How do health professionals work in a recovery-oriented way?

Abstract

Introduction: In the Metro South geographical area in South East Queensland, the Logan Beaudesert Wellbeing Program was developed and implemented in order to offer revolutionary, community-based, person-centred care. Staff entered the program feeling passionate about recovery; hoping to achieve better outcomes for people with severe mental illness who were at high risk of hospital admission or readmission through the use of intensive recovery-oriented practice. This qualitative study aimed to elucidate how health professionals practice in a recovery-oriented way, and reports on: health professionals’ conceptualisations of recovery; how health professionals turn the concept of recovery into recovery-oriented practice; and how health professionals go about supporting recovery in practice. Theory / Methods: Staff were invited to participate in individual, face-to-face, semi-structured interviews prior to on-boarding consumers (n=24), and again six months after the program commencement date (n=21). A total of 16 participants partook in both pre and post implementation interviews. Research questions were based on Normalization Process Theory. Interviews were digitally recorded and transcribed verbatim. Two researchers then thematically analysed the data using techniques of initial coding. Data were then collectively aggregated into higher order themes, continuing until all data were accounted for and a succinct representation of themes was accomplished. Results: The concept of recovery is subjectively interpreted. Furthermore, understandings continue to shift as health professionals grow accustomed to the addition of peer support workers in multidisciplinary teams. Whilst some health professionals are interpreting recovery-orientation from a medically oriented paradigm, others view recovery-orientation as a way of life rather than a prescriptive approach that can be learned through traditional methods. Discussion: There was cause for concern that health professionals’ subjective conceptualisations of recovery, and past design of treatment according to medical definitions of mental illness, influenced therapeutic relationships. However, participants were keen to break these trends and felt strongly that person-centred practice should underpin all aspects of the treatment program, including service design. Conclusion: Health professionals are aware that recovery-oriented practice is yet to become the predominant way of working in mental health. Thus, in addition to generating best outcomes for people with severe mental illness, health professionals see their roles as important for developing and spreading the ethos of person-centred care amongst the health care community. Lessons learned: The paradigm shift away from medically-oriented mental health practice toward recovery-oriented practice presents significant rewards and challenges for health professionals. Supporting recovery in a legislated context requires special levels of navigation and negotiation. Critically reflective practice is imperative for the ongoing development of health professionals’ conceptualisations of person-centred care. Limitations: Because this research occurred in the specific context of a pilot program in South East Queensland, generalizability beyond this context cannot be assured. Conceptualisations of person-centred and recovery-oriented practice may differ in other locations. Future Research: Longitudinal studies would be of benefit to continue to gauge how health professionals’ conceptualisations of recovery change over time; with a particular view to investigating whether over time, health professionals revert to more traditional, less person-centred ways of working in mental health practice.