Knowledge and Attitudes of Mental Health Professionals to the concept of Recovery in Mental Health Anne Cleary Registered Advanced Nurse Practitioner East Galway Mental Health Services April 2011

Aim of study Knowledge and attitudes of mental health professionals to the concept of recovery in mental health.

Recovery Clinical recovery/Social recovery “a deeply personal, unique process….a way of living a satisfying, hopeful and contributing life even with limitations caused by illness” (Anthony, 2003)

HopeEmpowerment Collaborative working Risk Taking Non Linearity Recovery Themes Cleary, A. & Dowling, M. (2009) The road to recovery. Mental Health Practice 12(5): 28-31

Values Underpinning Recovery Philosophy Hope/A belief that recovery is possible Recovery as a uniquely personal journey/process Focus on whole person not just illness Respect for and belief in Service Users’ expertise by experience Acceptance of where people are Empowerment – ‘Being with’ not ‘doing to’ Enabling – Service Users ‘Taking back Control’ Personal responsibility for Illness and Wellness Self Agency Choice Partnership/Collaboration Focus on Strengths not Deficits

Values Underpinning Recovery Philosophy Respect for Diversity Awareness of potential power imbalance between Service Users and MH Professionals Positive Risk Taking Commitment to anti-discriminatory practice, social inclusion and challenging inequalities Human Rights Perspective Use of Recovery focused language Community Based Interventions Awareness of Workers’ own mental health and well being Respect for Service User activism and use of independent advocates Supporting Families

Recovery Skills Ability to engage in collaborative positive therapeutic relationship. Hold Key Counseling Skills that promote role of facilitator and resource person. Provide user friendly education on mental health experience thus normalizing the experience Convey Hope sensitivity particularly in times of distress  Promote Empowerment by listening and respect service users views  Acknowledge the Expertise of service users/families  Promote Self Determination/Choice  Use Strengths Based approach to care and encourage lead in planning goals  Encourage meaningful relationship that promote creative therapeutic risk taking.  Support and encourage advance statements

Background to recovery Roots in consumer/survivor movement. Internationally- recovery a guiding vision Irish context.

Study participants Target population(264 nurses 53 AHP) Comprising 5 strata groups. Stratified random sampling Disproportionate sampling. 153 (45%) surveyed. Response 130 (85%) rate.

Data Collection Tool (RKI) Data Collection Tool (RKI) Ethical approval. RKI- (Bedregal et. al 2006). 20 statements –positively and negatively worded- 5 point likert scale format. 4 domains of understanding (theoretical domains). Permission to adapt to Irish context. Additional 10 questions added. Pre-tested. Postal questionnaire. Response rate

Domains of recovery Roles and responsibilities in recovery. The role of self-determination & peers in recovery. Non linearity of recovery process. Expectations regarding recovery.

Data Analysis SPSS. Parametric tests. Content analysis (Burnard, 1991)

Gender of Respondents

Work Setting

Profession

Professional GradeNo.% Staff Nurse (S/N)5240 Nurse Manager1915 Clinical Nurse Specialist (CNS)1612 Senior House Officer (SHO)118 Psychiatrist54 Senior Registrar43 Psychologist (Senior)32 Psychologist (Basic Grade)22 Social Worker (Senior)32 Social Worker (Basic Grade)22 Occupational Therapist (Senior)22 Occupational Therapist (Basic Grade)22 Table 2 Professional grade of respondents.

Years Worked in Mental Health 34% 23% 32% 8% 3%

Study Findings

Table 3: Overall mean scores for all of the recovery components. Recovery componentsNMinimumMaximumMeanStandard Deviation Roles and responsibilities in recovery Non-linearity of the recovery process The role of self-definition and peers in recovery Expectations regarding recovery

Work SettingRecovery ComponentstdfPMean Acute Unit Community Roles and responsibilities in recovery Acute Unit Community Non-linearity of the recovery process Acute Unit Community The role of self-definition and peers in recovery Acute Unit Community Expectations regarding recovery Table 4: Independent t test for community and acute setting.

Table 5: Significant statistical findings of independent t tests Recovery CompetenciestdfPMean Level of Experience <15 years >15 years Non-linearity of the recovery process Gender Differences Role of self-definition and peers in recovery (Male) 4.13 (Female) Expectations regarding recovery (Male) 3.06 (Female) Nursing V Non Nursing Roles and responsibilities in recovery (Nursing) 4.00 (Non- Nursing) Non-linearity of recovery process (Nursing) 3.02 (Non- Nursing)

Qualitative findings

Read Recovery Information

Received Recovery Training

Information Needs

Content analysis Key skills: (a) counselling skills (b) collaborative working (c) sharing knowledge No formal training in recovery. Importance of collaborative MDT working. Importance of knowledge/sharing.

Limitations Findings not representative of total pop. Larger sample –allowed statistical comparisons of individual disciplines. Positive note –endorsement of RKI

Implications for practice Recovery viewed positively. Majority requested further training/information. Less knowledge regarding- Non-linearity of process Hope Risk-taking-similar to USA findings. Skills/inter-professional learning. Challenges for future.

Acknowledgments Luis.E. Bedregal (Psychiatry Faculty; Yale University, New Haven USA) regarding use of RKI. Dr Maura Dowling (Research Supervisor).

For more details on this study see: Cleary, A. Dowling, M.(2009) Knowledge and attitudes of mental health professionals in Ireland to the Concept of recovery in mental health. Journal of Psychiatric and Mental Health Nursing 16,