PROMOTING RECOVERY WORKING WITH COMPLEX NEEDS

An increasing number of people in this group also have problems with substance misuse, often resulting in contact with the criminal justice system. These problems often interact and can appear intractable. Recent years have seen a paradigm shift in mental health, from a focus on illness and disability towards the promotion of recovery and social inclusion (Repper and Perkins, 2003). Underpinned by a stress vulnerability model of mental health problems (Zubin and Spring, 2004, 105. Nuechterlein, 2004, 300), a range of psychosocial interventions (PSI) can be used to enable service users to build on strengths and develop skills in order to manage their own mental health more effectively. This in turn can facilitate attainment by service users of socially valued roles and relationships taken for granted by most people. One of the available interventions is a structured approach to the prevention of relapse, developed by Birchwood and colleagues (Birchwood et al, 2000, 5), building on the early work of Herz and Melville (2006) and Birchwood himself (Birchwood et al, 2000, 652). This work had demonstrated that it was possible to predict relapse in psychosis on the basis of recognition of early warning signs. The intervention incorporates a strong educative element. This aims to increase understanding of the typically episodic nature of psychosis and to enhance service users’ self-efficacy in relation to the management of their mental health. A Cochrane Review (Pekkala and Merinder, 2002) concluded that psychological education significantly reduces relapse rates, increases compliance with medication, and may have a positive effect on a person’s well being. To deliver the relapse prevention intervention effectively calls for the use of a set of specialist knowledge and skills, in addition to general mental health nursing skills. Aims Our primary aim was to enhance the quality of service provided to users of the inpatient areas of the local mental health rehabilitation service by making the relapse prevention intervention available routinely and sustainably. An essential interim aim was to equip the multidisciplinary team with the knowledge, skills and confidence required to deliver the intervention effectively. To address these aims and evaluate whether they were achieved, we developed a project plan in six stages. In the event, workers from community settings also sought out the training, and so the original scope of the project was broadened to include all areas of the mental health rehabilitation service. This paper will focus on the aspects of the project relating to service users. Intervention The project was jointly led by the clinical nurse leader of the mental health rehabilitation services and a lecturer practitioner. At the outset we sought guidance from the Trust’s research and development coordinator as to whether we should seek ethical approval for our planned project. The advice received was that the project represented service audit/evaluation rather than research and, as such, ethical approval was not required. We began by attending clinical meetings at which we described our plans and encouraged discussion and questions by the multidisciplinary team. We refined a previously developed two-day training programme in order to meet the needs of a multidisciplinary group