Informing recovery approaches: new SRN research
12th May 2014
A key element of SRN’s Strategic Plan is to ensure that mental health services and supports are provided in a way which is focused on recovery.
Earlier this year we commissioned new research to consult people on their views on how we continue to inform recovery approaches in Scotland. Ruth Stevenson of Ruthless Research, who were selected to complete the research, describes the approach she took and some of the findings.
Research background and methods
To identify current thinking around recovery in Scotland a variety of stakeholders from different roles, disciplines and relationships with recovery were interviewed to identify their opinions and priorities. This article briefly gives a collective sense of the key themes arising, which are described in more detail within the full research report. In total, 35 depth interviews were conducted with key stakeholders by telephone during February and early March 2014, with an average interview length of just under half an hour. Interviews were guided by a set of themes and issues identified through prior research on current issues in the development of recovery approaches both in Scotland and more widely.
The participants represented a broad range of organisations and individuals across Scotland (and in two cases beyond) based in different settings and with a variety of levels of seniority. All were selected for their knowledge of recovery approaches with a view to gathering views from those most actively attempting to put recovery into practice.
A collective sense of the key themes arising
The vast majority of the stakeholders felt positive about the way that recovery is working in Scotland to date. It was generally felt that recovery focused language was now in widespread use and was generally accepted as the norm, although often challenged by professionals that favour the medical model or individuals that consider ‘recovering’ to be a threat to their livelihood or identity.
Further progress required
All stakeholders therefore felt that further progress was still needed in order to achieve genuinely and consistently recovery-focused services.
A range of people are influential in an individual person’s recovery journey, and their approach to recovery often varies considerably. It was noted that any single individual within this journey could be more or less recovery oriented, depending on:
- Their buy-in to the medical model
- Their people skills
- Their training
- Their day-to-day approach as influenced by policy, environment and colleagues
Putting recovery principles into practice
Where individuals or teams were supported to be person centred, their care was more likely to be recovery focused. Some people, however, identified a challenge with putting recovery principles into practice.
Mental health nursing
One clear area where virtually all stakeholders mentioned that recovery was being championed was within mental health nursing. It was widely commented that recovery was built into training for mental health nurses from the start, and supported by the Rights, Relationships and Recovery agenda, creating a favourable environment for a consistent approach to recovery-focused care.
Peer support and the less engaged
Peer Support was also highlighted as an area where recovery generally thrives. However, a number of other professions were highlighted by the stakeholders as being somewhat less engaged with the recovery agenda and these included:
- Non mental health specialist clinicians
- People who have been in practice for longer
- Middle management
Training and leadership for medical professionals
It was argued that further work around training and leadership is essential across the medical profession to enable a recovery focus to be filtered into the professions though early training and continuing professional development – either professional led or service recipient led – and for this to be supported by recovery-focused managers and management practices.
A greater role for people with lived experience
It was also widely proposed that there should be a greater role for people with lived experience of mental health problems within this, to include:
- Influential roles at team, local and national levels
- Contribution to training through sharing of experience and what works
The less aligned
Some individuals and environments were widely felt to be currently less aligned with the recovery agenda, including:
- People with dementia
- People with addictions
- Rural areas
- Compulsory treatment
- Long-term treatment
- Acute settings
- Hospital treatment
- Transitions to the community
- Continuity of care
These areas tended to be highlighted as places where it was most difficult to provide a consistency of person-centred care and engage service recipients with recovery principles. There is certainly work to be done to emphasise that care in these areas can be provided in a recovery oriented way, with compassion, empathy and person centeredness.
Several stakeholders also felt that the important role of carers and supporters within the recovery journey must be further recognised and carers and supporters should be involved more widely and at the earliest opportunity.
Power dynamics and balance of responsibility
Unequal power dynamics between service users and professionals were seen as being a major challenge to the recovery agenda, often causing conflict and misunderstanding.
Many stakeholders felt that responsibility for recovery ought to be shared, and held by the individual in recovery wherever appropriate. Linked to this, risk taking should be positive, consensual and calculated.
The importance of research
Many stakeholders also felt that more research and evidence were needed, either as a way to demonstrate that the recovery agenda ‘works’ or as a way to measure progress along an individual’s recovery journey.
As part of the evidence gathering process, a wide range of key questions were highlighted relating to these issues, and potential solutions to support these were generated and outlined in the full report. SRN’s next step will be to consider and prioritise these as part of their strategic planning, while many have implications beyond any one organisation.