Citation du jour.

Occupational Engagement in Mental Health Recovery.

One of the major challenges I have to try an overcome at work is motivating the individuals whom I work with to engage in their recovery process. Individuals who have enduring mental health conditions often lack motivation and the drive to effectively move forward in their rehabilitation.

After discussing with the head OT where I work about how I could best motivate the service users on my ward to engage more in occupations and activities, we began to speak about the different stages of recovery for individuals. When thinking about recovery it is crucial to apply a client centred approach to formulating treatment plans. There is no one size fits all solution to recovery in Mental Health and so a knowledge of the different stages and ideas surrounding the recovery process can aid OTs and other health professionals in gaining a greater understanding of the needs of their service users.

A recent article published in the Canadian Journal of Occupational Therapy (June 2012, 79(3), pp.142-150) explores different stages in occupational engagement in Mental Health Recovery. I found the article an interesting read and it certainly helped me understand more about the process of engagement in recovery and has developed the way in which I am going to formulate treatment plans for my service users in the future.

This blog post is going to be a brief discussion about the article.

“A phenomenological study of occupational engagement in recovery from mental illness.”  

Sutton, D.J., Hocking, C.S., and Smythe, L.A. (2012).

The purpose of this article was to explore the experience and meaning of occupation for thirteen people who self-identified as being in recovery from mental illness. Recovery narratives were collected from participants in conversational interviews that were recorded and transcribed. These transcripts were then analysed and the finders were as follows:

·         A range of experiences were evident in the recovery narratives and these have led to implications for practice being that all forms of occupational engagement, from disengagement to full engagement can be meaningful in the recovery process. The article calls for therapists to understand these different modes of engagement in order to support their service users through recovery.

The findings of the article were most interesting. The authors explained how a range of occupational experiences emerged from the participants stories. Four points in the recovery continuum of engagement were proposed, there are; disengagement, partial engagement, everyday engagement and full engagement. Each of these were characterised by particular dynamics and each have the potential to support service user’s recovery.  Below is a brief summary of the four points.

Disengagement

This is the stage where individuals completely disengage or cut themselves off from everyday occupations. Individuals in this stage described themselves as feeling numb and having lost all intentionality for being in the world. During this point the absence of routine occupations and everyday living can cause a potential loss of meaning and sense of self. This point in an individual’s recovery can act as a kind of asylum which protects the individual from the demands of the outside world. Stripping back everyday existence and disconnecting from routine occupations can create space for individuals to gain a fresh perspective and reconnect with their volitional foundations of everyday life.

Partial Engagement.

This is the stage where individuals could not engage themselves full in the everyday world however could connect in some way with the immediate world around them. Individuals in this stage often express it as a slow process which provides a grounding for them in the future. Partial engagement ideally creates a space of respite where individuals can gradually get back in touch with the everyday world by slowly engaging more in occupations. The process of occupations in this stage are more about the process than the enjoyment or outcome.

Everyday engagement

This is the stage where individuals enter everyday engagement which involves having direction and increased commitment, meeting expectations and synchronising with others space and time. It is about individuals learning how to be a part of something shared and engage more in community and social situations.

Full Engagement

This is the stage which sees individuals create a sense of flow through deep engagement in meaningful occupations. It is characterised by focused attention, great enjoyment and integration of the individual with their environment.

I feel that from having an understanding of these four points in recovery and recognising that individuals dwell in them at specific and often varying times can help therapists when planning their treatment plans for service users. I particularly like the first stage mentioned, disengagement, this is a stage which I see often with my service users and this article has provided me with a new way of looking at their current place in their recovery process. Before reading this article I had not viewed disengagement and the characteristics of this as being a very positive stage and struggled with knowing where to start really with my service users in this stage. This article has given me a deeper understanding of disengagement in the recovery process and how it can be looked on a positive part of the process and therefore how it can be a springboard for individuals to more onto a more functional area of occupational engagement.

Having a picture of the four stages of occupational engagement in the back of my mind when thinking about my service users, I feel, will help me to formulate both individual and group activities and opportunities on my ward. I am looking forward to returning to work tomorrow and thinking more about these stages and how I can incorporate some of the ideas which the article explored in my practice.

Happy OTuesday!

Kate.

Reference:

Sutton, D.J., Hocking, C.S., and Smythe, L.A. (2012). A phenomenological study of occupational engagement in recovery from mental illness. Canadian Journal of Occupational Therapy, 79, 142-150, doi: 10.2182/cjot.2012.79.3.3

First eight months as an OT.

About eight months ago I started my first job as an Occupational Therapist, working in a Medium Secure unit for mentally disordered offenders. This was the area which I had wanted to work in since completing my final and role emerging placement in a Male Cat C. Prison. 

After waiting three months from accepting the position to starting the job I was both incredibly excited and also nervous about starting. I had had to move away from home to a new county where I didn't know anyone so that was also another added change. The first few weeks at work were an induction as the unit I would be working in was brand new, meaning, new staff and a new service to run..and I soon found out, I would be running my own 15 bed Male Assessment and High Dependency Ward.

The past eight months have included copious amounts of challenges which I have had to overcome as well as many successes and rewarding moments. From speaking to other newly grad. OT's in a variety of settings it was reassuring to see similarities and know that it wasn't just me struggling at times. My hope from this post is to share with you my top 5 main challenges/reflections from my past eight months at work in the hope that it can not only inform but also reassure others in similar positions that they are not alone and to 'Keep Calm and Shine On.'

1. It's OK not to know everything! - Probably the most important lesson which I have learnt over the past eight months is that it is OK not to know everything. I have learnt an incredible amount about OT and about my identity as a practitioner simply by working and developing my skills as and when situations arise. Being able to bounce ideas off other OTs and other professionals is also a great way of fine tuning skills and increasing your competence as a professional. I had to learn that it is OK to be unsure about some things and to get second opinions and advice from others - it is so important to work as a team! Don't be shy about asking for help. It doesn't make you weak, it only means you are wise. 
2. Utilise Clinical Supervision! - Probably the most helpful tip I could give is for newly grads. to really take their supervision seriously and to make the most of it. I find that in my job I am so busy all the time that I rarely have the time to just sit back an think and plan what I am doing with my residents. I often found (and still find if I'm being honest) that I spent a lot of time outside of work planning and thinking about my intervention plans and strategies for my ward. One really valuable part of supervision for me is being able to discuss my plans and the progress of my work with my supervisor who, as a senior OT, can give me the advice and support that I need to increase my skills and effective practice. Supervision is also a good time to be able to talk things through and to get situations out of your mind and problems solved. Working within the Forensic settings means working regularly with challenging behaviours, unpleasant and upsetting circumstances for example assaults and restraints. Being able to have a space and time set aside to talk about the effects of these situations is vital to be able to maintain a professional manner whilst at work and not allowing circumstances to affect you personally. Finally another point to make about supervision is that it is a brilliant time to receive reassurance and praise that what you are doing is actually good and making a difference. 
3. Age! One challenge which I didn't anticipate meeting was the way I was perceived and treated by some members of both staff and residents due to my age. Being young for some of the staff caused them to treat me like a child and I felt like I wasn't taken seriously or treated the same as the other Band 5 staff members I was working with, also some of the residents have found/find it hard to be much older than a staff member. I found that simple steps such as dressing smart, acting maturely and being able to maintain a professional manner and stick to your personal and professional boundaries has been crucial in proving that just because I am only 22 I can still perform my job to a high standard.   It takes time, but eventual once people get to know you, age won't matter. 
4. Working in a secure setting! Working in a secure setting with policies and procedures to follow. I started the job and had so many ideas which I arrived with and thought of within the first few months. Working in a secure setting however comes with barriers and limitations and interventions and ideas which would have worked perfectly in another environments are no longer suitable. A big learning curve for me was in having to problem solve and be flexible in altering ideas and interventions which could be carried out in the secure setting. It has been, and still is, a test of my creativity and perseverance however I feel will make me a stronger and more adaptable OT in the future.
5. Working in today's economic climate! I don't need to inform anyone of the tough economic times which we are having to live and work in. The NHS is having to make cut backs and tighten up on areas such as spending and resources. For me this has directly resulted in budget cutbacks and a radical change in shift patterns for staff. Having to contend with this has meant that my skills in prioritizing have been tested as well as having to be able to reorganize and restructure activity programs and adjust to working new hours. However despite the challenge I have been able to adjust to the changes and still run a structured and purposeful activity program on my ward. Despite the cutbacks which the NHS are facing I believe that OTs and other professionals can still function and perform their jobs to high standards. After all being an OT takes patience, ingenuity and determination. Lets rise to the challenge and make the most out of what we have.

For me working with this group of individuals is a real privileged and the opportunities to make a difference in their lives, helping them to move forward, are endless. I am looking forward to the challenges and the successes that the next eight months, and years to come, will bring. 

Kate. 

Gordon Behind Bars – Part three.

Final episode: Tuesday 17^th July 2012

The final episode of Gordon Behind Bars showed the Bad Boys Bakery showed Gordon persuading Caffe Nero to stock the Bad Boys Bakery's lemon curd treacle slice for a 'make or break' showcase week and asking Justice Secretary Ken Clarke for vital financial backing. The show showed how with the help of a branding Guru, the prisoners themselves packaging the slices using their own personal stories and aimed the treat at the socially conscious consumer. I really liked how the prisoners were so involved in every stage of the business from their name, food production and then through to the branding and packaging. Plus the fact that the packaging revealed a bit about the project and the stories of the prisoners would hopefully help the consumers understand more about the backgrounds of prisoners and hopefully begin breaking down negative stereotypes. My favourite quote from the packaging was along the lines of ‘once a criminal, not always a criminal.’

The program also spent time following the journey of two of the ‘Bad Boy Bakers’ as they got jobs in two restaurants after release. One Gordon had found a job for in the Savoy Restaurant. Unfortunately despite the individual doing well to begin with the pressure of returning to his previous drug habits proved too much and he returned to using drugs and consequently lost his job. One of the biggest worries for the residents that I work with who are close to release or moving on surround the amount of support they will have when they leave. For someone who has perhaps spend decades or at least many years in secure environments where they are constantly living within strict rules and procedures to suddenly move back into society where there are pressures and freedom which can prove to be stressful and lead to relapse. This just highlighted to me how important it is that people leaving Prison and other similar settings need support once they are back into the community to reintegrate into society and live pro-social lifestyles.

Gordon also spoke to and showed Ken Clarke around the Bad Boys Bakery attempting to secure future funding for the project. Unfortunately funding was not secured although at the end of the program it was said that funding and support was trying to come from a social enterprise.

Of the twelve Bad Boy Bakers now:

2 work in restaurants.

3 are looking for work.

4 have moved Prisons.

1 continues with his struggle with drugs.

2 remain in the Bad Boys Bakery with 10 new recruits.

There are two main points which I reflected on whilst watching both this episode and the series as a whole.

The first being I wondered how the celebrity endorsement of the project being fronted by Gordon Ramsey affected the overall success of the project. I don’t think that it can be overlooked how the filming of and the work of Gordon Ramsey one of the world’s most famous chefs would have promoted an instant success and positive vibe for this project. His hands on approach throughout production to market research, having contacts in the food industry and through selling the product would have undoubtedly advanced the success of Bad Boys Bakery. I don’t feel like a normal social enterprise of project which was being run in either Prison or similar setting would necessarily achieve the same success without having celebrity endorsement. I think that it is brilliant to have celebrities such as Gordon promoting such valuable vocational rehabilitation and projects however can’t help but wonder about how Prisons and other settings could attempt similar projects on their own and gain such success.

The second reflection which I had was concerned with the sustainability of the project. With Gordon only being able to support the project for six months and having him not been able to secure funding for its continuation after this I have concerns with regards to expectations and hopes of the prisoners involved. At work it is important for me to not offer services or interventions with residents which I am not able to continue through to completion. I think that it is vital that when working with individuals in secure settings and indeed throughout Occupational Therapy and health and social care settings that as professionals we are able to see work through to completion and not just provide a service before stopping within a short amount of time of before objectives have been met. I do however understand and acknowledge that projects and interventions etc. may have to stop due to unforeseen circumstances or similar reasons.

I sincerely hope that funding and support will become available for the Bad Boys Bakery and that its success and the awareness generated by the program will spur on the creation and development of other similar projects.

In my opinion vocational rehabilitation is a key part of the rehabilitation process for individuals in Prisons and other Secure Units. 

Kate

Gordon Behind Bars - Part Two.

Gordon Behind Bars. Channel Four, Episode Three: 10th July 2012. 

It was episode three of Gordon Behind Bars and yet again another interesting watch. The week saw Gordon and the Bad Boy Bakers attempt to set up a local gourmet lunch delivery service and then pitch a sweet treat snack to several major coffee shop chains.

It was clear to see throughout that the pressures of working ‘behind bars’ and adhering and running a functioning kitchen within such strict and rigid regimes and protocols was taking its toll on the Gordon and the team.

The ideal to have the team produce a high volume lunch service to local businesses is one that would have made excellent use of the facilities within the Prison and as the program explained had potential to generate just under £1million pounds a year along with providing needed vocational rehabilitation to the offenders involved. However this idea proved to be too much off a challenge considering it would require a change in routine and would equate to adding more pressure on the already overstretched Prison Staff. It is a shame that this initiative could not come to fruition however as seen in the program Gordon and the team were able to work within their limitations and find a more manageable and cost efficient product.

Plan B; a sweet lemon treacle tart which they aim to sell in a major coffee shop chain. This new product was able to be produced in higher volumes than previous ideas and was also more cost effective whilst fitting in well with the regimes which the kitchen has to work within. I was impressed with the way that Gordon was able to move on from the initial disappointment and frustration of not being able to uphold the lunch service and come up with another, more effective idea. This is something which I often find I have to do at work. It is often that within secure services new ideas and initiatives are not able to happen due to security procedures and other contributing factors. Being able to think outside of the box and work within a challenging environment to achieve the best opportunities for the residents/offenders is a pivotal skill for OTs/other professionals working in these environments to grasp. I am really looking forward to finding out in the next episode whether the Bad Boy Bakers will have found a supplier for their sweet treat.

Whilst watching the episode it was interesting to see how the public reacted to produce being sold by offenders. The majority of the public who were featured in the show were supportive of the project and brought the lunches from Gordon which I was pleasantly surprised by. However there were some who wouldn’t as they were unsure of the cleanliness of the food and the sorts of offences which the bakers had committed had a definite effect on whether people would buy the lunches or not. It was interesting although not surprising to hear the most common worry the public showed was whether or not the prisoners were sex offenders. Public perception and stigmatisation are massive challenges which need to be overcome if offenders whether in Prisons or in other facilities are truly going to be accepted back into society. I believe that a large part of rehabilitation and reducing reoffending rates stems from whether this group of socially excluded offenders are able to mix back into society, feel accepted and be supported into living pro-social lifestyles. Having projects which bring the skills and rehabilitation of this group of society into the public eye can only be a positive step in improving

Finally it was really encouraging to hear the following from one of the ‘Bad Boy Bakers’ at the end of the program:

‘...for me I believe now when I get out of jail. I believe I can be something. What Gordon’s done is he’s put that fire in people’s bellies to make people want to do something when we get out. To think yeah we can do this. I actually can do it.’

In my opinion projects like these are testament to the fact that engaging in meaningful and productive occupations aids not only the rehabilitation of offenders but also in the development of individuals as a whole.

Kate

Citation du jour.

Gordon Behind Bars - part one.

Gordon Behind Bars - Channel Four. Episodes one and two: Tuesday 26th June 2012 and Tuesday 3rd July 2012.

I took a little break from blogging so that I could concentrate on my current professional work load, however I'm back and what better way to restart the blogging than with some reflections on the new Gordon Ramsey show; 'Gordon Behind Bars'.

The documentary series follows Gordon Ramsey as he starts up and runs a catering business in Brixton Prison (a category B prison in South London) for six months. In an interview with Channel 4 Gordon said the following:

What is Gordon Behind Bars all about?This isn't just a 'let's go and cook along with Gordon in prison' thing. The idea came from the fact that there are approximately 80,000 inmates across the country now, which is a hell of a lot. It was about getting them doing something with their time, giving something back, and also getting job-ready. The biggest problem is the re-offending percentages, people just go round and round in the system.

Brixton prison homes 800 prisoners whom spend up to 21hours locked up in their cells. Prisoners have access to a variety of exercise programs and can also pursue a range of educational opportunities. By setting up a catering business inside the prison Gordon would be adding to the rehabilitative opportunities available to the inmates whilst working towards Government initiatives to get more inmates across the prison system working full time job roles. 

The first two episodes of this series saw Gordon choosing 12 prisoners to become a kitchen team able to sell produce outside of the Prison walls. Week one showed the 12 inmates decorating cupcakes to be sold within the Prison and then cooking dinner for the Prison. The challenges were raised during week two which saw the team baking produce to be sold in a pop up shop in London. 

  

As a Forensic Occupational Therapist working on a medium secure ward (for mentally disordered offenders) I have been finding the programme incredible interesting. The benefits of vocational rehabilitation and projects such as this can be excellent in providing prisoners with structure, meaningful occupations and a chance at building positive identities and roles for the future. Below are a few of my reflections on the past two episodes:

The main point which I have been thinking about during these episodes is the dynamics between security and therapy. Both in the prison and in my work setting the balance between maintaining security procedures (which are vital to uphold as you can imagine) and allowing the men to work in a therapeutic and efficient way is at times a hard balance to maintain. I try and incorporate an environmental model with regards to the relationship between therapy and security. Aiming to place security within the context of therapy, in doing so emphasising the importance of safe practice whilst providing a holistic approach to providing meaningful occupations. Security procedures and the tight structure of secure environments can play a fundamental role in creating occupational deprivation and so it is important for OTs and other key workers to maximise the occupational opportunities in a safe and effective way. Relational security is also another important factor. Relational security describes the importance and effect of developing therapeutic relationships with this client group. It is interesting looking at how important gaining a therapeutic, or working, relationship with the prisoners has been in the two episodes. I find that this is a pivotal part of the work which I do as an OT as well. Without gaining a rapport with the men I work with it is difficult to get them to open up and engage in goal setting and then interventions. I think that Gordon has demonstrated well in this programme that treating the men with respect and genuinely taking an interest in them and what they would like to achieve has helped him begin the process of forming a kitchen team in a safe and therapeutic way. 

The challenges which Gordon has faced from both the prison system and from society has made interesting viewing. Within the prison system there are staff who hold more of a security and punishment view as apposed to secure recovery, this coupled with stigmatised views of offenders and a view by some members of society that they should not be given such opportunities can be damaging to offenders and only add to the cycle of re-offending rates and lack of rehabilitation of offenders. These views can create challenging environments with projects such as this and other occupational and educational based works to successfully run and make a difference to these individuals lives. It should be noted however, that there are a great number of prison staff and members of society who hold a very rehabilitative view to secure recovery and it was encouraging to see the attitudes of members of the public who brought products from the pop up shop. 

Finally the past two episodes have also highlighted to me how even little successes can build self confidence. As the men in the program were shown increasing their skills and producing baked goods you could see their self esteem and confidence growing. This is also something which I have witnessed at work. The pride and hope which can be gained from little accomplishments should not be overlooked by professional working with this client group. This in particular, I feel is where OTs are able to utilise goal setting and grading and adaption techniques to help these individuals to accomplish great things through the completion of little successes. 

The programs have both been really interesting and I'm looking forward to seeing how the series develops, if you haven't already been watching I encourage you to do so. They are available in the UK at the following link: http://www.channel4.com/programmes/gordon-behind-bars/4od . I will continue to blog about the series as the weeks go by so keep your eyes peeled! 

Kate :)