What’s #recovery really about in #mentalhealth? For many it means so much more than a return to how we were. Join my one hour seminar to learn more.
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The tripartite model of recovery
Are you hanging on to a limited view of recovery when in truth life is fine? Don’t limit your self-concept unnecessarily. Mental health encompasses far more than merely symptom management.
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Labelling, recovery and therapeutic optimism
Back in 1963, researcher David L. Rosenhan masterminded an elaborate hoax. It was a scam designed to study the effects of labelling upon clinical practice and to determine whether psychiatric diagnosis is based upon professional skill or simple expectation and prejudice. It was a bold experiment with profound implications for clinical practice even now almost half a century later.
The idea was simple enough. Rosenhan persuaded a group of confederates to approach state hospitals in America and request a consultation. Each told the psychiatrist who assessed them that they had begun to hear a voice which said “Empty”, “Hollow” or “Thud”. That was enough to secure them a bed in the local psychiatric hospital. But that wasn’t all, bad though that low threshold for admission might be, in itself.
Once admitted on to the ward Rosenhan’s confederates ceased any pretence of voice-hearing. They behaved perfectly normally and showed no symptoms of mental disorder at all. At this point we might expect the staff running the ward to smell a rat but that’s not what happened. Whilst the fellow patients could tell very quickly that their fellow patients weren’t actually ill, the staff apparently could not.
Even perfectly ordinary activities such as writing was seen as pathological. Pacing up and down through boredom in this secure, low-stimulus environment was interpreted as a sign of illness. It seems that once the label of ‘mentally ill patient’ was applied everything the confederate did was interpreted by those lights.
The staff saw precisely what they expected to see.
This mirrors an earlier study by Rosenhan and his colleague, Jacobson who examined teachers’ attitudes to students who had arbitrarily been tagged either as ‘bright’ or ‘not bright’ by the researchers. The school, known as ‘Oak school’ to protect the identities of all concerned, also lived up to expectations of labelling theory. Not only did teachers interact with children in accordance with the labels they had been assigned, but the children also began to live up or down to the expectations of the teachers – even though their actual test scores had been ignored when they were randomly assigned ‘bright’ or ‘not bright’ status. Each child took on the behaviours and traits of the label, regardless of their actual abilities and achievements.
This is why it is so important that we understand labelling in our work with people who have mental disorders. Whatever we believe and expect is likely to come true.
If you want the people you work with to recover you need to start believing that they can, and you need to act upon that belief. Remember that recovery is built upon lots of little steps in the right direction and we can encourage that simply and effectively by doing relatively simple things, things like offering praise, acknowledgement, recognition and practical help, repeatedly and well.
That’s hardly rocket science, is it?
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Schizophrenia, social care and the tripartite recovery model
What is schizophrenia? How do reasonable attempts to cope with symptoms like voice-hearing come to be thought of as symptoms of illness in themselves? Why is it so easy to get diagnosed with schizophrenia? More importantly, how can we use an understanding of the diagnostic process to aid recovery?
In this short video Stuart Sorensen introduces the basic idea behind the tripartite recovery model and shows how meaningful recovery is really all about coping. It’s not magical and it’s not complicated. Like most of mental health work in social care it’s about doing relatively simple things, repeatedly and well. Do the things that help people to feel valued and to cope with their experiences and you’re more than half way there.
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Therapeutic risk-taking
It is possible to assist people with social care needs (complex or otherwise) to develop the quality of their lives and to enhance their coping strategies. In large part this is achieved by assessing and encouraging risk-taking.
Without risk, life becomes empty. We develop as people by stretching ourselves and by gradually pushing the limits of what has come to be known as the ‘comfort zone’. But there is a balance to be struck, both in terms of ensuring that risks are reasonable and also in motivating clients to take therapeutic risks with a high likelihood of success.
This involves careful planning in order to ‘factor in’ the possibility of failure so that setbacks are seen not as disasters but as learning experiences – grist for the mill in refining plans to enable future success. This process is known as ‘risk debriefing’.
An understanding and appreciation of risk in relation to personal development is a vital element in the provision of social care in any setting. The process of person-centred planning must involve personal development and a striving for increased independence. This cannot happen without appropriate risk-taking.
So what are the elements of risk assessment?
According to the Health & Safety Executive there are 5 elements of good risk assessment and management and 5 principles that risk assessment is not
Risk management principles
- Ensuring that workers and the public are properly protected
- Providing overall benefit to society by balancing benefits and risks, with a focus on reducing real risks – both those which arise more often and those with serious consequences
- Enabling innovation and learning, not stifling them
- Ensuring that those who create risks manage them responsibly and understand that failure to manage real risks responsibly is likely to lead to robust action
- Enabling individuals to understand that as well as the right to protection, they also have to exercise responsibility
Sensible risk management is not about:
- Creating a totally risk free society
- Generating useless paperwork mountains
- Scaring people by exaggerating or publicising trivial risks
- Stopping important recreational and learning activities for individuals where the risks are managed
- Reducing protection of people from risks that cause real harm and suffering.
We all learn by our mistakes. Everything that you have achieved has been the result of trial and error – often the most valuable and effective lessons are learned precisely because of our errors in judgement. This is as true for our service-users as it is for us. If we give up on our plans at the first hurdle then we are doomed to fail. If we give up on our service-users when they make mistakes we doom them to failure just as surely.
Autobiography in 5 chapters (Anonymous):
Chapter 1
I walk down the street. There’s a hole in the road. I fall in the hole. It’s deep and I can’t get out.
Chapter 2
I walk down the street. There’s a hole in the road. I see the hole but I fall in it anyway. It’s deep and dark and I can’t get out.
Chapter 3
I walk down the street. I have my ladder with me. There’s a hole in the road. I see the hole but I fall in it anyway. I use my ladder to get out.
Chapter 4
I walk down the street. I have my ladder with me. There’s a hole in the road. I see the hole and I walk around it.
Chapter 5
I walk down a different street.
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What’s it like to hear voices?
What’s it like to hear voices?
Early on when I first started trying to make videos I made a very poor version of this. That video is no longer available but I liked the concept so I’ve had another crack at it. I think this one’s a lot more satisfactory in getting the point across to non voice-hearers.
Voices can be single or multiple, internal or external and complimentary or abusive. Often they’re mood-congruent and they always take some time to get used to.
Some people never get used to the voices they hear. That’s when mental health services step in. It’s OK to talk about voice-hearing as a fairly common part of the human experience. About 15% of people hear voices. The vast majority of those people never need any help at all to deal with them. But for some – for the 1 or 2 percent who do have problems with their voices the assistance of mental health services can be a life-saver.
So the next time you see someone in the street shouting at nobody, cut them slack., They’re dealing with something you’d probably find pretty hard to handle yourself.
To arrange training for your staff please complete the contact form below…
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A nasty little rash
I almost didn’t make this video. In truth, I almost didn’t make any video at all today – or tomorrow – or the next day – or however long it might take to get rid of my latest ‘problem’. My first thought about going before the camera at all, let alone uploading the fruits of my labour on to Youtube was acute embarrassment. You see I’ve developed a rather nasty little rash, courtesy of an interesting brand of fabric conditioner that doesn’t seem to agree with me.
Yes, it’s fine – I’ve been to the pharmacy, collected a nice little box of antihistamine tablets and some soothing gel for my burning skin. I’m not going to die from this and it’s likely to be cleared up in a week or two. But that’s not the point.
Ironically I uploaded a video recently about care plans and how we tend to give up too early when things get a bit difficult. In that video I challenged all those who saw it to apply the same principles to their own life and see how often they’d have been given up on themselves as they struggled to overcome the obstacles that life inevitably throws before us all. I encouraged people not to give up on their service-users just as they don’t give up on themselves. And here was I seriously considering doing just that. And for what? Because of a little bit of embarrassment about an allergic reaction to a perfectly ordinary part of life – laundry.
Since I started making these Youtube videos in earnest about a month ago I’ve set myself the target of producing at least 2 videos each week. That might not sound a lot but when you’re working full time and travelling to and from home in another part of the country the opportunity soon disappears if you let it. But that was the goal I set myself and that’s the goal I intend to keep. It’s my little care plan for myself, if you like.
I’ve long believed that in health and social care we must at least try to practice what we preach. We won’t always manage it but we should give it a go. If my service-user had wanted to use a non-serious rash like this as a reason not to push themselves I’d have bent over backwards to encourage them to carry on with the plan we’d agreed. I’d come up with lots of arguments about how nobody really cares what other people look like, no matter how awkward we might feel ourselves and how there’s no reason to let the few small-indeed people who did judge them spoil their achievement of their personal goals. I’d remind them that most people who saw them would be strangers who they’d probably never see again and how those that did know them would understand. Most of all I’d point out that they have a positive momentum and that’s a good thing. Positive momentum is worth a lot to peoples’ welfare and well being.
I’d say all that because I believe it. I believe in change and the potential for all people to grow beyond their current limits when given the right opportunities. So I have to behave the same way myself. I have to grit my teeth, accept emotionally what I know to be true intellectually and get in front of this camera, rash or no rash. And here I am.
So that’s my message for today – don’t worry what small-minded others might think. Keep the momentum of positive change going and never, ever let other peoples’ attitudes keep you from pursuing what’s right.
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Don’t blame people with mental disorders…
“Don’t blame people with mental disorders for behaving like people with mental disorders”
Too often mental health workers expect far more from their service-users than they are currently able to give. Then they blame them for having the very problems that brought them into mental health services in the first place. This is a fundamental misunderstanding of mental illness, of the process of recovery and of the role of mental health workers themselves.
It’s true that people are just people and there really is no ‘us and them’. But when people are struggling it’s not fair to expect them to perform at their best. Instead we should practice ‘therapeutic optimism’… Accept the person’s current difficulties but continue to expect them to overcome those difficulties with a succession of little steps.
If you liked this video please share it with others. And don’t forget to subscribe to my Youtube channel too!
https://www.youtube.com/channel/UCzG3jox1gdqSOxWVpf-AaLQ
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Mental health recovery: A care workers’ guide to the stress and vulnerability model
If you enjoyed this tutorial please subscribe to my youtube channel. Lots more videos on mental health and social care to come. You can subscribe to the website and Facebook too. Just click on the left of the screen or scroll down if you’re viewing this via mobile.
This video tutorial outlines the stress and vulnerability model as a tool for mental health recovery. It’s intended for anyone with an interest in mental health and recovery as well as workers at all levels in mental health and social care.
We begin with an overview of the 3 main symptom groups of mental disorder before outlining the model itself and the progressive role of anxiety, depression and psychosis.
Next we consider categories of vulnerability and stressors before defining recovery and providing a brief overview of how it might be achieved.
Finally a collection of slides are included for download. Screenshot the images and save them in a word document to make handouts for reference.
To arrange training for your staff please complete the contact form below…
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The social care recovery model
I’m a great believer in process. That doesn’t mean pigeon-holing the people we work with. It means having a process, a system that’s clear enough to keep us on track and flexible enough to allow truly collaborative and individualised working. That’s why I developed 2016-the-social-care-recovery-model-final. Designed around existing keyworking processes this model allows mental health care providers, housing association support workers and residential care workers to pinpoint exactly what their service-user needs and plan with them to meet their needs in a straightforward but effective way.
The Social care recovery model is simple to understand. It involves 9 domains that come together to create a cohesive system of care provision based upon skills development and recovery in an efficient and enabling environment.
The first 6 domains (the support domains) focus upon direct work with service users. They are developed through regular keyworking sessions and tools are provided to help service users and keyworkers to develop and plan for a range of situations as required.
As they progress through the 6 support domains, staff and service-users work collaboratively to address not only immediate needs but also the longer term issues that form the basis of recovery. The underlying assumption is that meaningful recovery is achieved via a succession of little steps, each of which is manageable and achievable. We always aim to take the next little step.
The 6 support domains are supported by 3 ‘process’ domains that govern the organisation’s own internal processes and the values and philosophy that make up the enabling environment.
If the support domains are about what we do, the process domains are concerned with how we do it. The process domains direct staff attention to key areas of work and the systems the organisation uses.
The first two process domains, ‘Focus on recovery’ and ‘Creating the right atmosphere’ relate entirely to the values and philosophies that govern social care work. They are based upon established recovery principles such as therapeutic optimism, expressed emotion and the self-fulfilling prophecy. All 9 domains should be supported by the appropriate training to ensure that staff understand how to help people recover most effectively.
The final domain concerns itself with the administrative and duty of care aspects of social care work and again, training and guidance is provided to ensure that both these vital activities are maintained.
To get more information about the Social care recovery model and how it can help your staff click here. Go on – you know you want to!
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