Advertisement

Competing Priorities: Staff Perspectives on Supporting Recovery

  • Clair Le Boutillier
  • Mike Slade
  • Vanessa Lawrence
  • Victoria J. Bird
  • Ruth Chandler
  • Marianne Farkas
  • Courtenay Harding
  • John Larsen
  • Lindsay G. Oades
  • Glenn Roberts
  • Geoff Shepherd
  • Graham Thornicroft
  • Julie Williams
  • Mary Leamy
Original Article

Abstract

Recovery has come to mean living a life beyond mental illness, and recovery orientation is policy in many countries. The aims of this study were to investigate what staff say they do to support recovery and to identify what they perceive as barriers and facilitators associated with providing recovery-oriented support. Data collection included ten focus groups with multidisciplinary clinicians (n = 34) and team leaders (n = 31), and individual interviews with clinicians (n = 18), team leaders (n = 6) and senior managers (n = 8). The identified core category was Competing Priorities, with staff identifying conflicting system priorities that influence how recovery-oriented practice is implemented. Three sub-categories were: Health Process Priorities, Business Priorities, and Staff Role Perception. Efforts to transform services towards a recovery orientation require a whole-systems approach.

Keywords

Mental health service provision Recovery orientation Staff perspective Competing priorities 

Notes

Acknowledgments

We would like to thank all staff who participated in this study and who generously gave their time and honest thoughts. We also acknowledge the support of the MHRN and MHRN Clinical Studies Officers team that helped to recruit participants. We are very grateful to the REFOCUS research team based at 2gether NHS Foundation Trust for recruiting and conducting individual staff interviews. This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research (PGfAR) Programme (Grant Reference Number RP-PG-0707-10040), and in relation to the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London. The project will be published in full in the NIHR PGfAR journal. The views expressed in this publication are those of the authors, and the views and opinions expressed by interviewees are those of the interviewees, and do not necessarily reflect those of the NHS, the NIHR, MRC, CCF, NETSCC, the PGfAR programme or the Department of Health. Further information is available at www.researchintorecovery.com/refocus.

Conflict of interest

None.

Supplementary material

10488_2014_585_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 27 kb)

References

  1. Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial rehabilitation journal, 16(4), 11–23.CrossRefGoogle Scholar
  2. Australian Government Department of Health and Ageing. (2012). Partners In Recovery: Coordinated support and flexible funding for people with severe, persistent mental illness and complex needs initiative. Australia: Australian Government, Department of Health and Ageing.Google Scholar
  3. Bird, V. J., Le Boutillier, C., Leamy, M., Williams, J., Bradstreet, S., & Slade, M. (2014). Evaluating the feasibility of complex interventions in mental health services: Standardised measure and reporting guidelines. British Journal of Psychiatry, 204, 316–321.PubMedCrossRefGoogle Scholar
  4. Blumer, H. (1969). Symbolic interactionism. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
  5. Bracken, P., Thomas, P., Timimi, S., Asen, E., Behr, G., Beuster, C., et al. (2012). Psychiatry beyond the current paradigm. British Journal of Psychiatry, 201(6), 430–434. doi: 10.1192/bjp.bp.112.109447.PubMedCrossRefGoogle Scholar
  6. Braslow, J. (2013). The manufacture of Recovery. The Annual Review of Clinical Psychology, 9, 781–809.CrossRefGoogle Scholar
  7. Brown, T., Mahoney, C. B., Adams, N., Felton, M., & Pareja, C. (2010). What predicts recovery orientation in county departments of mental health? A pilot study. Administration and Policy in Mental Health and Mental Health Services Research, 37(5), 388–398. doi: 10.1007/s10488-009-0253-8.PubMedCentralPubMedCrossRefGoogle Scholar
  8. Chen, S., Krupa, T., Lysaght, R., McCay, E., & Piat, M. (2013). The development of recovery competencies for in-patient mental health providers working with people with serious mental illness. Administration and Policy in Mental Health and Mental Health Services Research, 40(2), 96–116. doi: 10.1007/s10488-011-0380-x.PubMedCrossRefGoogle Scholar
  9. Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., Petticrew, M. (2008). Developing and evaluating complex interventions: New guidance: Medical Research Council.Google Scholar
  10. Cresswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: Sage.Google Scholar
  11. Department of Health. (2011a). No Health Without Mental Health: A Cross-Government Mental Heath Outcomes Strategy for People of All Ages. London: Department of Health.Google Scholar
  12. Department of Health. (2011b). No health without mental health: A cross-government mental health outcomes strategy for people of all ages. London: Department of Health.Google Scholar
  13. Department of Health. (2012a). The mandate. A mandate from the government to the NHS commissioning board: April 2013 to March 2015. London: Department of Health.Google Scholar
  14. Department of Health. (2012b). The NHS Outcomes Framework 2013/14. London: Department of Health.Google Scholar
  15. Department of health human services. (2003). Achieving the promise: Transforming mental health care in America. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  16. Dickerson, F. B. (2006). Commentary: Disquieting aspects of the recovery paradigm. Psychiatric Services (Washington, D. C.), 57(5), 647. doi: 10.1176/appi.ps.57.5.647.CrossRefGoogle Scholar
  17. Farkas, M. (2007). The vision of recovery today: What it is and what it means for services. World Psychiatry, 6(2), 68–74.PubMedCentralPubMedGoogle Scholar
  18. Gilburt, H., Slade, M., Bird, V., Oduola, S., & Craig, T. (2013). Promoting recovery-oriented practice in mental health services: A quasi-experimental mixed-methods study. BMC Psychiatry, 13(1), 167.PubMedCentralPubMedCrossRefGoogle Scholar
  19. Hardiman, E. R., & Hodges, J. Q. (2008). Professional differences in attitudes toward and utilization of psychiatric recovery. Families in Society: The Journal of Contemporary Social Services, 89(2), 220–227.CrossRefGoogle Scholar
  20. Henwood, B. F., Derejko, K.-S., Couture, J., & Padgett, D. K. (2014). Maslow and mental health recovery: A comparative study of homeless programs for adults with serious mental illness. Administration and Policy in Mental Health and Mental Health Services Research, 1–9. doi: 10.1007/s10488-014-0542-8.
  21. Le Boutillier, C., Leamy, M., Bird, V. J., Davidson, L., Williams, J., & Slade, M. (2011). What does recovery mean in practice? A qualitative analysis of international recovery-oriented practice guidance. Psychiatric Services (Washington, D. C.), 62(12), 1470–1476. doi: 10.1176/appi.ps.001312011.CrossRefGoogle Scholar
  22. Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. British Journal of Psychiatry, 199(6), 445–452. doi: 10.1192/bjp.bp.110.083733.PubMedCrossRefGoogle Scholar
  23. Mental Health ‘Recovery’ study working group. (2009). Mental health ‘Recovery’: Users and refusers. What do psychiatric survivors in Toronto think about Mental Health ‘Recovery’? Canada: Wellesley Institute.Google Scholar
  24. Morgan, D. L. (1997). Focus groups as qualitative research. Thousand Oaks, CA: Sage.Google Scholar
  25. Piat, M., & Lal, S. (2012). Service providers’ experiences and perspectives on recovery-oriented mental health system reform. Psychiatric Rehabilitation Journal, 35(4), 289–296. doi: 10.2975/35.4.2012.289.296.PubMedCrossRefGoogle Scholar
  26. Repper, J., & Perkins, R. (2013). The team recovery implementation plan: A framework for creating recovery-focused services. London: Mental Health Network NHS Confederation.Google Scholar
  27. Roberts, G., & Boardman, J. (2014). Becoming a recovery-oriented practitioner. Advances in Psychiatric Treatment, 20, 37–47.CrossRefGoogle Scholar
  28. Roberts, G., & Hollins, S. (2007). Recovery: Our common purpose? Advances in Psychiatric Treatment, 13, 397–399.CrossRefGoogle Scholar
  29. Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free.Google Scholar
  30. Rose, D., Thornicroft, G., & Slade, M. (2006). Who decides what evidence is? Developing a multiple perspectives paradigm in mental health. Acta Psychiatrica Scandinavica, 113, 109–114. doi: 10.1111/j.1600-0447.2005.00727.x.CrossRefGoogle Scholar
  31. Salyers, P., Rollins, L., McGuire, B., & Gearhart, T. (2009). Barriers and facilitators in implementing illness management and recovery for consumers with severe mental illness: Trainee Perspectives. Administration and Policy in Mental Health and Mental Health Services Research, 36(2), 102–111. doi: 10.1007/s10488-008-0200-0.PubMedCrossRefGoogle Scholar
  32. Salyers, M. P., Stull, L. G., Rollins, A. L., & Hopper, K. (2011). The work of recovery on two assertive community treatment teams. Administration and Policy in Mental Health and Mental Health Services Research, 38(3), 169–180. doi: 10.1007/s10488-010-0311-2.PubMedCentralPubMedCrossRefGoogle Scholar
  33. Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., et al. (2014). Uses and abuses of recovery: Implementing recovery-oriented practices in mental health systems. World Psychiatry, 13, 12–20.PubMedCentralPubMedCrossRefGoogle Scholar
  34. Strauss, A., & Corbin, J. (1990). Basics of qualitative research. Thousand Oaks, CA: Sage Publications.Google Scholar
  35. Tansella, M., & Thornicroft, G. (2009). Implementation science: Understanding the translation of evidence into practice. British Journal of Psychiatry, 195(4), 283–285. doi: 10.1192/bjp.bp.109.065565.PubMedCrossRefGoogle Scholar
  36. Tse, S., Siu, B. W. M., & Kan, A. (2013). Can recovery-oriented mental health services be created in Hong Kong? Struggles and strategies. Administration and Policy in Mental Health and Mental Health Services Research, 40(3), 155–158. doi: 10.1007/s10488-011-0391-7.PubMedCentralPubMedCrossRefGoogle Scholar
  37. Whitley, R., Gingerich, S., Lutz, W. J., & Mueser, K. T. (2009). Implementing the illness management and recovery program in community mental health settings: Facilitators and barriers. Psychiatric Services, 60(2), 202–209.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Clair Le Boutillier
    • 1
  • Mike Slade
    • 1
  • Vanessa Lawrence
    • 1
  • Victoria J. Bird
    • 1
  • Ruth Chandler
    • 2
  • Marianne Farkas
    • 3
  • Courtenay Harding
    • 4
  • John Larsen
    • 5
  • Lindsay G. Oades
    • 6
  • Glenn Roberts
    • 7
  • Geoff Shepherd
    • 8
  • Graham Thornicroft
    • 1
  • Julie Williams
    • 1
  • Mary Leamy
    • 1
  1. 1.Institute of PsychiatryKing’s College LondonLondonUK
  2. 2.Sussex Partnership NHS Foundation TrustWorthingUK
  3. 3.Boston University Center for Psychiatric RehabilitationBostonUSA
  4. 4.International ConsultingNew YorkUSA
  5. 5.Rethink Mental IllnessLondonUK
  6. 6.Business Wellbeing InstituteUniversity of WollongongWollongongAustralia
  7. 7.Devon Partnership NHS TrustExeterUK
  8. 8.Centre for Mental HealthLondonUK

Personalised recommendations