A national framework for

recovery oriented mental health

services

‘The journey begins Recovery is in my hands, the

creator within is the spirit of hope for a better life’

Pauline Miles 2012 ©

Aims to provide:

Why the Recovery Framework is important

What the Recovery Framework is

The changes it seeks to encourage

OVs digging in and helping change

Other helpful guides

.ABOUT TODAY’S CLASS.

A national framework for recovery-oriented mental health services: policy and theory - http://www.ahmac.gov.au/cms_documents/National%20Mental%20Health%20Recovery%20Framework%202013-Policy&theory.PDF

A national framework for recovery-oriented mental health services: guide for practitioners and providers - http://www.ahmac.gov.au/cms_documents/National%20Mental%20Health%20Recovery%20Framework%202013-Guide-practitioners&providers.PDF

.WHERE TO FIND IT.

.OUR SIMPLE TASK.

Develop a national framework for recovery oriented mental heath service provision that spans all levels of practice and service delivery

A framework suitable for guiding national mental health system change

.THE HEART OF THE FRAMEWORK.

Guidance based on people’s lived and personal experience of what helps them to live:

A full life

A life they choose

With people they love

Doing things they want to do and dream of

. WHAT’S THE AIM OF THE FRAMEWORK?

Shifting services and practice to help people experiencing mental health and SEWB issues to have a:

A full life

A life they choose

With people they love

Doing things they want to do and dream of

.POLICY CONTEXT. 4th National Mental

Health Plan

Supporting Recovery Standard - (10.1) National Mental Health Service Standards

National Statement of Rights & Responsibilities & National Mental Health Practice Standards

Relevant international human rights instruments

Pauline Miles 2012 ©

Pauline Miles © World view

Action 4 of Priority Area 1 of the 4th Australian National Mental Health Plan, 2009-2014 The promotion and adoption of a recovery

oriented culture within mental health services.

The adoption of attitudes, expectations and good practices of a recovery orientation by individual practitioners, service leaders and policy makers - public, private or non-government sector and irrespective of the practice setting.

All Australian Governments have committed to implement the Plan and its Actions.

POLICY CONTEXT CONT.

Mid March 2012 Discussion Paper and Online Survey released & strategic discussions &

meetings

8 May………….. 1st Consultation Draft of the Recovery Framework released

Mid–late May… Consultation forums in capital cities

End June……… 2nd Consultation Draft following Inaugural National Recovery Forum

July-mid Aug…. Further consultations

30 November…….. Final Draft National Mental Health Recovery Framework!

21 August 2013 Framework launched, TheMHS

.THE TIMELINE.

.FRAMEWORK.

.KEY BITS.

Definitions and explanation of concepts

Language shifts

Practice domains/areas = 5

Capabilities = 17 skill sets across the 5 domains and comprising:

Core principles, values an attitudes, knowledge, skills and behaviours, practice

guidance, leadership guidance, opportunities, resource materials.

.A DEFINITION OF RECOVERY.

The concept of recovery was conceived by people with mental health issues to describe their experiences and to affirm their identity beyond that of diagnosis and symptoms.

The framework adopts this definition:

“being able to create and live a meaningful and contributing life in a community of choice with or without the presence of mental health issues.’

.WHAT’S A RECOVERY APPROACH?

Recovery-oriented approaches recognise the value of lived experience and meld it with the experience, knowledge and skills of mental health practitioners, many of whom have experienced mental health issues either in their own lives or within their family and friends.

In short… approaches that learn from the coming together of lived experience and professional experience.

.PERSONAL RECOVERY AND CLINICAL RECOVERY?

Personal recovery and clinical recovery support each other.

Recovery is much broader than symptom improvement… On one hand, symptom improvement

helps a sense of wellbeing While on the other hand, a sense of

wellbeing regardless of ongoing symptoms can help to reduce those symptoms or their severity.

.LANGUAGE SHIFTS.

Words and language are particularly important in mental health because of the impacts of stigma, discrimination e.g. loss of self-esteem and exclusion.

Shifts p. 28 Policy and Theory

To person first language e.g. person rather than consumer; family and friend rather than carer; mental health issues and emotional distress in place of, or alongside of mental illness.

. PRACTICE DOMAINS.

Person 1st & Holistic

Supporting Personal Recovery

Organisational commitment

Action on Social

Determinants

Culture & language of

Hope

.PRACTICE DOMAINS & CAPABILITIES.

.AN EXAMPLE.

Domain: Organisational commitment and workforce development

Capability: Acknowledging, valuing and learning from lived experience

NB we didn’t just make them up

Draws on international research as well as existing recovery-oriented frameworks e.g. Victorian, NZ, UK

A key piece of research – Le Boutillier, Leamy, Bird, Davidson, Williams & Slade Dec 2011, ‘What does Recovery Mean in Practice? A Qualitative Analysis of International Recovery-oriented Practice Guidance’

Sought to provide an evidence-based conceptual framework for putting recovery concepts and principles into practice

Qualitative analysis of 30 international recovery-oriented practice guidance documents

16 dominant themes identified that were grouped into four practice domains

.THE EVIDENCE BASE FOR THE DOMAINS.

A focus on personal recovery and wellbeing is a desirable direction for mental health services

The experience of mental illness is helpfully understood through the lens of the perspectives, values and preferences of the individual i.e. what’s important to each person

The emphasis on professionally judged best interests can inadvertently do harm; a recovery-oriented approach directs treatment and support around what is important to the individual

The benefits of clinical treatment are enhanced through broader whole of life approaches i.e. by helping a person get on with their immediate lives

.SOME KEY EMPHASES.

This is a challenge for many as it is embedded within most helping and caring professions, to do for another when they

experience distress, pain, illness or disability. The risk of doing this on a constant basis is that because the helping

and caring professions often contribute to a state of impotence, we learn more about our inabilities rather than

our many abilities. It was only when I began to reclaim responsibility for the direction of my life that I appreciated

the active role of recovering; it would be difficult, if not impossible, to maintain a recovery space while someone

else is holding responsibility for us’ (Glover 2012)

‘You can do it, we can help you’ Janet Meagher, Commissioner, National Mental Health Commission

2012

.SOME KEY EMPHASES.

Personal recovery is possible for everyone & begins when a person takes responsibility and personal control

Professionals assist in the first instance by helping a person to identify what’s important to them here and now

People with mental health issues want the same as everyone else – someone to love, a home, a job and something meaningful to do

Mental health practice and service delivery consistent with recovery principles require an emphasis on maximising choice and self-determination.

Reduced reliance on coercion, seclusion and restraint is also required.

.SOME KEY EMPHASES.

.SOME PRACTICE SHIFTS.

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Pauline Miles © Rowing my own boat

.SOME PRACTICE SHIFTS…POSITIVE RISK.

Pauline Miles © Got me PsPauline Miles © Come on follow me

Shift from an emphasis of what’s wrong with a person to a strengths emphasis

Rethinking of risk, least restrictive and best interests

Lived experience of mental health issues is valued and respected in people, their families and friends, staff and the local community

The desirability of lived experience in selection criteria for professional positions is acknowledged

Dedicated roles including leadership positions within services for people with lived experience are ensured

The development of peer-designed and operated service models is supported

SOME ORGANISATIONAL SHIFTS

.OVS DIGGING IN & HELPING.

Some suggestions

.OVS AS A TALKATIVE WATCHDOG.

Why are our rates of involuntary treatment including seclusion and restraint high by international standards?

How persistence of risk averse environments and policy frameworks can undermine recovery efforts and increase harmful risks by denying people the opportunity to self-regulate & self-manage

Policies, practices and environments that are traumatizing and which retraumatise

.IDENTIFY PRACTICAL ACTIONS – LOW HANGING FRUIT.

Ways of promoting a greater focus on fostering self-determination, personal responsibility and self-management

Suggestions for how services and professionals can get on board with promoting robust participation

Leading by example – seeking out and drawing upon lived experience

Promote and support peer-led initiatives and peer-run services in hospital-based settings

.CHANGING WAYS AND WAYS TO CHANGE.

Identify opportunities for supporting services with positive risk-taking on one hand and duty of care and promoting safety on the other

Promote joint or supported decision-making about reducing risk and promoting safety

Promote jointly constructed service plans as well as early warning sign/relapse signature plans

Promote use of advanced directives/statements

.CHANGING WAYS & WAYS TO CHANGE. Understand and embrace the tenets of ‘trauma

informed care’

Promote understanding of the traumatic nature of acute episodes

Promote understanding of trauma often associated with involuntary interventions

Promote joint or supported decision-making about self-calming strategies to assist people to manage their own distress and turmoil

Encourage transparency and open and honest discussion of any legal requirements, the individual’s and the practitioner’s views about such, as well as identification and negotiation of differences

.OTHER IMPORTANT PRACTICE GUIDES.

Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery http://www.asca.org.au/About/WHATWEDO/ASCAsPracticeGuidelinesforTreatmentofComple.

Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice, 2nd Ed. http://aboriginal.telethonkids.org.au/kulunga-research-network/working-together-2nd-edition/

.FINAL WORDS.

Where can a recovery-oriented approach take us?

Services that put people and their families first

Services that people want to use

Rethinking of “professionalism” – personal experience of mental health issues viewed as an “advantage” or “head start”

As most recovery occurs at home, increased focus will be given to incorporating and supporting families, friends, communities and workplace

New service models including peer designed and run services and programs

Improved service outcomes as people are supported to live full and contributing lives

.ACKNOWLEDGEMENT & THANKS

Leanne Craze, Ruth Vine, John Allan and the Recovery Group of the Safety, Quality &

Partnerships Subcommittee wishes to thank everyone for all the support, help and advice

provided.

‘Be the change we want to see’

Pauline Miles 2012 ©