Recovery practice in Scotland: how are we doing? |
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| Monday, 31 October 2011 |
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In the last of her series, mental health communicator Heidi Tweedi examines the progress of establishing recovery orientated practice in Scotland. "Scotland is an example of a country where incorporation of recovery into mental health practice has at least been partially successful," notes journal article 'Implementing recovery: an analysis of the key technologies in Scotland (2011)'. An impressive statement when you consider that the SRN, the Scottish hub for recovery tools and support for services, was only created in 2003. With the launch of the SRI 2 this month it seems a good time to look at recovery practice in services and explore how we are progressing, what is supporting change and what barriers still exist.  "I joined the Patients’ Council in 2007 and things were changing then." Alison Robertson, Convenor of the Management Committee of the Royal Edinburgh Hospital (REH) Patient’s Council, has seen the change toward recovery values in services, both statutory and voluntary, but feels recovery practice is variable. "We had an issue on the ward that the washing machines for the ward kept breaking down causing hassle to staff and patients alike. I wrote to the nursing manager regarding this and it resulted in a new machine being installed. It gave me confidence things could be done, that people were listening." Conversely, Alison found herself up against established stigma when she realised she had not been minuted at meetings as a Patients’ Council representative. "Things are different now, possibly due to government pressure to include a service user voice. Meetings now have more excitement as everyone can see we can work together to solve problems; we are breaking down the ‘them and us’."  "The embedding of recovery values in the NHS is a continuing process," admits Derek Barron, Associate Nurse Director Mental Health Services, NHS Ayrshire and Arran. "For many, the NHS is still seen as the bogey man in regards to recovery, but our views have been changing since the mid-nineties. We moved from a custodial to a parental role in the nineties. The latest step has been moving from a parental to a partnership role. We have seen changes in levels of understanding in that [those who use our services] have a choice. I now see people talking about recovery all the time." Indeed some see the NHS as being slow in embracing recovery practice in comparison to the voluntary sector. Cathy Hamilton, Project Manager at Tayside Carers Support Project Support in Mind (Scotland), shares her experience: "Although there has definitely been a positive shift to recovery I would say that the voluntary sector is more advanced than the statutory. We have pockets of good practice and I think people are interested in recovery, but it’s how they action this that changes from region to region."Derek feels the issue of risk taking is a key component as to why the statutory sector can be seen to be behind in recovery practice: "If you’re in the third sector and get a decision wrong nobody is going to take you to an incident enquiry. We all have to find a way to share when people want to take positive risks."  One key group that can be seen as particularly risk adverse are carers. Linda Macleod, Development Worker with Edinburgh Carers Council, agrees: "It’s true many carers have difficulty with recovery but if they are offered things over time it starts to seep in." Linda refers to recovery tools such as WRAP, courses of which she has been organising successfully for carers. "The interdependency between carers and users is important in recovery but the medical model splits carers and users up. Recovery practice should be more holistic and see carers as part of a service user’s life. You do get professionals who are great at this. Social work for example is more likely to look holistically, involving carers and family." Due to feedback such as this, carers are now included in the SRI 2, emphasising their role in recovery. Plus, with the SRI highlighted in the Scottish Government's Mental Health Strategy for Scotland: 2011-15 A Consultation as a practice tool for embedding recovery approaches within services for the future, it will have a increasing reach to support a greater number of services explore core values and self-reflect. You can read more about the Government's consultation in this article by health writer, Emma Razi.  "It keeps you focused and shows you what needs to be changed," James Kennedy, Practice Development Nurse in the Angus Adult Integrated Mental Health Services and Learning Disability Team, explains. "In teaching, you don’t know how you’re making a difference until you can see practice changing and the SRI has allowed this to happen. The trick is to get people to do the SRI by selling the message that by doing this you can make a difference. It measures strengths and shows what can be changed rather than just hitting you over the head with failures. Recovery must be embedded in practice; it’s a cultural change."If some services are trailblazing why not others? "Perhaps people aren’t linking things together and don’t explore solutions [such as using recovery tools]. They just say they have no time but that’s not the full picture," considers James. "Although other national drivers come and go recovery is here to stay. It’s written in national policy and relates to lots of work we do. In Angus we have been quick off the mark and service users say there is real difference between our services and others they have accessed. We have not been afraid to look at service user satisfaction and have very good relationships with the voluntary sector. I know that is not the case across Scotland." Additionally, managerial support can frustrate frontline staff, as James explains: "I’ve seen instances of people put on training but then not allowed to put it into practice, not allowed to change. It’s the medical model versus implementing a principle. I have a very good manager who does not hold me back and allows me to make some autonomous decisions." Derek agrees: "We need to engage both hearts and minds and demonstrate how things can be different; it’s a key part of my role."  Joyce Mouriki, Chair of VOX and Senior Public Partnership Officer for Healthcare Improvement Scotland, feels service users are key to supporting change: "It’s down to interest and involvement. If people in a Board area are willing to back a user led initiative then they have an underlying interest in recovery. These groups act as a catalyst for recovery and provide support to struggling practitioners. It’s also been the other way around in some areas like Lanarkshire where the success is partly due to strong funding. Unfortunately, some areas have lost their involvement if backs are against the wall financially." Leadership, both from within organisations and from external recovery champions, is vital to progressing recovery practice in Scotland. Taking good practice, positive results and supportive policy to staff in a manner that they can access, learn from and then action is a role that must be met. Tools such as the SRI 2, as well as evolving health policy, will support this process by increasing communication both within and between services regardless of sector, to and from service users and carers, and finally challenging stigma by permeating wider society over time. Comments (1)
... written by chrys muirhead, November 01, 2011
I think that recovery focused practice will vary according to the area of Scotland you live in. Some of us live in areas that have limited meaningful involvement of users, survivors and carers. I agree with Joyce Mouriki's comments about the health boards who back user led initiatives being the ones really interested in recovery. The new mental health strategy out for consultation is an opportunity to revisit recovery and highlight the importance of user, survivor and carer led initiatives.
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