What is Recovery-Oriented practice?
Recover-oriented practice (RoP) is at the core of healthcare for people with mental health issues that focuses on the personal journey of people living with mental ailment. RoP is based on the principles of involving the person and their orientation. By following these principles, the practice aims at supporting individuals to gain a satisfactory and meaningful life through the promotion of personal goal-attainment, social inclusion, relationships that are supportive and promotion of hope (Waldemar et al., 2016; Chester et al., 2016). Recovery-oriented practice focuses on the individual’s life and is not restricted to their mental health conditions or symptoms. The approach is personalised and aims at allowing individuals to gain back the control of their lives that does not primarily involve living with their symptoms (NSW, 2022).
The difference between recovery-oriented practice and traditional medical model of care is that the traditional care approach places the “abnormal” behaviour within a person, claiming that the issue is caused due to an internal factor in the individual which causes the problems in an individual’s behaviour, on the other hand, the recovery approach focuses on the support from the professionals, peers and empowers the individual to overcome their condition (Farre & Rapley, 2015). The traditional medical model of care remained restricted to the illness or disease that is present in an individual whereas the recovery-oriented approach of care includes the psychosocial approach to care without disregarding the advantages of biomedical approach- this provides the opportunity of providing care to the patients through the standpoint of disease in addition to the social and psychological information that is also given equal importance during the care provision (Farre & Rapley, 2015). The traditional medical care approach focused on resolution of the symptoms which did not provide improvement in the psychological condition of the individual; the recovery-oriented approach shifted the focus of care to emphasize on the control of issues and resilience in the life of the patient. Moreover, the recovery-oriented practice dismisses only treating or management of the presented symptoms and focuses on supporting the individuals in emotional distress and builds resilience of those with mental health conditions (Jacob, 2015).
The Framework for recovery-oriented practice (Department of Health, 2011), states its purpose as referring to the unique personal experience, journey or process that is defined and lived by each individual with respect to their health and wellbeing. In addition, it also recognises the role of mental health facilities in creating an environment that supports and does not interrupt people’s efforts on their journey to recovery. Moreover, the purpose of the Framework is to provide broad guidance to the service leaders and individual healthcare workers across different disciplines and settings of healthcare (Department of Health, 2011). The Victorian specialist mental health workforce’s work should be guided by the concepts, capabilities, practises, and leadership identified in the Framework for recovery-oriented practise. As a result, the framework is meant to provide broad advice to both individual practitioners and service leaders across the specialist mental health service system, specifically clinical and PDRS services, spanning multiple practise settings and age groups. The goal of a recovery-oriented approach to mental health treatment delivery is to help people create and sustain a (self-defined and self-determined) meaningful and rewarding life and personal identity, whether or not they are experiencing persistent symptoms of mental illness. In addition, the purpose of the framework is to clarify the principles that should guide practise in order to improve the quality of people’s mental health treatment experiences. As a result, the framework is meant to be used in conjunction with other professional standards and competency frameworks (Department of Health, 2011).
Domains of the Framework for Recovery-Oriented Practice
The domains that make up the Framework for recovery-oriented practice are as follows: The domain for promoting a culture of hope that urges mental health services to promote the principles of self-determination, hope, personal agency and choice and social inclusion. The second domain is the promotion of autonomy and self-determination where the mental health providers are responsible for promoting people’s self-determination and involve individuals in their mental health care as partners (Chester, et al., 2016). The third domain is the collaborative partnerships and meaningful engagement where it details the process of engaging with people by mental health professionals so that they can support the recovery efforts of the individuals. This domain is central to the recovery-oriented practice that encourages the development of collaboration between the people accessing the healthcare service and the mental health professionals that includes the significant others of the patient and their support networks. The fourth domain is the focus on strengths that orients the services towards the positive approach that is focused on building the strengths of people. It focuses on the skills, resources and assets that a person possesses (Department of Health, 2011). The fifth domain is the provision of holistic and personalised care. The sixth domain is the importance of family, carers, support people and significant others while providing mental healthcare to an individual. It focuses on the important role of family, support people and other important people during the recovery journey of individuals as it supports them through this process. The seventh domain is the community participation and citizenship that relates to the social life of the people (Dixon et al., 2016; Department of Health, 2011). The eighth domain in the framework is the responsiveness to diversity that describes that effective mental healthcare includes the provision of tailored and personalised care that is responsive to the individual’s needs, circumstances and values. The ninth and final domain is the reflection and learning that outlines the self-reflective practice, insight and learning that is necessary for mental health workers as it allows them to provide good quality recovery-oriented mental healthcare.
The principles of the Mental Health Act are the same as those that govern the domains in the framework for recovery-oriented practise. It promotes the culture of hope, self-determination, choice and personal agency. The principle states that the environment of service must support the recovery of an individual, must communicate and sustain a culture of optimism, hope and encourage their efforts for recovery (Mental Health Act, 2014). The services are responsible for involving people as partners in their care and it is aimed at promoting the self-determination and their capability to manage their mental wellbeing. The principles are also focused on the inclusion of family, carers and other important people who can support the patient in their journey to recovery. The service providers must also use their existing support networks to support the people who are accessing care. The principle also states that the rights, autonomy and dignity of people must be promoted and respected and that stigmatising attitudes towards people suffering from mental health issues must be rejected and demotivated in the service as it adversely affects the mental health and progress with recovery of people (Mental Health Act, 2014). This principle also includes the healthcare worker’s role in working responsively and sensitively people belonging to the diverse groups in the community. The mental health services are responsible for providing mental healthcare that is appropriate, effective, sensitive towards the people from the different communities, language groups, cultural backgrounds, sexual and gender identities (Mental Health Act, 2014). The principle emphasises on the importance of feedback from people who access the service and their families so that the existing service can be improved. Under the principle, the mental health care must be personalised and informed by the circumstances, goals, preferences and requirements of people seeking care. Moreover, the principle implies that participation in community activities and social engagement is important for the mental wellbeing and health of people and mental health workers are responsible for supporting individuals to engage in vocational and social networks and the communities they choose to be a part of. Moreover, the principle encourages developing collaborative relations between the people accessing the care services and the mental health professionals, including the significant others of the patient and the carers involved (Mental Health Act, 2014).
Benefits of Recovery-Oriented Practice
A. In this chosen case scenario where Felicity, a 22-year-old social work student has been allocated to me, I would apply the principle of creating a supportive environment so that she can be supported in her journey to recovery. I will ensure that the service environment where the patient has trusted to provide care will be optimistic and inspires hope in her through humanistic practice. In addition, the principle of involving Felicity in her mental health care so that her self-determination is promoted. Moreover, I will recognise the lived experience of Felicity and involve these in the decision-making process so that the recovery is supported. Also, as her registered nurse, I will ensure that Felicity has access to high-quality care that is responsive of her particular needs. Moreover, I will form meaningful engagement with Felicity and utilise collaborative practice that ensures that the service works constructively to aid her in understanding the experience that she is going through and which enables her to find the positive meaning in her experience. As Felicity was unable to find hope in her life as it was presented in the scenario that she intentionally overdosed on paracetamol and claimed that no one cared for her and that her life was over, applying the above principles would aid in changing her perspective on the situation and help her in finding the positivity in the experience. Evidence that a recovery-oriented approach to borderline personality disorder that focuses on promoting optimism and targeting the intervention based on the patient’s needs has been successful, provides proof that this practice will be able to help Felicity to overcome the emotional barrier in her life and manage her condition (Ng et al., 2019; Balaratnasingam & Janca, 2020). Moreover, studies support that promoting the engagement of patients such as Felicity in her interests such as singing promotes their recovery (Ng, Bourke & Grenyer, 2016).
The three domains of the Framework that I choose are: Promoting a culture of hope, Holistic and personalised care and Community participation and citizenship.
I would actively uphold a culture of hope through supporting Felicity and using optimistic language and celebrate her recovery efforts. I would sustain optimism and display that Felicity is capable of recovery and she will achieve it. In addition, I would also modify my practice to provide appropriate and responsive care and use the appropriate practice that is personalised for her age and condition. I would utilise my skill of recovery-oriented language in every interaction with Felicity and document her experience in the same manner. I would utilise my skill of being respectful while enquiring about the needs, wishes and circumstances of Felicity. Moreover, I will understand and ensure effective communication of the recovery principles and emphasize optimism and hopefulness towards her recovery. I would also utilise my knowledge of an updated research on the results of recovery and convey these to her and work to improve my knowledge on the resources and services available that would help her. This would allow me to actively celebrate and share the experience of recovery with permission from Felicity who was under the care. Through the use of affirmative, positive language the achievements and success of Felicity would also be emphasised. This would allow me to remind Felicity of the improvements in behaviour and her condition. Through using the domain of promoting a culture of hope, Felicity’s hope of recovery would be sustained, most importantly during the time when she finds it difficult to carry that hope (Department of Health, 2011). I believe developing necessary skills that would support Felicity to live her chosen lifestyle and supporting a dedicated (personalised) approach would also be helpful in improving her condition through the practice. In addition, I would enquire about the services that were involved in Felicity’s healthcare and incorporating these practices if they were successful in bringing about positive changes in her. This would enable Felicity to restore her health and wellbeing and develop a positive perspective towards her situation and eventually, her life. Lastly, I would support Felicity to locate or create opportunities for social participation and recognise that stigmatising attitude within the care setting could affect her wellbeing (Dixon et al., 2016). I would assist Felicity to identify and access social opportunities that arise in the community of her choice and also develop knowledge of the meaningful opportunities that could encourage education and social engagement within her community (Department of Health, 2011).
Conclusion:
In conclusion, it is certain that using a recovery-oriented practise in this case scenario 2 of Felicity, would prove to be supportive of her recovery through this emotionally traumatic experience that led her to overdose. Moreover, through the use of Promoting a culture of hope, Holistic and personalised care and Community participation and citizenship domains of the Framework for recovery-oriented practice (Department of Health, 2011), it is expected that Felicity will be encouraged to build her self-confidence and participate again in social and academic settings.
References:
Balaratnasingam, S., & Janca, A. (2020). Recovery in borderline personality disorder: Time for optimism and focussed treatment strategies. Current Opinion in Psychiatry, 33(1), 57-61. 10.1097/YCO.0000000000000564
Chester, P., Ehrlich, C., Warburton, L., Baker, D., Kendall, E., & Crompton, D. (2016). What is the work of recovery oriented practice? A systematic literature review. International Journal of Mental Health Nursing, 25(4), 270-285. https://doi.org/10.1111/inm.12241
Department of Health. (2011). Framework for recovery-oriented practice. Retrieved from https://content.health.vic.gov.au/sites/default/files/migrated/files/collections/policies-and-guidelines/f/framework-recovery-oriented-practice—pdf.pdf
Dixon, L. B., Holoshitz, Y., & Nossel, I. (2016). Treatment engagement of individuals experiencing mental illness: review and update. World Psychiatry, 15(1), 13-20. 10.1002/wps.20306
Donald, F., Duff, C., Lawrence, K., Broadbear, J., & Rao, S. (2017). Clinician perspectives on recovery and borderline personality disorder. The Journal of Mental Health Training, Education and Practice. 10.1108/JMHTEP-09-2016-0044
Farre, A., & Rapley, T. (2017, December). The new old (and old new) medical model: four decades navigating the biomedical and psychosocial understandings of health and illness. In Healthcare (Vol. 5, No. 4, p. 88). Multidisciplinary Digital Publishing Institute. 10.3390/healthcare5040088
Gabrielsson, S., & Looi, G. M. E. (2019). Recovery-oriented reflective practice groups: Conceptual framework and group structure. Issues in Mental Health Nursing, 40(12), 993-998. 10.1080/01612840.2019.1644568
Gunderson, J. G., Fruzzetti, A., Unruh, B., & Choi-Kain, L. (2018). Competing theories of borderline personality disorder. Journal of personality disorders, 32(2), 148-167. 10.1521/pedi.2018.32.2.148
Jacob, K. S. (2015). Recovery model of mental illness: A complementary approach to psychiatric care. Indian journal of psychological medicine, 37(2), 117-119. 10.4103/0253-7176.155605
Mental Health Act. (2014). Mental Health Act. Retrieved from https://www.health.vic.gov.au/practice-and-service-quality/mental-health-act-2014
Ng, F. Y., Bourke, M. E., & Grenyer, B. F. (2016). Recovery from borderline personality disorder: a systematic review of the perspectives of consumers, clinicians, family and carers. PloS one, 11(8), e0160515. 10.1371/journal.pone.0160515
Ng, F. Y., Townsend, M. L., Miller, C. E., Jewell, M., & Grenyer, B. F. (2019). The lived experience of recovery in borderline personality disorder: a qualitative study. Borderline personality disorder and emotion dysregulation, 6(1), 1-9. https://doi.org/10.1186/s40479-019-0107-2
NSW. (2022). What is a recovery-oriented approach? – Principles for effective support. Retrieved from https://www.health.nsw.gov.au/mentalhealth/psychosocial/principles/Pages/recovery.aspx
Waldemar, A. K., Arnfred, S. M., Petersen, L., & Korsbek, L. (2016). Recovery-oriented practice in mental health inpatient settings: A literature review. Psychiatric Services, 67(6), 596-602. https://doi.org/10.1176/appi.ps.201400469
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