Transcript Well Ways MI Recovery - Mental Illness Fellowship Victoria

Well Ways MI Recovery
a peer designed and peer
facilitated recovery education
program
Cassy Nunan, Julie Anderson, Brendon Clarke
Mental Illness Fellowship Victoria
Neil Thomas, Nuwan Leitan
Swinburne University
Caillin Porter, John Farhall
La Trobe University
Delivery numbers
• 16 partnering organisations also deliver MI
Recovery Australia wide
• 74 facilitators
• Since mid-2009 to the end of 2014, 1046
people have participated in the program.
Context
Well Ways MI Recovery is one of a suite of peer facilitated
programs developed by MI Fellowship including:
‘Building a Future’ for ‘carers’/families
‘Duo’ for ‘carers’/families: about dual diagnosis,
‘BAF Snapshot’
‘Well Ways to Work’
Snapshot MI Recovery is in development.
2006: MI Recovery
research and design
Theory and evidence of the value of Consumer
Delivered Services (Yanos et al. 2001; Solomon 2004)
Evidence and Best Practice approaches about mental
illness management and Recovery (Davidson 2005,
Frese 1993 )
Lived Experience of what conditions and factors assist
recovery (Mead & Copeland 2000)
Consumer movement human rights values.
.
Underpinning conceptual frameworks
 C.H.I.M.E. Recovery Processes: Connectedness, Hope,
Identity, Meaning and Empowerment (Leamy et al 2011)
 Intentional Peer Support (Mead and Hansen 2010)
 Identity, Stigma and rights (Corrigan; Yanos; Solomon)
 The bio-psycho-social model (Engel 1977)
 Stages of Recovery model (Leamy et al 2011)
 Peer facilitation of lived expertise and support: mutual
support and empathy, practical tools, strategies and
skills
Session Content
Introductory Session: a ‘taster’ of the
program, and what to expect.
Week 5- Being prepared for down times;
learning about early warning signs,
developing advance statements.
Week 1- Mental Illness and Recovery
possibilities
Week 6- Communication Skills and
Strategies
Week 2- Recovering a holistic picture of
myself
Week 7- Stigma, Discrimination, Rights and
Advocacy
Week 3- Treating Myself: Doing
enjoyable and healthy activities for
myself that decrease stress and
symptoms
Week 8- Taking steps towards having a
meaningful occupation (work/volunteering
etc)
Week 4 - Planning for Recovery
Week 9- Review of recovery aspirations
and program conclusion
Participant feedback
Comments from participants:
“We get ill but we look after ourselves and we’re part of a group environment that
shares. It keeps me well and thinking straight and I think they appreciate the friendship
as well. We don’t hurt each other, we know what it’s like to be judged.”
“Education, informing myself. Before I just didn’t know any of it and just took everybody
else’s word as ‘it’. Now, before making decisions, I make decisions or make any choices I
research what I’m doing or questioning before making decisions.”
“The respect that comes from the peer facilitators having a shared lived experience.
You’re not just spouting off some theory, you’ve actually lived it and it works.”
“There’s nothing like it that I’ve seen. It’s really strengthened my life. This kind of put
things into place. Put the building blocks or stepping stones into where I was going.”
Baseline-controlled trial
Treatment-as-usual
baseline period
(2 months)
First baseline
assessment
(during info session)
MI Recovery
delivered
(2 months)
Second baseline
assessment
(pre-intervention)
Treatment-as-usual
follow up period
(2 months)
Post-intervention
assessment
Follow-up
assessment
Primary outcome
Empowerment
Empowerment Scale
Secondary outcomes
Internalised stigma
Social connectedness
Mental health symptoms
Internalised Stigma of MI Scale
Friendship Scale
General Health Questionnaire
Participants
Total N
171 participants who enrolled in a program
Gender
Age
111 female, 50 male, (10 missing)
average ??, range ?? to ??
Psychiatric
32% schizophrenia-related, 23% bipolar, 18% depression, 17% other
72% had prior psychiatric hospital admission
Employment
3% employed full-time, 12% part-time, 5% voluntary
81% not working
Education
21% tertiary (commenced or completed)
28% trade/apprenticeship/TAFE (commenced or completed)
13% graduated year 12
23% did not completed year 12
Results
PRIMARY OUTCOME—EMPOWERMENT
1. Was empowerment “level” at baseline before starting MI Recovery?
YES. No change over baseline: t(137) = 0.806, p = .42.
Effect size (Glass’s Δ) = –0.04, 95% CI [–0.15, 0.06]
2. Did empowerment improve after starting MI Recovery?
YES
Empowerment
81
*
*
80
79
78
77
Main effect of time:
F(2,340) = 21.96, p < .001
Effect size: η2 = 0.114
N = 171, conservative test using LOCF
Change from pre to post: p < .001
Change from pre to follow-up: p < .001
76
75
74
Baseline
Post-intervention
Follow-up
Results
PRIMARY AND SECONDARY OUTCOME EFFECT SIZES
0.5
Glass’s Δ
0.4
0.3
0.2
Before MI Recovery,
Empowerment,
Symptoms and
Connectedness all level.
However, a small change
observed on Self-stigma
*
*
*
*
*
*
*
*
Empowerment
*
Self-Stigma
Connectedness
0.1
Symptoms
Significant improvements
found on all four scales
between starting and
completing MI Recovery
0
-0.1
Improvement
during baseline
(N=138)
Improvement
pre to post
(N=112)
Improvement
pre to follow-up
(N=50)
These changes were all
maintained 2 months
after completion.
Each effect size (Glass’s Δ) calculated from mean change in complete data standardised against SD of pre-intervention scores,
positive being in direction of improvement. Pre/post and pre/FU contrasts all p<.001 in both completer and ITT/LOCF analyses
Conclusions
SUMMARY OF FINDINGS
- Participants feel more empowered about their mental health following MI Recovery
- This effect is maintained 2 months later
- There were also beneficial effects on mental health symptoms and connectedness
- Whilst self-stigma also changed, spontaneous improvement might account for this
LIMITATIONS
- Not a randomised controlled design, assessments not blinded
- Diagnosis self-reported without standardised assessment
- Changes in medication and other treatments not assessed
CONCLUSIONS
- The peer-developed peer-facilitated recovery program is feasible
- The trial supports its effectiveness in enhancing key recovery-related domains
Thank you
Cassy Nunan
Project Manager, Peer Workforce Development
MI Fellowship, Australia
[email protected]