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Recovering Ordinary Lives –Two Years on
Genevieve Smyth
College of Occupational Therapists
12th February 2009
Introduction
Recovering Ordinary Lives launch December 2006 (COT 2006)
Current context Themes and key messages –update Challenges and opportunities
Launch of Recovering Ordinary Lives Launch with HRH Culmination of 18 months of work Aimed to: Raise the profile of occupational therapy
in mental health Develop professional leadership Promote occupation and its relationship
to mental health and well being
Recovering Ordinary Lives documents Recovering Ordinary Lives. The
strategy for occupational therapy in mental health services 2007-2017. A vision for the next ten years.
Recovering Ordinary Lives –literature review
Recovering Ordinary Lives –results of service user and care focus groups
The Vision
By 2017, mental health service provision in the UK will be better for the active role and inspirational leadership provided by the cultural heritage and identity of occupational therapy which at its core is social in nature and belief. It will therefore deliver the kind of care that service users want, need and deserve.
Five themes
Valuing occupation Added value of occupational therapy Occupational therapy leadership Education and training Workforce development
Key messages for:
Occupational therapy practitioners Occupational therapy managers College of occupational therapists Occupational therapy educators Commissioners of mental health
services Occupational therapy researchers
Current context
Closing DH work streams Changes in the NHS Employment agenda NICE guidelines Mental Health Act (2007)
Closing DH work streams
Embedded in NHS culture Enhance, include, evolve: New Ways of
Working for the Allied Health Professionals (CSIP/NIMHE 2008)
National Social Inclusion Programme –occupational therapy secondment:
Capabilities for inclusive practice (DH 2007)
Closing DH work streams
End of the Mental Health National Services Framework (Appleby 2008) resulting in:
Better community care Modern interventions –anti psychotic medications
and Improving Access to Psychological Therapies (IAPT)
Decreased suicide rates Smoke free wards BUT lack of progress about stigma www.time-to-change.org.uk - ending mental health
discrimination
Closing DH work streams
“Baby of NSF” in 2009 Louis Appleby talks about: Care pathways of choice Evidence based psychological therapies Race equality Mental health spectrum
Closing DH work streams
A New Vision for Mental Health discussion paper (Future Vision Coalition 2008)
A movement away from the dominance of the medical model, avoiding segregation
Greater importance of public mental health Aim of services should be recovery of a good
quality of life Power relations need to shift to give
individuals real self determination
Changes in the NHS
Next stage Review final Report –High quality care for all (DH 2008a).
The Health Bill (Stafford 2009) Framing the contribution of AHPs (DH 2008b)
data collection, ease of access, improve quality, piloting personal budgets
Foundation trusts Payment by Results (Smyth 2008)
The Employment agenda
Working for a healthier tomorrow (Black 2008) highlighted mental health growing problem for the working age population
Waiting for the mental health and employment strategy promised Spring 2009
Welfare Reform Bill (Stafford 2009)
The Employment agenda
Mental Health and Work (RCP 2008) Individual Placement support versus pre
work skills training Work matters- Vocational navigation for
occupational therapy staff (COT 2008a) Vocational Rehabilitation Strategy (COT
2008b) Recession
NICE guidelines
Occupational therapy and physical activity interventions to promote the mental well being of older people in primary and residential care (NICE 2008)
Research evidence base Five study days to support implementation of
guidance (Lawson Porter 2008)
NICE guidelines
Older people and their carers should be offered regular group and /or individual sessions to encourage older people to identify, construct, rehearse and carry out daily routines and activities
Occupational therapists should be involved in the design and development of local relevant training schemes for those working with older people to include essential knowledge of occupational therapy principles and methods
Mental Health Act (2007)
Came into force November 2008 New roles now open to occupational
therapists (Carr and Smyth 2008) Approved Mental Health Professional (AMHP) Responsible Clinician (RC) Best Interests Assessor (under amendments
to the Mental Capacity Act 2005)
So over the past two years…
A time for endings A time for beginnings Shifting emphasis
Valuing Occupation
A healthy human being is a healthy human doing
Mental health spectrum and mental well being
Employment agenda -Work is good for you
Darzi -Prevention
Valuing occupation
Using occupational language explain with confidence the meaning of occupation and its relationship to recovery and well being.
Developing an agreed occupational language and then auditing care plans, integrated notes, reports and letters
Valuing occupation
Opportunities – embracing the social model in mental health
Occupation and Health; A review of selected literature (Creek and Hughes 2008)
Challenge – how much is occupation really valued in relation to mental health among competing priorities?
The added value of occupational therapy Selling what we have to offer NICE guidelines Payment by Results
The added value of occupational therapy Build pathways of care that highlight what
service users can expect of their occupational therapy intervention.
Following pathways devised by the London Professional OT leads about occupational therapy specific roles: adult inpatient; community; older people; forensic; rehabilitation; employment –disseminated later in 2009 (Morley 2009)
The added value of occupational therapy Opportunities –DH interest in the
employment pathway
Challenges - Differentiate between the added value of an occupational therapist and occupational therapy
Occupational therapy leadership Leading occupational therapy into the
future Darzi – all AHPs developing leadership
Occupational therapy leadership Secure representation on government
working parties, committees and other groups that develop or influence policy in mental health.
Meetings with Ivan Lewis, Phil Hope, Louis Appleby, Professor Dinesh Bhugra, Lord Adebowale, Steve Shrub
COT leadership conference, seminars and a toolkit
Occupational therapy leadership COT increased political activism –Public
Affairs Officer attendance at the three party political conferences –jointly hosted round table discussions with MPs with Sainsbury Centre for Mental Health about vocational rehabilitation (COT 2009)
Early day motion tabled in the house of Commons during OT Week 2008 signed by 60 MPs including Vince Cable (Christie 2009)
Occupational therapy leadership Opportunities – locally and nationally.
Trusts using Recovering Ordinary Lives to develop local strategies to lead the profession.
Challenges – reducing numbers of leadership posts
Education and training
Pre and post registration training about mental health
Develop research capacity NICE guidelines Post graduate training for the new roles
(NIMHE 2008)
Education and training
COT conducted a mapping exercise of Higher Education Institutes programmes against Recovering Ordinary Lives at end of 2008 reveals most institutions are working well towards all the education and training factors
Education and training
Seek to develop and take the lead in co-ordinated programmes of research
Research Centre for Occupation and Mental Health (RCOMH) currently has three research streams:
Occupation and people with psychosis in the community
Work for mental health and well being Boredom www.yorksj.ac.uk
Education and training
Opportunities – RCOMH allows people to work together
Challenges – Is there enough occupational therapy specific post –grad training?
Workforce development
Where and how many? Framing the contribution of AHPs –access Employment agenda –Not enough support for
mentally ill to work due to shortage of skilled OTs in vocational rehabilitation, The Guardian, 8th December 2008
NICE guidelines New roles under the Mental Health Act
Workforce development
Take an overview of the skills mix across services and consider where occupational therapists might have the most impact in meeting service user need.
Occupational therapists working shifts on wards (Stopher 2009)
BAOT insurance cover for the new roles Self assessment audit tools
Workforce development
Opportunities – we have lots to offer
Challenges – do we have too much too offer?
Summary
Current local and national positioning of Recovering Ordinary Lives
Practical examples of the strategy’s impact
Opportunities and challenges [email protected] 0207 450 5220
References
Appleby L (2008) Mental health ten years on - Progress on mental health care reform. Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_074241
Black C (2008) Working for a healthier tomorrow. Available at www.workingforhealth.gov.uk
Carr J, Smyth G (2008) New roles –are you ready? Occupational Therapy News, 16(11), 24-25.
Christie D (2009) Early motion success. Occupational Therapy News, 17(1), 11.
COT (2006) Recovering Ordinary Lives. The strategy of occupational therapy in mental health services 2007-2017. London, COT.
References
COT (2008a) Work matters –Vocational navigation for occupational therapy staff. London, COT.
COT (2008b) Vocational Rehabilitation Strategy. London, COT. COT (2009) Annual Review 2007-2008. Occupational Therapy
News, 17(1), 10. Creek J, Hughes A (2008) Occupation and health: a review of
selected literature. British Journal of Occupational Therapy, 71(11), 456-468.
CSIP/NIMHE (2008) Enhance, include, evolve. New Ways of Working for Allied Health Professionals. Available at: www.newwaysofworking.org.uk
References
DH (2007) Capabilities for inclusive practice. London, DH. Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_078095
DH (2008a) High Quality Care for all –Next stage review. Available at: www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/DH_085825
DH (2008b) Framing the contribution of Allied Health Professionals. Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089513
References
Lawson Porter A (2008) OT and physical activity interventions. Occupational Therapy News, 16(12),15.
Morley M (2009) Pathways in mental health. Occupational Therapy News,17(1), 31.
NICE (2008) Occupational therapy interventions and physical activity interventions to promote the mental well being of older people in primary care and residential care. Available at: www.nice.org.uk/PH16
NIMHE (2008) Mental Health Act 2007 New Roles. Available at www.mhact.csip.org.uk
Royal College of Psychiatrists (2008) Mental health and work. Available at www.rcpsych.ac.uk
References
Smyth G (2008) Payment by results for mental health and learning disabilities. Occupational Therapy News, 16(12), 9.
Stafford G (2009) The health and welfare reform bills. Occupational Therapy News, 17(1), 6.
Stopher R (2009) Reflections on a pilot post. Occupational Therapy News, 17(1), 11.
The Future Vision Coalition (2008) A new vision for mental health discussion paper. Available at: www.newvisionformentalhealth.org.uk