Recovery-oriented practices within an Australian psychosocial Clubhouse : a case study analysis

Abstract

In the field of mental health, the biomedical idea of 'clinical recovery', emphasises treatment of symptoms with the aim of return to a former state of health. This concept has been challenged in modern times by a new approach referred to as 'personal recovery', developed by people with lived experience of mental illness. Personal recovery, focuses heavily on addressing the complex social challenges experienced by people with mental illness, assisting them to pursue their individual journey towards a satisfying life that may or may not include continued symptoms. In response to increasing political advocacy by people with lived experience of mental illness, the concept of personal recovery has been incorporated into the government health policies of many countries during the past two decades. In this context, how to operationalise recovery oriented practice has become an important consideration for those who manage mental health services. Despite this, limited studies have investigated how recovery practices are implemented within individual services, such as psychosocial Clubhouses. Psychosocial Clubhouses provide an internationally recognised approach to mental healthcare, delivering supported employment, educational and social programs. Informed by a meta-theory of human motivation known as self-determination theory (SDT), this qualitative case study explored how recovery practices are implemented within one Australian psychosocial Clubhouse. Research questions included: (a) How are recovery practices reflected in the documentation of a Clubhouse? (b) How are recovery practices embodied in the behaviours of staff within a Clubhouse? (c) How are recovery practices perceived as being implemented by the staff and members within a Clubhouse? The first question was explored through a documentation review within the Clubhouse. Qualitative content analysis revealed recovery was well represented in Clubhouse documents, strongly reflecting principles such as 'collaboration' and 'participation'. The second and third questions were explored through one hundred and twenty hours of participant observation of six staff, and interviews with the same six staff, and twelve members. Data were analysed using thematic analysis which revealed two overarching themes. The first theme was 'social environment', which suggested a sense of community, participation and autonomy. The second overarching theme was 'autonomy support'. This theme highlighted the absence of coercion and controlling practices within the Clubhouse. In contrast, individuality and personal choice were strongly promoted. This was achieved by encouraging self-expression, identifying talents and building confidence. In contrast to traditional medical approaches, the psychosocial Clubhouse operationalised distinctly social and interpersonal approaches to implement recovery-oriented practice. Findings contribute constructive information regarding the utility of SDT in recovery focused research. The study also provides valuable insights for other mental health services interested in developing recovery-oriented practice.

Date of Award	2016
Original language	English