Acknowledgment – This blog post is a personal opinion piece, based on thoughts and ideas about my own lived experience, writing is an occupation that helps me make sense of my thoughts and ideas. I acknowledge these may not be shared others, and respect peoples rights to have, different even conflicting ideas. This website has an accessible feature, that allows different accessible formats by simply clicking on a button labelled ‘Accessibility Menu’ that appears in green on all pages. It will provide you with a number of options to change the appearance to meet your accessibility needs. This communication has been written by a dyslexic person. If you have any trouble with the meaning of any of the sentences or words, please do not be afraid to ask for clarification. I’m #MadeByDyslexia – expect creative thinking & creative spelling.
This week at work, I attended a two day event to look at the provision of mental health rehabilitation services that the trust I work for provides and how we might redesign it as part of the national driver of community transformation expected within all NHS mental health service providers.
In a nut shell community transformation is about dramatically changing how services are run by braking down barriers to care, by removing criteria and long referral processes. A service that meets the needs of the individual rather than the individual having to fit in to the narrow criteria of a service.
Brilliant, just the sort of service I have talked about when reflecting on my own journey of recovery.
Changing cultures are hard, and perhaps although a lot of difficulties with poor practice that dehumanises people still remain within institutional services. Mental health and learning disabilities organisations and national drivers are ahead of the curve when it comes to progressing towards services that meet the needs of people.
Why might this be?
For me it’s a move towards, co-creation, recovery focused and inclusive practices that don’t just listen to stories of lived experiences, but actively invites it in to work for the organisations and develop alongside traditional health and care professionals changes in culture, and service delivery.
Something NHS services, delivering physical health services and local authorities that provide social care need to embrace.
So at this event there was a mixture of health professionals working within the current rehabilitation service, like nurses, health care assistants, psychologists, occupational therapists, peer support workers, experts by experience, managers, service leaders, etc..
Our first task was to define rehabilitation. What it is, how it is different from other services offered by the trust. In essence the unique selling point.
This blog will focus on this question as perhaps you might be surprised how difficult a group of people who have worked in or received care from rehabilitation services found it so hard to define.
Where to start?
Perhaps with the general population understanding of rehabilitation or rehab as it is often referred to. Like me your first thought might be of the Amy Winehouse song Rehab and the lines ‘They tried to make me go to Rehab, but I said no, no, no’
We often hear of celebrities attending ‘Rehab’ for addiction issues, so it’s easy to understand when you might start talking to a person about getting some rehab, they might be confusion if an addiction to substances is not a priority concern or not apparent at all.
But when you add another word for context it becomes more understandable.
- Nero rehabilitation (which was the rehab I have personally experienced)
- Mental health rehabilitation
- Physical Rehabilitation
- Vocational Rehabilitation
- Cognitive Rehabilitation
- Rehabilitation Therapy.
So what are the origins of the word?
The noun rehabilitation comes from the Latin prefix
“re” meaning “again” and “habitare” meaning “make fit.”
- the action, process, or result of rehabilitating or of being rehabilitated: such as a restoration especially by therapeutic means to an improved condition of physical function
- the process of restoring a person to a drug- or alcohol-free state
- the process of restoring someone (such as a criminal) to a useful and constructive place in society
- the rehabilitation of prisoners
- the restoration of something damaged or deteriorated to a prior good condition the rehabilitation of the neighbourhood the rehabilitation of a person’s reputation
How do other organisations define rehabilitation?
The World health organisation says Rehabilitation is defined as “a set of interventions designed to optimise functioning and reduce disability in individuals with health conditions in interaction with their environment”.
From NHS England’s guide on commissioning rehabilitation. A modern healthcare system must do more than just stop people dying. It needs to equip them to live their lives, fulfil their maximum potential and optimise their contribution to family life, their community and society as a whole. Rehabilitation achieves this by focusing on the impact that the health condition, developmental difficulty or disability has on the person’s life, rather than focusing just on their diagnosis. It involves working in partnership with the person and those important to them so that they can maximise their potential and independence, and have choice and control over their own lives. It is a philosophy of care that helps to ensure people are included in their communities, employment and education rather than being isolated from the mainstream and pushed through a system with ever-dwindling hopes of leading a fulfilling life.
What about occupational therapy and rehabilitation?
In 2020 the royal college of occupational therapists (RCOT) ran events called the Big Rehab Conversations to help them develop best practice for rehabilitation, identify the challenges and ensure the advice they offer reflects what’s actually happening on the ground.
Within the RCOT Informed View – mental health rehabilitation it is argued that
The term ‘rehabilitation’ can be problematic within the mental health sector, as it is typically associated with complex rehabilitation for people with psychosis, delivered in tertiary services. This means occupational therapy delivered in wider mental health services, such as community teams, is not commonly framed as rehabilitation.
As a broad term, the aim of rehabilitation is to maximise people’s ability to live, work and learn. Occupational therapy interventions focus on helping people to achieve these goals to the best of their potential. This aligns with a recovery approach in adult mental health services and a reablement approach within older people’s mental health services.
Occupational therapists are underrepresented within multidisciplinary mental health teams. Where roles do exist, capacity to offer rehabilitation may be diluted by generic responsibilities.
Across the UK there is a renewed focus on the best way to deliver rehabilitation. This requires innovative new approaches and service redesign, co-produced and co-delivered with people who access services. This offers a unique opportunity for occupational therapists to influence development and implementation.
They go on to state occupational therapist need to lead mental health rehabilitation reform with a focus on meaningful occupations, ensuring people keep links with local employment and education, manage daily living and social skills, and take part in leisure and community activities. It is fundamental that rehabilitation is person and occupation focused and that services address environmental, social and economic need.https://www.rcot.co.uk/files/rcot-informed-view-mental-health-rehabilitation-april-2022pdf
Of course this is a statement i’m going to agree with because occupational therapy is my bread and butter and anything that helps occupational therapy being seen as a treatment tool rather than the name of a profession is always going to be helpful, but there is a need to look at what resources are available and what other skills other professions can bring, for me its more about having an approach to rehab that is important one that has a common way of working with people, rather than doing things for people.
If rehabilitation is about the person do we need to define it?
Is it the complexity of a persons needs, and the goals they want to accomplish that is the essence of rehabilitation?
When I reflect on my own lived experience of rehab it wasn’t focused on my goals but a set of expectations, expectations I would walk again, when that expectation took longer than expected, services were at a loss of what to do!
At times it felt like they had given up.
My goals and wants were thought about to an extent but not explored, not set out as a goal to work towards. Walking again, was never my priority. I got there, but only when I was allow to hold the rains myself and seek support privately that my goals were really addressed.
- Finding passion again
- Sharing my thoughts
- Doing art,
- Being a wife and not a person who needed constant caring for
- Enjoying life
- Getting back to work
Washing myself, dressing my self, feeding myself were needs but not priorities for me. They were met in a way that was satisfying to me.
That’s rehabilitation to me, finding away through what is difficult to be the person I wanted and do the things I wanted, that make my life fulfilling.
By the end of the two day event, we have created an outline of a new model of delivering rehabilitation, but i’m not sure we were able to define it in a way that was agreeable, and maybe that’s the point?