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Tuesday, 31 January 2012

Desistance and what helps in mental health recovery

Written by Discovering Desistance

Our Engage column features comment from leading figures within the world of social work. This time we feature the blog, Discovering Desistance, in which Marguerite Schinkel of Edinburgh University reflects on previous research experience looking into ‘recovery competencies’ in relation to mental health.

Desistance and what helps in mental health recovery

In the latest in a series of excellent posts from doctoral researchers, Marguerite Schinkel of Edinburgh University reflects on previous research experience looking into ‘recovery competencies’ in relation to mental health.

There has been some discussion on this blog about the parallels (and overlap in the target groups) between recovery from addictions and desistance. Fergus’s recent article in the Howard Journal (Counterblast: A Copernican Correction for Community Sentences? ) made me reflect on the similarities between the work done on recovery in the mental health field and desistance.

A few years ago a friend and I conducted a piece of research for what was then the Scottish Executive on recovery competencies, or the skills and values mental health workers needed to help people to recover. We spoke to different groups of people using mental health services, as well as groups of professionals and carers. When you substitute the word desistance for the word recovery in our eventual recommendations, it is interesting how many are relevant.

For example, our participants emphasised the need for mutual respectful relationships, that workers have a belief in recovery (see also interesting articles on the importance of hope in a reintegration or social work context here and here, involve significant others and focus on strengths rather than weaknesses.

Other recommendations would be more difficult to make in a criminal justice context, but are probably no less apt for all that. For example, our participants said they found it helpful when their workers shared something of themselves in the relationship, making the interaction thereby more genuine, and did not hide behind professional boundaries. They also wanted to have a greater say, and more options, in their care.  After we wrote the report we reflected on our recommendations and realised that some of them were contradictory.

For example, what happens when a person is feeling hopeless themselves. How does the worker then balance the need to promote recovery and to take the person’s experiences seriously? Or, while some participants wanted greater involvement of their significant others, others felt this would hamper their recovery.

This highlights the danger of working with set tick-lists and shows that the real skill is in finding a balance between the different principles by tuning into the individual. Challenges, choices, and participation have to be negotiated with people themselves, and tailored to the individual.

This mirrors the point Fergus makes in his article: Since desistance is an inherently individualised and subjective process, approaches to supervision must accommodate and exploit issues of identity and diversity. There are, therefore, important limitations for one-size-fits-all approaches to rehabilitation.

As many people, notably mental health service users, have been working for a long time to bring about a more recovery oriented ethos in the mental health field, there is a wealth of resources that I would argue are a useful (initial) guide if we want to change the way we work with offenders, at least as a starting point. For example The Scottish Recovery Network holds publications related to recovery-oriented practice training, developing recovery oriented services and more. I would also say that mental health services have been much more thoughtful and successful in employing peer support workers, but that is a whole other story.

Discovering Desistance is an ESRC Knowledge Exchange Project