Rehabilitation and Rehabilitation and Recovery in Mental Recovery in Mental

HealthHealth

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Rehabilitation and Recovery Rehabilitation and Recovery session objectivessession objectives

At the completion of this session students will:At the completion of this session students will:1.1. Define Rehabilitation in a mental health Define Rehabilitation in a mental health

settingsetting2.2. Define Recovery in a mental health settingDefine Recovery in a mental health setting3.3. Understand the origins of a recovery Understand the origins of a recovery

approachapproach4.4. Understand the characteristics of a Understand the characteristics of a

recovery orientated servicerecovery orientated service5.5. Be aware of the competencies required for Be aware of the competencies required for

a mental health professionala mental health professional

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Defining Rehabilitation Defining Rehabilitation ‘‘Encompasses the services and resources made Encompasses the services and resources made

available to people with disabilities to facilitate available to people with disabilities to facilitate adaptation to their world’ (Deegan, 1988)adaptation to their world’ (Deegan, 1988)

Focuses on improving knowledge and skillsFocuses on improving knowledge and skills

Advocates viewing people suffering a mental illness as Advocates viewing people suffering a mental illness as people with disabilities who share the same aspirations people with disabilities who share the same aspirations as others as others

The concept of physical rehabilitation can be applied to The concept of physical rehabilitation can be applied to psychiatric rehabilitationpsychiatric rehabilitation

It is not a passive processIt is not a passive process

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Principles of Psychosocial RehabilitationPrinciples of Psychosocial Rehabilitation1.1. Believe in the recovery process from psychiatric Believe in the recovery process from psychiatric

disabilitydisability2.2. Engender hope and the possibility of changeEngender hope and the possibility of change3.3. Maintain a client-centered focus that promotes individual Maintain a client-centered focus that promotes individual

choices and empowerment choices and empowerment 4.4. Facilitate collaborative client/consumer/family Facilitate collaborative client/consumer/family

participation in developing rehabilitation goals and plansparticipation in developing rehabilitation goals and plans5.5. Use holistic assessment of physical, emotional, Use holistic assessment of physical, emotional,

intellectual, social and spiritual dimensionsintellectual, social and spiritual dimensions6.6. Develop educational opportunities that build life skills Develop educational opportunities that build life skills

and knowledge to maximize independence in life roles and knowledge to maximize independence in life roles and daily functioningand daily functioning

7.7. Build and strengthen community and social support Build and strengthen community and social support systems that client and consumers learn to access easilysystems that client and consumers learn to access easily

8.8. Educate health care providers, legislators, and the public Educate health care providers, legislators, and the public about psychiatric disabilities to reduce stigma and foster about psychiatric disabilities to reduce stigma and foster understanding understanding

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Defining RecoveryDefining Recovery ‘‘Encompasses the lived experience of people as Encompasses the lived experience of people as

they meet and overcome the challenges of their they meet and overcome the challenges of their disability’ disability’ (Deegan,1988)(Deegan,1988)

Not a one-dimensional processNot a one-dimensional process

‘‘Living well in the presence or absence of illness’ Living well in the presence or absence of illness’

(MHC, 1998)(MHC, 1998)

Historically mental health services have failed to Historically mental health services have failed to use a recovery approachuse a recovery approach

Current notion of recovery from mental illness Current notion of recovery from mental illness dates back to 1980’sdates back to 1980’s

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Stages in the Recovery ProcessStages in the Recovery Process

1.1. Initial ShockInitial Shock

2.2. Denial and RageDenial and Rage

3.3. Despair and Self-pityDespair and Self-pity

4.4. Turning point of HopeTurning point of Hope

5.5. Finding new meaning and Purpose in LifeFinding new meaning and Purpose in Life

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Common Themes in RecoveryCommon Themes in Recovery

1.1. HopeHope

2.2. Personal responsibilityPersonal responsibility

3.3. Self-advocacySelf-advocacy

4.4. EducationEducation

5.5. SupportSupport

6.6. Personal meaningPersonal meaning

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HOPEHOPE

People need to believe – both the People need to believe – both the client and the mental health client and the mental health practitioner that life can be practitioner that life can be different different

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Personal responsibilityPersonal responsibility In order to build a sense of control and self-In order to build a sense of control and self-

determination people must take determination people must take responsibility for responsibility for Their livesTheir lives Managing their well-beingManaging their well-being

Historically Health professional have advised Historically Health professional have advised clients what to do/ not to doclients what to do/ not to do

Causes concerns regarding risk management Causes concerns regarding risk management for some mental health professionalsfor some mental health professionals

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Self-advocacySelf-advocacy

Service users are finding their ‘voice’ Service users are finding their ‘voice’ and being able to say what is wanted and being able to say what is wanted and what is notand what is not

It provides an opportunity to re-It provides an opportunity to re-engage with ones environment engage with ones environment

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EducationEducation

Important for the client to Important for the client to understandunderstand their illness their illness the medications they are the medications they are

takingtaking

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SupportSupport

One of the biggest determinants of One of the biggest determinants of recoveryrecovery

May be supported through:May be supported through: Family/WhanauFamily/Whanau Friends and colleaguesFriends and colleagues Peer support groups and self help Peer support groups and self help

groupsgroups Mental health Professionals Mental health Professionals

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Personal MeaningPersonal Meaning

Clients need to create personal Clients need to create personal meaning in their livesmeaning in their lives

This can be through numerous This can be through numerous channels:channels: SpiritualitySpirituality EmploymentEmployment RelationshipsRelationships Peer support groupsPeer support groups Service user movementService user movement

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Recovery and New ZealandRecovery and New Zealand

The recovery vision is integral to our national The recovery vision is integral to our national mental health policymental health policy

The Mental Health Commission’s The Mental Health Commission’s Blueprint for Blueprint for Mental Health Services Mental Health Services (MHC, 1998) directed (MHC, 1998) directed services to use the recovery approachservices to use the recovery approach

At present although the recovery is fast At present although the recovery is fast becoming accepted in principle – not yet becoming accepted in principle – not yet clear what a recovery-orientated service will clear what a recovery-orientated service will look likelook like

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Characteristics of a recovery- Characteristics of a recovery- orientated service (1)orientated service (1)

A recovery philosophyA recovery philosophy AccessibilityAccessibility Services available in home and community settingsServices available in home and community settings Diverse workforce, showing respect for culture and Diverse workforce, showing respect for culture and

individualityindividuality Service user advocacy and leadershipService user advocacy and leadership Choice of services and treatmentsChoice of services and treatments Delivery of treatments that are safe and effective Delivery of treatments that are safe and effective

and help with recovery as well as symptomsand help with recovery as well as symptoms Availability of peer support and other forms of Availability of peer support and other forms of

consumer-operated servicesconsumer-operated services Respectful two-way communicationRespectful two-way communication Provision of useful informationProvision of useful information

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Characteristics of a recovery- Characteristics of a recovery- orientated service (2)orientated service (2)

Collaboration with service users in decision-makingCollaboration with service users in decision-making Conveying hope and optimismConveying hope and optimism Providing reassurance and safetyProviding reassurance and safety Whole of life approachWhole of life approach Avoiding force against service users and upholding their Avoiding force against service users and upholding their

rightsrights Countering stigma and discriminationCountering stigma and discrimination Encouraging appropriate involvement from family and Encouraging appropriate involvement from family and

friendsfriends Priority on enhancing and maintaining wellnessPriority on enhancing and maintaining wellness Encourages access to good physical health careEncourages access to good physical health care Flexible services providing good linkages with services and Flexible services providing good linkages with services and

supports relating to employment, housing and community supports relating to employment, housing and community participationparticipation

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Recovery based competenciesRecovery based competencies

The term competencies is defined broadly The term competencies is defined broadly to include attitudes, skills, knowledge and to include attitudes, skills, knowledge and behaviour required of the mental health behaviour required of the mental health workforceworkforce

They apply to all people working in all They apply to all people working in all services – mainstream, kaupapa Maori or services – mainstream, kaupapa Maori or service user run groupsservice user run groups

Everyone in the workforce needs to Everyone in the workforce needs to acquire recovery-based competencies to a acquire recovery-based competencies to a certain levelcertain level