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The Recovery Experience: Daring to Dream

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South West London and St George's Mental Health NHS Trust ... Composers like Ravel. Visual artists like Van Gogh. Writers like Auden and Chesterton ... – PowerPoint PPT presentation

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Title: The Recovery Experience: Daring to Dream


1
The Recovery Experience Daring to Dream
Rachel Perkins Director of Quality Assurance and
User/Carer Experience South West London and St
Georges Mental Health NHS Trust
2
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

3
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 roles…The 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

4
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.

5
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)
6
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

7
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

8
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

9
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

10
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

11
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

12
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

13
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)

14
  • 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

15
Early Intervention for First Episode
Schizophrenia in South West London Individual
Placement with Support with work and education
16
Hope, control, opportunity are all important but
underlying these there must be Images of
Possibility
  • one of the biggest barriers to recovery and
    inclusion is low expectations If people are to
    rebuild their lives then they must believe in the
    possibility of a decent future for themselves If
    health and social care providers are to
    facilitate recovery then they must believe in the
    possibility of a positive future for those they
    serve

17
  • 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
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