Recovery 1


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  • Patrica Deegan – was a service user who wrote about her journey through mental illness and her recovery to maximize levels of functioning and develop resources within the community to support successful living People with psychiatric disabilities want safe, affordable housing, the opportunity to work for fair wages, the opportunity to learn, time to enjoy social and leisure activities, involvement in the communities where they live and most of all families and friends who love and care about them – by viewing the person as having a psychiatric ‘disability’ rather than a person destined for life long suffering and a decline in functional abilities it creates a sense of possibility for overcoming the challenges of a disability and for living to ones maximum potential Physical rehab focuses on helping people to develop skills that enhance adjustment to their living environment and develop environmental supports that facilitate successful community living- psychiatric likewise focuses on the same areas of intervention – Psychiatrically disabled adults who choose to embark on a recovery process become active participants in their own rehabilitation project – corresponds with the view of the nurse-client relationship as a collaborative partnership ( re Peplau )
  • Patricia Deegan( a service user) drew a distinction between rehabilitation and recovery Recovery does not necessarily mean being entirely symptom free - to the person who has recovered the illness is no longer the primary focus of their life The Mental Health Commission definition is broad – to the mental health professional recovery might mean absence of symptoms but to the person with mental illness recovery might mean regaining one’s life How could recovery ever take place in an environment where people were isolated from their communities, where power was used to coerce people and deny them choices, and where people with mental illness were expected never to get better Major study demonstrated that the course of severe mental illness was not an inevitable deterioration ( The Vermont longitudinal study of persons with severe mental illness: long term outcome of subjects who retrospectively met DSM III criteria for schizophrenia. (For abstract -American Journal of Psychiatry 144: 727-735 1987) and several first-person accounts by consumers who described their experiences of mental illness and how they managed to emerge intact or recover _ Consumers have been the most active in advancing the concept of recovery from mental illness - Mental health professionals have and are drawing on such accounts to formulate theoretical and practical models of recovery that could be used in psychosocial rehabilitation and other mental health services Important to note that there is no recipe or template for recovery in a persons life as there is no definitive recovery model -the journey is defined by the individual concerned. However research does indicate that there are common themes to peoples stories and that they describe a process of stages that are universal to anyone who has experienced a catastrophic loss including those associated with a mental illness
  • the onset of acute symptoms and initial diagnosis – shatter the sense of self Perceived symptoms are viewed as a mistake or bad dream. Anger at family and health care providers who attempt to care Overwhelming sense of hopelessness and powerlessness- may last many months years or a lifetime Concerned others who remain hopeful despite the odds provide a source of hope for person who despairs. A spark of hope brings motivation and willingness to try again In accepting personal limitations person discovers and explores new possibilities
  • Group Exercise – in 4 groups read assigned stories (4 families – MHC series 2) and identify how the service users story illustrates each of the points above Discussion on aspects of the persons life / experience that helped and hindered their ability to move on with her life, (30mins)
  • Refer to ‘Recovery as a journey of the heart - powerful in getting this message across
  • Mental Health Professionals need to deal with their own fears/concerns – Baby steps are needed for consumers that have been in the system for some time
  • Can be seen as non-compliance Negotiation needed around issues with a perceived risk – succeed and fail are key elements of the human experience
  • They may need to educate themselves about their wellness/illness cycle eg triggers, early warning signs and things that help to get them well They need to know and understand what the medications are that they are taking why they are taking it and what the potential side effects may be
  • It is extremely difficult for a person to recover without any support of any kind
  • Personal meaning helps to develop a sense of identity – the opportunity to be able to place ones stamp of uniqueness and individuality on the environment is crucial to recovery
  • MHC states that recovery – orientated service will be one that supports service users to lead their own recovery
  • To ensure that the workforce is well equipped to carry the philosophy of the recovery approach forward and make it a reality Handouts– Mental Health Recovery Competencies Patricia Deegan article –Recovery as a journey of the heart 1995 article - A recovery orientated service system: setting some system level standards – William Anthony 2000
  • Recovery 1

    1. 1. Rehabilitation and Recovery in Mental Health
    2. 2. Rehabilitation and Recovery session objectives <ul><li>At the completion of this session students will: </li></ul><ul><li>Define Rehabilitation in a mental health setting </li></ul><ul><li>Define Recovery in a mental health setting </li></ul><ul><li>Understand the origins of a recovery approach </li></ul><ul><li>Understand the characteristics of a recovery orientated service </li></ul><ul><li>Be aware of the competencies required for a mental health professional </li></ul>
    3. 3. Defining Rehabilitation <ul><li>‘ Encompasses the services and resources made available to people with disabilities to facilitate adaptation to their world’ (Deegan, 1988) </li></ul><ul><li>Focuses on improving knowledge and skills </li></ul><ul><li>Advocates viewing people suffering a mental illness as people with disabilities who share the same aspirations as others </li></ul><ul><li>The concept of physical rehabilitation can be applied to psychiatric rehabilitation </li></ul><ul><li>It is not a passive process </li></ul>
    4. 4. Principles of Psychosocial Rehabilitation <ul><li>Believe in the recovery process from psychiatric disability </li></ul><ul><li>Engender hope and the possibility of change </li></ul><ul><li>Maintain a client-centered focus that promotes individual choices and empowerment </li></ul><ul><li>Facilitate collaborative client/consumer/family participation in developing rehabilitation goals and plans </li></ul><ul><li>Use holistic assessment of physical, emotional, intellectual, social and spiritual dimensions </li></ul><ul><li>Develop educational opportunities that build life skills and knowledge to maximize independence in life roles and daily functioning </li></ul><ul><li>Build and strengthen community and social support systems that client and consumers learn to access easily </li></ul><ul><li>Educate health care providers, legislators, and the public about psychiatric disabilities to reduce stigma and foster understanding </li></ul>
    5. 5. Defining Recovery <ul><li>‘ Encompasses the lived experience of people as they meet and overcome the challenges of their disability’ (Deegan,1988) </li></ul><ul><li>Not a one-dimensional process </li></ul><ul><li>‘ Living well in the presence or absence of illness’ </li></ul><ul><li>(MHC, 1998) </li></ul><ul><li>Historically mental health services have failed to use a recovery approach </li></ul><ul><li>Current notion of recovery from mental illness dates back to 1980’s </li></ul>
    6. 6. Stages in the Recovery Process <ul><li>Initial Shock </li></ul><ul><li>Denial and Rage </li></ul><ul><li>Despair and Self-pity </li></ul><ul><li>Turning point of Hope </li></ul><ul><li>Finding new meaning and Purpose in Life </li></ul>
    7. 7. Common Themes in Recovery <ul><li>Hope </li></ul><ul><li>Personal responsibility </li></ul><ul><li>Self-advocacy </li></ul><ul><li>Education </li></ul><ul><li>Support </li></ul><ul><li>Personal meaning </li></ul>
    8. 8. HOPE <ul><li>People need to believe – both the client and the mental health practitioner that life can be different </li></ul>
    9. 9. Personal responsibility <ul><li>In order to build a sense of control and self-determination people must take responsibility for </li></ul><ul><ul><li>Their lives </li></ul></ul><ul><ul><li>Managing their well-being </li></ul></ul><ul><li>Historically Health professional have advised clients what to do/ not to do </li></ul><ul><li>Causes concerns regarding risk management for some mental health professionals </li></ul>
    10. 10. Self-advocacy <ul><li>Service users are finding their ‘voice’ and being able to say what is wanted and what is not </li></ul><ul><li>It provides an opportunity to re-engage with ones environment </li></ul>
    11. 11. Education <ul><li>Important for the client to understand </li></ul><ul><ul><li>their illness </li></ul></ul><ul><ul><li>the medications they are taking </li></ul></ul>
    12. 12. Support <ul><li>One of the biggest determinants of recovery </li></ul><ul><li>May be supported through: </li></ul><ul><ul><li>Family/Whanau </li></ul></ul><ul><ul><li>Friends and colleagues </li></ul></ul><ul><ul><li>Peer support groups and self help groups </li></ul></ul><ul><ul><li>Mental health Professionals </li></ul></ul>
    13. 13. Personal Meaning <ul><li>Clients need to create personal meaning in their lives </li></ul><ul><li>This can be through numerous channels: </li></ul><ul><ul><li>Spirituality </li></ul></ul><ul><ul><li>Employment </li></ul></ul><ul><ul><li>Relationships </li></ul></ul><ul><ul><li>Peer support groups </li></ul></ul><ul><ul><li>Service user movement </li></ul></ul>
    14. 14. Recovery and New Zealand <ul><li>The recovery vision is integral to our national mental health policy </li></ul><ul><li>The Mental Health Commission’s Blueprint for Mental Health Services (MHC, 1998) directed services to use the recovery approach </li></ul><ul><li>At present although the recovery is fast becoming accepted in principle – not yet clear what a recovery-orientated service will look like </li></ul>
    15. 15. Characteristics of a recovery- orientated service (1) <ul><li>A recovery philosophy </li></ul><ul><li>Accessibility </li></ul><ul><li>Services available in home and community settings </li></ul><ul><li>Diverse workforce, showing respect for culture and individuality </li></ul><ul><li>Service user advocacy and leadership </li></ul><ul><li>Choice of services and treatments </li></ul><ul><li>Delivery of treatments that are safe and effective and help with recovery as well as symptoms </li></ul><ul><li>Availability of peer support and other forms of consumer-operated services </li></ul><ul><li>Respectful two-way communication </li></ul><ul><li>Provision of useful information </li></ul>
    16. 16. Characteristics of a recovery- orientated service (2) <ul><li>Collaboration with service users in decision-making </li></ul><ul><li>Conveying hope and optimism </li></ul><ul><li>Providing reassurance and safety </li></ul><ul><li>Whole of life approach </li></ul><ul><li>Avoiding force against service users and upholding their rights </li></ul><ul><li>Countering stigma and discrimination </li></ul><ul><li>Encouraging appropriate involvement from family and friends </li></ul><ul><li>Priority on enhancing and maintaining wellness </li></ul><ul><li>Encourages access to good physical health care </li></ul><ul><li>Flexible services providing good linkages with services and supports relating to employment, housing and community participation </li></ul>
    17. 17. Recovery based competencies <ul><li>The term competencies is defined broadly to include attitudes, skills, knowledge and behaviour required of the mental health workforce </li></ul><ul><li>They apply to all people working in all services – mainstream, kaupapa Maori or service user run groups </li></ul><ul><li>Everyone in the workforce needs to acquire recovery-based competencies to a certain level </li></ul>