This is an initial report on developing a Whole Life Recovery Community and Recovery House and Centre, Trieste, Italy. This is a six month initiative intended to develop a permanent recovery house as part of the public mental health services.
The Recovery House initiative was conceived and developed over a one year period with the partner organisations.
This report was written in June 2015 after the Recovery House had been running for seven weeks and has been founded on previous recovery house initiatives in the Isle of Lewis, Scotland and Faenza in Italy. We will continue to report on progress.
Introduction
Trieste Health Services in partnership with the IMHCN and The Cooperativa Germanica established a Whole Life Recovery initiative centred around a Recovery House. The programme started April 2015 as an integral part of existing services.
The IMHCN prepared and trained the people involved and offer continued support in developing and sustaining the programme.
The Whole Life Recovery Community and Centre offers opportunities for individual service users, their family members and co-workers to work together to examine their life stories and the importance of embarking on their whole life recovery journeys.
The key principle is that everybody involved is an equal and full partner in the process of development and implementation. The work commences with sharing and understanding their clinical story and creating their own whole life story, from this foundation they then create their whole life recovery plan based on their identified dreams and goals.
This is then negotiated with the service and the family and social network. Individual service users choose to participate and will already received support and treatment from the Mental Health Services.
The Recovery House, Trieste, Italy
The Recovery House location was near San Giovanni Campus. It accommodates six in six rooms. It has a pleasant garden with scope for gardening and horticultural activities with a space for reflection and exercise.
The Recovery House was established by the following steps:
- Identifying a group of service users, workers and family members who are committed to the programme
- Providing and facilitating training for the group in the whole person whole life recovery approach for the group together with the relevant community services that will play a crucial part in this programme
- Preparing the group to take part in the recovery programme in the house
- Providing essential ongoing support and mentoring to all the participants in the programme
- Ensuring that people continue to be supported in their recovery journey after they have left the house
- Establishing a methodology for the evaluation of the programmes
- The programme people addressed in the house to support individual recovery included:
- Supporting reflections on individual recovery including determining peoples dreams, goals and pathways.
- Working alongside families
- Building resilience in the face of personal and emotional difficulties
- Working with voices and other unusual states
- Developing and cementing autonomy from services
- Extending friendship and peer support networks
- Engaging in meaningful activities and work
- Involving other agendas identified by individuals
People who are staying in the house are expected to develop a recovery plan and work on that during their stay, however the length of a persons stay is flexible.
Identifying and developing a recovery action plan through maintaining a journal, (the team members also keep a journal). Then over the course of the six months undertaking voices work, PATH Planning, recording a Personal Video Statement, writing a Recovery Action plan. Developing local circles of support within their own communities.
Partner Organisations in the Programme
Azienda per i Servizi Sanitari n. 1 Triestina
Family Association
Social Cooperative Germanica
IMHCN
Facilitators and Trainers
Training and Development
Facilitators and Trainers: The facilitators and trainers are:
Roberta Casadio, a psychologist who fulfilled the role as external coordinator based on her experience of supporting the Recovery Houses in the Isle of Lewis, Faenza and York.
Paul Baker acted as the Recovery House external supporter, mentor and trainer based on his experience of providing support to the Recovery House in Faenza and on the Isle of Lewis.
John Jenkins acted as trainer and consultant on the Whole Life Recovery Approach and the Action Learning Sets given his experience of doing this in the UK and other places.
Workshops and Preparation: Introducing the Whole Life Recovery Community Process:
This was achieved by holding two, one workshops to give the opportunity for the participants to be able to focus on the task in hand and to form a strong group forged on mutual trust and understanding of each other and to develop a sense of ownership and direction.
The workshops also prepared the key people who would be involved in the programme. It was essential that these people have agreed in principle to take part. They included the following: the people participating in the house; family members and important others; the staff from Brandasia: community mental health centre operators and psychiatrists, relevant representatives from community services and associations.
This training experience was interactive and fully participative. The number of participants was about 40.
Preparing the people for their recovery journey:
It is crucial that all stakeholders feel that they own this programme and its objectives, and the part they will play in its success.
Each person and their family or important others worked together with the operator of their choice as partners.
The partners used personal planning tools and the person given the necessary time and space to tell their life story as they wish.
This formed the foundation for determining the work that needed to be done during their time in the recovery house community.
The people who lived together design, negotiate and agree the rules for living and working together. This included the daily living programme and working together as a group and in thematic and activity groups. For this process to be successful people were expected to take personal responsibility for themselves and the other people in the group.
Ongoing support and development: the Recovery Programme, starting with the first group are supported through their recovery journey by the presence of the external support workers. They provided advice, mentoring and critical reflection.
They also provided specific support on working with the following:
- Holding Family Support Meetings
- Working and negotiating with individual families with their key concerns
- Individual support and counselling for group members
- Critical reflection session with operators and others
- Specific Techniques and Approaches: e.g. Hearing Voices, Paranoia, Sleep, Self Injury and harm;
- Wellbeing and Mindfulness; Sport and Leisure; Art and Culture and spontaneous collective activity.
Conclusions so far
A Whole Life Recovery Community offers opportunities for individual service users, their family members and co-workers commit to work together in new ways to examine their life stories and the importance of embarking on their recovery journey.
Individual service users participated already received support and treatment from the Trieste Mental Health Services. Many of them heard voices and experienced other unusual states. It was fundamentally important that family members are fully involved in the programme from the beginning.
For people to embark on a recovery journey, time and space is essential, for this reason the community includes a Recovery House, a place where this can be achieved and where people will be assisted to develop and pursue their recovery journey. The length of a persons stay is flexible, however a minimum of six months is recommended as best practice.
The Recovery Community is essentially an integral part of the mental health services an it provides specific support on the following:
Developing ownership of a common purpose within the Recovery Community
Family Recovery Support and Education Sessions
Working and negotiating with individual families with their key issues and concerns
Developing new working practices and procedures based on shared responsibility and co-production
Working in an interdependent way with the current mental health system to create understanding of the approach and its application for all current and new service users and their families
Specific ways of working peoples experiences of: Medication, Paranoia, Sleep, Fear, Anger, Hearing Voices, Self Injury and harm; Health and Wellbeing
It was important to demonstrate this programme improves the mental health wellbeing and resilience of this group of people. We believe it could be replicated for other groups of service users in Trieste and beyond.
Paul Baker, John Jenkins, Roberta Casadio and John Stacey, 2015