Recovery for all


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  • What about the service users and carers, what would they say about where your service was at in terms of compassion, strengths based practice and inclusion etc.
  • AA 12 step recovery programme, published in 1939Psychosocial rehabilitation started in the 1940’s, with social workers in ‘intermediate care facilities’, and the establishment of the first clubhouse – Fountain House in America. Rehabilitation has continued in many forms to this day, and in many countries has collaborated with the recovery movement. The divided self: R.D.Laing – quintessential Anti-psychiatrist. The other main figure = Thomas Szasz, an American who published the Myth of Mental Illness, 1960First Anti-psychotic: Chlorpromazine, discovered by a French physiologist, Laborit – not used widely until the 70’sWater Tower Speech: Enoch Powell – minister of health: phasing out of asylumsItalian Psychiatric Reform: Passed a law making new referrals to psychiatric hospitals illegalThe Disability Rights Movement began in the 60’s, and was initiated into law in 1973 in the US with the Rehabilitation Act, outlawing discrimination
  • In the second half of the twentieth century, with de-institutionalisation underway and patients released into the community, their voices turned to other subjects, including the possibility of recovery. Fuelled by the successes of the disability rights movement, consumers/survivors began speaking out about their experiences, and most importantly about their recovery journey.
  • Anthony’s description of paraplegia: The Reeve Effect = The Recovery Effect: Read recovery description & key themesRecovery involves the development of new meaning andpurpose in one’s life as one grows beyond the catastrophiceffects of psychiatric disability (Anthony, 1993).2. Recovery refers to the. . . real life experience of personsas they accept and overcome the challenge of the disability(Deegan, 1988, p. 15).3. Recovery is a process by which people with psychiatricdisabilities rebuild and further develop important personal,social, environmental, and spiritual connections,and confront the devastating effects of discriminationthrough. . . empowerment (Spaniol & Koehler, 1994,p. 1).
  • Recovery is an accepted concept which is now included in mental health policies around the world.Despite the inclusion in policy, the translation of this to practice is slow. Many believe that they are already working in a ‘recovery orientated’ way. Others are anxious/resistant to change. A belief that recovery focused support needs additional funding is also adding to resistance.
  • Recovery Conference: Visions & VoicesRecovery Policies: Rights, Relationships & Recovery: Mental health nursing reviewDelivering for Mental Health
  • Natalie Goldberg story – of telling your story and listening with illuminationNarratives and lived experienceSelf managementSelf led self help groups and communities such as the hearing voices networksSocial activists
  • Group discussion
  • Most people with problems and difficulties get better without service intervention. Why? How? Could services sometimes even make things worse and unintentionally be a barrier to recovery.
  • Solution focused brief therapy and the role of the miracle as part of a one to one strengths based intervention. Worth looking at our srn discussion paper on strengths based practice and recovery for a description of the miracle question, exceptions and moving from this to an action plan. Also useful to imagine preferred future from other perspectives.
  • Bob Dylan says at 20 a man wants to save the world and at 40 he’s lucky if he can save his salary.
  • Make sure you are there every step of the way.
  • Recovery for all

    1. 1. R Recovery for all
    2. 2. six word short stories ‘He didn't. She did. Big mistake.’ AL Kennedy ‘For sale: baby shoes, never worn’ Ernest Hemmingway ‘A&E IOU’ Toby Litt ‘Womb. Bloom. Groom. Gloom. Rheum. Tomb.’ Blake Morrison ‘Purse found. "No notes," she said.’ Andrew O'Hagan ‘Mother's-milk. Ribena. Tetley's. Chibuku-Shake-Shake. Complan. Morphine.’ Marina Lewycka ‘Defenestrated baby, methamphetamine, prison, rehab, relapse.’ Jeffrey Eugenides
    3. 3. Overview  What is recovery?  Why is recovery important?  Social movement to policy goal  Recovery focused mental health services
    4. 4. Recovery? • How confident do you feel working in a recovery focussed way? Scale of 1-10?
    5. 5. What is recovery? Personal RecoveryMental Illness & Medical Model
    6. 6. Social movement • "revolutions begin when people who are defined as problems achieve the power to redefine the problem” McKnight (1992) • Recovery involves people living with addictions and mental health problems
    7. 7. Defining Recovery “a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” Anthony, 1993
    8. 8. Recovery Timeline Recovery Model Anti-depressants,1957 DementiaPraecox1883 Anti-psychotics,1960De-institutionalisation Psychosocial Rehabilitation, 1940’s - 70’s Disability Rights Movement SelfHelp,1930’s Survivor Narratives BillAnthony,1993 RecoveryAssessmentScale, 1996 Policy, 2006… Practice TheDividedSelf,1960 1959MentalHealthAct TheWaterTowerSpeech, 1961 InternationalPilotStudy OfSchizophrenia,1967 RecoveryConference,2004 SRN,2003 WWII: 1939-45 Chlorpromazine,1952 Anti-psychiatry ItalianPsychiatricReform, 1978 1960’s & 70’s
    9. 9. “People need to recover from the system, not their mental health problem.” Ron Coleman “We have the right to be heard and listened to. We…need not be passive victims of an illness.” (Deegan, 1993) Foundations of Recovery
    10. 10. Medical Recovery Maintenance Personal Recovery What is Recovery?
    11. 11. People of all ages living with mental health problems and illnesses are actively engaged and supported in their journey of recovery and well-being. “Mental health service providers should operate within a framework that supports recovery.” “Rights” “Best Practice” “Social Inclusion” “Active participation & empowerment strategies.” “Focus on Outcomes” “Rights, Relationships & Recovery: review of mental health nursing (SGHD 2006, 2010) Recovery Policies
    12. 12. Recovery in Scotland  Devolution (1999)  Recovery conference, Ron Coleman (2004)  Mental Health Care & Treatment Act (2003)  Scottish Recovery Network (2004)  Rights, relationships and recovery: review of mental health nursing (2006) (refreshed, 2010)  Delivering for mental health plan, 2006  Mental health strategy (2012)  New Mental Health Act (2012)  Future: – Personalisation & SDS – Practice & Measurement
    13. 13. Recovery key themes  Being Supported by Others  Renewing Hope & Commitment  Engaging in Meaningful Activities  Redefining Self  Incorporating Illness  Overcoming Stigma  Assuming Control  Managing Symptoms  Becoming Empowered & Exercising Citizenship
    14. 14. What is recovery? • A reality (it happens) • A process rather than an event • Processes have fluctuations • Built on growth and learning • Unique experience with common themes
    15. 15. CHIME (Leamy et al. 2011)
    16. 16. What helps recovery? • Telling your story and being listened to • Developing awareness and skills • Taking part in life • Supportive relationships • The positive role of work • Recovery leadership / champions • Identity , hope and creativity
    17. 17. Recovery-focused nursing  Why is recovery important to nursing?  How can you work in a recovery focused way?  What is holding back recovery?
    18. 18. What it’s not • A fad, buzz word or new phenomenon • A service model but they do need to change • All about mental health services ‘I know everyone talks about hope, as if it’s the jargon and the latest fad. The thing is, it’s not jargon. It’s the light in the darkness which kept me going; the wish and yearning for change.’ Personal narrative:
    19. 19. What it’s not • Something you can do to people • Necessarily easy or quick ‘Recovery is a personal journey and is different for everyone, and the way is not always easy... My journey to recovery took several years and much time was spent finding out what helped and what didn’t.’ Personal narrative:
    20. 20. Implications of recovery • People in recovery are the evidence • Different knowledge, skills and values • Shared roles - walking alongside • A shift in power ‘I feel that it’s vital that professionals are open to letting people take control, but I know that it’s hard to get it right. Ultimately, it’s about treating people as individuals.’ Personal narrative:
    21. 21. How do we know this? • Narrative research projects • Local recovery networks • Promoting WRAP • Influencing services – SRI 2 • Encouraging Peer Working • Listening to ‘experts by experience’ • Research
    22. 22. The vision (your preferred future) Let’s imagine a (recovery) miracle takes place… What do you see yourself and others do? From staff, service user and carer perspectives What’s different about it?
    23. 23. Achieving our vision What is the first very small step you will take that will let you know that you are moving towards you vision? Discuss Acknowledging power SMART objectives Recovery is action oriented
    24. 24. Recovery = Journey
    25. 25. References • Anthony W. A., (1993) Guiding vision of the mental health service system in the 1990s. Psychosocial rahabilitation journal, 16(4), 11-23. • Cowan S, Guise J, (2012) Revisiting the narrative research project: a follow up study of mental health recovery. Available at: . Last accessed: 12/01/14. • Katalova-O’ Docherty Y, Stevenson, C, Higgins, A (2012) Reconnecting with life: a grounded theory study of mental health recovery in Ireland Journal of mental health 21 (2) 136 – 144. • Leamy M, Bird V, Le Boutillier C, Williams J, Slade M, (2011) A conceptual framework for personal recovery in mental health: systematic review and narrative synthesis, British Journal of Psychiatry: 199:445-52.
    26. 26. References • Stickley, T., Wright, N. (2011) The British research evidence for recovery, papers published between 2006 and 2009. Part two: a review of the grey literature including book chapters and policy documents. Journal of psychiatric and mental health nursing, (18), 297-307. • Stickley, T., Wright N. (2011) The British evidence for recovery, papers published between 2006 and 2009. Part one: a review of the peer reviewed literature using a systematic approach. Journal of psychiatric and mental health nursing, (18) 247-256. • Smith– Merry J, Freeman R, Sturdy S, (2010). Recovering mental health in Scotland: Recovery from social movement to policy goal Louvian-la- Neuve: Universite Catholique de louvian. • Scottish Government Health department (2006) Rights, relationships and recovery: The review of mental health nursing in Scotland • Scottish government (2012) The mental health strategy.