Recovery: Getting your life back

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Recovery Getting your life back

• Miles Rinaldi
• Head of Recovery and Social Inclusion

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The policy context

• Beyond the treatment of illness
• Choice, control, social inclusion, personal
  responsibility core goals of NHS modernisation
• Improve peoples whole experience of using
  services tailor what we do around the wishes,
  concerns and convenience of those whom we serve
• Help people to manage their own problems become
  experts in their own self-care
• Positively promote health and well-being
• Maximise life chances
• Promote social inclusion and citizenship
• Central to developing recovery-focused services

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• Independence, Well-being and Choice (2005) the
  vision guiding the future of social care
• the principle that everyone in society has a
  positive contribution to make to that society and
  that they should have a right to control their
  own lives. Our vision is to ensure that these
  values will drive the way we provide social
  care.
• Breaking Down Barriers (National Director for
  Mental Health 2007) vision for the development of
  mental health services
• Employment, housing and a strong social network
  are as important to a persons mental health as
  the treatment they receive we have to continue
  to improve community care and break down the
  barriers than can prevent people from rebuilding
  their lives go beyond traditional clinical care
  and help patients back into mainstream society.
• Darzi (2007) Healthcare for London A Framework
  for Action areas of mental health care
  requiring particular improvement
• Service users should be put in control of their
  recovery and social inclusion should be
  supported.
• Chief Nursing Officers Review of Mental Health
  Nursing (2006)
• Mental health nursing should incorporate the
  principles of the Recovery Approach into every
  aspect of their practice.

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The journey from institutionalisation to recovery
-focused practice and self-directed support
(adapted from Robin Murray-Neill and Ruth Allen)

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The experience of mental health problems a
catastrophic an life changing experience

• Strange and often frightening symptoms
• Prejudice, discrimination, exclusion
• Loss of confidence and self-belief
• Feel very alone and very frightened
• Out of the blue your job has gone, with it any
  financial security you may have had. At a
  stroke, you have no purpose in life, and no
  contact with other people. You find yourself
  totally isolated from the rest of the world. No
  one telephones you. Much less writes. No-one
  seems to care if youre alive or dead . (Bird,
  2001)
• Last month I was a regular mum walking down the
  street with my kids in their push-chair now Im
  just a mental patient.
• They are all very nice to me here, but I dont
  think they understand what a big deal this
  schizophrenia is for me.
• (South West London Local User Surveys 2006)

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Challenge rebuilding a meaningful, valued and
satisfying life

• Recovery involves
• building a new sense of self, meaning and
  purpose
• growing within and beyond what has happened to
  you
• a deeply personal, unique process of changing
  ones attitudes, values, feelings, goals, skills
  and rolesThe development of new meaning and
  purpose in ones life as one grows beyond the
  catastrophic effects of mental illness
• (Anthony 1993)
• Ideas about recovery born not of learned
  academics but of people who had themselves
  experienced the challenge of living with mental
  health problems

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• Recovery is about
• living hopefully
• taking control over your problems and your life
• pursuing your dreams and ambitions
• relatives, carers, people close to the individual
  also face the challenge of recovery for
  themselves and for their loved one
• Recovery is not
• the same as cure
• a professional intervention an individual
  journey
• an end point an ongoing process of
  accommodating and moving beyond what has happened
  to you
• restricted to adults of working age older
  people, children, people with addictions
  problems, learning disabilities, people in
  forensic services )
• Not unique to people with mental health problems
  a common human experience

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• Recovery requires reframing the treatment
  enterprisethe issue is what role treatment plays
  in recovery. (Davidson et al, 2006)
• Away from the person in our services needs
  defined in terms of what we offer
• Towards the person in their life and how what
  we do helps (or hinders) the person in living the
  life they want to live
• Treatment one of many possible means to an end
  living the life you want to lead not an end in
  itself
• Key question Do our services help or hinder
  people in their recovery journey?

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2008 National Service User Survey
Overall involvement in decisions about treatment
and care scores
Overall rating of care received from the Trust in
the last 12 months scores

• But how good are we at helping people to rebuild
  their lives?

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What helps people in their recovery journey?
OPPORTUNITY accessing the roles, relationships
and activities that are important to you I
dont want a CPN, I want a life. (Rose, 2001)
Taking back CONTROL Recovery means I try to
stay in the drivers seat of my life. I dont
let my illness run me. Over the years I have
worked hard to become an expert in my own
self-care (Deegan, 1993)
HOPE and hope inspiring relationships The
turning point in my life was where I started to
get hope. Dr. Charles believed that I could. And
Rev Goodwin believed that I could. Certain
people believed that I could and held that
belief even when I didnt believe in myself.
(Donna in Vincent 1999)
Adapted from Repper Perkins (2003)
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A different approach to professionalism

• Traditionally assumed that the expert
  professional has access to a body of knowledge
  that cannot be understood by non-experts.
  Therefore it is our job to tell people what they
  should do.
• Traditionally we think about compliance
  getting people to do what we think is best for
  them
• Compliance interventions are often designed to
  increase clients behavioral conformity to a
  practitioners point of view of optimal
  treatment.
• (Deegan and Drake, 2006)
• A change in our view of professionalism ... on
  tap not on top putting our expertise at the
  disposal of those who be able to make use of it
  ... We need to see ourselves ascarriers of
  technologies that we may want to use at times,
  just like architects, plumbers and hairdressers.
  (OHagan, 2007)

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Promoting recovery, facilitating social
inclusionNot an add on to existing ways of
doing things but a fundamental change in vision,
values and practice