Recovery in the community New Ways to Manage Depression and Distress Changing practice to improve care Lessons from addiction Mark Gilman Strategic Recovery Lead Public Health England

The Little Prince Antoine de Saint-Exupery (1943)Antoine de Saint-Exupery 'Why are you drinking?’ 'In order to forget,' 'To forget what?‘ 'To forget that I am ashamed,' 'Ashamed of what?‘ 'Ashamed of drinking!’

Addiction science

Lifestyles that are depressing:-

Lifestyles that aren't depressing:- Abstinence - the new using and drinking?

Alienation Jimmy Reid ( ) Rector of Glasgow University 1971 New York Times: "the greatest speech since President Lincoln's Gettysburg Address" Credited to Dr Oliver Aldridge

Bruce Alexander: ‘The Globalisation of Addiction’ “Poverty of the Spirit” The Addiction Factory Psychosocial dislocation Credited to Dr Oliver Aldridge

Waves of Public Health First waveMid 19 th Century Great Public Works, sanitation Second WaveAdvanced Industrialisation Refinement of scientific approach, germ theory of disease, hospitals Third WavePost WW2 Welfare State Fourth WaveRisk theory of disease, lifestyle issues, smoking, diet, exercise People living much longer

‘Fifth Wave’ (builds on first 4) + The ‘quality’ of those ‘longer lives’ & social isolation? from independence to inter-dependence and cooperation Rebalance models – mechanistic to organic Rebalance our orientation – objective to subjective Iterate and scale up through learning – try things out and share the learning. (Hanlon, et al, 2011)

5 TH WAVE OF PUBLIC HEALTH

5 th Wave Public Health: Meaning and Social Relationship's “If you did something about your drinking, drug use, smoking, diet & exercise - you could live another 20 years!” “And why would I want to do that?!” Is the Search for Meaning a spiritual activity?

Addiction – a search for meaning

Common features of Depression & Addictions Socially isolated Trapped Lost Worthless Misunderstood Confused Bewildered Doubting

Some features of Depression Recovery Good relationships Understanding your depression in the context of your lived life Learning how to create positive social relationships Identify patterns where, when, with who you feel better or worse Supportive group environments (‘Mutual Aid’ – AA, NA, SMART etc) Good relationship with good therapist Techniques to boost low self esteem Spiritual beliefs and practices

Recovery does slowly what drink, drugs & medications do fast......changes perception of reality. Learning how to fit in To live life on life’s terms Free from fear Free from addiction “Community as method” Recovery community a place where you learn how to live right, with other people...

Self Reliance Positive Social Network Recovery Community Treatment Towards Self Reliance Bio-Medical and Psychological Treatments + Positive Social Networks BIO PSYCHO SOCIAL

Co-production with people in recovery Increase Successful Completions “Those who successfully complete don't hang around” RECOVERYCOMMUNITYRECOVERYCOMMUNITY RECOVERYCOMMUNITYRECOVERYCOMMUNITY TREATMENT 5 ways to well being “You alone can do it but you can’t do it alone” Treatment Plan Treatment Plan Recovery Plan Recovery Plan Start Long term, in treatment population

Features of recovery

Social relationships: Overall findings from this meta-analysis Social relationships have big impact : comparative odds of decreased mortality Social relationships: High vs. low social support contrasted Social relationships: Complex measures of social integration Smoking <15 cigarettes daily Smoking cessation: Cease vs. continue in patients with CHD Alcohol consumption: Abstinence vs. excessive drinking Flu vaccine: Pneumococcal vaccination in adults Cardiac rehabilitation (exercise) for patients with CHD Physical activity (controlling for adiposty) BMI: Lean vs. obese Drug treatment for hypertension in populations > 59 years Air pollution: low vs. high Holt-Lunstad J et al. PLoS Med. 2010;7:e Social relationships have as great an impact on health outcomes as smoking cessation, and more than physical activity and issues to address obesity

CONNECT (Five ways to wellbeing) SOCIAL PRESCRIBING

Getting Started? A Map… TOPICACTIONSCORE 5=High 1=Low Connect SMART RECOVERY AA, NA, CA, OA... Weight Watchers Stop Smoking Groups Peer Led Groups Be Active Exercise Give Volunteering Community Involvement Keep Learning Further Education Hobbies Take Notice Mindfulness Spiritual Activity Presentation title - edit in Header and Footer