E1142Mental Health6 Recovery oriented services and relationships6.2 Delivering service is a recovery-oriented framework6.2.4 Supporting consumers through challengesThe road to recovery is a very individual path of unknown geography and duration. There may bemany changes during the process which require coping skills from the consumer as well as theworker. As mentioned before, recovery plans need to be reflective of the true nature of recoverywhich can be a complex and difficult process.Challenges and barriers are normal aspects of the recovery process and it is important to beclear about this when communicating with consumers. Much like lapses are a normal part ofrecovery from problematic AOD use, challenges and potential setbacks will occur as part ofrecovery from mental illness. Workers should include discussion about challenges and barriersinto planning for recovery and respond proactively to potential obstacles, challenges and barriersthat arise, working with the consumer to identify ways to proceed and to reduce the likelihood ofoccurrence.There are many ways which might allow for potential barriers and obstacles to be worked with.The key task for workers is to introduce challenges and barriers as one aspect of recovery, asthis will form a basis for coping with the challenges if and when it arises, rather than putting inThere is only one thing that can be said about recovery as a universal statement: the roadto recovery is never entirely smooth, and there will be bumps in the road. “question the whole process of recovery. This allows workers to embrace one of the key values ofrecovery-oriented practice which is to inspire and “hold hope’ for the consumer. Talking openlyabout challenges and potential barriers also allows for mitigating strategies to be built into therecovery plan. One mitigation strategy is the development of personal wellness plans, risk plans, crisisplans, self-care plans or relapse plans etc. These plans might have different names butoverlap in nature as they all offer practical strategies to deal with challenges that arise.Wellness plans often have a more preventative focus, offering activities and tools which enhancethe well-being of the person and thus reduce the risk of crises arising. Activities such asmeditation, sports, connecting with friends, seeking the support of family etc. can become part ofa wellness toolbox which is then at the disposal of the person.Another aspect of wellness plans can be more centred around internal resources, such asawareness of internal stress, triggers and general signs of being unwell. Wellness plans thenoutline practical plans on what to do if and when the consumer identifies that they are stressed,triggered or unwell. This can include stress management techniques, grounding exercises andtools to manage anxiety, but also contact numbers and names of support people in theprofessional and/or personal circle of care.Wellness plans can also take on a more creative format such a ‘wellness toolbox’. Whereas thisdescription can also be used to refer to a more accessible version of a wellness plan, workerscan also support consumers in creating an actual wellness toolbox.This box can include little items that are symbolic of specific strengths and resources theconsumer has, as well as suggestions of self-care activities, contact details of supportive peopleand positive affirmations. Not all consumers will be open to such an activity, but this activity canoffer a slightly different way of creating a wellness plan which incorporates meanings andreferences from the consumer’s life. It can also be a viable alternative if consumers are finding itdifficult to work with written documents, such as wellness plans, as it allows for a morekinaesthetic approach to recovery planning.A crisis plan is especially important for people who are at risk of experiencing mental healthcrises, such as self-harm, suicide ideation or other behaviours which can have a potentially very| Topic – 2 / 11© Open Colleges Pty Ltd, 2020.harmful impact on the person. Crisis plans usually do not include “preventative measures”, butclearly outline strategies of what to do if the person experiences signs and symptoms whichcould signal the beginning of a crisis. Usually, these strategies need to involve seeking help,especially when the situation has gone past a certain point. Emergency measures can includecontact with support workers, 24-hour phone services or, if the risk is extreme, accessing theemergency services.Asking a person about suicide ideation and self-harm can be challenging, but it is important forworkers to address these issues as part of the assessment process. As an exploration of thistopic can be a highly personal and sensitive nature, it is essential to have a strong workingrelationship in place before honest conversation is possible. The same is true for any negativeimpact and triggers relating to trauma, especially complex trauma. Many consumers willexperience flashbacks and strong emotions as part of their dealing with their traumabackground and this can lead some of them into crisis. This means that triggers and posttraumatic stress can be and should be part of crisis planning, but this is again only possible on thebasis of a strong relationship and the establishment of safety.Relapse plans are another important feature of recovery planning. As already explored in othermodules of this course, many people living with mental illness are also affected by AOD use andare experiencing dual (and sometimes multiple) recovery processes. Supporting people withmultiple and complex means working in a holistic way, addressing both issues of mental healthrecovery and AOD use.Depending on context, some relapse plans might however also extend to mental health, astriggers to use AOD are usually deeply rooted in experiences related to mental illness (e.g.anxiety, depression, PTSD etc.).There are no clear rules of how to document a relapse plan, so it is up to the worker to negotiatewith the consumer what works best. Rather than having several different plans, it might be easierand more practical for the consumer to have one plan in place which also extends to AOD use andA comprehensive relapse prevention plan accounts for social interactions, emotionaltriggers and the development of positive coping mechanismsWagner et al., n.d. “| Topic – 3 / 11© Open Colleges Pty Ltd, 2020.sees relapse in a more holistic framework, including physical, emotional and mental relapse (addictionsandrecovery.org[http://www.addictionsandrecovery.org/relapse-prevention.htm]).There are also many options of how to do contingency planning, workers can explore withconsumers how to meet their needs and then go through a process of trial and error to find outwhat works best for the person. The only important thing in this process is to work proactivelytowards managing barriers and obstacles, rather than having to deal with them as they arise, asthe risk of damage is much higher in this case.Some consumers might however not be open to putting a “formal” contingency plan in place, but itis still important for workers to remain empathic towards the person’s needs and create spacewithin the working relationship where these issues and management strategies can be discussedin an open and conducive way.Activity 42616Wellness planThiswellness plan template[https://opencolleges.sharepoint.com/:b:/s/OS/ETiodYIxFsZIgwuFaw4h3AEB42PjHVSnaWAe-Bb9lOCMDg?e=iICyjO]has been developed by an organization of peer workers in the UK. This is one way of conductingwellness planning. Remember, it might be important to check in with the consumer what worksbest when it comes to wellness planning.Think of a person you have met who was recovering from mental illness. Complete the templateprovided above to see how the process might work for you.If possible, you could even do this activity with a person at your work or on your placement. Also,try and think of other ways you might be able to undertake wellness planning to meet theindividual needs of the consumer.ACTIVITY 42616 TYPE Contribute| Topic – 4 / 11© Open Colleges Pty Ltd, 2020.SCENARIO Wellness plan Reading 42620Crisis planThis isone example[http://www.maine.gov/dhhs/samhs/mentalhealth/rights-legal/crisis-plan/crisis-instructions.pdf]of crisis plans which are commonly used in the recovery planning process.HintsThe meaning and perception of crisis can be different from person to person which should bereflected in the crisis plan.ACTIVITY 42620 TYPE ReadingSCENARIO Crisis plan Last but not least, it is important to mention that some crises can be expressed as challengingbehaviour from the consumer. This can be a personal and professional challenge for workers, asthey should maintain an empathic, supportive and hope-inspiring approach at all times and seechallenges as sources for learning, both for the consumer and themselves. Workers also need tobe able to respond promptly and positively to consumers in distress or crisis, even if the personis not cooperative at the time.Consumers can experience high levels of anxiety as part of their experience with mental illness,especially if they have a background of complex trauma. This anxiety is often not recognized andcan cause the person to respond in a defensive and aggressive manner, as they perceive theworld around them as unsafe and threatening.| Topic – 5 / 11© Open Colleges Pty Ltd, 2020.Aggressive and other challenging behaviours can represent a huge challenge to services andworkers, as there is an issue of safety for all involved. At the same time, there is a need to remainas supportive as possible and to avoid responses of a punitive nature whilst not taking awayresponsibility from the consumer. The main aim for workers is to connect consumers withsources of support, including the required services, which is especially difficult of the person isnot able to maintain a safe relationship with others at the time of crisis. Workers shouldcommunicate the highest level of empathy to the person while attempting to de-escalate potentialincidents and promoting safety for all involved, including themselves.Best practice in cases of escalation should be:| Topic – 6 / 11© Open Colleges Pty Ltd, 2020.Keep calmUse active listening to find out what the problem isAcknowledge the concerns/emotions of the client whether you agree with them or not(validation)Use positive language and avoid negative languageLet them know you want to help themLet them know the consequences of their behaviour if it continues or escalatesSeek help from co-workers or the consumer’s family/friendsFollow your organisation’s proceduresClear the space as much as possible (make it as safe as possible)Remove others from the scene (danger)Speak to the client in a clear, non-provocative mannerGive the person enough personal space/maintain a safe distanceUse voice and eye contact to attempt to maintain the balanceUse diversion if possible – a change of focus, distraction or an interruption to a train ofthoughtContact/Inform other staff as soon as possible (duress alarm)Call emergency response teams if needed (e.g. police, ambulance, mental health responseteams)Source: University of Tasmania, n.d.Contacting emergency services should be used as a last straw only if all other de-escalationstrategies have failed, it is important to acknowledge that this step is unavoidable at times.As stated above, safety should be at the heart of all considerations, and this refers to thephysical, emotional and psychological safety of everyone involved. It is also important toacknowledge that consumers with a heightened state of arousal can not only be a danger toothers but also to themselves, and it is crucial to get the necessary support in place, even if this| Topic – 7 / 11© Open Colleges Pty Ltd, 2020.means to make involuntary referrals.Supporting people through challenges and crises can also take a strong emotional toll onworkers. It is thus very important to also look after the emotional safety of professionals and topractice sufficient self-care. Managing escalation and crisis is not a solo-job, but is best done incooperation with colleagues and supervisors. Debriefing and self care after the incident areequally important to providing safety during times of crisis.Some workplaces fully acknowledge the risk for staff and offer wellness toolboxes for bothconsumers and staff. Workers can also look at creating their own wellness plan to make sure thatthey are safe and in the best position to provide recovery-oriented services to consumers.Flipping the lid!Watch neurological scientist Dr Dar Siegel explain how some escalations may come about. It’s allabout the brain![https://youtube.com/watch?v=gm9CIJ74Oxw]Note: Understanding can be the to empathy.| Topic – 8 / 11© Open Colleges Pty Ltd, 2020.Activity 42647Managing escalationThispresentation[http://www.utas.edu.au/__data/assets/pdf_file/0006/528045/Managing-Challenging-Behaviours-slides.pdf]contains very useful information about managing challenging behaviours in the context of a mentalhealth crisis.HintsStaying calm is the most important skill when attempting to manage crisis.ACTIVITY 42647 TYPE ResourceSCENARIO Managing escalation | Topic – 9 / 11© Open Colleges Pty Ltd, 2020. SELF-CHECK 42648Working towards recoveryWhat is a ‘Release of Information document’?Provide a definition of informed consent.Name some of the plans that can be part of a recovery plan (at least 3)?Some theorists suggest to compile a service-oriented AND a person-oriented recoveryplan. Name at least two differences between these plans.Name at least 3 potential key milestones in the recovery process.What is the main difference between a wellness plan and a crisis plan?Why is it important to review recovey plans?What are the main differences between reflection-on-action and reflection-in-action.Name 3 items you would put in your OWN wellness toolbox.Name at least 5 strategies to de-escalate challenging behaviours.HintsHave you learned enough? Make sure to watch the videos and texts which are part of thismodule!ACTIVITY 42648 TYPE SelfcheckSCENARIO Working towards recovery SummaryThis module looks at what it means to work within a framework of recovery-orientation. Thisservice model is part of the Mental Health Strategy in Australia, but there has been criticism1 2 3 4 5 6 7 8 910| Topic – 10 / 11© Open Colleges Pty Ltd, 2020.about the lack of implementation of recovery-orientation to day-to-day practice.The working model of recovery-orientation can only be fully understood in the context of thehistory of mental health/ illness and treatment. In the past, people living with mental healthconditions were mainly locked away in institutions, including asylums. Treatments were often doneinvoluntarily, including some forms of treatment which are now considered as harmful and hurtful,including brain surgery (lobotomy), cold water treatments, insulin-induced comas andelectroconvulsive therapy.The values of recovery-orientation are a direct response to the atrocities of the past and putconsumers in the driver’s seat of their recovery journey. Working in collaboration with consumersfrom a strengths-based perspective is equally important to workers being able to inspire hopefor people in their recovery and to work in strong working relationships, based on mutuallyagreed service arrangements. Reflective practice should also be provided at all times, and it isessential for workers to seek out areas of further empowerment for consumers andimprovement of professional practice for themselvesPractical applications of the working model include gaining informed consent, working withrecovery plans and supporting the person through challenges and crises. Recovery planningshould always be a collaborative process, involving consumers at all stages and all levels of theprocess. This means that it might be helpful to develop two different documents to reflect theplanning process, one to meet the requirement of the services and one to truly reflect the needsand aspirations of the consumer. Managing challenges and obstacles is also of vital importance,and workers need to be equipped to do this in the best way possible. This includes forprofessionals to look after their own needs and practice sufficient self-care.Recovery-orientation, much like trauma-informed care- should be reflected in every interactionbetween the service and the consumer and should inform every level of the organization. Thisincludes the involvement of peer workers and creating spaces for consumers where they cancontribute to the organization and towards even further implementation of recovery-orientatedpractice into the mental health sector in Australia and in an international context.| Topic – 11 / 11© Open Colleges Pty Ltd, 2020.
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