Australian Mental Health Consumers' Contributions to the Evaluation and Improvement of Recovery-Oriented Service Provision
Marshall, Sarah L., Oades, Lindsay G., Crowe, Trevor P., The Israel Journal of Psychiatry and Related Sciences
Background: One key component of recovery-oriented mental health services, typically overlooked, involves genuine collaboration between researchers and consumers to evaluate and improve services delivered within a recovery framework.
Method: Eighteen mental health consumers working with staff who had received training in the Collaborative Recovery Model (CRM) took part in in-depth focus group meetings, of approximately 2.5 hours each, to generate feedback to guide improvement of the CRM and its use in mental health services.
Results: Consumers identified clear avenues for improvement for the CRM both specific to the model and broadly applicable to recovery-oriented service provision. Findings suggest consumers want to be more engaged and empowered in the use of the CRM from the outset.
Limitations: Improved sampling procedures may have led to the identification of additional dissatisfied consumers.
Conclusions: Collaboration with mental health consumers in the evaluation and improvement of recovery-oriented practice is crucial with an emphasis on rebuilding mental health services that are genuinely oriented to support recovery.
Research involving consumers in the evaluation of recovery-oriented practice appears rarely if at all in the literature (1). Despite the increasing emphasis on recovery as a guiding vision for mental health service (2-4) few models of care have attempted to operationalize the principles of recovery into practice (5, 6).
The Collaborative Recovery Model (CRM) and associated training program for mental health staff is an example of an early attempt to convert a recovery vision for mental health services into specific principles and practices. This model was developed with a view to bringing together evidence-based practice and constructs consistent with the recovery movement to assist people with chronic and recurring mental disorders to work towards recovery in community mental health contexts (7). A definition of recovery consistent with this model involves "the establishment of a fulfilling and meaningful life and a positive sense of identity founded on hopefulness and self determination" (8, p. 588).
Development of the CRM and its related training program draws on existing evidence from the recovery literature, in particular concepts such as facilitating hope, supporting autonomy, and subjective goal ownership (7). For example CRM training champions the individuality of the lived experience and ownership of the recovery process by the consumer, while recognising that other people, including mental health staff, can support individuals' recovery processes. A key way in which this is enacted within the CRM is through a focus on authentic, approach oriented goals, collaboratively agreed upon by the consumer and staff. It is known that active goal setting focuses recovery and provides individuals with a sense of what is important and meaningful to strive towards in the future (9). The Collaborative Goal Technology (CGT) was specifically developed with this purpose in mind. Using this tool, staff members are encouraged to assist consumers to identify a personal recovery vision, as well as autonomous goals to support them in moving towards a fulfilling and meaningful life (10).
Specifically the CRM consists of two guiding principles: 1) recovery as an individual process and 2) collaboration and autonomy support. It also has four practical components: 1) change enhancement, 2) collaborative needs identification, 3) collaborative goal setting and striving, and 4) collaborative task striving and monitoring. These principles and components form the six training modules delivered to staff as part of the Collaborative Recovery Training Program. Initial training occurred within a two-day workshop, followed by two one-day booster sessions at 6 and 12 months following the initial training (11). There are four specific protocols for staff to follow, which require associated knowledge, skills and particular attitudes in order to work within a recovery orientation. …