Centre For Recovery And Social Inclusion

11th June 2008

-TOWARDS A RECOVERY ORIENTED MODEL OF CARE-

Dr Martin LawlorConsultant Psychiatrist

Carraigmor PICUHSE, Cork & Clinical Senior

Lecturer, U.C.C.

Acknowledgements

Dr Michael Kelleher Dr Mike Doyle PhD Dr Stephanie Kennedy & Dr Robin Ellis Mr Malcolm Rae FRCN OP 64, Irish College of Psychiatry, Nov 2007 Sainsbury Centre for Mental Health, (2008)

Shepherd, Boardman & Slade

Learning themes

Discuss recovery as a systematic, dynamic process

Outline a framework for developing a recovery oriented care pathway-Practitioner, Team and Organisational level

Highlight the proposed role of the CRSI in promoting service user, staff and organisational development

Discourse-performative effect of language Systemic use: language-has a power enforcing function

You believe what clinician says, you give permission to operate, etc

The language game of discourse expresses and enacts the authority of those who are empowered to use it within a social group

It can be used to marginalise, exclude or subordinate those who are outside it

Rational model - ‘Show me the evidence’

The importance of meaning, understanding and narrative

Tension in developing a shared understanding.

Psychiatric perspective

Prominent symptoms-cancer, multiple sclerosis, Rheumatoid arthritis

improve with treatment but often d'ont recover to where they were when they became ill

Focus on symptoms, severity, duration

Psychiatric perspective

Integrated model

gene enviroment interaction-including the social environment (Family and Childhood)

Psychosis-final common pathway is dopamine dysregulation in CNS

Risk paradigm

Risk v personal quality of ‘dangerousness’

Two components-Probability/Impact

Structured Professional Judgement

Multidisciplinary approach

RECOVERY

Re-(dis)-cover

a sense of personal identity

separate from illness or disability a movement away from pathology, illness and

symptoms

to health, strengths and weaknesses Needs based approach

RECOVERY Recovery is not an end point, but a

continuing journey

People are ‘recovering’

MH staff, MH services cannot in themselves practice recovery

This can only be lived by service users

RECOVERY MH staff can try to create the conditions

In which individuals feel empowered And their sense of personal ‘agency’ can

flourish

Need clear models of service delivery

Underpinned by Policy Implementation Guide

FAMILY & CARERS

Family or other supporters are central to recovery

should be included as partners whenever possible

Peer support is crucial for many people

SELF MANAGEMENT

is encouraged and facilitated

no one size fits all

Helping relationship between clinician and patient moves from Expert/patient to coach/partner

RECOVERY What kind of behaviours do staff need to

display to create a recovery-oriented service?

What kind of training programmes are required to produce those behaviours?

What kind of organisational factors, promote or inhibit the uptake of these practices?

RECOVERY-Practitioner level OPENNESS

COLLABORATION AS EQUALS

A FOCUS ON THE INDIVIDUALS INNER RESOURCES

RECIPROCITY-Give and take-

A WILLINGNESS TO GO THE EXTRA MILE

RECOVERY-Practitioner level Empathy Positive expectation of the future Caring

Acceptance Mutual affirmation ‘Hope’ inspiring relationships An encouragement of responsible risk

taking

RECOVERY-Practitioner level Actively listen Help the person identify and prioritise their

goals for recovery Show a belief in person’s existing strengths and

resources

Encourage self-management (Information, reinforce existing coping strategies)

Discuss what the person wants in terms of therapeutic interventions

Convey an attitude of respect Express optimism

RECOVERY-Individual Needs Based Assessments

Diagnosis/ Co-morbidity

Risk assessment-to inform therapeutic risk taking

Recovery Factors Personal goals Hopes Aspirations Engagement with service Motivation for self management

RECOVERY-Individual Assessments Functional & Occupational skills

Psychological well being Developmental model, early childhood, stressors, coping

strategies

Cognitive Functioning

Physical Health

Unmet needs

Carer assessment

RECOVERY-Individual Assessments: Key steps Review history/collateral

Engage service user and family

MDT Assessment-SKILLS OF DIFFERENT PROFESSIONALS MUST BE INCORPORATED INTO CARE PLANS

Holistic-Biopsychosocial assessment, Needs Led

Shared view of service users difficulties and strengths

Create a person centred formulation/care plan

RECOVERY-Team level Opportunity for service users to be

employed in care giving roles

Does the team encourage real user involvement?

How do you know that this is happening? Job description/ Appraisal Clinical supervision

RECOVERY-Training 10 essential shared capabilities,

Framework NIMHE (2004)

Organisational rules and behaviour which promotes recovery oriented practice

RECOVERY-Strategic Level ‘Vision for change’ offers a template

Assertive outreach : provision of individualised, focussed and proactive care to service user

Minimise risk of disengagement

Patient centred-evident in detailed individual assessments and carefully formulated care plans

Practical/ Key worker / Liaison with other agencies

RECOVERY-Organisational Level Mission statement-goals and aims. Move form

‘excellence’ to ‘responsibility to positively improve the lives of others’

Commitment to involve service users in running the organisation at all levels

Shift towards an educational Vs Therapeutic model

Peer Professionals

Therapeutic relationship

Organisational culture-what we do Power, role and task culture

Mentoring

Guided discovery

Adult learning

Organisational culture

Culture is the sum of shared, values and beliefs that people in the organisation hold

Shared assumptions they make Shared philosophy they identify with

Shared attributes are the foundations of organisational culture

Organisational culture

PowerCulture

Role Culture

Task Culture

Person centred culture The community is the organisation

This organisation is service users , carers and professional coaches/mentors

Order/structure-by mutual consent

Emphasis on warmth, consideration and mutual support-Humanitarian

Centre for Recovery and Social Inclusion, C.R.S.I.

‘Open source’ templates-customisable; web-based support; Action Research Model

Role of CRSI: Develop capacity for hope, creativity, compassion, realism and resilience-at practitioner, team, and organisational level

Person centred culture-provide a service to a community (no ‘them and us’)

Social inclusion

People do not recover in isolation

Recovery is closely associated with social inclusion

and being able to take on meaningful and satifying social roles within local communities as opposed to segregated services

Recovery-Summary

Lived experience

Unifying force for the organisation

Break the traditional barriers between service users and staff

Both are respected for what they can bring

Power of organisation stems from central focus on service user & carer

HOPE is central to recovery

can be enhanced by each person seeing how they can have more active control over their lives

and by seeing how others have found a way forward

RECOVERY EXPLICITLY VALUES A PERSON CENTRED CULTURE