DEVELOPING SOCIALLY INCLUSIVE PRACTICE

1
DEVELOPINGSOCIALLY INCLUSIVE PRACTICE

• THE ROLE OF COMMUNITY MENTAL HEALTH TEAMS
• Bluntisham 19th April 2006

2
OVERALL AIMS OF REGIONAL PROGRAMME

• The aim of this initiative is to
• Support the development of socially inclusive
  practice within Community Mental Health Teams
• Identify challenges and solutions, test new ways
  of working to support social inclusion recovery
• Support dissemination of lessons learned

3
AIMS OF TODAY

• To
• Gauge progress over the last 6 months
• Share learning experience from 1st wave sites
• Support development of regional learning network
  for CMHTs
• Map out any constraining issues and develop
  strategy for change
• Identify any further development needs
• Engage with support 2nd wave sitess

4
Defining Recovery

• A return to a state of wellness (e.g., following
  an episode of depression)
• Achievement of a personally acceptable quality of
  life (e.g., following an episode of psychosis)
• A process or period of recovering (e.g.,
  following trauma)
• A process of gaining or restoring something
  (e.g., ones sobriety)
• Obtaining useable resources from apparently
  unusable sources (e.g., the value of the
  experience)

5
Defining Recovery

• These examples promote a broad vision of recovery
  that involves
• A shift away from a negative focus on a troubling
  event or circumstances psychopathology
• Towards a greater emphasis on positive
  restoration, rebuilding, reclaiming or taking
  greater control of ones life

6
Guiding Principles of Recovery

• Focus on people rather than services
• Monitor outcomes rather than inputs
• Emphasis strengths rather than deficits
• Fight stigma in the community
• Develop collaborative therapeutic alliances
• Promote autonomy and self management
• Providing evidence based approaches that work

7
European and North American studies from 1904 to
2000 and recent Japanese studies
Admission cohorts from late 1880s to early
1990sMixed duration of illness and mixed
subtypes Follow-up 1 to 40 years after
admissionDead included as not recovered when
no outcome data provided
20th century outcome studies in schizophrenia
8
20th century outcome studies in
schizophreniaMeasuresComplete recovery Loss
of psychotic symptoms and return to a
pre-illness level of functioningSocial
recovery Economic and residential independence
and low social disruptionIn hospital at
follow-up
9
20th century outcome studies in schizophrenia
Year of admission No. of subjects 1901-20
1,919 1921-40 4,264 1941-55 3,285 1956-75
3,160 1976-95 1,951
10
Recovery from schizophreniain Europe North
America
11
Recovery (inverted) unemploymentin Britain
12
Recovery (inverted) unemployment in US
13
Conclusions about Long-term Outcome Complete
recovery around 20 Social recovery around
40 But Complete and social recovery related
to the national economy Standard
antipsychotic drugs ineffective in improving
long-term complete or social recovery
Deinstitutionalization ineffective in improving
social recovery
14
What works? Early InterventionAlternatives
to hospital for acute treatment e.g. Crisis
resolution Home treatment Assertive
community treatment Psychosocial clubhouse
Supported employment Social firms Family
intervention Cognitive-behavioral therapy
Collaborative multi-agency programs
15
ConclusionsRecovery rates are substantial in
psychosis and are enhanced by Domestic,
non-alienating inpatient settings Relapse
prevention by ACT community alternatives to
hospital admission Empowering rehabilitative
settings (like the psychosocial clubhouse)
Reduced disincentives to employment in the
benefits system Opportunities for employment
through - supported employment - social firms