W4-T4 The Recovery Paradigm

Question 1

recovery key idea according to Anthony (1993)

Answer 1

may occur without full symptoms remission
not a linear process

Question 2

define recovery according to Anthony (1993)

Answer 2

a deeply personal unique process of changing
someone’s attitudes, values, feelings, goals, skills, and or roles. It is a way of living a satisfying, hopeful, and contributing life, even with 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.

Question 3

differences between personal recovery and clinical recovery

Answer 3

clinical
- measured by professional
- it is an outcome/dichotomous
- observable/objective
-consistent between individual
-emphasis on symptoms

personal
- measured by service user/survivor
- is a process/continuum
-subjective
-differs between people
-emphasis placed in hope, meaning, empowerment

Question 4

name 5 recovery process

Answer 4

Connectedness
Hope
Identity
Meaning of life
Empowerment

Question 5

why recovery is a complex process Anthony (1993)

Answer 5

involves recovering from the consequences of
the illness (i.e. stigma, lack of opportunities, and iatrogenic effects of treatments)

Question 6

recovery misconception (Slade et al., 2014)

Answer 6

1. mental health services that hire peer workers are recovery-oriented
2. recovery paradigm focuses on psychosis, or not possible in patients with severe symptoms
3. treatment service encourages recovery - in fact, it can hinder the recovery process if do not promote self-determination
4. compulsory treatment aids in recovery - not in life with the value of self-determination
5. recovery paradigm envision closing service - recovery is not linear, service availability is essential for people who need them
6. recovery means independent and normal - the same point as above
7. welfare reform disrespects people with mental illness - the right to work and welfare benefits equally important

Question 7

name 4 recovery promoting intervention

Answer 7

peer support
wellness recovery action planning
illness management and recovery
individual placement and support

Question 8

define peer support

Answer 8

people with mental health provide support to other people with mental health ( in traditional service or peer-run service)

Question 9

evidence base in peer suppot

Answer 9

Cochrane studies by Pitt et al. (2013)
- no difference between peer support and professional support in several outcomes such as QoL, satisfaction, symptoms
- peer support care uses less emergency service than clinician service care

meta-analysis by White et al. (2020)
- does not impact clinical outcomes but improves empowerment and recovery
- improved empowerment and recovery outcomes studied of peer support as an additional intervention
- suggest possible beneficial role peer support has as an autonomous intervention

Question 10

What is wellness recovery action action plan (WRAP)

Answer 10

group intervention facilitated by peers with the aim of promoting the development of a recovery plan (8-10 weekly session)
provide a safe and non-judgement environment

the goal is to create a wellness toolbox with tools that promote well-being and tools that help recognise and deal with triggers and
stressors

Question 11

what was WRAP evidence-based according to a study by Cook et al? (2019)

Answer 11

suggest benefits in symptom reduction, increase QoL and hopefulness.

Question 12

describe meta analysis Canacott et al. 2019 difference between WRAP to inactive control condition

Answer 12

more effective in promoting recovery outcome
equally effective in reducing psychiatric symptom

—> possibility of personal recovery without an essential decrease of symptoms

Question 13

define Illness management and recovery (IMR)

Answer 13

standardized intervention
- aims to teach people with mental illness strategies to manage their illness
- to help them achieve personal and meaningful goals

1. curriculum based
2. 6 month to a year
3. group or individual

Question 14

module includes in IMR

Answer 14

recovery
practical facts of mental illness
stress-vulnerability model
build social support
use medication effectively
drugs and alcohol
reduce relapses
cope with stress
cope with persistent symptoms
get you need met in mental health system
live a healthy lifestyle

Question 15

IMR strategy (Meyer et al., 2010)

Answer 15

education, motivation, cognitive behavioural strategy (reinforcement, modelling, behaviour rehearsal and shaping)

Question 16

IMR efficacy

Answer 16

mixed result – could be related to model fidelity (the degree of staying to the protocol) and IMR completion

Randomised Controlled Trials (RCT) 187 outpatients receiving either IMR plus treatment as usual or treatment as usual only. Findings suggested that in comparison (Roosenschoon et al., 2021):

–The IMR group demonstrated improved illness self-management and
self-esteem with the control group.
– Completing the programme and fidelity in terms of its delivery are associated with better outcomes.

Question 17

define Individual placement and support (IPS)

Answer 17

evidence-based practice aimed at helping people with mental illness to get and keep a job in mainstream competitive market

Question 18

IPS principle

Answer 18

focus on the goal of competitive employment
zero exclusion
attention to client preference
rapid job search
targeted job development
employment service and mental health treatment integration
personalized benefits counselling
individualized long-term support

Question 19

IPS evidence based

Answer 19

27 / 28 RCT shows better competitive employement outcomes for people who received IPS (Bond et al., 2020)

Question 20

what are the values of recovery-oriented mental health services according to Slade (2013)

Answer 20

to support personal recovery
to support the person’s goal
people receiving services are responsible for their own lives

Question 21

define recovery-oriented practice according to Meadows (2019)

Answer 21

staff, clinical or other, work and relate to people who use services in a way that promotes growth and empowerment so that they can achieve their full potential.

Question 22

what is REFOCUS, the goal and components

Answer 22

5 years programme research led by KCL (2009-2014) – the goal is to increase recovery-orientation approaches in mental health services

components:
recovery-promoting relationships

working practices include
–understanding values and treatment preferences
–assess strengths
–support goal-striving

Question 23

what are the roles of the coach in REFOCUS

Answer 23

– to encourage the person to think about their own solutions.
– IS not aimed at fixing problems.
– guides the individual to use their strengths and resources, the person being coached is accountable for their life.

Question 24

define three working practice in REFOCUS

Answer 24

1. values and treatment preferences (care should be consistent with the person’s values) (i.e. family background, religion)
2. assessing strengths – to gain a holistic understanding of the person (assess internal and external resources) (i.e. daily living conditions, occupation, finances)
3. support goal-striving through GROW framework
   Goal – where you want to be
   Reality – where you at now
   Option – option to achieve the goal
   Wrap-up – agree on next step

Question 25

main values in setting goal through GROW

Answer 25

approach goal (involve positive change) better than avoidance goal (escaping from something negative)
needs to be done sensitively
trusting relationship between service user and staff member is essential

Question 26

REFOCUS evidence-based according to two articles published in the Journal,
The Lancet Psychiatry.

Answer 26

In the UK, results suggested that high team participation would be significantly better than low participation in terms of staff rated
recovery-promoting behaviours and patients-rated interpersonal scores –the failure of the intervention to improve the primary outcome of recovery may have to do with implementation problems.
– patient has been receiving services for more than 15 years – deeply rooted in them, maybe need more time view change

in Australia – REFOCUS-PULSAR (Principles Unite Local Services Assisting Recovery) – Recovery measured by the questionnaire – the process of recovery was significantly higher in the intervention group but the effect size was
small.
Despite the small effect size, the significant difference is encouraging since small effects are common in pragmatic trials, which means trials assessing the effectiveness of interventions in real-life conditions.