Recovery: a journey of the heart Patrick Mundy Physiotherapist

Learning Outcomes No Health without Mental health (2011) Principles of Recovery REFOCUS: Model of Recovery Supporting Recovery Physiotherapy and Recovery

No Health without mental health (2011) The Vision: More people will have good mental health More people with mental health problems will recover More people with mental health problems will have good physical health More people will have a positive experience of care and support Fewer people will suffer avoidable harm Fewer people will experience stigma and discrimination

Recovery Supporting Organisations Implementing Recovery organisational change (ImROC) Recovery colleges Both for service users and Staff Courses lead by both a Practitioner teacher and a Peer teacher Non-clinical Promoting trusts and organisations to hiring Peer support workers

Clinical Recovery Evidence based practice and skilful use of interventions Getting rid of symptoms Restoring social functioning “Getting back to normal”

“…. A deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills &/or roles. It is a way of living a satisfying, hopeful, & contributing life even within the limitations caused by illness. Recovery involves the development of new meaning & purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” (Anthony 1993)

Personal Recovery Physical, mental and spiritual journey Spontaneous and Natural Deeply Personal Can occur with or with out professional help Involves growth and setbacks, periods of rapid and little change Can occur with continuing symptoms http://youtu.be/jhK-7DkWaKE

Core concepts of Recovery Hope – Sustains motivation and supports expectations of an individually fulfilled life Sense of control – Service users taking control of their own problems, the services they receive and their lives Opportunity – Participation in a wider society. To be valued, to contribute and have access to the opportunities that exist within those communities

Recovery Vs. Rehabilitation The goal of the recovery process is not to become normal. The goal is to embrace the human vocation of becoming more deeply, more fully human. (Deegan, 1995) A person with paraplegia can recover even though the spinal cord has not. Similarly, a person with mental illness can recover even though the illness is not “cured”. (Anthony, 1993) Def: restore (someone) to health or normal life by training and therapy after imprisonment, addiction, or illness (Oxford Dictionary) The process whereby a disabled person is enabled to use their residual abilities to function effectively in as normal a social situation as possible (Bennet 1978) Recovery is what people with disabilities do. Treatment and case management and Rehabilitation are what helpers do to facilitate recovery. (Anthony, 1993)

Stages of Recovery Moratorium Denial, confusion, hopelessness, identity confusion, self-protective withdrawal Awareness The first glimmer of hope for a better life, that recovery is possible. Can emerge from within or be triggered by significant other, role model, clinician Preparation The person resolves to start recovery work, taking stock of personal resources, values, limitations Rebuilding Forging a more positive identity, setting & striving towards personal goals, reassessing old values Growth Whether or not symptom-free, can manage illness & stay well (resilience, self-confidence, optimism) Andresen R et al (2003) The experience of recovery from schizophrenia: towards an empirically-validated stage model, Australian and New Zealand Journal of Psychiatry, 37, 586-94

REFOCUS: Model of Recovery Recovery-promoting Relationships Relationship between staff and service users is central to personal Recovery Exploring team understanding of Recovery and team values Skill training in Coaching Working Practices Understanding values and treatment preferences: Care planning is centred around person 2. Assessing strengths: Focussed on amplifying a person’s strengths and ability 3. Supporting goal-striving: Oriented around personally valued goals and that staff support active goal-striving

Supporting Recovery Download: www.rethink.org/100ways

Recovery-promoting Relationships Valuing people for who they are – seeing beyond a diagnosis/set of symptoms “Listening” & believing in the authenticity Seeing & having confidence in their skills, abilities & potential Recognising that problems or set backs are part of the recovery process

Recovery-promoting Relationships Tipping points for successful recovery: Insights and acceptance in the person being supported Allowance of risk taking Co-development of social opportunities and knowledge Positive relationships with formal services based on good communication Carers involved in self-recovery and respite Parr H (2009) Carers and supporting recovery, Glasgow: Scottish Recovery Network.

Mental Health Life Coaching Established from sport and Business Non-clinical Defined as a holistic orientation to working with people, to find balance, enjoyment and meaning in their lives as well as improving performance, skills and effectiveness.

Coaching Continued Goal: Setting clear goals Reality: Exploring the current situation Options: Alternative strategies or courses of action Way forward: What is to be done, when, by whom and the will to do it.

Social Inclusion Supporting people regain their place in their communities where they live Restitution – Regaining something that was lost or taken away

Peer Support Mutual self-help groups Peer support specialists Is a role in the mental system for which personal experience of mental illness is a job requirement Their own lived experience is valued Act as Role models Peer run programmes

Physiotherapy and Recovery Currently no research in the role of Physiotherapy in Recovery Currently little involvement in Recovery Is there a place for physiotherapy in Recovery? Natural Coaches! Goal-striving practice

Online Recovery Resources www.rethink.org www.scottishrecovery.net www.iop.kcl.ac.uk/recovery www.researchintorecovery.com

Further Reading/information Slade, M (2009) 100 ways to support recovery. Rethink Recovery Series Vol. 1. London: Rethink Mental Illness Bora R, Leaning L, Moores A, Roberts G (2010): Life coaching for mental health recovery: the emerging practice of recovery coaching. Advances in Psychiatric Treatment, Vol 16, 459-467 Gallwey T (1974), The Inner Game of Tennis. Random house, New York.