THE CHALLENGE OF DEVELOPING RECOVERY ORIENTATED SERVICES IN SECURE ENVIRONMENTS

Transcription

1 THE CHALLENGE OF DEVELOPING RECOVERY ORIENTATED SERVICES IN SECURE ENVIRONMENTS Dr Caroline Clarke Southern Health NHS Foundation Trust Dr Suzanne Sambrook University of Southampton

2 CHALLENGES FOR THE SERVICE Dual nature of the services Risk and mental health Balancing risk management with rehabilitation Containment vs Growth Risk reduction vs positive risk taking Culture

3 CHALLENGES FOR THE SERVICE USER Mandated Long periods in hospital loss of skills Prison mentality Hopelessness and lack of motivation Stigma seen as different, unreliable

4 RECOVERY Not just an intervention values based way of working Focus on collaborative enterprise Developing choices and self-motivation Living a meaningful life

5 CAN THE RECOVERY ETHOS BE PART OF SECURE SERVICES? The therapeutic purpose of detaining someone and treating them against their will is to achieve the gradual handing back of choice and control in ways that are safe and enable them to resume responsibility for themselves (Roberts et al, 2008)

6 DRIVERS Commissioning for Quality and Innovation (CQUINs) Payment framework encouraging continual improvement 2011/12: Patient reported recovery measures 2013/14: My Shared Pathway 2014/15: Collaborative risk assessment - training 2015/16: Collaborative risk assessment - implementation

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8 MY SHARED PATHWAY Offers a collaborative framework for planning, following and managing a patient s stay in secure services and aims to increase the focus on recovery in order for it to achieve parity with security. Patients are encouraged to be more responsible for their care by working in partnership with their care teams to identify and meet the outcomes that will help them be discharged A number of workbooks are used to identify recovery journeys and care pathways by exploring what led patients to secure services and what they can do to help them move on.

9 RECOVERY Aim: Explore the lived experience of recovery for male patients who were detained under the Mental Health Act (MHA, 1983) in a low secure service.

10 INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS (IPA; SMITH, FLOWERS, & LARKIN, 2009). Phenomenological focus on hermeneutic empathy that allows for the exploration between what people say in their interviews and the way that they think about their experiences. It has an idiographic focus that places the individual and their experience at the centre of the research as the unit of the analysis. The purpose of IPA is to become experience close in order to illuminate the links between thoughts, talk and experience, ensuring a holistic focus on the individual s experience

11 METHOD Convenience sampling 6 included in analysis Semi-structured interview IPA Analysis Quality and validity Reflexivity and independent audit

12 It s a journey Loss Freedom Power/control Lights vs dark Having a voice Leave the past behind you and don t look back The road is long Getting stuck Road map Relationships with staff Support Different perspectives We re vulnerable in here We can be victims too Get it down in black & white Let down Hope Self-discovery Identity

13 ROAD MAP Bob: You write it all down, you ve got these questions that you ve gotta answer, about you, your life, your past. You get it all down, all the pain, all the trauma and mistakes you made, so you know where you went wrong, do you know what I mean? Then, you can look at that and see what needs to change, how you move forward from the past.

14 FREEDOM Bob: Medication, wellness, getting out and breathing the air that s wellness.

15 DIFFERENT PERSPECTIVES Philip: There is no recovery. I shouldn t be here. There won t be recovery until I come off treatment and that s going to be a long time, because the doctor don t see to it that I need to come off.

16 LET DOWN Richard: I ve they ve told me about the Shared Pathway two or three times but they haven t actually done anything with it and erm I ve not had I ve hardly any say in my treatment so I haven t erm I don t think the Shared Pathway is really operated much.

17 SUMMARY Participants were able to give a clear account of their experience; central to this was their description of My Shared Pathway as a journey, one that was long and challenging, during which people were vulnerable and suffered loss. Relationships with staff were reported to be important; they can provide support and nurture hope to help people move along their recovery journey.

18 PROBLEMS ENCOUNTERED Difficulties embedding New CQUINs each year don t always build on previous ones Can be a paper exercise no real buy-in. Set up as a target rather than an ethos Champions come and go difficulties with sustainability and consistency Staffing - process seen as extra rather than part of the daily work Seen as belonging to psychology and OT

19 IMPLICATIONS For service users For nursing staff For psychology For services

20 THANK YOU