Recovery Communities of Practice: An Innovative Strategy for Mental Health System Transformation

Membership is open, and participants can join or leave the CoP at any time. Any person or organization expressing an interest in the CoP’s mission and objectives is welcome. To promote constructive dialogue, all members are asked to leave corporate issues aside to allow for expression of diverse experiences and opinions. Members include 38 participants from a variety of community and public organizations, including service users, practitioners, family members, agency administrators, and researchers. On average, 18 participants attend monthly meetings and participate on special committees. CoP meetings are conducted face to face, although videoconferencing is available for those in other sites in the province of Quebec. A voluntary executive committee of five CoP members facilitates decision making and planning between meetings.

At monthly meetings, the focus is on knowledge translation and sharing local recovery practices. The innovative work of CoP members, or recovery champions, is showcased. Several methods are used to engage CoP members: literature is e-mailed before the meeting, members are invited to present their area of expertise or experience, and outside experts are invited. An array of topics is discussed, such as risk management and shared risk taking; quality of services and recovery measures; role of peers in clinical and organizational decisions; shared decision making; and hiring peers. As members learn about the various recovery initiatives, they are motivated to translate knowledge gleaned from meetings into their local contexts.

The CoP also discusses broader-based transformational strategies: creating a recovery college; providing recovery training for physicians, administrators, service providers, and service users; introducing recovery “change agents” within organizations; replacing intervention plans with recovery plans; recognizing peer-support workers in public organizations; and advocating for a long-term plan to implement recovery into services.

Since 2012, the CoP has met some of its initial objectives. It created a neutral space where people from different professional affiliations and personal identities now meet and develop a culture of collaboration. It has achieved significant recognition on the political front and has influenced decision-making bodies. Staff from the Ministry of Health have attended several CoP meetings to better understand the CoP’s work and focus. The CoP participated in provincial consultations, advocating for recovery to be designated as a priority in the new Quebec Mental Health Action Plan. Such efforts have been successful: the provision of recovery-oriented services is the primary focus of the 2015–2020 plan.

The CoP has also been successful in sharing and transferring knowledge. It played an important role in the 2014 Annual Provincial Mental Health Conference. The CoP led a keynote presentation and panel discussions about recovery, an event that validated the CoP’s leadership role in knowledge dissemination in this area. Subsequently, the CoP was invited to be on the organizing committee for next year’s conference, thus increasing its capacity to influence the public agenda and promote the uptake of recovery-oriented practices. Although CoP members have initiated numerous discussions on quality improvement and implementing evidence practices, there is no hard evidence that these activities are taking place in CoP member organizations.

Sustaining the CoP is not without challenges. Maintaining participant engagement is challenging, because some members are primarily interested in recovery-oriented practices, whereas others expect the discussions to address system aspects of such care. Efforts must be taken to balance meeting agendas. In addition, working collaboratively in a context of scarce resources and “silos” is a source of tension. Corporate rivalries emerged when some members believed that their organizations might incur budget cutbacks as the CoP was gaining prominence. Concrete efforts were taken to prevent members from feeling threatened. It was important to consistently remind members about their shared passion and beliefs in order to dismantle corporate rivalry and promote group cohesion. In addition, transcending corporate agendas to achieve collective action and to function as a cohesive entity has been challenging. Some members felt disloyal to their organizations when the CoP advocated for issues that were seen as inconsistent with their employer’s orientations. For example, some members were uncomfortable with the CoP’s lobbying of the Ministry of Health. Unable to reach consensus on this issue, the CoP encouraged individual members to support specific actions simply as individual citizens.

Questions related to the CoP’s structure and leadership have been the object of recurrent discussions. Under whose jurisdiction will the CoP evolve? Should the group be led by a specific organization? Should the government financially support the CoP? Until now, the CoP has chosen to remain independent. However, governance issues will need to be resolved if the CoP is to flourish. Not being affiliated with any organization means that the CoP functions without a budget. Coordination of activities is assumed on a voluntary basis. The lack of funding limits the CoP’s potential to expand its membership across the province. Solutions are needed to support sustainability of the CoP’s activities.

Looking ahead, the goal of the CoP is to consolidate its efforts and pursue its mission to promote implementation of recovery-oriented care in Quebec. The CoP envisions developing a network of smaller and more locally based recovery CoPs dispersed throughout the province, inspiring others to build their own entities. The Quebec Recovery CoP was recently invited by the Mental Health Commission of Canada to present its work to a pan-Canadian group of stakeholders from the mental health sector. That the CoP is serving as a model for others to develop their own CoPs to promote recovery-oriented practices is evidence of the potential of recovery CoPs to bring about system transformation from the bottom up.