1、College of Occupational Therapists 2008 PRINCIPLES OF RECOVERYGenevieve SmythProfessional Affairs OfficerMental Health and Learning Disabilities The College of Occupational Therapists106-114 Borough High StreetLondon SE1 1LBCollege of Occupational Therapists 2008IntroductionlCurrent position of Reco
2、very in mental healthlDefinitionslHistorylTen Recovery principles lRecovery processlRelationship to Recovering Ordinary Lives and occupational therapylChallenges and strengthsCollege of Occupational Therapists 2008Current Position of RecoverylFundamental guiding principlelRecovering Ordinary Lives t
3、he strategy for occupational therapy in mental health services 2007-2017 (COT 2006)lOther professional bodies;RCN,BPS,RCPlNIMHE Guiding Statement on Recovery(2005)lMaking Recovery a Reality Shepherd et al(2008)Sainsbury Centre for Mental HealthlVivienne Wheeler,Hilary WilliamsCollege of Occupational
4、 Therapists 2008Defining Recovery“Recovery is a deeply personal,unique process of changing ones 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 meani
5、ng and purpose in ones life as one grows beyond the catastrophic effects of mental illness”(Anthony 1993)College of Occupational Therapists 2008Contested DefinitionslCan you define a personal journey?lIs it a model a clearly constructed set of theories that model or represent clinical phenomena?Coll
6、ege of Occupational Therapists 2008History of RecoverylConsumer/Survivor Movement of 1980s and 1990s not professionalslSelf help,empowerment,advocacylNew Zealand,USA,UKlChallenge disease-driven ideas of mental illnesslService user narratives e.g.Patricia Deegan Recovery as a Journey of the Heart(199
7、6)Recovery;the Lived Experience of Rehabilitation(1998)College of Occupational Therapists 2008Research EvidencelDavidson and McGlashan(1997)lLong-term outcomes of people with serious mental health conditionslResearch found -2/3 of people experiencing first episode of psychosis recover to a degree wh
8、ere symptoms do not interfere with daily functioningCollege of Occupational Therapists 2008Occupational Therapy LiteraturelReberio Gruhl K(2005)Reflections onthe recovery paradigm;Should occupational therapists be interested?CJOT,72(2),96-102lLloyd et al(2007)The association between leisure motivati
9、on and recovery;A pilot study.AJOT,54,33-41.lLloyd et al(2008)Conceptualising recovery in mental health rehabilitation.BJOT,71(8),321-328.College of Occupational Therapists 2008Policy ContextlSelf management and choice in England Securing our Future Health Wanless 2002 Mental Health and Social exclu
10、sion 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 lIreland A vision for a recovery model in Irish mental health services(2005)lScotland Rights,Relationships and Recovery(2006)College of Occupational Th
11、erapists 2008Shift in dominant paradigms and power relationshipslFrom professional to service userlFrom medical to social modellValues based practice The Ten Essential Shared Capabilities (Hope 2004)College of Occupational Therapists 2008Ten Principles of Recovery(Shepherd et al 2008)lRecovery is ab
12、out building a meaningful and satisfying life,as defined by the person themselves,whether or not there are ongoing or recurring symptoms or problemslRecovery represents a movement away from pathology,illness and symptoms to health,strengths and wellnessCollege of Occupational Therapists 2008Recovery
13、 Principles cont.lHope 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 forwardlSelf-management is encouraged and facilitated.The processes of self-management are similar,but what
14、works may be very different for each individual.No one size fits all.College of Occupational Therapists 2008Recovery Principles cont.lThe helping relationship between clinicians and patients moves away from being expert/patient to being coaches or partners on a journey of discovery.Clinicians are th
15、ere to be“on tap,not on top”lPeople 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 servicesCollege of Occupational Therapists 2008Recovery Principles
16、cont.lRecovery is about discovering-or re-discovering a sense of personal identity,separate from illness or disabilitylThe 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
17、 and possibility,or invite pessimism and chronicityCollege of Occupational Therapists 2008Principals of Recovery cont.lThe 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
18、,care,compassion,realism and resiliencelFamily 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 recoveryCollege of Occupational Therapists 2008Common Recovery Factors(from )lEmploymen
19、t/Meaningful activitylHopelMedication and treatmentlEmpowermentlEducation/KnowledgelSupportlSelf HelplSpiritualityCollege of Occupational Therapists 2008Components of the process of recovery(Andresen et al 2003)Finding and maintaining hope-believing in oneself;having a sense of personal agency;optim
20、istic 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-fe
21、eling in control of illness and in control of lifeCollege of Occupational Therapists 2008And then I lost that life;a shared narrative of four young men with schizophrenia(Gould et al 2005)lI remember when I was normallIts like your computer crasheslCoasting through lifelTry to remake that life as be
22、st you canlFinally,I can move on with my lifeCollege of Occupational Therapists 2008Recovering Ordinary Lives the strategy for occupational therapy in mental health services 2007-2017 (COT 2006)l“Occupational therapists will value recovery and will work within a socially inclusive framework to achie
23、ve 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 2008Recovering Ordinary Lives guiding principleslInterventions as
24、sist the client to achieve greater autonomy of thought,will and actionlInterventions support the client in developing or maintaining a satisfying personal and social identity lInterventions move the client in the direction of fuller participation in society through performance of occupations that ar
25、e appropriate to her or his age,social and cultural background,interests and aspirations.College of Occupational Therapists 2008Recovering Ordinary Lives key messageslFor practitioners Using occupational language explain the meaning of occupation and its relationship to recovery and wellbeing to ser
26、vice users,carers,colleagues and commissioners.lFor managers-Provide information within your organisation on the importance of occupation to recovery and wellbeinglOur profession need to be able to articulate the links between occupation and building a meaningful,satisfying lifeCollege of Occupation
27、al Therapists 2008Challenges(from )lVague and subjectivelLack of research evidence baselWeve been doing this for yearslLanguage reconstructive operatives giving old things new nameslTension between standardisation and individual processlLack of BME involvementlLinked to dischargelBacklash from the m
28、edical model(Craddock et al 2008)attacking“psychosocial support with extremely limited therapeutic ambition”.College of Occupational Therapists 2008Advantages of RecoverylShifting power balanceslFocuses on people not serviceslEmphasises strengths rather than weaknesseslCost effective?lWellness Recov
29、ery Action Plans(Mary Ellen Copeland)lEmphasis on hope alerting healthcare professionals to institutional responseslPositive risk takingCollege of Occupational Therapists 2008Summary lContexts and definitions of RecoverylHow it links to occupational therapy and Recovering Ordinary LiveslChallenges a
30、nd strengthsCollege of Occupational Therapists 2008ReferenceslAndresen 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.lAnthony W A(1993)Recovery from mental illness;the guidi
31、ng vision of the mental health service system in the 1900s.Psychosocial Rehabilitation Journal,16,11-23.lCraddock N.et al(2008)A wake up call for British psychiatry.The British Journal of Psychiatry,193,6-9.lCollege of Occupational Therapists(2006)Recovering ordinary lives the strategy for occupatio
32、nal therapy in mental health services 2007 2017.London:COT.lDavidson L,McGlashan TH(1997)The varied outcomes of schizophrenia.Psychiatric Services,57,642 645.College of Occupational Therapists 2008ReferenceslDeegan P(1996)Recovery as a journey of the heart.Psychiatric Rehabilitation Journal,19(3),91
33、-97.lDeegan P(1998)Recovery;the lived experience of rehabilitation.Psychosocial Rehabilitation Journal,11,11-19.lHope R(2004)The 10 essential shared capabilities:a framework for the whole of the mental health workforce.London:DH.lGould A,DeSouza S,Rebeiro-Gruhl KL(2005)And then I lost that life:a sh
34、ared narrative of four young men with schizophrenia.British Journal of Occupational Therapy,68(10),467-473.lNational Institute for Mental Health in England(2005)NIMHE Guiding statement on recovery.Available at www.nimhe.org.uk lShepherd G,Boardman J,Slade M(2008)Making recovery a reality.London:Sainsbury Centre for Mental Health.
