ADVANCING PSR AND RECOVERY Island Health Experience
Faculty/Presenter Disclosure • Presenter: John Braun • Relationships with commercial interests: – Employee with Mental Health and Substance Use Services, Island Health
Disclosure of Commercial Support • This program has received financial support from Otsuka/Lundbeck, Janssen and Mylan in the form of unrestricted educational grants. • This program has received in-kind support from Lundbeck Inc, BMS in the form of logistical support. • Potential for conflict(s) of interest: – None
Island Health MHSU Context • Island Health Mental Health and Substance Use Services is a region-wide program (includes Gulf Islands and Mainland across from our North Island) • Approximately 1700 employees • Provides direct services and oversees contracted services • All aspects of treatment and support are provided • Tertiary care – Secondary care – Acute care • Community and facility based programming • Housing/Residential Supports
Examples of advancing a Recovery Orientation
SI Housing/Residential PSR Initiative • Goal to imbed PSR and Recovery practices within the South Island MHSU Housing and Residential sites • Formation of Housing, Assessment, Rehabilitation and Transition Team Vision Statement “The HART team creates a positive recovery -centered environment and works with MHSU residential clients to develop their individual strengths and resources to live increasingly healthy and fulfilling lives.” • Adoption of Recovery Centred Clinical System
Assessment by staff and clients on recovery orientation Never Sometimes Unsure Often Always p I never feel p Sometimes we p I am unsure and p I often feel p I always feel 1 Feel Supported in the Recovery supported in recovery. discuss my recovery, want more supported in my supported in my of Process We do not discuss my but usually I am told information or I have recovery. I feel staff recovery. I see staff (connected, client recovery goals what to do. felt a mix of control often refer to my consistently advocate focused)) and recovery support recovery goals. for resident recovery p I never feel p Sometimes staff help p I am unsure how p I feel staff often p I always feel my 2 I feel supported in making choices supported to make a me to understand my many choices I have, support me to make choices are presented choices. I often feel choices but usually they or feel subject to an choices. and explained to me controlled. tell me what to do. even mix of choice so I can make an and control. informed decision. p Staff never seem p Sometimes, staff will p I am unsure of p I often feel listened p I always have a 3 Harm Reduction ..have you ever interested in my point be open to discussing what harm reduction to. I am able to chance to talk about …what if you did of view. I feel my ideas, and thoughts, is. I want more discuss my thoughts my understanding of nagged to quit all but usually I feel nagged information about drug and the harm and the drugs and alcohol to abstain from D&A. alcohol use. benefits I get from my (D&A) D&A use. p Interactions with p Sometimes my p I am unsure of p My interactions p My interactions 4 Self Confidence staff always leave me interactions with staff how I feel after with staff often leave with staff always discouraged or with leave me with a sense of talking with staff or I me with more self leave me feeling decreased sense of self confidence have an even mix of confidence. empowered with confidence interactions with staff increased self that leave me felling confidence better or worse about myself. p I never feel we p I am aware that p I am unsure of p . I am often treated p I consistently see 5 Respect Honesty are spoken to with sometimes I, or my co- whether I am spoken with respect, honesty staff interacting with Fairness respect, honesty and residents are being to with respect, and fairness. myself and others fairness treated with respect, honesty and fairness. with respect, honesty honesty and fairness. and fairness. p I see most staff as p Sometimes staff p I am unsure p I often feel p I always feel that 6 Staff Empathy uncaring or lacking understand me, but I whether I am listened understood and hear staff are trying to empathy; they never think many staff have to with interest and random words of understand my beliefs. say things that are sense of pessimism and positive encouragement from I always feel that they encouraging or discouragement about encouragement. staff. encourage me to do convey a sense of my future my best. hope. p I never have good p I sometimes have p I have an even p Often I say p I always have say 7 Client Response to Staff Members things to say about positive feedback about mix of complaints positive things about positive things to say staff, I have a lot of staff, but more and compliments staff. about staff. complaints about complaints. about staff, or I am staff. unsure. p I think I leave co- p Occasionally I leave p I leave co-residents p I often leave co- p I always leave co- 8 Interactions with Co- Residents to residents discouraged a co-resident feeling with a roughly even residents with an an residents with a sense Enhance Their Self- or with decreased more confident after mix of both more & increased sense of of increased self Confidence sense of self interactions with me. less self-confidence confidence after my confidence after my confidence after after my interactions interactions with them interactions with them interactions with me with them, or am unsure p I never feel part of a p Occasionally I am p I am unsure of p Often I feel part of p I always feel like a 9 Contribution to Team Recovery Team I do able to feel like part of whether I am part of my Recovery team.. full contributing not know who or what my recovery team, and the team or half the member in my a recovery team is. contribute to team time I am including Recovery Team. meetings and and half the time feel conferences. excluded from the team. p Staff never like p Staff have trouble p I am unsure about p I often offer p Staff always 10 Acceptance of Feedback from feedback from me. accepting feedback, but this. At times it is feedback to staff and welcome and Residents sometimes they listen difficult to give it has helped to make encourage feedback, feedback, but I’ve changes. and then make had some success. changes
Keeping Recovery Front and Centre!
Booster Buddy https://www.youtube.com/watch?v=2s7nQ1reXyM
Participation in Community Events
Challenges along the Road to Recovery Agreeing on a definition of Recovery • Is it possible/a reality for Mental Illness? • What does it mean – cure, harm reduction, abstinence, etc.? “[Recovery is] a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and contributing life, even with the 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…” (Anthony, 1993) “Doing the best you can with what you have” (Victoria Life Enrichment Society)
Working within a large system • Systems and processes are generally designed for the acute care system • Care Plans versus Recovery Plans • Expert versus coach/guide • Electronic Health Record • Environments are often clinical in nature • Moving from doctor-centered decision making to team based decision making (including service user and family) • Employee/leader “churn”
Moving from a traditional approach while working within a medical system Medical/Traditional Approach Recovery Oriented Approach Clinical Setting designed to treat sick Designed to promote recovery and people wellness Creates separation from community Designed to stay connected to community Expert directs care The individual directs care Risk adverse; paternalistic & protective Willing to let people learn and grow Sees setbacks as an indicator of problems Setbacks are opportunities for learning Staffed by medically trained “experts” Staffed by clinically trained individuals, peers, family, etc. Culture of low expectations and Culture of hope, empowerment, growth dependency Goal is to survive Goal is to thrive Adapted from Ashcroft, 2012
Balancing Risk, Safety and Empowerment • Worksafe BC and Union focus on violence prevention • Clarifying Medical-Legal liability, ethical and team-based decision making • Confidentiality and information sharing • Freedom of Information and Protection of Privacy Act (FIPPA) (RSBC 1996) • Adult Guardianship Act (RSBC 1996) • Community Care and Assisted Living Act (SBC 2002) • Continuing Care Act (RSBC 1996) • Coroner’s Act (SBC 2007) • Health Act (RSBC 1996) • Health Authorities Act (RSBC 1996) • Health Care (Consent) and Care Facility (Admission) Act (RSBC 1996) • Hospital Act (RSBC 1996) • Patients Property Act (RSBC 1996) • Personal Information Protection Act (SBC 2003) • Public Guardian and Trustee Act (RSBC 1996) • Public Health Act [SBC 2008]
Change is in the Air!
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