A Summary of Recovery Principles with Suggestions as to
What the Implications are for Practice. (cont.).
Implications for Practice
HOPE:
Kirkpatrick et al (1995) stated that clinicians working with people in recovery identified the strategies of building relationships, facilitating success, connecting to role models, managing the illness and educating both clients and the community as being important in this process.
Kirkpatrick et al (2001) found that levels of hope were related to subjective positive quality of life but not to symptom severity. When participants were asked what maintained hope in their lives five key themes were identified; maintaining relationships, experiencing success, taking control and finding meaning.
Russinova (1999) suggests that the recognition of the crucial role of hope in the recovery process demands that mental health workers be competent in inspiring hope in users of mental health services. This, it is suggested, therefore becomes a training issue in terms of in-service training and also pre-service training curricula.
This may mean that instilling hope will be a more lengthy process involving very small, well documented moves forward which can then be fed back to the clients as evidence that it is possible to change. As well as this it may be important for us to listen carefully to our clients stories in order to identify and feed back what has changed since they first became ill.
ACCEPTANCE:
Ridgway (2001) states that this acceptance of mental health problems, within an “illness model”, is not a prerequisite to recovery. Instead she believes that having a way to think about and understand one's experiences is crucial but that the content of this explanatory framework is less important.
Acceptance is a complex issue and for some acceptance of a mental illness label may bring about acceptance of life long disability. For others, as we have seen, this can be positive and as pointed out in the review it is important for people to have a framework which aids their understanding of where and who they are. This framework does not have to be based around the medical model and it is the duty of staff to aid patients towards an understanding of what has happened which makes sense for them.
CONTROL:
The first is relatively easy to deal with in terms of staff development, training and encouraging good practice. There are a plethora of tools available for helping patients with symptoms including medication, cognitive behaviour therapy, stress management techniques, voices groups and other forms of self help that staff can introduce the clients to. The second aspect of control is inextricably bound up with issues of learning, empowerment, responsibility and defining a sense of self and is much more problematic as it has undeniable implications for clients detained under the mental health act. There is also the fact that one cannot hand control or power to someone who doesn't want it or has not got the capacity.
Power and control comes with responsibility and many clients are reluctant to take responsibility as this has been something denied to them in their years in the system when decisions about their future have usually been made by others. This may be difficult but not impossible to change and can begin with relatively minor decisions. In this context it will be important for the service to develop as much choice as possible for its clients and exercise truly collaborative working. Also handing power back to clients must become a fundamental philosophy within the service. This is likely to be helped by the involvement of the very active user movement in Exeter . Individuals from this movement may be able to act as role models and also remind staff of their obligation to hand power back to clients as soon as they are able to take it.
EMPOWERMENT:
Barker, Stevenson and Leamy (2000) describe, what they call, an empowering interactions framework. This, they state, is built on certain assumptions:
- People should be treated as equals and the relationship should be based on collaboration.
- The person is an expert on his or her life, its problems and potential resolutions.
- The person is able to make personally appropriate choices.
- The person retains a problem solving capacity
- The person has responsibility for beginning, controlling and ending therapeutic contact
They go on to state that power is an inevitable component of human relationships and that sharing power is central to the cultivation of hope and the development of a sense of control and therefore empowerment.
Power, control, learning and defining a sense of self are about choice but also, as pointed out in the review, are about clients making mistakes and being allowed to fail in order to learn. Risk policies are a potential problem here and myself and others will have to exert as much influence as possible over these policies to ensure that they allow positive risk taking and don't just enshrine defensive practice.
FINDING MEANING:
Finding meaning is impossible to impose even if one wanted to and is something the clients will have to do for themselves. Staff can be supportive in this by listening to clients wishes and providing opportunities through meaningful activity and interactions.
RELATIONSHIPS:
The aim of the service must therefore be to encourage clients to develop a new social network through the use of local resources such as educational establishments and employment schemes.
LEARNING:
Davidson and Strauss (1992) offer one way out of this dilemma when they quote one of their subjects as saying, “psychotic people can learn from mistakes too”. They go on to argue that taking too much control as a clinician deprives patients of this very human experience and therefore impedes their ability to develop an active sense of self.
REFERENCES
Anthony, W. (1993). Recovery from Mental Illness: The Guiding Vision of the Mental Health System in the 1990s. Psychosocial Rehabilitation Journal, Vol 16, No 4, pp 11-23.
Barker, S., Lavender,T . and Morant , N. (2001). Client and Family Narratives on Schizophrenia. Journal of Mental Health, Vol 10, No 2, pp 199-212.
Davidson, L. and Strauss, J. (1992). Sense of Self in Recovery from Severe Mental Illness. British Journal of Medical Psychology, Vol 65, pp 131-145.
Deegan , P. (1996). Recovery as a Journey of the Heart. Psychiatric Rehabilitation Journal, Vol 19, pp 91-97.
Jacobson, N. and Greenley , D. (2001). What is Recovery? A Conceptual Model and Explication. Psychiatric Services, Vol 52, No 4, pp 482-485.
Kirkpatrick, H., Landeen , J., Byrne, C., Woodside, H., Pawlick , J. and Bernardo, A. (1995). Hope and Schizophrenia: Clinicians Identify Hope-instilling Strategies. Journal of Psychosocial Nursing and Mental Health Services, Vol 33, No 6, pp 15-19.
Kirkpatrick, H., Landeen , J., Woodside, H. and Byrne, C. (2001). Meaning, Relationships and Control. Journal of Psychosocial Nursing, Vol 39, No 1, pp 46-53.
Miller, J. (1992). Coping with Chronic Illness: Overcoming Powerlessness, 2 nd edition. Davis , Philadelphia . Cited in Kirkpatrick et al (2001)
Pettie , D. and Triolo , A. (1999). Illness as Evolution: The search for Identity and Meaning in the Recovery Process. Psychiatric Rehabilitation Journal, Vol 22, No 3, pp 255-262.
Repper , J. (2000). Adjusting the Focus of Mental Health Nursing: Incorporating Service Users' Experiences of Recovery. Journal of Mental Health, Vol 9, No 6, pp 575-587.
Ridgway , P. (2001). ReStorying Psychiatric Disability: Learning from First Person Recovery Narratives. Psychiatric Rehabilitation Journal, Vol 24, No 4, pp 335-343.
Russinova , Z. (1999). Providers' Hope Inspiring Competence as a Factor Optimizing Psychiatric Rehabilitation Outcomes. Journal of Rehabilitation. Pp 50-57.
Yanos , T., Primavera, L. and Knight, E. (2001). Consumer-Run Service Participation, Recovery of Social Functioning and the Mediating Role of Psychological Factors. Psychiatric Services, Vol 52, No 4, pp 493-500.
Definitions of Recovery
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