Well, the time has come to wrap this blog up!
So far we have covered what recovery and the Recovery Approach are. We have also covered aspects of the Recovery Approach being applied in an acute mental health setting, including the restrictive environment of the ward, hope, stigma, funding issues and medication. Finally, we have also looked at how OT's and other staff members can help give acute wards more of a recovery focus.
Personally, I have enjoyed sharing my knowledge and views about the Recovery Approach with you. I have strong views about the Recovery Approach in the acute mental health setting. Completing this blog and the research behind it has enhanced these views greatly.
It is my opinion that it is important to use the Recovery Approach as it puts the client’s best interests first. It is a key approach which an occupational therapist is well equipped to use within the realm of mental health. However I do believe there are issues when applying it to the acute mental health setting and I do not think that it is currently the best approach to be used in an acute ward, unless it is used in an eclectic manner. I do believe that in the future there is huge potential for the Recovery Approach to be applied more exclusively in this setting.
After completing this blog I feel I have expanded my knowledge about the Recovery Approach, and have also re-familiarised myself with the blogging world. It has been great to learn all the tricks of the trade and I plan to use these skills to help promote occupational therapy again, further down the track.
I now feel, that if I get a job in an acute mental health ward, I would be better able to incorporate the principles of the Recovery Approach into my practice, as I am familiar with the competencies expected of mental health workers, and the key points of the approach.
I hope you have found the information in this blog useful and interesting, thank you for following my progress!
Anna
Sunday, September 5, 2010
How can OT's make it work?
As those of you who are occupational therapists will already know, participation in occupation can benefit everyone, particularly those who experience mental illness. Occupational therapists are trained to increase peoples participation in occupation. Therefore, OT's can offer the recovery agenda a lot as we help our clients participate in meaningful occupations (Dowling & Hutchinson, 2008).
The benefits of participation in occupation include skill acquisition, routine, productivity and purpose (Kelly, Lamont & Brunero, 2010).
OT's have the potential to play a huge role in helping acute wards become more recovery focused, through educating staff members and clients about the approach and creating a less restrictive, more interactive environment.
OT's can employ the help of their fellow staff members when making a ward more recovery focused. This will enhance the sense of unity among staff members, and encourage everyone to use this recovery focus in their treatment of clients.
The benefits of participation in occupation include skill acquisition, routine, productivity and purpose (Kelly, Lamont & Brunero, 2010).
OT's have the potential to play a huge role in helping acute wards become more recovery focused, through educating staff members and clients about the approach and creating a less restrictive, more interactive environment.
OT's can employ the help of their fellow staff members when making a ward more recovery focused. This will enhance the sense of unity among staff members, and encourage everyone to use this recovery focus in their treatment of clients.
How can we make the Recovery Approach work?
Image retrieved September 5th from http://www.cultureofrecovery.org/?page_id=16This is an interesting website about 'building a culture of recovery' - check it out for some more information!
Despite identifying these issues about the use of the recovery approach in an acute inpatient mental health ward, I personally do believe there is scope for it to be applied.
In time, there is significant potential for the Recovery Approach to be applied effectively in this setting, which is a vision expressed in the document entitled, Our lives in 2014 (Mental Health Commission, 2004). For this to happen, mental health workers, including OT's would require further education about the Recovery Approach. In particular, mental health aides would need to be educated as they currently do not require any training before employment (Cowan, 2008). All staff would need to put a lot of effort into resolving the issues explored in this blog.
In order for acute mental health wards to adopt this approach effectively, they would have to adapt to the principles of the Recovery Approach and clients would need to be given more trust and freedom of choice.
Mental health workers would need to become very familiar with the Recovery Competencies that the government has outlined (in the document previously referred to - Recovery Competencies for New Zealand Mental Health Workers).
It is also noted that until the Recovery Approach can be used effectively as the sole approach there is significant potential for it to be used in conjunction with other models. By working in an eclectic manner all staff can ensure they cover all aspects of a client’s life.
In the author’s opinion, occupational therapists could use models such as the Canadian Model of Occupational Performance and the Model of Human Occupation to complement their use of the Recovery Approach. In addition, the Maori health model, Te Whare Tapa Wha could also be used. This model also ensures a holistic approach is used for the client.
Do you have any other ideas about how to make the Recovery Approach work in this environment? I would love to hear about your ideas, or what you currently do in your own practice.
Thank you!
Funding restrictions in an acute ward
In order to assist in the recovery process of clients, it is important to provide a stimulating environment (Mental Health Commission, 1998). A stimulating environment will encourage them to participate in activities and therefore increase their hope that they will feel 'normal' again and can recover.
However, in an acute inpatient mental health ward it can be very difficult to provide this stimulating environment due to a lack of funding and resources.
Usually, in an acute mental health ward their is only one occupational therapist working. They have extensive roles, including assessing client's, coordinating client's participation in occupation and attending meetings (NZAOT, 2005). As OT's have such a busy schedule, it can be difficult to provide a constant, active ward programme with activities on throughout the day.
In order to run a full day programme, an activity coordinator would need to be employed to run groups, and possibly more occupational therapists. Nurses and mental health aides would also need to be willing to help out, to ensure the group programme was meaningful and run effectively.
If a full day programme was run, clients would not be expected to attend every single group, however they should attend the groups that are meaningful to them, or that would directly enhance their recovery. The clients would share in the decision making about which groups to attend (Lloyd, Waghorn, & Williams, 2008).
In the case where there is only one OT working on the ward, they may be able to incorporate some group activities into the daily timetable but they must also make time for individual assessment and treatment. They also need to set aside time for paperwork and meetings.
This can lead to other inpatients getting bored which can create a negative environment. This may even increase the amount of conflict experienced on the ward and will certainly not enhance a clients recovery as they will not be so encouraged to keep busy and take part in activities.
More soon!
However, in an acute inpatient mental health ward it can be very difficult to provide this stimulating environment due to a lack of funding and resources.
Usually, in an acute mental health ward their is only one occupational therapist working. They have extensive roles, including assessing client's, coordinating client's participation in occupation and attending meetings (NZAOT, 2005). As OT's have such a busy schedule, it can be difficult to provide a constant, active ward programme with activities on throughout the day.
In order to run a full day programme, an activity coordinator would need to be employed to run groups, and possibly more occupational therapists. Nurses and mental health aides would also need to be willing to help out, to ensure the group programme was meaningful and run effectively.
If a full day programme was run, clients would not be expected to attend every single group, however they should attend the groups that are meaningful to them, or that would directly enhance their recovery. The clients would share in the decision making about which groups to attend (Lloyd, Waghorn, & Williams, 2008).
In the case where there is only one OT working on the ward, they may be able to incorporate some group activities into the daily timetable but they must also make time for individual assessment and treatment. They also need to set aside time for paperwork and meetings.
This can lead to other inpatients getting bored which can create a negative environment. This may even increase the amount of conflict experienced on the ward and will certainly not enhance a clients recovery as they will not be so encouraged to keep busy and take part in activities.
More soon!
Saturday, September 4, 2010
The restrictive environment of an acute ward
Competency number 2 of the Recovery Competencies for New Zealand Mental Health Workers states that "A competent mental health worker recognises and supports the personal resourcefulness of people with mental illness" (Mental Health Commission, 2001). This includes that the mental health worker must empower client's as much as possible (Mental Health Commission, 1998).
However, it is my belief that the inpatient mental health ward is a very restrictive environment which has strict timetables and rules. This is backed up by Goldsack et al (2005).
Within the ward clients can experience a lack of choice about what they want to do each day. Caltaux (2002) states that this limited choice and lead to negative self perception.
Another restriction of the acute inpatient mental health ward is that many patients in New Zealand will be under the Mental Health Act, 1992 to ensure their own and others safety. Being under the Act will create further restrictions for clients on the ward.
These restrictions can cause a feeling of disempowerment for clients. This feeling of disempowerment will make it harder to feel in control of recovery and may make it harder for clients to hold hope that they can live positively with a mental illness. Therefore, the setting is not conducive to empowering clients.
Within the ward there may also be a lack of resources, which can make it difficult for occupational therapists to empower clients. The first step in empowering people can involve offering them a choice about what they would like to do. Although an occupational therapist can ask clients what sort of activities they would like to do each day, it may be difficult to follow through on the expressed desire. For instance, a client may express a want to do woodwork. However an occupational therapist may not be able to assist in this task on the ward due to the risk perceived about the tools required, such as hammers, nails and saws.
A possible way around this is to let the client to certain aspects of the task - for example the OT could carry out some parts of the woodwork, and the client could paint it and decorate it.
However, it is my belief that the inpatient mental health ward is a very restrictive environment which has strict timetables and rules. This is backed up by Goldsack et al (2005).
Within the ward clients can experience a lack of choice about what they want to do each day. Caltaux (2002) states that this limited choice and lead to negative self perception.
Another restriction of the acute inpatient mental health ward is that many patients in New Zealand will be under the Mental Health Act, 1992 to ensure their own and others safety. Being under the Act will create further restrictions for clients on the ward.
These restrictions can cause a feeling of disempowerment for clients. This feeling of disempowerment will make it harder to feel in control of recovery and may make it harder for clients to hold hope that they can live positively with a mental illness. Therefore, the setting is not conducive to empowering clients.
Within the ward there may also be a lack of resources, which can make it difficult for occupational therapists to empower clients. The first step in empowering people can involve offering them a choice about what they would like to do. Although an occupational therapist can ask clients what sort of activities they would like to do each day, it may be difficult to follow through on the expressed desire. For instance, a client may express a want to do woodwork. However an occupational therapist may not be able to assist in this task on the ward due to the risk perceived about the tools required, such as hammers, nails and saws.
A possible way around this is to let the client to certain aspects of the task - for example the OT could carry out some parts of the woodwork, and the client could paint it and decorate it.
Medication and the Recovery Approach
Picture retrieved on 5 September, 2010 from http://notmytribe.com/2008/can-i-bum-a-neurotransmitter-82666.html#more-2666
Often, in an acute mental health ward, clients are expected to take medication in order to control their symptoms of mental illness (Duxbury, Wright, Bradley & Barnes, 2010). While on the ward they may also be trialling new medications to see if they help. Medications often cause severe side effects, including nausea, headaches, dry mouth and dizziness.
Often, in an acute mental health ward, clients are expected to take medication in order to control their symptoms of mental illness (Duxbury, Wright, Bradley & Barnes, 2010). While on the ward they may also be trialling new medications to see if they help. Medications often cause severe side effects, including nausea, headaches, dry mouth and dizziness.
Some clients choose not to take medications as they find the adverse side effects of the drugs affect them too much. Other patients decide that the benefits of the medications far outweigh the side effects and choose to take them.
Unlike the acute ward, the Recovery Approach accepts that everyone’s journey to recovery is different, and does not take a specific stance about medication (Cowan, 2008).
This illustrates the differing perspectives of the Recovery Approach and that of an acute ward. Personally, I believe that this expectation of an acute ward contributes to the lack of choice and individuality experienced by clients.
But how does medication relate to the role of an occupational therapist? OT's do not have any control over the medications clients are expected to take, as they are not at all trained in this area.
An OT is able to bring the issue of medication into the open through discussions on the ward, both in groups and individually, and also in community meetings on the ward. I am aware that many inpatient wards hold these meetings each morning of the week (excluding weekends), and they are an opportunity for patients to find out about the schedule for the day and deal with any issues they may have come across on the ward. These meetings are meant for both patients and staff, therefore it may be a good opportunity for the issue of medication to be discussed as nurses and doctors may also be there to share their knowledge.
When clients are taking medications, and especially when they are trialling new medications, it might be difficult for an OT to work with them effectively. The side effects of the medication can cause clients to be very drowsy and unmotivated. This makes it very complicated for an OT to help them focus on their recovery process.
What are your views on medication and mental illness?
Personally, I feel it is the clients own choice. Medications will benefit some but not others, and clients should be allowed to make an educated choice, with the help of family, friends and health professionals, about their medications. After all, it is their life!
Thursday, September 2, 2010
One in Four
Statistics show that one in four adults experience mental illness. Why then is it so stigmatised?
I found another video which attempts to increase peoples awareness of mental illness. This one is from the UK, and personally I found it quite hard hitting. Unfortunately I couldn't upload it straight onto the blog but if you follow the link bellow and scroll down to the '1 in 4' heading you should be able to download and view this 2 minute film.
http://www.rcpsych.ac.uk/default.aspx?page=1648
I found another video which attempts to increase peoples awareness of mental illness. This one is from the UK, and personally I found it quite hard hitting. Unfortunately I couldn't upload it straight onto the blog but if you follow the link bellow and scroll down to the '1 in 4' heading you should be able to download and view this 2 minute film.
http://www.rcpsych.ac.uk/default.aspx?page=1648
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