Recovery in Mental Healthcare

 

 

 

Explore and develop an understanding of the literature in relation to recovery, and in relation to the therapeutic relationship. 

 
Question 1:Discuss the meaning of recovery in mental healthcare. In your answer, identify principle tenets of the recovery paradigm and its general implications for practice.

 

The mental health care or mental health nursing indicates the services related to diagnose and treat the individuals who are suffering from mental disorders and ensuring the mental well being of these individuals. In other works, the nursing professionals delivering the mental health services utilize their interpersonal, behavioural and psychological skills in order to improve the health outcomes through a number of techniques including counselling and interviewing (Slade et al.2014). The current assignment, deals with analysis on the concept of recovery in the context of mental healthcare or mental nursing. The ideas on how the recovery is applied in mental health nursing, how do the therapeutic relationships are developed by the professionals with the consumers of mental health services.

Recovery in mental healthcare/ mental health nursing with its principle tenets:

The recovery for the individuals with mental health issues can be described as a process of affirming own identity through diagnosis. The recovery in mental health care is often viewed as the movement of consumers unlike the conventional medical model (De Vecchi et al.2015). However, in case of the recovery approach in the mental health care model, special emphasis is given upon dependency, pathology and the deficits. In case of mental health care, the idea of recovery varies significantly among the individuals (Carbone and Echols,2017; Fortinash and Worret, 2014). Still, there are some key components on recovery that apply for everyone. The factors like self-management, hope, empowerment, self-advocacy and self-determination are at the centre of the recovery approaches in mental health care (Parker, 2014). However, the recovery from the mental health issues also enables the individuals to choose the own way of meaningful life which is not impacted by the personal stigma and discrimination. The recovery in the health care nursing is also described by a personal and unique journey, a regular human process , a continuous experience that changes with time, a cumulative effort of the healthcare professionals and the patients, and also as a journey which has own setbacks and achievements.
The recovery model in mental healthcare can be considered as the combined effort of the health care service providers, the health care professionals and the peer specialists (Slade et al.2015). In addition, the roles of family, friend and community are also important in the mental health care nursing. In the recovery model of nursing the individuals are diagnosed through treatment, continuous support from all the parties involved, and advocacy. The aim of the recovery model in mental health care is ensuring a better living experience of the individuals through enhancement of strengths, optimism and hope.

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Application of recovery in mental health nursing:

The recovery oriented mental health nursing practices focuses on inspiring people to live a better life and meeting requirements of the individuals (Zugai et al.2015). The individuals related to the mental health nursing service delivery, focuses on having a common mission with the patients, the community and the care-givers (Tickle et al.2014). The service delivery of the mental health based nursing practices is done by a diverse workforce who has right resources. Such workforce may include the individuals who have experienced the problems related to mental health issues either in their own life or in case of their close relationships.
The recovery oriented mental health care service delivery has some distinctive features. Firstly, the recovery oriented therapy focuses on providing the evidence-based treatment (Tondora et al.2014). Such services also focus on ensuring the mental health, physical well-being and health of the individuals who are being treated (Kidd et al.2015). Working in partnership is another feature of the recovery oriented service delivery model in health care. In other words, the mental health care nursing professionals focuses on involving the organization, consumer and community groups with the service delivery process (Jacob, 2018). In case of mental health care nursing, the professionals always look for ways to improve the service through innovative ideas. So, while applying the recovery based model, the health care professionals focuses on implementation of their creativity in the existing models.
While applying the recovery-oriented mental health care services, the self- determination and safety recognition of the individuals is given extensive importance. The principle of recovery in mental health care nursing centres on meeting the medico-legal requirements of the patients and adhering to the duty of care needs (Le Boutillier et al.2015). At the time of service delivery, it is also ensured that harmful risks for the patients are mitigated and the complex situations due to the mental health issues are handled effectively. In case of mental healthcare services, the service providers may need to take risks many times (Halter, 2017). So, it is necessary to ensure that the health care professionals are supporting the positive risk taking behaviours only. The degree of risk is also assessed before delivering any mental healthcare nursing services (Vine and Komiti, 2015). In addition to ensure that the services adhere to the duty of care needs and the medico-legal requirements, it is also focused that self-determination of the consumers is increasing and the level of restraint, seclusion and coercion is reducing gradually (www.healthdirect.gov.au, 2018). The service providers focus on continuing the involuntary assessment until no other restrictive option for improving the health and safety of an individual is not present.

 

Question 2:Discuss how and why nurses develop a therapeutic relationship/therapeutic alliance with consumers. Relate the discussion to recovery principles.

 

Development of the therapeutic relationship between the nurse and the client is at the core of recovery- oriented service delivery in mental healthcare. However, developing the therapeutic relation with the client is quite different than the social or other intimate relation (Fortinash and Worret, 2014). To develop the therapeutic relationship, the nurse has to maximize her communication skill. Understanding the human behaviour is crucial for development of the therapeutic relation.

Developing the therapeutic relationships/ alliances with consumers:

To create a close relation, the nurses use their communication skill and identify the personal issues of the individuals. The techniques like interviews with the clients are conducted to identify the requirement of change and degree of the change within the client (Maybery et al.2017). Playing in different roles is one of the crucial factors for development of the relationship with client for effective delivery of healthcare services (Rizvi, 2016). The nurses can play the role of counsellor, teacher , liaison or the socializing agent to identify the issues faced by the client and mitigate those. However, it s necessary for the nurses to get their own requirements fulfilled outside the therapeutic relationship with the consumer. If a nurse starts expecting that the consumer of mental healthcare services will recognize their efforts or will start following their suggestions, effectiveness of the therapeutic relation reduces. 
The relation starts becoming detrimental for the client. So, it is necessary to ensure that the nurses are adhering to the health care standards and keep boundaries of the relationship clear (Ribeiro et al.2017). In some cases, the nurses adopt an approach of friendship while making the relationship with the consumer. In comparison with other roles, playing the role of a friend is easier as the individuals are more familiar to it. However , while developing the relationship in this way, the nurses need to ensure that they are getting their needs fulfilled outside the relation and incorporating the boundaries. In this case also, the nurses focus on empathy, genuineness and positive regards when developing the relation with others. 

Discussion on therapeutic relationship with recovery principles:

The therapeutic alliance with the nurse helps the consumers to recover from their issues in several stages. At the first stage is called orientation stage. In this stage, the nurses arrange for a number of meetings to explore the issues faced by the individual. Carrying out this phase successfully helps the nurses to create a basic idea on needs of the individuals and the possible ways to solve those needs (www.health.gov.au, 2018). The next phase is working phase where the nurses gather more information on the factors that are causing problem for the consumer through development of a therapeutic alliance (Rizvi, 2016). Successful execution of the phase is important for recovery of the patients as in this phase; the patients develop their problem solving skills, increase the self-esteem, foster behavioural changes and overcome the behavioural resistances. The next phase is termination phase when the therapeutic relation between the nurse and client ends. In this phase, the patient starts having greater sense of identity, the social functionalities of the patient starts to improve and the patient also gets relief from the symptoms. In this stage, the goals of the mental healthcare services star to accomplish. The termination is an important part of the nurse- client therapeutic relationship and without terminating the relation, treatment of the patient remains incomplete.
The discussion indicates that the therapeutic relationship between the nurse and client , when the clear boundaries are set and the nurse focuses on using her communication skill and empathy. However, terminating the relationship is also crucial when condition of the patient improves.

References:

Carbone, E.G. and Echols, E.T., 2017. Effects of optimism on recovery and mental health after a tornado outbreak. Psychology & health, 32(5), pp.530-548.
De Vecchi, N., Kenny, A. and Kidd, S., 2015. Stakeholder views on a recovery-oriented psychiatric rehabilitation art therapy program in a rural Australian mental health service: a qualitative description. International journal of mental health systems, 9(1), p.11.
Fortinash, K.M. and Worret, P.A.H., 2014. Psychiatric Mental Health Nursing-E-Book. Elsevier Health Sciences.
Fortinash, K.M. and Worret, P.A.H., 2014. Psychiatric Mental Health Nursing-E-Book. Elsevier Health Sciences.
Halter, M.J., 2017. Varcarolis' Foundations of Psychiatric-Mental Health Nursing-E-Book: A Clinical Approach. Elsevier Health Sciences.
Jacob, K. 2018. Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care. [online] www.ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418239/ [Accessed 7 Apr. 2018].
Kidd, S., Kenny, A. and McKinstry, C., 2015. The meaning of recovery in a regional mental health service: an action research study. Journal of Advanced Nursing, 71(1), pp.181-192.
Le Boutillier, C., Chevalier, A., Lawrence, V., Leamy, M., Bird, V.J., Macpherson, R., Williams, J. and Slade, M., 2015. Staff understanding of recovery-orientated mental health practice: a systematic review and narrative synthesis. Implementation Science, 10(1), p.87.
Maybery D, Goodyear M, Reupert A, Sheen J, Cann W, Dalziel K, Tchernagovski P, O’Hanlon B, von Doussa H. Developing an Australian-first recovery model for parents in Victorian mental health and family services: a study protocol for a randomised controlled trial. BMC psychiatry. 2017 Dec;17(1):198.
Parker, J. 2014. Recovery in mental health. SAMJ: South African Medical Journal, 104(1), 77-77.
Ribeiro, A.P., Ribeiro, E., Loura, J., Gonçalves, M.M., Stiles, W.B., Horvath, A.O. and Sousa, I., 2014. Therapeutic collaboration and resistance: Describing the nature and quality of the therapeutic relationship within ambivalence events using the Therapeutic Collaboration Coding System. Psychotherapy Research, 24(3), pp.346-359.
Rizvi, S., 2016. The essential aspects of building a therapeutic relationship. Indian Journal of Positive Psychology, 7(3), p.359.
Slade, M., Amering, M., Farkas, M., Hamilton, B., O'Hagan, M., Panther, G., Perkins, R., Shepherd, G., Tse, S. and Whitley, R., 2014. Uses and abuses of recovery: implementing recovery?oriented practices in mental health systems. World Psychiatry, 13(1), pp.12-20.
Slade, M., Bird, V., Clarke, E., Le Boutillier, C., McCrone, P., Macpherson, R., Pesola, F., Wallace, G., Williams, J. and Leamy, M., 2015. Supporting recovery in patients with psychosis through care by community-based adult mental health teams (REFOCUS): a multisite, cluster, randomised, controlled trial. The Lancet Psychiatry, 2(6), pp.503-514.
Tickle, A., Brown, D. and Hayward, M., 2014. Can we risk recovery? A grounded theory of clinical psychologists' perceptions of risk and recovery?oriented mental health services. Psychology and Psychotherapy: Theory, Research and Practice, 87(1), pp.96-110.
Tondora, J., Miller, R., Slade, M. and Davidson, L., 2014. Partnering for recovery in mental health: A practical guide to person-centered planning. John Wiley & Sons.
Vine, R. and Komiti, A., 2015. Carer experience of Community Treatment Orders: implications for rights based/recovery-oriented mental health legislation. Australasian Psychiatry, 23(2), pp.154-157.
www.health.gov.au .2018. Principles of recovery oriented mental health practice. [online] The Department of Health. Available at: http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-servst10-toc~mental-pubs-n-servst10-pri [Accessed 7 Apr. 2018].
www.healthdirect.gov.au .2018. Recovery and mental health. [online] healthdirect. Available at: https://www.healthdirect.gov.au/mental-health-recovery [Accessed 7 Apr. 2018].
Zugai, J.S., Stein-Parbury, J. and Roche, M., 2015. Therapeutic alliance in mental health nursing: an evolutionary concept analysis. Issues in mental health nursing, 36(4), pp.249-257.

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