From Less Sick to More Well:
Shifting the Focus of a Mental Health Team
The treatment approach to mental illness tries to make people 'less sick' by managing or eliminating symptoms. The recovery approach attempts to make people 'more well' by encouraging hope and happiness. Like the proverbial glass that is half full, the recovery approach is optimistic and measures success in positive terms - the same terms that are used by the general population: self-determination, friendships, contribution to community…
The recovery approach to mental illness is about being human. It challenges mental health professionals to break out of the medical model and change the way they think, talk and interact with mental health clients. In the last three years, the Carlington Assertive Community Treatment Team (ACTT) in Ottawa has been moving from a treatment model for mental health to the recovery approach. As program manager, Joann Michels has been responsible for much of that shift while still meeting Ministry of Health standards. It has been a process full of challenges and rewards.
"In 2004, the team as a whole decided that they needed more education around rehabilitation," explains Joann. "We invited Christine Gayler to speak to us. She helped us think differently about our mission statement. She helped us become more recovery rather than treatment focused and more consumer friendly." Over the two day retreat with Christine, the team discussed how to change their services, how to approach clients and how to communicate hope.
For example, assessing a client' readiness for a variety of situations is a common ACTT activity. Using the recovery approach, Carlington ACTT now employs conversational assessments that promote hope through recovery type questions. They now worry less about active symptoms and more about an individual's ability to live a satisfying life without putting themselves or others at risk. "Even if they are not symptom free, we can still weave in hopefulness and quality goals," says Joann.
When Christine returned in 2006, the team was comfortable with their progress in terms of integrating recovery into the care they delivered. The new hurdle was shifting the expectations of families who think of recovery as having their loved one symptom free. In recovery, everything is not perfect. The individual may have an apartment, a job or go to school but they may still have symptoms of their illness. The teams new challenge is communicating to friends and family that "recovery is not linear and not the same for everyone". In October, 2007 a family session is planned to share ACTT's findings and open a dialogue around recovery.
According to Joann, ACCT's transition to the recovery approach was supported by a number of important factors:
-
1. The team included trained consumer/providers who understood and could mentor recovery. "None of us would have changed without Helen, the Peer Specialist, on our team. We wouldn't have got it."
2. Management and the team psychiatrist who were willing to change. Again, "without the support of Chantal Whelan, our psychiatrist our transition would not have been possible".
3. Most members of the team were willing to change.
4. The process of change was guided by an external resource who challenged entrenched ideas, helped participants think differently and imagine what the change could look like.
5. The discussion about the shift to recovery took place in a retreat - a safe environment away from the clinic.
6. The external resource followed up on a regular basis to help keep the team on track with their planned change.
7. In a retreat two years later, the team reviewed what had been achieved and identified new goals.
Joann identifies the number one factor contributing to their success was the Peer Specialist on the team. Helen White has been a Peer Specialist (someone who has suffered from mental illness and works with ACTT clients) on the team for some time. It was she who suggested that they move away from the medical mode of serving consumers. Joann's commitment to Peer Specialists is so great that when the opportunity to hire an additional team member arose, Joann chose to hire another Peer Specialist rather than an Occupational Therapist as would be the norm for ACTT. "I decided to contract out occupational therapy if needed so that we could have another Peer Specialist. I had to rationalize this to my regional representative and they were supportive," explains Joann.
At times it has seemed to Joann that their progress with the recovery approach was a bit slow. "But I now know that it takes time to change and more time to experience and observe the results - to see that change is making a difference." And the results are seen. With clients exhibiting new coping mechanisms, getting involved in more diverse activities and, sometimes, requiring less medication, the principles of recovery are now guiding the care offered by the Carlington Assertive Community Treatment Team.