PRINCIPLES OF RECOVERY

1. PRINCIPLES OF RECOVERY Genevieve Smyth Professional Affairs Officer Mental Health and Learning Disabilities The College of Occupational Therapists 106-114 Borough High Street London SE1 1LB College of Occupational Therapists 2008

2. Introduction • Current position of Recovery in mental health • Definitions • History • Ten Recovery principles • Recovery process • Relationship to Recovering Ordinary Lives and occupational therapy • Challenges and strengths College of Occupational Therapists 2008

3. Current Position of Recovery • Fundamental guiding principle • Recovering Ordinary Lives –the strategy for occupational therapy in mental health services 2007-2017 (COT 2006) • Other professional bodies; RCN, BPS, RCP • NIMHE Guiding Statement on Recovery (2005) • Making Recovery a Reality – Shepherd et al (2008) Sainsbury Centre for Mental Health • Vivienne Wheeler, Hilary Williams College of Occupational Therapists 2008

4. Defining Recovery “Recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and contributing life, even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness…” (Anthony 1993) College of Occupational Therapists 2008

5. Contested Definitions • Can you define a personal journey? • Is it a model –a clearly constructed set of theories that model or represent clinical phenomena? College of Occupational Therapists 2008

6. History of Recovery • Consumer/Survivor Movement of 1980s and 1990s –not professionals • Self help, empowerment, advocacy • New Zealand, USA, UK • Challenge disease-driven ideas of mental illness • Service user narratives e.g. Patricia Deegan Recovery as a Journey of the Heart (1996) Recovery; the Lived Experience of Rehabilitation(1998) College of Occupational Therapists 2008

7. Research Evidence • Davidson and McGlashan (1997) • Long-term outcomes of people with serious mental health conditions • Research found ¼ - 2/3 of people experiencing first episode of psychosis recover to a degree where symptoms do not interfere with daily functioning College of Occupational Therapists 2008

8. Occupational Therapy Literature • Reberio Gruhl K (2005) Reflections on…the recovery paradigm;Should occupational therapists be interested? CJOT, 72(2), 96-102 • Lloyd et al (2007) The association between leisure motivation and recovery;A pilot study. AJOT, 54, 33-41. • Lloyd et al (2008) Conceptualising recovery in mental health rehabilitation. BJOT, 71(8), 321-328. College of Occupational Therapists 2008

9. Policy Context • Self management and choice in England Securing our Future Health – Wanless 2002 Mental Health and Social exclusion 2004 Our Health, Our Care, Our Say 2006 The Next Stage Review 2008 –personal health budgets The NHS Constitution 2008 –rights to respect and choice • Ireland –A vision for a recovery model in Irish mental health services (2005) • Scotland –Rights, Relationships and Recovery (2006) College of Occupational Therapists 2008

10. Shift in dominant paradigms and power relationships • From professional to service user • From medical to social model • Values based practice – The Ten Essential Shared Capabilities (Hope 2004) College of Occupational Therapists 2008

11. Ten Principles of Recovery (Shepherd et al 2008) • Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems • Recovery represents a movement away from pathology, illness and symptoms to health, strengths and wellness College of Occupational Therapists 2008

12. Recovery Principles cont. • Hope is central to recovery and can be enhanced by each person seeing how they can have more active control over their lives (‘agency’) and by seeing how others have found a way forward • Self-management is encouraged and facilitated. The processes of self-management are similar, but what works may be very different for each individual. No ‘one size fits all’. College of Occupational Therapists 2008

13. Recovery Principles cont. • The helping relationship between clinicians and patients moves away from being expert/patient to being ‘coaches’ or ‘partners’ on a journey of discovery. Clinicians are there to be “on tap, not on top” • People do not recover in isolation. Recovery is closely associated with social inclusion and being able to take on meaningful and satisfying social roles within local communities, rather than in segregated services College of Occupational Therapists 2008

14. Recovery Principles cont. • Recovery is about discovering - or re-discovering a sense of personal identity, separate from illness or disability • The language used and the stories and meanings that are constructed have great significance as mediators of the recovery process. These shared meanings either support a sense of hope and possibility, or invite pessimism and chronicity College of Occupational Therapists 2008

15. Principals of Recovery cont. • The development of recovery-based services emphasises the personal qualities of staff as much as their formal qualifications. It seeks to cultivate their capacity for hope, creativity, care, compassion, realism and resilience • Family and other supporters are often crucial to recovery and they should be included as partners wherever possible. However, peer support is central for many people in their recovery College of Occupational Therapists 2008

16. Common Recovery Factors (from www.mhrecovery.com) • Employment/Meaningful activity • Hope • Medication and treatment • Empowerment • Education/Knowledge • Support • Self Help • Spirituality College of Occupational Therapists 2008

17. Components of the process of recovery (Andresen et al 2003) Finding and maintaining hope - believing in oneself; having a sense of personal agency; optimistic about the future; Re-establishment of a positive identity - finding a new identity which incorporates illness, but retains a core, positive sense of self; Building a meaningful life - making sense of illness; finding a meaning in life, despite illness; engaged in life; Taking responsibility and control - feeling in control of illness and in control of life College of Occupational Therapists 2008

18. And then I lost that life; a shared narrative of four young men with schizophrenia(Gould et al 2005) • I remember when I was normal • It’s like your computer crashes • Coasting through life • Try to remake that life as best you can • Finally, I can move on with my life College of Occupational Therapists 2008

19. Recovering Ordinary Lives –the strategy for occupational therapy in mental health services 2007-2017(COT 2006) • “Occupational therapists will value recovery and will work within a socially inclusive framework to achieve goals that make a real difference to peoples’ lives. They will encourage people with mental health problems to make decisions and responsibilities for their lives by providing the necessary support.” College of Occupational Therapists 2008

20. Recovering Ordinary Lives –guiding principles • Interventions assist the client to achieve greater autonomy of thought, will and action • Interventions support the client in developing or maintaining a satisfying personal and social identity • Interventions move the client in the direction of fuller participation in society through performance of occupations that are appropriate to her or his age, social and cultural background, interests and aspirations. College of Occupational Therapists 2008

21. Recovering Ordinary Lives –key messages • For practitioners – Using occupational language explain the meaning of occupation and its relationship to recovery and wellbeing to service users, carers, colleagues and commissioners. • For managers - Provide information within your organisation on the importance of occupation to recovery and wellbeing • Our profession need to be able to articulate the links between occupation and building a meaningful, satisfying life College of Occupational Therapists 2008

22. Challenges (from www.mentalhealthnursingstaff.com) • Vague and subjective • Lack of research evidence base • ‘We’ve been doing this for years’ • ‘Language reconstructive operatives’ – giving old things new names • Tension between standardisation and individual process • Lack of BME involvement • Linked to discharge • Backlash from the medical model (Craddock et al 2008) attacking “psychosocial support with extremely limited therapeutic ambition”. College of Occupational Therapists 2008

23. Advantages of Recovery • Shifting power balances • Focuses on people not services • Emphasises strengths rather than weaknesses • Cost effective? • Wellness Recovery Action Plans (Mary Ellen Copeland) www.mentalhealthrecovery.com • Emphasis on hope – alerting healthcare professionals to institutional responses • Positive risk taking College of Occupational Therapists 2008

24. Summary • Contexts and definitions of Recovery • How it links to occupational therapy and Recovering Ordinary Lives • Challenges and strengths College of Occupational Therapists 2008

25. References • Andresen R, Oades L, Caputi (2003) The experience of recovery from schizophrenia; towards an empirically validated stage model. Australian and New Zealand Journal of Psychiatry, 37, 586-594. • Anthony W A (1993) Recovery from mental illness; the guiding vision of the mental health service system in the 1900s. Psychosocial Rehabilitation Journal, 16, 11-23. • Craddock N. et al (2008) A wake up call for British psychiatry. The British Journal of Psychiatry, 193, 6-9. • College of Occupational Therapists (2006) Recovering ordinary lives the strategy for occupational therapy in mental health services 2007 – 2017. London: COT. • Davidson L, McGlashan TH (1997) The varied outcomes of schizophrenia. Psychiatric Services, 57, 642 – 645. College of Occupational Therapists 2008

26. References • Deegan P (1996) Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 19 (3), 91-97. • Deegan P (1998) Recovery; the lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 11, 11-19. • Hope R (2004) The 10 essential shared capabilities: a framework for the whole of the mental health workforce. London: DH. • Gould A, DeSouza S, Rebeiro-Gruhl KL (2005) And then I lost that life: a shared narrative of four young men with schizophrenia. British Journal of Occupational Therapy, 68 (10), 467-473. • National Institute for Mental Health in England (2005) NIMHE Guiding statement on recovery. Available at www.nimhe.org.uk • Shepherd G, Boardman J, Slade M (2008) Making recovery a reality. London: Sainsbury Centre for Mental Health. College of Occupational Therapists 2008