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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
Introduction
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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
Current Position of Recovery
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Fundamental guiding principle
Recovering Ordinary Lives –the strategy for
occupational therapy in mental health services 20072017 (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
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
Contested Definitions
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Can you define a personal journey?
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Is it a model –a clearly constructed set of theories that
model or represent clinical phenomena?
College of Occupational
Therapists 2008
History of Recovery
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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
Research Evidence
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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
Occupational Therapy Literature
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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
Policy Context
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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
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Ireland –A vision for a recovery model in Irish mental
health services (2005)
Scotland –Rights, Relationships and Recovery (2006)
College of Occupational
Therapists 2008
Shift in dominant paradigms and
power relationships
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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
Ten Principles of Recovery
(Shepherd et al 2008)
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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
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Recovery represents a movement away from pathology, illness and
symptoms to health, strengths and wellness
College of Occupational
Therapists 2008
Recovery Principles cont.
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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
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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
Recovery Principles cont.
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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”
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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
Recovery Principles cont.
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Recovery is about discovering - or re-discovering a
sense of personal identity, separate from illness or
disability
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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
Principals of Recovery cont.
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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
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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
Common Recovery Factors
(from www.mhrecovery.com)
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Employment/Meaningful activity
Hope
Medication and treatment
Empowerment
Education/Knowledge
Support
Self Help
Spirituality
College of Occupational
Therapists 2008
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
And then I lost that life; a shared
narrative of four young men with
schizophrenia (Gould et al 2005)
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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
Recovering Ordinary Lives –the strategy
for occupational therapy in mental
health services 2007-2017 (COT 2006)
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“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
Recovering Ordinary Lives –
guiding principles
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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
Recovering Ordinary Lives –key
messages
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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
Challenges
(from www.mentalhealthnursingstaff.com)
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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
Advantages of Recovery
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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
Summary
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Contexts and definitions of Recovery
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How it links to occupational therapy and Recovering
Ordinary Lives
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Challenges and strengths
College of Occupational
Therapists 2008
References
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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
References
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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