Recovering Ordinary Lives: the strategy for occupational therapy in mental health services 2007-2017 Impact, Progress and Next steps Genevieve Smyth September 2014

Introduction

• Review of

Recovering Ordinary Lives: impact

, progress, next steps –collecting OT views • What did OTs tell me?

Impact of the document What OTs are proud of Challenges for the profession Focus for the future COT work plan

Review of

Recovering Ordinary Lives

Three questions posed to the OT community: • What impact has commissioners?

Recovering Ordinary Lives

had for practitioners, managers, academics, COT and • What progress has been made towards the aims and key messages in the document?

• What might next steps look like?

Review of

Recovering Ordinary Lives

BAOT members gave their views via: • COT conference 2013 • Four network meetings, one in each of the four UK countries • Meeting of the original Steering group • From COT Specialist Section- Mental Health • Mental health email network • OTN and the website • Comments from about 150 people • Service user and commissioner also approached for views

Impact of

Recovering Ordinary Lives

for OTs

• Formalised professional values in relation to our unique contribution and promoted value of OT and meaningful activity • Gave definition and helped refocus identity and direction • Chance to agree a common language across mental health • Helped OTs increase strategic input across organisations • Used as framework to inform and develop OT services • Led to increased use of outcomes measures • Audit tool used in supervision • Students used to guide case studies • Encouraged dissemination of best practice

Impact of

Recovering Ordinary Lives

for others

• Provided a framework for marketing OT and increasing understanding • Local events held to promote the documents –inviting service users, service directors, charities, third sector • Given to students from other disciplines • Copies sent to people in national positions • Authorised explanation of OT role useful to bring to discussions with managers and commissioners • Increased the recognition of the value of activity and occupation particularly around employment

What OTs are proud of

• Involvement in Recovery, Implementing Recovery through Organisational Change (IMROC) development of Recovery Colleges, co-production • Recovery coaching, sharing staffs experience of mental illness to enhance Recovery culture • Use of Wellness Recovery Action Planning • Movement into third sector particularly vocational services • Vocational champions, using Individual Placement Support • Offering early intervention for vocational outcomes • Trust repatriation schemes, influencing build of new environments • Embedding Payment by Results care packages • Increasing numbers of OT consultants

New posts/roles

• Prisons • Primary care and public health • Autistic Spectrum Disorders, CAMHs, eating disorders • Condition Management • Early intervention for dementia, memory clinics • Care homes • Bariatric services • RAID – psychiatric liaison in acute physical hospitals • Drop in crisis and duty • Expert witness • Best Interest Assessors (Mental Capacity Act) • Approved Mental Health Professionals (Mental Health Act)

“

We are extending our scope of practice across a range of agencies by being the experts in occupation but not having to totally own it”

(COT Conference session 2013)

Challenges for the Profession

• Evidence base – lack of OT randomised controlled trials, allows other professions to dominate, means OT does not get into NICE guidelines although OT components recognised such as ADLs, employment, professions lacks understanding of quantitative research, less links between what academics research and practice • Lack of recognition/support – at higher levels in organisations and for Recovery orientated ideas, for moving into new areas of practice, many Recovery Colleges led by OTs and this is not recognised, promoting understanding of OT to multiagencies is tricky, commissioners recognise value of occupation but not OT, commissioners are hard to access, hard to know how to influence them, they don’t want detail –only broad brush strokes

Challenges for the Profession

• Dominance of medical model – leading to restrictive emphasis on risk management, OT posts integrated with other roles and responsibilities, generic duties increasing, demand for case managers and crisis practitioners, delivery of psychological interventions, need to fight for the OT specific role • Cost improvements – leading to loss/conversion of OT posts, OT replaced by cheaper support workers, services going out to tender to voluntary sector, range of people offering activity, higher banded posts lost, OT managers are not budget holders

“

The OT message is getting lost in translation”

(Email correspondence 2013)

Focus for the Future

• Evidence base – more training in EBP, literature searching, NICE, writing for publication, expanding evidence base will give us the authority to say “

We do this best”

, need to prioritise clinical and cost effectiveness, manualised interventions, value of quantitative research must be reinforced with students, need to map research capacity to support partnership • Marketing and influence – need to promote OT but not be too protective of the role as all professionals need to incorporate OT as away of life, sell ourselves more, get involved in local projects/groups, political lobbying, collaborations, into the media, speak as AHPs to have more influence

Focus for the Future

• Recovery – involve service users in coproduction, design , delivery and evaluation, Recovery focused language, collect Recovery stories that show importance of occupation • Prepare for future employment – not in the statutory sector, increase awareness of how to make this move, network more outside statutory services, support people so they can confidently retain their OT identity keeping OT supervisors and mentors. Also preparing by making better use of technological solutions and moving to seven day services, increasing our involvement in informatics, promoting our role in community development and tackling the social determinants of health

Focus for the Future

• New OT models/theories – needed to support working in new ways, match extended scope with extended theories, look at work from South America and Africa where OTs work in a more entrepreneurial and community oriented spirit, need more debate about new ideas and theories

“

Times are changing –we need to change also”

(Recovering Ordinary Lives Steering group 2013)

Service user comments “

I'm delighted that the vital importance of appropriate activity and occupation in motivating and maintaining personal recovery and actualisation is being championed so vehemently and articulately by OTs. I think this gives hope to mental health services users everywhere”

(Service user correspondence 2014)

Commissioner comments “

You need to provide evidence based outcomes to show you are increasing quality and decreasing costs. I don't mind how you do this or what particular tools you use but all I really want to see is how you improve quality and save money”

(Commissioner conversation 2014)

COT Work plan 2015-2017

• Expanding the evidence base, promoting opportunities for research and training particularly studies that consider clinical and cost effectiveness. Mapping research capacity to promote research partnerships.

• Market and promote OT role in mental health and Recovery and support OTs to do this locally. Profile increased through political lobbying and media.

• Collect case studies and service user narratives which show value of OT in Recovery.

• Disseminate examples of OTs use of technology and involvement in informatics • Dissemination of examples of OTs contribution to community development and the social determinants of health • Supporting OTs moving into new forms of employment with diverse providers

COT Work plan 2015-2017

• Work plan agreed with COT Specialist Section –Mental Health and all four COT Country Boards - published in September OTN 2014 pages 22 and 23 • Next question –how to deliver these objectives!

Evidence base Marketing and promotion Technology and informatics Community development and social determinants New forms of employment • Views? What can you offer to help?

Summary

OTs views about: Impact of the document What OTs are proud of Challenges for the profession Focus for the future Priorities for next steps COT work plan [email protected]

0207 450 5220