Rights, Relationships and Recovery

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Rights, Relationships and Recovery

• Report of The National Review of Mental Health
  Nursing in Scotland
• http//www.scotland.gov.uk/Publications/2006/04/18
  164814/0

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Context of the Review

• Policy context
• The Mental Health (Care and Treatment) Scotland
  Act (2003)
• The Principles of the Acts
• The impact on service redesign
• The National Programme for Mental Health and Well
  Being
• Delivering for Health and evolving mental
  health delivery plan

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Purpose of the Review

• Enabling continual improvements to the process
  and outcomes of care for people who use mental
  health services and their families and carers
• Ensuring that the skills of mental health nurses
  are utilised in the most effective way in the
  context of an exciting and challenging change
  agenda
• Ensuring we have in place a profession with high
  esteem, supported and developed to deliver the
  best quality values and evidence based practice

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A Mental Health Nursing Review but Mental Health
is everyones business

• 1 in 4 but not just any 1 in 4
• Predicated world-wide increase in mental health
  problems particularly in some population
  groups
• Inextricable link between physical and mental
  health
• High rates of mental distress/problems among
  people with long standing physical health
  problems
• High rates of mental distress/problems among
  informal carers

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Mental Health is everyones business

• People who experience mental health problems
  experience stigma and discrimination in all
  facets of society ---and in health services
• People with long-term mental health problems
  experience health inequalities
• have higher rates of physical ill-health
• lower life expectancy than the general
  population.
• have been disadvantaged in accessing health
  promotion advice and health screening for
  physical health problems

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The National Programme
www.wellscotland.info
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All nurses, midwives and allied health
professionals have a role in

• Mental health promotion , prevention of mental
  health problems and anticipatory care
• Tackling health inequalities
• Prompting social inclusion
• Challenging stigma and discrimination in
  society--- and in the NHS
• Understanding that mental health issues impact us
  all we need to be aware of our own mental
  health and well being

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Review Method and Process

• Project Steering and Reference Groups
• Sub groups
• Literature review
• Focus groups and forums
• Conferences
• Web site
• Calls for contributions and comments on draft
  reports
• National and international links
• Most importantly active involvement, engagement,
  joint working and among practitioners, service
  users and carers

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The Outcome of the review and the start of the
next stage

• Main Review Report, summarised version
• 5 year Action Plan why ?
• National Implementation Group
• Local Implementation Groups
• Actions for progression by
• -NES
• -SRN
• -Nurse Directors
• -CHPs/NHS Boards
• -HEIs
• -QIS
• -Mental Health Nurses Forum
• -Scottish Executive
• - Mental Health Nurses !

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Mental Health and Delivering for Health

• Current model of services
• Most resources geared towards episodic treatment
  of
• acute episodes of ill health/distress.
• Hospital centred.
• Lack of choice in alternatives to pharmacological
  therapies focused on illness and deficits, and
  risk averse.
• Disjointed care
• Reactive care.
• Service user as passive recipient.
• Low emphasis on self care/management.
• Carers undervalued
• Low tech, with recognised problems with
  information systems.

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Mental Health and Delivering for Health

• Evolving Model of Services
• Geared towards supporting recovery from long
• term problems.
• Embedded in local communities, based on local
  community need with increasing alternatives to
  hospital care and enhanced quality of inpatient
  care provision.
• Enabling, person-centred recovery and strengths
  -based focus with a move towards positive
  management of individual risk.
• Maximising choice and access to evidence-based
  interventions.
• Continuous whole-systems care.

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Mental Health and Delivering for Health

• Evolving Model of Services
• Preventive care and focus on early intervention
• Service user as active partner and expert in his
  or her experience and recovery
• Emphasis on facilitating self management and peer
  support.
• Carers supported as partners
• Improved technology with the potential for
  innovative use of technology to support access to
  care.

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Summary of Mental Health Nursing Responseto
Delivering for Health

• Continuing to develop key roles in the support of
  people with complex and long-standing mental
  health problems and for older people
• Adopting strengths and recovery-focused models,
  maximising self management and peer support.
• Adopting frameworks for practice that promote
  values-based practice, maximising therapeutic
  contact time and the therapeutic management of
  individual risk
• Continuing to build capability to increase access
  to psychosocial interventions and psychological
  therapies.
• Continuing to develop and maximise roles and
  capability in anticipatory care and early
  intervention.

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Summary of Mental Health Nursing Responseto
Delivering for Health

• Continuing to develop and maximise roles in
  health improvement, health promotion and tackling
  health inequalities
• Playing key and extended roles across the
  spectrum of acute inpatient, crisis care and
  intensive home treatment services (hospital and
  community based), incorporating new whole-systems
  ways of working
• Recognising carers/families as partners and
  supporting them in their caring role.

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What are mental health nurses valued for ?

• Relationships that are about
• Constancy, regularity and time for interactions
• Looking after people caring and nursing
• Being ordinary and professional human
  qualities along with skills and confidence
• Multi-faceted support -reducing stigma,
  preventing isolation, providing practical
  support.
• Making the system work

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What are we criticised for?

• Not being available
• Passing relationships key workers
• Not enough time for talking and listening
• Not enough information
• Not involving carers and relatives
• Poor communication
• Attitude

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We know what helps what stops us doing it?

• Poorly designed services
• Competing demands
• Plugging gaps
• Risk aversion
• Limited support
• At times - a lack of confidence
• Too little emphasis on clinical leadership
• Not using our own resources

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So What Can We Do About It ?

• The Actions from the Review
• Rights, Principles and Values Based Practice
• Maximising Relationships
• Promoting Recovery
• Prioritised areas of practice development
• Getting the right education and development
  infrastructure in place

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• Rights, Principles and Values Based Practice

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A values base for MH nursing
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Summary of the KEY Principles

• Non-discrimination
• Equality
• Respect for Diversity
• Reciprocity
• Informal care
• Participation
• Respect for Carers
• Least Restrictive Alternative
• Benefit
• Child Welfare

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Review actions

• Values based training
• Assessment and care planning frameworks revised
  to fit values base
• National training framework in recovery-based
  practice
• Recovery audit tools

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• Maximising Relationships

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Relationships - Resounding messages simple but
important

• Previous reviews of mental health nursing have
  affirmed that the relationship between the nurse
  and person requiring support, based on
  partnership and mutual respect, is at the heart
  of mental health nursing practice.This report
  makes no apology for restating this core element
  of mental health nursing. Aspirations for role
  development and expansion have to be built on
  this foundation (SEHD, 2006).
•  
• The relationship between the mental health nurse
  and the person requiring support is what service
  users value most. It is about much more than the
  nurse being someone nice to talk to (SEHD
  ,2006).
• Before you get carried away with expanding
  roles make sure you can deliver what people want
  and need (Service user and carer reference
  group, 2005).

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Main Thrust of Three Decades of Empirical
Research

• Its the Relationship
• A review of 1000 control studies including 300
• meta--analyses, involving psychotherapies found
  that the largest chunk of outcome variance that
  is not attributable to pre-existing client
  characteristics involves the therapy relationship
  and then the individual therapist regardless of
  technique or school of therapy. Steve Onken

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The Actions from the review

• Recovery

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Starting point

• People can and do recover
• A common human experience
• Recovery as process or journey rather than an end
  point
• More than recovery from illness or absence of
  symptoms

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The starting point

• Different things help different people
• Creative, person centred approaches
• Values based approach
• Values and evidence based approaches
• What we think and say impacts outcomes

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Understanding recovery
What matters in recovery is not whether were
using services or not using services using
medications or not using medications. What
matters in terms of a recovery orientation is,
are we living the life we want to be living? Are
we achieving our personal goals? Do we have
friends? Do we have connections with the
community? Are we contributing or giving back in
some way? Pat Deegan
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Long term process
I think theres just a lack of understanding that
recovery can take place over a long period of
time, so the fact that however much further down
the line a period of being symptomatic occurred
it doesnt mean that I wasnt recovering SRN
Narrative Research Project
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Some helping factors

• Having hope
• A belief in change
• Being ready to lead own recovery
• Triggers and starting points
• Self management and coping skills development
• Being optimistic yet realistic

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What people say helps them

• Having a chance to contribute or give back
• Finding meaning and purpose
• Supportive relationships
• Becoming engaged and involved (at all levels)
• Supportive and accessible services and treatments
• Patience, creativity etc etc

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A recovery approach

• Is based on a belief in recovery
• Understands role and limits guiding, helping,
  supporting person on their journey
• Creates an expectation of recovery
• Emphasises and promotes hope and optimism
• Promotes strengths and capacity

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A recovery approach

• Values lived experience and knowledge
• Is person centred and holistic
• Encourages self-direction and personal
  responsibility
• Ensures, wherever possible, that service users
  are active participants not passive recipients
• Promotes social inclusion

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A recovery approach

• Offers a range of services and treatments which
• are responsive and accessible
• are appropriate and therapeutic
• offer continuity
• Promotes self management and skills development
• Considers attitudes and values
• Considers recovery outcomes

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A recovery approach

• Allows positive risk taking and creative
  solutions
• Is seen throughout a service
• Allows people to contribute and give back
• Promotes meaning and purpose
• Promotes involvement and influence at all levels

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The Actions

• Priority areas for support and Development

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The spectrum of acute care its not just what
hospitals do

• Supporting inpatient units in adopting new models
  and new ways of working
• Acute care knowledge and practice development
  network
• Investment in development of education to support
  nurses working across the spectrum of acute care
  and promote new ways of working

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The Actions - Priority areas for support and
development

• Raising the profile of older peoples Mental
  Health Nursing
• Maximising the role of Mental health Nurses in
  supporting others
• Investment in development of educational
  opportunities
• Increasing opportunities in training for
  psychosocial interventions and psychological
  therapies

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The Actions

• Education and development
• Redesign pre-registration preparation
• Investment in CPD in priority areas
•  Health care support worker staff development
•  Development of newly qualified nurses
•  Leadership in mental health nursing - increase
  number of nurse consultants, ensure leadership
  development programmes
•  Research culture and capability
• National mental health nursing learning climate

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4 months on - any progress ?

• National Implementation Group
• Local Implementation Groups
• NES/SRN/QIS activities
• The 3 Rs Network bringing about and
  supporting change via strong alliances
• The evolving mental health delivery plan

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The Next 5 Years Challenging but ----

• From Shaun McNeil  Karen Robertson (on behalf
  of their groups)
• For too long, mental health nurses have known
  what they would like to do to improve service
  users lives, but have often felt constrained.
  The review of mental health nursing in Scotland
  now gives us the instrument to support, develop
  and liberate mental health nurses undoubted
  skills and talents. (SEHD, 2006)
•  

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What can we do about this ? A Mandate for Change

• My challenge to mental health nurses is to own
  this report and drive implementation of the
  action plan. To do this, you need to positively
  exercise your accountability, voice, influence
  and leadership to bring about the changes you
  want for yourself and others, harnessing and
  strengthening alliances to make a difference. Be
  brave, challenging, and productive in promoting
  service users rights and recovery.
• Paul Martin
• Chief Nursing Officer

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• THANK YOU