Mental Health Chapter 10 PDF

Chapter 10 The Recovery Model Copyright ©2019 F.A. Davis Company Introduction § Research has indicated that the striving for, and achievement of, recovery is realistic for many individuals. § Recovery began in the addictions field, referring to a person recovering from a substance use disorder. § Th...

Chapter 10 The Recovery Model Copyright ©2019 F.A. Davis Company Introduction § Research has indicated that the striving for, and achievement of, recovery is realistic for many individuals. § Recovery began in the addictions field, referring to a person recovering from a substance use disorder. § The term has recently been adopted by mental health professionals who believe that recovery from mental illness is also possible. Copyright ©2019 F.A. Davis Company What Is Recovery? § Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. (S A M H S A, 2011) Copyright ©2019 F.A. Davis Company What Is Recovery? (continued_1) Recovery is supported by four major dimensions. 1. Health: overcoming or managing one’s disease, as well as living in a physically and emotionally healthy way. 2. Home: a stable and safe place to live. 3. Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society. 4. Community: relationships and social networks that provide support, friendship, love, and hope. Copyright ©2019 F.A. Davis Company What Is Recovery? (continued_2) § The basic concept of a recovery model is empowerment of the consumer. Copyright ©2019 F.A. Davis Company Guiding Principles of Recovery § Emerges from hope § Is person-driven § Occurs via many pathways § Holistic § Supported by peers and allies § Supported through relationship/social networks § Culturally based and influenced Copyright ©2019 F.A. Davis Company A set of guiding principles that support the recovery definition § Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future—that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. Recovery is person-driven: Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) toward those goals. Recovery occurs via many pathways: Individuals are unique, with distinct needs, strengths, preferences, goals, cultures, and backgrounds that affect and determine their pathway(s) to recovery. Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual. Recovery is holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. This includes addressing the following: self-care practices, family, housing, employment, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care, complementary and alternative services, faith, spirituality, creativity, social networks, transportation, and community participation. Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery. Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community. Recovery is supported through relationship and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change. Family members, peers, providers, faith groups, community members, and other allies form vital support networks. Recovery is culturally based and influenced: Culture and cultural background in all of their diverse representations are keys in determining a person’s journey and unique pathway to recovery. Services should be culturally grounded, attuned, sensitive, congruent, and competent, as well as personalized to meet each individual’s unique needs. Recovery is supported by addressing trauma: The experience of trauma is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues. Services and supports should be trauma-informed to foster safety and trust, as well as promote choice, empowerment, and collaboration. Recovery involves individual, family, and community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery. In addition, individuals have a personal responsibility for their own self-care and journeys of recovery. Recovery is based on respect: Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems—including protecting their rights and eliminating discrimination—are crucial in achieving recovery. Copyright ©2019 F.A. Davis Company Guiding Principles of Recovery (continued) § Supported by addressing trauma § Involves individual, family, and community strengths and responsibility § Based on respect Copyright ©2019 F.A. Davis Company The Tidal Model § A mental health nursing recovery model that may be used as the basis for interdisciplinary mental healthcare § A person-centered approach to help people deal with their problems of human living § Focus is on the individual’s personal story. Copyright ©2019 F.A. Davis Company The Ten Tidal Commitments and Practitioner Competencies § Value the voice. Actively listen to the person’s story and help the person record it in his or her own words. § Respect the language. Help individuals express in their own language their understanding of personal experiences through use of stories, anecdotes, and metaphors. § Develop genuine curiosity. Show interest in the person’s story. Copyright ©2019 F.A. Davis Company The Ten Tidal Commitments and Practitioner Competencies (continued_1) § Become an apprentice. Develop a plan of care and help the individual identify specific problems and ways to address them. § Use the available toolkit. Help individuals identify which efforts may be successful in solving the identified problems. § Craft the step beyond. Help the individual determine what kind of change would represent a step toward recovery. Copyright ©2019 F.A. Davis Company The Ten Tidal Commitments and Practitioner Competencies (continued_2) § Give the gift of time. Dedicate the time to address needs and plan and implement care. § Reveal personal wisdom. Help individuals develop self-confidence in their ability to help themselves. Copyright ©2019 F.A. Davis Company The Ten Tidal Commitments and Practitioner Competencies (continued_3) § Know that change is constant. Help individuals become aware of changes that are occurring. § Be transparent. Ensure that the individual is aware of the significance of all interventions and gets copies of the plan of care. Copyright ©2019 F.A. Davis Company The Wellness Recovery Action Plan (W R A P) § A step-wise process through which an individual is able to monitor and manage distressing symptoms that occur in daily life § Others may be included in the process to assist the individual, but individual empowerment comes from selfadministration of the plan. Copyright ©2019 F.A. Davis Company The Wellness Recovery Action Plan (W R A P) (continued) § Steps in the W R A P process include: Developing a wellness toolbox Daily maintenance list Triggers Early warning signs Things are breaking down or getting worse Crisis planning § W R A P is highly individualized and addresses the unique needs of the person and his or her situation. Copyright ©2019 F.A. Davis Company WRAP process § § § § § § Step 1. Developing a wellness toolbox: In this first step, the individual creates a list of tools, strategies, and skills that he or she has used in the past (or has heard of in the past that he or she would like to try) to assist in relieving disturbing symptoms. Step 2. Daily maintenance list: This list is divided into three parts. In part 1, the individual writes a description of how he or she feels when experiencing wellness. In part 2, using the wellness toolbox as a reference, the individual makes a list of things he or she needs to do every day to maintain wellness. In part 3 of this step, the individual keeps a list of things that need to be done. Step 3. Triggers: This step is divided into two parts. In part 1, the individual lists events or circumstances that, should they occur, would cause distress or discomfort. In part 2, the individual uses items from the wellness toolbox to develop a plan for what to do if triggers interfere with wellness. Step 4. Early warning signs: This step is divided into two parts. Part 1 involves identification of subtle signs that indicate a possible worsening of the situation. In part 2, the individual develops a plan for responding to the early warning signs that result in relief or in preventing them from escalating. Step 5. Things are breaking down or getting worse: This step is divided into two parts. In part 1, the individual lists symptoms that are occurring that indicate that the situation has worsened. In part 2, the individual makes a plan that he or she thinks will help when the symptoms have worsened to this degree. Step 6. Crisis planning: This stage identifies symptoms indicating that individuals can no longer care for themselves, make independent decisions, or keep themselves safe. This stage is multifaceted and is meant for use by caregivers on behalf of the individual who developed the plan. Copyright ©2019 F.A. Davis Company The Psychological Recovery Model § Psychological recovery is defined as “the establishment of a fulfilling, meaningful life and positive sense of identity founded on hopefulness and self-determination.” § Four components of the recovery process Hope: finding and maintaining hope that recovery can occur Responsibility: taking responsibility for one’s life and well-being Self and identity: renewing the sense of self and building a positive identity Meaning and purpose: finding purpose and meaning in life Copyright ©2019 F.A. Davis Company The Psychological Recovery Model (continued) Five stages of recovery Stage 1. Moratorium: This stage is identified by dark despair and confusion. Stage 2. Awareness: In this stage, the individual comes to a realization that a possibility for recovery exists. Stage 3. Preparation: This stage begins with the individual’s resolve to begin the work of recovery. Stage 4. Rebuilding: The hard work of recovery takes place in the rebuilding stage. Stage 5. Growth: The outcome of the psychological recovery process is growth. Although it is called the final stage of the psychological recovery model, it is important to remember that this is a dynamic stage and that personal growth is a continuing life process. Copyright ©2019 F.A. Davis Company Nursing Interventions That Assist With Recovery § The Tidal Model § The W R A P Model § The Psychological Recovery Model Assessment Interventions Outcomes Copyright ©2019 F.A. Davis Company Clicker Question 1 1. The nurse is assisting a client with mental illness recovery using the W R A P model. Which of the following interventions would be included? A. Assisting the individual to tell his personal story B. Helping the client examine his philosophy of life in search of meaning and purpose C. Taking control of the recovery process for the client D. Helping the client craft a psychiatric advanced directive for when the client can no longer care for him/herself Copyright ©2019 F.A. Davis Company Clicker Question Answer 1 Correct Answer: D Helping the client craft a psychiatric advanced directive for when the client can no longer care for himself or herself is part of the W R A P model of recovery. The client makes decisions (in writing) about treatment issues (what type, who will provide, and who will represent the client’s interests). Copyright ©2019 F.A. Davis Company