STR Newsletter No 6 - Recovery Devon

Support, Time and Recovery (STR)
Devon STR Project Team Newsletter no 6 March 2006
North Devon makes it Seven
The seventh STR Foundation
course took place at the Castle
Centre, Barnstaple 13th—
15th March.
This completes the ‘Grand
Tour of Devon’ and groups are
now established in West,
South, East, Exeter and North/
Mid Devon. It brings the total of
people to complete the course
up to 87.
The course members were
drawn from the Link Centers in
Barnstaple and Holsworthy, the
Community Mental Health
Teams in Barnstaple, Bideford
and Ilfracombe, the Assertive
Outreach team, Rethink in Mid
Devon and Coombehaven
Acute ward in Exeter
Further courses are being
planned for East Devon and
South Devon.
First inpatient staff attend STR course
George Harris and Anne Romanowski
were the first inpatient team members to
attend the foundation course.
Although the structure is not yet in place
for them to become STR workers,
George and Anne from Coomehaven
ward were able to help develop thinking
about the potential role of STR in inpatient
wards and to suggest a possible
format for a pilot.
It was felt that STR involvement may be
less appropriate when a person is first
admitted if they are acutely distressed,
but when the patient has been assessed
and working towards discharge, the STR
could have an important role in; address-
The North Devon STR Foundation Course
The latest group to complete the STR training are:- Carol Lavery, June
Kershaw, Rosie Bundy and Valerie McWilliams,
Claire Marrelli, Maria Martin, George Harris, Claire Lane, Cheney Penrose,
Jo Giles, Rob Reece, Tina Webber, Anne Romanowski, Shelley
Ford and Val Hughes. Russ Drayton attended as manager of the Link
Centers and organized the venue and refreshments (and took the photo)
ing worries by the patient about what is
going on in the community, preparing the
way for discharge through developing
Wellness Recovery Action Plans (WRAP),
going with people outside of the hospital
to help them address any issues which
may be delaying discharge and to smooth
the way towards discharge.
It was also felt that WRAP could be very
helpful in work with drug and alcohol detox.
The role would need to be supernumerary
or protected. Most support has come for
the idea of working closely with the Occupational
Therapists on the ward.
The North Devon WRAP
Support Group
One of the highlights of the
foundation course was the input
from people who have used
the service and supporters.
We heard about the Wellness
Recovery Action Plan (WRAP)
Support Group, which was set
up by Sam Ismael and Chris
Brown, who work at the North
Devon Link Centres.
Two of the people who have
used the service told of how
important their WRAP plan
has been in maintaining their
wellness and how important
the support group has been in
providing mutual support.
Such strong anecdotal evidence
of the effectiveness of the approach
was very encouraging.
The group is aiming to be
eventually service user led with
its own budget, though having
a structure and support from
Sam and Chris is highly valued
by the group.
The WRAP group has started
to invite speakers and will be
meeting with the Crisis Resolution
Team to share their crisis
plans and ensure that the team
are aware of their preferences.
The group is becoming involved
with Senior House Officer
(SHO) training and will be
looking at ways of linking to
the Expert Patient Programme.

Page 2 Support, Time and Recovery (STR)
Triggers, Early Warning Signs …. how to deal with them
(Taken from the North Devon STR
Foundation Course WRAP Training)
• Talk, talk, talk. Share, talk to
someone you trust
• Step back, reflect on the situation,
decatastrophise,.Ground
yourself, see the funny side. Take
time out—go for a walk. Stop,
think, start again, don’t panic.
Challenge the feeling—remember
you always have a choice. Reality
check—putting things into perspective.
Write things down. Rationalise,
plan it, do it.
• Look for a positive within a negative.
Take what positive steps you
can. Assertive confrontation and
Support Time Recovery (STR) Worker -Implementation Tool for Managers
The Care Services Improvement
Partnership (CSIP) has produced
an Implementation Toolkit for STR. It
was dev eloped by the South East
Region STR Leads Network.
It includes sections on:-
• The STR role, value base,
recovery and the 10 Essential
Shared Capabilities
• Implementation—recruitment,
process, system map, job descriptions,
person specifications,
education, employment
and induction
• Career development—the Career
and Skills Escalator, Career
Pathway, education,
training and development and
an ability assessment map
• Competent framework—
national occupational standards
and the Knowledge,
Skills Framework
• Evaluation
communication.
• Have a cuddle. Pamper and treat
yourself. Have a long bath. Plant a
rose bush. Sex, chocolate and
appreciating nature. Hug/stroke
pet or friend/tree
• Awareness of eating and sleeping
patterns. Controlled breathing
skills. Step back—chill. Visualise
each morning. Mental activity.
Stay off the smokes. Have a routine—break
it.
• Walk the dog. Writing, shopping,
drawing—diversion. Sunshine,
music, books, Time for self. DIY.
Crosswords.
The toolkit is a bit of a hotchpotch
from the Policy Implementation
Guidelines on STR, a variety of
guidance documents from NIMHE
and the Knowledge Skills Framework.
It is clearly aimed at managers and
has very little added value for practitioners,
with the possible exception
of the evaluation tools, which could
be used in conjunction with the outcome
measures based around the
DREEM recovery makers being
used locally.
It identifies key areas for evaluation
as:-
• The views of service users
• The views of carers
• The views of other workers
who work in the same mental
health team as the STR
Worker(s)
Sorry... I thought you said
Tigger
• The views of the STR workers
themselves
• The views of the employing
organisations
The Devon STR Project Team will
consider using this format

Developing a Recovery-Based System
Underlying
Assumptions
Human Givens
Maximising independence
Social Inclusion
Operationalising
Whole Life, Whole Systems
Access
Coordination
Practical application
Wellness Recovery Action Planning
(WRAP)
Expert Patient Programme
(listening to experts by experience)
Value system
Recovery concepts and ideas
Service user experience
Person Centred Planning
Recovery
Based
System
Approaches
consistent with
values
Educational / life skills
Solution focussed
Motivational interviewing
Community integration
Evaluation
DREEM
Developing the workforce
Recovery competencies
Setting consistent standards
Developing and valuing staff
Support, Time & Recovery Workers
The above representation is an early attempt to pull together the key elements of a recovery—
based system. STR workers are the first group of workers to work to this framework. The model
provides a value base from which to identify what beliefs, attitudes and competencies the STR
workers will work within. It looks at how these values translate into practice and how such a system
could be operationalised and evaluated. Suggestions for improvement welcomed.
Page 3
“Recovery can be construed as a paradigm, an organizing construct that can guide the planning
and implementation of services and supports with people with severe mental illness.
The outlines of a new paradigm recovery-enhancing system are emerging. Such a system is
person-oriented, and respects people's lived experience and expertise. It promotes decision
making and self-responsibility. It addresses people's needs holistically and contends with
more than their symptoms. Such a system meets basic needs and addresses problems in living.
It empowers people to move toward self-management of their condition. The orientation
is one of hope with an emphasis on positive mental health and wellness. A recoveryoriented
system assists people to connect through mutual self-help. It focuses on positive
functioning in a variety of roles, and building or rebuilding positive relation”
From ‘What Helps and What Hinders Recovery ‘ http://www.namiscc.org/Recovery/2002/MentalHealthRecovery.htm

“I think most people, at least in the world I know,
attempt to make sense of their lives, and when a
profound experience (such as mental illness)
strikes us, we struggle to make sense of that too.
Why did it happen? What caused it? We may even
impose an explanation. But sometimes there is no
meaning– at least not one we understand. Then
we have to put up with the pain of not
understanding and eventually we have to put
aside the need to know.
What I began to understand through listening to
the other’s stories and thinking about my own
was that getting well and staying well depend on
coming to terms with meaning. Ultimately we are
able either to make sense of things or to accept
that we cannot. I think this is a very important
point because it has to do with getting peace of
mind. It means we can stop asking, ‘Why did this
happen? ‘And start asking, ‘How can I best deal
with this experience?’ Julie’s Story
What are STR workers concerned about?
This a collection of some of the themes
which are around for STR workers at present:-
• The Day Opportunities Review.
Although very supportive of the
move towards individual recovery
packages rather than day centres,
there is a concern that babies are
not thrown out with the bathwater.
Some people find normal community
facilities difficult and appreciate
having somewhere to go where
they feel safe. Drop in may still be
an important option for some.
• Primary Care. STR workers could
have a lot to offer in a preventative
role before engagement with a
mental health service. A Recovery
perspective would suggest this
approach, though current targets
Notes from LEIBRICH, J. (1999) A Gift of Stories. New Zealand:
University of Otago Press.
Personal recovery stories which tell us about individual experience
make ideas real and fill them with meaning. They show
how a person tries to make sense of their world and offer their
truth. Stories give us far more than information or knowledge –
they offer the opportunity to understand something, to understand
it from within.
seem to be forcing more, not
less people into secondary
mental health services.
• STR work offers a real opportunity
to break the mould and
work in creative ways across
tradition boundaries. However,
the system—financial and organisational,
has to be in place
to support flexible and responsive
work.
• All professionals need to share
the recovery vision for the
whole mental health system to
deliver consistency.
• It is important that service
changes value the good work
which is already taking place.
Any change feels like a criticism
WHAT DO THEY HAVE IN COMMON ?
Steady consistent and trusting relationships
A manageable relationship with the illness
Someone to believe in the (well) person
Acceptance and self-acceptance
Creativity
Spirituality
Play
Purposefulness and belonging
Independence and self-control (freedom)
Understanding of experiences and situation
A rationale for recovery
Nature – animals and gardens
Personal solutions: finding / working out your own unique combinations
(Extract from a summary by Dr Glenn Roberts)
and has to be handled sensitively.