Recovery in the Bin at #RCOT2018

Wow! What a day! Recovery in the Bin had their abstract accepted for a poster and short presentation at the Royal College of Occupational Therapists’ Conference in Belfast on the 12th of June 2018. We were very excited to be able to share our work at such a big and prestigious event.

This blog post is an opportunity to expand on our poster and presentation. It is also a resource for those who were unable to attend who may want to know a bit about us and our work. As it is for a wide range of audiences, we have included an Occupational Therapy Language Translator for those who are not familiar with the language used by occupational therapists – or maybe more appropriately – the way occupational therapists understand and use certain words : )

For in depth critiques on the notion of recovery, please feel free to browse the groups numerous blog posts.

Occupational Therapy Language Translator!

Occupation:

Most people associate the word occupation with the words, job, career or vocation.  Some associate it with the occupation of land by military force.

However, occupational therapists use the word occupation differently.  In its broadest sense, the word occupation can refer to anything that somebody occupies their time doing – literally anything! 

Occupational therapists typically split occupations into 3 main categories – Self-care, Work and Leisure.  Work does not necessarily mean paid work – it can mean voluntary work and other things classed as work, for example house work, caregiving, DIY.  Importantly, the definition should always be made by the person themselves – some people might think DIY is a leisure occupation etc…

What was the presentation about?

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We decided that the Unrecovery Star would be a good introduction to the groups philosophy and views on recovery – it is visual, and it has a catchy name!  Most importantly, we wanted to emphasise that our work is survivor and service user led, although we have members who are also health and social care professionals.

Why are Recovery in the Bin critical of recovery?

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Everyone working in mental health services has heard of the word recovery.  You cannot read a mental health policy without coming across the word on multiple occasions.

So what’s wrong with this? Isn’t recovery a good thing?

Unfortunately, since recovery has become mainstream and has been implemented across health and social care services, it no longer represents its original ethos that made it so popular.

It is no longer service user or survivor led, and it is no longer radical: Professionals typically lead or control the recovery process and the services in which a recovery approach is delivered.

Conversely, the notion of recovery originated from grassroots service user / survivor organisations, which placed emphasis on personal meaning and agency, in contrast to a traditional professional led approach.

The current power imbalance in service provision is incompatible with recovery’s origins.

The impact of Neoliberalism and Austerity

Recovery in the Bin is critical of the influence our socio-political environment (primarily neoliberalism and austerity) has had on recovery’s implementation, and peoples understanding of recovery.  Recovery’s original emphasis on what is personally meaningful has evolved to reflect neoliberalism’s overemphasis on personal responsibility and choice.

Services and working practices have changed to reflect this.  The premise that continued involvement or contact with services results in ‘dependency’ and a lack of ‘responsibility’ is widespread.  Discharge is the goal, whether recovered or not.

Neoliberalism’s emphasis on personal responsibility and choice, fails to acknowledge the social injustices inherent in a neoliberal society that prevent choice and minimise others’ and societies responsibilities.  Recovery in the Bin challenges neoliberalism’s individualism by advocating a collectivist approach.  It highlights society’s role in addressing social injustice and creating a socio-political environment that enables a meaningful recovery.

What is the Unrecovery star?

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The Unrecovery Star was developed through consensus based and participatory methods by Recovery in the Bin.  It visually depicts the socio-political barriers faced by people living with mental health conditions or distress, which inhibit recovery.  As such, it directly contrasts the individualised focus of the traditional ‘Recovery Star’: The Unrecovery Star does not place the responsibility and burden for recovery on the individual, rather, it situates recovery within the wider context of social change.

It is not a validated outcome tool. Instead, its purpose is to encourage clinicians to become aware of the way the recovery approach is implemented in practice, with an over emphasis on the individual as opposed to society. It promotes critical reflection on the recovery approach from a socio-political perspective.  It seeks to strengthen clinicians’ commitment to social justice

What implications does it have for occupational therapy?

  1. Holistic Practice:

Occupational Therapy Language Translator!

Holistic:

Occupational therapists use this word a lot.  It means that they look at the whole person, not just the ‘condition’ or difficulties a person may experience.  This includes their environment – physical, social etc, what’s important and meaningful to them – their values, their interests, their habits, what they enjoy doing and how they think and feel about themselves. 

As this blog was produced at short notice – this section will be updated to include examples of holistic practice!  Here’s an OT model of practice, which gives you an overview of what we mean by ‘holistic’.  This model does outline ‘Social and Economic Systems’ well.

RITB Holistic

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As a holistic profession, occupational therapy purports the dynamic interaction between a person, their occupations and their environment (Taylor 2017).

As a tool to aid critical reflection, the Unrecovery Star can be used to enhance holistic practice by increasing occupational therapists’ awareness of the socio-political environment and its impact on occupational participation and recovery.

This could include welfare reform, for example, the Bedroom Tax, cuts to Employment and Support Allowance and DLA / PIP, which may limit the amount of money someone may have to access and participate in meaningful occupations.   Cuts to local government funding have meant that many local libraries have shut, and community groups have ceased to exist.  This restricts people’s occupational opportunities and the freedom people have to make occupational choices.  Packages of care are being restricted and so are programmes of intervention.  Recurrent ESA and PIP assessments may have an on-going long-term impact on someone’s occupational identity as a person: emphasis on work and productivity can diminish the value people believe they have as occupational beings.

These broader aspects of the socio-political environment can and often remain hidden.  Standardised assessments may not be particularly attuned to picking up these wider, insidious influences on occupational performance.  Critically reflecting on the recovery star can facilitate this insight which can be used during the assessment process to inform realistic plans of intervention.  In addition, it can aid critical reflection on the service and organisational environment within which occupational therapists work.  In particular, this could include the socio-political environments’ impact on the way the recovery approach is implemented locally.

2. Occupational Justice:

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The Unrecovery Star’s emphasis on social justice closely aligns with the notion of occupational justice.  As Durocher et al (2014) states, “occupational justice extends the notion of social justice” (p421):  Just social structures are necessary when seeking occupational justice.  The Unrecovery star raises awareness of the particular social injustices people with mental health conditions experience, which must be addressed when seeking occupational justice.

Both occupational and social justice call for political action.  Given the socio-political injustices, including austerity and welfare reform, that people with mental health conditions and distress experience, it is time to find and embrace a political voice.  As a profession, occupational therapists can bring these injustices to the attention of decision makers and governments through policy, lobbying, activism, petitions and protest.

Without political action, occupational and social injustices cannot be changed on a large scale.

Talking about occupational justice…We’d like to draw occupational therapists’ attention to the United Nation’s Committee on the Rights of Persons with Disabilities Report.  Their concerns regarding the ability of people living with a disability to live independently and be included in their communities in the UK are outlined at the end of this blog and the full document can be accessed here: http://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=6QkG1d%2FPPRiCAqhKb7yhspCUnZhK1jU66fLQJyHIkqMIT3RDaLiqzhH8tVNxhro6S657eVNwuqlzu0xvsQUehREyYEQD%2BldQaLP31QDpRcmG35KYFtgGyAN%2BaB7cyky7

To conclude…

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Post Presentation Questions (not word for word…relying on poor memory!):

Unrecovery can come across as quite a negative word. How would you respond to this challenge?

That’s a great question. Unrecovery should be seen as the same kind of ethos as ‘unconference’ or ‘antiuniversity’*. It’s about including the excluded, going back to the grassroots. Surprisingly, Recovery in the Bin is not actually opposed to ‘recovery’. What we want to bin Is the ‘Recovery Approach’ in the form it often takes in services that can be very far from Recovery’s original values: commitment to the service user and personal meaning.

*Unconference can be described as participant-driven meetings that try to avoid top down organisation, fees, sponsorship typical of conventional conferences. Antiuniversity is about free and inclusive learning events and as such challenges academic and class hierarchy that may exclude people who aren’t privileged in society.

How can Recovery in the Bin’s materials be used in a Recovery College?

The Unrecovery Star could be used to discuss Recovery’s original values and give service users the opportunity to talk about how it may be being implemented in services. Perhaps it could be shared with participants as part of discussion about how to challenge professionals or colleagues or managers who may be implementing recovery in a way that departs from the original values of recovery. It could also be used to think about how society’s responsibilities and duties toward people influence an individuals recovery and personal values, goals and meaning^

^We also have a blog on Recovery Colleges. This hard hitting satire was meant to challenge. It had a very positive impact resulting in an editorial in a per reviewed journal, by the founders of Recovery College’s focusing on how colleges could return to their original principles when they drifted into the kind of practices satirised by RITB’s ‘Stepford Recovery College’ blog.

The United Nation’s Committee on the Rights of Persons with Disabilities Report. 

Living independently and being included in the community (art. 19)

44.The Committee is concerned about:

(a)The fact that the State party’s legislation fails to recognize living independently and being included in the community as a human right that enshrines individual autonomy, control and choice as intrinsic aspects of that right;

(b)Policies and measures that affect the ability to live independently in the community, such as the reduction in social protection schemes related to housing, household income and budgets for independent living, as well as the closure of the Independent Living Fund;

(c)The fact that responsibility for supporting independent living has been transferred to the devolved administrations and local authorities without providing appropriate and earmarked budget allocation;

(d)The fact that many persons with disabilities are still institutionalized and deprived of the right to live independently and be included within the community, when: (i) they lack the financial resources to afford personal assistance; (ii) local authorities are of the opinion that they can provide assistance within care homes; and (iii) the cost rationale constitutes the main parameter of an assessment;

(e)The lack of support services and accessible public facilities, including personal assistance, for persons with disabilities, regardless of sex, gender, age and other status, to live independently and be included in the community.

  1. The Committee recommends that the State party, in line with the Committee ’ s general comment No. 5 (2017) on living independently and being included in the community and the Committee ’ s report on its inquiry concerning the United Kingdom of Great Britain and Northern Ireland carried out under article 6 of the Optional Protocol to the Convention:

(a) Recognize the right to living independently and being included in the community as a subjective right, recognize the enforceability of all its elements, and adopt rights-based policies, regulations and guidelines to ensure implementation;

(b) Conduct periodic assessments in close consultation with organizations of persons with disabilities to address and prevent the negative effects of policy reforms through sufficiently funded and appropriate strategies in the area of social support and living independently;

(c) Provide adequate, sufficient earmarked funding to local authorities and administrations, including the devolved governments, to be able to continuously allocate adequate resources allowing persons with disabilities to live independently and be included in the community and to exercise their right to choose their place of residence and where and with whom to live;

(d) Set up a comprehensive plan, developed in close collaboration with organizations of persons with disabilities, aimed at the deinstitutionalization of persons with disabilities, and develop community-based independent living schemes through a holistic and cross-cutting approach, including education, childcare, transport, housing, employment and social security;

(e) Allocate sufficient resources to ensure that support services are available, accessible, affordable, acceptable, adaptable and are sensitive to different living conditions for all persons with disabilities in urban and rural areas.

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recoveryinthebin

A critical theorist and activist collective.