Recovery-Oriented Practice in Mental Health

Recovery-Oriented Practice in Mental Health

What is the difference between ‘clinical recovery’ and ‘personal recovery’ for people with lived experience of mental illness?    

In a simple word” Recovery is pretty much getting back to normal “Clinical recovery is an idea which involves mental health medical team such as mental health nurses, doctors, psychologist and social worker who works together in team to treat a person with mental illness with or without involvement of medication( “What is recovery”, 2019).  Australian Health Ministers Advisory Council (2013) has described clinical recovery as a patient attend regular appointments and following the plan made by a medical team in the partnership with a patient and followed up regularly by medial staff. The department said clinical recovery not is only to treat the symptoms of the illness, but also help to take a control of the life. It is designed how they can improve and keep tracks of the changes and identify and manage in the future (Australian Health Ministers Advisory Council, 2013).  On the other hands, Personal recovery can be different from person to person. A personal recovery is a unique and personal experience which is a challenging journey of one who’s is battling own’s mental illness, however, still try to focus to gain and retaining the hope of positive changes on self, understanding own’s capability to make it happen and create a positive environment, engaging in an active life and participating in social function and programs and any other various ways that could help to build a positive future for a healthy lifestyle, leaving a unhealthy past behind (“Recovery”, 2017). Slade (2009) introduced personal recovery framework which focus on promoting well-being rather that treating illness that involves 4 recovery task which are developing a positive identity besides its illness. Secondly, Framing the mental illness involves frame and understand the illness as it is a part of the person. Thirdly, Self-managing the mental illness that comes after framing the illness which gives the ability to self-manage by taking personal responsibility of own well-being, seeking help and support from others however, it doesn’t mean doing everything on own. The final recovery task is developing valuable social roles and relationship which has no linked with mental illness. This may form new, previous or modified valued social roles and its important during the breakdown point of the life, when friends and family can provide comfort and effort to support the person for recovery (Slade,2009).

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What is recovery-oriented language in mental health?

According to the mental health coordinating council (MHCC), Recovery oriented language is the concept where language or communication are most priorities and value that fetch hope and support to bring positivity and promote a culture, providing support for the people with mental illness or disability. MHCC has some general principles based on language we use which should represent the good meaning and should not impact or offence any other people. Similarly, our language needs to be respectful, non-judgmental, understandable and should be aware of its positive and negative contribution in someone’s life who may in their journey of recovery.

Why is recovery-oriented language important for a person’s recovery? 

Language has a power to shape and sense of the person’s reflection by describing self and others. It also helps to shape possibilities and promote positivity to others to break with the past, talk about their trauma, which may have resulted in a range of psychosocial difficulties. Similarly, language also create a good environment to ease or promote openness that could contribute in recovery. Language is very crucial as it provide an opportunity to build a rapport relationship with the partnership that eases therapeutic liaison. This recovery ensures that accurate language and ways to communicate to the client reflecting theirs’s voice and support the recovery journey, plus doesn’t exaggerated any opinion of professionals. The care plan is designed with client perspectives with client’s consent for the treatment, recommendations, discharge plans, housing referrals etc. which promotes client directed service planning.

• https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-recovpol-toc~mental-pubs-n-recovpol-8
• http://content.ementhe.eu/Recovery/Diagnosis-Labelling-stigma/Theuseof.pdf

NSW Mental Health Act (2007)

What is the purpose of the Mental Health Act?

Mental health ACT is the legislation established by government to provide care and treatment of people in Australia who experience mental disorder. This ACT can relate to voluntary patient who are admitted to a hospital with their consent, involuntarily patient who are admitted to or apprehended in a hospital setting against their consent and those who required to access the treatment in the community under Community treatment order (CTO). The main aim of this act section 3 is to protect the civil rights of every individuals to access the care and treatment; they are to provide care, treatment and promote recovery for mentally ill or disorder people. This ACT also facilitate who access the care and treatment from the community care facilities and facilitate the voluntary or involuntary patient in the hospital setting provisional treatment. This act provides care and comfort to the people with mental disorder and their carer by involving them in decision making and appropriate education about the treatment plan. As per Division 1 General, Section 68, the parliament has ensured that the principles are more practicable and people with mental illness receive the best possible care and treatment in any circumstances.

• https://www.legislation.nsw.gov.au/#/view/act/2007/8/whole#%2Fchap1%2Fsec3

Who has rights under the Mental Health Act?

According to the Australian legislation, Mental Health Act 2007, no.8 Schedule 3, Section 74, Person with mental illness or disordered, mental health team, next of kin and designated care have right under mental health act. Person can get treatment on request or may also get refused if authorised medical officer and psychiatrist think that it won’t be beneficial for the patient or does not need one. On the other hand, person can also be retained as an involuntary patient against their ill for his own protection and prevent serious harm for self and others. Person can be detained no more than three times a month and no more than three months if admitted as involuntary patient. Patient or carer may appeal for the decision of medical team which would be reviewed by a medical health review tribunal under the mental health act. Discharge, referral can be made by a patient and carer if any alternative however, appropriate and reasonable care available which need medical superintendent or medical officer approval. A person can be given consideration for the least restrictive environment care and treatment if safe to do so. A patient has a right to check medical records, have primary carer, relatives, friends, even lawyer or interpreter and also can wear street clothes as they desire. A help can get easily via facility staff member, medical team or mental health advocacy service. A person may get the treatment in order to save life or prevent serious damage including electro convulsion therapy (ECT) against the will, if mental health review tribunal determines if its desirable or necessary.

What are the criteria for mental illness under the NSW Mental Health Act 2007?

There are different criteria that applied to a person for their admission in a mental facility. A person may give admitted on own request as a voluntary patient or get an admission as an involuntary patient on request from a carer, friends or colleagues if the person has any mental illness or disorder but will be assessed by a authorised team. An authorised Medical officer Must notify parent of the person on admission and begin the treatment as soon as possible in case of children under 16 years as a voluntary patient. For the age 14 or 15 years, a child may get discharge on the objection of parent unless the child elect self to continue the treatment as voluntary patient. Under CD 1990, section 9, Criteria for involuntary admission etc as mentally ill person if the person it’s suffering from mental illness and does or self harm or harm to others then he or she needs an admission. In same way, mentally disordered person would meet the criteria if patient is deteriorating, had some behavioural issues which can not be justify or any sign of doing harm.

Least Restrictive Practice

Why is the use of seclusion and restraint risky – for the consumer?

Number of incident occurred due to seclusion and restraint while a consumer is held in a physical/ manual restraint, but the mechanism of death is not clear however, possible reason may be positional as physic or cardiac arrest .... notepad reference.....  Some good example of restraint is apparent pressure on neck, thorax or abdomen and inappropriate application of the strain. Studies have revealed that a period of intense struggle, severe lactic acidosis excessive muscle activity and the position could be the reason of death. Another adverse event associated with the use of restraint and seclusion may include choking, loss of consciousness, pressure sore, muscle strains, skin and circulatory problems and in rare case death.  There’s intervention contribute to self-harm, self-directed aggression including self-multinational and cutting and suicidal attempts. There are policies and protocols in every Australian state and territory for the use of these interventions.

Why is the use of seclusion and restraint risky – for staff members?

All physical restraints are potential risk to the staff and consumer. It is stated on mental health act  under section 190 recognised the work, health and safety legislation for workplace safety which is why Recognised medical officer or staff should take an appropriate action in order to prevent serious incident during unfavourable situation in order to the safety of staff and other member. NCBI has mentioned in his articles that use of physical restraint has an adverse physical and psychological on staff as well, which could be clinical or non-clinical factors such as cultural biases, role perceptions and attitudes. Author has also provided a report of survey which has proven that mental health profession are at a considerably higher risk fro workplace violence, followed by nurses while physical restraint and seclusion was in use. There should be programme and training provided to the staff member to be familiar with the type of restraint and management of behaviour to minimise or eliminate the incidents related to restraint and seclusion.

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What does ‘least restrictive care’ mean in the mental health context?

Least restrictive care can be defined as a treatment or care provided in a least restrictive environment. Community based treatment and institutional based treatment may also provide but a person needs to be eligible and meet some criteria. A report based on the reform for more recovery oriented and least restrictive approach surveyed in 2014 in Queensland's acute mental health including locked wards has found that the least restrictive practice has better outcomes for patient, hospital and community. It has also outlined that all Australian state and territory has committed to implement the least restrictive practice in the legislation and works towards recovery oriented practice implementing supportive relationship, organisation culture and monitor and review of recovery-oriented practice.

Describe two (2) nursing interventions that could be used to promote a person’s personal recovery in the inpatient or community mental health setting.

Being the mental health nurse can be very challenging and emotionally draining however, it very rewarding as well. Mental health nurse treats and care the patient with type of mental illness or disorder such as depression, schizophrenia, bipolar disease or a psychosis including the patient locked in a special locked psychiatric unit. Nurses have a various role to play in the treatment of the patient.

1. Building a therapeutic relationship with a client.

Nurses can be the best advocates for the patient. The nurse-patient relationship is build with mutual trust and respect, nurturing of faith and hope and providing the support and care through the skill and knowledge.  (pullen and omo). this can help to promote awareness, person growth and work in collaboration through the challenges . It is also important to the nurse to develop a trust and empathy to support the patient throughout the recovery journey.  Empathy and trust can be build by being an active listener, providing comfort, maintaing eye contact and some physical gesture with professional boundaries and using the appropriate and simple language.

2. Encouraging and participating the groups’ session.

Group session can be beneficial for the patient as it facilitates the confrontation or sharing the feelings, fears, concerns and experiences that they went through the treatment with others. Sharing the things provides an opportunity to ventilate and provide feedback to the person to person. Involvement of the nurse can be very supportive and also encourage their patient to participate. Stress management, psychosocial groups, substance related abuse group, physical health, peer support group and creational activity group are some good examples of group therapy where patient get to share and shows their gratitude or even talk about their grief, regret, mistakes and past life.  A recent survey from UK found sharing the feelings increase hospital discharge rate and have better health outcomes in patient's health. During the group therapy, nurses and other group member can provide support by building new relationship and give a hope, which may led to a positive environment. This led to build a good therapeutic relationship between nurse and patient which can be contribute in the treatment and care plan.

References: -

• What is recovery, 2019. Mentis Assist. Retrieved from https://mentisassist.org.au/what-we-do/what-is-recovery
• Department of Health, Australian Health Ministers Advisory Council. 2013). A national framework for recovery-oriented mental health services: Guide for practitioners and providers. Retrieved from https://www1.health.gov.au/internet/main/publishing.nsf/content/67d17065514cf8e8ca257c1d00017a90/$file/recovgde.pdf
• Recovery, 2017. Think Mental Health. Retrieved from https://www.thinkmentalhealthwa.com.au/supporting-my-mental-health/recovery/
• Slade, M., 2009, Rethink mental illness, 100 ways to support recovery: A guide for mental health professionals. Retrieved from https://www.rethink.org/advice-and-information/living-with-mental-illness/treatment-and-support/100-ways-to-support-recovery/