NOVEMBER 2009 Recovery Discussion Topic Recovery Pathways

Transcription

1 NOVEMBER 2009 Recovery Discussion Topic Recovery Pathways (Ref: META Services Inc toolkit) Rethink Personal Recovery Framework Supporting personal recovery involves moving away from a focus on treating illness and towards promoting well-being. This will involve transformation, in which professional models become part of a larger understanding of the person. This understanding can be guided by the Personal Recovery Framework which is based on the four domains of recovery that emerge from accounts of people who have lived with mental illness: Hope Self identity Meaning Personal Responsibility as a frequent self reported component of recovery including current and future self image in life, including life purpose and goals the ability to take personal responsibility for one s own life The Personal Recovery Framework is based on four recovery tasks commonly undertaken during recovery. These are loosely ordered, to suggest a general but not universal ordering from belief to action and from personal to social: Recovery task 1: Developing a positive identity The first task is developing a positive identity outside of being a person with a mental illness. Identity elements which are vitally important to one person may be far less significant to another, which underlines that only the person can decide what constitutes a personally valued identity. Recovery task 2: Framing the mental illness The second task involves developing a personally satisfactory meaning to frame the experience which professionals would understand as mental illness. This involves making sense of the experience so that it can be put in a box; framed as part of the person but not as the whole person. This meaning might be expressed as a diagnosis, or as a formulation, or it may have nothing to do with professional models a spiritual or cultural or existential crisis (hence the quotes in the task title). Recovery task 3: Self-managing the mental illness Framing the mental illness provides a context in which it becomes one of life s challenges, allowing the ability to self-manage to develop. The transition is from being clinically managed to taking personal responsibility through self-management. This does not mean doing everything on your own. It means being responsible for your own well-being, including seeking help and support from others when necessary. CPFT Recovery Topic - Recovery Pathways November 2009 Page 1 of 5

2 Recovery task 4: Developing values social roles The final task involves the acquisition of previous, modified or new valued social roles. This often involves social roles which have nothing to do with mental illness. Valued social roles provide scaffolding for the emerging identity of the recovering person. Working with the person in their social context is vital, especially during times of crisis when support usually received from friends, family and colleagues can become most strained. Recovery involves minimising the impact of mental illness (through framing and selfmanaging) maximising well-being (by developing a positive identity and valued social roles and relationships). A personal recovery-oriented mental health service is organised to support individual to undertake the four recovery tasks, underpinned by an emphasis on relationships. The central differences between recovery-oriented and traditional practice have been considered by several authors with experience of trying to implement pro-recovery service change and some points of variation are shown below. Since personal recovery is something the individual experiences, the job of staff is to support the person in their journey towards recovery. References: 1 Andresen R, Oades L, Caputi P. The experience of recovery from schizophrenia: towards an empirically validated stage model. Australian and New Zealand Journal of Psychiatry 2003; 37: Allott P, Loganathan L, Fulford KWM. Discovering hope for recovery: a review for practiceand systems change. Canadian Journal of Community Mental Health 3 May R. Making sense of psychotic experience and working towards recovery. In: Gleeson JFM, McGorry PD, editors. Psychosocial Interventions in Early Psychosis. Chichester: John Wiley & Sons; Roberts G, Wolfson P. The rediscovery of recovery: open to all. Advances in Psychiatric Treatment 2004; 10: Roberts G, Wolfson P. New directions in rehabilitation: learning from the recovery movement. In: Roberts G, Davenport S, Holloway F, Tattan T, editors. Enabling Recovery. The principles and practice of rehabilitation psychiatry. London: Gaskell; Farkas M, Gagne C, Anthony W. Recovery and rehabilitation: a paradigm for the new millennium: Boston, MA: Centre for Psychiatric Rehabilitation; 1999 CPFT Recovery Topic - Recovery Pathways November 2009 Page 2 of 5

3 Traditional Approach Recovery Approach Values and power arrangements (Apparently) value-free Professional accountability Control oriented Power over people Value-centred Personal responsibility Oriented to choice Awakens people s power Basic Concepts Scientific Pathography Psychopathology Diagnosis Treatment Staff and patients Humanistic Biography Distressing experience Personal meaning Growth and discovery Experts by training and experts by experience Knowledge base Randomised controlled trials Systematic reviews Decontextualised Guiding narratives Modelled on role models Within a social context Working practices Description Focus on the disorder Illness-based Based on reducing adverse events Individual adapts to the programme Rewards passivity and compliance Expert care co-ordinators Understanding Focus on the person Strengths-based Based on hopes and dreams Provider adapts to the individual Fosters empowerment Self-management Goals of the service Anti-disease Bringing under control Compliance Choice Pro-health Self-control Return to normal Transformation CPFT Recovery Topic - Recovery Pathways November 2009 Page 3 of 5

4 Recovering Innovations Arizona Pathways to Recovery Webster defines pathway as a foot path, a beaten track, any path or course. In other words, it s a path that s easy to find and follow. Recovery services should lay out a clear path that makes it easy for people to continue their journey of recovery. People who recover from serious mental illnesses and/or substance abuse addictions generally point to one or more of five pathways that helped them find their way to recovery. These five Recovery Pathways are: Hope, Choice, Empowerment, Spirituality and Environment. A little about each pathway is described below. Hope (a belief ) that things will get better that I can do better that I can have dreams in the positive in a better future an optimistic outlook Choice recovery is a choice choice promotes identity choice promotes strength choice promotes self-determination choice is an exercise at being an expert Empowerment resisting the being fixed role resisting the fix it role for others putting the power where it s needed, i.e., with the person recovering promoting a helping role promoting self-advocacy recognising the value of resistance Spirituality connecting within and beyond the self finding meaning and purpose using the force to move things forward developing our own spiritual strengths respecting each person s chosen spiritual path Recovery Environment staying on the recovery side using recovery language celebrating diversity avoiding gossip maintaining a caring level of consciousness CPFT Recovery Topic - Recovery Pathways November 2009 Page 4 of 5

5 Questions for discussion: Hope What does a person believing that they can get better have to do with their recovery? Choice How does having choices promote (increase) a person s identity? Empowerment Why does the person recovering need the power? Spirituality How can spirituality give a person a meaning and purpose? Recovery Environment Why must a recovery environment be one that maintains a caring level of consciousness in order for people to recover? CPFT Recovery Topic - Recovery Pathways November 2009 Page 5 of 5