Making Recovery a Reality: The Devon Story … so far

1. Making Recovery a Reality: The Devon Story … so far Glenn Roberts Consultant in Psychiatric Rehabilitation and Recovery Exeter, Devon

2. Devon • Rural country in SW England • 2,500 square miles • Population 850,000 • Devon Partnership NHS Trust • 2,400 employees • 14,000 people use DPT services pa • National reputation for recovery innovations ..

3. Devon in the (Recovery) papers

4. Timeline of Developments 1998-2002 Individuals with an interest (passion) 2003 first RecoveryDevon Conference and cascade of WRAP training 2005 LIT ‘Vision’ and commitment 2006 second RecoveryDevon Conference, Recovery Devon Web site, STaR training 2007 DPT reorganised into ‘functions’ inc R&IL 2008 Trust adopts, ‘Recovery at the heart of all we do’ 2009 Core commitment to KPIs, training and strategy 2010 Implementation of standards and measures

5. Our recovery story • Awareness and understanding • Engagement • Endorsement • Progressive action • Auditing benefit and effectiveness • Cultural change – transformation … not dissimilar to anyone's recovery story

6. Awareness and understanding • Promotion • Engagement • Progressive action • Audited benefit and effectiveness • Cultural change – transformation

7. Recovery is … ‘ … a way of living a satisfying hopeful and contributing life, even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness…’ Anthony, 1993, SCMH, 2008, New Horizons, 2010

8. Recovery of ... myself “To me recovery means being in the driving seat of my life. I don’t let my illness run me. Over the years I have worked hard to become an expert in my own self-care. Over the years I have learned different ways of helping myself. Sometimes I use medications, therapy, self-help, mutual support groups, friends, my relationship with God, work, exercise, spending time in nature – all of these measures help me remain whole and healthy even though I have mental health problems.” Deegan, P. (1993) Recovering our sense of value after having been labelled mentally Ill, Journal of Psychosocial Nursing and Mental Health Services, 31, 7-11

9. Clinical recovery Personal recovery Symptoms Disability Intervention Evidence Standardised Compliance Risk management Avoiding incidents Relapse prevention Remission Discharge relief from symptoms getting over problems Strengths Empowerment Agency Experience Personalised Choice Safety planning Taking opportunities Successful self management Resilience Discovery: meaningful lives development of wellbeing getting into life and living

10. 2010 2008

12. ‘Recovery’ as a unifying concept(a rose by any other name ...) Social inclusion Choice Self-management Wellbeing Personalisation Person-centred Self-care Self-directed care Whole life

13. Awareness and understanding • Promotion • Endorsement • Progressive action • Audited benefit and effectiveness • Cultural change – transformation

14. Celebrating recovery

18. Laurie Davidson MBE for services to the development of mental health services

19. Awareness and understanding • Promotion • Engagement • Progressive action • Audited benefit and effectiveness • Cultural change – transformation

20. Policy NZ (1998) England and Wales (2001 / 6) Australia (2003) Scotland (2004) USA (2005) Ireland (2005) Caneda (2009)

21. Devon Partnership NHS Trust ‘Having focused primarily on financial recovery for three years, we can now really start to put the principles of personal recovery at the heart of everything we say and do. …this won’t happen overnight but shifting our focus to a persons recovery rather than their diagnosis is both an exciting and uplifting step forwards and one I hope will transform the way we work with people’2008

22. Awareness and understanding • Promotion • Engagement • Progressive action • Audited benefit and effectiveness • Cultural change – transformation

23. All Job descriptions in DPT ... ‘It is a requirement of all employees to have an understanding of the broad principles of the recovery approach and to incorporate them into every aspect of their work …’ 2008

24. Principles into practicereframing CPA as PRPand practitioners as recovery coaches

25. Engaging with ‘lived experience’ in the workforce‘no more ‘them and us’’ Results 560 respondents 43% with ‘personal experience’ 65% with experience as a supporter Valuing this ‘wealth of experience’ in the workers ‘Supporting staff in their recovery journeys’

26. Devon Partnership Trust strategic aims (2009) Care good enough for my family - that is: safe, timely, personalised, recovery-focused and sustainable

28. Training and development strategy 2009-11 Objective To embed throughout the workforce the knowledge, skills and attitudes necessary to support the Trust’s strategic aim of delivering services which are recovery focused and personalised.

29. Awareness and understanding • Promotion • Engagement • Progressive action • Audited benefit and effectiveness • Cultural change – transformation

30. ... and the new Chairman asked (2009) There’s so much talk about recovery ... Why does it sound like a religion? Where’s the evidence? Where’s our evidence?

31. The evidence ...

32. Leading to: consensus, policy, guidance

33. Our evidence?

34. Devon recovery guidance and advisory papers(those published by RCPsych) • Standards and recovery outcome measures • Recovery coaching • OPHM and dementia care • Recovery and detention under the MHA • Medicines management and prescribing • WRAP and self management • Stories of personal recovery journeys (ie evidence of activity, thought and creativity but doesn’t = evidence of benefit or outcome)

35. coming soon ...Moving towards, ‘Recovery at the heart of all we do’: Workforce development and the contribution of ‘lived experience’Glenn RobertsJohn GoodJames WooldridgeElina BakerThe Journal of Mental Health Training, Education and Practice (due September 2010) even more evidence of activity but still falling short of evidence of outcome …

36. Plans for evidencing outcome: monitoring, reporting and action planning Monthly clinical standards monitoring (CTL – 20 case records) Progress on ‘team performance dashboard’ Quarterly surveys of experience and satisfaction of people using services (n = 1000) Independent ward visits each 2 weeks 6 monthly Practice Quality Audit (PQA) (CTL with each RC) Peer and executive walk-around audits Clinical Audit programme attuned to strategic objectives Inpatient settings signed up for AIMS Quality and Safety Committee– Chaired: Medical Director / Director of Nursing receive all the above and monitor progress report to board

37. Growing interest in operational research Development of RRIG Recovery Research and Innovation Group (re-engaging people with a passion)

38. Awareness and understanding • Promotion • Engagement • Implementation • Progressive action plans • Audited benefit and effectiveness • Cultural change – transformation …

39. ‘A good beginning … and still a long way to go’ but being ‘in recovery’ and with a clear sense of destination and direction, and a means of knowing where you are and how you are getting on is what it’s all about. Glenn.roberts@nhs.net www.recoverydevon.co.uk