Title: The Recovery Experience: Daring to Dream
1The Recovery ExperienceDaring to Dream
Rachel Perkins Director of Quality Assurance and
User/Carer Experience South West London and St
Georges Mental Health NHS Trust
2Images 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
3What 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 rolesThe 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
4The 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.
5Taking 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)
6Recovery 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
7Recovery 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
8Recovery 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
9Employment 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
10Most 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
11Unemployment 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
12But 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
13What 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
16Hope, control, opportunity are all importantbut
underlying these there must be Images of
Possibility
- one of the biggest barriers to recovery and
inclusion is low expectationsIf people are to
rebuild their lives then they must believe in the
possibility of a decent future for themselvesIf
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