Recovering Ordinary Lives Two Years on Genevieve

Recovering Ordinary Lives – Two Years on Genevieve Smyth College of Occupational Therapists 12 th February 2009

Introduction n Recovering Ordinary Lives launch December 2006 (COT 2006) n Current context n Themes and key messages –update n Challenges and opportunities

Launch of Recovering Ordinary Lives n Launch with HRH n Culmination of 18 months of work n Aimed to: n Raise the profile of occupational therapy in mental health n Develop professional leadership n Promote occupation and its relationship to mental health and well being

Recovering Ordinary Lives documents n Recovering Ordinary Lives. The strategy for occupational therapy in mental health services 2007 -2017. A vision for the next ten years. n Recovering Ordinary Lives –literature review n Recovering Ordinary Lives –results of service user and care focus groups

The Vision n By 2017, mental health service provision in the UK will be better for the active role and inspirational leadership provided by the cultural heritage and identity of occupational therapy which at its core is social in nature and belief. It will therefore deliver the kind of care that service users want, need and deserve.

Five themes n Valuing occupation n Added value of occupational therapy n Occupational therapy leadership n Education and training n Workforce development

Key messages for: n Occupational therapy practitioners n Occupational therapy managers n College of occupational therapists n Occupational therapy educators n Commissioners of mental health services n Occupational therapy researchers

Current context n Closing DH work streams n Changes in the NHS n Employment agenda n NICE guidelines n Mental Health Act (2007)

Closing DH work streams n Embedded in NHS culture n Enhance, include, evolve: New Ways of Working for the Allied Health Professionals (CSIP/NIMHE 2008) n National Social Inclusion Programme – occupational therapy secondment: n Capabilities for inclusive practice (DH 2007)

Closing DH work streams n End of the Mental Health National Services n n n Framework (Appleby 2008) resulting in: Better community care Modern interventions –anti psychotic medications and Improving Access to Psychological Therapies (IAPT) Decreased suicide rates Smoke free wards BUT lack of progress about stigma www. time-to-change. org. uk - ending mental health discrimination

Closing DH work streams n “Baby of NSF” in 2009 n Louis Appleby talks about: n Care pathways of choice n Evidence based psychological therapies n Race equality n Mental health spectrum

Closing DH work streams n A New Vision for Mental Health discussion n n paper (Future Vision Coalition 2008) A movement away from the dominance of the medical model, avoiding segregation Greater importance of public mental health Aim of services should be recovery of a good quality of life Power relations need to shift to give individuals real self determination

Changes in the NHS n Next stage Review final Report –High quality n n care for all (DH 2008 a). The Health Bill (Stafford 2009) Framing the contribution of AHPs (DH 2008 b) data collection, ease of access, improve quality, piloting personal budgets Foundation trusts Payment by Results (Smyth 2008)

The Employment agenda n Working for a healthier tomorrow (Black 2008) highlighted mental health growing problem for the working age population n Waiting for the mental health and employment strategy promised Spring 2009 n Welfare Reform Bill (Stafford 2009)

The Employment agenda n Mental Health and Work (RCP 2008) n Individual Placement support versus pre work skills training n Work matters- Vocational navigation for occupational therapy staff (COT 2008 a) n Vocational Rehabilitation Strategy (COT 2008 b) n Recession

NICE guidelines n Occupational therapy and physical activity interventions to promote the mental well being of older people in primary and residential care (NICE 2008) n Research evidence base n Five study days to support implementation of guidance (Lawson Porter 2008)

NICE guidelines n Older people and their carers should be offered regular group and /or individual sessions to encourage older people to identify, construct, rehearse and carry out daily routines and activities n Occupational therapists should be involved in the design and development of local relevant training schemes for those working with older people to include essential knowledge of occupational therapy principles and methods

Mental Health Act (2007) n Came into force November 2008 n New roles now open to occupational therapists (Carr and Smyth 2008) n Approved Mental Health Professional (AMHP) n Responsible Clinician (RC) n Best Interests Assessor (under amendments to the Mental Capacity Act 2005)

So over the past two years… n A time for endings n A time for beginnings n Shifting emphasis

Valuing Occupation n A healthy human being is a healthy human doing n Mental health spectrum and mental well being n Employment agenda -Work is good for you n Darzi -Prevention

Valuing occupation n Using occupational language explain with confidence the meaning of occupation and its relationship to recovery and well being. n Developing an agreed occupational language and then auditing care plans, integrated notes, reports and letters

Valuing occupation n Opportunities – embracing the social model in mental health n Occupation and Health; A review of selected literature (Creek and Hughes 2008) n Challenge – how much is occupation really valued in relation to mental health among competing priorities?

The added value of occupational therapy n Selling what we have to offer n NICE guidelines n Payment by Results

The added value of occupational therapy n Build pathways of care that highlight what service users can expect of their occupational therapy intervention. n Following pathways devised by the London Professional OT leads about occupational therapy specific roles: adult inpatient; community; older people; forensic; rehabilitation; employment –disseminated later in 2009 (Morley 2009)

The added value of occupational therapy n Opportunities –DH interest in the employment pathway n Challenges - Differentiate between the added value of an occupational therapist and occupational therapy

Occupational therapy leadership n Leading occupational therapy into the future n Darzi – all AHPs developing leadership

Occupational therapy leadership n Secure representation on government working parties, committees and other groups that develop or influence policy in mental health. n Meetings with Ivan Lewis, Phil Hope, Louis Appleby, Professor Dinesh Bhugra, Lord Adebowale, Steve Shrub n COT leadership conference, seminars and a toolkit

Occupational therapy leadership n COT increased political activism –Public Affairs Officer attendance at the three party political conferences –jointly hosted round table discussions with MPs with Sainsbury Centre for Mental Health about vocational rehabilitation (COT 2009) n Early day motion tabled in the house of Commons during OT Week 2008 signed by 60 MPs including Vince Cable (Christie 2009)

Occupational therapy leadership n Opportunities – locally and nationally. Trusts using Recovering Ordinary Lives to develop local strategies to lead the profession. n Challenges – reducing numbers of leadership posts

Education and training n Pre and post registration training about mental health n Develop research capacity n NICE guidelines n Post graduate training for the new roles (NIMHE 2008)

Education and training n COT conducted a mapping exercise of Higher Education Institutes programmes against Recovering Ordinary Lives at end of 2008 reveals most institutions are working well towards all the education and training factors

Education and training n Seek to develop and take the lead in con n n ordinated programmes of research Research Centre for Occupation and Mental Health (RCOMH) currently has three research streams: Occupation and people with psychosis in the community Work for mental health and well being Boredom www. yorksj. ac. uk

Education and training n Opportunities – RCOMH allows people to work together n Challenges – Is there enough occupational therapy specific post –grad training?

Workforce development n Where and how many? n Framing the contribution of AHPs –access n Employment agenda –Not enough support for mentally ill to work due to shortage of skilled OTs in vocational rehabilitation, The Guardian, 8 th December 2008 n NICE guidelines n New roles under the Mental Health Act

Workforce development n Take an overview of the skills mix across services and consider where occupational therapists might have the most impact in meeting service user need. n Occupational therapists working shifts on wards (Stopher 2009) n BAOT insurance cover for the new roles n Self assessment audit tools

Workforce development n Opportunities – we have lots to offer n Challenges – do we have too much too offer?

Summary n Current local and national positioning of Recovering Ordinary Lives n Practical examples of the strategy’s impact n Opportunities and challenges n Genevieve. Smyth@cot. co. uk n 0207 450 5220

References n Appleby L (2008) Mental health ten years on - Progress on n n mental health care reform. Available at: www. dh. gov. uk/en/Publicationsandstatistics/Publications/Public ations. Policy. And. Guidance/DH_074241 Black C (2008) Working for a healthier tomorrow. Available at www. workingforhealth. gov. uk Carr J, Smyth G (2008) New roles –are you ready? Occupational Therapy News, 16(11), 24 -25. Christie D (2009) Early motion success. Occupational Therapy News, 17(1), 11. COT (2006) Recovering Ordinary Lives. The strategy of occupational therapy in mental health services 2007 -2017. London, COT.

References n COT (2008 a) Work matters –Vocational navigation for n n occupational therapy staff. London, COT (2008 b) Vocational Rehabilitation Strategy. London, COT (2009) Annual Review 2007 -2008. Occupational Therapy News, 17(1), 10. Creek J, Hughes A (2008) Occupation and health: a review of selected literature. British Journal of Occupational Therapy, 71(11), 456 -468. CSIP/NIMHE (2008) Enhance, include, evolve. New Ways of Working for Allied Health Professionals. Available at: www. newwaysofworking. org. uk

References n DH (2007) Capabilities for inclusive practice. London, DH. Available at: www. dh. gov. uk/en/Publicationsandstatistics/Publications/Public ations. Policy. And. Guidance/DH_078095 n DH (2008 a) High Quality Care for all –Next stage review. Available at: www. dh. gov. uk/en/publicationsandstatistics/publications/publicat ionspolicyandguidance/DH_085825 n DH (2008 b) Framing the contribution of Allied Health Professionals. Available at: www. dh. gov. uk/en/Publicationsandstatistics/Publications/Public ations. Policy. And. Guidance/DH_089513

References n Lawson Porter A (2008) OT and physical activity interventions. n n Occupational Therapy News, 16(12), 15. Morley M (2009) Pathways in mental health. Occupational Therapy News, 17(1), 31. NICE (2008) Occupational therapy interventions and physical activity interventions to promote the mental well being of older people in primary care and residential care. Available at: www. nice. org. uk/PH 16 NIMHE (2008) Mental Health Act 2007 New Roles. Available at www. mhact. csip. org. uk Royal College of Psychiatrists (2008) Mental health and work. Available at www. rcpsych. ac. uk

References n n Smyth G (2008) Payment by results for mental health and learning disabilities. Occupational Therapy News, 16(12), 9. Stafford G (2009) The health and welfare reform bills. Occupational Therapy News, 17(1), 6. Stopher R (2009) Reflections on a pilot post. Occupational Therapy News, 17(1), 11. The Future Vision Coalition (2008) A new vision for mental health discussion paper. Available at: www. newvisionformentalhealth. org. uk