Bexley recovery audit. Done in January / February 2008Seven community teams: two long term teams, two intake teams, Assertive Outreach, Early Intervention and Crisis teamsStaff were asked to assess their team's working practice against 10 components of recovery and give examples ofWorking practic
1. Recovery in mental health: Bexley audit Caroline Cupitt
Dr Paul Wolfson
Dr Ewa Okon Rocha
Oxleas NHS Foundation Trust
2. Bexley recovery audit Done in January / February 2008
Seven community teams: two long term teams, two intake teams, Assertive Outreach, Early Intervention and Crisis teams
Staff were asked to assess their team’s working practice against 10 components of recovery and give examples of
Working practices that reflect these
Working practices that hinder these
3. The 10 Fundamental Components of Recovery: Self-direction
Individualised and person-centred
Learning from experience
4. Examples COMPONENT ONE: Self direction
People who use mental health services are encouraged to decide their own goals, and how best to achieve them.
COMPONENT FIVE: Learning from experience
Recovery is not a step-by-step process but one based on continual growth, occasional setbacks, and learning from the experiences of yourself and others.
5. A lack of peer support?
6. Analysis by team type Peer support was rated lowest by the functional teams (AO, EIS, Crisis)
Functional teams also thought responsibility, self-direction and strengths approaches needed development.
Intake teams identified hope and learning from experience as the most underdeveloped.
Longer term teams identified empowerment and learning from experience as underdeveloped.
7. Further analysis A weakness of the methodology is that ratings confound knowledge and perception
We therefore looked in more detail at the examples of team working practices given
They were assessed independently and those items which were not judged to be team working practices were eliminated
8. Themes in eliminated items Staff can feel that there is something about their client group which means they can not recover, e.g. “some clients have poor motivation”, “resistance”
Teams can feel that a lack of resources means that they cannot support recovery. This includes lack of time.
External factors may prevent this work, either Trust systems such as CPA, or wider systems such as Benefits
Some teams feel there are carers who are not on board with recovery or ‘interfere’ with it.
9. Hindering factors within teams
low expectations of clients by team members
stigma of diagnosis
hopelessness and burnout amongst staff
lack of information about local resources and other services
lack of time to work with clients, because of a requirement to move people on
concerns about confidentiality preventing development of peer support
a need to focus on risk issues
lack of cultural awareness
lack of resources within the team, for example for CBT
10. Examples of good practice using recovery-based tools e.g. WRAP and The Web
providing holistic support
ensuring support is individualised
access to specific team facilities that enhance recovery e.g. fast track clinics, advocacy
finding time for reflective practice as a team
basing support and interventions in the community
positive risk taking
making care planning collaborative
working with cultural and spiritual life
access to specific team resources such as psychology, motivation interviewing, Bridge Builders / support workers, smoking cessation, relapse prevention
11. Recommendations Develop peer support for service users
Address staff fears, such as confidentiality
More education about the concept of recovery
How it applies to all
How to work within existing resources
How to engage carers
Develop specific projects to address areas of underdevelopment with opportunities for teams to learn from each other
Re-audit, ideally including service users and carers to help generate a more critical perspective
12. Progress A series of recovery workshops have addressed the broad educational issues. External agencies and carers were included in this process.
Projects have been started to develop
The Recovery Star
Strengths approaches and positive risk taking