college of occupational therapists 2008 principles of recovery genevieve smyth professional affairs...

College of Occupational Therapists 2008

PRINCIPLES OF RECOVERY

Genevieve Smyth

Professional Affairs Officer

Mental Health and Learning Disabilities

The College of Occupational Therapists

106-114 Borough High Street

London SE1 1LB


Introduction

Current position of Recovery in mental health Definitions History Ten Recovery principles Recovery process Relationship to Recovering Ordinary Lives and

occupational therapy Challenges and strengths


Current Position of Recovery

Fundamental guiding principle Recovering Ordinary Lives –the strategy for

occupational therapy in mental health services 2007-2017 (COT 2006)

Other professional bodies; RCN, BPS, RCP NIMHE Guiding Statement on Recovery (2005) Making Recovery a Reality – Shepherd et al (2008)

Sainsbury Centre for Mental Health Vivienne Wheeler, Hilary Williams


Defining Recovery

“Recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and contributing life, even with the 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)


Contested Definitions

Can you define a personal journey?

Is it a model –a clearly constructed set of theories that model or represent clinical phenomena?


History of Recovery

Consumer/Survivor Movement of 1980s and 1990s –not professionals

Self help, empowerment, advocacy New Zealand, USA, UK Challenge disease-driven ideas of mental illness Service user narratives e.g. Patricia Deegan

Recovery as a Journey of the Heart (1996)

Recovery; the Lived Experience of Rehabilitation(1998)


Research Evidence

Davidson and McGlashan (1997) Long-term outcomes of people with serious

mental health conditions Research found ¼ - 2/3 of people experiencing

first episode of psychosis recover to a degree where symptoms do not interfere with daily functioning


Occupational Therapy Literature

Reberio Gruhl K (2005) Reflections on…the recovery paradigm;Should occupational therapists be interested? CJOT, 72(2), 96-102

Lloyd et al (2007) The association between leisure motivation and recovery;A pilot study. AJOT, 54, 33-41.

Lloyd et al (2008) Conceptualising recovery in mental health rehabilitation. BJOT, 71(8), 321-328.


Policy Context

Self management and choice in England Securing our Future Health – Wanless 2002

Mental Health and Social exclusion 2004 Our Health, Our Care, Our Say 2006

The Next Stage Review 2008 –personal health budgets The NHS Constitution 2008 –rights to respect and choice Ireland –A vision for a recovery model in Irish mental

health services (2005) Scotland –Rights, Relationships and Recovery (2006)


Shift in dominant paradigms and power relationships

From professional to service user From medical to social model Values based practice – The Ten Essential Shared Capabilities

(Hope 2004)


Ten Principles of Recovery (Shepherd et al 2008)

Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems

Recovery represents a movement away from pathology, illness and symptoms to health, strengths and wellness


Recovery Principles cont.

Hope is central to recovery and can be enhanced by each person seeing how they can have more active control over their lives (‘agency’) and by seeing how others have found a way forward

Self-management is encouraged and facilitated. The processes of self-management are similar, but what works may be very different for each individual. No ‘one size fits all’.



The helping relationship between clinicians and patients moves away from being expert/patient to being ‘coaches’ or ‘partners’ on a journey of discovery. Clinicians are there to be “on tap, not on top”

People do not recover in isolation. Recovery is closely associated with social inclusion and being able to take on meaningful and satisfying social roles within local communities, rather than in segregated services



Recovery is about discovering - or re-discovering a sense of personal identity, separate from illness or disability

The language used and the stories and meanings that are constructed have great significance as mediators of the recovery process. These shared meanings either support a sense of hope and possibility, or invite pessimism and chronicity


Principals of Recovery cont.

The development of recovery-based services emphasises the personal qualities of staff as much as their formal qualifications. It seeks to cultivate their capacity for hope, creativity, care, compassion, realism and resilience

Family and other supporters are often crucial to recovery and they should be included as partners wherever possible. However, peer support is central for many people in their recovery


Common Recovery Factors (from www.mhrecovery.com)

Employment/Meaningful activity Hope Medication and treatment Empowerment Education/Knowledge Support Self Help Spirituality


Components of the process of recovery (Andresen et al 2003)

Finding and maintaining hope- believing in oneself; having a sense of personal agency; optimistic about

the future;

Re-establishment of a positive identity- finding a new identity which incorporates illness, but retains a core, positive

sense of self;

Building a meaningful life- making sense of illness; finding a meaning in life, despite illness; engaged

in life;

Taking responsibility and control- feeling in control of illness and in control of life


And then I lost that life; a shared narrative of four young men with schizophrenia (Gould et al 2005)

I remember when I was normal It’s like your computer crashes

Coasting through life Try to remake that life as best you can Finally, I can move on with my life


Recovering Ordinary Lives –the strategy for occupational therapy in mental health services 2007-2017 (COT 2006)

“Occupational therapists will value recovery and will work within a socially inclusive framework to achieve goals that make a real difference to peoples’ lives. They will encourage people with mental health problems to make decisions and responsibilities for their lives by providing the necessary support.”


Recovering Ordinary Lives –guiding principles

Interventions assist the client to achieve greater autonomy of thought, will and action

Interventions support the client in developing or maintaining a satisfying personal and social identity

Interventions move the client in the direction of fuller participation in society through performance of occupations that are appropriate to her or his age, social and cultural background, interests and aspirations.


Recovering Ordinary Lives –key messages

For practitioners – Using occupational language explain the meaning of occupation and its relationship to recovery and wellbeing to service users, carers, colleagues and commissioners.

For managers - Provide information within your organisation on the importance of occupation to recovery and wellbeing

Our profession need to be able to articulate the links between occupation and building a meaningful, satisfying life


Challenges (from www.mentalhealthnursingstaff.com)

Vague and subjective Lack of research evidence base ‘We’ve been doing this for years’ ‘Language reconstructive operatives’ – giving old things new names Tension between standardisation and individual process Lack of BME involvement Linked to discharge Backlash from the medical model (Craddock et al 2008) attacking

“psychosocial support with extremely limited therapeutic ambition”.


Advantages of Recovery

Shifting power balances Focuses on people not services Emphasises strengths rather than weaknesses Cost effective? Wellness Recovery Action Plans (Mary Ellen

Copeland) www.mentalhealthrecovery.com Emphasis on hope – alerting healthcare professionals

to institutional responses Positive risk taking


Summary

Contexts and definitions of Recovery

How it links to occupational therapy and Recovering Ordinary Lives

Challenges and strengths


References

Andresen R, Oades L, Caputi (2003) The experience of recovery from schizophrenia; towards an empirically validated stage model. Australian and New Zealand Journal of Psychiatry, 37, 586-594.

Anthony W A (1993) Recovery from mental illness; the guiding vision of the mental health service system in the 1900s. Psychosocial Rehabilitation Journal, 16, 11-23.

Craddock N. et al (2008) A wake up call for British psychiatry. The British Journal of Psychiatry, 193, 6-9.

College of Occupational Therapists (2006) Recovering ordinary lives the strategy for occupational therapy in mental health services 2007 – 2017. London: COT.

Davidson L, McGlashan TH (1997) The varied outcomes of schizophrenia. Psychiatric Services, 57, 642 – 645.


References

Deegan P (1996) Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 19 (3), 91-97.

Deegan P (1998) Recovery; the lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 11, 11-19.

Hope R (2004) The 10 essential shared capabilities: a framework for the whole of the mental health workforce. London: DH.

Gould A, DeSouza S, Rebeiro-Gruhl KL (2005) And then I lost that life: a shared narrative of four young men with schizophrenia. British Journal of Occupational Therapy, 68 (10), 467-473.

National Institute for Mental Health in England (2005) NIMHE Guiding statement on recovery. Available at www.nimhe.org.uk

Shepherd G, Boardman J, Slade M (2008) Making recovery a reality. London: Sainsbury Centre for Mental Health.

college of occupational therapists 2008 principles of recovery genevieve smyth professional affairs...

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