Recovery and the assets-based approach

18th July 2012

With the publication of the report by the Commission on the Future Delivery of Public Services (the “Christie Report”), and the moves towards creating an Assets Alliance, the spotlight has fallen on how taking an ‘assets-based approach’ could help improve health in Scotland. Here, SRN Network Manager Lucy Mulvagh takes a look at what this could mean for recovery in Scotland.

assets_graphicWhat are assets?

Assets are the resources or strengths that empower individuals and communities to make the most of life and help them survive and overcome obstacles. They can take many forms, including the knowledge, skills and lived experience of people, the strength of local associations and the support of institutions as well as the economy, buildings and infrastructure.

Health assets have been defined as:

any factor or resource which enhances the ability of individuals, communities and populations to maintain and sustain health and wellbeing and to help to reduce health inequalities. These assets can operate at the level of the individual, family or community and population as protective and promoting factors to buffer against life’s stresses.” (Morgan and Ziglio 2007)

They can be identified at three levels:

  • Individual: social competence, resilience, positive values, self-esteem and a sense of purpose.
  • Community: supportive networks, intergenerational solidarity, community cohesion, religious tolerance and harmony.
  • Organisational: environmental resources necessary for promoting physical, mental and social health, employment security and opportunities for voluntary service, safe and pleasant housing, political democracy and participation opportunities, social justice and enhancing equity. (Morgan and Ziglio 2007)

What is the assets-based approach?

The aim of assets-based approach (ABA) is to reduce health inequalities and help achieve sustainable good health and wellbeing. It is underpinned by a concept known as ‘salutogenesis’, a term first coined by Aaron Antonovsky in the 1970s. He defined it as “how people manage stress and stay well”. He noted that although stress is ever-present, some people achieve and maintain a good standard of health despite having been exposed to extremely adverse circumstances.

ABA is about identifying the factors that create and support good health. Rather than focusing on deficits, ABA involves “mobilising the skills and knowledge of individuals and the connections and resources within communities and organisations” (NHS Health Scotland 2011). It puts individuals and communities at the centre of decision-making and in control of health improvement rather than being passive recipients of health programmes. The top-down model whereby institutions tell people what’s wrong with them and how they’re going to be ‘fixed’ is replaced with one that is empowering, participatory and rights-based.

ABA is not new. Also known by a myriad of different names, such as ‘strengths-based practice’ and ‘asset based community development’, there are many examples in Scotland and internationally of projects that have used this method, even within SRN. In fact, the long tradition of community led action was recognised in December 2010 at the Assets Alliance, an event convened by the Scottish Community Development Centre (SCDC), Long-Term Conditions Alliance Scotland (LTCAS) and the Scottish Government. The purpose of the meeting was to find out from key stakeholders using assets-based approaches what form an Alliance should take and what its key functions should be. Although it is yet to become a tangible entity, further developments are expected.

Projects developed using an ABA will inherently be unique to the individual or community involved rather than ‘one size fits all’. A variety of techniques can be used to empower, identify and deploy assets. In his presentation to the Assets Alliance – which he helped initiate – the Chief Medical Officer for Scotland, Sir Harry Burns, notes that the ABA “helps individuals rediscover the skills and strengths they may have forgotten they have”. Building trusting relationships – no matter how long this may take – is essential. Active listening and asset mapping are other potential methodologies.

Recovery and the assets-based approach

As we know, there is no universally agreed definition of recovery. Nevertheless, there is growing agreement about some of the common principles and values that adhere to recovery and widespread evidence of the factors that help.

Recovery for SRN, as for many others, does not simply mean clinical recovery, the traditional medical model of a ‘return to normal’, or ‘absence of symptoms’. We describe recovery asbeing able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms. It is about having control over and input into your own life. Each individual’s recovery, like his or her experience of the mental health problems or illness, is a unique and deeply personal process.”

In order to gain a better insight SRN has conducted research into what helps and hinders recovery, predominantly by actively engaging with people with lived experience of mental ill-health and recovery and listening to their stories.

As our learning has developed, some key themes that support recovery have emerged, including:

HOPE, OPTIMISM AND STRENGTHS
Hope is widely acknowledged as key to recovery. One way to realise a more optimistic approach is to focus on strengths.

EMPOWERMENT, CONTROL, CHOICE AND INCLUSION
Empowerment and taking control can be challenging but many people describe how important it is to find a way to take an active and responsible role in their own recovery. Control is supported by inclusion in communities and reduced by exclusion, stigma and discrimination. Access to support that is responsive and reflective of changing needs, i.e. a choice of the right kind of support that is available at the right time.

LEARNING AND UNDERSTANDING
Learning about and understanding about our own mental health and general wellbeing (self-awareness) is important

FINDING MEANING AND PURPOSE
We all find meaning in very different ways. Some people may find spirituality important, while others may find meaning through employment or the development of stronger interpersonal or community links. Many people describe the importance of feeling valued and of contributing as active members of a community.

RELATIONSHIPS
Developing positive and supportive relationships based on belief, trust and shared humanity help promote recovery. Having friends and family who are supportive, but do not undermine self-determination.

Putting these recovery principles into practice could be termed ‘the recovery approach’. It is firmly underpinned by the concept of human rights, including the rights to self-determination, equality, participation and information, amongst others.

Strengths, choice, control, inclusion, learning, relationships … it is hard to avoid the obvious parallels between recovery and the assets-based approach. Individuals are placed at the centre of decision-making and, in an empowering and participatory way, supported to identify, choose and control resources that will help achieve and sustain good mental health and wellbeing. Each process is unique to that individual because they decide what is required, when and how.

recovery_assets_wordleCurrent opportunities and challenges

There are strong interests in and support for recovery and assets-based approaches from many perspectives including health, community development and public service reform. There is also strong governmental support for recovery and the assets-based approach in Scotland. As I’ve begun to demonstrate here, there are undoubtedly strong links between the two that, if properly harnessed, could bring about a Scotland where mental health recovery is a reality for all.

Three areas of opportunity lie in the policy developments around personalisation through self-directed support, community empowerment and renewal and the integration of health and social care. We don’t yet know what these will look like in practice but all have the potential, to varying degrees, to redefine the balance between the traditional deficits, medical model and a person/community-centred, collaborative approach to health improvement.

However, the assets/recovery approach presents several challenges. Firstly, fundamental changes – including to the very institutions that are currently advocating its wider adoption – will likely occur. As Sir Harry Burns notes: “Institutions have reached the limit of their problem solving potential.” The Glasgow Centre for Population Health (GCPH) also points out that: “Adopting an assets-based approach is community led, long-term, open ended and has less certain, unpredictable outcomes, which are likely to take time to emerge.” (GCPH 2011)

This goes to the very heart of what is needed if the approach is to be mainstreamed throughout Scotland – motivation. Institutions become the servants of the people and people become pro-active participants in their communities. There will have to be a radical reinterpretation of the current system with its predetermined frameworks, plans, outcomes, and targets.

Also, coming as it does at the time of welfare reform and financial austerity the assets/recovery approach could be seen as an ideological ‘hard sell’ if it’s interpreted as just another way of withdrawing much-needed state support. The reality is in fact the opposite. Any meaningful implementation of an assets/recovery approach could only be done with continued investment.

There are many other questions to be debated, not least how to implement what is ostensibly a local-level approach on a national scale, and how we would measure success. This article has only begun to scratch the surface, but it would seem that we could be witnessing the emergence of an assets/recovery model in Scotland.

Further reading:

Fiona Crawford: Doing it differently: an asset-based approach to well-being

Jane Foot: What makes us healthy? The asset approach in practice: evidence, action, evaluation

Improvement & Development Agency: A glass half-full: how an asset approach can improve community health and well-being

IRISS: Strengths-based approaches for working with individuals

IRISS & East Dunbartonshire Council: Using an assets approach for positive mental health and well-being

IRISS: Blog on asset mapping

NHSHealthScotland: Chief Executive’s Annual Report 2010-11