ACTivating Recovery in Public Mental Health Services

Transcription

1 ACTivating Recovery in Public Mental Health Services Presenters; Dr Lisa Soares Dr Nigel Alexander Dr Eliot Goldstone Jesse Gates NorthWestern Mental Health

2 NorthWestern Mental Health One of the largest publicly funded providers for mental health services in Australia, Offering comprehensive hospital-based, community and specialist services to youth, adults and aged people across northern and western Melbourne.

3 What we offer Provide a range of components so that consumers have access to similar service responses and functions wherever they live Service delivery depends on local service environment and catchment area. The critical factor is that all area mental health services provide the full range of functions

4 ACTivating Recovery at NWMH ACT has been introduced in a variety of ways across NWMH This symposium aims to highlight how NWMH has adopted ACT as part of its service delivery model.

5 Learning Objectives 1) Identify ways ACT can be integrated as part of Recovery Oriented Framework of care within a public mental health service. 2) Understand how ACT principles can be used within AOD services to further enhance the treatment of consumers with dual diagnosis issues. 3) Consider the effectiveness of ACT group programs in the treatment of severe mental health issues.

6 ACTivating Recovery Through Meaning: Embedding ACT within a Public Mental Health Setting? Working towards recovery with evidence based interventions Dr. Lisa Soares Senior Clinical Psychologist Manager, Practice & Strategy Inner West Area Mental Health Service, Melbourne

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8 Recovery is about building a meaning and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems Shepherd, Boardman and Slade (2008)

9 Working towards Recovery with Evidence-Based Interventions Make a difference every time... every opportunity. Our Identity The Inner West AMHS is committed to working with consumers during their recovery by offering holistic and evidence-based treatment aligned with their values, which is inclusive of family/carers and provided by clinicians with well-developed skills. Our Commitment To build and maintain a program based on evidence-based interventions, informed by lived experience, for mental health conditions To provide training and learning opportunities through various modalities including the IW Practice Development Calendar, peer consultation, coaching and supervision as well as external training opportunities. To support staff to acquire and maintain a high degree of skill in a range of evidence-based treatments

10 Psychological Interventions Early Warning Signs & RWP discussion (within 3/12) CBT Fundamentals* CBT for Psychosis (CBTp) Acceptance & Commitment Therapy (ACT) Therapies for Borderline Personality Disorder Core and Specific Evidence Based Interventions Family and Carer Work Family Contact (within 6/52) Family Consultation/ Single Session Multiple Family Group Family Therapy FaPMI Programs Healthy Lifestyle Physical Health Form (within 3/12, repeated annually) Assisted Intensive Medication Service (AIMS) Medication Alliance Health Promotion, awareness and coaching Wellness Program Vocation Conversation about Vocation APQ6 (within 3/12, repeated annually) Vocational OT Assessments & Interventions Action Over Inertia The Works Lived Experience Conversation about Peer Support options Peer Zone Peer-led Recovery Groups Peer Support Family/Carer Peer Support Overcoming Hurdles LSI-R:SV Screen Alcohol and Other Drugs Screening and Assessment SCOFF Risk Management Planning Risk Reduction Treatment D2 Motivational interviewing Harm minimisation CBT for co-morbid Anxiety & Depression Be Well Live Well - Early Warning Signs Relapse Prevention Program Relapse prevention Referral for detox Eating Disorder CBTe

11 Recovery Through Meaning Exploration of the promotion of recovery through evidence based principles Many ACT principles complement the Framework for Recovery Oriented Practice Though identifying values can be a challenging task for some, it can help guide and motivate us towards meaningful goals and aspirations. Helping consumers to normalize and flexibly open up to previously stigmatized and/or avoided mental experiences in order to more effectively pursuit a meaningful and rich life is a central aspect of our work as mental health clinicians.

12 ACTivating Recovery Process driven Personal vs Clinical Recovery The relationship facilitates supports, and/or focuses the person s direction for meaning (Hubble, Duncan & Miller, 1999) The overarching message is that hope (for the person) and restoration of a meaningful life are possible, despite serious mental illness (Deegan, 1988; Stocks, 1995; Spaniol et al., 1997). the development of new meaning and purpose in one s life as one grows beyond the effects of mental illness (Anthony 1993).

13 ACTivating Our Plan ACT Foundation sessions offered to all staff as part of the Practice Development Sessions at a local level ACT Peer Supervision Group: Based on the Portland Model Psychiatric Registrar Tutorials on ACT Continuation of the ACT Peer Supervision Group: Based on the Portland Model Area of Practice Representative Guidelines developed for ACT ACT Introductory Advanced Sessions offered to interested clinicians across NWMH Wise Choice Group Program

14 ACT Foundation Sessions 3 x 2 hour sessions offered Pre reading was required Sessions were experientially based Staff were encouraged to base their learning on themselves rather than thinking of a client they were working with The Triflex

15 Attendance at ACT Foundation Sessions Values Open Present 5 0 Total

16 Discipline Attendance at ACT Foundation Sessions Values Open Present 2 0 Medical Nursing OT Psychology Social Work

17 Overall Themes from the Data Overall quality of each session was rated as very good for all sessions. Participants rated their understanding of topics prior to sessions as poor or satisfactory. Participants agreed that their understanding of topics had improved following all sessions. Participants agreed that all sessions met their expectations, that they would recommend them to colleagues and that the resources provided were helpful. Participants regularly stated that they found practical exercises and demonstrations most useful. Participants also expressed enthusiasm about ACT and requested further training or longer sessions incorporating more material, and the provision of additional resources.

18 ACT Peer Consultation Group Running for 24 months Occurs monthly for 1 ½ hours Average of 10 clinicians attend each session Based on the Portland Model

19 The Inner West Model Group Structure Mindfulness Exercise Outstanding business Review of Theory Interactive Skill building exercise Observations from the group Case Presentation Group discussion Roles & Responsibilities Group Leader Mindfulness Exercise Facilitator Skills Builder Case Scenario Case Presenter

20 Reflections from our group Learning the art of Self Compassion Take time out of my busy schedules to reflect of what matters to me, right now Reassurance Day to day work with consumers does not need to be structured therapy members Embracing mindfulness Has been really good hearing how other people use ACT in day to day work, and how to use it creatively, and start conversations Opening up conversations Working with our own struggles Curiosity Sharing of experiences, knowledge, ideas and resources The group is great, but it is difficult to have a regular group of people given people s time pressures at work. Use the ideas of ACT in day to day life

21 Introducing ACT to our Medical Increased requests for 1 on 1 ACT supervision for Psychiatric Registrars rotating through our service Facilitation of Psychiatric Registrar Tutorials focusing on ACT Workforce

22 Feedback from the group I really different way of conceptualising cases Really neat way to help consumers make decisions based on what is most important to them I like the focus on values and trying to help the patient understand the importance of this I can see how this could be helpful for people who don t have the cognitive skills to dispute or reframe their thoughts An interesting way of using the ideas of ACT in day to day life I like the options around different mindfulness techniques Does the evidence really give enough support for use of these approaches over more traditional CBT options? I d like to know more!

23 Area of Practice Representative Key messenger for ACT Guidelines for ACT Deliver a key, consistent message to their team Conduit between own team, discipline and wider service Educate, advocate, build relationships and navigate barriers to the message of practice development across the IW Have sound, up-to-date knowledge Highlight the intervention/use of instrument in clinical meetings Meet with new staff to explain competencies Support team colleagues with intervention/instrument Provide feedback to ACT practice lead

24 Understanding Behaviour There are many challenges of working within a diagnosis-centric service system Attitudes and stigma related to certain diagnoses Shifting perspective towards the function behaviours may serve Functional Behavioural Assessment Hurl, K., Wightman, J., Virues-Ortega, J., & Haynes, S. N. (2016).

25 Group Programs Wise Choices in 2017 ACT group 10 week program for BPD Collaboration with NAMHS Supported by Spectrum PLAN: Offer group ongoing within IWAMHS Future possibilities: ACT for life (psychosis) Mindfulness based groups

26 Expanding ACT across NWMH Therapeutic help for troubling voices: Strategies from CBT and ACT : John Farhall (MHTDU) Introductory and Advanced ACT training opportunities are being offered to all staff across NWMH in 2017 (MHTDU) ACT Peer Forum, Mindfulness based therapies, in 2017 (WETS) Previous forums; Louise Hayes (2014) Eric Morris (2016)

27 Questions If you would like to know more, please feel free to contact Lisa at

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