Recovery Focused Practice

Agnes Higgins PhD School of Nursing and Midwifery Trinity College Dublin Individual Care Planning: Enabling the Paradigm Shift to Recovery Focused Care - Lessons from the National Mental Health Services Collaborative Burlington Hotel 7 th February 2012

Recovery

2006 Recovery 1 of the16 guiding principles 2005 Recovery discussion paper 2007 Recovery focussed approach is a standard 2008 Recovery Framework

Recovery Perennials

• • • • • • • • • • Active process Individual and unique process Gradual process Non- linear process Trial and error process Life changing Stages or phases Can occur without professional help Aided by supportive healing environment Journey of discovery Leamy , M et al (2011) Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis BJPsych 199:445-452

Journey of discovery

• Discovery – Identity – Voice – Hope – Belief – Meaning – Belonging – Strengths – Personal control/agency –

Life long journey

Recovery

• Process/journey that person experiences • Philosophy/Approach to care and service provision

Recovery: approach to care

• ‘Recovery offers a transformational ideology for services and suggests reform in illness’ is

how understood

and managed, as well as in people living with mental illness are understood and helped. This guiding philosophy challenges ideas and beliefs and treatment of ‘mental illness’, including the way in which mental health practice and implemented

how

‘mental about the etiology is organised to ensure that people living with ‘mental illness’ lead meaningful and productive lives.’ – Boutillier et al (2011) What does recovery mean in practice? A qualitative analysis of International recovery oriented practice guidance psychiatric services 62(11):1470-1476

Current narrative

Recovery Absence of symptoms Symptoms/Diagnosis Technical interventions/Prognosis Practitioners ‘Symptom spotters’ Professional distancing Risk adverse

Privileging of professional knowledge and bio/psychiatric narrative

Diagnosis ‘Social death sentence’ ‘Master status ’ Disempowering practices ‘Compliance’ ‘’Conformity ’ ‘Control’

Narrative Synthesis of Recovery Processes

Connectedness

• Peer support and

support groups

• Relationships • Support from

others

• Community

Hope and optimism

• Belief in recovery • Motivation to

change

• Hope-inspiring

relationships

• Positive thinking

and valuing success

• Having dreams

and aspirations Identity

• Rebuilding

positive sense of identity

• Overcoming

stigma Meaning

• Meaning in

mental ‘illness experience’

• Spirituality • Meaningful life

and social roles

• Meaningful life

and social goals Empowerment

• Personal

responsibility

• Control over life • Focusing upon

strengths

Leamy , M et al (2011) Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis BJPsych 199:445-452

Recovery focused practice

• • • • More than assimilating into current paradigm More than adopting language of recovery.

A challenge to new ways of thinking and acting An invitation to fresh and new possibilities and new narrative

Recovery Narrative

Social Inclusion

Challenge barriers to recovery Self Services Society

Persons lived experience

Hopes, dreams and wishes

All aspects of persons life Build connectedness

‘ME’ Family Peers Community

Wellness

Recovery plans Advanced directives

Meaning Power

RIGHTS

Collaborative relationships

Giving back power, control, choices shared decision making

Dialogue with our demons

Finding meaning Hope

Existing skills and strengths

Therapeutic risk

Shepherd et al 2008

Hope Agency Opportunity

• •

Insight and Internalised stigma

People who accept that they have mental illness may feel driven to conform to an image of incapacity and worthlessness, becoming more socially withdrawn and adopting a disabled role. As a result, their symptoms may persist and they may become dependent on treatment providers and others. Thus,

insight into one’s illness may be rewarded with poor outcome.

Empowerment of people and helping them reduce their internalised sense of stigma are as important as helping them find insight into their ‘illness’. Until now, however, more effort has been expended on the last than on the former.

– Warner R. (2004).Recovery from Schizophrenia: Psychiatry and Political Economy (3rd edn). Brunner-Routledge,

Recovery: not anti medication

‘The biomedical model and medical treatments may have an important place for some people in their recovery, but as

an invited guest, rather than an overarching paradigm

’

• Higgins, A (2008)

‘My journey of recovery is still ongoing. I still struggle with symptoms, grieve the losses I have sustained…I am also involved in self help and mutual support and I still use professional services including medications, psychotherapy and hospitals. However, I do not just take medications and go to the hospital. I have learned to use medications and to use the hospital. This is the active stance that is the hallmark of the recovery process.’ Deegan, P (1996) Recovery as a journey of the heart Psychiatric Rehabilitation Journal 19, 3 91-97

DREEM: Developing Recovery Enhancing Environment Measure Staff and resident ratings of importance of factors.

(Ridgeway & Press, 2004)

Dinniss S et al. User-led assessment of recovery service using DREEM Psychiatric Bulletin 2007;31:124-127

©2007 by The Royal College of Psychiatrists

Staff and resident ratings of how well recovery factors were achieved/supported by service *P<0.05, **P<0.01, ***P<0.001

.

Dinniss S et al. Psychiatric Bulletin 2007;31:124-127

©2007 by The Royal College of Psychiatrists

Ten key organisational challenges

1. Changing the nature of day-to-day interactions and the quality of experience 2.

Delivering comprehensive, service user-led education and training programmes 3. Establishing a ‘Recovery Education Centre’ to drive the programmes forward 4. Ensuring organisational commitment, creating the ‘culture’ 5. Increasing ‘personalisation’ and choice 6. Changing the way we approach risk assessment and management 7. Redefining service user involvement 8. Transforming the workforce 9. Supporting staff in their recovery journey 10. Increasing opportunities for building a life ‘beyond illness’ – Sainsbury Centre for Mental Health

Pillars of Recovery

A Higgins TCD

Lasting change

Culture Values Professional narrative

Recovery: Thinking Differently

“There are risks and costs to a program of action, but they are far less than, the long-range risks and costs of comfortable inaction” John F. Kennedy