What would a “Recovery Hub” look like?

May 24, 2012 2 Comments


I’m currently starting to ask people in online spaces that I visit what would be useful tools for them in their recovery from periods of mental distress.

I want to post a copy of some conversations going on in groups I’m a member of on Facebook, where some really interesting points have been made. Do join in with this discussion- the question posed is:

I wondered if you would be interested in helping me to start a conversation about what services and resources are useful to people who are in recovery after experiencing mental distress?

I’m hoping to be able to prove that service users and carers have some great ideas that they should try to develop- can I ask you to share any ideas you have?

Some initial thoughts-

  • Physical space in a non nhs setting to meet up for a coffee
  • Education/self management resources available to look at or take away
  • Computers and online access to search for your own resources, or build your support networks
  • Staff could arrange to meet you there for appointments, if you didn’t want to go to an nhs building
  • Training for you to develop and run your own groups to support each other
  • Help with getting funding for mental health projects you’ve thought of
  • Access to volunteering
  • Access to paid work, delivering training, speaking about mental health, as peer support workers
  • An online resource, maybe a social network? you could log in from your phone or at home?

None of these solutions would be right for everyone, and I’m sure you’ve got your own ideas- what do you think would be helpful?

The results in so far:

if you suffer with social anxiety the thought of being placed in a group with other people is enough to put some one back in hospital.

me:  if someone has social anxiety, is it helpful to have a range of resources online rather than recommend them come to a physical group?

more services that do home visits would be good – if you have social anxiety, for example, it would help to get to know someone in a “safe” place like your own home, talk about barriers to getting out and then have support (for as long as needed) to go out and meet people.

me:  like a “parachute” service that could be called out to visit at home? would this be mental health staff, or trained peer workers?

main thing would be consistency so you can learn to trust someone and they can take you to different places – maybe with the aim of being able to meet up with people who have similar problems in future

One of my bugbears is the lack of recognition that if you are chronically sick you are more likely to be socially isolated and suffer from depression

me: And equally, people with mental health diagnoses have poor physical health- perhaps we could include this too?

i live in a part of the city where there are very few facilities if you have mental health problems apart from GPs. the support groups, charities, outreach centres etc are mainly on the other side of the city which don’t necessarily have direct bus routes from where i live. buses are difficult when you have social anxiety, going to places you don’t know can be too frightening, and i can’t drive because i have epilepsy. The churches don’t provide much if you’re under 60 but don’t have young children. it’s easy to lose touch with friends when you don’t go out to work and can’t cope with going to the pub.

A consortium of employers in the regional areas that can come together and universally employ an individual in that the individual isn’t committed to a single one employer. This would benefit those employers during there occasional busy days or seasonal times and have a higher success rating for actually being able to maintain some form of employment for the individual.

me: this is exactly what mobility DLA is for to cover costs due to your disability such as taxis for trips to support centres (I know it’s a rotten time to be a DLA applicant, btw) So, for people with social anxieties, it’s important to either have safe ways to travel to a physical centre or hub- or there could be “parachute” visits out into community, or there could be a certain amount of online support for days when physical travel is just too hard? Does that reflect what you’re saying well enough?

me: That’s interesting, xxxxxx, so in your model, people would be “signed up” a bit like signing up to an employment agency? Then they could be allocated work for days that they feel able to do work? Like, sign in by 10 am for today’s work? I’m guessing those people would have to keep records- would they be self-employed, or employed on zero hours contracts?

a friend of mine said a couple of weekends ago there must be loads od small, medium and large companies that have all manner of tasks on projects that someone working from home could do that are hugely time critical but in alarge project needs doing at some point, but project workers, managers etc wouldnt employ someone to do one task,l but if lots of employer could do to an agency that is task focused with all manner of people with skills and knowledge. they work for the agency and the agency make sure the work is done…

I’m against be forced to do work I don’t want just because I feel well on a good day, I want to work but it has to be stuff I want to do other wise my mental state suffers, and being poked and prodded to do work is just putting pressure on people which they don’t need when they are ill, they need to get well first.

me: Yes, the power should sit with the person who has the difficulty as they are best placed to know their own limits. But lots of people want to get back into it- even feel that forced inactivity makes them worse, so lets not assume that this is all part of a sinister way to shove everyone off benefits- I genuinely want to have this conversation and hope to develop a DPULO to respond to this.

me: A bit like this, http://www.taskrabbit.com/?

I make stuff at home I have about one good week in 3 where I manage to do stuff, the rest of the time I’m away with the fairy’s with anxiety much of the time or just resting as I suffer burn out. I would love to make money with my creativity, I have the skills but don’t produce enough of anything to make a living at this time.

Not an employment agency Claire they are a cost to the employers but a consortium of employers themself’s. More in the lines of a sponsorship employment.

yes in effect but for projects, businesses etc . My friend is a project manager, he has a tutorial guide to write, he doesn’t have time to do it but it has to be done before the project goes live. so he thought if he could assign it to an agency, who then finds the right person or offers it up to its clients and they say yes. then as long at is done by the end of the project say in 1 months time it doesn’t matter how long it takes as long as its done. there must be loads of tasks that need doing but no point employing 1 person for what is ordinarily a half-day job but to us is a big thing..

me: I was thinking WE could develop our own “agency” and supply people to work on projects? as part of the recovery process? would have to check out with DWP etc how it would work- but there should be a way of ensuring self-employment as a way for people to do some limited work, with Working Tax Credits as a back-up?

i have mobility DLA, but atm i’m too anxious to go somewhere that i don’t know at all. we could also do with drop-in centres for people who are fighting self-harm urges where they can get support and company. they could also have the ingredients to make that cake that the care team suggested you try …

an agency run by and for people with physical and mental health problems would be great.

Much of those things are already in place from the point of being a hospital patient to work therapy especially in my area any ways.

Not sure self-employment is the way forward especially with all the complexity of paperwork. Many simply wont be able to handle that.

if you have a problem with authority of any sort be self-employed, is an option, you can always get other people to do the paper work

The costs involved in forming agency’s will out weigh purpose and eventually fail.

At least if employers themself’s set this up people will have confidence that those employers are going to provide supportive environments from the outset.

me: I hope it’s okay with you guys, I’m capturing this (anonymised) conversation to keep it on record on my blog at claireot.wordpress.com

me: I agree, there are costs involved. It would be important to ensure we got funded to cover those costs. I think you’re right, we would have to get “sign up” from employers to provide work, but perhaps this would be an extension of the “Mindful Employer” project, or simply as part of their drive to reflect the diversity of the populations they work with?

An example. 33 employment positions I’ve been through in the past maintaining employment due to illness has been the biggest barrier. 18 of those employment positions had been with the same employer this despite walking out on that employer each of those 18 times due to having an illness. In between each of those employment positions faced sanctions of benefits time and time again. On the balance due to the sanctions it wasn’t actually worth carrying on with trying to gain employment as monies over the year balanced out no more than benefits any way.

me: yes, I think this experience is one many people will have shared. We started to work on this at the “Benefits Camp Hackday”. Our team were prototyping an app to use to enable people to show on a weekly basis what work they were able to do, and get their benefits calculated for weeks when they needed more support.

some where that would help do their paper work would encourage more people to start-up for themselves, and if someone failed to earn enough one week and some sort of system that paid and made up for the bad weeks would be good.

Very difficult to calculate an illness Claire one can be ill for months on end with no break then maybe only have a couple of good days. especially if part of the illness is that one is not able to measure time or unaware of time going by.

me: Yes, it is xxxxx and that’s why I think flexibility, and not “pushing” people before they’re ready would be important. But equally, it is important to set a “just right” challenge for people (e.g. as an OT that’s what the rehab would be aiming for) to help people along in their recovery. Perhaps what you’re picking up here is another, separate need, for early access to increased support when you feel like it’s slipping back again? Is that an accurate interpretation of what you’re saying?

Employer sponsorship at minimum based on existing individuals levels of benefits as an outset. With further sponsorship being paid above an achieved hours gained. With all sponsorship based on the level of minimum wage.

me: Hmm, I think this would need some thinking through. I’m not clear what employers would see that as a “good deal” for them, and it sounds a bit like “Workfare Plus”, can we have a bit of a think about how that would be attractive to employers to sign up?

I’d love to help in anyway I can and I think it’s a fantastic idea x

Far from workfare. If a group of employers came together and employed one individual in a coup sponsorship it would actually be cheaper for them all round paying the rate of minimum wage.

In another group, asking the same question,

having bosses who are supportive when you are going thru depression i had to walk from my job because i was not getting any support at all it was on ly when i did what i did then the support came but it was little bit late

me: That’s a great point. So, could a service be provided that helps employees to approach their mental health needs with their employers/ and a complementary service that educates employers how to manage sickness/ support for employees with mental health be part of the package (and stuff about Equality Act etc)? Could it be this is delivered by people who have been through it, who could call on staff expertise as needed? Or just staff? Or just peers?

i think bosses need to be sent on awareness courses to pick up on the first signs of depression it would have helped me big style if i was given the help from the get go i really would like to help others who are going thru what i went thru would like some more info claire it’s so good that your able to help people i wanna do the same maybe volunteering

me: I think for anyone with long-term illness or experience of mental distress, there’s so much we can offer to others who are going down the same road. And you’re right, there’s so much we could do to raise awareness for employers about how to retain staff who become well. Or better still, how to put things in place to protect their workers from becoming ill, if at all possible! So, I see there being a training need (we could deliver to employers) an advice need (for people going through it or carers) and a peer support or “buddy” need (to keep you going when times are tough)- but access to volunteering and even paid work opportunities to get involved with this stuff, not just sharing our stories for free.

I’m serious about this project. It’s clear to me that people with experiences of distress have every right to be involved in service re-design and they have valuable skills and experiences to contribute. I’m actively continuing to continue this conversation, and I would love to hear your views in the comments. Do feel free to comment anonymously if you prefer.

Filed under Commons, Occupational Therapy, Recovery Tagged with , , , , , , , , , ,

What should be included in a #MedEdMOOC? Social Media in Continuing Professional Development

February 7, 2012 12 Comments


After previously considering what a MOOC for OT, and indeed for healthcare should look like, I am delighted to report that plans are underway to develop the first MOOC for Healthcare Professionals and other interested people, and the name chosen is MedEdMOOC (Medical Education MOOC).

One of the things to be considered, is what content we would wish to see included in the MOOC. I’m hoping to use some posts to record my hopes and fears for the MOOC, and I look forward to reading your comments about what I’ve written.

First, a quick reminder of what a MOOC is.

Social Media in CPD (Continuing Professional Development) for HCP (Healthcare Professionals)

One of my passions is the use of online technology and social media by HCPs to enhance and update their skills and experience, in order to offer the very best care to their patients. This can take many forms, and perhaps one of the nearest “real life” analogies I have is that of a peer supervision group.

Within peer supervision, a group of people without large differentials in status and seniority come together to share their thoughts, feelings, challenges and successes around their practice. Whilst patient confidentiality is observed during such sessions, challenges in particular cases may be shared with the group in order to get renewed insights and ideas about how to move the treament on. Additional insight may feed back into the case formulation, and therefore affect the future direction of treatment. Similarly, where a success has been hard won by our clients, the delight of the therapist involved might be shared with the group, who might be invited to help reflect on what the critical factors might have been.

Other ideas can be introduced, for example in a Journal Club, where people discuss and critically evaluate as a group recent research relevant to their treatment area(s). New assessments may be discussed, evaluated, or even tried out on each other. Audit tools, ways to collate evidence and interpret statistical information- anything at all that affects the way we can provide care is up for discussion.

Peer supervision is a time efficient way of supporting occupational therapists and HCPs in practice, using the benefits of group process in addition to the benefits of the individual reflective process. In some ways, it can be seen as the equivalent to a therapeutic group as used within OT practice- in that group process and support from peers is as important as the quality of the supervision received.

I see many parallels in the use of peer supervision offline and the use of communities of practice that form online through social media use, or by clustering around topics of mutual interest. One of the differences is that in the online space through the use of social media, this process often happens in a public space, rather than a private one. This changes the experience of membership of the group.

It contains opportunities as well as challenges:

Opportunities

  • By extending the membership beyond natural boundaries such as the employer or the physical location, groups may coalesce around mutual interest where before insufficient members were present in any single location.
  • Groups can be flexible, and a fluid membership can mean that new members can join the group at any time.
  • The non-heirarchical nature of the medium supports the formation of a group of “peers”, despite differences in status that might be apparent in “real life”. This can offer new opportunities to freely share with each other.
  • Groups can offer opportunities to develop confidence and skills in presenting information in an online format.
  • Group membership can lead to “real-life” relationships and support in an offline setting.
  • The public nature of the setting may serve as a reminder of acceptable public behaviour and mores related to professional role, embedding these behaviours in further online activity such as social networking; in line with professional guidance.
  • The public nature of the group means that insights from experts can be fed directly into the group, ensuring accuracy of the information and relevance of the opinions present.
  • The transparency of this approach may be attractive to HCPs who find it in line with their personal philosophy.
  • Patients and the public may be reassured to understand that this process is part of the “back end” of therapeutic work or medicine, ensuring the support they receive is evidence based, and the basis for clinical decision making may be better understood as a result.

Challenges

  • The public nature of the group can inhibit the most frank discussions of difficulties in practice.
  • Where social media guidance is lacking or insufficient, mistakes around information governance, or exposure of the individual practitioner to risk, may occur.
  • Rich information captured in body language and non-verbal cues in the “real-life” group setting may be lost in the online group.
  • Engagement in the activities may not be valued by the employer and traditional line-management structure, undermining the value of the process.
  • Participants could undervalue the process because of the fluidity and ease of membership, thus “drop out” before real benefits are gained.
  • Disruptive influences could “flood” the online space making positive progress of the group within the space difficult.

It is my hope that the MOOC will offer space not only to develop CPD for HCP, but also offer a structure around which HCP can reflect and discuss these challenges and opportunities presented by CPD in a community based in an online environment.

These are my initial thoughts about the value of looking at CPD within a healthcare MOOC, what are yours?

Filed under CPD, Evidence based practice, Reflection, Risk, Social Media Tagged with , , , , , ,

An experiment in Social Media in Clinical OT practice Growing Together 3- Growing shoots

January 4, 2012 1 Comment


I’ve posted a couple of blogs about my experimental use of Social Media in Clinical OT practice (see part1 and part2). Today’s post discusses the first foray into the use of Social Media.

As I discussed in the first blogs, I visited other groups both within the city and more widely. During these visits, I took photos to share with our group members when we talked about what we could learn from other groups. These photos were also included in reports I made about the visits, which were uploaded to the Staffnet site discussed in the previous post. They made the reports more interesting, and also made my service users more likely to connect with the reports, when I printed them out to share with them a little like magazine articles.

Service users wanted to be involved. They wanted reports like these relating to their project. In response to service users asking if we could take photos of our progress, and to enable the participants in the group to share this progress as they wished, I took photos with my smartphone.  Initially, we only shared the photographs during the tea break with each other, but then I considered the use of a photo sharing social networking site in order to share the photos more widely with family and friends of group members. We talked about how to do this, and settled on using FlickR, a free social media tool for sharing photographs. This would mean they could share their progress with others, all that was required was internet access.

As health service employees we have a duty of care for everybody that uses our services, including protecting their data. Mindful of our Information Governance issues, this was cleared by our IG department, and clear boundaries set for the use of cameras to record progress. Consent forms were developed to capture informed consent from service users before they were photographed. Part of  gaining the informed consent was to discuss what we could do with the pictures  and what kind of boundaries I was operating under in terms of what information would be photographed. We made sure that the majority of the photos we took didn’t have “patient identifiable information” on them (faces, distinctive tattoos) because this made the Information Governance issues much easier to handle, and it made our service users comfortable with the process. Of course, if people didn’t wish to be photographed, we would respect their wishes.

We started to take more pictures, uploading them to the FlickR site we had set up.

As we developed the project and they became more comfortable with what was happening, they did ask to be photographed on occasion. One particularly memorable photo was of a young man holding a crop of onions he was proud of harvesting! Because of our informed consent proceedure, the subjects of the photos (if identifiabe) got a second chance to decline their permission for publication on FlickR, but if they agreed, my clinical reasoning was that it was okay to publish.

Disabled people and people with mental health issues are often socially excluded, and I felt that including the photos within the larger social network was a way to combat some of that exclusion, in our own small way. We had set up a group that was non-stigmatising- it didn’t carry “health” branding, and our group members had as much right to occupy the virtual space as any other community group. Had we encountered any adverse comments or increase in social difficulty for the group members as a result of this, we could have taken alternative action. But we didn’t.

Sometimes, the things which matter in a therapeutic group are not the things we carefully plan for. Within this group, the wildlife that we saw around us became a real hot topic of conversation, and this was another great opportunity to take pictures to share.

We also had a regular visitor in the form of our Allotment cat.

Many people with disabilities and mental health issues don’t have pets because they fear they either cannot afford to look after them, or they have lifestyles which mean they wouldn’t be able to offer the care they feel the animals need. This was the case for several of our group participants. However, they all felt very affectionate about the Allotment cat, and he seemed to return their affection. He would visit during every group, and was inevitably fed and offered a saucer of milk by the group. He would then make his way from knee to knee, offering every group member the opportunity to give him a stroke or two. Who knows what effect this affection has on a person with limited social skills?

At this point, I felt I needed to learn more about Social Media, in order to really maximise how we used it within the group; so I attended a local Social Media Surgery. I am immensely grateful for the help I received there. I felt encouraged to venture further into the realms of social media.

What are your views about using photo sharing social media with mental health service users? Please share in the comments.

To find out our next steps, watch out for my next post.

Filed under Digital Inclusion, FlickR, Occupational Therapy, Recovery, Social Inclusion, Social Isolation, Social Media Surgery, Stigma Tagged with , , , , , , , ,

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