recovery an overview
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RECOVERY an overview. Prof.dr. Chantal Van Audenhove KU.Leuven GAMIAN Budapest may 28th 2011. Content. Recovery: what is it ? Why now? New trends in society Towards balanced care in mental health What helps and what hinders in care ? - PowerPoint PPT PresentationTRANSCRIPT
RECOVERYan overview
Prof.dr. Chantal Van Audenhove
KU.Leuven
GAMIAN
Budapest may 28th 2011
Content
Recovery: what is it ? Why now?
New trends in society Towards balanced care in mental health
What helps and what hinders in care ? Evolutions to recovery-oriented mental
health services and organisations Challenges for the future
The concept of recovery
A deeply personal, unique process of changing one’s attitudes, values, feelings goals, skills, and/or roles.
It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness.
Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.
Anthony, 1993.
Recovery from mental illness: the guiding vision of the mental health service system in the 1990s
The concept of recovery
Recovery is what people with disabilities do. Treatment, case management and rehabilitation are what helpers do to facilitate recovery.
Successful recovery from a catastrophe does not change the fact that the experience has occurred, that the effects are still present..
It means that the person has changed and that the meaning of these facts to the person has therefore changed. They are no longer the primary focus of one’s life. The person moves on to other interests and activities.
Anthony, 1993. Recovery from mental illness: the guiding vision of the mental
health service system in the 1990s
Basic assumptions
Recovery can occur without professional interventions A common denominator of recovery is the presence of people
who believe in and stand by the persons in need of recovery A recovery vision is not a function of one”s theory about the
causes of mental illness Recovery can occur although symptoms reoccur Recovery changes the frequency and the duration of symptoms Revovery does not feel like a linear process Recovery from the consequences of mi is sometimes more
difficult than recovering from the illness itself Recovery from mi does not mean that one was not “really
mentally ill”
Recovery as a process(Young & Ensing, 1999)
Stabilisation Re-orientation Re-integration
Control over symptoms and reducing the suffering Pharmaco-therapy Medication management Need for support and safety
Exploring the consequences of illness Mourning process Psycho education Symptom management Making plans for the future
Take on or restore meaningful relations of roles Return to a normal existence Practice skills Reinforce self-confidence
Engage in activities
Key elements of the process:
Personal aspects Person orientation : sense of self Person involvement : attitude change Self-determination : Choice Hope
Role of society Social relations Social roles and functions in work and education
Existential aspects Objectives at a higher level
Pat Deegan
“The aspiration of people with disabilities is to live, work and love in a community in which one makes a significant contribution”
(Deegan, 1988)
WHY NOW ?
New care forms:• Alternatives to admission and
transitional forms arise on top of the residential offer
• Increasingly scientific focus of care (evidence-based)
• Fading barriers between health care and social care
Position HCP:• Increased specialisation• Expert position• Decreased interest in general care
professions• Increasingly equal accessibility of
education • “Territorial wars”
New trends in care
Demand
Growing demand for care
Increase in chronic conditions
More critical consumers and assertive clients who are organising themselves
Personal patterns of expectations towards care
Multi-cultural dimension of care
Offer Policy
Deïnstitutionalisation and increased focus on society
Fading barriers between health care and social care
Commercialisation of health care
Cost effiency rules the debate
Increased focus on science and internationalisation
International trends in mental health care since 2000
Deïnstitutionalisation comes to completion Decrease in number of hospital beds slows
down Large institutions are being replaced by
smaller ones Increased recognition of the role for
families and concern about the balance between controlling the patient and their autonomy
Re-allocation of health care providers to home care
New emphasis on team work
Also: Promotion of evidence-based psychiatry in pharmacological, social and psychological
treatment Increase in personal contribution in treatment and care Emphasis on efficiency and cost reduction
“Balanced care”
Equitable care with a large spectrum of health care organisations in society, to provide all care necessary without the negative impact of a hospital admission:
in natural environment mobile oriented towards symptoms and limitations specific care for diagnoses and problems in accordance with the international convention on human rights focused on the users’ priorities coordinated
Example of balanced care
Front line health care with specialised support, in which all areas of life and partners are given a place
“Community integration and personal empowerment”
Bron: Substance Abuse and Mental Health Services Association (www.SAMSHA.gov)
Trends in care and social wellfare
1. Younique: more differences between consumers2. Power to the Patient: more do-it-yourself approach3. The sky is the limit: high quality expectations 4. Afraid for care: anxiety by unsafety and complexity 5. Healthy Grey Societies: lifelong vitality6. Everybody patient : more frequently chronic illness7. Health as a choice : more attention for lifestyle8. Prevention: high priority9. Care without borders: globalising health10. Googleritis: digitalisation of consumer-provider interaction 11. One-to-One: more direct treatment with medical technology 12. Caring is Sharing: more transparancy in knowledge and competency 13. Greener care: towards sustainable care14. Saving lives, saving costs: more business, market and entrepreneur
attitudes15. Who cares for me? More demand, less provision on the labour market16. Transition: reorganising the care chain17. The bill please : more demand more costs …
Idenburg en Van schalk 2010
Bigger diversity Global 3 types Less empowered users (49%):
Difficulties with responsibility and choice Pragmatic care users (41%):
Trust in new technologies, empowered, high achievement motivation, wanting to make own choices or to participate
Society critical users (10%): Critical and assertive, against individualisation
(Motivaction VWS Amsterdam 2005, in Idenburg en van Schalk)
Diversitity in care users and differing demands
An ideology ?
“The Diamond of Change”(M. Kmita 2005)
“The Mad”dangerous persons, excluded from society
STIGMA
Users of servicesrole of service providers
accepted,
self-actualisation, fight against stigma and powerlessness
CitizenshipHuman rights, responsibilities, participation and inclusion in
society
PatientsVictims, passive receptors of care and treatment, receive care
from experts who know what is the right thing to do
Implications for treatment
Self-help and informal help (peer support) gain importance
Professional support not necessary, but can be a facilitator
Many other organisations potentially involved apart from mental health care
psychiatrist
caregiver
domestic help
family support
friend
pharmacist
PsyCoT
day centre
home owner
client
Administrator of property
Paradigms in the therapeutic relationship
ChronicityDiagnostic categoryPessimismDysfunctionsFragmented modelPaternalismProfessional carePower and submissionArticial environmentStabilisationHelplessness
HerstelIndividualisationHope, realistic optimismStrengths, resilienceBio-psycho-social modelUser orientedSelf help, expertise by experienceEmpowerment, choiceNatural support, peer supportGrowth, calculated riskSelf determination (Onken e.a., 2002)
Key components in helping relationships
‘Helping to keep hope alive‘ Balanced, client-oriented
He didn’t have his own programs that I had to go throughI was the one who decided what to talk about
Human, respectfulHe was not afraid to tell me that he didn’t understand how I feel
Available every day helpersI could talk about anything, not only problemsI didn’t need much helpers, but a few good helpers over time,
someone who can keep it up, who’s there, who stuck with me all these years
TherapeuticWith him, I found confidence, the charisma that he had made me
dare to look at my life and talk about it
Key components in helping relationships
But also: Breaking the rules
He lent me some money over the weekend (because my welfare check would not come through the next Monday)
he accepted my present (and allowed me the chance to offer something to someone else)
Good chemistryWe got on with each other very well, she was like a friend
(Borg & Kristiansen, 2004)
Ten tips for recovery oriented practice
After each interaction, ask yourself did I…• actively listen to help the person make sense of their mental health problems?• help the person identify and prioritise their personal goals for recovery • demonstrate a belief in the person’s existing strengths and resources?• identify examples from my own ‘lived experience’ which inspires and validates their
hopes?• pay particular attention to the importance of goals which enable the person actively to
contribute to the lives of others?• identify non-mental health resources relevant to the achievement of their goals?• encourage self-management?• discuss what the person wants in terms of therapeutic interventions, respecting their
wishes wherever possible?• behave at all times so as to convey an attitude of respect for the person and a desire
for an equal partnership, indicating a willingness to ‘go the extra mile’?• while accepting that the future is uncertain continue to express support for the
possibility of achieving these self-defined goals – maintaining hope and positive expectations?
(Shepherd, Boardman & Slade 2008)
Barriers to recovery
Loss of rights and equal treatment Discrimination in employment and housing Care systems that provide few possibilities of
choice and undermine a sense of control and mastery
System standards
Mission: define the offer in terms of recovery Evaluation: role functioning from different
perspectives Leadership: recovery not only in print and words
but also in practice Management: programmes, protocols, action-
oriented processes of change, evaluations, ... Integration: goals set by the users are the starting
point for all organisations involved
Extensiveness: functioning in housing, work, school, social environment, ...
Involvement of patients and family: user-led organisations and self-help
Cultural relevance: appropriateness for other cultural groups
Advocacy: lobbying so that users can fully take part in life in society
Education and training: focused on introducing and implementing recovery-oriented practice
Financing: user needs-based, priority of patients: priority of processes
Accessibility: preference of patient is crucial
System standards
Challenges for the future
1. Paradigma shift in care
2. New organisational contexts
3. Research on recovery
4. Changes in society
New competencies
Patient centered practice Shared decision making Psycho-education Promotion of selfhelp and illness
management …
To help people on their way to recovery
New organisations
Guided by the recovery paradigm
Combined with Evidence based practice
Research on recovery
What helps people on the way to recovery? How are interventions stimulating or
hindering: Shared decision making Motivational interviewing Self management Matching the person of the counselor Etc…
Changes in society
Accepting communities Fight against stigma and self-stigma Inclusion in work environments Participation in care services
Leonard Cohen sings...
Ring the bells that still can ringForget your perfect offering
There is a crack in everything,That's how the light gets in
Thank you for your attention