Realising Potential our own and others

Supported self-management and recovery

Supported self-management is where:

"… the person and all appropriate individuals and services [are] working together to support him or her to deal with the very real implications of living their life with one or more long term condition ... [it is] a person-centred approach in which the individual is empowered and has ownership over the management of their life and conditions."^[6]

Successful supported self-management relies on people having access to the right information, education, support and services. It depends on a person-centred, empowering approach in which the individual is the leading partner in managing his or her own life and condition(s).

The term "supported self-management" is essentially new to many AHPs in mental health - early explorations following the launch of Realising Potential found that many were not familiar with the term - but the concepts underpinning it are not.

Supported self-management is embedded in approaches that are integral to how AHPs in mental health deliver services, particularly in relation to promoting health behaviour change. It consists of a range of approaches that support health-promoting behaviours, such as providing appropriate information, maintaining social connections, maximising employment and/or education opportunities and making connections between physical, emotional, spiritual, social and economic well-being. This means respecting the lived experience, working with individual preferences and balancing risks so that the service user remains integrated within the community, is socially included and has a repertoire of knowledge and skills to self-manage his or her condition(s) and live well.

Consequently, there is already a strong tradition of activity in this area among AHPs in mental health, even though they may have referred to it as something else!

Realising Potential is now trying to streamline, hone and focus this activity to ensure the development of common understandings and common language among AHPs, with a common evidence base to support practice. Over time, it is anticipated that this will actually build the evidence base for supported self-management approaches.

The Scottish Government is committed to the implementation of a supported self-management approach by AHPs in mental health and has supported self- management masterclasses with AHPs from a range of disciplines who work in dementia.^[7] The particular focus in supported self-management since the launch of Realising Potential has been on dementia care, building on the substantial evidence base in this area to develop "training for trainers" workshops for AHPs. A cohort of trainers has been prepared: they are now returning to their NHS boards to support others to adopt and deliver best evidence-based practice. In addition, a consultant AHP in dementia care with a national remit for supported self-management has been appointed to support boards as they move forward.

Realising Potential made specific reference to how the AHP community has embraced the principles of recovery, with AHPs working with colleagues and agencies to develop recovery services and creatively implement recovery principles, and a recommendation to ensure recovery approaches feature in all AHP practice in NHSScotland is included in the action plan.

Some examples of initiatives across the five key areas of supported self-management set out in Realising Potential are presented below. The associated recommendation from the action plan is flagged up for each area - the initiatives have not been developed specifically as a consequence of the Realising Potential recommendations but are being influenced and supported by them.

1. Recovery
Recommendation 3

Facilitating supported self-management for people with mental health problems through use of a self-management tool

An occupational therapist in Inverness is working with the Scottish Recovery Network (SRN) to roll out a self-management tool for people with mental health problems. The tool - Wellness Recovery Action Planning (WRAP) - is described as a structured plan developed by an individual to help them work through mental health challenges or life issues.

The occupational therapist is one of three Highlands-based facilitators who can run WRAP workshops, which aim to support group members to create their own plan to empower them to take control of their health. Group members typically attend two-hourly workshops weekly over a six-week period, during which they not only grasp the WRAP concepts, but can also gel as a group. They are encouraged to share their own personal experience relating to each of the sections of WRAP, completing their plan as they progress. A session is held two months after the workshop programme completes to review progress.

Early indications from evaluations by group members suggest a reduction in the use of services following completion of the programme and an increase in their sense of empowerment in relation to their health.

2. Physical activity
Recommendation 4

Facilitating supported self-management for people with mental health problems through physical activity

"Pedal 4th" and "Move 4th" provide a pathway through which people living in the NHS Forth Valley area who have a diagnosed mental health problem can experience health gains through physical activity. The programmes aim to provide support for individuals to the point where they have the confidence to independently access physical activity opportunities in their own communities. They are taken forward in a partnership involving physiotherapists and other health staff from NHS Forth Valley, Cycling Scotland (who have supplied grants of almost £10,000), Forth Valley College of Further and Higher Education, and Bannatyne's Health Club in Falkirk.

Significant improvements in participants' physical health have been seen since the programmes started, with all individuals taking part moving up at least one level on the General Practice Physical Activity Questionnaire (GPPAQ) and many achieving the full "active" level, which means they have surpassed World Health Organization recommendations for physical activity. Reductions in the Borg Rating of Perceived Exertion (RPE), a way of measuring physical activity intensity level, have been noted. Other benefits include:

• self-reported improvements in diet with variable weight loss
• significant improvements in anxiety, depression and self-esteem
• return to work for a number of long-term unemployed participants
• reduced hospital admissions.

Future plans include further developing the vocational elements of the programmes and supporting other health board areas to develop similar projects.

3. Diet and nutrition
Recommendation 5

Facilitating supported self-management for people with dementia and their carers through eating and nutrition

Dementia Care − support with eating and drinking: a practical guide for carers is a leaflet developed by dietitians in Lanarkshire to provide information and reduce stress for individuals with dementia and their carers around commonly encountered problems. The leaflet can be used by professional and unpaid carers such as family, friends or voluntary workers who care for a person with dementia in the community or within any formal care setting.

Issues such as overeating, problems with using cutlery, changes in food preference, difficulty consuming adequate nutrition when agitation is problematic, food refusal and achieving adequate hydration are addressed. It is anticipated that by offering this information initially via health professionals and carer voluntary groups at an early stage in the person's journey, his or her nutritional health will be maintained or improved in the community for longer while simultaneously reducing anxiety for carers.

4. Valuing everyday activity
Recommendation 6

Facilitating supported self-management for people with dementia through valuing everyday activity

People with dementia, like everyone else, have a basic need to engage in activity. The importance of activity is underpinned by a number of strategic drivers, including the Standards of Care for Dementia in Scotland^[8] which advocate that "people with dementia will have the opportunity to be included in community life and meaningful activity as they wish".

An occupational therapy team in Ayrshire and Arran agreed that by encouraging collaborative working between health and partner agencies, they could help to support and encourage the use of activity within their areas. An "activity masterclass", based on a similar event held by colleagues in Perth and Kinross, was therefore developed.

The masterclass aimed to raise awareness about activities among AHPs, nurses, care home staff and others, provide networking opportunities and support, and facilitate options for joint training and peer supervision. The one-day event consisted of presentations from experts followed by activity workshops that provided short "taster sessions" participants could take away and try in their own areas. Workshop topics included the development of an activity pack produced by occupational therapists for use by nursing colleagues on a ward for people with dementia, the importance of sensory experiences, life-story work and football reminiscence, a demonstration of software that provides a communication support system for frontline carers and friends/family to assist them in engaging, interacting and communicating with people who have dementia, and even the opportunity to try out a number of different Wii computer games.

Participants reported that they had particularly enjoyed the activity workshops and felt that many of the ideas could be taken back to their workplace. A number of participants also commented on the presentations from experts, feeling that they provided extremely valuable information.

An additional event to cater for those who were not able to attend due to the high demand for places is being arranged and a working group has been set up to establish an activity network in the area.

5. Socially inclusive practice
Recommendation 7

Facilitating supported self-management for people with mental health problems through social inclusion

"Buddy Beat"^[9] was inspired by the Scottish Government's With Inclusion in Mind^[10] document and a realisation that occupational therapists needed to become more inclusive in their practice. Having learned about the "social inclusion traffic lights" system of red, amber and green, an occupational therapist in Renfrewshire and a community musician began a hospital-based drumming group (which placed them in the "red" zone of social inclusion). As it gathered interest, they then moved it to a community arts centre ("amber"). "Buddy Beat" is now well in the "green" zone as a constituted community group with trained workshop assistants drawn from its membership. The model has been followed by two art groups in Renfrewshire who are now independently constituted and another two groups are in the process of being established.

Tom, the "Buddy Beat" storyteller, has this to say about his experience.

"Buddy Beat has been the single biggest support in my recovery over the last four years. Finding the courage to get out of the house and find something to channel myself into was a problem and I was in a bad place. Buddy Beat came along at exactly the right time.

"I had never imagined being part of a community group, but here I am still part of Buddy Beat after all this time. The support we offer one another is better than any prescribed medication. My self-confidence has soared and my self-belief and creativity expand to a place I thought was long out of bounds. Buddy Beat has helped me find and keep friends after a lifetime of pushing them away. It is the place where I can be myself."

"Buddy Beat" has now been developed and adapted for service users in Dundee and is called "Drumdee".