November 2010 Recovery Discussion Topic - What can services do to support Recovery?

‘nothing about me without me’ Equity and Excellence; Liberating the NHS (DH 2010)

“I am tired of being talked about. Treated as a statistic Pushed to the margins of human conversation, I want someone who will have time for me, Someone who will listen to me, Someone who has not already judged Who I am or what I have to offer I am waiting to be Taken seriously” (Mental Health Foundation 2002 P1)

In an earlier discussion topic titled ‘Recovery Pathways’ we identified a number of frameworks which can be helpful for thinking about Recovery. One such framework (Recovery Innovations) identifies five key themes: • • • • •

Hope Choice Empowerment Recovery Environment Spirituality (Meaning and Purpose)

So when you think about your own service think about what you do to support recovery in these five areas. Some ideas about what you can do might be: Recovery language: Language has the power to create reality. In other words, what you speak about - you can bring about. We can use positive and empowering words of recovery or we can use words that create and promote stigma. Stigmatising language creates a deficit based reality. A person who uses stigmatic language causes others to see a person as "less than". A person who internalises language directed at themselves, will often develop a self image as "less than". In a recovery environment it is important to use language that doesn't discriminate or stigmatise; that doesn't make assumptions; that doesn't limit people, but always recognises their strengths. Recovery language views people from an asset perspective by focusing on "what's strong" as opposed to "what's wrong". When absolutely necessary to communicate clinical information then we should always do so using "people-first" language. "Person first" language is a concept which grew out of the disability movement. It affirms that individuals are first and foremost people; not a diagnosis, nor client, nor patient, nor service user. It goes beyond being politically correct and begins to frame the way we experience the people we work with because the language and phrasing we use strongly influences our thoughts. To quote George Orwell "if thoughts corrupt language, language can also corrupt thought". If we are serious about transformation, we need to take a close look at our Recovery Topic – What can services do to support Recovery?

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language because it is a core element in developing recovery-oriented services. The same old worn out language will not help us move toward better recovery outcomes and may even become the sticky glue that holds us in old patterns of doing our work. Questioning and changing the seemingly inconsequential elements, like language, will free us up to move ahead with more velocity. Tips for developing a more Recovery focused language: • Think carefully about how you and others around you talk, Recovery focused language may be different to what we are used to • Think about using ‘Person first’ language • Focus less on medical language and symptoms • Focus more on strengths rather than challenges • Avoid gossip and negativity • Think about your documentation, is the language Recovery focused, strength based and person centred (or dominated by medical jargon and symptom deficit, problem based language). Choice • recovery is a choice • choice promotes identity • choice promotes strength • choice promotes self-determination • choice is an exercise at being an expert The goal of assessment is to create a partnership relationship which amplifies the individual’s efforts towards recovery. The challenge is to get out of the way of the person’s recovery, by avoiding dependency-creating relationships, deficit-focused assessments, doing-to treatments, and drip-feeding responsibility back to the person. What practical difference does this orientation make? The challenge is then not to get in the way by assuming responsibility, for example through helping the client to decide whether the goal is realistic, or identifying for the person the steps towards their goal. The antidote to any professional tendency to assume responsibility is to use coaching skills for supporting partnership relationships: “What would it take to meet this goal?”, “What would happen if you challenge the rule that says you’re not allowed to do that?” Workers need expertise in facilitating as well as doing. Support service users to clarify their aspirations, celebrate their successes, find strength in their resilience in the face of adversity, tackle their mental health problems and plan their recovery journeys (as revealed in assessment and care planning documentation) View service users’ lives as bigger than the services that they receive. Deliver support in a way that promotes service user citizenship and community participation, and enhances independence from formal services in as many life areas as possible. Work collaboratively with service users and equip them to feel confident in directing and defining their own care. Empowerment • resisting the “being fixed” role • resisting the “fix it” role for others • putting the power where it’s needed, i.e., with the person recovering • promoting a helping role • promoting self-advocacy Recovery Topic – What can services do to support Recovery?

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•

recognising the value of resistance

Empowerment is a recovery pathway that is all about giving back. Since recovery is the person’s job, the person is the one who needs the power. When we empower others, we’re validating and honouring them for their own expertise and strengths to navigate through challenges. They get the opportunity to rise above the line toward self-determination and accountability to get the results they want. One key way to empower others is by avoiding the “fix-it” approach and, instead, using empowering interactions. Empowerment emerges from self-belief and involved behaviours which impact positively on one’s life. The traditional approach has been to view the person as the problem. The fundamental shift in a recovery perspective is to see the person as part of the solution. A recovery oriented approach assumes the person has capacity to take responsibility for their life. The question then moves away from how the worker can stop the damaging behaviour and becomes how to support the person to get to a point where they want to stop. The ‘What’s in it for me’ principle motivates the behaviour of most people. The challenge is to identify what personally-valued recovery goal is being undermined by the behaviour. If this proves impossible, then the behaviour (such as disengaging from services which are not targeting the individual’s goals) may be entirely rational and nothing to do with illness. (Mike Slade – Rethink Recovery Innovations Arizona - Empowering Interactions • Be a good listener • Be fully present with the person in a way that validates and reinforces their abilities and strengths • Ask open-ended questions • Provide choices • Point out their progress • Remind them that they are the experts • Promote self-advocacy; support them in taking the lead; and not giving their power away • Roll with resistance • Avoid power robbing language; use empowering language Environment is possibly the key predictor for recovery. If a person is in a recovery environment, they are more likely to recover than if they are in a non-recovery environment. Some of the characteristics of a recovery environment include: a) Psychological environment: avoid labels, seek and acknowledge strengths, provide and promote choices. One important characteristic of a recovery environment is the level of consciousness that exists within that environment. In other words, it is the invisible source of energy that can be felt by people. For an environment to be recovery oriented, the level of consciousness or energy must be positive. Gossip and negativity are certain to undermine a recovery environment. b) Physical environment: providing a positive setting which demonstrates care, compassion and respect. A physical environment can be beautiful – but without the elements which address a) psychological and c) creativity the experience of hope and empowerment from an environment will not be achieved. c) Creative thinking: a recovery environment nurtures creativity Webster defines creativity as “the ability to generate meaningful new forms and interpretations characterized by originality.” A true recovery environment, then, cannot help but be one that values, encourages and nurtures creativity. Recovery itself is about remembering who we are and using our strengths to become all we were meant to be. The very essence of recovery calls Recovery Topic – What can services do to support Recovery?

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us to honour the unique and original beings that we are and to use our strengths to pursue our individuality. (Recovery Innovations) Spirituality • connecting within and beyond the self • finding meaning and purpose • using the “force” to move things forward • developing our own spiritual strengths • respecting each person’s chosen spiritual path Spiritual and religious care is integral to holistic assessment and to recovery. As mental health practitioners we need to learn to sit beside, listen to and then walk with people on their journey. Elements of Spiritual Care • • • • •

An environment fostering hope, joy and creativity Being valued and trusted, treated with respect and dignity Sympathetic and confidential listening Help to make sense of, and derive meaning from, illness experience Receiving permission, encouragement (and sometimes guidance) to develop spiritually.

Benefits of Spiritual Care • • • • • • • • •

Healthy grieving of losses enabled (letting go) Improved self esteem and confidence Maximisation of personal potential Relationships improved (with self, others and with the absolute/God) Renewed sense of meaning and purpose Enhanced feeling or belonging Improve capacity for solving problems Insoluble problems, continuing distress and disability more easily endured Hope renewed

Identifying the spiritual dimension is integral to good assessment and not separate from it. It is part of the care programme approach and has the potential to be a component of all therapeutic encounters between practitioner and service user. For many practitioners it is what they do already either as a conscious decision leading out of the assessment or unconsciously as part of the process of working alongside a service user to support them in addressing issues from the past and fears and aspirations for the future. The mental health practitioner is not a specialist in religious or spiritual matters but by prompting the service user, the practitioner can begin to identify with the spiritual and/or religious dimensions to their lives. The language used and the questions asked will be determined by the style of the practitioner, the needs of the service user. Larry Culliford suggests the following as a guide: Key Questions and Prompts • • • •

What is important to you in your life? What helps and sustains you? Does faith and spirituality play a part in this and how? Do you need support in relation to this?

Recovery Topic – What can services do to support Recovery?

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Summary Fundamentally if you want to be recovery oriented in your interventions remember if it was you sitting there instead of the person you are meeting how would you want it all to be, look and feel for you? 1 in 4 of us will experience mental health problems at some point in our lives, whatever differences you make now might make things better for your relative, friend or even you in the future. Changes don’t have to be big – even changing your language will have a significant ripple effect and an impact on the way things are now. This may mean being brave and coping with negative comments from your colleagues, but persevere, if you have a peer worker in your team learn from them and support each other – change will happen. After all you don’t have to ask other people to change, just start with yourself and think about what you could do. Above all remember why you came into the job, was it to make a difference?

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Questions for discussion: 1. What language are we using within team meetings, in staff rooms and handovers?

2. Are our conversations inspiring instead of controlling and managing the person, is there talk about recovery instead of just stability?

3. How do we speak about the people we work with? Are we hopeful, do we give them choices?

4. Do we challenge others’ disparaging or non recovery focused language?

5. What and how do you provide choices for the people you see?

6. How do you enable people to retain their identity and self-determination?

7. What do you or your team do that disempowers people?

8. Do you really know the person you are working with? Or do you know their clinical presentation and you interpret or assume the rest? 9. Do you really believe in the people you work with and their potential for selfmanagement and self-belief? If you don’t believe in them how can you help them to believe in themselves? What needs to change in you for this to be different?

10. What do you say to someone when they come up with an idea of what they want to do or be in the future? Do you tell them it is unrealistic or do you support them to explore how to get there?

11. What are some things we can do to ensure that our recovery environment maintains a positive and supportive energy?

12. What can you do to ensure spirituality is part of you working philosophy? If you feel this isn’t your role where could you go to discuss this and over come this barrier?

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References: Recovering Innovations Arizona (RIAZ) Mike Slade and Rethink – 100 Ways to support Recovery – a guide for mental health professionals Mental Health Foundation 2002 . Taken Seriously. The Somerset Spirituality Project. London Mental Health Foundation. CPFT Spirituality strategy http://www.cpft.nhs.uk/Patientscarers/Socialinclusionrecovery/Spirituality/tabid/830/language/ en-GB/Default.aspx

Culliford. L. & Sarah Eagger (eds.) 2009. “Assessing Spiritual Needs” in Spirituality and Psychiatry. The Royal College of Psychiatrists Culliford L. Notes taken at conference Spirituality and Psychiatry . Peterborough 28 October 2010. Equity and Excellence; liberating the NHS, Dept of Health 2010

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