Interview with Pam Rutledge, former Chief Executive Officer, RichmondPRA (Pam Rutledge is now Deputy Commissioner, NSW Mental Health Commission)

PRA and Richmond Fellowship of NSW knew they shared many values when they decided to merge in 2011. Early in the process, Janet Meagher, who was then PRA’s General Manager Inclusion, asked about recovery values and peer work. Richmond Fellowship had started to discuss the issue, but they hadn’t formally embraced peer workers, aside from a small number in their PHAMS program. In contrast PRA already employed peer workers in their community businesses. So Meagher and two other staff with a lived experience worked together on Embracing Inclusion, a policy document about employing people with a lived experience.

‘The merger was not about becoming one or the other, it was about creating something completely new.’

The board adopted the report early in 2013 and, after some debate, the new organisation set two major targets. First, to be an employer of choice for anyone with a lived experience; second, that by 2017, 50% of their workforce would be people with a lived experience, including but not limited to peer workers. (By the end of 2015, they had reached 49 %.) Subsequently, they also decided that anybody using their services could access a peer worker.

On the frontline, RichmondPRA worked to harmonise their workforce, aligning roles, classifications and pay scales. They simplified roles and clarified the skill requirements, strengthening the position description for peer workers. Frontline peer workers have the same job description and the same pay rate as other RichmondPRA mental health workers. But while the core activities are the same, peer workers must purposefully draw on their lived experience as part of their work. Thus the two groups work together but in different ways, which strengthens the organisation’s team work.

Fay Jackson, appointed General Manager Inclusion in 2014, enhanced the development of the peer workforce when she led the development of a major recruitment strategy known as ‘Why Not a Peer Worker?’ Simply put, RichmondPRA asks the question every time they have a vacancy. Tim Fong, General Manager Human Resources, led the resolution of the associated policy and industrial issues.

RichmondPRA has set the bar high for peer workers. A mental health worker with lived experience can become a peer worker, but they have to meet the criteria, undergo an interview and demonstrate that they can use their lived experience purposefully. Not everyone has that skill, says Rutledge, and some may need Certificate IV training.

‘We don’t compromise on the need for people to be quite skilled. It’s not a learning job, or a step up from being a volunteer, it is a serious job with high expectations’.

Currently 30% of frontline staff are peer workers, and RichmondPRA will continue to grow their frontline peer workforce until it reaches at least 50%. And they won’t stop there. They plan to develop other roles for people with a lived experience, and offer a career structure through their organisation. Many of these new roles will come through the rollout of their recovery learning network.

Not everyone in the organisation realised the value of peer work before they saw it in action. Historically, says Rutledge, peer workers were different, ‘kept in a box to do specific things’. But once RichmondPRA employed peer workers as skilled professionals to work alongside mental health workers, attitudes soon changed. ‘I don’t think we’ve got any pockets of any sort of resistance or even delay now, everyone’s champing at the bit more and more’, she says.

‘Peer workers are shining stars. They hold their own with people from other professional backgrounds who are mental health workers and they bring the reality of what we are trying to do into our everyday work and our everyday conversations.’

At an organisational level, embracing peer work has made profound changes. ‘There’s no them and us’, says Pam Rutledge. ‘The value we place on lived experience to inform everything we do is lived out in the workplace every day. It’s all very alive. People need to be careful and respectful and sensitive to their work colleagues and to the people who access our services. It is a different organisational culture that has a richness to it, it’s very nuanced’.

The organisation has defined three vital behaviours that apply to everyone: to encourage each other to use strength-based language; to engage in recovery conversations; and to engage in reflective practice. ‘And that’s stuff we all do, sometimes better than others.’ The mixed nature of the workplace encourages these behaviours, making everyone aware that ‘we’re all on the continuum, we all have our challenges’.

‘It’s not perfect of course, it’s over 600 people all working hard to get it right.’

RichmondPRA is committed to measuring the return on investment. ‘We know we have good returns on helping people to avoid unnecessary hospitalisation, for example, across all our services, and helping people to stay well and connected’. Feedback tells them peer workers have improved client engagement. They know that peer workers offer hope and connection to people who might otherwise be struggling to engage with a service of any kind. But separating a peer ROI is challenging in a mixed workforce.

In Hervey Bay, however, RichmondPRA runs a fully Peer Operated Service (POS) and recently they started looking at its social return on investment (SROI). Whilst the evaluation has not yet concluded, the results to date are excellent, providing evidence of efficiency. Preliminary results suggest that the POS will forecast an SROI ratio of 3.27:1 based on the investment across ten years between 2016–17 and 2025–26. This means stakeholders should expect about $3.27 of social and economic value for every $1 invested.

The fact that POS is fully peer-operated makes it unique in Hervey Bay and attracts people to the service. RichmondPRA discovered many people in consultations who thought being 100% peer-operated was a key driver of its success. People accessing the service found it compelling and motivating to see peers on a pathway to employment, or doing well in jobs. In addition, the success of the POS service has influenced the acceptance and appreciation of peer workers within Wide Bay Mental Health, the community and RichmondPRA.

‘We are starting to develop our own evidence base. For us there is no doubt about the value of someone who can speak from experience and bring hope and is a powerful role model of what a future can look like.’

The organisation is now developing consulting work around their peer work model by leveraging their experience and skills in recruiting and supporting peer workers. One example is employing peer workers in mental health teams. ‘We’re doing that in the Hunter, employing a couple of peer workers who work in the mental health service’, Rutledge says.

But their experience enables them to expand their services too. Currently they a working with a large government department undergoing significant change management, using a peer support model among their staff group. While the massive changes have led to a high number of mental health issues, the focus is not just on mental health peers. They have also organised all staff members to support each other, in a peer-on-peer style.

In Pam Rutledge’s view, Richmond PRA’s experience has created a ‘strong, robust culture and a whole lot of people with a lot of resilience, and absolute commitment to the people they are supporting’. It is, she says, an exciting and fabulous place to work.