New Horizons in Devon

New Horizons: a shared vision for mental health (2009) is intended to build on and replace the NSF for Adult Mental Health (1999) and it specifically states that this whole approach is equally applicable to older adults too (p71). It places a major emphasis on prevention, health education, early intervention and recovery. Whereas the NSF made only 2 mentions of recovery and both related to overcoming anxiety, New Horizons makes 56, and the values, attitude and stance of recovery is written all through it like the proverbial Brighton rock. It makes it clear in its introductory paragraphs that recovery is central to its vision for future practice services and organisations,

‘New Horizons sets out the expectation that services to treat and care for people with mental health problems will be accessible to all who need them, based on the best evidence and focused on recovery, as defined in discussion with the service user’ (p7)

And that New Horizons is about, ‘Timely access to high-quality services to support the individual recovery of everyone who experiences mental ill health’ (p54)

It also sets out a commitment to subsequently measure what is happening and whether these aspirations are being delivered,

‘Effectiveness and acceptability to the service user will be measured frequently using agreed indicators and the results used to plan further improvements in pathways and whole systems as well as to monitor the progress of individuals. It also acknowledges the need to develop and refine measures but states that, ‘services need to develop measures and tools to ensure care is planned around user-defined goals and quality of life outcomes’ (p55) and that measures need to be, ‘integrated into relevant systems guiding routine practice such as the Care Programme Approach’ (p56)

Developments in Devon

This bears a striking resemblance to our commitments in Devon to ‘have a regular cycle of measuring recovery outcomes embedded in routine practice, with is used to inform progressive practice and service improvement (Devon Recovery Standard 2) and the planned integration of these measures into ‘Recovery Coordination’ within the Devon Partnership Trust.

There is much else within the document that is supportive of the aims and priorities of Recovery Devon, for example:

‘Peer support and natural support networks are seen as important in recovery as well as giving good value for money’ (p16)

‘Quality includes recovery orientation, inpatient environments and staffing levels, attitude and skills’ (p16)

‘Service use empowerment is clearly an aspect of the personalisation agenda but also of, for example, local leadership and tackling stigma.’ (p17)

‘A common theme is shifting the balance of staffing from management and regulation towards frontline staff and from medical to nursing, social care, talking therapy and peer support workers’ (p17)

‘Tackling stigma through the provision of socially and culturally competent services based on people’s needs rather than their diagnostic category is an essential step towards more inclusive, recovery-based approaches to care.’ (p26)

‘Personalisation is fundamental to a recovery approach’ (p29)

‘A meaningful approach to recovery has to be underpinned by effective partnership working across all sectors.’ (p55)

‘Personalised care is fundamental to recovery and to addressing the needs of individuals within the most vulnerable groups’ (p55)

‘Promote recovery and inclusion for people using acute mental health services’ (p59)

‘Reduce barriers to care and ensure clearer, recovery-focused pathways into primary and specialist care’ (p69)

vis5_small This whole manifesto for change and development states that it is but a beginning and in many ways it is an overview of an action plan that will be developed over the next 10 years. It states that, ‘a great deal is already known about what can be done. There is therefore an increasingly powerful economic case as well as moral imperative for taking this programme forwards.’

Taking it forwards

Taking it forwards is largely addresses focused on progressing specific actions and no 79 is ‘Developing recovery-focused organisations and services’. It states that there is already a plan in place combining commitment for the National Mental Health Development Unit (NMHDU), the Mental Health Network, the NHS Confederation and the Sainsbury Centre for Mental Health to conduct specific pilots of ‘recovery-focused organisational development.’ Building on the succession of Sainsbury Centre publications and aiming to, ‘demonstrate and evaluate the use of measures of quality and service-level outcomes for providers and commissioners of recovery-focused services’.

Developments in Devon have already informed the planning behind these pilot studies and we hope that we may be able to practically participate in their implementation too.

The DH concludes by offering an aspiration that, ‘Under New Horizons, people with mental ill health will face a more hopeful future, in which services are safe, accessible and personal, and in which opportunity – for education, jobs, relationships and decent housing – will replace prejudice.’

This is an aspiration we can agree with but clearly it will not be fulfilled just from the publication and dissemination of a document but it also states that the Department of Health will work to ‘ensure the development of recovery approaches across organisations, supported by the development of better measures for individuals and organisations’ – which is great! – So let’s contribute what we can, personally and collectively, to support all these initiatives and take whatever opportunities we can to remind them of their commitments.

To download the main New Horizons report (pdf, 100pages, 1.36MB), click on:
New Horizons: A shared vision for mental health – updated February 2010

Glenn Roberts