Recovery Focused Practice
Agnes Higgins PhD
School of Nursing and Midwifery
Trinity College Dublin
Individual Care Planning: Enabling the Paradigm Shift to Recovery Focused Care
- Lessons from the National Mental Health Services Collaborative
Burlington Hotel
7th February 2012
Recovery
2006
Recovery
1 of the16
guiding
principles
2005
Recovery
discussion
paper
2007
Recoveryfocussed
approach is
a standard
2008
Recovery
Framework
Recovery Perennials
•
•
•
•
•
•
•
•
•
Active process
Individual and unique process
Gradual process
Non- linear process
Trial and error process
Life changing
Stages or phases
Can occur without professional help
Aided by supportive healing
environment
• Journey of discovery
Leamy , M et al (2011) Conceptual framework for personal recovery in mental health:
systematic review and narrative synthesis BJPsych 199:445-452
Journey of discovery
• Discovery
–
–
–
–
–
–
–
–
Identity
Voice
Hope
Belief
Meaning
Belonging
Strengths
Personal control/agency
– Life long journey
Recovery
• Process/journey that person experiences
• Philosophy/Approach to care and service
provision
Recovery: approach to care
• ‘Recovery offers a transformational ideology for
services and suggests reform in how ‘mental
illness’ is understood and managed, as well as in
how people living with mental illness are
understood and helped. This guiding philosophy
challenges ideas and beliefs about the etiology
and treatment of ‘mental illness’, including the
way in which mental health practice is organised
and implemented to ensure that people living
with ‘mental illness’ lead meaningful and
productive lives.’
–
Boutillier et al (2011) What does recovery mean in practice? A qualitative analysis of International recoveryoriented practice guidance psychiatric services 62(11):1470-1476
Symptoms/Diagnosis
Current
narrative
Technical
interventions/Prognosis
Practitioners
‘Symptom spotters’
Diagnosis
Recovery
Absence of
symptoms
Privileging
of
professional
knowledge and
bio/psychiatric
narrative
‘Social death
sentence’
‘Master status’
Professional
distancing
Disempowering
practices
‘Compliance’
Risk adverse
‘’Conformity’
‘Control’
Narrative Synthesis of Recovery
Processes
Connectedness
• Peer support and
support groups
• Relationships
• Support from
others
• Community
Hope and
optimism
• Belief in recovery
• Motivation to
change
• Hope-inspiring
relationships
• Positive thinking
and valuing
success
• Having dreams
and aspirations
Identity
Meaning
Empowerment
• Rebuilding
positive sense of
identity
• Overcoming
stigma
• Meaning in
mental ‘illness
experience’
• Spirituality
• Meaningful life
and social roles
• Meaningful life
and social goals
• Personal
responsibility
• Control over life
• Focusing upon
strengths
Leamy , M et al (2011) Conceptual framework for personal recovery in mental health:
systematic review and narrative synthesis BJPsych 199:445-452
Recovery focused practice
• More than assimilating
into current paradigm
• More than adopting
language of recovery.
• A challenge to new
ways of thinking and
acting
• An invitation to fresh
and new possibilities
and new narrative
Recovery
Narrative
Persons lived
experience
Hopes, dreams and wishes
Social Inclusion
Challenge barriers to recovery
All aspects of persons
life
Self
Services
Society
Build connectedness
‘ME’
Family
Peers
Community
CITIZENSHIP
RIGHTS
Values
Meaning
Power
Relationships
Collaborative relationships
Giving back power, control,
choices
shared decision making
Wellness
Dialogue with our demons
Recovery plans
Finding meaning
Hope
Advanced directives
Existing skills and
strengths
Therapeutic risk
Shepherd et al 2008
Hope
Agency
Opportunity
Insight and Internalised stigma
• People who accept that they have mental illness may feel driven
to conform to an image of incapacity and worthlessness,
becoming more socially withdrawn and adopting a disabled
role. As a result, their symptoms may persist and they may
become dependent on treatment providers and others. Thus,
insight into one’s illness may be rewarded with poor outcome.
• Empowerment of people and helping them reduce their
internalised sense of stigma are as important as helping them
find insight into their ‘illness’. Until now, however, more effort
has been expended on the last than on the former.
– Warner R. (2004).Recovery from Schizophrenia: Psychiatry and Political
Economy (3rd edn). Brunner-Routledge,
Recovery: not anti medication
‘The biomedical model and medical
treatments may have an important
place for some people in their
recovery, but as an invited guest,
rather than an overarching
paradigm’
• Higgins, A (2008)
‘My journey of recovery is still ongoing. I still
struggle with symptoms, grieve the losses I
have sustained…I am also involved in self help
and mutual support and I still use professional
services including medications, psychotherapy
and hospitals. However, I do not just take
medications and go to the hospital. I have
learned to use medications and to use the
hospital. This is the active stance that is the
hallmark of the recovery process.’
Deegan, P (1996) Recovery as a journey of the heart
Psychiatric Rehabilitation Journal 19, 3 91-97
DREEM: Developing Recovery Enhancing Environment Measure
Staff and resident ratings of importance of factors. (Ridgeway & Press, 2004)
Dinniss S et al. User-led assessment of recovery service using DREEM Psychiatric Bulletin 2007;31:124-127
©2007 by The Royal College of Psychiatrists
Staff and resident ratings of how well recovery factors were achieved/supported by service
*P<0.05, **P<0.01, ***P<0.001.
Dinniss S et al. Psychiatric Bulletin 2007;31:124-127
©2007 by The Royal College of Psychiatrists
Ten key organisational challenges
1. Changing the nature of day-to-day interactions and the
quality of experience
2. Delivering comprehensive, service user-led education and
training programmes
3. Establishing a ‘Recovery Education Centre’ to drive the
programmes forward
4. Ensuring organisational commitment, creating the ‘culture’
5. Increasing ‘personalisation’ and choice
6. Changing the way we approach risk assessment and
management
7. Redefining service user involvement
8. Transforming the workforce
9. Supporting staff in their recovery journey
10. Increasing opportunities for building a life ‘beyond illness’
–
Sainsbury Centre for Mental Health
Pillars of Recovery
A Higgins TCD
Lasting change
Culture
Values
Professional
narrative
Recovery: Thinking Differently
“There are risks and costs to a program of action, but
they are far less than, the long-range risks and costs of
comfortable inaction”
John F. Kennedy
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Recovery Focused Practice - Mental Health Commission