Centre for Mental Health

Implementing Recovery

There are problems facing the implementation of recovery.

• Recovery is not a new form of treatment - it isn't a set of interventions that you can apply to people in order to make them 'recover'.
• Recovery is a set of stories describing the lives of individuals living with mental distress: these are their lives, their stories and only they can make them happen.
• But professionals and services by their attitudes and actions can (and do) influence these stories - helpfully or unhelpfully.
• From the narrative accounts it appears that mental health services will need to make significant changes to practice, services and culture in order to be more supportive of recovery processes. It may also mean radical changes to the workforce.

Changes to practice

Implementing recovery requires many changes to practice:

• Professionals need to support service users in the pursuit of their personal life goals ('personalisation') and convey the belief that this is possible. They have a key role as the carriers of hope.
• Services should empower service users and carers by working in true partnerships, sharing knowledge and expertise, with mutual respect (that goes beyond user involvement).
• Educational approaches, e.g. 'Illness Management and Recovery' programmes provide a useful model. Staff should be life coaches rather than therapists - 'on tap' but not 'on top'.
• Use empowering interventions, e.g. Shared decision-making for medication management; Joint crisis plans for crisis management and relapse prevention.
• Aim to increase people's sense of 'agency' (control) over their lives.

Changes to services

There are extra things that services will have to provide:

• Training - Services need to set up user-led education and training programmes on the principles of recovery for all staff, across all professions and at all levels. This will require a group of suitably trained and supported service user educators to act as the champions of change. Hence, the need to create a Recovery Education Centre in each service.
• Support for service users to become active citizens in their community - integrated into the community, not just physically located in it.
• Anti-stigma programmes with housing, employment, education and leisure groups to ensure access and opportunity.
• A particular emphasis on employment as the central vehicle for social reintegration and also address people's spiritual needs.

Changes to culture

But services have to recognise that the culture must change to make it work.

• Understand that training will not be enough. Recovery values need to become embedded into every management process: recruitment, supervision, management and appraisal, operational policies, etc. Even in an organisation's mission statement, strapline, language, etc.
• There should be staff supervision to support recovery-oriented practice and user involvement in staff recruitment and appraisal.
• This will require leadership at all levels - from clinicians, team leaders and managers.
• The culture will need to change to prioritising social goals over controlling symptoms. It is not that therapeutic goals are unimportant; it is simply that they must always be seen as a means to an end.
• Services need to re-evaluate risk by discussing risk openly and involving service users in risk assessment and planning.

Changes to the workforce

• We believe that this will lead to a fundamental review of the skill-mix and professional/user balance within the mental health workforce.
• We suggest a radical transformation aiming for perhaps 50% of care delivery by appropriately trained and supported peer specialists.
• This has implications for Human Resource and Occupational Health departments, but it is possible (see Gene Johnson's lecture - Peer support is now 'billable' in the US).
• We also need to support staff (and carers) in their recovery journeys, valuing their lived experience and the contribution that this can make to their professional roles.

Everything working together

Studies done on implementing recovery principles highlight the influence of managerial and organisational factors. For example, a studied implementation of Illness management and recovery programmes across 12 community settings and found four important factors:

1. Quality of training
2. Quality of management (particularly supervision)
3. Local leadership
4. A culture of innovation

They found that these four factors are interdependent and need to be applied together. Hence, training staff is ineffective without good supervision, local leadership and a receptive culture.