Recovering Ordinary Lives: the strategy for
occupational therapy in mental health services
2007-2017
Impact, Progress and Next steps
Genevieve Smyth September 2014
Introduction
• Review of Recovering Ordinary Lives: impact,
progress, next steps –collecting OT views
• What did OTs tell me?
Impact of the document
What OTs are proud of
Challenges for the profession
Focus for the future
COT work plan
Review of Recovering Ordinary Lives
Three questions posed to the OT community:
• What impact has Recovering Ordinary Lives had
for practitioners, managers, academics, COT and
commissioners?
• What progress has been made towards the aims
and key messages in the document?
• What might next steps look like?
Review of Recovering Ordinary Lives
BAOT members gave their views via:
• COT conference 2013
• Four network meetings, one in each of the four
UK countries
• Meeting of the original Steering group
• From COT Specialist Section- Mental Health
• Mental health email network
• OTN and the website
• Comments from about 150 people
• Service user and commissioner also approached
for views
Impact of Recovering Ordinary Lives for OTs
• Formalised professional values in relation to our
unique contribution and promoted value of OT and
meaningful activity
• Gave definition and helped refocus identity and
direction
• Chance to agree a common language across mental
health
• Helped OTs increase strategic input across
organisations
• Used as framework to inform and develop OT
services
• Led to increased use of outcomes measures
• Audit tool used in supervision
• Students used to guide case studies
• Encouraged dissemination of best practice
Impact of Recovering Ordinary Lives for others
• Provided a framework for marketing OT and
increasing understanding
• Local events held to promote the documents –inviting
service users, service directors, charities, third sector
• Given to students from other disciplines
• Copies sent to people in national positions
• Authorised explanation of OT role useful to bring to
discussions with managers and commissioners
• Increased the recognition of the value of activity and
occupation particularly around employment
What OTs are proud of
• Involvement in Recovery, Implementing Recovery
through Organisational Change (IMROC)
development of Recovery Colleges, co-production
• Recovery coaching, sharing staffs experience of
mental illness to enhance Recovery culture
• Use of Wellness Recovery Action Planning
• Movement into third sector particularly vocational
services
• Vocational champions, using Individual Placement
Support
• Offering early intervention for vocational outcomes
• Trust repatriation schemes, influencing build of new
environments
• Embedding Payment by Results care packages
• Increasing numbers of OT consultants
New posts/roles
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Prisons
Primary care and public health
Autistic Spectrum Disorders, CAMHs, eating disorders
Condition Management
Early intervention for dementia, memory clinics
Care homes
Bariatric services
RAID – psychiatric liaison in acute physical hospitals
Drop in crisis and duty
Expert witness
Best Interest Assessors (Mental Capacity Act)
Approved Mental Health Professionals (Mental Health
Act)
“We
are extending our scope of
practice across a range of agencies
by being the experts in occupation
but not having to totally own it”
(COT Conference session 2013)
Challenges for the Profession
• Evidence base – lack of OT randomised controlled trials,
allows other professions to dominate, means OT does
not get into NICE guidelines although OT components
recognised such as ADLs, employment, professions
lacks understanding of quantitative research, less links
between what academics research and practice
• Lack of recognition/support – at higher levels in
organisations and for Recovery orientated ideas, for
moving into new areas of practice, many Recovery
Colleges led by OTs and this is not recognised,
promoting understanding of OT to multiagencies is tricky,
commissioners recognise value of occupation but not
OT, commissioners are hard to access, hard to know
how to influence them, they don’t want detail –only broad
brush strokes
Challenges for the Profession
• Dominance of medical model – leading to restrictive
emphasis on risk management, OT posts integrated with
other roles and responsibilities, generic duties increasing,
demand for case managers and crisis practitioners,
delivery of psychological interventions, need to fight for
the OT specific role
• Cost improvements – leading to loss/conversion of OT
posts, OT replaced by cheaper support workers, services
going out to tender to voluntary sector, range of people
offering activity, higher banded posts lost, OT managers
are not budget holders
“The OT message is getting
lost in translation”
(Email correspondence 2013)
Focus for the Future
• Evidence base – more training in EBP, literature
searching, NICE, writing for publication, expanding
evidence base will give us the authority to say “We do
this best”, need to prioritise clinical and cost
effectiveness, manualised interventions, value of
quantitative research must be reinforced with students,
need to map research capacity to support partnership
• Marketing and influence – need to promote OT but not
be too protective of the role as all professionals need to
incorporate OT as away of life, sell ourselves more, get
involved in local projects/groups, political lobbying,
collaborations, into the media, speak as AHPs to have
more influence
Focus for the Future
• Recovery – involve service users in coproduction, design ,
delivery and evaluation, Recovery focused language, collect
Recovery stories that show importance of occupation
• Prepare for future employment – not in the statutory sector,
increase awareness of how to make this move, network
more outside statutory services, support people so they can
confidently retain their OT identity keeping OT supervisors
and mentors. Also preparing by making better use of
technological solutions and moving to seven day services,
increasing our involvement in informatics, promoting our role
in community development and tackling the social
determinants of health
Focus for the Future
• New OT models/theories – needed to support working in
new ways, match extended scope with extended theories,
look at work from South America and Africa where OTs
work in a more entrepreneurial and community oriented
spirit, need more debate about new ideas and theories
“Times are changing –we need to
change also”
(Recovering Ordinary Lives Steering group 2013)
Service user comments
“I'm delighted that the vital importance of
appropriate activity and occupation in
motivating and maintaining personal
recovery and actualisation is being
championed so vehemently and
articulately by OTs.
I think this gives hope to mental health
services users everywhere”
(Service user correspondence 2014)
Commissioner comments
“You need to provide evidence based
outcomes to show you are increasing
quality and decreasing costs. I don't mind
how you do this or what particular tools
you use but all I really want to see is how
you improve quality and save money”
(Commissioner conversation 2014)
COT Work plan 2015-2017
• Expanding the evidence base, promoting opportunities for
research and training particularly studies that consider
clinical and cost effectiveness. Mapping research
capacity to promote research partnerships.
• Market and promote OT role in mental health and
Recovery and support OTs to do this locally. Profile
increased through political lobbying and media.
• Collect case studies and service user narratives which
show value of OT in Recovery.
• Disseminate examples of OTs use of technology and
involvement in informatics
• Dissemination of examples of OTs contribution to
community development and the social determinants of
health
• Supporting OTs moving into new forms of employment
with diverse providers
COT Work plan 2015-2017
• Work plan agreed with COT Specialist Section –Mental
Health and all four COT Country Boards - published in
September OTN 2014 pages 22 and 23
• Next question –how to deliver these objectives!
Evidence base
Marketing and promotion
Technology and informatics
Community development and social determinants
New forms of employment
• Views? What can you offer to help?
Summary
OTs views about:
Impact of the document
What OTs are proud of
Challenges for the profession
Focus for the future
Priorities for next steps
COT work plan
Genevieve.Smyth@cot.co.uk
0207 450 5220