Recovery: A debate about what constitutes an outcome, who decides, and who takes the credit Assoc. Prof. Lindsay G Oades Australian Institute of Business Wellbeing 1800s Century of Separation Aradale Asylum Ararat, Victoria 1900s Century of Treatment Medication treatment for symptoms, some rehabilitation and closure of asylums, commencement of early interventions The recovery movement in mental health has led to mainstream policy across the English speaking world. With the development of policy calling for recovery oriented service provision, the inevitable questions have arisen: What is recovery? How do we develop recovery oriented services? How do we measure recovery? The recovery movement has presented a Zen Koan to mental health services, in which seemingly illogical debates occur about focussing on a process or focussing on an outcome, in which each logically require the other. This leads to a transitional discourse, in which those linked to mental health ponder more deeply about what is required of standard services to support personal strivings i.e. what are recovery oriented services? Like a Zen Koan, the practice of contemplating a question or statement, the answer to which transcends dualistic thinking, the recovery movement has helped us see beyond dualistic thinking, either of the need for outcomes, for health managers and longitudinal studies, and the need for process, for consumers to have their experiences heard Seemingly Illogical Questions There are different types of koans. One type takes the form of a seemingly illogical question used by a master to teach or test his students. "What was your face like before you were born?" and "What is the sound of clapping with one hand?" are two classic examples. Is recovery an outcome, or a process? How do you do recovery? How do people recovery with symptoms? With the majority of outcome measures in Australian mental health services focussing on symptoms and functioning, several stakeholders have argued for the necessity of a recovery outcome measure. Conversely, many consumers argue that recovery is a personal process, and should not be reduced to an outcome measure. Recovery is a debate about what constitutes knowledge Knowing That- declarative knowledge, science Knowing From- experiential knowledge, lived experience Knowing How- procedural knowledge, practice They can however live side by side PWB, SWB HoNOS, LSP, K10 DECREASE SYMPTOMS/ UNWANTED BEHAVIOUR (EXPENSE) 1 PREVENT SYMPTOMS/ UNWANTED BEHAVIOUR (INSURE) 2 PROMOTE WELLBEING & STRENGTHS (INVEST) 4 INCREASE WELLBEING (INCOME) 3 PRESENTFUTURE AVOID (ILLNESS) APPROACH (WELLBEING) Whilst consumers need to be involved in the development and rating of outcomes, outcome measures should remain measures of wellbeing- a well established science, with constructs such as hope, meaning, identity, empowerment and connectedness as indicators. Levels of wellbeing can be made into target outcomes (the distance you have travelled north). We should use established quantitative measures of wellbeing e.g. hope, meaning, identity, autonomy to measure aspects of recovery outcomes and personalised goal attainment measures as outcomes. Similarities between Psychological Wellbeing and Processes of Personal Recovery Psychological Wellbeing Self Acceptance (Being) Quality Ties (Belonging) Autonomy Environmental Mastery Personal Growth (Becoming) Personal Recovery Identity (Being) Connectedness (Belonging) Responsibility Meaning Hope (Goals) (Becoming) This however is different from idiographic processes, often analogous to a journey or path taken, and certainly subjective, which remains an ongoing direction (you wish to continue travelling north). We should use qualitative measures to explore the recovery process/journey Who takes the credit for progress? Outcome of what? Consumer Carer Staff Service Medication Beware of outcome measures designed to attribute change to things outside of the consumer- are they truly recovery oriented? If the consumer is an autonomous agent, they chose things from their environment! In summary Recovery is a seemingly illogical discourse (Zen Koan) that requires us to consider two processes of moving away from illness and moving towards wellbeing at the same time. This dual process requires two types of measures (those that measure wellbeing increases, and those that measure symptom/dysfunction reduction). Established measures can do this. This should not be confused with personalised process narratives and individualised goal attainment measures. Recovery is a transitional discourse- its brought hope, approach motivation, consumer ownership- it is not the end point of service reform Beware of attribution bias of outcome measures