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The recovery approach to care in psychiatric services: staff attitudes before and after training

  • Gisli H. Gudjonsson (a1), Gemma Webster (a1) and Timothy Green (a2)
Abstract
Aims and method

To investigate the attitude of staff towards the recovery approach in forensic mental health services and the impact of training on staff knowledge and attitudes. A specially constructed 50-item recovery approach staff questionnaire, which focused on the core components of the recovery approach, was completed by 137 members of staff in in-patient forensic services in Lambeth, south London.

Results

Staff were generally very positive about the implementation of the recovery approach in forensic services and those who had received training scored significantly higher on the questionnaire than non-trained staff.

Clinical implications

The great majority of staff agree that the recovery approach to care does have a place in forensic services. This is important and needs to be built into the implementation of this approach in forensic services.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Gisli H. Gudjonsson (gisli.gudjonsson@kcl.ac.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Roberts, G, Wolfson, P. The rediscovery of recovery: open to all. Adv Psychiatr Treat 2004; 10: 3748.
2 Department of Health. The Journey to Recovery: The Government's Vision for Mental Health Care. Department of Health, 2001.
3 Pilgrim, D, Waldron, L. User involvement in mental health service development: how far can it go? J Ment Health 1998; 7: 95104.
4 Repper, J, Perkins, R. Social Inclusion and Recovery: An Approach for Mental Health Practice. Balliere-Tindall, 2003.
5 Rickwood, D. Recovery in Australia: slowly but surely. J Adv Ment Health 2004; 3: 13.
6 Torrey, WC, Wyzik, MA. The recovery vision as a service improvement guide for community mental health center providers. Community Ment Health J 2000; 6: 209–16.
7 British Psychological Society. Understanding Mental Illness: Recent Advances in Understanding Mental Illness and Psychotic Experiences. BPS, 2000.
8 Crowe, T, Deane, F, Oades, L, Caputi, P, Morland, K. Effectiveness of a collaborative recovery training program in Australia in promoting positive views about recovery. Psychiatr Serv 2006; 57: 14971500.
9 Care Services Improvement Partnership, Royal College of Psychiatrists, Social Care Institute for Excellence. A Common Purpose: Recovery in Future Mental Health Services. Joint Position Paper 08. SCIE, 2007.
10 Slade, M, Luke, G, Knowles, L. Methodologies for evaluating recovery training. Clin Psychol Forum 2009; 193: 10–5.
11 National Institute for Mental Health in England. NIMHE Guiding Statement on Recovery. Department of Health, 2005.
11 Gudjonsson, GH, Young, S. The role and scope of forensic clinical psychology in secure unit provisions. A proposed service approach for psychological therapies. J Forens Psychiatry Psychol 2007; 18: 534–56.
12 Gudjonsson, GH, Young, S, Yates, M. Motivating mentally disordered offenders to change. Instruments for measuring patients' perception and motivation. J Forens Psychiatry Psychol 2007; 18: 7489.
13 Hope, T. Evidence-based patient choice and psychiatry. Evid Based Ment Health 2002; 5: 100–1.
14 Borg, M, Kristiansen, K. Recovery-oriented professionals: helping relationships in mental health services. J Ment Health 2004; 13: 493505.
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The recovery approach to care in psychiatric services: staff attitudes before and after training

  • Gisli H. Gudjonsson (a1), Gemma Webster (a1) and Timothy Green (a2)
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eLetters

Staff attitudes to Recovery

Anne Cleary, Advanced Nurse Pactitioner(Candidate).
08 September 2010

We read the paper by Gudjonsson et al.(1) with interest. We wish to highlight the findings of our study in Ireland, which examined the knowledge and attitudes of mental health professionals (n = 153, nurses, doctors, social workers, occupational therapists and psychologists) to theconcept of recovery in mental health across both in-patient and community settings.(2) We used the Recovery Knowledge Inventory (RKI), an instrumentdeveloped in the US,(3) but which we found useful for an Irish population,and has also been found to be of use in European and Australian populations.(4)The RKI was developed to gauge recovery-oriented practices among providers. It assesses four domains of understanding: roles and responsibilities in recovery; non-linearity of the recovery process; rolesof self-definition and peers in recovery; and expectations regarding recovery. It comprises 20 items, each of which is rated on a 5-point Likert scale.

Our study findings concurred with Gudjonsson et al in finding that respondents viewed recovery positively as a philosophy of care for delivering mental health services. Participants in our study indicated their positive approach to recovery, and expressed a need for more training on recovery, acknowledging the need for inter professional learning as a team and the need for a multidisciplinary team approach to care. Respondents were less comfortable with encouraging healthy risk taking.

However, while Gudjonsson et al. report that experience of working inforensic service was not significant to total scores; in our study, less experienced staff scored higher in having more positive attitudes and knowledge regarding recovery. Also of interest was that females and non nursing professionals scored higher (than nursing professionals) in our study. We found no significant difference between inpatient or community based staff. 22% of our staff had received training in Recovery, comparedwith 37% in Gudjonsson study. We did not compare results of those with training and without, sharing the concern that those who had received training may have been positive about recovery prior to training.

Both studies discuss decision making and its challenges around choiceand control, and both studies are in strong agreement regarding hope and optimism being central to the process. Finally, both studies support the idea that irrespective of the specialty (or indeed country), the deliveryof a recovery approach to care can be implemented, and knowledge and attitudes of mental health professionals are key in this process.

We look forward to the findings of the prospective study on the recovery approach currently under investigation by Gudjonsson and colleagues, and further discussion on this important topic.

References>

1. Gudjonsson, GH, Webster, G. and Green , T. The recovery approach to care in psychiatric services: staff attitudes before and after training. The Psychiatrist. 34, p. 326-329. [2.Cleary, A. & Dowling, M. 2009. ‘Knowledge and Attitudes of Mental Health Professionals to the Concept of Recovery in Mental Health: a questionnaire survey’. Journal of Psychiatric and Mental Health Nursing, 16, 529-545).3.Bedregal, L. E O`Connell, M. Davidson, L. (2006) ‘The Recovery Knowledge Inventory: Assessment of Mental Health Staff Knowledge and Attitudes about Recovery’. Psychiatric Rehabilitation Journal. 30(2), 96-103.4.Meehan T, Glover H (2009) Using the recovery knowledge inventory (RKI) to assess the effectiveness of a consumer-led recovery training program for service providers. Psychiatric Rehabilitation Journal. 32(3), 223-226.
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Conflict of interest: None Declared

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