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A road map for recovery

The Iris Care Group RISE Framework

A road map for recovery – the Iris Care Group RISE Framework

March 2024

 

Recovery from mental health problems can be a hard road for all of us. Life is hard – we all struggle with relationships, with trying to find a sense of meaning, and with coping with illness, loss and trauma. For some of us, those struggles develop into problems that lead us into the mental health system. Once that happens, our problems can take on a new form. They get given names, called diagnoses, and we come into contact with mental health professionals.

But there’s a problem with the mental health system. It can, if we are not careful, take people’s feeling of control over their life away. It can make them feel like they are like corks on a rough sea, being tossed around by a frightening illness that they can do nothing about. It can make them feel like the only people who have any control are people like psychiatrists and psychologists, who can end up taking decisions for them. If we aren’t careful this can make people feel even worse. The mental health system can make people’s mental health worse.

When people feel hopeless about the situation they are in, on top of the original problem that led them to need help from the system, they can become more depressed, angrier. If they feel like all control has been taken away from them, like all human beings in that situation, they can become angry. And then they can end up spending even longer in the system and made subject to even more control – more forced medication, more use of the mental health act. At Iris Care Group we don’t want to run our services in a way that causes that to happen. We need to make sure that both the people we support and our staff have a clear ‘road map’ to help them navigate their own personal path to recovery. Without a map, you get lost!

RISE is the model that we use in Iris Care Group to help prevent the things I’ve talked about from happening. RISE stands for ‘Recovery in Supported Environments’.  It’s not complicated. It’s based on these three key principles:

 

Firstly, everyone is entitled to  support to help them develop their own goals for how they want to recover. This isn’t just about symptoms getting better .This is about the things in life that we all need to have good mental health. RISE supports people to develop their own goals, based on the things that matter to all of us – feeling connected to others, building hope for the future, developing a sense of identity, experiencing meaning in life, and feeling empowered. These goals must underpin all the clinical plans that professionals then develop. Everything we do should be based on the person’s own goals in these areas. Our RISE resources include guides to help support people to develop these plans, to write them down and to keep a record of progress in these areas.

Secondly, everyone is entitled to support to help them understand the mental health treatment  evidence base and to be given information about the techniques and treatments that are most likely to help. RISE includes a large range of self help tips and guides, given to people in our services. When they join our services, all service users are given a list of resources with a handbook explain simply and clearly what kind of resources might help. These include all kinds of issues, such as low mood, trauma symptoms, self harm, anger, hearing voices, bereavement, difficulties with eating and getting on with others. People are able to record the materials they want to use, and also to say whether they want to use them themselves or whether they need staff support .Their choices are then written into the person’s overall care plan.

Thirdly, above all, our duty in mental health services is to not make people feel any worse. Everyone is entitled to receive treatment and care that avoids side effects as much as possible. At Iris Care Group our hospital and community teams typically work with people with really complex, long standing difficulties. We know that it’s very easy for conversations to trigger people to feel worse. Mental health staff, with the best will in the world, might ty to support but if they aren’t aware of this, attempts to help can cause a severe deterioration in how people feel. Because of this, it’s really important that staff are supported with a guide to help them understand this, and that they know the risks and side effects of different interventions. It’s also important that the potential risks of all interventions are completely transparent to people receiving care and treatment. It’s not good enough for mental health professionals to say ‘you might feel worse before you feel better’. If a treatment is making someone feel much worse, it isn’t going to help the person feel safe, and that is going to reduce their trust in the people supporting them. To avoid this, our RISE materials are all ‘safety rated’ – based on the evidence base. Both people we support and our support staff can read straightforward, jargon free, information about how and when to use all the materials safely. For some problems, such as trauma, this can make the difference between recovery and relapse, so we put a big emphasis on this.

We’ve been using our RISE materials in our community services for about four years now. Our research has shown that it helps people do better quicker and that it helps staff to deliver support that is both evidence based and safe. This year we’ll be introducing RISE into our inpatient services, to make sure that staff in all our sites use the same framework for recovery .We hope that this will further reduce the time people spend in hospital and also make it easier for them to move into our community services, confident that staff will be familiar with the approaches that they have used in hospital. We’ve been doing a lot of work updating all the RISE materials – including people we support –  to make sure that they are up to date with new developments in mental health treatment and recovery. We’re also rolling out training and information sessions for staff, online and in work.

Dr. Andrew Hider explains how we use restraint data to drive improvements in safety

Dr Andrew Hider is Iris Care Group’s Clinical Director as well as a Consultant Clinical and Forensic Psychologist.

He studied Experimental Psychology and Philosophy (PPP) at Corpus Christi College, University of Oxford, graduating in 1996.  After a period of two years working for a specialist challenging behaviour service based at the Welsh Centre for Learning Disability he completed his clinical training at the University of Plymouth and received his Doctorate in Clinical Psychology in 2001.

Since then he has worked exclusively with people with severe and complex problems and offending behaviour and has worked with forensic populations in low and medium secure and community settings in the United Kingdom. Clinically he is interested in providing psychological support to people whose needs may cross over multiple clinical areas including mental illness, personality and complex trauma, and learning disability.

His research interests include evaluating inpatient group therapies and interventions for men with offending behaviours and mental health problems, evidence-based triage in the psychological therapies, the relationship between neurodevelopmental disorders and offending behaviour, violence risk, and mental health staff cultures.  He is currently an external examiner on the Doctorate in Forensic Psychology at the School of Medicine, University of Nottingham.

Andrew is a member of Iris Care Group’s  Board of Directors with specific accountability for supporting reductions in restrictive practice and the promotion of person-centred principles throughout the organisation.

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