Transcript: Recovery 2020: A vision achieved? SRN 5th national gathering

Podcast Episode: Recovery 2020: A vision achieved? SRN 5th national gathering

What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.

MD - Michelle Drumm
SB - Simon Bradstreet
RP - Rachel Perkins
JM - John McCormack
LC - Louise Christie
JG - Jenny Graydon
ED - Elinor Dowson
SS - Susan Scott

MD On 18th March 2013, Iriss.fm attended the 5th Scottish Recovery Network Gathering on the theme of ‘Recovery 2020: A Vision Achieved?’ It featured a number of speakers from various mental health disciplines, each of who presented using the very upbeat and visual Pecha Kucha format comprising 20 images and 20 seconds per image to get the point across. These short presentations were followed by a keynote presentation from Dr Rachel Perkins who offered a lot of inspiring food for thought around recovery in mental health. Themes of the day included the importance of relationships and working with and empowering individuals and communities to make recovery a reality by 2020. The day involved performances from A Choired Taste, as well as dancing and movement workshops from Indepen-dance. A chill out zone also provided a space for reflection from, with arts and crafts and holistic therapies. Simon Bradstreet, Director of the Scottish Recovery Network and Chair of the event offered his thought around the vision of Recovery 2020.

SB Well we have made great progress with recovery in Scotland - we have moved from a place where recovery wasn’t really on the landscape in terms of mental health - we had of forgotten that it happened and we were losing sight of how best to promote recovery and how to achieve recovery, particularly within services. So a lot of the initial talk was about getting people to talk about it at all - and we have moved beyond that since then. We are now talking about how we support people with tools and interventions to better promote recovery. But now, in the 5th Conference, we are talking of “Where next? What is the next big step we need to take?” While we have got lots of buy into recovery and lots of interest in recovery, we need to be looking ahead and talking about things like the sorts of relationships that happen that support recovery, which is one of the themes this morning.

MD On the current dialogue around recovery, he responded …

SB I think it is very positive, I mean one of the indicators is the number of people who have come today. At the same time though there are challenges, particularly with the current economic situation, the welfare reform process, cuts to services - and sometimes recovery has been conflated with a risk of losing services or losing income - and that is something that does concern us about we need to take more control of the agenda to say recovery is not about losing money, it is not about losing services - it’s about recovering your life and having a satisfying and fulfilling life.

MD When asked about whether professional identities might be challenged as a result of communities and individuals taking more of an active role, Simon had this to say …

SB Yes, I think it is challenging for professionals because it does ask us to look at different types of expertise, as Rachel was mentioning this morning - the experience of lived experience as well as professional expertise. But I don’t think it necessarily means seismic changes - sometimes the changes we are talking about are to do with the way conversations take place, for example, the sorts of language that is used. So I think any change can be frightening for people - whether they work in services, provide services - but it is possible, and we see indications of the change that is happening. But with any change, resistance is, of course, also very likely - and really the key thing is how we work with that resistance - we recognise it, work with it and understand it.

MD Iriss.fm also spoke to Dr Rachel Perkins, the key note speaker who told us about her roles in mental health and the importance of lived experience.

RP Well I started working in mental health services as a Clinical Psychologist, and I was a Psychologist for a number of years and then I moved onto being a Director of Services in Southwest London. But I have also, for the last 25 years, used mental health services - so there is a kind of parallel bit that I’ve been both inpatient and community service … I think I have been admitted 8 times now over the last 25 years. But I have also done a lot of working the voluntary sector, campaigning work, writing, speaking, so I find that I have sort of tried to combine activism with provision, with actually understanding things from lived experience. But I suppose now I have retired from the National Health Service and what I am trying to do is influence policy now. I will take a rain check on whether that is effective or not, but that’s what I decided I wanted to do.

I think lived experience is as valuable as professional experience - I don’t think it’s just valuable, I think it is absolutely critical. I do though think that many of us have to think about how we use our lived experience, because I think sometimes I see people with lived experience talking only about what hasn’t helped and how awful things are. I think we have got to actually start looking at the more positive side about that - what is useful? And offering images of possibility - certainly I have found … felt totally depressed when people were saying “oh yes I have been coming here for years- it’s all hopeless” - and you sort of think “right, I will go and kill myself now”. It is something about having people who recognise where they have been, where they have come from, and actually going to talk about the possibilities - not to minimise the challenges, but there are possibilities. Everyone always says that people with mental health problems, the kind of view is that they are weak - I actually think they are the strongest people I have ever met, and I think sometimes people forget their strength and the strength it took just to survive the things that have happened to them.

And I think it’s really important that we celebrate that strength, not just talk about the awfulness. So I would like to see more celebrating of strength.

MD She went on to talk about the importance of supporting people in communities …

RP I think it is a mistake to look at individuals as islands - I think people do exist in the context of friends, neighbours, families, communities, and our challenge is not to see people as taking people out of those communities. Too often our mental health services take people out of communities - either saying “you stay at home until you get better”, or in hospital or in segregated settings. I think the challenge is how to support people in those communities. And that means supporting the communities as well as the individual - so I think we should see our services not as supporting individuals in isolation, but supporting communities.

MD Rachel also explained how she sees recovery focused practice …

RP Anything that helps an individual in their personal journey of discovery - I see recovery as being each individual’s personal journey of discovery. And individuals who have mental health conditions don’t have a choice - you have to live with … move beyond what has happened to you. And I think the question we have to ask, if anything, whether it’s a service or a friend or parent, is “did that actually help me to move forward in my life, or did it get in the way of that? Did it make me believe that something was possible, or did it destroy my hope?” And I guess I think the parallel is very much of a seed - that seeds can appear to lie dormant for years and years - and what they need is fertile ground to grow. You can’t make a seed grow, but you can give it the conditions in which it can grow. And I think the big questions we have got to ask ourselves is - each individual is going to be different - how can we make sure there is that range of different possibilities that people can actually have those conditions in which they can grow?

MD On the challenges for existing services and for professional identity she went on to say …

RP And I think the big challenge is that services always see themselves as experts who determine what is going to be good for people - and I think it is very, very difficult getting out of that - that what we need to be saying is “how could this individual use us to support their journey?” So it’s now “how can we prescribe what is good for them”, it’s “how can they use us?” And it might be, you know, dropping in to see the Psychiatrist when you feel like it, going and having a cup of coffee with the receptionist, someone to call in the middle of the night when you are feeling bad. We have got to actually look at how that resource can serve people, rather than how we fit people into our existing services. And I think professionals don’t have to assume that they have some special expertise that other people can’t understand. I would see my job, as a Psychologist, as explaining to people the difference theories that Psychologists have and the different sorts of therapies based on those theories, and see if they make sense to anyone - because one thing we do know from all the research, all the professional research, is that if someone thinks something is going to help them, it does. So actually we should, according to the research of professionals, be giving people a choice of what suits them - because different models make sense to different people, and our job is to share those and see if the person finds them a use.

MD Iriss.fm spoke to a number of delegates who gave their perspectives of recovery and their visions for 2020.

Delegate 1: My name is Margaret, I am a Lecturer in Mental Health Nursing at Edinburgh Napier University. I suppose I am here because I want to hear what people are thinking and understanding about this notion of recovery … which isn’t notional, of course, it is much more than that - thinking about it from an educational perspective, how we can garner more energy, how we can think about new and creative ways of supporting students to teach and learn about recovery and work alongside people. I think we need to give student nurses and mental health nurses far more explicit permission to follow and understand a social model of mental health and wellbeing. And so, as Rachel said in her talk, it is not about CBT will source out problems for you - CBT won’t find you a home and it won’t find you a boyfriend - but we can work alongside you in terms of thinking about your relationships - let’s hear about your relationships? Let’s hear about your I suppose I am here because I want to hear what people are thinking and homelessness? Let’s see if we can give you some practical advice and support - and I would like to see mental health nurses going back to that again.

Delegate 2: Well I am a student and these are my lecturers. From a point of a student’s view, I think when we have the knowledge and the background it will help us, as students, when we go out as future mental health nurses, to be able to implement self-directed management of patients or service users, so that they are much more better at what they want - not really what we want them to do.

Delegate 3: I’m Gwen - I am also a Lecturer at Edinburgh Napier University. My vision is I hope that we have a shared understanding of how to work positively with people regardless of their situation and the experiences that they have had over their contact with services. My role is teaching undergraduate student nurses in mental health - and the reason for coming along to events like this is to hear the inspiration and the people that speak and take that forward and integrate that into the education programmes that we run at Edinburgh Napier.

Delegate 4: I am here from a third sector organisation called Health & Mind, but I guess I am here as a sort of recovery champion representative, to come here and hear all these wonderful different viewpoints and ideas and thoughts and feelings about recovery - the idea and the concept of recovery - and to take that back and to channel that back into the people I work with and also my colleagues and what not. So yes, disseminate. I do have a vision - I think Rachel, who was the keynote speaker, kind of more or less summed up my own vision. I feel if it wasn’t so wonderful I would feel a little bit hijacked. I think every single idea that came out of … or every single thought that came out of that woman’s mouth echoes exactly how I feel about my vision for recovery. And I guess, to put it in my own words, a humanistic … a humanistic view, you know, about reducing the us and them idea to even less than people with mental health issues and people who don’t have mental health issues, or service users and service providers - but people in general, you know? And I think eventually I would love to see 2020, that the word “recovery” doesn’t exist anymore - that we just talk about mental wellbeing in general.

MD John McCormack, Scottish Recovery Network Manager for Learning & Development spoke to us about his work at the Scottish Recovery Network and what recovery means for mental health services …

JM I am particularly involved with something called the ‘Scottish Recovery Indicator’, which is a tool designed to get mental health services to reflect on how recovery focused they are in their practice. The recovery indicator basically has 10 indicators that a service could look at in terms of its recovery focus practice - and they gather information about that from service users, carers, the staff team, the paperwork - they kind of triangulate it all, if you will, and see how the opinions cross over with each other, rate that on a scale. And then what becomes quite clear from that process is what needs to change. Everybody becomes clear what it is that needs to change, the service users become clear, the staff become clear - and out of that drops an action plan. So you take a set of actions, review it in 6 months’ time or 9 months’ time and notice what has improved in the service to everybody’s satisfaction. So it is a really very simple tool to use.

For me, Recovery 2020 does involve a lot of the things that people have been talking about today - it’s a shift, I believe, towards relationships. And there is something about the relationships between professionals and people with mental health problems, and there is something about the relationships that could move more towards acknowledging all the strengths and skills that the service users have and making that much more the centre of any way forward into recovery. So I think you will see … I think you will see a complete transformation of services by 2020. I think we are well on that journey and it’s going to happen.

MD: Louise Christie, Network Manager for Policy & Development also gave us some information on her work and the challenges for recovery.

LC I am the Network Manager for Policy & Development, and that means that I manage the Network Team which promotes the tools that Scottish Recovery Network have developed, so the Scottish Recovery Indicator, RAP and Peer Working - and also part of my job is to look at the wider policy agenda and to make those links with recovery. I think what has been really interesting is I think a lot of it was picked up by people this morning - recovery does seem to be there in terms of the rhetoric - the reality to which it is there in practice and what our understanding of what recovery would look in practice, particularly about services - I think that is the big challenges coming. And I was really interested in what a lot of the Pecha Kuchu speakers and Rachel Perkins were saying, because I think that is absolutely the sort of challenges that we need to be thinking about - is how do we make sure that recovery doesn’t become a thing that the establishment or the established institutions take and almost distort into something that fits with what they are doing already - and how do we really get a change.

MD Louise also speaks about the importance of community development in mental health recovery and her work on self-directed support in mental health.

LC Well I love the saying, you know, “experts on tap, not on top”. I worked in community development the last 20 years and that was a big rallying cry there and I really hope it works more in mental health, because I do still think there is … we have a public sector in a state system in the UK. I think in Scotland we seem to be very, very fond of it. And for all its benefits, and nobody can say it hasn’t … there has been down sides. And we have got quite a big state infrastructure, and that is not necessarily what people need to move on in their lives. And I know that people talk about users of services not wanting to lose those services, not wanting to, you know … being more reluctant maybe about the languages round empowerment. But I think it’s about a process for people - and if we just keep giving people more of the same we are going to end up with more of the same. And part of it is about the journey for people, as well as services, and I suppose that means that things take time to change, but you need to know where you are going.

I am doing some work on self-directed support in mental health, and I think that is a really good example. Self-directed support in terms of its objectives and the theory behind it all fits very much with recovery - but there is a lot of mental health service user organisations who are very uncomfortable with self-directed support, because in the end, I suppose, if you are being told you have to take choice and control now - that isn’t choice and control. So I think there is a real tension between the top down big policy objectives and the way people are nurtured from the bottom up to embrace and to take their journey at their pace - and I think we forget about the fact that this is about people.

MD Jenny Graydon, Chief Executive of the Glasgow Association of Mental Health, tells us about the importance of the Scottish Recovery Network and the significance of the Conference.

JG It has been really helpful to us over the years. It is a network and so it interacts with us and finds ways to make learning and research accessible to us - both people using the services, the workforce - it gives us a lot of access to information, research, other people, contacts, that we wouldn’t otherwise have because we are a smaller, local organisation. This event is one that is looked forward to by everyone in the organisation, because there is a unique way that the Network has of presenting and gathering people together to share learning. There is networking, there is opportunities to meet new contacts and just generally, all of us in our different roles come together around the theme of recovery.

MD On the theme of Recovery 2020: A Vision Achieved? She had this to say …

JG Yes, and I think it was a very positive thing that Simon Bradstreet had a question mark at the end of that theme - can we do it by 2020? I think we can. I think that Scotland’s mental health policies are, by and large, pretty progressive. manage change more evenly, but then because we are a small country, perhaps attitudes are a little bit more conservative, with a small ‘c’. So that’s a strength and a challenge I think. We have got a long way to go - but if you look back 10 years and look at how far we have come already, then that should give us hope for the future, because in another 10 years we could really see a recovery focused country.

I think we need, you know, it’s a truism that changes a constant - we do need threads of continuity, and I think that that is where the people who are responsible for supporting the Network, the government, any government - when change comes, people need to have some experience of the advantage of the new way of doing things. If it is all letting go of something that is familiar - even if it wasn’t that great, it puts people off. And at the minute, I think for a lot of people, there are deterrents to change, and I think there needs to be leadership in the country about how we address that, because the momentum for support and recovery is there - it’s there in the professions, it is there in the service user movement, it is there among carers, it’s everywhere. And I think it could be well supported by our ideas about making public services more responsive to people and communities - but we have to get the communities signed up.

MD On the importance of communities in recovery, Jenny goes on to say …

JG And actually in Scotland there has always been huge support for the collective - we need to stop this individualistic … yes, our service needs to be individualised, but we need to stop this dividing ourselves up into these little individual units. Unless we can connect with the community… the community is one of the greatest resources for recovery - but they don’t always know it. so how can we support communities to play their part at a time when, partly because of the austerity measures, communities are really having a lot of their resources stripped away. And it is just we are building, I think, more expertise in how we join up. We talk about regeneration in communities, but we can also think about recovery in communities. Communities are both an asset, but they also should be a beneficiary of our recovery - a wellbeing approach rather than this constant deficits … what’s wrong with these communities? What’s wrong with these people? And we need to be looking at what is right with them and how we do it more and how can we share - if it works for you, it might work for your neighbours.

MD Elinor Dowson, a member of the Scottish Recovery Network’s Strategy Group and carer, gave us her thoughts on recovery, as well as her highlight of the day.

ED I am on the Steering Group as a carer on the Scottish Recovery Network, and I have been doing this for a number of years - and at long last I see that families are being … a lot more recognition is being given now to families and the important part that families play. So that’s what I do on the Recovery Network - try to speak up for families. I would hope that the family would have to play very little part, because things would be going so well - but if they are still having to play a part, I would hope that they are being listened to, because I think that is one of the greatest problems - families know the individual, they know their likes and dislikes, and often they are completely ignored and things happen and the family member is busy saying “but I said, I said, and nobody was listening” - as though it is only professionals who have an opinion. Of course this is changing - there are good pockets and bad pockets - there are people who are listening, but still a lot of work to be done here.

The highlight for me today has been the amount of focus on creativity, because I think that creativity is so important - people finding creativity as a means to recovery. I think the fact there has been singing, dancing, all sorts of Reiki, all kinds of things - that that’s the kind of example we want to be putting out to people - that, you know, you can help support your own recovery.

MD The Pecha Kucha format of presentation was very well received. Simon Bradstreet told us more about it.

SB Well I have been aware of it as a format for quite a number of years, and we have always thought about using it at previous events. This event seems to really lend itself to the format, because what we were most keen to do was to get a range of different perspectives from, for example, a Clinical Director, from a lead civil servant, from very well-known recovery applicants from personal lived experience, and we managed to know that in a very short space of time with people, actually I thought, really rising to the challenge and making really good points in a very short space of time.

MD Yes, I think the use of visuals especially was really powerful…

SB Yes, in mental health that’s really important, and someone made that point that the traditional mental health image is someone with their head in their hands, which is something we really want to move away from - and we saw such a great example of how to do that today from all of the contributors.

MD A delegate sums up how positive, creative and inspiring the day was overall.

SS My name is Susan Scott and I work for Plus Perth, which is a mental health charity in Perth, and I am here today really just to be inspired and try and take back a lot of the kind of enthusiasm and the kind of reality of what is happening in recovery in Scotland back to Perth really, and to try and move on the good work that we are hoping to continue to do there. It has been a really brilliant conference - I have been to them all, I think, I have been to every one of them - and I would say that this has been the best in that … I liked the short … the speakers just having a shorter length of time to speak. But not just that, because it was shorter, they really brought out the points and the things they were saying, so there were lots of really important points made and you didn’t have to sift all that out from a long conversation. I think Rachel Perkins coming on second probably summed up an awful lot of what the individuals were saying. I think the ideas around mental health services almost downsizing, so that we weren’t over- professionalising mental health and we were trying to put the power back into the communities and get the communities to solve the problems by helping one another, you know, by sharing one another, peer support, that kind of thing - so that we weren’t kind of losing that valuable asset in the community that we already had. Because I think over the years, things have been taken out of the community and people have kind of lost the abilities, or even they have not been enabled to keep doing a lot of the stuff that they would have done in the past, like helping a neighbour and that kind of thing.

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