Search results

The purpose of this paper is to explore the leadership qualities and behaviours required to support recovery-focussed practice in mental health.

This paper contrasts the prevailing leadership style within the NHS with the leadership style required to support recovery-focussed practice in mental health. The underlying reasons for, and implications of, this disparity are explored.

The leadership style required to support recovery-focussed practice in mental health services is one based on collaboration, empowerment, service-user led practice, autonomy, shared decision making, distribution of power, compassion, strengths, valuing, recognising and rewarding positive behaviours and using a collective approach. This is fundamentally at odds with that experienced by staff working within the NHS.

If NHS services are genuinely to promote the recovery of those whom they serve then the leadership and culture of organisations is critical.

The purpose of this paper is to provide an account of Central and North West London NHS Foundation Trust Mental Health Rehabilitation Services’ experience of utilising Team Recovery Implementation Plan (TRIP) as a framework to embed recovery-focused practice. The paper explores the challenges to creating recovery-focused services in inpatient settings and sets out how using TRIP has enabled frontline staff to work in partnership with people who use services and coproduce changes in practice and service development.

The paper draws on the process of utilising TRIP as a methodology to embed recovery-focused practice.

The account finds that using TRIP as a framework to embed recovery-focused practice supports frontline staff to work in partnership with people who use services and share responsibility for delivering recovery-oriented services, measure progress and drive change.

The paper provides an informative account of implementing TRIP as a framework to embed recovery-focused practice in mental health rehabilitation services. It explores the challenges faced by services in creating recovery-focused services and sets out how the TRIP has been used by teams as a methodology for coproducing, co-delivering and co-reviewing action plans. The paper gives practical examples of keeping the TRIP process alive and identifies several changes to practice and service developments achieved since TRIP’s implementation.

The purpose of this paper is to examine empirical, epistemological and conceptual challenges and clinical narratives in the application of risk assessment and management in mental health.

The authors used a narrative review of empirical, conceptual and clinical literature.

The worldwide prevalence of violence in mental health settings remains high. Risk assessment and management approaches, while well intentioned as an attempt to reduce harm and increase people’s safety, have negligible effect on both. They are invariably individual centric, ignore wider environmental, societal and behavioural influences that foment violence and have a stigmatising effect on people using mental health services. They also reinforce the myth that people who are mentally unwell threaten society and that through current risk assessment and management approaches, we can minimise this threat.

There is a need to reconsider the study and application of violence risk assessment in mental health.

The practice of risk assessment and management in mental health is marred by an overuse of risk assessment measures that are limited in their predictive efficacy. As a result, they have little value in preventing, reducing and/or managing harm. The language of risk punishes and stigmatises service users and reinforces the image of menace. An alternative language of safety may nourish and protect. A collaborative approach to safety assessment based upon recovery-focussed principles and practices may fuse professionals and service users’ horizons. Combining service users’ self-perception, professionals’ sound clinical judgement, assisted by electronically derived risk algorithms and followed by evidence-based risk management interventions, may lessen the threat to service users, reduce harm and transform the practice of violence risk assessment and management.

Risk appraisals discriminate against the small number of people who have a mental illness and are risky, an example of preventive detention that is ethically questionable. On the basis of the limitations of the predictive efficacy of actuarial measures, it is ethically dubious to subject people to interventions with limited benefits. Risk assessment processes tend to reinforce stigma by classifying individuals as risky, sanctioning society’s prejudices and fear through scientific authority.

The increasing focus on risk assessment and management to tackle violence in mental health is fraught with empirical, conceptual and practical concerns; the authors have suggested ways in which these concerns can be addressed without compromising people’s safety.

The purpose of this paper is to explore the impact of attending a Recovery College (RC) on NHS staff attitudes towards mental health and recovery, clinical and peer interactions, and personal wellbeing.

Qualitative and quantitative data were collected via online surveys from 94 participants. Thematic analysis and descriptive statistics were used.

Themes were identified for change in attitudes towards mental health and recovery: new meanings of recovery; challenging traditional views on recovery; hope for recovery; and increased parity. The majority felt that the RC positively influenced the way they supported others. Themes relating to this were: using or sharing taught skills; increased understanding and empathy; challenging non-recovery practices; and adopting recovery practices. Responses highlighted themes surrounding impacts on personal wellbeing: connectedness; safe place; self-care; and sense of competency and morale at work. Another category labelled “Design of RC” emerged with the themes co-learning, co-production and co-facilitation, and content.

It is important to understand whether RCs are a useful resource for staff. This research suggests that RCs could help to reconcile Implementing Recovery through Organisational Change’s 10 Key Challenges and reduce staff burnout, which has implications for service provision.

This is one of the first papers to directly explore the value of RCs for staff attending as students, highlighting experiences of co-learning.

The purpose of this paper, a qualitative study, is to explore service users’ experiences of attending clinical psychology within a public community adult mental health service.

Six individuals who had completed at least 16 sessions of psychotherapy participated in semi-structured interviews. Data were transcribed and analysed using interpretative phenomenological analysis.

The results showed the following overarching domains: the relationship and its impacts, structure and focus, and participant factors – timing/readiness. The importance of the use of language was also identified. Participants appeared to value a sense of humanity within the relationship. Interestingly, the personal impact of therapy as perceived by the participants was not focussed on symptom reduction, but on broader changes. The results are discussed in relation to the relevant literature.

Suggested principles for practice include maintaining attentiveness to relational factors, to client factors such as readiness for change and to the use of structure and flexibility. The use of recovery focussed and alliance measures are recommended.

For clinical psychologists providing psychotherapy within the public system, there are valuable lessons we can learn from asking the service users directly about their experiences, in terms of focussing on the human element of the relationship, and striking a balance between professionalism and humanity.

The purpose of this paper is to argue that if mental health services are to genuinely support the recovery of those who they serve then recovery principles must permeate all facets of the organisation, in particular human resources and workforce development.

This paper draws on the principles of recovery-focused approaches to people who use services and explores how these might guide a recovery-focused approaches to human resources and workforce issues.

The recovery principles like recognising and utilising the expertise of lived experience, co-production and shared decision making, peer support, focusing on strengths and becoming an expert in your own self-care all have as much relevance for creating a recovery-focused workforce as they do in the recovery journeys of those who use services. Everyone who uses services is “more than a mental patient” and everyone who provides services is “more than a mental health practitioner” – we need to use all the assets that everyone brings.

Although there has been a great deal of discussion about the features of recovery-focused services, there has been little, if any, consideration of extending the principles of recovery to human resources. The aim of this paper is not to offer a blue print but to begin an exploration of what a recovery-focused approach to workforce issues might look like.

The purpose of this paper is to propose a recovery-focused approach to risk and safety and what this might look like in practice.

Review of recovery approaches and the ways in which traditional approaches to risk might hinder people in their recovery journey. Consideration of the principles of a recovery-focused approach to safety.

A recovery-focused approach to risk based on co-produced safety plans that enable people to do the things they value as safely as possible and shared responsibility for safety. Four key principles of a recovery-focused approach to promoting safety, autonomy and opportunity are proposed.

A recovery-focused approach to risk and safety is central to the development of recovery-focused practice within services. This paper outlines such an approach.

“Co-production” is a process in health and social care wherein service users and practitioners work in partnership. Recovery colleges (RCs) are educational establishments offering mental health education; a cornerstone feature is that courses are designed and delivered in parity by both mental health practitioners and “peers” – people with lived experience of mental illness. This paper aims to consider, through the identification of key themes, whether co-production within RCs is operating successfully.

The paper is a systematic review of qualitative literature. Relevant concept groups were systematically searched using three bibliographic databases: Medline, Social Care Online and Scopus. Articles were quality appraised and then synthesised through inductive thematic analysis and emergent trends identified.

Synthesis identified three key themes relating to the impact of co-production in RCs: practitioner attitudes, power dynamics between practitioners and service users, and RCs’ relationships with their host organisations. As a result of RC engagement, traditional practitioner/patient hierarchies were found to be eroding. Practitioners felt they were more person-centred. RCs can model good co-productive practices to their host organisations. The review concluded, with some caveats, that RC co-production was of high fidelity.

RC research is growing, but the body of evidence remains relatively small. Most of what exists examine the impact of RCs on individuals’ overall recovery and mental health; there is a limited empirical investigation into whether their flagship feature of parity between peers and practitioners is genuine.

The purpose of this paper is to provide insights into the views and attitudes that psychiatrists have about recovery colleges (RCs).

Semi-structured interviews were conducted with ten psychiatrists from the Norfolk and Suffolk Foundation Trust.

Psychiatrists had a strong concept of the RC model, and were broadly positive about it, recognising many benefits. Various challenges were also acknowledged including how the RC model interacts with the medical model.

This is the first known study to explore solely the psychiatrists’ views of RCs, a group who are likely to be particularly influential within services. The sample was relatively unexposed to RCs, enabling insight into how the RC is perceived by those outside of its functioning as well as the state of wider organisational support, which is important for the success of RCs.

This paper summarises two 2014 research papers. The purpose of this paper is to suggest how the treatment of “schizophrenia” and other serious mental distress might realistically benefit both from new research evidence and recommendations for values-based practice that supports personally meaningful recovery.

First the author discusses a paper that reviews recent research on how people may come to have experiences labelled as psychosis. It looks at what happens to our brains and bodies when we experience severe stress and adversity, especially in childhood. Then the author discusses a paper that updates the international and values-driven consensus on how mental health services can support personal recovery, that is, recovery uniquely meaningful to each person and incorporating social inclusion.

The first paper summarises how a very adverse childhood can lead to experiences labelled as psychotic because of how the brain and body copes with stress. This and another paper suggest talking therapies may allow these changes to reverse. The paper on recommendations for practice illustrates the international consensus and wealth of guidance available to support values-based recovery-focused practice. Both allow the possibility that refusing antipsychotics may be a sensible decision.

The review of evidence on adversity, the brain and psychosis is the first summary of new research in this area since 2001. The paper on recovery-focused practice brings together a wealth of relevant material and recommendations for psychiatry.