Thursday, 16 September 2010

Recovery – pie in the sky or a star?

Donna Kemp asks who ‘owns recovery’?

Recovery is everyone’s business. It seems to have been the buzz word for the last few years in mental health and is rapidly gathering momentum. Indeed, it appears to be morphing, growing arms and legs, changing its meaning and expanding its territory. Its mental health roots were firmly in the service users’ ground; it was something that service users owned – ‘you know what, despite what I’m going through with mental health services, of being care programme approached up hill and down dale, of being told what my needs are and what services and tablets can do to make me better, regardless of all of this, I can and I will have a life (so up yours!)’. It was empowering and liberating; it actually made sense and generated energy. Energy is contagious, get near it and you too will feel energised with recovery.

Everyone wants a piece of the recovery pie – it’s just so damned good! Mental health services are enchanted, a genuine bona fide tool for engagement, something that service users actually want to be involved with – a promised hope that is not a tablet or a weekly visit, whether you need it or not. Services are smart quickly picked up the new language, the new currency, developing recovery-focused services and offering recovery training. It is truly the age of recovery and the future looks rosy.

But the recovery baton has been taken rather than willingly passed from the user to the service. Yes, service users stay central to their support and care; yes, the ethos of recovery remains strong with collaborative working, but yes, the locus of control has shifted from the individual to the service. Like anything that you nurture and hold dear, to have it taken from you and given back is like the perpetual spare Christmas present, rewrapped and presented back as an original. Disappointed, you act surprised and feign gratitude, but it’s not right, the shine has dulled, it’s lost its energy and appeal.

Services have grabbed the tools from the recovery tool kit (marked ‘service users only’) and sculpted them into service-friendly instruments; paper heavy, but also oddly compatible with an electronic system – kind of – well, it will look better printed off. Take the Mental Health Recovery Star for instance. It’s all the rage, and rightly so. It’s good, it makes sense, it hits the mark, it’s visually pleasing and portable. For all of these reasons, it is fast becoming the tool of choice for measuring outcomes; commissioners are happy, services are happy, maybe even service users are happy at the idea that the ‘Star’ is stealing the show. But, it’s across the board, now everyone should have a recovery star with the outcomes measured regardless. It becomes mandatory, meaning that ultimately recovery is mandatory. You have no choice, you must ultimately recover and we will all be watching. We need you to recover, to show those positive outcomes; that means that you no longer need a service because you met the outcomes.

Congratulations, you just outcomed yourself out of a service. Now that may be great for some individuals, but frankly it fills some people with fear and confusion.  The rules have changed, services were always going to be there; to tinker with medications that must be taken; to keep on visiting come rain or shine; to remind people that they are too unwell to work at the moment; that going to the day centre is best. The rules have changed and it’s become time to fly the comfortable mental health nest that was filled with promises of foreverness.

To be clear, the paternalistic tendencies of mental health services are not acceptable. A shift in attitude and practice is evident, welcome and long may it prosper. Recovery-focused work with individuals is the right approach, but I would suggest affording caution to the wholesale use of one specific tool. This would be a move away from individualised service-user-centred care and support. Let mental health practitioners be creative in how they engage with people, give them a selection of tools to use, but remember that any craftsman will tell you that their own hand is their best tool – practitioners are fully capable of working with individuals to develop outcome-based care plans. As for recovery, it’s here to stay, but we need to consider the language and how we use it. It can have a paradoxical effect with some people, there is always the option of being maverick and actually using a term that the person you are working with uses: ‘getting better’ ‘getting back on the horse’ ‘feeling well’ ‘wellbeing’, ‘getting back to normal’; you never know, it could work.

Donna Kemp

Care Programme Approach Development Manager

Leeds Partnerships NHS Foundation Trust

Published in Mental Healt Nursing magazine Aug/Sept 2010 Volume 30 number 4

1 comment:

Anonymous said...

Seems unfortunate that in this era of payment by results recovery is now a duty expected of the patient but defined by staff in line with totally impersonal government bureaucracy.Clusters only allow for one condition and one kind of treatment - for those with more than one condition this is not likely to be enough or even the right treatment.I've not seen the recovery star before, but it seems that the number of recovery points needing to be achieved from the star is not defined by the patient - 1 or 2 points achieved appear to count as recovered and on the list for discharge from services in my area. The attitude now is 'Had a treatment? Well you should now be recovered. What do you mean you're not? You're obviously not trying hard enough / ungrateful / don't want to get well / wasting our time. Next NHS number off the list please.'