Report from – Refocus on Recovery Conference 2017

Filed in News on 8th December 2017

The aim of the conference was both to advance the field of recovery research and to create an international community of influence. The conference brought together leading researchers and people who use mental health services, their carers and informal supporters, mental health workers and professionals, and policy-makers and other people with an interest in mental health issues.

Refocus on Recovery conference, September 2017 – the view from where I was standing

THE SPACE

The event took place in a big conference centre in Nottingham, with the main sessions in a huge tiered lecture hall. It’s a bit daunting to go into one of those halls. If it’s empty, you have to choose where to sit and then you feel awkward when other people don’t sit in the same area. If it’s full it’s even more difficult because people will sit on the ends of the rows, and the middle seats are empty but you have to climb over someone to get there, and you have to ask if the seat is free, and then you don’t like to sit right next to someone if there is plenty of space, so you end up creating another empty space that is awkward for someone else to sit in. Then you get all muddled up with your coat and your scarf and your bag and your pen and your pad of paper, and then when you’ve done all that, you look around to get a feel for the space, and which of two giant screens you are going to look at, and is the lighting going to give you a migraine, and have you put on too many clothes so that you will be unbearably hot, and are you the oldest person in the room and if so does it matter? Then just as it’s starting, you notice your fellow attendees from Devon on the other side of the room and you wish you could go and sit with them but it’s too late by then.

Next time I’m going to manage this better and make sure I go in with someone else. Even if it’s someone I just met at the coffee table.

Anyway within five minutes all this discomfort has worn off because I am so interested in what’s going on.

THE PEOPLE

Who was attending? I was asked when I booked to identify myself as a person using mental health services, a researcher, a mental health worker, or a carer. Now in fact I am none of those things – I used to work in administration in the mental health trust and I have experience of mental health difficulties in my family, but I don’t fit into any of the categories given. In fact I was a bit surprised to be asked because I think it’s well accepted now that people have many different and overlapping roles and you might be all or none of the things mentioned! In the end I put down “mental health worker” as I am on the Board of Recovery Devon. But when we got the list of people attending, there was no indication of what their background was except the organisation they had come with. There were about 350 people there, of whom about one third were from universities and one third were from the health services – also some people from government organisations, social services, charities, and some people were there in their personal capacity and not from any organisation.

Who spoke? There were a wide variety of presentations, some on specific research projects, but many also on project work in healthcare and in communities, on setting healthcare policy, on philosophical approaches to mental health and on information-gathering about how things work (or don’t work). There was an international perspective too, with representatives from Belgium, Canada, China, France, Hong Kong, India, Israel, Italy, Norway, Saudi Arabia, Sweden, the United States, and maybe other countries but that is all I found.

Was it “Death By PowerPoint”?

Well … there were some presentations where the screens were FULL OF WORDS and you really had to concentrate – but we were also treated to a performance by the People’s Choir, which was great, and then after lunch on one day we were all given a pair of Boomwhackers and the band showed us how to make a surprisingly musical noise by banging plastic tubes together. This was new to me and I have to say it could have been really fun – but the big tiered hall worked against us and the band had to work really hard to get us all to participate. The person next to me was messaging on her phone throughout the session … well, it was a good effort. Then there was the MAD space, but I never found out what that was – and of course the posters to look at – and frequent breaks so you could catch up and talk to people – and nice food – and a gala dinner as well but I didn’t go to that because I had travelled with someone not attending the conference so I went back to my accommodation in the evenings.

WHAT WE TALKED ABOUT

There were a total of 109 presentations and 24 posters to look at so no-one could attend everything and it would take more than three days to describe everything that happened! But as I listened I started to notice some common ideas and concerns coming through. Here are some of them:

“Appreciative enquiry”

This is all about “looking on the bright side” – asking about what works well, how we can get it right. This idea is very familiar in recovery: for example, a WRAP plan will start by looking at what things are like when we are well; a recovery-focused approach will look at strengths and resources and capabilities, not concentrating on deficit and illness jn order to find a “cure”. But during the conference we heard a lot about times when this approach is still not taken. We heard about a leaflet on medication which went into great detail about side-effects and contra-indications and risks, and hardly mentioned the benefits of the medication. [1] During a question-and answer session a member of the audience pointed out that a lot of questionnaires measuring the effect of interventions ask more about the absence of bad things than the presence of good things. And the most striking example of this approach was one presenter[2] who summed up the best approach to helping someone with mental health difficulties and said, “The patient has a life. How do we keep this life intact?” It was in the context of in-patient treatment, and how a hospital admission can weaken or sever a lot of connections with family, friends, work, activities or community. But by asking the questions “how can we keep this life intact”, then a lot of useful things can flow from that, whether it’s making visiting easier, or maintaining connections with the outside world.

Principles into Practice

This is something I think we don’t really understand yet. Even when the recovery principles are accepted, and everyone knows about them – still we find times when things aren’t done in the way they should be. This was mentioned in the presentation about shared decision-making, where the guidelines were not always implemented even after they had proved to be effective. A presenter from Canada told us that even though recovery-oriented practice guidelines had been launched nationally, it was still difficult to see progress within individual healthcare organisations.[3]  Another person described a new approach to helping people back into work, which had proved to be successful but which was dropped as soon as the study was over.

Recovery-friendly communities

A number of speakers recognised the importance of communities and social networks and there was some exploration of the place of mental health services in a person’s recovery, their role and their limitations.  This reminded me of the comment earlier “The patient has a life. How do we keep this life intact?”  Recovery Devon articulates its belief that “With help, people can build meaningful and satisfying lives, whether or not there are ongoing mental health issues”[4]. But there are so many elements that go towards enabling a person to build that life, including the political, social and economic circumstances in which they live. Professor Mike Slade[5] looked forward to research into how mental health services can engage with creating whole systems which support recovery, and understanding the relationship between recovery and other aspects of human experience. He ended with a very striking view: “Human rights and social justice should be the core business of mental health [services], not providing evidence-based treatment” – I hope I’ve quoted him correctly. Mark Hopfenbeck[6] also stressed the importance of the family and community surrounding a person struggling with mental health issues. He talked of the need for “a collective cultural and political recovery” and recognising that a person often bears “the burdens of poverty, discrimination and isolation”.

Both of these presenters seemed to be pointing towards a wider role for mental health services but another speaker, Isabelle Goldie[7], took a slightly different view in stressing the need for the whole community to be involved in supporting and addressing mental health difficulties. She said: “Although there is a need for specialist support at times in people’s lives, much of mental health is determined in family homes, neighbourhoods, schools, workplaces and through those social protection systems that are all too often failing us. A cultural change is needed – one that involves all of us, to ensure […] that people are able to live in inclusive and cohesive communities”. So I would not say that there was any agreement or consensus on how mental health services fit in to this wider need for creating recovery-friendly communities, but Mike Slade certainly took the view that it was an area which was becoming increasingly important in recovery research.

SO WHAT NEXT?

I made lots of notes on interesting papers and hope to gradually add some of those to the Recovery Devon website. In the meantime there is lots more information online at

http://www.researchintorecovery.com/

and if you would like to know more about any of the presentations or the programme, please get in touch at recoverydevon@gmail.com.

Thanks for reading!

Judith Belam

[1] Professor Shulamit Ramon, University of Hertfordshire, in a presentation entitled Shared decision-making as a co-produced preventive self-management strategy: a UK case study

[2] Unfortunately I did not make a note of which presenter!!

[3] Simone Arbour, Ontario Shores Centre for Mental Health Science, in a presentation called The implementation of a recovery-oriented practice training module for service providers at a tertiary mental health hospital in Canada

[4] www.recoverydevon.co.uk

[5] Professor Mike Slade, University of Nottingham, in a presentation entitled New frontiers in recovery research

[6] Professor Mark Hopfenbeck, Norwegian University of Science and Technology, in his presentation Peer-supported open dialogue – On Recovery Difference

[7] Isabella Goldie from the Mental Health Foundation; her talk was called Surviving or Thriving? Creating a Movement for Change

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