policy literature, focus groups

of people with experience of mental health difficulties in Ireland and an Irish focus group

with multi-stakeholder membership.

The NDA considers that disabled people’s participation in strategic decision-making is a

vital component of promoting their inclusion in Irish society. Such participation is strongly

supported by international bodies such as the World Health Organisation. It is an

increasing feature of Irish Government and public administration, where structures and

projects to promote participation are occurring at all levels. These activities are welcome.

However, it is important that good practice is established in order to ensure effective and

equal involvement.

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This Guide is designed to be a valuable, practical tool across all sectors. The NDA looks

forward to working with all stakeholders to develop good practice in this area.

I would like to thank all those who contributed their time and expertise in providing

feedback and input into the consultation, and to particularly thank the NDA’s statutory

Advisory Committee on Mental Health members for their input and insight into delivering

this important project.

Angela Kerins

Chairperson

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12 Essential Principles for Effective StrategicPartnership with People with Experience ofMental Health Difficulties

1 Gain support from the organisation�s management

2 Identify appropriate partners � who, why, what can theycontribute, how can they represent others?

3 Build the foundations for the partnership � ensure equalentitlements and access to resources

4 Establish shared vision, purpose and ownership

5 Recognise diversity and equality of partners

6 Define the ground conditions for working together

7 Acknowledge the human and humanitarian elements ofthe partnership

8 Avoid undue pressure through flexibility in time scale and organisation

9 Consider overlapping and differing agendas of partners

10 Be realistic and be explicit about working in partnership

11 Attend to partners� needs non-judgementally, includingneeds for training and external support

12 Continually review and revise expectations through acycle of reflection-action-reflection

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Contents

Acknowledgements 2

Foreword 4

Twelve essential principles for effective strategic partnership with people with experience of mental health difficulties 6

1 How the Strategic Partnership Guide can help you 9

1.1 Defining partnership, strategic partnership, strategic partnership with people

with experience of mental health difficulties and advocacy 11

1.1.1 Partnership 11

1.1.2 Strategic partnership 11

1.1.3 Strategic partnership with people with experience of mental

health difficulties 11

1.1.4 Strategic partnerships and advocacy 12

2 Getting started 15

2.1 Winning hearts and minds 16

2.2 Identifying appropriate partners 17

2.3 Building the foundations for the partnership 18

2.4 Establishing shared vision, purpose and ownership 19

2.5 Recognising diversity and equality 21

2.6 Defining the ground conditions 22

2.7 Acknowledging the human and humanitarian characteristics of partners 23

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3 Keeping going by attending to process 25

3.1 Avoiding undue pressure 26

3.2 Assessing for overlapping and differing agendas 27

3.3 Being realistic and being explicit 28

3.4 Attending to partners’ needs 29

3.5 Continually reviewing and revising expectations 30

3.6 References 31

4 Training materials 33

4.1 Training exercises 34

4.1.1 Understanding strategic partnerships 34

4.1.2 Making a case 35

4.1.3 Partners 1 35

4.1.4 Partners 2 35

4.1.5 The initial strategic partnership meeting 36

4.1.6 Building blocks 36

4.1.7 Sharing 36

4.1.8 Different and equal 37

4.1.9 The process of partnerships 38

4.1.10 How strategic partnerships have worked for others 38

4.2 Training exercise pointers 38

4.2.1 Defining strategic partnerships 38

4.2.2 Evidence to help win hearts and minds 39

4.2.3 Engaging appropriate partners 1 40

4.2.4 Engaging appropriate partners 2 42

4.2.5 Organising the initial strategic partnership meeting 43

4.2.6 Strengthen the foundations for the partnership 43

4.2.7 Working out shared vision, purpose and ownership 44

4.2.8 Diversity and equality of points of view 44

4.2.9 Partnership process 44

4.2.10 First hand testimonials 45

References and further reading 48

Feedback 49

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1. How the StrategicPartnership Guide can help you

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1. How the StrategicPartnership Guide can help you

The Guide is a practical tool to help people understand the processes of forming and

maintaining strategic partnerships with people with experience of mental health difficulties.

It is divided into 4 parts:

• Part One looks at definitions of partnerships

• Parts Two and Three cover the process of starting off and maintaining partnerships

• Part Four is a resource for training, either to support ongoing partnership working or

more generally as a resource for training agencies, education providers or health

provider organisations

The first three parts of the Guide give information (in black text) and instructions that

point to action (in purple text). The actions can be treated as a check list for strategic

partnerships to refer to and work through. The fourth part of the Guide provides

experiential learning tasks to support in-service or other training.

Strategic partnerships are new and are breaking new ground. Partners may find new

issues that need to be addressed. With this in mind, the Guide has an evaluation

component that users are invited to complete in order that the Guide continues to grow

and remain useful.

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1.1 Defining partnership, strategic partnership,strategic partnership with people withexperience of mental health difficulties and advocacy

It is important to be clear about what is meant when we use the word partnership alone

and in combination as in ‘strategic partnership’ and ‘strategic partnership with people with

experience of mental health difficulties’.

1.1.1 Partnership

According to the Oxford English Dictionary, a partner is a person who takes part in an

undertaking with another or others, especially in a business with shared risks and profits.

A partnership is an association of two or more people as partners.

1.1.2 Strategic partnership

A strategic partnership involves forming part of a long-term plan or aim to achieve a

specific purpose. Strategic partnerships involve a shared sense of the need for change.

The change may be needed in organisational structure and function, in policy, or in

philosophy. The focus in strategic partnerships is action. There is a balance between

talking and doing. They are not ‘talking shops’.

1.1.3 Strategic partnership with people with experience ofmental health difficulties

When we talk about strategic partnership with people with experience of mental health

difficulties, there is a further dimension to the partnership. Mental health difficulties

involve a continuum along which all of us move. People find themselves at different points

on this continuum at different times in their lives. Human distress is universal, and we are

all recovering ourselves all of the time. However, some people find themselves at the

‘sharp end’ of the continuum for prolonged periods of time. Deegan pointed out in 1992

that severe mental health difficulties do not diminish an individual’s worth; everyone still

deserves respect and recognition of personal strengths, no matter what the mental health

issues are [1].

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It is important to recognise that strategic partnerships are not therapeutic partnerships.

Sometimes the two merge and a means of managing the merger is needed, as the

following example shows:

In a 1998 study, Smith describes a partnership in which evaluation instruments were

developed with mental health service-users [2]. Smith points out that the most difficult

task for the group was keeping on track with the task in hand and not going off on a

tangent and becoming a ‘support group’. However, the process demonstrated a need for

such a group within the service and as a compromise they set aside 15 minutes at the

commencement of each session for the mutual support before tackling the task in hand.

In a strategic partnership the partners are considered as seeking change external to

them. Inevitably all partners will grow in the context of a successful strategic

partnership, but this is not the main function of the partnership.

One factor that can limit a strategic partnership is a strong belief that mental health

difficulties are due to a disturbance in biological functioning as in physical illnesses like

diabetes. With this belief, treatment relies heavily on medication and is controlled by

professionals. The person is not seen as having a strong degree of independence, or

the capability for self-determination. When professionals enter into partnership with this

explanation, they tend to assume greater responsibility. This is inappropriate for a

strategic partnership where the partners are equal. One way to guard against hierarchy

is to set strategic partnerships within an advocacy framework.

1.1.4 Strategic partnerships and advocacy

Advocacy has many voices: personal, political, assisted self, self, collective, and group.

The strategic partnership must explicitly acknowledge and actively support the advocacy

needs of partners. To meet advocacy needs within your strategic partnership you must:

• Look inwards and look outwards. Monitor and reflect on the process of the

partnership to ensure that it is remaining strategic and not lapsing into a hierarchical

and/or therapeutic mode. Monitor and reflect on the context of the partnership in order

to assess whether change is occurring and where change still needs to occur and

what might be affecting the change process externally.

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• Develop and sustain self determination. Accept that people have the desire and ability

to represent their own views. Do not try to colonise others by trying to impose your

particular view of the world on them. Enable and support individual expression where

needed, even if this is sometimes at the expense of your own agenda and ego.

• Represent the group agenda. Express a belief in and commitment to the larger group

agenda, even though this may differ from your own ideas.

• Promote a culture of human rights. Ensure that the strategic partnership is non-

coercive and non-violent. Do not use force, either emotional or verbal, in order to push

one agenda over another, or block views that are culturally different.

• Facilitate people in their own empowerment process. Empowerment is defined as a

psychological sense of personal control, involvement, influence and awareness of

options in one’s life. Make explicit the importance and value of partners’ contributions.

• Redress power. In 2002, El Ansari and colleagues stated that the way decisions are

made is determined by how power is structured and make the point that power can

take many forms:

‘ …accessing and utilising data and information (information power), resources and

funds (economic power) as well as the competencies, capacities and proficiencies of

the stakeholders (technical power)’. [3]

The (re)sources of power tend to cluster around professionals who can then dictate the

nature of the partnership. In 2004, an article in Mental Health Today pointed out that for

professionals to view service-users working in a strategic fashion can be daunting [4]:

‘They were working with service users in a planning and strategic arena who knew

more about it than they did. It really flagged up how good the service user

involvement project is, how well trained the people are and how well up they are on

policy and operational issues. You might expect people to be experts on their own

health but when people say, it would help my recovery more if there was a service like

this – it’s a whole new arena for some staff.’

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• Give equal value to professional knowledge and experiential knowledge.

• Adopt flexible practices in relation to how meetings take place, and how meetings

are recorded.

• Negotiate the roles within the strategic partnership. Encourage people to try

out roles outside their existing experience in order to maximise alternative and

creative contributions.

It is not possible to define the aims and objectives of individual strategic partnerships

involving people with experience of mental health difficulties. However, the partnership

must seek change that promotes rather than compromises the rights and dignity of

individuals within organisations and especially in the context of care provision. In this

respect, partnerships with people who experience mental health difficulties are different

from other strategic partnerships where profit may be prioritised over human rights. The

strategic partnership with people who experience mental health difficulties has a

collective advocacy function. For example, a partnership established with the aim of

introducing social employment would consider the rights of workers to an equitable wage.

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2. Getting started

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2. Getting startedEstablishing a responsive organisational ethos and culture helps to prevent superficial

organisational commitment, for example in relation to resources. It prevents tokenism as

the input of people who have experience of mental health difficulties will have been

appropriately justified.

2.1 Winning hearts and minds

• Seek commitment from ‘the top’, for example the management of the hospital, health

service, or team leader.

• Consider the socio-political, cultural and economic context in which the partnership

will operate.

• Beware of compromising the autonomy of the partnership by accepting sponsorship,

for example support from the pharmaceutical industry.

• Engage with cynical and obstructive individuals in positions of power for whom the

prospect of change is more threatening than keeping things the same. Try to

understand the reasons for their negativity, for example vested interests, or previous,

poor experiences of strategic partnerships.

• Make a general case for why partnership is a good way forward. Use the evidence

presented in Section 4.2.2 that supports the philosophy, principles and practice of

strategic partnerships with people who have experience of mental health difficulties.

• Make a specific argument as to why the partnership is needed now, for example,

because of a current issue, and how the partnership might be enacted, and to what

end. Identify how the change will improve the situation for individuals who resist the

idea of change.

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2.2 Identifying appropriate partners

The first stage in establishing a strategic partnership is to identify appropriate partners,

to arrive at the right constituency. Remember that some individuals would not wish to

participate and, as Cahill suggested, professionals need to ensure that people are not

coerced as reluctant collaborators [5].

Sometimes the idea of the partnership will have emerged from existing groups. Despite

this, you must ask yourself four questions and be able to give yourself clear answers:

• Who is to be a partner?

• Why they are to be included?

• What is the potential contribution that they will make?

• How can they communicate with others to ensure they represent the broader

reference group?

This gives the partnership a solid basis for beginning to work.

There are no hard and fast rules about who should be invited, for example, how many

people with experience of mental health difficulties to how many professionals or what

disciplinary mix. However,

• The partnership must include people who have experienced mental health difficulties

at the pre-planning stage to ensure that they have parity of esteem and real, equal

status within the partnership.

• Consider all partners, and not just professionals, as stakeholders, or key players, that

is people who have special interest in the area and concern to create change.

Invitations to participate should be carefully worded, and be non-threatening or

demanding. An example of a letter that can be adapted for your own situation is given

in the training section of the Guide (4.2.4).

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Good preparation will ease the initial coming together process. Attention to detail and

building up momentum works best. You must consider what an appropriate venue is,

by asking:

• What are the travel implications for the partners?

• What facilities are available, including provision of refreshments?

• Is the physical environment accessible for all?

• Does the venue have any drawbacks?

For example, a meeting room on a hospital ward might be unattractive to

someone who has undergone treatment there; a venue may be unsafe in relation

to evening attendance.

• Are there other venues that might be more inspirational?

For example, it may be appropriate to draw on alternative settings that are closer to

the natural environment and which can inspire different kinds of thinking in relation to

growth, learning and insight.

• What degree of formality do we want when meeting together?

Remember, a formal meeting room will lead to a more formal meeting and may inhibit

more creative discussion; equally, an informal meeting room may not help to keep

people focused on the business at hand.

2.3 Building the foundations for the partnershipThe partnership must be built on strong foundations, and with a commitment to ‘give and

take’. If it is not, then small irritations will end up becoming big enough to discourage

attendance or effective working together. The partnership is, by definition, equal and so

each partner must have equal entitlements. Resources must be made available to

support the partnership.

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• Where possible non-wage earners must be paid appropriately for their participation.

The level and kind of payment is decided on an individual basis to allow for

differences in income sources, and preferences. For example, Pivik and colleagues

found that an honorarium was of more value to the service-user as a sign of respect

and of service-user expertise because payment could call into question the dedication

of a volunteer [6]. It should be bourne in mind that payment can also negatively

impact on benefits such as social welfare. Some statutory bodies may be precluded

from making such payments under current legislation.

• Where expenses are being paid, they should be paid promptly.

• Regular meetings must be set up in order to help to build a sense of rhythm and keep

up the partnership’s momentum.

• Sufficient time has to be allowed to get to grips with the realities of working together,

to do the groundwork.

This may be time set aside and used formally, for example in setting ground

conditions. Some time may be used more informally, for example in conversation over

lunch, so that the partners begin to know each other in a more human to human way.

They can establish trust and connectedness. A trusting relationship is critical

according to Linhorst and Eckert’s study in 2002 [7]. People who have experience of

mental health difficulties may worry that they are not heard by the professional

partners and that no change will occur, or that there will be repercussions for them as

a result of their involvement. Staff may fear victimisation from managers and other

senior professionals if they were critical of service delivery. Trust also helps to prevent

defensiveness when a challenge to a partner’s view is made.

2.4 Establishing shared vision, purpose andownership

In his 1996 study, Bowl pointed out that there was confusion about the purpose and

meaning of user involvement at all levels of the organisation [8]. The idea of creating a

strategic partnership may have come from one person or one organisation, with a

particular issue in mind. On the other hand, a strategic partnership might have been

suggested with more vague motives, for example, because of the current culture of

service user involvement. In either case, you must establish shared vision and ownership

in relation to the partnership and the hoped for outcomes. Such clarity and commonality

is found when the partnership:

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• Establishes shared interests or aims or goals or purposes of strategic significance.

It is inevitable that people coming from different positions will have different

perspectives. The function of the partnership is to meld these into an agreed vision

and purpose. This will underpin the partnership’s Terms of Reference. The Terms of

Reference provide the reason and/or the purpose for which the partnership is being

developed. They help people to understand the perspectives and motivations of the

partnership and support a plan of action.

• Clarifies the core values.

• Shares risks.

The fear of taking risks can close down the productivity of a partnership. There is no

dignity without risk and the partners can sustain one another in this respect.

• Shares benefits.

• Shares strategising.

• Encourages joint effort and active participation.

• Clarifies the roles and responsibilities of each of the partners.

This is particularly important (within the bounds of confidentiality) when people

cross boundaries from service-user to service employee, or from professional to

service-user.

• Rotates responsibility for key tasks, especially those that can increase professional

control, for example, chairing meetings or minute and note taking.

• Clarifies the desired outcomes.

• Clearly defines the decision-making process.

• Embodies respect and trust in relation to different interests.

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2.5 Recognising diversity and equalityStrategic partnerships benefit from the bringing together of diversely experienced people

in forums that encourage dialogue. They function best when there is shared ownership,

interests, goals and purposes but different experiences and perspectives all equally

valuable and valued. The partnership must:

• Actively bring out different experiences and perspectives by asking questions of one

another that help to energise creative dialogue. For example, ask, ‘What was your

best experience of a therapeutic activity?’

• Treat different experiences and perspectives respectfully and equally with open-

mindedness, rather than questioning which is the most accurate.

• Consider different experiences and perspectives as a pool of knowledge.

• Accept that the process of the dialogue involves unpredictability and uncertainty.

Unpredictability, uncertainty and not trying to force a solution can lead to novel

representations of an issue or a new solution to a problem.

• Check regularly with partners that the new representation is helpful.

Diversity may also mean that the needs of the partners in relation to the partnership

differ. The needs may be obvious or emerge as the partnership progresses (see Section

3.4). In the initial stages, the partnership must:

• Allow time and space to explore what initial needs different people have.

• Actively respond to those needs, with resources both within and without the group.

• Make information available about best practice in partnership working.

Some partners will be experienced in working constructively together, others less so.

Knowing that strategic partnerships can and do work inspires confidence at the start

of the enterprise.

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2.6 Defining the ground conditionsGround conditions are not just risk limiters. They can be important in ensuring that all

participants have fair and transparent access to involvement in the partnership. The

ground conditions will vary according to the membership. However, there are some key

guiding principles that form the bedrock for the partnership:

• Treat every partner as equal with the same entitlements as a citizen.

A citizen is entitled to the protection and benefits of being part of the society and is

entitled to be included and to contribute.

• Promote dialogue between partners by asking each other questions that encourage

debate. For example, ask, ‘What are your hopes and dreams for the organisation?’

• Listen to others and hear what they say.

Sometimes people ‘listen in order to talk’ rather than ‘talk in order to listen’.

• Show mutual respect for other people’s opinions, by valuing each contribution and

trying to understand why it matters.

• Make a commitment to honesty and openness.

It is not always easy to express one’s honest opinion without the safety of statements

about confidentiality and non-judgemental philosophy.

• Build and maintain trust through being together in a respectful, honest and open way.

• Pay attention to language; make sure that language is used unambiguously.

Unambiguous communication leads to unambiguous communicating and

unambiguous communicating leads to unambiguous communication.

• Maintain accessible communication; use words that are not jargon-laden, prejudiced,

or that do not encourage stereotyping or stigmatising.

• Create freedom for partners to use the language appropriate for them (collectively

or individually).

Language that is unfamiliar to the partners will not help the relationships built up in

the group to progress.

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• Use language to both create and reflect a culture of mutual respect and interests

shared by the partnership.

• Be aware that not everyone has access to the same communication media, for

example e-mail.

• Be creative in using communication tools, for example, verbal (audio taped) and

written submissions, questionnaires etc.

• Give space to creativity in thought, and in the use of resources. For example,

encourage partners to visualise an ‘ideal world’ or use meeting spaces to role play

different problem-solving strategies.

• Commit to a balance of rights and responsibilities.

2.7 Acknowledging the human and humanitariancharacteristics of partners

In successful partnerships, the abilities of humans are celebrated. Human capabilities are

often taken as ordinary but can have an extraordinary potential when used in partnership.

The following list serves as a reminder:

• Self-determination

• Wisdom

• Integrity

• Honesty

• Emotionality – emotions can act as a barometer for what is happening within

and outside the partnership, and can provide the passion for seeking change,

if they are contained and harnessed by the partnership

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• Capacity for understanding, for example, understanding staff resistance – ‘These

aren’t proper users’, ‘It’s tokenism’

• Capacity for self-reflection on emotional states and communication impacts

• Accessibility or openness to the needs and views of the other

• Consistency

• Friendliness.

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3. Keeping going by attending to process

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3. Keeping going by attendingto process

It is very easy once a partnership is established to think that it will continue automatically

until it achieves its goals. However, without attention to the process (what is happening

within the partnership) it is possible to end up with individuals travelling in different

directions at different paces towards different ends. In maintaining strategic partnerships

you must:

• Ensure that there is a clear and open reflexive process, so that the partnership puts

itself under the spot light.

• Detect problems early through regularly seeking views.

• Engage in constructive problem solving.

3.1 Avoiding undue pressureAccording to Linhorst and Eckert’s 2002 study, people who experience mental health

difficulties reported some problems in being consistently involved in partnerships,

especially in the long term, if symptoms and treatments get in the way [7]. Professionals

have competing demands to balance. Pressure is avoided when flexible and adaptable

processes and agendas are in place.

• Do not place outcomes over process and expect too much too soon.

• Be explicit about the demands of the partnership and you will help people to decide

whether and how much they can commit.

• Ensure organisational support, and the finance and other resources that go with it.

• Be tolerant towards both the quantity and quality of the partners’ contributions.

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3.2 Assessing for overlapping and differingagendas

The idea of forming a strategic partnership might come from different people. For

example, a person with experience of mental health difficulties, a carer, a mental health

service user organisation, a hospital manager, a professional.

• Have an open conversation about how the idea of a partnership arose, and what

the individual’s or organisation’s hopes and expectations are in relation to the

strategic partnership. Ask the questions of each other, ‘What brought you to think

about a strategic partnership?’ and ‘What do you think is to be gained by the

partnership working?’

This transparency promotes honesty and clarity in relation to the partnership’s

objectives and prevents ‘hidden agendas’ and concerns about the motives for

joint working.

• Remember that people have different hopes and expectations for the partnership

depending on the position they hold.

• Both strive for commonality and…

• take the other’s position.

When people have been trained in and/or have deeply meaningful experiences of

mental health care, it is sometimes difficult for them to see the other person’s point of

view or position as justified. Shared training sessions for staff, service users and

carers (for example, in strategic partnership working, advocacy, communication skills,

and non-violence techniques) can help develop a sense of the other’s experience.

• Pay attention to potential conflicts of interest. For example, a professional’s loyalty to

the employer may get in the way of changing how care is provided.

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3.3 Being realistic and being explicitA partnership cannot achieve solutions for every problem or create every change needed

in an organisation.

• Identify the scope the partnership has with careful consideration of factors external to

the partnership; not everything is possible in all circumstances.

• Focus on what the partnership can achieve rather than what it cannot; that is, set

realistic goals.

• Appreciate what each other can achieve in the context of the partnership.

• Set a realistic time frame and be flexible about it to allow space for time out, or panic,

or second chances.

• Identify the steps towards goals so that progress can be monitored and achievements

acknowledged.

• Establish exit strategies for partners at early stages.

It is important that people know they can leave the partnership at any time without

any sense of resentment. When there are decisions made about what the partnership

aims to achieve it is easier to know when it has reached its natural end. Having a

meeting to ‘round off’ by celebrating the partnership’s achievements, or a social

gathering, can help with the disbanding process.

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3.4 Attending to partners� needsDifferent partners have different support needs in relation to their functioning. The needs

may be emotional, physical, or practical. People who have experience of mental health

difficulties may have had lack of opportunities in terms of education and employment,

less chance to be self-determining and have had to deal with the reality of shattered

dreams. As Turner-Crowson and Wallcraft pointed out, this has an impact on the success

or otherwise of partnership working [9]. But it is important to remember that people who

have experience of mental health difficulties are as different as they are similar as Minett

noted recently [10]. The same applies to professionals. Partnerships must:

• Acknowledge that sometimes needs are not obvious, but nevertheless should be

actively assessed.

• Use the ability to imagine oneself in another's place and understand the other's

feelings in order to discover needs where they are not obvious.

• Accept that needs shift according to time and context. For example, as Cahill reports,

if professionals extend their roles to become involved in promoting service-user

involvement, they will have to adjust their own position with regard to the duties and

functions they perform [5]; or someone with literacy needs may develop within the

partnership and not need the same support as the partnership progresses.

• Accommodate partners’ needs non-judgementally.

• Ensure that professional partners offer support that is non-patronising, for example,

support that focuses on the person as self-determining and which tries to engineer

scope for the person to perform.

• Assess for participation.

Some people are quiet, or silent, partners. However, silence may indicate that the

person finds some obstacle to taking part and needs support to become included.

• Allow space to grow self-confidence.

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• Accept that emotional distress for any partner is meaningful; safety to be emotional

and non-pathologising of emotions is required.

• Be vigilant in relation to professional attempts to covertly control partnership process.

• Build in adaptability in response to changing needs or agendas.

• Organise relevant training.

By not just learning ‘on the job’ individuals/groups can be more effective more quickly.

• Be willing to help each other to identify or build networks, or take consultancy, internal

and external to the organisation and to seek resources to this end.

• Ensure sharing of the resources that professional partners have in relation to meeting

needs, for example desk or office space or meeting facilities.

3.5 Continually reviewing and revisingexpectations

The initial expectations for the partnership in terms of outcomes may need to be re-

visited because of how the partnership is working internally or because of the changing

external context. For example, if there is difficulty in attending, the original expectations of

the group might not be met; if new policy is introduced in the organisation, the

partnership will have to re-think their contribution.

• Establish a review mechanism, for example, after every second meeting, or after

certain milestones are achieved.

• Rotate responsibility for review amongst partners.

• Consider review and revision of expectations as a strength and not a weakness as it

will contribute to a relevant and meaningful set of outcomes in the longer term.

• Take stock regularly as a means to recognising the achievements to date and to

ensuring early identification of obstacles that need to be overcome.

This prevents raising hopes of change that are not followed through.

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• Engage in an action-reflection-action cycle to keep forward movement.

The partnership is subjecting itself to audit or is self governing when it is monitoring

its own performance against initial targets for performance.

• Actively seek input from all partners.

This may be achieved in regular meetings and by convening extra meetings.

3.6 References1. Pat Deegan, “The independent living movement and people with psychiatric

disabilities: taking back control over our own lives”, British Journal of Therapy and

Rehabilitation, 9/2 (1992): 52-55.

2. M.K. Smith, “Empowerment evaluation: theoretical and methodological

considerations”, Evaluation and programme Planning, 21(1998): 255-261.

3. W. El Ansari and colleagues, “Narrowing the gap between academic professional

wisdom and community lay knowledge: perceptions from partnerships”, Public Health,

116 (2002): 151-159.

4. “Shared Vision”, Mental Health Today, November (2004): 18-19.

5. J. Cahill, “Patient participation: a concept analysis”, Journal of Advanced Nursing,

24/3 (1996): 561-571.

6. J. Pivik and colleagues, “A consumer involvement model for health technology

assessment in Canada”, Health Policy, 69/2 (2004): 253-268.

7. D.M. Lindhorst and A. Eckert, “Involving people with severe mental illness in

evaluation and performance improvement”, Evaluation and the Health Professions,

25/3 (2002): 284-301.

8. R. Bowl, “Involving service users in mental health services: social services

departments and the national health service and community care act 1990”,

Journal of Mental Health, 5/3 (1996): 287-303.

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9. J. Turner-Crowson and J. Wallcraft, “The recovery vision for mental health services

and research: A British perspective”, Psychiatric Rehabilitation Journal, 25/3

(2002): 245.

10. R.J. Minett, (2002) “User participation in mental health care: a literature review”,

British Journal of Therapy and Rehabilitation, 9/2 (2002): 52-55.

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4. Training Materials

33

4. Training MaterialsThe purpose of this section of the Guide is to enable people who are thinking about

working within a strategic partnership with people with experience of mental health

difficulties to get started. This self-directed learning will provide you with some of the

foundations required to build successful and longstanding partnerships. The exercises

are tailored to both individual and group learning and can be undertaken by people from

different backgrounds and learning abilities. Each of the exercises relates to a part of the

Guide and we recommend that you have a look at each section before starting the

associated exercise. Additional pointers and some answers can be found in Section 4.2.

However, for some exercises there are no right or wrong answers as the exercises are

designed to encourage the individual or group to think about what partnerships mean to

their particular situation. We hope that you enjoy working through the ten exercises

shown below.

4.1 Training exercises

4.1.1 Understanding strategic partnerships

(For this exercise we suggest you read the ‘Defining partnership, strategic partnership,

strategic partnership with people who experience mental health difficulties and advocacy’

section of the Guide pages 11-12).

Task: Think of a partnership that, in your experience, works well. It might be a

relationship in an organisation that you are connected with or a relationship in your family

or social network.

Write down what you think are the important features of the partnership. Compare your

ideas to those set out in the Guide and the descriptions of partnerships in Section 4.2.1.

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4.1.2 Making a case

(For this exercise we suggest you look at the ‘Win hearts and minds’ section of the Guide

page 16)

Task: Put together an argument for introducing Strategic Partnerships within your

organisation. If you are working in a group you each might like to present your

ideas to the group. Then turn to Section 4.2.2 to find more reasons for strategic

partnership working.

4.1.3 Partners 1

(For exercises 4.1.3 and 4.1.4 we suggest you look at the ‘Identifying partners’ section of

the Guide page 17)

Task: Ask yourself or ask within the group the following 4 questions:

• Who is to be a partner?

• Why they are to be included?

• What is the potential contribution that they will make?

• How can they communicate with others to ensure they represent the broader

reference group?

It is important to have positive attitudes in relation to involving people with experience of

mental health difficulties as partners. Section 4.2.3 gives a report of some relevant research.

4.1.4 Partners 2

Task: Design a letter to invite people to take part in the first Strategic Partnership meeting.

Have a go at writing your own letter before looking at the example in Section 4.2.4.

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4.1.5 The initial strategic partnership meeting

(It is important here that you read the section in the Guide on Building the foundations of

the partnership, page 18, before you undertake this exercise).

Task: Imagine you are preparing for the first strategic partnership meeting. Write a list of

items that you think should appear on the agenda.

Look at Section 4.2.5 once you have done this to see if there is anything else you might

have included.

4.1.6 Building blocks

(To enable you to think about the task below first read the ‘Building foundations for the

partnership’ section of the Guide on page 18)

Task: Think about or share imaginative ways that individuals in a new Strategic

Partnership Group might get to know one another? Draw on your experiences of training,

social events or meetings.

You will find some ideas in Section 4.2.6.

4.1.7 Sharing

(You will need to read the section entitled ‘Establishing shared vision, purpose and

ownership’ on page 19 before you try this task).

Task: Make a list of the processes through which a partnership might arrive at shared

vision, purpose and ownership.

Some additional ideas on how you might do this will be found in Section 4.2.7.

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4.1.8 Different and equal

(It is important here that you read the section in the Guide on Recognising diversity and

equality, page 21, before you undertake this exercise).

Question: Strategic partnerships benefit from bringing together people who have

had different life experiences. Different views allow others to see different aspects of

the whole picture. How can you make sure that all views have equal value and are

equally valuable?

Try this exercise:

Take ‘medication’ as your topic.

There are some ground rules. You must listen carefully to each person’s point. You may

not interrupt or disagree. Each person may only make one point.

• If you are working within a group to do this exercise

Each person in turn is to offer one thing they know about medication. It can be

anything at all.

Someone needs to write down all the ‘snippets’ of knowledge to form a pool of

information known about medication held by the whole group collectively.

• If you are working independently on these exercises

Try to generate pieces of information about medication as if they came from

the perspective of another. For example, what would a nurse, doctor, member

of the public or a person who has experienced mental health problems say

about medication?

Turn to Section 4.2.8 for a further exercise.

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4.1.9 The process of partnerships

(We suggest you read ‘Keeping going: attend to process’ in the Guide pages 25-31 now).

Task: Think about what particular needs you might have in order to engage in a strategic

partnership. What might help meet your needs? If you are working in a group, explore

expertise within the group that might be helpful.

Refer to Section 4.2.9 for an example of how needs were attended to in a real strategic

partnership.

4.1.10 How strategic partnerships have worked for others

Task: Take time to read and discuss the first hand accounts of setting up and being

involved in strategic partnerships in Section 4.2.10. Look for similarities and differences

between the testimonial accounts and your experiences of partnerships to date.

4.2 Training exercise pointers

This section of the Guide will provide you with extra information and answers to the

training exercises in Section 4.1.

4.2.1 Defining strategic partnerships

Definitions of partnerships:

Partnership is a voluntary collaborative agreement between two or more parties in which

all participants agree to work together to achieve a common purpose or undertake a

specific task and to share risks, responsibilities, resources, competencies and benefits.

Marriage is not a ritual or an end. It is a long, intricate, intimate dance together and

nothing matters more than your own sense of balance and your choice of partner.

Amy Bloom, author.

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4.2.2 Evidence to help win hearts and minds

Below are some arguments for working within Strategic Partnerships.

1. “It is increasingly important that consumers be involved both in the planning and

delivery of services.” Dr Dermot Walsh, Inspector of Mental Hospitals, Ireland.

2. A paper published by the Office for Health Management, Ireland in 2002 describes

different levels and qualities of partnerships in relation to patients and the public.

3. The lay public are ‘knowledgeable partners in health-care’ (Allen 2000).

4. The UK NHS and Community Care Act of 1990 emphasised the involvement of the

service-user as an essential component of healthcare philosophy (Anthony and

Crawford 2000).

5. Citizen involvement allows governments to share the blame and pain in the rationing

debate (Pivik and colleagues 2004).

6. Individuals have the right to participate in services that impact upon them and in turn

this involvement impacts on communities by promoting healthier behaviours,

increased education and support (Pivik and colleagues 2004).

7. With the increasing importance attributed to evidence based practice service-user

involvement is an essential element in any service (Anthony and Crawford 2000).

8. Partnerships or collaborations with communities have emerged as a form of

resistance to various forms of oppression including economic, cultural, gender and

sexual (El Ansari and Phillips 2001).

9. The views and decisions of service-users are powerful and add credit and worth to

any service, influencing both professional staff and management and can be an

invaluable asset in enabling change (Ainsworth 2003).

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10. (Linhorst and Eckert (2002) and O’Donnell and Entwistle (2004) suggest:

It should be a matter of principal and an ethical requirement in the philosophy of

partnership working that the service user, as a major stakeholder in the success of

any intervention, should be evaluating it from an experiential view point as only they

know what it is like to live with a particular health condition.

Service-users might highlight areas of importance to them thus influencing policy

development which professionals and others have not considered at all or thought to

be of low priority.

Understanding between stakeholders can be greatly improved as each acknowledges

the role of the other thus increasing quality in the service delivery. Professionals in

particular will be made more aware of how their work might improve the lives of

people with a particular health condition.

11. The very act of being involved is of huge benefit to the individual service-users in

terms of increased self-esteem, development of new skills, increasing motivation,

possible financial gain if they are to be paid as equal members of the team.

Involvement may break down barriers and reduce the fear of contacting and using

mental health services (Pathways Report 2002).

12. Services are delivered to the public and are paid for by the public and therefore it is

only proper that the public influence the agenda and have a say in the processes.

Partnership working gives greater transparency to service delivery and makes them

more accountable to the community they are being provided for (O’Donnell and

Entwistle 2004).

4.2.3 Engaging appropriate partners 1

In a study conducted by Alison Summers in 2003 in the UK, psychiatrists were found to

cluster in 3 groups in relation to their attitudes to people with mental health difficulties

as partners:

• Optimists thought that users and professionals have different but equally important

perspectives, neither of which should take precedence,

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“I think that in practice professionals do often prevail but that is not necessarily always

how it should be.”

They stated that success requires that users’ views are properly attended to through

flexible systems and that service user involvement is useful in and of itself, irrespective of

the outcome.

• Rationalists though service user involvement was helpful if it provided a specific and

limited contribution, in particular as a source of information to improve services. They

wanted to retain the last word on decisions because of their greater accountability

and greater knowledge and expertise:

“I think that it is good to hear users’ voices but that shouldn’t absolve health authorities

however from making the right decisions rather than the most popular decisions.”

Some suggested that user input be limited to specific topics like ward environment,

to general tasks rather than detailed planning. Most worryingly, the rationalists

thought that service users should not be involved in formulating ideas from scratch or

strategic planning.

“…it was suggested that users could interview staff, that was going too far. I have always

resisted user involvement at directorate level. I don’t suppose that users have to be at

every level.”

“…I think sometimes that people think that the psychiatric services should be entirely led

by what users want and anybody who says anything against that is anti-user.”

• Sceptics thought that service user involvement is unnecessary, even irrelevant to the

process of service development. They had even more extreme and cynical attitudes

than the rationalists in relation to user involvement:

“I don’t think it will be of any benefit to anybody. I really don’t think it will make much of

a difference.”

“…you see most of us are cynical, it’s just another game by the politicians.”

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4.2.4 Engaging appropriate partners 2

Invitations to participate should be carefully worded, and be non-threatening or

demanding. An example of a letter that can be adapted for your own situation is

given below.

Dear

My organisation is supporting the development of a strategic partnership between

people who have experience of mental health difficulties, carers, professionals,

managers, and service user groups. The partnership is being formed in relation to ...

I have taken on the role of inviting people who have an interest and expertise

in the area to join the partnership. However, once the first meeting is convened we

will be able to talk about how we might share responsibility for organisation.

At the beginning of the meeting sequence we can concentrate on the foundations

that the partnership will need to put in place in order to work well together, for

example, our shared aims and goals and terms of reference. There will be room on

the agenda to add items that participants think are important. Different partners may

have different support needs in order to function well, and we will spend some time

making sure that every partner has access to the resources they need, including

appropriate payment for their time. On the day, there will be information about how

strategic partnerships are set up and run made available and, if necessary, training

will offered to partners.

The initial meeting is scheduled for (DATE) and will take place in the Community

Centre at (TIME). This venue is central for most people. However, we can revisit

where to hold further meetings on the day. 3 hours are set aside for the meeting and

refreshments will be provided. We will have time to get to know one another, although

some people may not be able to stay throughout. Someone will be available to help

with expenses claims in order that they are dealt with promptly.

I do hope very much that you will be able to attend and join the partnership.

Kind regards

Ruth Johnson (Ruth Johnson)

Acting partnership convener

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4.2.5 Organising the initial strategic partnership meeting

Here is a list of potential items for discussion:

• Introductions – personal narratives

• Getting here – travel arrangements and expenses

• Venue – suitability/alternatives

• Payment for contribution

• Meeting schedule agreed

• Discussion of partners’ initial needs and ways to meet these needs

• Information about strategic partnerships, including where external expertise can

be found

• Rotation of tasks

• Shared vision, shared purpose

• Terms of reference for the group built up from discussion on shared vision

and purpose

4.2.6 Strengthening the foundations for the partnership

All too often at meetings where people may not know each other, each person is called,

in turn to say who they are and what they do. Introductions in this way further define the

boundaries that exist between people who experience mental health difficulties and

various health care professionals. An introductory exercise needs to prevent group

participants falling back into defining themselves through their professional role or

health status.

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For example, try the following instead;

Ask each person to say their name (or name they like to be called) and then say one

thing about their self that people may not know.

“I like to be called Ruth. One thing that not many people know about me is that I have 4

Grandchildren”.

Marooned – ask members of the group to think of one item they would have brought with

them if they had known that they might be marooned on a desert island. Write the items

on a flip chart and ask people to justify their choice. This activity helps the group learn

about each other’s values and problem solving styles and promotes teamwork.

4.2.7 Working out shared vision, purpose and ownership

You might employ well recognised techniques such as brainstorming or imagining, in

great detail, what an ideal partnership might look like. Another useful method is to ask

each person to offer a two or three words that summarise why they want to be involved in

the strategic partnership, for example, service user rights, affecting policy, inspiring hope,

changing practice, passion for equality. Write the words on a flip chart or paper. Go

around the group until no new words are offered. Distribute copies of the list to partners.

4.2.8 Diversity and equality of points of view

If you are undertaking these exercises as you are about to embark on a strategic

partnership, you might now like to try the same exercise using a topic that will be of

importance to the partnership.

4.2.9 Partnership process

I was employed by a vocational training service for people with disabilities called Rehab.

I was a Project Manager for an EU-funded project that delivered advocacy training to

people with mental health difficulties. Following completion of the training course, a user’s

advocacy group was formed and it entered into a strategic partnership with my employer.

The organisation I worked for provided practical and financial support to the user’s group

over a period of two years. It was a very useful learning experience but was dogged by

many difficulties. I certainly learned a lot during the process. The strategic partnership

ended after two years and the advocacy group survived independently for about a year

after that. However it eventually disbanded.

(MS DEIRDRE DE BURCA, ex REHAB, Green Party)

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4.2.10 First hand testimonials

1 Our experience in establishing Clubhouse services in EVE Limited has been a major

learning curve in the area of building strategic partnerships. As a developmental

process, it highlighted the multi-dimensional and multi-levelled nature of partnership

one had to achieve systemically to ensure the model had the optimum chance

for success.

In our instance, we had to engage in strategic partnerships with six key stakeholders

to facilitate organisational change, the member of the club (the service user), the

staff, the social partners (unions), the management team, the board of directors and

the funders. The co-operation and consensus of all was essential for the service

model to have any opportunity for success. Considerable effort and energy was

expended building the trust, sharing the vision of Clubhouse and growing the

partnership in this instance. And this partnership continues to evolve.

Critical in our experience was building in an honesty factor about the reality of

“risk-taking” and the permission to “make mistakes”. By acknowledging the learning

curve of all partners, one built in the opportunity to look at mistakes as key learning

moments and build upon them. It was essential to create this space in the partnership

so that the vision could grow.

We are now about to open our fourth club and are facing new challenges in

maintaining the integrity of the partnership. As we have grown, we have become

conscious of the need to build in self-reflective processes both locally and

organisationally to ensure the integrity of the partnership and the decision-making

process remains true to the model. Partnership is a way of working together which

needs to embed in one’s organisational process. There is no quick-fix!!!

(DR MARGARET WEBB, EVE)

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2 I was involved with a project which became known as the Pathways project. This was

a service user-led piece of research which explored the experiences of users of

Mental Health Services in Galway city. When I became involved in this project I’d been

using the mental health services for over 10 years and had lost faith in myself and

hope in my ability to find meaningful employment again. But this project involving

working with professionals who listened, respected and believed in me and the other

team members, and this support, as well as the affirmation of the other team

members, allowed me rediscover skills and abilities that I’d lost touch with over the

demoralising years of contact with the mental health services. The experience of

working with this project gave me the confidence to apply for and secure meaningful

work at a professional level again.

This project came about because a professional working within West Galway MHS

believed it was important to consult service users about the kind of service they

needed. She secured funding from the service administrator, sought support from the

area development officer working at that time with Schizophrenia Ireland, and another

Occupational Therapy colleague, and got a team of service users involved too. This

project involved strategic partnerships between the statutory mental health service, a

voluntary group, and service users. It was a liberating and empowering, indeed

ultimately life changing, process for me.

(MS LIZ BROSNAN, PATHWAYS PROJECT)

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3 Rehab Group was involved in a Horizon funded project designed to establish an

organisation that represented the views of mental health service users. The project

titled NEART (meaning strength in Irish) was focused upon developing a partnership

with people with mental health difficulties rather than an established representative

organisation.

Interested people with mental health difficulties were invited to a public meeting to

discuss the issue of mental health and service user representation. After the meeting

people were invited to volunteer to join the project. Over 30 people agreed to

participate in an initial phase of capacity building and awareness raising. After a three

month phase of development, twelve individuals opted into a more intense process of

development that included awareness raising, the building of administrative and

organisational skills, advertising and marketing, the development of a formal

organisational structure and charter and an organisational development plan. The

participants chose a name ‘Making Minds Matter’, and an image for the organisation.

Two facilitators were allocated to the project on a part-time basis, both of whom came

from a psychological background.

The organisation operated for a number of years and held several public seminars

with invited speakers. They also carried out a Participant Action Research project into

‘the revolving door’. The organisation attempted to gain mainstreaming resources from

a number of agencies including the Eastern Regional Health Authority and some

charitable donors. Several submissions were made but were unsuccessful. The

Rehab Group continued to provide logistical and practical support to the organisation

until they decided to voluntarily cease operations. At this point the files and research

information generated by the organisation were handed over to the Irish Advocacy

Network, which had developed and grown substantially since the initiation of the

NEART project.

(DR DONAL McANANEY, REHAB GROUP)

47


References and furtherreading

Ainsworth, D. (2003) Patient Involvement – The Derby Theatre Project Experience.

British Journal of Perioperative Nursing, 13 (12): 519-521.

Allen, D. (2000) ‘I’ll tell you what suits me best if you don’t mind me saying’: ‘lay

participation’ in health care. Nursing Inquiry, 7: 182-190.

Anthony, P. and Crawford, P. (2000) Service user involvement in care planning: the mental

health nurse’s perspective. Journal of Psychiatric and Mental Health Nursing, 7: 425-434.

Deegan, P.E. (1992) The independent living movement and people with psychiatric

disabilities: taking back control over our own lives. British Journal of Therapy and

Rehabilitation, 9(2): 52-55.

El Ansari, W. and Phillips, C.J. (2001) Interprofessional collaboration: a stakeholder

approach to evaluation of voluntary participation in community partnerships. Journal of

Interprofessional Care, 15(4): 351-368.

Linhorst, D.M. and Eckert, A. (2002) Involving people with severe mental illness in

evaluation and performance improvement. Evaluation and the Health Professions,

25(3): 284-301.

O’Donnell, M. and Entwistle, V. (2004) Consumer involvement in research projects: the

activities of research funders. Health Policy, 69(2): 229-238.

Pathways Report (2002) Experiences of the East Galway Mental Health Services from

Service Users’ perspectives. The Western Health Board, Schizophrenia Ireland.

Pivik, J., Rode, E. and Ward, C. (2004) A consumer involvement model for health

technology assessment in Canada. Health Policy, 69(2): 253-268.

Summers, A. (2003) Involving users in the development of mental health services:

A study of psychiatrists’ views. Journal of Mental Health, 12(2): 161-174.

Office for Health Management (2002) Public and patient participation in healthcare:

A discussion paper for the Irish health services.

www.officeforhealthmanagement.ie

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FeedbackThe National Disability Authority seeks to promote best practice in all its activities. The

Good Practice Guide will benefit from ongoing evaluation and refinement so that it meets

tomorrow’s needs as well as current ones. Thus, people already engaged in strategic

partnerships might reflect on the contents in relation to their ideas about the future

development of partnership working and suggest different or additional content for the

Guide. We would appreciate it if you, irrespective of how you are using the Guide,

would take some time to tell us of your experience of the Guide by answering the

questions below.

1. How often have you used the Guide in the last year?

2. Which sections of the Guide have you used?

3. Please could you briefly describe the situation in which the Guide was used?

4. What did you find most helpful about the Guide and its contents?

5. Please could you give us any suggestions you may have for improving future

editions of the Guide?

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6. What other resources would be useful to include in this document?

7. Please could you also give the following information?

Name

Organisation

Position

Date

THANK YOU

Please copy and return these pages to:


25 Clyde Road, Ballsbridge, Dublin 4

Tel/Minicom: 01 608 0400

Fax: 01 660 9935

Web: www.nda.ie

email: [email protected]

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25 Clyde Road, Dublin 4. Tel: 01 608 0400 Fax: 01 660 9935 Email: [email protected]

www.nda.ie

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