Research and Practice
Recovery-oriented professionals are those who have the courage to deal with the complexities and the individuality of the change process, and are able to use their professional skills and expertise in a collaborative partnership with the service user. A recovery-orientation in professionals also involves the willingness and ability to shape services to the needs and preferences of each individual service user.
1. Assessment (Knowing the Person)
Building a relationship, time and space
Personal life story, able and comfortable to tell own story
Personal approach, start of a recovery journey, guiding the user on their journey
Self determination and hope,taking responsibility, to regain responsibility for recovery journey
Belief that the person can recover, self belief
Common attainable goals, joint ownership
What does diagnosis really mean? difference with/without labels, we need no labels in
preventing stigma and discrimination?
What hinders, what fosters recovery in services, organisations?
The user is the expert,not scarred of own emotions, able to deal with emotions
Trusting relationship, mutual understanding,mutual agreement
To find personal strengths and resources for recovery
What makes you survive, resources,allies
Structure and summarize the conversation and jointly put it on paper or whiteboard
Collaborative diagnosis, negotiate about it,mutual agreement
What the psychiatrist can contribute to the recovery journey,pro’s and con’s, easy access, further information, discussion about responsibility of psychiatrist and user
2. Treatment Plan (Recovery Plan)
Giving and sharing knowledge and information of best evidence in recovery practice and resources, tools and instruments
Whole life in all respects, where do you want to be?, hopes and dreams
Self determination to start a recovery journey as key aspect
Involving friends and families, their roles and responsibilities
Choice of treatments/clinical interventions. Giving knowledge
Local whole life resources available, art and culture, sport and leisure, occupation, employment, volunteering,housing, learning and education, welfare benefit advice
Self help opportunities, groups, clubs
Giving and sharing hope by psychiatrist
Physical health checks
Healthy life style plan
Formulation of recovery plan jointly with service user and psychiatrist
3. Review (Celebrating progress and joint ownership of solving set backs)
Celebrating progress and identifying steps taken in the recovery journey
Redefining some goals if necessary, who can help?
Relapse prevention strategy
Understanding the self
Providing more alternatives and choice
Sharing hope again
4. Revised Treatment (Recovery Plan)
Focus on success and strengths
Joint ownership and responsibility
Continued hope and dreams
100 Ways to Support Recovery Rethink, 2013, a practical guide for mental health professionals to work in a recovery-oriented way.
Recovery is for All Hope, Agency and Opportunity in Psychiatry A Position Statement by Consultant Psychiatrists South London and Maudsley NHS Foundation Trust, South West London and St George’s Mental Health NHS Trust December 2010 Recovery focused services are a central component to making our mental health services fit for the twenty-first century. Whilst the concepts of Recovery is not new, as psychiatrists we need to rethink how we work alongside, in partnership with, people who use our services to enable them to get on with life from the point when they first access services.
Recovery is for All Hope, Agency and Opportunity in Psychiatry A Position Statement by Consultant Psychiatrists South London and Maudsley NHS Foundation TrustSouth West London and St George’s Mental Health NHS Trust, December 2010 Recovery focused services are a central component to making our mental health services fit for the twenty-first century. Whilst the concepts of Recovery is not new, as psychiatrists we need to rethink how we work alongside, in partnership with, people who use our services to enable them to get on with life from the point when they first access services. As clinicians we are not abandoning our traditional medical skills of assessment, diagnosis and treatment. However, the challenge for us is to look beyond clinical recovery and to measure effectiveness of treatments and interventions in terms of the impact of these on the goals and outcomes that matter to the individual service user and their family. We need to continually ask ourselves are we helping or hindering a person in their recovery.
Making Recovery A Reality Geoff Shepherd, Jed Boardman & Mike Slade, Sainsbury Centre for Mental Health 2008 For recovery to have the impact it deserves, professionals need to understand what it means and, together with service users and others, actively support its implementation across services.
Research and Practice
Subjectivity and institutions: from Franco Basaglia to recovery Roberto Mezzina Keynote speech at the INTERNATIONAL MEETING “Franco Basaglia’s vision: mental health and complexity of real life. Practice and research”, Trieste, 9-‐12 December, 2014. WHO CC for Research and Training in MH Trieste -‐ Azienda per i Servizi Sanitari n.1 “Triestina” Today, the recovery movement seems to be almost as important for some as it was, a few years ago, the anti-‐institutional movement, although players, methods and philosophies, even the powers involved, appear to be different and completely new. If that were the case, we would really be in the presence of a historical phenomenon and not just a passing trend, or, worse, a fashion. To quote Basaglia, it would not be a mere "change of ideology" from old psychiatric knowledge and powers (Basaglia, 1980), but a true paradigm shift in the field of health and mental health. On the other hand, if what happened in Italy could be seen as an anticipation of these issues – so dramatically topical today -‐, it would be an important test of the topicality of Basaglia’s theoretical-‐practical action and of the anti-‐institutional movement over forty years later. The "recovery" construct was itself a challenge to medical-‐biological reductionism in psychiatry, since it appeared possible, through it, to oppose the active role of the person, the importance of factors associated with his/her concrete existence, his/her empirical givenness, such to influence the course of his/her psychopathological condition not in a mechanistic and extrinsic, hetero-‐ determined way, but through the significance of said factors within the world of an individual subject. Precisely because they are identified with this world, they must be contextualized, and so become founding elements of a reconstruction of subjectivity. The emphasis on factors and determinants that are internal and external to the person, subjective and social, versus naturalistic factors related to the "disease", is combined with the need to obtain answers to a whole set of needs and, simultaneously, to demand rights, in a process that sees the "sick person" as an individual and collective subject, protagonist of change in services, culture and knowledge. The task of today’s psychiatry would therefore seem to be that of refusing to seek a solution to mental illness as a "disease", but working to approach and consider this particular type of patient as a problem that – only because existing in our social reality – may represent one of the contradictory aspects to resolve which new approaches and treatment facilities should be set up and invented. (Basaglia, 1967, p. 420) Basaglia’s statement, therefore, calls into question the issue of the interpretative models of psychiatry and the very concept of disease, which has never been, and clearly is not yet so today, protected from criticism. The issue of paradigms was again revived strongly in the recent international reflection (Bracken, Thomas, Timimi et al. 2012; Priebe, Burns, Craig, 2013; Mezzina, 2005; 2012a). The reductionist neurobiological, "technological", paradigm which is connected to the medicalization of daily life and to the various forms of "biopower" (see Foucault), has re-‐proposed invariances as founding principles of the scientific knowledge within a framework exclusively centered on the positivist vision of the sciences of nature, without taking due account of the crisis of scientific models inspired by the knowledge of complexity (as in the works of Von Forster, Prigogyne, Morin). Psychosocial aspects such as relationships, values and systems of beliefs, different practices are, in this logic, an afterthought if not openly disavowed. The wider definition of bio-‐psycho-‐socio-‐ cultural approach seems to line up these different fields, but while recognizing the interaction, it does not return a meaning to us, in any case. From a theoretical perspective, the criticism of disease models, and particularly of the construct of schizophrenia and its heterogeneity, has now pushed the reliability of this, as well as of psychiatric diagnoses in general, to a critical limit (Bentall, 1990; Boyle, 1994; Buchanan , Carpenter, 1994), and similarly there has been a normalization of experiences such as hearing voices (Romme, Escher, 1989; Coleman, 2011), up to the attempt at reconstructing a meaning in the experience of madness (Geekie, Read, 2009; Read, Mosher, Bentall, 2004; Bentall, 2003); while there has been considerable advancement in the reflection on the limitations of the biomedical model (Rose, 2006; Whitaker, 2010) affected by the creation of a system of expectations, and related economic interests around pharmacological treatments.
Supporting recovery in mental health services: Quality and Outcomes Geoff Shepherd, Jed Boardman, Miles Rinaldi and Glenn Roberts Centre for Mental Health and Mental Health Network, NHS Confederation 2014 The development of mental health services which will support the recovery of those using them, their families, friends and carers is now a central theme in national and international policy (DH/HMG, 2011; Slade, 2009). In order to support these developments we need clear, empirically- informed statements of what constitutes high-quality services and how these will lead to key recovery outcomes. This is what the present paper aims to do.
Recovery-oriented professionals: Helping relationships in mental health services Marit Borg & Kristjana Kristiansen, Journal of Mental Health, October 2004; 13(5): 493 – 505 Traditionally mental health services have been based on the view that health professionals effect changes within a person with psychiatric problems via a range of treatment methods. Service users have had little opportunity to speak for themselves about their view of professional help or about what supports their recovery process. Aim: Explore helping relationships from the perspective of service recipient experiences. Method: Qualitative study based on interviews with 15 service users with lived experience of severe mental illness. Results: Certain common factors about helpful relationships were identified. Service users valued professionals who conveyed hope, shared power, were available when needed, were open regarding the diversity in what helps, and were willing to stretch the boundaries of what is considered the ‘‘professional’’ role. Conclusions: Recovery-oriented professionals were those who had the courage to deal with the complexities and the individuality of the change process, and were able to use their professional skills and expertise in a collaborative partnership with the service user. A recovery-orientation in professionals also involves the willingness and ability to shape services to the needs and preferences of each individual service user.
Recovery Competencies for New Zealand Mental Health Workers Mary O'Hagan (2001) Published by Mental Health Commission, New Zealand This paper presents the recovery competencies developed for New Zealand mental health workers. The paper was developed to provide educators with guidance on the inclusion of 'recovery' content in the courses they run for mental health workers. It includes recovery based competencies that relate to training standards and curricula in New Zealand and provide a large list of resources to support teaching and learning of these recovery competencies.
A Literature Review and Documentary Analysis on Recovery Training in Mental Health Practice by Campbell, J. & Gallagher, R. [AskClyde] (2007) Published by NHS Education for Scotland and Scottish Recovery Network. An international literature review into training throughout the world in mental health recovery. Providing training content, methods, and format. The discussion and conclusion provides a good description on the way forward. Click here
The National Framework for Pre-Registration Mental Health Nurse Programmes in Scotland published by NHS Education for Scotland (2008)This framework sets a foundation for nursing programmes to make strong links with Rights, Relationships and Recovery and the 10 Essential Shared Capabilities in Scotland. Areas focused on includes: developing shared values; health improvement & promotion; the student experience. Click here
Annelle Primm: Transforming the Mental Health Workforce Through Recovery to Practice. Dr. Annelle Primm is the Deputy Medical Director and director of the Office of Diversity and Health Equity for the American Psychiatric Association.
Video produced by the School of Nursing, Midwifery and Physiotherapy. Creative Practice as Mutual Recovery for Mental Health and Well-Being is an innovative £1.5m research project funded for 5 years by AHRC/RCUK Connected Communities. It will investigate how shared creative activity between patients/ service users, informal carers and health, social and education practitioners can advance mutually beneficial social connections and enhance mental health and well-being for all participants.
Moving Recovery from Policy to Practice in NSW - Interview with Helen Glover The NSW Consumer Advisory Group - Mental Health Inc. (NSW CAG) is the independent, statewide organisation representing the views of mental health consumers at a policy level in NSW, working to achieve and support systemic change. NSW CAG's vision is for all mental health consumers to experience fair access to quality services that reflect their needs.