The Recovery Approach at St Martins

Introduction

At St Martins we use The Recovery Approach because we believe it offers people the best opportunity to overcome and or successfully self manage their mental health illness and or any of life’s difficult challenges and live a fulfilling and rewarding life. The approach also works when supporting all other service user groups, including offenders, young people and those with dual diagnosis etc. We strongly believe that all our service users can enjoy a better quality of life as a direct result of using this approach and it’s associated ‘tools’. The Recovery Approach is all about putting the people who use our services at the very centre of what we do. In real terms this means that our service users identify their own priorities, make the choices and decisions and ultimately lead their own support, asking our staff teams for assistance, how, where and when they need it.

The following few pages aims to tell you about The Recovery Approach in a little more detail. (It might seem like a lot of information, but the approach is a work in progress, meaning it is developed over time and can involve a lot of reading and training!) It covers the history of the approach, the philosophy and key ideas behind it.Remember, whilst there might be a lot of reference to mental health in this document, the approach is also very successful when used to support anyone managing any of life’s most stressful and difficult challenges.

The history of The Recovery Approach

The Recovery Approach was developed in United States in the 1950s, as a result of one woman’s experience of mental ill health and the mental health system. Mary Ellen Copeland’s mother spent many years in an asylum and Mary Ellen herself was later diagnosed with manic depression. She experienced negative and unhelpful attitudes from mental health professionals and no real alternative to medication. In response she set about finding a way to managing her (mental) health herself.

Mary Ellen wrote hundreds of letters asking for people’s experiences of mental health and received hundreds of replies from people with mental illness, telling her how they had overcome their problems and were living full lives. She was privileged to be invited into the lives of people whose courage and persistence impressed and inspired her greatly, then and now. Through this process of networking recovery information, she uncovered strategies, which whilst often very simple and safe, have the capacity to create major life change. The Recovery Approach was born.

The dictionary definitions of recovery are, amongst others:

‘Become healthy again; regain a former condition; find again; get back (a loss or expense)’.

During contact with mental health services you might have heard and been involved in, a lot of discussion about illness; what it’s called, what the symptoms are, what medication will be required and what effect it might have on a service user. One thing you may never have experienced, however, is someone telling you that the service user is going to or could recover.

Think about this:

A physical health matter, such as one of our service users breaking their leg. They would go to hospital and have it x-rayed and put in plaster. Over the following weeks they would have check ups and perhaps have the cast reset. During this process they might be told that the bone won’t heal quite as strongly, that they may be left with a bit of a limp or that they may experience aches and pains in cold or wet weather. However, the overriding messagethey will hear is that the broken leg will get better and recover. Maybe it won’t be quite the same as before, but it will recover.

Did anyone ever tell you that about mental health?

The Recovery Approach takes the view that you can recover from mental health problems. That doesn’t mean that it can cure, it’s not a magic wand which will make symptoms disappear. What it can do is present ideas and information, so that changes can be made to help recover wellness. It aims to providesystems, techniques and ideas to support service users recover something, not recover from something.

There are five key principles behind The Recovery Approach

  • Hope

If there is no hope, it is very difficult to start a journey of recovery. And, there is always hope, no one controls this but ourselves. We use hope often, sometimes without even thinking about it. For example, a service user might hope the book they have been searching for is in the Library, or the car makes it for another year before they have to scrap it, or that it won’t rain when they are planning a picnic or barbeque!

There is much to hope for. Remember the hundreds of people who responded to Mary Ellen telling her how they overcame their problems, they all had hope they would recover and enjoy a good quality of life.

  • Personal responsibility

This is perhaps the most fundamental principle, as the truth is no one else can really help or make changes for or to us. The one and only person that can help and or change us and our lives is ourself. The old saying is, ‘if you want something done properly, do it yourself!’ If support staff consistently manage the lives of our service users, they cannot be expected to recover or gain any real level of independence. If they had a headache and you asked what they might want to do about it, they would more than likely say they might take a paracetamol. So, if they say they would like to open a bank account, why respond with I’ll call a few banks and ask what you will need to do? Why not respond with, ‘so, what do you think you might need to do’?

Or if a service user is telling you about a really difficult problem they are experiencing, using the Personal Responsibility concept within The Recovery Approach, you might respond, ‘I appreciate this is really troubling you, have you thought about what you might want to do, what approach to take’ etc

  • Education

To reach any level of independence or recovery, it’s really important to access as much information and knowledge as possible. Service users should be encouraged and perhaps assisted to access resources, through the internet, within the community, using libraries etc. For example, if a service user want to go back to college, find work or volunteer, there are numerous ways of getting started, just Google! If a service user needs a specific support group, they can do some research, in the library, on a council website etc. The more you know the more choices you have and independent living becomes more of a reality.If a service user has a mental health illness, they can educate themselves about their illness and get to know themselves better; what’s good for them, what’s bad for them, their strengths and achievements, their diagnosis, their treatment, their medication, what other therapies there are that compliment their treatment.

  • Self-advocacy

Service users have rights and should know they have the right to stand up for them. They have the right to be treated as a person and with respect. They have the right to be listened to and the right to request the type of support they want. They have the right to challenge their medication, decisions that are made about them, for example legal action being taken against them, or simply to return something they have bought, if it is faulty or not what they were expecting. As professionals, we must encourage self advocacy as it is key to increasing self esteem and living more independently.

  • Support

There is so much support out there and service users should be encouraged to make the most of it. In The Recovery Approach, support is defined as friends, colleagues, family, neighbours, doctors, tutors etc. A problem shared is often a problem halved or at the very least, talking to someone can be a relief. Service user should be encouraged to accept support when it’s offered and needed and to surround themselves with people who are good to them, who are positive and loving and to avoid those who are abusive, negative, criticise or are mean towards them.

Seeing things differently

The Recovery Approach encourages you to accept who you are. Recognise that the person you are today is not the person you were yesterday or the person you will be tomorrow. It also recognises that Recovery is a personal journey and can be described as a ‘work in progress’.

When we are supporting very vulnerable people, they should be reminded that:

They are…
a valuable and individual person / They are not…
a burden, difficult
a diagnosis
an illness
The have…
hope
capabilities, desires, dreams,
plans, ambitions, choices / They are not just….
A lost case, difficult, awkward, a problem
a prognosis
a compliant patient
They can have the opportunity…
to work or study if you want to
They are able to
maximise their potential
be independent
live a fulfilling life / They can…
live life the best way they can
find their own inner strength
develop a personalised plan to help them recover

The Wellness Recovery Action Plan and The Independence Plan

Most of us know what independence is and it is generally what our service users aim towards. For those that have a mental health diagnosis or have milder forms of depression, anxiety, feel isolated or disengaged, wellness is simply feeling more positive, more in control, healthier, happier and well!

There are many definitions, because wellness means different things to different people. It might mean being kind to yourself, being able to have a laugh, liking yourself (mostly!), accepting that you’re not perfect and that you don’t have to be, recognising that you have choices and being able to make them, feeling that you have a place in the world and feeling OK about it… the list goes on. The trick is to find what wellness means to you.

The Wellness Recovery Action Plan (WRAP) and The Independence Plan (IP) are the strategies which take all or some ofthe Recovery concepts and puts them into practice. They are plans that can be used to help everyone in their everyday life. It can help you take responsibility for your ‘wellness’ and take control of your own recovery and path to independence.

Stage 1 Knowing yourself: The process begins by helping (or asking) service users to list their skills and potential strategies they use or want to use, to keep themselves well, happy, connected, satisfied, safe etc, things they can use or do, when they feel the opposite of the list above, e.g. unhappy, isolated etc

Ideally these skills and strategies should be low or no cost financially and they should do no harm to themselves or others! They could include for example, having a short walk very day, going to bed before 11pm, speaking to a friend on the phone once a week, eating one hot meal a day etc. Though some service users will enjoy alcohol and or smoking, this should not be used as part of this strategy because it ‘breaks both of the rules’ as it comes at a financial cost and can harm your health.

Stage 2 Daily maintenance plan

Following on from the examples of strategies in stage 1is the daily maintenance plan. This involves service users knowing what they are like when they are well – for example, they might be happy, positive, energetic, motivated, interested, engaging, quiet, thoughtful or funny – then figuring out what helps keep them this way. It might be eating three meals a day, getting enough sleep, getting out of bed at a reasonable time, doing some exercise or having some fun. So, if a service user regularly eats three meals a day and then stops doing so, it might be a sign of them becoming unwell, or that something else is wrong and staff could offer additional support.

Stage 3 Triggers

The next part of the WRAP or IP is to recognise triggers. These are the things that can lead to a service user becoming unwell, at risk etc. Again, everyone’s triggers are different. They might include feeling stressed, not getting enough sleep, being criticised, not coping with work or study, drinking too much alcohol, too much or too little contact with family etc.

Early warning signs

If they are not dealt with, the triggers can lead to early signs of distress. These are the alarm bells which signal a deterioration in wellbeing. The service user might start to get moody, sleep too much, not sleep enough, feel unmotivated or just stop caring. At this stage they should be asking, ‘Am I using my wellness tools?’. Go back to their daily maintenance plan and make sure they are making the most of your wellness tools. Think about whether there are other tools they can add and make sure they’re using them every day.

5) Breaking down or ‘losing it’

The next step is for them to take action to try and stop the deterioration. If they don’t act at this stage they could find themselves drinking too much, not eating, using street drugs, not washing, shutting themselves away, not taking medication, picking fights or feeling out of control. Using the Recovery Approach they should take responsibility and ask for help. Make sure people around them are aware that they need support at this time and keep using their wellness tools.

6) Crisis planning

The crisis planning stage of the WRAP or IP is about the things service users do and don’t want to happen on their behalf if they do ‘lose it’ and are unable to look after themself. By its nature this stage will need to involve other people.

Some of the things they might want to include are instructions about who should be informed, the types of treatment or medication that have worked or not worked for them, details about who can access their room or bank account, what food they’d like to eat or any spiritual or religious preferences.

7) Post crisis planning

The final stage of the WRAP or IP is post crisis planning, which is all about making service users are kind and care for themselves after a crisis. It might include taking things easy, not rushing to take on too much at once, setting achievable goals and accepting support when needed.

Putting it into practice

The Recovery Approach is not a linear process. No-one will follow each and every step in order and many will find themselves moving back and forth, sometimes taking a step back before taking a step forward.

You might think that The Recovery Approach, WRAP’s and IP’s seem like hard work, or that they just create more paperwork. However they are tried and tested and really do work. They are deeply personal and are designed to be developed by you, for you.

Finally, staff are encouraged to use the Recovery Approach in their own lifes and in particular write a WRAP or IP. Unless you are prepared to face up to your own life and or work challenges and know how the process feels, it will be difficult to support others to do so!

So now it’s over to you…