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

Recovering Ordinary Lives –Two Years on

Genevieve Smyth

College of Occupational Therapists

12th February 2009

Introduction

Recovering Ordinary Lives launch December 2006 (COT 2006)

Current context Themes and key messages –update Challenges and opportunities

Launch of Recovering Ordinary Lives Launch with HRH Culmination of 18 months of work Aimed to: Raise the profile of occupational therapy

in mental health Develop professional leadership Promote occupation and its relationship

to mental health and well being

Recovering Ordinary Lives documents Recovering Ordinary Lives. The

strategy for occupational therapy in mental health services 2007-2017. A vision for the next ten years.

Recovering Ordinary Lives –literature review

Recovering Ordinary Lives –results of service user and care focus groups

The Vision

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

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

Key messages for:

Occupational therapy practitioners Occupational therapy managers College of occupational therapists Occupational therapy educators Commissioners of mental health

services Occupational therapy researchers

Current context

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

Closing DH work streams

Embedded in NHS culture Enhance, include, evolve: New Ways of

Working for the Allied Health Professionals (CSIP/NIMHE 2008)

National Social Inclusion Programme –occupational therapy secondment:

Capabilities for inclusive practice (DH 2007)

Closing DH work streams

End of the Mental Health National Services 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

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

Closing DH work streams

A New Vision for Mental Health discussion 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

Next stage Review final Report –High quality care for all (DH 2008a).

The Health Bill (Stafford 2009) Framing the contribution of AHPs (DH 2008b)

data collection, ease of access, improve quality, piloting personal budgets

Foundation trusts Payment by Results (Smyth 2008)

The Employment agenda

Working for a healthier tomorrow (Black 2008) highlighted mental health growing problem for the working age population

Waiting for the mental health and employment strategy promised Spring 2009

Welfare Reform Bill (Stafford 2009)

The Employment agenda

Mental Health and Work (RCP 2008) Individual Placement support versus pre

work skills training Work matters- Vocational navigation for

occupational therapy staff (COT 2008a) Vocational Rehabilitation Strategy (COT

2008b) Recession

NICE guidelines

Occupational therapy and physical activity interventions to promote the mental well being of older people in primary and residential care (NICE 2008)

Research evidence base Five study days to support implementation of

guidance (Lawson Porter 2008)

NICE guidelines

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

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)

Came into force November 2008 New roles now open to occupational

therapists (Carr and Smyth 2008) Approved Mental Health Professional (AMHP) Responsible Clinician (RC) Best Interests Assessor (under amendments

to the Mental Capacity Act 2005)

So over the past two years…

A time for endings A time for beginnings Shifting emphasis

Valuing Occupation

A healthy human being is a healthy human doing

Mental health spectrum and mental well being

Employment agenda -Work is good for you

Darzi -Prevention

Valuing occupation

Using occupational language explain with confidence the meaning of occupation and its relationship to recovery and well being.

Developing an agreed occupational language and then auditing care plans, integrated notes, reports and letters

Valuing occupation

Opportunities – embracing the social model in mental health

Occupation and Health; A review of selected literature (Creek and Hughes 2008)

Challenge – how much is occupation really valued in relation to mental health among competing priorities?

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

The added value of occupational therapy Build pathways of care that highlight what

service users can expect of their occupational therapy intervention.

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 Opportunities –DH interest in the

employment pathway

Challenges - Differentiate between the added value of an occupational therapist and occupational therapy

Occupational therapy leadership Leading occupational therapy into the

future Darzi – all AHPs developing leadership

Occupational therapy leadership Secure representation on government

working parties, committees and other groups that develop or influence policy in mental health.

Meetings with Ivan Lewis, Phil Hope, Louis Appleby, Professor Dinesh Bhugra, Lord Adebowale, Steve Shrub

COT leadership conference, seminars and a toolkit

Occupational therapy leadership 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)

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 Opportunities – locally and nationally.

Trusts using Recovering Ordinary Lives to develop local strategies to lead the profession.

Challenges – reducing numbers of leadership posts

Education and training

Pre and post registration training about mental health

Develop research capacity NICE guidelines Post graduate training for the new roles

(NIMHE 2008)

Education and training

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

Seek to develop and take the lead in co-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

Opportunities – RCOMH allows people to work together

Challenges – Is there enough occupational therapy specific post –grad training?

Workforce development

Where and how many? Framing the contribution of AHPs –access Employment agenda –Not enough support for

mentally ill to work due to shortage of skilled OTs in vocational rehabilitation, The Guardian, 8th December 2008

NICE guidelines New roles under the Mental Health Act

Workforce development

Take an overview of the skills mix across services and consider where occupational therapists might have the most impact in meeting service user need.

Occupational therapists working shifts on wards (Stopher 2009)

BAOT insurance cover for the new roles Self assessment audit tools

Workforce development

Opportunities – we have lots to offer

Challenges – do we have too much too offer?

Summary

Current local and national positioning of Recovering Ordinary Lives

Practical examples of the strategy’s impact

Opportunities and challenges [email protected] 0207 450 5220

References

Appleby L (2008) Mental health ten years on - Progress on mental health care reform. Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/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

COT (2008a) Work matters –Vocational navigation for occupational therapy staff. London, COT.

COT (2008b) Vocational Rehabilitation Strategy. London, COT. 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

DH (2007) Capabilities for inclusive practice. London, DH. Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_078095

DH (2008a) High Quality Care for all –Next stage review. Available at: www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/DH_085825

DH (2008b) Framing the contribution of Allied Health Professionals. Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089513

References

Lawson Porter A (2008) OT and physical activity interventions. 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/PH16

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

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