Recovery in mental health: Bexley audit

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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

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Recovery in mental health: Bexley audit

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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 Empowerment Holistic Learning from experience Strengths-based Peer support Respect Responsibility Hope

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 compulsory treatment 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 Peer support The Recovery Star Strengths approaches and positive risk taking

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