Moving towards a recovery focused approach in a low secure forensic mental health setting: staff perceptions and understanding of the impact of service change.

Abstract

Background: Evidence suggests that the recovery focused approach provides a new conceptual framework for modern rehabilitation practice; encouraging a movement away from traditional medical treatment, towards a more person-centred, social approach to patient care. Mental health services are increasingly focused on supporting the recovery approach to patient care, with government policies continuing to encourage local teams to develop recovery focused services. In relation to the recovery focused approach, this thesis had two aims. Firstly, to systematically analyse literature which explores the impact of recovery-oriented training on staff knowledge and attitudes toward recovery practice, and secondly, to explore nursing staff perceptions and experiences concerning moving towards and using a recovery focused approach within a low secure forensic mental health setting. Methods: Aims were addressed in two separate pieces of work. The first journal article presents a systematic review. Literature searches of six computerised databases, hand searching of selected journals, and the contacting of key authors of identified papers identified nine papers which explored the impact of recovery-oriented training programmes on increasing staff knowledge and changing attitudes towards practice. In journal article 2, interviews were conducted with eleven forensic mental health nurses in relation to service changes and analysed using Framework Analysis. Results: The systematic review found that all nine studies demonstrated significant positive changes in mental health practitioners’ self-reported recovery-based knowledge, recovery-consistent attitudes and attributions, and optimism following completion of a recovery-oriented training programme. In journal article 2, five themes were identified: managing risk; patient engagement; service developments; development of job role and ward environment. Conclusions: The systematic review demonstrated the effectiveness of recovery-oriented training programmes at facilitating positive changes in staff knowledge, attitudes and attributions towards recovery oriented practice in clinical populations. Limitations of the papers included the relatively small sample sizes, the complex nature of the populations reviewed and the high rate of demographic confounding variables identified. The results of the original study provided insight into the views and understandings of forensic mental health nursing staff, specifically, into factors which were perceived to promote and impede the recovery focused approach within a low secure forensic mental health setting. In both articles, results are discussed in relation to clinical implications, strengths and limitations, and directions for future research.