Friday, 30 September 2011

No symptoms, no problems

“Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems.” Shepherd, Boardman and Slade 2008.

There are implications for any mental health recovery programme if it is to take place regardless of 'ongoing symptoms or problems'. Firstly, it requires that the recovery programme is not determined solely by an individual's clinical diagnosis. Instead, it must be determined by a person identifying what he or she needs to build a life that is 'meaningful and satisfying'.

An appropriate service and environment in which this identification can take place needs to be in place to help signpost the journey towards invidual goals and aspirations. Fortunately, there are strategies built in to the care pathway that can enable individuals to identify personal goals and locate the sites in mainstream where hopes and goals can be realised. Whether these services are commissioned locally and regionally in specific areas is another matter.

It is important that aspirational settings are embedded in mainstream because individual goals are not fulfilled in clinical environments, although they may be identified therein. It is in mainstream where each and every one of us makes the path to achieving our goals. Mainstream is where we live, work, learn, create, exercise, develop and grow. Mainstream venues are the sites where these developments can take place. Sites that include the arts, sports, education, retailing, volunteering, befriending, family, friends, faith and employment. It is broadly one or more of these areas that an individual will identify as useful to his or her developmental choices.

When this person-centred practice is backed up by a team that can help direct an individual to the appropriate mainstream setting, then a recovery programme can start in earnest. It may well be that other settings have helped or continue to help in achieving this - settings such as day services and what used to be referred to as 'sheltered' activities or community projects. The clinical teams also - assertive outreach, O.T.'s and key workers all contribute to client independence.

It is important that the initial conversation about an individual's mainstream goals and aspirations takes place in a mainstream setting. This may well be an individual's first re-introduction to the mainstream world after what could have been years of semi-institutional or supported environments. It is extremely unlikely that the practical hope of achieving mainstream is communicated in a hospital consulting room or even in an individual's own home. Those areas are associated with support, care and treatment. Mainstream recovery has to go beyond these boundaries.

So what sort of team can best support an individual when it's not support he or she is requesting but access to goals and self-development? I would argue that this needs to be provided by a bridge-building team, each member equipped to identify the mainstream venues appropriate to the goals the client has identified.

Regular readers of this blog will know that I am an arts and faith bridge builder based in south London. Readers will also know that I work directly with people referred from secondary care, that is people with what are called 'severe and enduring' mental health diagnoses. I work with colleagues who are all trained in identifying the mainstream areas appropriate to their bridge building roles. The employment advisor must know about mainstream employment, the sports bridge builder about sports venues, the arts bridge builder must know about the arts locally and regionally.

Mainstream is often achieved indirectly and obliquely. For example, a client who has identified music as a mainstream goal may not go on to achieve in that field or may change their mind about music as a choice in their recovery. This can be disappointing for me as arts bridge builder, but it is often the case that these individuals benefit immensely from other aspects of mainstream that the team is able to offer. I frequently find that some clients who have not engaged through the arts are nonetheless following mainstream goals via the befriending service or through volunteering and sports activities.

Conversely, it can be the case that a client who has been signposted to a music outlet in mainstream, goes on to achieve goals that go far beyond the initial contact with a music studio or rehearsal room that he or she has requested. Such clients can and do develop employment and self-employment pathways or go on to further and higher education opportunities. These goals have been achieved through the initial contact with mainstream and couldn't have been realised any other way. Mainstream itself will often generate these opportunities for the client independently of the bridge building service.

Because bridge building has the strength to enable an 'oblique' approach, there can be limitless opportunities for motivated clients choosing their recovery pathway. Even a relapse can only hold up rather than destroy the process. The confidence and skill levels that clients develop in mainstream enhance growth into further mainstream activities and domains.

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