Care Planning in Mental Health

Supervised Community Treatment (SCT)/Community treatment: section 17A–section 17G

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Care planning in mental health : promoting recovery / edited by Angela Hall, Michael Wren,
Dr. Stephan D. Kirby. – 2nd edition.
p. ; cm.
Includes bibliographical references and index.

ISBN 978-0-470-67186-3 (paperback)
I. Hall, Angela, 1962– editor of compilation. II. Wren, Mike, 1967- editor of compilation.
III. Kirby, Stephan D., editor of compilation.
[DNLM: 1. Mental Health Services. 2. Mental Disorders–rehabilitation.
3. Patient Care Planning. WM 30]
RC440
616.89′0231–dc23

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Cover design by His and Hers Design, www.hisandhersdesign.co.uk

Contributors

Sarah Bonney RMN, Dip (H&SW), BSc (Hons)
Sarah has been a mental health nurse for 24 years in a variety of settings including a community recovery team and a rural community eating disorder team in the NHS Lincolnshire Trust. She currently works at British Columbia Children’s Hospital, Canada, within the provincial specialised eating disorder programme.

Jim Campbell MA, RN (Mental Health), Dip (Training & Development)
Jim is a self-employed mental health trainer based in Edinburgh. He is also a researcher, writer and practitioner, specialising in recovery and sexual abuse. He has worked for over 15 years in both healthcare and education and is currently working as a person-centred counsellor in Primary Care. He enjoys writing, publishing in a range of areas and is on the Editorial Collective of Asylum Magazine. He recently coauthored, with Ron Coleman, Reclaiming Our Lives: A Workbook for Males Who Have Experienced Sexual Abuse, which draws on the direct experiences of the authors’ own recovery journeys. His passion and enthusiasm lies in recovery, giving people hope that change can and will happen.

Charlotte Chisnell BA (Hons), PgCE, Cert (HE)
Charlotte has had a career in Social Work which has spanned over 20 years predominately within safeguarding and youth offending based within Glasgow and the Northeast. Charlotte’s last post was with a Youth Offending Team working with persistent young offenders. Her research interests centre around safeguarding, law and mental health issues for young people. Charlotte is also currently undertaking a Masters in Mental Health Law. At present, Charlotte is a Senior Lecturer at the School of Health and Social Care, Teesside University. She is Module Leader for the Social Policy and Law modules on the Social Work BA Degree programme and Module Leader on the Contemporary Issues for Children and Families on the post qualifying Social Work Course.

Sandra Cleminson MA (Creative Writing), Dip (COT)
Sandra is currently a Senior Lecturer in Occupational Therapy at Teesside University. Having worked for 16 years in mental health as an Occupational Therapist, she came into teaching 9 years ago. Her interest in service user perspective has always been central to her work, and during the past 5 years she has been able to include this more directly in teaching sessions by involving service users. Her involvement with Aidan Moesby has allowed both of them to develop a collaborative relationship where they have aimed to promote mental health awareness and the need for service user led therapy. They have presented at conferences and written a journal article together about the way they work and hope this inspires others to do the same. She is passionate about the development of services and professionals that aim to put the person central whilst promoting recovery.

Dr. Mike Fleet BSc, MSc, RMN, RGN, RNT, PgCE, Dip (Thorn), DProf, FHEA
Mike is a Senior Lecturer, at the School of Health and Social Care, Teesside University, and is Module Leader for several programmes in Recovery and Psychosocial Interventions. He is the Field Leader for Pre-registration Mental Health Nursing and leads a recovery-focused module on promoting positive outcomes for people affected by mental health issues. Mike’s doctoral research involved a critical enquiry into the concept of care and recovery on a Psychiatric Intensive Care Unit. Before entering the field of lecturing, Mike was Clinical Nurse Specialist with the South West London and St. George’s Hospital Mental Health NHS Trust’s Assertive Community Treatment Team.

Scott Godfrey MA (Ed), PgCE (HE), BSc (Hons) Nursing, ADNS, RN
Scott qualified as a registered nurse in 2001 from Teesside University. His passion for emergency care, and trauma management, resulted in him perusing a career within the Emergency Department (ED). Scott currently works as a Senior Lecturer at Teesside University and has worked in higher education for the past 6 years. In 2011, Scott completed an MA in Education and developed a particular interest in reflective writing. His academic responsibilities include pre- and postregistration module leadership, he is a field leader for Adult Nursing and is currently working as an External Examiner for Essex University. Scott also has a strong interest in acute and emergency care and in nursing education.

Angela Hall MA, BSc (Hons), RMN, RGN, RNT, EdD Student (Durham) (co-editor)
Angela has been qualified as a Mental Health Nurse for 30 years and has been in nursing education for the past 20 years. Her main experience was as a Community Psychiatric Nurse working with adults and older people within a primary care setting and then later within a Community Mental Health Team. She became a nurse educator in 1992, and her MA thesis was in Humanistic Counselling. Her current interests are in human potential, recovery and caring.

Natalie Iley BSc (Hons), Cert (AdvEd), RNLD, RSW
Natalie originally worked with adults experiencing challenging behaviour in a community-based setting and has continued to work alongside adults with learning disabilities within a variety of settings for 5 years. She completed her BSc (Hons) Social Work and Learning Disabilities Nursing and remains committed to the philosophies of obtaining her dual qualification, choosing to pursue a career in social work within integrated teams. Natalie’s current role is as a Registered Social Worker for Adults, Older People and Safeguarding and spans nearly 5 years. She is currently working closely as a Practice Educator with Teesside University to support students and their transition to becoming a qualified Social Work Practitioner. Natalie’s interests include supporting people with learning disabilities to achieve realistic goals through meaningful activities and working with older people to maintain and achieve independence within their own local communities.

Dr. Stephan D. Kirby PhD, MSc, PgCE (L&T), UCPPD (L&T), Dip MDO, RMN (co-editor)
Steve is a son, father, grandfather and occasional user of mental health services (as well as a Registered Mental Nurse, a Senior Lecturer and Buddhist Practitioner – must try harder!!). Currently, he is a Senior Lecturer (Forensic Mental Health) in the School of Health and Social Care at Teesside University. He has over three decades of working with people with mental health (and associated) problems, the largest part being within Forensic Mental Health Services. The research for his PhD (in 2010) explored ‘What is the meaning of segregation for prisoners’. He has researched and published extensively on a range of mental health and forensic mental health matters and was a coeditor of Mental Health Nursing: Competencies for Practice published by Palgrave in 2004 as well coeditor of the first edition of this text Care Planning in Mental Health: Promoting Recovery.

Devon Marston
Devon is musician, actor and mental health campaigner. His musical career began with lovers rock band ‘the Investigators’. He also acted on the West End stage. Following an episode of mental ill health, he worked to found Sound Minds, an arts and mental health charity. He now helps facilitate music and drama sessions and is a member of the award-winning reggae band ‘the Channel One Band’ and Chair of the charity’s trustees. Devon feels strongly about speaking out on mental health issues and has a national media profile, with appearances on news and current affairs programmes such as BBC2’s Newsnight; Radio 4’s Today; Radio 5 Live and Channel 4 News as well as working with Comic Relief on the Time to Change TV campaign. Devon was nominated for a Mental Health Media Award in 2002.

Gordon J. Mitchell RN, Dip Nursing (Lond); BSc (Hons) Nursing Science, PgD (L&T), MA (Advanced Nursing Practice)
Gordon is currently Principal Lecturer for Mental Health and the Course Director for IAPT Programmes in the School of Health and Social Care at Teesside University. The majority of his clinical experience has been gathered in acute mental health units, culminating finally in the opening of a new acute unit in North Durham as a Charge Nurse. Since moving into education, he has worked in a number of areas, including the training of Healthcare Assistants and qualified staff through CPD provision, becoming Pathway Leader for preregistration Mental Health Nursing and finally Principal Lecturer. He is also an NMC Reviewer for preregistration Mental Health Nursing programmes. He became the Course Director for Improving Access to Psychological Therapies programmes when Teesside University was successful in securing the training for qualified CBT therapists and Psychological Wellbeing Practitioners with both programmes receiving accreditation with relevant professional bodies. He has previously written book chapters on the law and presented papers at regional and national conferences.

Aidan Moesby MA (Art and Psychotherapy) Artist, Writer, Facilitator, TrainerTeesside University, Launchpad Newcastle, The Art House (Wakefield)
As a socially engaged artist working primarily with text, Moesby explores relationships between people and places. He is intrigued by rituals and personal myth – repetitive and mundane. From these interactions, he produces responsive interventions, including site-specific installations for venues including spaces for health and contemporary art. He works extensively in Arts and Health, particularly around Mental Health. He works with a variety of health and cultural organisations around wider issues of Disability and Equality in development, training and facilitating. http://aidanmoesby.co.uk/

Teresa Moore RMN, RN, MA (Hons) Health Service Management
Teresa is a Senior Lecturer in Mental Health at the School of Health & Social Care, Teesside University. She is Module Leader for Pre-registration Mental Health Nursing Skills for students in the second year of the Programme, promoting holistic nursing care for those with mental illness. Prior to her post with Teesside University, she worked as a Lecturer/Practitioner in Mental Health, in a joint post with East London and the City NHS Mental Health Trust and City University. Her interest in the complex physical and mental health needs of the older adult, particularly in the area of dementia nursing, continues.

Donna Piper MSc, BA (Hons), PgCE (L&THE), Cert. Ed, Dip (Early Years)
Donna is a Senior Lecturer at the School of Health and Social Care, Teesside University. She is module leader for Advanced Research in Social Work and final year dissertation projects, including care coordinator spanning years 1 to 4 on the BA (Hons) Social Work degree programme. Donna is also the Admissions Tutor for the Social Work programme. She has pursued a career spanning over 19 years predominantly with young people, children and their families in specialist teams. Her research interests are driven by a passion for working with children/young people, societal inequalities, substance use and offending. Her last post was with a ‘Leaving Care’ Team working with ‘Looked After Children/Young People’.

Dr. Theo Stickley Associate Professor of Mental Health – University of Nottingham
Theo is a Mental Health Nurse and also trained as a counsellor. He leads the MSc in Recovery and Social Inclusion at Nottingham and has also researched these subjects. His research interests are mainly focused on the arts and mental health and his book Qualitative Research in Arts and Mental Health offers a unique perspective on this specialist subject. When he is not thinking about work, Theo is a keen gardener and motorcyclist and is a member of the Nottingham Society of Artists.

Julie Wardell MA, BA (Hons), DipSW, Dip (Counselling)
Julie is a qualified Social Worker and Practice Educator. She has worked in children’s services, young people’s services and adult’s services and in the field of substance misuse for 18 years. She is currently the Manager of the Addictive Behaviours Service in Stockton, employed by Tees, Esk and Wear Valleys NHS Foundation Trust. Julie’s teams have won awards for Quality Improvement, Working in Partnership with other agencies and tackling stigma and promoting social inclusion. Her accolades include being highlighted for delivering ‘innovative’ services by Community Care Magazine and Alcohol Concern.

Jenny Weinstein
Jenny is an Independent Consultant, writer and researcher in health and social care and an honorary lecturer at Kingston University. Her experience spans practice, teaching and development in the statutory, voluntary and university sectors. In her current role as Chair of the Local Involvement Network/HealthWatch, Jenny campaigns alongside service users, carers and community groups for improvements in health and social care services with a particular interest in mental health and coproduction initiatives. Recent research and publication activities, undertaken in collaboration with service users and carers, have focused on mental health service user involvement, recovery and personalisation.

Mike Wren BA (Ed), MA (Ed), CertEd, CSS, FAETC, CMS, DMS, MCIM, RSW, RMCSW (co-editor)
Mike has worked in a variety of social work positions spanning more than 19 years, including at senior management level in relation to older people, children and learning disability community-based services. Mike’s career has predominantly involved direct contact with children in schools and with special educational needs. His interests include transitions from childhood to adulthood, development of supported living schemes for people with learning disabilities and exploring adult placement provisions for older people to enable individuals to live within their own local communities. Mike joined Teesside University in July 2004 and took up the position of Course Coordinator for BSc (Hons) Social Work & Mental Health Nursing & Social Work & Learning Disability Nursing programmes. In 2010, he became Programme Leader for the BA (Hons) Social Work programme, where he continues to develop his passion for encouraging collegiate approaches toward integrated collaborative working, interprofessional education and practice-based learning opportunities with a wide range of partners from practice.

Dr. Nicola Wright PhD, MA
Research Fellow – Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Nottinghamshire
Nicola Wright is a registered mental health nurse and has worked clinically in both inpatient and community mental health before completing an Economic and Social Research Council-funded MA in Research Methods (2005) and PhD in Nursing Studies in 2009. Since completing her PhD, Nicola has worked in the School of Psychology at the University of Birmingham on a multisite randomised control trial of Joint Crisis Plans for people with Psychosis. She is currently a Research Fellow at the Collaboration for Leadership in Applied Health Research and Care – Nottinghamshire, Derbyshire and Lincolnshire (CLAHRC-NDL).

Chapter 1

Introduction: The Emergence of Recovery as a Key Concept

We shall never cease from exploration. And the end of all our exploring
Will be to arrive where we started. And know the place for the first time

At the end of the first edition, we left you with two rhetorical questions that arose as a consequence of producing that text:

How different would services look if their primary focus was to enable people to use and develop their skills, make the most of their assets and pursue their aspirations?,

Would this not change, for the better, the experience of using services, and the relationship between workers, and those whom we serve? (Repper & Perkins, 2003:11)

In this second edition, we hope to address these questions and in doing so raise your awareness of wider issues and concepts so that you are better informed to decide if you want to be agents of and for the organisation or champions of future change.

Building upon the strengths of our previous book (still available at all good book sellers, Blackwell Publishing website and Amazon), this current text utilises a more conceptual and person-focused approach that will enable the reader to plan for the future, and to challenge political, medical, social and professional identity issues. It is worth pointing out that even though this is a second edition, we have not simply, as is traditional, taken the original chapters and updated them; rather, we have preferred to reflect the developments and advances in mental health care and recovery. We felt it was important that the book reflected the notion that care planning is not simply APIE; rather, it is a move from a professional model focus to the active promotion of the person and their individually constructed narrative. So by engaging with the person’s resilience, reserves and inner resources, we are able to focus recovery work around the individual, their story, hopes, dreams, skills and strengths rather than the symptoms of their mental distress (Saleebey, 2009). To address this paradigm shift, our stance within this text openly acknowledges, introduces and applies a variety of differing concepts and ideas underpinning the fact that we best serve people on their journey to recovery by collaborating with them (White & Epstein, 1990).

The reader will find (and we make no apologies for this) that there is no – or very little – explicit mention of APIE as a care-planning process. Whilst this is inherent within the text, it is not the primary focus of this work; rather, we are offering the reader insights into ways of approaching and understanding an alternative underpinning philosophy when implementing care planning in mental health. The structures of Care Planning are well documented and established within the delivery of mental health care; what we hope the reader will gain from this text is a more enlightened and person-focused way of approaching the activities involved in planning collaborative, interprofessional and person-centred care that gives the person with the mental health problem the hope, optimism and opportunity to express their own desires, aspirations and potential that will enhance their journey on the road to recovery.

In the first edition, we attempted to address the issues around recovery as a concept and its application within the care-planning process. However, we were directed by the traditional and dominant frameworks that pervade mental health: such as Care Programme Approach (CPA), a range of ‘new’ legislations (e.g., the then proposed amendment of the Mental Health Act 1983 (DoH, 1983), the influences of numerous medical model-focused clinical practice guidelines and not forgetting the APIE of the prescriptive Nursing Process. The dominant culture within mental health has prevented professionals from challenging and progressing recovery-focused practice and has made them into (despite their good intentions and desires) passive recipients of the status quo which is shrouded in new terminology and contemporary rhetoric. They become afraid to deviate from this to embrace the recovery concepts as these are often questioned by the organisation as they are not seen to be part of the corporate vision and identity, which is invariably based upon financial requirements and popular trends with no thought for the people receiving and centrally involved in the care. In policy terms, mental health needs to be more concerned with health and wellbeing as well as providing direct support to people to enable them to function as full citizens in their communities (DoH, 2007). ‘Increasingly services aim to go beyond traditional clinical care and help patients back into mainstream society, redefining recovery to incorporate quality of life – a job – a decent place to live – friends and a social life’ (Appleby, 2007).

We are conscious that there have been major changes in mental health in the years between these two editions. These encompass a refocusing of organisational structure, culture and delivery models. We have continued to see legislative documents and dictates published as well as the further move into community care and, in some cases, even the rebirth and refocus of inpatient provision. Most importantly is the drive, through education and into services, towards the further promotion of the recipient of mental health services being accepted as human beings and equal partners.

This has reawakened the emphasis on ‘The Person’ (their essence, attributes, uniqueness and individuality and all the factors that exert an influence on personhood) and the hopeful demise of interchangeable labels of stigma, discrimination and depersonalisation. It is obvious that there are, and will be, difficulties and resistances to the professional’s acceptance and adoption of these ‘new’ (though not really new, just old ideas rebranded and repackaged) ways of perceiving the new mental health landscape. There are resistors from all sides, the need to meet organisational targets (the ubiquitous audits and quotas which appear to (and indeed do) drive and underpin service provision), both the personal and organisational paranoia of litigation that appears to underpin service delivery today; and the need to have every meeting with the person with the mental health problem; every action; assessment; intervention and interaction recorded and rated on a sliding scale of risk and the appropriate risk management strategies created accordingly. There are ever-decreasing timescales and ever-increasing caseloads that services have to contend with, as well as the change in funding and the move towards a market-led provision with GP fund holding imminent; resistance from individuals and organisations abound. Organisations are being driven by ‘New Managerialism’ (Hafford-Letchfield, 2009) which relies on targets and outcome-driven agendas and where the illusion of being an involved customer is created and maintained, but in reality, people are merely a commodity of the market place. Recovery provides a new rationale for mental health services and has implications for the design and operation of mental health services and partnerships between health, social services and third-sector organisations (Shepherd et al., 2008).

Whilst in the latter half of the last century, recovery was thought to be an alien concept (Coleman, 1999), it is now firmly on agendas; indeed, it is the agenda. Work started by Romme and Escher in their seminal work with voice hearers started a paradigm shift (Romme & Escher, 1993) and it is up to everybody to continue that work until the shift is complete. The Hearing Voices Network, informed by this work of Romme and Escher, works positively with people’s experiences of hearing voices (Rogers & Pilgrim, 2010). Rather than trying to obliterate the voices, as a traditional symptom-based approach might do, this user-led initiative attributes meaning to voice hearing. This offers alternative means of coping with voices that may at times cause their recipients distress. Recovery as an idea, a concept and a care focus has now come of age and its importance has been recognised and acknowledged and it provides a new rationale for mental health services (Shepherd et al., 2008). It is based on the notions of self-determination and self-management and emphasises the importance of ‘hope’ in sustaining motivation (Shepherd et al., 2008). It has become the key principle underlying mental health services across the world, for example, New Zealand (Mental Health Commission, 1998), the United States (Department of Health and Human Services, 2003), Australia (Australian Government, 2003), Ireland (Mental Health Commission, 2005), Scotland (Scotland Government, 2006) and in England (DoH, 2001, 2006, 2007).

Ron Coleman (Coleman, 1999) tells us that there is a common joke amongst people with mental health problems that they all understand, ‘What is the difference between God and a Psychiatrist? Answer: God does not think he is a Psychiatrist’. He continues that there is another major difference between God and Psychiatrists: while ‘God created the world in 7 days, a Psychiatrist can change a person’s in little under an hour’ (Coleman, 1999:7). It is no surprise therefore that the road to recovery is difficult and fraught with dangers and traumas, but the road to illness is surprisingly easy – far too easy (Coleman, 1999:7).

It must be pointed out though that this somewhat scathing attitude towards psychiatry and psychiatrists was taken from a number of years earlier in Ron’s career towards ‘product champion and leader’ for voice hearing and trainer for voice hearers. This was a period when clear, distinct lines of battle were drawn between professionals and purveyors of psychiatry and the population that were deemed to be in need, usually against their free will and without consultation, of such disempowering actions. However, as years have passed and with the advent of mental health, so has the culture and climate of recovery. The culture and infantilising nature of psychiatry is diminishing, and partnership working and engagement and empowerment from a recovery framework is growing. Ron and many of his contemporaries now collaborate closely with psychiatrists; indeed, some of his working partners and trainees are psychiatrists. Traditionally, the medical model has served as a means of deflecting attention away from the person and their lived experience(s). None of this is a condemnation of the medical model and psychiatry (as opposed to mental health) per se, but acknowledges the fact that there are limitations to this particular way of representing the experience(s) and problems of living for the person with mental health problems (Barker, 2001). Nor does it, or should it, promote the exclusion of the medical model from the mental health care arena or from the delivery of a person-focused approach to mental health care recovery. Rather, it has its place as does every other approach and discourse; there are times when paternalistic decision making has to occur without the person’s involvement and for their best interest. Similarly, there are times, as the person progresses through the phases of recovery, where this approach has to take a back seat and allow the more person-centred, empowering and self-management approach to occur. One that affords the person more growth opportunities towards, and along, an empowering, person-centred approach to recovery within mental health recovery.

But what is recovery? It has been said (Coleman, 1999) that professionals define recovery as maintaining a person in a stable condition, regardless of issues such as adverse effects of medication or even the expressed wish of the person. However, from the person experiencing the mental health problems, recovery is a personal construct, one that is defined by the person themselves, based upon their own experiences and resources. Importantly, the essence of clinical recovery is based upon the premise that clinical recovery occurs because of the effectiveness of the clinical treatment. It is this aspect of recovery, effective (person-centred) treatment that this book is hoping to capture and promote. Recovery is also seen (Anthony, 1993) to be ‘…a deeply personal, unique process of changing one’s attitudes, values, feelings, goals and/or roles…a way of living a satisfying, hopeful and contributing life even with the limitations caused by the illness…the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness’ (p. 17).

Shepherd et al. (2008) offer what they propose to be the key themes of recovery, these being:

1) Agency – gaining a sense of control over one’s life and one’s illness. Finding personal meaning – an identity which incorporates illness, but retains a positive sense of self;

2) Opportunity – building a life beyond illness. Using nonmental health agencies, informal supports and natural social networks to achieve integration and social inclusion;

3) Hope – believing that one can still pursue one’s own hopes and dreams, even with the continuing presence of illness. Not settling for less, that is, the reduced expectations of others.

These three overarching themes of recovery were taken on board by the Devon Recovery Group and resulted in the following Principles of Recovery (see Box 1.1). This resulting set of principles (Davidson, 2008) clearly demonstrates an active collaboration of the mutual roles, responsibilities and resources which aim to promote the person, their experience(s) of mental health problems and also reflect a desire and drive to capture the essence of their recovery. These are seen, by the editors, as being key concepts of ‘making recovery a reality’ (to borrow a phrase from the Sainsbury Centre) and through which we discover the person, their life and celebrate their diversity for, and opportunities to, change. These principles were the inspiration behind, and also formed the underlying belief system for, the development of this text.

One of the central and primary principles of recovery is the notion that it does not necessarily mean cure (clinical recovery); rather, it acknowledges the unique journey a person goes through when building a life beyond mental illness (social recovery) (Shepherd et al., 2008). People have to come to terms with the trauma that the occurrence of mental health symptoms can have on their lives and incorporate these experiences into a new sense of personal identity (Larsen, 2004).

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;
Recovery represents a movement away from pathology, illness and symptoms to health, strengths and wellness;
Hope is central to recovery and can be enhanced by each person seeing how they can have more active control over their lives (‘agency’) and by seeing how others have found a way forward;
Self-management is encouraged and facilitated. The processes of self-management are similar, but what works may be very different for each individual. No ‘one size fits all’;
The helping relationship between clinicians and patients moves away from being expert/patient to being ‘coaches’ or ‘partners’ on a journey of discovery. Clinicians are there to be ‘on tap, not on top’;
People do not recover in isolation. Recovery is closely associated with social inclusion and being able to take on meaningful and satisfying social roles within local communities, rather than in segregated services;
Recovery is about discovering – or rediscovering – a sense of personal identity, separate from illness or disability;
The language used and the stories and meanings that are constructed have great significance as mediators of the recovery process. These shared meanings either support a sense of hope and possibility, or invite pessimism and chronicity;
The development of recovery-based services emphasises the personal qualities of staff as much as their formal qualifications. It seeks to cultivate their capacity for hope, creativity, care, compassion, realism and resilience;
Family and other supporters are often crucial to recovery and they should be included as partners wherever possible. However, peer support is central for many people in their recovery.

Such traumas can only be resolved if the person can discover – or rediscover – their sense of, and ability to action, personal control (agency) and thus gain a belief in the future (hope); and without hope, (re)building lives cannot begin. Recovery is about this process and the quality of this experience is central (Shepherd et al., 2008). The power of, and responsibility for, recovery lies within us – all users, professionals and carers – and this can only be achieved by working together, by talking and listening to each other. This can only be done by a paradigm shift from the dominant biological reductionism to one of personal and societal development (Coleman, 1999). This road to self-discovery starts when you look at your own life and how events outside have affected you this includes family, friends, traumatic experiences and life events and how you feel about the things that have happened. A turning point for many people in recovery can be taking the first steps to dealing with feelings of guilt and inadequacy for something you probably have little or no control over. Recovery should follow the premise that professionals should be on tap; not on top (Repper & Perkins, 2003).

Recovery is applicable and appropriate to anyone who experiences a significant mental health problem at any age as well as applied in specialist areas such as forensic mental health services, CAMH Services and Drug and Alcohol Services, and management relies heavily on the provision of information and self-management in addition to treatment and symptom control (Shepherd et al., 2008). Recovery is our common goal, and it is now achievable, so we should not lose the moment for we need to work together to make it happen, and we need to put our past (professional) differences behind us to let us go forward towards recovery (Coleman, 1999).

Many of the ideas underpinning the recovery philosophy are not new (Shepherd et al., 2008). They come from the consumer/survivor movement of the 1980s and 1990s which ran along the lines of self-help, empowerment and advocacy. This was the basis of challenging traditional notions of professional power and expertise which pervaded mental health services (and arguably still do) (Shepherd et al., 2008). These ideas themselves have their roots in the Civil Rights movements of the 1960s and 1970s in the US and in self-help and politically motivated groups such as Mad Pride, Survivor’s Speak Out and The Lunatic Liberation Front. From this patients were beginning to be seen, and see themselves, as victims and then survivors of mental health – a notion equitable to those people who survived the concentration camps. Between 1970 and 1990, mental health survivor activity in the UK saw a range of user-led organisations arguing either for the abolition of psychiatry or for its radical reform. These included the ‘BNAP’ (British Network of Alternatives to Psychiatry), ‘PROMPT’ (Protection of the Rights of Mental Patients in Therapy) and ‘CAPO’ (Campaign Against Psychiatric Oppression) (Rogers & Pilgrim, 2010). However, the current recovery movement and frameworks, supported and adopted as they are by a wider range of participants (professionals and users, groups and official bodies), no longer have the political undercurrents of the earlier movements (Shepherd et al., 2008).

There are continuous and consistent concerns that recovery in mental health is being, indeed already has been, hijacked by professionals and that they are rebranding it into a technology, a science, absorbing it into the academic domain and in doing so making it their own. Recovery is now perceived to be a term that is used, possibly indiscriminately, by professionals to represent a panacea of all mental woes; the new ‘holism’. The term recovery is used in different contexts by both people with mental health problems and mental health professionals. As recovery ideas have been devised by, and for, patients to describe their individual experiences of their mental health, professionals need to be aware that accusations may be levelled at them for taking over the concept of recovery. There are product champions from both sides who continue to publish around and promote recovery. Despite national policies and frameworks (Shepherd et al., 2008) from a number of diverse organisations, the mental health system continues to be patriarchal and bureaucratic, and ever increasingly so as the years progress and with each subsequent ‘development and improvement’.

For recovery to become a reality, professionals need to fully understand the concept of recovery and what it means from a patient perspective so that they can work with the person in the recovery process (Shepherd et al., 2008). Mental health professionals should challenge their own, as well as each other’s, negative assumptions and detrimental communications and interactions and strive towards positive attitudes and attributes, because until a sound, collaborative rapport is formed, it is not possible to facilitate a psychoeducational approach. Through the continued usage and promotion of this conceptual shift, one that is mutually beneficial and dynamic and within the framework of interprofessional (partnership) working, the realities of emancipation and empowerment will continue to enable people to no longer ‘just exist’ but to now ‘thrive’ in contemporary mental health.

Before we introduce the individual chapters, we would like to offer a quick word on terminology. Language in mental health is a constant site of debate and struggle (Barnes & Bowl, 2001). Not all people with mental health problems reject the notion of ‘mental illness’, although some do consider the notion of ‘illness’ an inappropriate and outdated manner of understanding and describing their distress. Similarly, others reject the label ‘service user’, because of an implication of active engagement with services which does not match their experiences of mental health. ‘Consumer’ is a term associated with the market and business domains. Others have adopted the terms ‘victims’ or ‘survivor’ to portray either a negative or positive image of people in distress and people whose experiences differ from, or who dissent from, society’s norms (Barnes & Bowl, 2001). To this end in this text, the reader will find a number of differing terms used throughout the chapters by the differing authors. These are not necessarily those that would have been chosen by the editors, nor by the individual authors themselves; rather, they are used to describe, in a generic, easily conceptualised, widely used and conventional manner, the person who has mental health problems and who engages (or comes into contact) with mental health services. Throughout the editors’ individual and combined chapters, they have chosen the term ‘person with the mental health problem’ – or some derivative – while other authors have gone for the easily understood and conceptualised term of ‘patient’; neither – or all – is necessarily always correct or appropriate. The debate regarding a correct term that appropriately describes a person with mental health problems continues, which is why we have chosen to use this term as it is the nearest we can find to a term; a ‘label’ that does not (hopefully) become a source of discrimination or negativity thus social control and stigma. Even by using a ‘soft’ term like ‘person with mental health problems/person with experiences’ is, in itself, a form of labelling; so we are as guilty as anybody of forcing people into categories. Indeed, why do we have to have a nomenclature, a label or some different way of talking about people; surely, they are just ‘people’ like you and I.

The individual chapters (as summarised in the following text) are grouped into three sections which we believe capture the essence of recovery: ‘Survive’, ‘Manage’ and ‘Thrive’.

According to Kaplan (1964), when people experience and respond to distress they start to make sense of this; to explain it and to understand it, in essence to survive – despite the difficulties that are happening to them. This starts by people acknowledging they have a problem and seeking assistance wherever they can (or, in some cases, have assistance thrust upon them). Kaplan devised a framework of preventative psychiatry where the person passes through three distinct phases: primary, secondary and tertiary. This moved the person from a point of psychological distress, through diagnosis and treatment to long-term disability. Devised as this was in the 1960s, the recovery model or focus did not exist; indeed, mental health services were exclusively institutional. Hence, Kaplan’s model was a reflection of its times. As we moved away from the Institutional Model of mental health, community care has allowed us to see and utilise a more recovery focus to care delivery and services.

Our framework and understanding of the domains of ‘Survive’, ‘Manage’ and ‘Thrive’ reflects, somewhat, Kaplan’s (1964) ‘Primary’, ‘Secondary’ and ‘Tertiary’ approach to preventative psychiatry. However, he defined tertiary as a long-term (institutional) care approach for people who had acquired chronicity and were thus engaging on a long-term basis with (institutional) mental health services. We have brought this up to date, and use the domain of ‘Thrive’ to explain a situation where the person does not seek nor accept chronicity and long-term institutional care. Rather, they seek ongoing recovery and ownership of their illness to a point where they are functioning within a social world to the best of their abilities and skills and continue to learn more about, and engage with, their symptomologies and pathologies, that is, recovery. To enable this to happen, we need, in practical and dynamic ways, to change the ‘Manage’ aspect of this, that is, the culture and the mindset and practices of people within the organisations, services and cultures. We need to continue to encourage and adopt more interprofessional working activities that include as an equal partner the person with the mental illness.