From the Practitioner’s Perspective: Second response to our Lit Review
In a series of blogs, expert practitioners from the fields of mental health, criminal justice and substance misuse are commenting on the recent Revolving Doors literature review comparing the processes of recovery from mental illness, recovery from addiction and desistance from crime. The blogs reflect on how the findings relate to frontline practice and what people think are the implications for services working on the frontline.
This blog is by Harriet Smith, a psychologist who works at the ACE service part of St Mungo’s Broadway.
Monitoring tools should ‘serve the needs of clients’
I am really heartened to see Revolving Doors’ latest research into ‘complex needs’.
As a practitioner in the field, I fully support the holistic approach when working with clients with complex needs, but I’m aware that that there are very few research projects that attempt to investigate the issues involved from a multi-dimensional point of view. By synthesizing and analysing the existing research on Recovery from multiple perspectives, this paper begins to address this gap.
One of the key aspects of the work we do within ACE is endeavouring to be guided by the evidence base. Whilst we take a very open-minded approach to what the ‘evidence base’ is (for example, we would privilege clients’ accounts and service user-led research) it is often very easy to limit our understandings and concepts to our own field.
For example, as a psychologist working in mental health, my understanding of Recovery has been guided by research from this field. I have been much less aware of how other disciplines define Recovery and how this affects their practice.
It was useful to be able to get an insight into how Recovery has been defined within the fields of drug and alcohol work and by researchers in the criminal justice system. This is particularly important with regard to our practice in working with other teams in these sectors as it would be all too easy to assume we have a shared understanding of how to work with complex needs when in fact this may not be the case.
I was particularly struck by the finding that clients often feel that the concept of Recovery can be appropriated by services; that there is a danger of using ‘Recovery’ as a management or monitoring tool (for example, in how the Recovery Star might be used). The idea that this removes meaningful choice and undermines the idea of a personalised recovery was particularly pertinent to me.
Developing best practice in outcome measurement
Part of my role within the ACE service is to develop best practice around how we monitor and evaluate the service we offer. This is an important part of reflecting on, and improving, our practice. The Revolving Doors paper has highlighted for me the pitfalls in coercing clients to use our monitoring tools and the need to be ever mindful of making sure that they serve the needs of the clients. At the ACE service we start from the point of asking clients ‘how would you like us to help you’ not ‘this is the way we will help you’.
The paper also provides me with a useful tool when working with commissioners as it reinforces many of the concepts our service embraces: the need for a flexible and holistic approach, the necessity for services to work together and how we need to challenge the current way in which services operate as silos. In fact, Bristol Mental Health was commissioned as a new kind of integrated service, designed with and for service users to be a local, responsive, city-wide mental health service for Bristol. It’s great to see Revolving Doors trying to draw the skills and knowledge of people from a wide variety of backgrounds together to present a more compelling argument for systemic change in how we work with people with complex needs.
About Harriet
Harriet Smith is the Psychological lead for the Assertive Contact and Engagement Service (ACE service), which is a new service run since April by St Mungos Broadway as part of Bristol Mental Health. ACE takes a flexible outreach approach to working with people who may have complex needs or who face multiple barriers to accessing mental health services. We have open access support at a variety of locations across the city. We work with clients to find their own individual pathway to recovery, using a flexible approach to try and meet clients’ needs.
