Ron Coleman and Karen Taylor discuss the meaning of Recovery
30th November 2011
Ron Coleman and Karen Taylor discussing “The Recovery Challenge” was broadcast as a video podcast on Thursday, 8th December the vis 30 minutes long. Go here for more information.
If you want to leave a comment or debate the issues raised in the podcast you can do so below.
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Hello Everyone, if you want to discuss the issues raised by Ron and Karen in the podcast you can do so here.
Hi everyone add your comments here and we will reply in real time from 15.00 pm UK time on Thursday, 8th December 2011
Best wishes
Ron and Karen
How would you suggest is the best way for a truly recovery focused service to address risk? What would an ideal risk policy look like, and an you run a service without risk assessment forms? I ask because in working to develop a Soteria house locally, we are aware that we cannot, in the current risk averse climate, expect to get funding or cqc approval without a robust risk assessment and management plan in place. How can we satisfy statutory bodies like the cqc and potential funders that we’re serious about safety, and at the same time give ourselves the freedom to practise in the common sense, recovery oriented ways we know really help?
Hi Yasmin
instead of being defensive about risk , and always assuming things are going to go wrong, we also need to ask this question what is risk to the persons recovery journey if we dont do this?
We use a simple self assessment sheet , the person is best able to tell you what the risks are. then we have a discussion where if we hae a different opinion we can debate it.
As far as previous history goes, it is always best to know the context when something happened ie what was happening to the person before hand, their feelings, if you like the story , this allows us to see that people can grow and change and just because at 21 they were angry & violent doesnt mean at 32 they are going to be the same
From what I gleaned from listening to your podcast, recovery is a contentious concept. Problematic arenas arising within the “consumers” system:
organisational/workers approach; Expected outcomes, definition of recovery, Investment in risk averse practice i.e. whose safety are we concerned with, fear of being human and what that may mean in terms of professionalism, investment in the expert role, lack of self awareness with regard to the relationship, infantalising, lack of understanding with regard to context and relevance, practice deficits, and last but not least lack of belief in self actualisation.
Family and Friends: Similar barriers to the above with slightly different focus, investment in the caring role, fear, lack of hope and trust in man’s potential, , infantalising, lack of self awareness in the relationship
Consumer: Lack of trust in the process, impact of medical model, fragile workers, flap of the butterflies wings…………..
My question is given this ‘system’ and recovery work desperately needed in the whole, where do we begin or is the relationship the ‘all’?
Thanks for this for us relationship makes up a large part of recovery process this does not mean other things are not important they are but without they relationship being right things tend not to work out that well
Ron and Karen
“Recovery is a Fad” – That’s what people have been saying to me for years, like partnership working, empowerment, etc…I have always stood up to these people and said – “No, it is not a fad”. I have argued, that change takes time, 40-50 years, maybe. To embed recovery practices fully throughout a service will take time, but it will happen.
Over the last few years, Professionals, Managers and Consumers have all embraced the ideas of recovery and tried to put them into practice. But in recent months I have heard people now saying “recovery is going out of fashion”.
My question is, what response do you think we can give in relation to comments that recovery is going out of fashion? Is there a new or progessive form of recovery?
Hi thanks for this, Recovery will never be a fad or a fashion though many hope it will be. The reason for this is that recovery is happening and has happened in the past despite services sometimes. so it is not new and will continue to happen. I guess the difference now is that families and consumers are expecting more from services and I believe this will continue. Cheers
Ron
Hi Ron – Thanks for this. Are you saying that some people don’t want recovery to happen?
Hi there … I was just reading and I had some thoughts … I think some people resist the notion that recovery does exist, for a number of reasons that suit them. When I was unwell I didn’t think recovery existed because I didn’t want to acknowledge that I, myself might have to be accountable for some changes …. I kinda felt at ease knowing that I somehow fitted in (even at the cost of other people’s opinions).
From what you say on the video to be in a position to help someone you need to have sorted out things for yourself (e.g. our own feelings about abuse etc), is this realistic? Most workers have messy lives too and may not have worked these things out – and – what about peer support workers,?
Self awareness is the most important component . If you know why you react in certain ways if you are able to seperate your own feelings out from the feelings someone you are working with are going through fine. If you have been abused and never faced up to what has happened to you, how can you help someone work through their own issues around abuse, you cannot be authentic, you are more likely to cut the conversation dead and change the subject just when the person has built up the courage to tell you about their true self.
this is the case for peer workers and any other worker.
I do believe that peer workers are there to demonstrate recovery and to talk about their journey , if they havent walked that journey how do they show the person that recovery is possible.
nobody has to be perfect and showing your flaws , the mistakes you have made , the wrong paths etc are all part of being human and help cement the relationship into a meaningful one
A really useful discussion, many thanks.
It reminds me that people are at widely different points in their understanding of Recovery as an idea, and how some see it very clearly as being about an alternative approach to the experience of and living beyond serious distress, whilst others seek to incorporate it as an additional option or a modifying influence within the traditional mental health system, or even as a new name for Rehabilitation practice!
Furthermore, not only is there a wide spectrum of ‘understanding’, but across that spectrum there are numerous ways of describing what recovery is, from an idea which shares its basic principles with those of Independent Living (as developed by disabled people) to those expressions of it which are more closely tied to the specific experience of mental distress and to some extent echo the traditional treatment ‘pathway’.
I’m in no doubt as to the significance of the discussion you are inviting through your talks, and am interested in your thoughts on a barrier which I believe is presently restricting peoples thinking within the NHS Trusts who presently hold the largest share of the resources available to provide mental health support: namely, what I understand to be the requirement to classify ‘patient clusters’ by diagnosis and define ‘treatment pathways’ for each group (or ‘cluster’) in order to receive funding against ‘tariffs’ for each pathway. My feeling is that whilst some people have talked of opportunities for creativity and recovery-based thinking within this approach, it is very likely that most of the people involved in this process will have fairly traditional notions of ‘mental illness’, be very influenced by the overwhelming viewpoint of traditional, medically-based research thinking as to what represents ‘evidence’ of ‘effective’ and ‘cost-effective’ intervention, and have a vested interest in maintaining their ‘market share’ as providing organisations. All this seems likely to mitigate against any significant change in the system which both of you, and I, feel is in many senses ‘deluded’ in respect of the many contradictions between its declared purposes and it actual impact.
How to broaden this debate, so it can be heard in the boardrooms and clinics, and not just in the training rooms and informal groups is a key question.
Also, because I believe the changes that will need to take place both within and outside of the mental health system are as (if not more) profound than the move from a predominantly hospital-based to a predominantly community-based model of support, we should not underestimate either the genuine anxiety that will need to be addressed, or the vested interests that will need to be overcome. Perhaps the most we can do is to encourage and support people to take greater control of their own futures, but I do wonder if we might also see an important role developing in seeking to work with organisations to actually change the assumptions on which they have operated and embrace not a professionalised ‘recovery model’, but true recovery practice.
I think there is absolutely no doubt of the direction of travel: it is beyond ‘Community Care’ towards the principles of Independent Living and Recovery, but we are still at the very threshold of this ‘second great de-institutionalisation’, and the first one took a great many years to happen, so we should not get despondent, but remain determined and, as you show so well in your broadcast, keep searching for inclusive, thoughtful ways forward.
Very best wishes,
Robin.
Hi Robin,
I agree very much with you about the way forward it appears clear that whilst the new Govt strategy offers opportunity the fact that mental health remains within the health remit means that the vested interests in our current system will continue to try to defend the status quo thereby continuing the same approaches that have failed in the past. Perhaps putting mental health into social care and out of health care may help.
Ron C
Dear Ron,
Many thanks for your reply. Certainly I think that we desperately need a broader understanding of mental health from a social perspective, where good medical and social support services are parts of what is available to all, but far from being the only things felt to be of benefit; but (in case it is what you were suggesting!) I’m a bit concerned that a move from one ‘care’ system into another might be a case of ‘out of the frying pan into the fire’!
I believe that it is impossible to make sense of the structural ‘health’ and ‘social’ care divide in any rational conversation about mental health – they are both system-created divisions of factors which can influence us concurrently and interdependently. Some of the most deluded (and therefore intractible) debates are over ‘who should pay for what’ between health and social care organisations, frequently, as confirmed by participants at an event in Hampshire on Tuesday, leaving the person inadequately supported as the well-paid Council and NHS opponents string out their meetings seemingly ad infinitum!
Unless we start with each person and work with them to discover what from the huge range of options will best support them we are in danger of narrowing down their options by system-led assumptions about what either ‘ill’ or ‘vulnerable’ people need.
Somehow I think that we have to demolish these divisions between health, social, housing, employment, etc. , and bring them together if we are to be able to address the support needs people have in a way that makes sense to the person rather than to a particular ‘profession’ or system. Because most people’s understanding of mental health comes from the perspective developed by professionals (which is particularly true for those trained and ‘qualified’ to provide support), people generally find it incredibly difficult to take on a new perspective which comes from another viewpoint. Some will never be able to accept it, partly, as you and Karen alluded to, because for some their own sense of self-worth and inner protection from distress is anchored to their social status in ‘helping’ ‘less-fortunate’ people than themselves to manage as best they can (the Florence Nightingale factor!). I have experienced the defensive anger of people who absolutely refuse to acknowledge that the people they ‘care for’ are their equals in every way.
However, you will have gathered I’m good at waffling, but what you won’t know is that all of this has been inspired by your discussion with Karen.
I hope that you will consider making these a regular thing.
Thanks.
With best wishes,
Robin.
Good to see you Ron & Karen, nothing especially brilliant to add–but as a professional with abuse & depression in my past & knowing many colleagues’ ‘issues’, I wholeheartedly agree that we’re all in the same boat with arrested developments, pessimism, & need for self-awareness/ confidence/acceptance. Thank you for the reminder that we can’t let agitation about the system get in the way of working out inner barriers . .
Hi Ron and Karen,
Nothing profound to add, but gratitude for the work you’re doing and for your commitment to spreading hope and action.