The Recovery Experience: Daring to Dream

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The Recovery ExperienceDaring to Dream
Rachel Perkins Director of Quality Assurance and
User/Carer Experience South West London and St
Georges Mental Health NHS Trust
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Images of people with mental health problems

• The poor unfortunate who cannot live a normal
  life the object of pity
• The dangerous mad axe murderer from whom the
  public must be protected
• The major barriers
• Prejudice, ignorance, fear
• Failure to receive the support you need to live
  the life you want to lead and do the things you
  want to do

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What is Recovery?

• Recovery is about
• building a new sense of self, meaning and purpose
• hanging on to and/or rebuilding a meaningful,
  satisfying and contributing life
• growing within and beyond what has happened to
  you
• the lived or real life experience of people as
  they accept and overcome the challenge of the
  disability. They experience themselves as
  recovering a new sense of self and of purpose
  within and beyond the limits of the disability.
  (Deegan, 1988)
• a deeply personal, unique process of changing
  ones attitudes, values, feelings, goals, skills
  and rolesThe development of new meaning and
  purpose in ones life as one grows beyond the
  catastrophic effects of mental illness (Anthony
  1993)
• Not a professional intervention an individual
  journey
• Not the same as cure

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The contribution of people with mental health
problems

• Statesman like Parnell and Churchill
• Scientists like Einstein and Babbage
• Scholars like Ruskin and Wittgenstein
• Composers like Ravel
• Visual artists like Van Gogh
• Writers like Auden and Chesterton
• Businessmen like Ted Turner who set up Cable
  Network News
• and many ordinary people living ordinary lives
  made harder by prejudice and discrimination
• Norwegian former prime minister Kjell Magne
  Bondevik 21.1.08
• Life has expanded because of those weeks. Life
  is richer because of those weeks. Through that
  period I have become stronger. I have learned
  more about myself appreciate more I became a
  better leader.

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Taking back CONTROL Recovery means I try to
stay in the drivers seat of my life. I dont
let my illness run me. Over the years I have
worked hard to become an expert in my own
self-care (Deegan, 1993)
OPPORTUNITY accessing the roles, relationships
and activities that are important to you I
dont want a Community Psychiatric Nurse, I want
a life. (Rose, 2001)
HOPE and hope inspiring relationships The
turning point in my life was where I started to
get hope. Dr. Charles believed that I could. And
Rev Goodwin believed that I could. Certain
people believed that I could and held that
belief even when I didnt believe in myself.
(Donna in Vincent 1999)
Adapted from Repper Perkins (2003)
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Recovery is impossible without hope

• If you cant see the possibility of a decent
  future for yourself what is the point in
  trying?
• Relationships are central to hope
• It is difficult to believe in yourself if
  everyone around you thinks you will never amount
  to very much
• When you find it hard to believe in yourself you
  need others to believe in you
• Not just relationships with mental health
  providers but friends, family and peers
  people who have been there themselves have a lot
  to offer one another

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Recovery involves taking back control

• Mental health problems often make people feel out
  of control and there is a tendency for others
  to take control over your life
• Recovery is about getting back into the driving
  seat treating distressing and disabling
  symptoms is only part of the story you also
  need to
• Take back control over your life and how you live
  it
• Work out ways of understanding what has happened
  to you
• Become an expert in your own self-care
• Make decisions about what sort of help you need
• The importance of Direct Payments and Individual
  Budgets

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Recovery is impossible without opportunity

• You cannot rebuild your life if everywhere you
  are debarred from doing the things by
• Simple prejudice
• Not receiving the support and adjustments you
  need
• Parallels with physical impairment adjustments
  and support to facilitate access. The
  psychiatric equivalent of the wheelchair and the
  ramp
• Social inclusion is important for recovery
• Being a part of our communities not apart from
  them
• Being a valued member of those communities
• Having access to the opportunities that exist in
  those communities
• Having the opportunity to contribute to those
  communities always being on the receiving end
  of help from others is a devaluing and
  dispiriting place to be

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Employment the opportunity to contribute

• Whether we like it or not, work has a central
  role in our society
• It links us to the communities in which they live
  and enables us to contribute to those communities
• It provides meaning and purpose in life
• It affords status and identity the second
  question What is your name? What do you do?
• It provides social contacts
• It gives us the resources we need to do the other
  things we value in life

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Most people with mental health problems want to
work few have the opportunity to do so

• 21 of adults with longer term mental health
  problems are in employment (2006 Labour Force
  Survey)
• In comparison with people with other health
  conditions, people with mental health problems
  are twice as likely to lose their jobs following
  the onset of problems (Burchardt, 2003)
• Among people using secondary mental health
  services the picture is even worse. In
  Wandsworth
• 1990 19.7 of longer term service users in
  employment
• 1999 8.1 of longer term service users in
  employment

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Unemployment is bad for your health

• Among unemployed people
• Higher incidence of physical health problems
• Higher incidence of mental health problems
• Higher incidence of suicide
• Greater likelihood of relapse and readmission
  among those with mental health problems

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But can they work?

• The research evidence
• Characteristics of individuals have little impact
  on employment outcomes therefore there is no
  justification for excluding people on the basis
  of clinical history, employability, work
  readiness
• Segregated sheltered workshops and pre-vocational
  skills training are not very good at helping
  people with mental health problems to return to
  employment
• There is strong evidence that with the right kind
  of help around 60 of people with serious mental
  health problems can successfully get and keep work

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What is the right kind of support?

• Individual Placement with Support evidence
  based supported employment
• Focus on competitive employment
• Eligibility based on consumer preference
  include anyone who wants to get a job
• Rapid job-search and minimal pre-vocational
  training place-train not train-place
• Employment support is integrated into the work of
  mental health teams and services
• Attention to consumer preferences
• Time unlimited and individualised support
• Benefits counselling
• (Bond, 2004)

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• Recent European randomised controlled trial
  compared traditional vocational service
  (non-integrated train-place with IPS for people
  with schizophrenia (Burns et al, 2007)
• 55 gained in IPS employment vs. 28 in
  traditional service
• 13 drop-out in IPS vs. 45 in traditional
  service
• 20 readmitted in IPS vs. 31 in traditional
  service
• Individual Placement with Support in 11/23 South
  West London Community Mental Health Teams 2006-7
• 1155 people successful in working/studying in
  mainstream integrated settings
• 645 people supported to get/keep open employment
• 293 people supported to get/keep mainstream
  education/training
• 217 people supported in mainstream voluntary work

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Early Intervention for First Episode
Schizophrenia in South West London Individual
Placement with Support with work and education
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Hope, control, opportunity are all importantbut
underlying these there must be Images of
Possibility

• one of the biggest barriers to recovery and
  inclusion is low expectationsIf people are to
  rebuild their lives then they must believe in the
  possibility of a decent future for themselvesIf
  health and social care providers are to
  facilitate recovery then they must believe in the
  possibility of a positive future for those they
  serve

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• Beyond being realistic
• daring to dream
• The value of dreams and ambitions lies not in
  their realism but in their ability to motivate us
  give us a reason to get up in the morning