A national framework for recovery oriented mental health services ‘The journey begins Recovery is in my hands, the creator within is the spirit of hope for a better life’ Pauline Miles 2012 ©

Aims to provide:  Why the Recovery Framework is important  What the Recovery Framework is  The changes it seeks to encourage  OVs digging in and helping change  Other helpful guides

 A national framework for recovery-oriented mental health services: policy and theory - Mental%20Health%20Recovery%20Framework% Policy&theory.PDF Mental%20Health%20Recovery%20Framework% Policy&theory.PDF  A national framework for recovery-oriented mental health services: guide for practitioners and providers - Mental%20Health%20Recovery%20Framework% Guide-practitioners&providers.PDF Mental%20Health%20Recovery%20Framework% Guide-practitioners&providers.PDF

 Develop a national framework for recovery oriented mental heath service provision that spans all levels of practice and service delivery  A framework suitable for guiding national mental health system change

Guidance based on people’s lived and personal experience of what helps them to live:  A full life  A life they choose  With people they love  Doing things they want to do and dream of

Shifting services and practice to help people experiencing mental health and SEWB issues to have a:  A full life  A life they choose  With people they love  Doing things they want to do and dream of

 4 th National Mental Health Plan  Supporting Recovery Standard - (10.1) National Mental Health Service Standards  National Statement of Rights & Responsibilities & National Mental Health Practice Standards  Relevant international human rights instruments Pauline Miles 2012 © Pauline Miles © World view

 Action 4 of Priority Area 1 of the 4 th Australian National Mental Health Plan,  The promotion and adoption of a recovery oriented culture within mental health services.  The adoption of attitudes, expectations and good practices of a recovery orientation by individual practitioners, service leaders and policy makers - public, private or non-government sector and irrespective of the practice setting.  All Australian Governments have committed to implement the Plan and its Actions.

 Mid March 2012Discussion Paper and Online Survey released & strategic discussions & meetings  8 May………….. 1 st Consultation Draft of the Recovery Framework released  Mid–late May… Consultation forums in capital cities  End June……… 2 nd Consultation Draft following Inaugural National Recovery Forum  July-mid Aug….Further consultations  30 November……..Final Draft National Mental Health Recovery Framework!  21 August 2013Framework launched, TheMHS

 Definitions and explanation of concepts  Language shifts  Practice domains/areas = 5  Capabilities = 17 skill sets across the 5 domains and comprising: Core principles, values an attitudes, knowledge, skills and behaviours, practice guidance, leadership guidance, opportunities, resource materials.

The concept of recovery was conceived by people with mental health issues to describe their experiences and to affirm their identity beyond that of diagnosis and symptoms. The framework adopts this definition: “being able to create and live a meaningful and contributing life in a community of choice with or without the presence of mental health issues.’

Recovery-oriented approaches recognise the value of lived experience and meld it with the experience, knowledge and skills of mental health practitioners, many of whom have experienced mental health issues either in their own lives or within their family and friends. In short… approaches that learn from the coming together of lived experience and professional experience.

 Personal recovery and clinical recovery support each other.  Recovery is much broader than symptom improvement…  On one hand, symptom improvement helps a sense of wellbeing  While on the other hand, a sense of wellbeing regardless of ongoing symptoms can help to reduce those symptoms or their severity.

Words and language are particularly important in mental health because of the impacts of stigma, discrimination e.g. loss of self-esteem and exclusion.  Shifts p. 28 Policy and Theory  To person first language e.g. person rather than consumer; family and friend rather than carer; mental health issues and emotional distress in place of, or alongside of mental illness.

Domain: Organisational commitment and workforce development Capability: Acknowledging, valuing and learning from lived experience

 NB we didn’t just make them up  Draws on international research as well as existing recovery-oriented frameworks e.g. Victorian, NZ, UK  A key piece of research – Le Boutillier, Leamy, Bird, Davidson, Williams & Slade Dec 2011, ‘What does Recovery Mean in Practice? A Qualitative Analysis of International Recovery-oriented Practice Guidance’  Sought to provide an evidence-based conceptual framework for putting recovery concepts and principles into practice  Qualitative analysis of 30 international recovery- oriented practice guidance documents  16 dominant themes identified that were grouped into four practice domains

 A focus on personal recovery and wellbeing is a desirable direction for mental health services  The experience of mental illness is helpfully understood through the lens of the perspectives, values and preferences of the individual i.e. what’s important to each person  The emphasis on professionally judged best interests can inadvertently do harm; a recovery- oriented approach directs treatment and support around what is important to the individual  The benefits of clinical treatment are enhanced through broader whole of life approaches i.e. by helping a person get on with their immediate lives

This is a challenge for many as it is embedded within most helping and caring professions, to do for another when they experience distress, pain, illness or disability. The risk of doing this on a constant basis is that because the helping and caring professions often contribute to a state of impotence, we learn more about our inabilities rather than our many abilities. It was only when I began to reclaim responsibility for the direction of my life that I appreciated the active role of recovering; it would be difficult, if not impossible, to maintain a recovery space while someone else is holding responsibility for us’ (Glover 2012) ‘You can do it, we can help you’ Janet Meagher, Commissioner, National Mental Health Commission 2012

 Personal recovery is possible for everyone & begins when a person takes responsibility and personal control  Professionals assist in the first instance by helping a person to identify what’s important to them here and now  People with mental health issues want the same as everyone else – someone to love, a home, a job and something meaningful to do  Mental health practice and service delivery consistent with recovery principles require an emphasis on maximising choice and self-determination.  Reduced reliance on coercion, seclusion and restraint is also required.

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 Shift from an emphasis of what’s wrong with a person to a strengths emphasis  Rethinking of risk, least restrictive and best interests  Lived experience of mental health issues is valued and respected in people, their families and friends, staff and the local community  The desirability of lived experience in selection criteria for professional positions is acknowledged  Dedicated roles including leadership positions within services for people with lived experience are ensured  The development of peer-designed and operated service models is supported

Some suggestions

 Why are our rates of involuntary treatment including seclusion and restraint high by international standards?  How persistence of risk averse environments and policy frameworks can undermine recovery efforts and increase harmful risks by denying people the opportunity to self-regulate & self- manage  Policies, practices and environments that are traumatizing and which retraumatise

 Ways of promoting a greater focus on fostering self-determination, personal responsibility and self-management  Suggestions for how services and professionals can get on board with promoting robust participation  Leading by example – seeking out and drawing upon lived experience  Promote and support peer-led initiatives and peer-run services in hospital-based settings

 Identify opportunities for supporting services with positive risk-taking on one hand and duty of care and promoting safety on the other  Promote joint or supported decision-making about reducing risk and promoting safety  Promote jointly constructed service plans as well as early warning sign/relapse signature plans  Promote use of advanced directives/statements

 Understand and embrace the tenets of ‘trauma informed care’  Promote understanding of the traumatic nature of acute episodes  Promote understanding of trauma often associated with involuntary interventions  Promote joint or supported decision-making about self- calming strategies to assist people to manage their own distress and turmoil  Encourage transparency and open and honest discussion of any legal requirements, the individual’s and the practitioner’s views about such, as well as identification and negotiation of differences

 Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery CAsPracticeGuidelinesforTreatmentofComple. CAsPracticeGuidelinesforTreatmentofComple.  Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice, 2 nd Ed. network/working-together-2nd-edition/

Where can a recovery-oriented approach take us?  Services that put people and their families first  Services that people want to use  Rethinking of “professionalism” – personal experience of mental health issues viewed as an “advantage” or “head start”  As most recovery occurs at home, increased focus will be given to incorporating and supporting families, friends, communities and workplace  New service models including peer designed and run services and programs  Improved service outcomes as people are supported to live full and contributing lives

Leanne Craze, Ruth Vine, John Allan and the Recovery Group of the Safety, Quality & Partnerships Subcommittee wishes to thank everyone for all the support, help and advice provided. ‘Be the change we want to see’ Pauline Miles 2012 ©