APNA 25th Annual Conference October 20, 2011 - Session 2013

Lambert 1

The Language of Recovery: “Making it Real”

for Patients, Families and Colleagues, g

Kris Lambert PhD, RNAPNA 25th Annual Conference

October 20, 2011

This speaker has no conflict of interest and nothing to disclose.

Learning Outcomes

• Upon completion of this session, participants will be able to: – define and analyze the term recovery in the context of mental 

health and mental illness. – identify and define the components of the Recovery Model. – explore and evaluate personal experience as a patient or family 

member in a healthcare setting. tili fl ti ti t h i t i t ll i ti t– utilize reflective practice techniques to internally investigate, 

analyze and critically evaluate current belief systems and daily practice habits through the exploration of the language used to communicate in the professional setting. 

– identify and evaluate the disparity between non‐recovery and recovery focused language in the healthcare setting and how it affects patient care. 

– translate the language of recovery into day to day care with patients and their loved ones.

"Knowledge is the antidote for fear"the antidote for fear

~Ralph Waldo Emerson~

Meaningful Connections

• This program is part of a larger initiative introduced in April of 2010 at Sharp Mesa Vista Hospital entitled:                          Meaningful Connections

• Meaningful Connections is an initiative designed to: – introduce staff members to the Recovery Model– offer patients and staff members the opportunity to work, grow and p pp y , g

heal using a recovery perspective– empower staff members to own their professional practice by 

demonstrating a willingness to reflect, analyze and adopt changes in collaboration with patients in their care. 

– stimulate a dialogue between and among staff members– identify and develop the skills required to deliver care based on the 

Recovery Model– transition staff members from paper based charting to EMR while 

maintaining a MEANINGFUL CONNECTION with their patients. 

Step One: 

The Method

• Introduced “Meaningful Connections” (MC) as a part of the Electronic Medical Record (EMR ) training.

• Strategically placed MC at the d f h EMR i iend of the EMR training to 

ensure retention of material.  

• Utilized moderate sized  groups (10‐16 individuals) to promote a dialogue among members. 

"Your vision will become clear only when you look

into your heart into your heart. Who looks outside, dreams. Who looks inside, awakens."

~Carl Jung~

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Step Two: 

Reflective Practice

• An evidence‐based approach to promote personalized professional growth, and responsibility. 

• Involves thinking back on h h dwhat you have done to 

discover how our knowing in action may have contributed to an unexpected or positive outcome. 

• This practice serves to reshape what you are doing, while you are doing it. 

Reflect 

• Ask the question: – How many of you have ever 

been a patient?

– How many of you have had a family member or loved one in the hospital? p

• Encourage exploration of the experience..– Tell us about that 

experience……the care, the feelings….the concerns….what worked…..what didn’t….etc.

Our Training: 

The Medical Model

• Negative Terms: – Focus is on the illness, rather 

than the person.– Emphasis: doing something 

FOR them.• Symptoms and complaints 

need to be eliminatedneed to be eliminated.• Illnesses need to be cured or 

removed.• Patients need to be relieved 

oF their conditions and returned to their baseline state.

– Use of dehumanizing language: “the case” or “the borderline in room 206.”

“For severe mental illness it may seem almost dishonest to talk about recovery.

After all, the conditions are likely to persist, in at least some form, indefinitely.

H f i bl ill ? How can someone recover from an incurable illness? The way out of this dilemma is by realizing that whereas

the illness is the object of curative treatment efforts,it is the person themselves

who is the object of recovery efforts”~Ragins, 2003~

Medical vs Recovery Model

Exclude• Professional distance

• Emotional detachment

• Absolute authority

Include• Special knowledge and 

training

• Acceptancey

• Strict hierarchies

– Other directed care

• Prescriptive care

• Development of skills

• Honoring past experience

• Caring, compassion and collaboration

• The belief that a meaningful life is possible for all people.

“The medical model treats me like a disease; k ;

the recovery model treats me like a person.”

Posted on December 5, 2007 by recoverysupport

APNA 25th Annual Conference October 20, 2011 - Session 2013

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Shift in Focus: 

Things to be Recovered

• Functionsmay be recovered ‐ as in the ability to read, to sleep restfully, to work, to have coherent conversations, to make love, to raise children, to drive a car, etc.

• External Thingsmay be recovered ‐ as in an t t j b f i d l i i b dapartment, a job, friends, playing in a band, a 

spouse, a car, family relationships, stereo, tv, educational programs, etc.

• Internal States can be recovered ‐ as in feeling good about oneself, satisfaction, self confidence, spiritual peace, self‐identity other than mentally ill, self‐responsibility etc. (Ragins)

“The language of the helping professions reveals in an especially stark way that

ti f th t ll perception of the same act can range all the way from one pole to its opposite.”

(Edelman, 1974)

Step Three: 

The Impact of Language

• Language is a distinctive characteristic of human beings. – Describes and creates 

our own realities (Edelman, 1974)

• Basic means of communicating with one another.

• A way to change thinking and attitudes

Hospital staff often deny or ignore the requests of angry mental health patients because to grant them would “reinforce deviant behavior.”

Words Can Establish Control & Dis‐Empower

• Using words that are       unfamiliar and technical

• Using acronyms that seem to be a secretseem to be a secret code

• Using unexplained scientific terms

• Using pejorative references to individuals

The Focus:

The Components of Recovery

Self Responsibility

A Meaningful Life

Hope

Empowerment

ConnectivitySelf‐Responsibility

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Step Four: 

Introduction to Recovery

• Review the five components of recovery with staff members. – Allow them to process each 

concept in a round table discussion. R i f th i tt t t– Reinforce their attempt to process their stories and examples.

– Remind them of behaviors, interactions, and inter‐ventions they often utilize in their professional practice. 

– Discuss the value of each component.

HOPE

How do you inspire hope in your

HOPEhope in your patients?• How do you communicate hope?

• How do you show them the light still exists?

•What image of hope do you  instill?

Spirituality

EMPOWERMENT

How do you empower your patients to take control of

EMPOWERMENT

patients to take control of their recovery?

•Believe in their abilities

•Focus on strengths

•Help them experience success

SELF RESPONSIBILITY

How do you encourage and support patients to take

SELF RESPONSIBILITY

support patients to take charge of their recovery?

•Help them own their behaviors

•Encourage personal goal setting

•Eliminate dependency

•Build confidence

CONNECTEDNESS

How do you assist patients in reconnecting with the

COMMUNITY/COMMUNITY/

CONNECTEDNESSCONNECTEDNESS

reconnecting with the community and community 

resources?• Be aware of resources in your community.

• Explore interests

• Seek out potential resources

A MEANINGFUL LIFE

A MEANINGFUL LIFE

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“Words are important. If you want to care for something you

call it a flower; call it a flower; if you want to kill something

you call it a weed.”Don Coyhis

Step Five: 

Reflection, Insight and Change

• The Gallery Walk– Divide group into 4‐5 

individuals. – Post three flip chart papers 

onto the wall– Give each staff member 

lti l t itmultiple post‐its. – Initial focus is on Non‐

Recovery focused terminology offered used or heard, ie. report, rounds, nursing station, treatment team, etc. 

– Ask them to write down as many answers as they desire

Gallery Walk

Patient

Non‐

Peers

Non‐

Families

Non‐NonRecovery Terms

Recovery Terms

NonRecovery Terms

Recovery Terms

NonRecovery Terms

Recovery Terms

Language Alternatives

• Crisis

• Decompensating

• Non‐compliant

• Low functioning

• Intensity

• Having a bad day

• Different opinion

• Experiencing difficulty

• High functioning

• Appropriate/inappropriate

• Issues

• Lack of insight

• Smart and capable

• Not working for you…….

• Fear of the unknown

• Learning more about her illness

Step Six: 

Internalizing Recovery

• Handout with Summary

R k• Rock

• Shell

What Now?  Promote a Recovery Based Environment

• Facility/program based on recovery principles– Encourage individual personal 

commitment to recovery.– Utilize recovery focused 

language.– Promote the use of recoveryPromote the use of recovery 

tools.– Embrace patient centered care– Listen to the voice of the 

patient.– Seek patient collaboration in 

treatment planning.– Develop recovery outcome 

measures.– Continually assess, evaluate, 

adjust to the needs of the patient.

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Questions to Ask: 

Saturation

• Are the programs saturated with recovery principles and values?– Policies– Policies

– Procedures

– Programming

– Language 

– Attitudes: Does everyone believe in the value of the model?

“Recovery is not about cure or absence of symptoms;

yet it is about empowering individuals to lead long fulfilling lives to lead long fulfilling lives

in spite of symptoms as well as learning

to develop a meaningful life”

Questions?

References• Ashcraft, L. & Anthony, W. ( 2009). What a recovery organization looks like.  

Behavioral Healthcare, 29, (6), 10‐13. 

• Brown,  C. , (Ed.). (2002). Recovery and wellness: Models of hope and empowerment for people with mental illness . New York, NY: Hawthorne Press.

• Caldwell, B., Sclafani, M., Swarbrick, M. & Piren, K. (2010). Psychiatric nursing practice and the recovery model of care. Journal of Psychosocial Nursing, 48,  (7), 42‐48. 

C ti t D t t f M t l H lth d Addi ti S i (2006)• Connecticut Department of Mental Health and Addiction Services (2006). Practice guidelines for recovery oriented behavioral health care. Hartford, CT: Author.  

• Craig, T. (2006). What is psychiatric rehabilitation. 3‐17. In G. Roberts, S. Davenport,  F. Holloway, & T. Tattan Enabling recovery, The principles and practice of rehabilitation psychiatry. (pp. 3‐17). London, England: The Royal College of Psychiatrists. 

• Copeland, M.R. (2002). Wellness recovery action plan. West Dummerston, VT: Peach Press. 

• Edeman, M. (1974). The political language of the helping professions. Politics and  Society, 4, 295‐310. 

References

• Davidson, L., O'Connell, M., Tondora, J., Styron, T., & Kangas, K. (2006). The top ten concerns about recovery encountered in mental health system transformation. Psychiatric Services, 57, 640‐645.

• Deegan, P. (1988). Recovery: The lived experience of rehabilitation. Psychosocial Rehabilitation, 11 (4), 11‐19. 

• Deegan, P.E. (2005). Recovery as a journey of the heart. In L. Davidson, C. Harding & L Spaniol (Eds.), Recovery from severe mental illnesses: Research evidence and p ( ) y fimplications.(pp.57‐68).  Boston,  MA: Center for Psychiatric Rehabilitation. Boston University.

• Deegan, P.E. (1993). Recovering our sense of value after being labeled mentally ill. Journal of Psychosocial Nursing and Mental Heatlh Services, 4, 7‐11. 

• Hodge, M, & Townsend, W. (2004). The impact of language and the environment on recovery. Retrieved from www.bbs.ca.gov/pdf/mhsa/.../impact_language_environment_recovery.pdf. 

• Jacobson, N. & Greenley, D. (2001). What is recovery? A conceptual model and explication. Psychiatric Services, 52, 482‐485. 

• McReynolds, C. (2002). Psychiatric rehabilitation: The need for a specialized approach. International Journal of Psychosocial Rehabilitation, 7, 61‐69, 

References

• Olsen, E. “Recovery”. Presentation at the General Assembly on Networking for Our Human Rights and Dignity, Vejle, Denmarkm July 17‐21, 2000.   

• President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America (DHHS Publication No. SMA 03‐3832). Rockville, MD: Author

• Ragins, M.(2010). The road to recovery. Los Angeles, CA: Mental Health America. 

• White, W. “Toward a New Recovery Movement: Historical Reflections on Recovery, TreatmentWhite, W.  Toward a New Recovery Movement: Historical Reflections on Recovery, Treatment and Advocacy.” Presented at Recovery Community Support Program (RCSP) Conference, April 3‐5, 2000.