Midterm ERASMUS+ Evaluation Meeting

DIGNITY & WELL-BEING: Exchange for changing
Florence   20 / 02 / 2018
  
 

4.   PILLAR - RECOVERY    Workshop Tuesday 20/2/2018          -  Facilitator: Luigi Leonori

Group:  Antonio Bento, Pierre Rykmans, Sofulis Tardis, Prebn Brandt, Per Glad Fuglsbjerg, Andrezej Czarnoki,
 John McEvoy   

Introduction

What do we mean by recovery?

“A return to a normal state of strength, mind and means”

“Process of change, through which individuals improve their wellness and life” 

This is a personal individual process, supported by but not managed by a professional. The mentally ill do not want the interference of a professional, there is transformation of participation.

The user themselves must manage the row recovery – it is RECOVERY BY THEMSELVES with support.

Recovery allows someone to be capable to make their own long term decisions. It is a return to a normal state. It was pointed out in the workshop that for many homeless people who suffer from a mental illness might never have been in a good state so it is a return to a normal life, perhaps ne of stability.

Recovery is the difference between a state of survival and life, from the street to stable housing to live again or start someone else.

Stabilisation is one process, followed by another process

Survival condition is the street, stabilisation and find yourself again and start to enjoy life.

Recovery is a very individual process, what people do for themselves, it is not our process we must be very respectful and careful with peoples process to recovery.

For a sustainable process we must support the transformation. But we must be careful as when you support you give your opinion, which is not always a good thing, you must support what they feel they need. It’s a matter of balance between their needs and your support and when we do this we must be very respectful.

An underlined note from this workshop was that we must always be careful to note that RECOVERY IS NOT TREATMNET, they are two very different things .

When someone is homeless and living in the street they have different priorities to when they are in a home. We must have a sensitivity to what  they say, you must be there to listen.

The mentally ill see their recovery process one way and we may see it another way.

Again we reiterated the point in this workshop that recovery is not a treatment and has no time limit, it takes as long as it takes and is self managed, Treatment has a tie.

Tasks and targets of recovery

The group felt that we had covered this in the introduction

Recovery Rights

Each person has the right to a supported recovery which they have the right to recover in their own time.

Each person has the right to work and have the support to find work They have the right to organise in their won way i.e street papers and other group organisations and we should support them in their effort. The have the right to the room to do all of this, we must not stop them or say something negative about this. There was also a discussion about the roles of Housing First and Shelters in recovery. Housing first, housing without a condition of being housed supports recovery. IN a shelter you have a lot of people for a short period of time. So for a recovery which is a slow process you can stimulate the person to help them recover themselves, it is not an ideal situation to support recovery in a shelter. You can guide a person, check if they have made progress but there is little time in a crowded shelter to support recovery.

There are limited possibilities in a shelter, it depends on the relationship with the service user.

The difference between housing first and a shelter were seen as:

Housing First   You have all the time and space you need to support a persons recovery.

Shelter :  Limited time and space, as long as there are shelters, they must be as human and as stimulating as  possible  

Participation in housing first and in a shelter

It was pointed out by Andrew that in a shelter there can be a great deal of meaningful participation. In their services in Warsaw service user are invoiced with cleaning, the catering and kitchen work. The shelter is a community that people must contribute to stay in, it gives people a structure in their life that also contributes in a meaningful way to the running of the shelter. This discipline keeps some of the users going, it gives their days structure.

Participation is a very individual thing with housing first is about citizenship in a broader way in society.

Best Practises from visits:

Lisbon – Lockers, it was pointed out that through the lockers people were integrated into the community and some people also got casual work from them. 

Lisbon – workshops where people did crafts, people did in depth work allowing recovery in Day Centres which was an informal way to a normal life.

 Luigi pointed out that there should be more priority in Athens, Barcelona and Poland to visit projects that aid recovery and to get a job.

Networking

What are the possibilities for patients? It is difficult to make a link from survival to a normal life.

In a shelter there can be links with occupational therapists, have jobs on display in the shelter notice boards, keep in touch with the labour office or send service users to the labour office, try to send people to places where the can do something for themselves.  Try to revive an interest in a basic need to have an income. For caritas they have a relationship with some employers and have a social cooperative which is next door, they have a restaurant and also provide cleaning services in a Carritas Hospital, which gives them an avenue for jobs for people.

It was pointed out that a focus on work and jobs is not always good.

Prebn pointed out that work has been used since the 1840s (in work houses) and it has not always worked as a means to recover (later in the day Philip Timms pointed out that the work houses were also used as a punishment and may be a poor example)

If we focus on work then we need to look at our communities. Prebn pointed that due to a class based society someone will always be at the bottom.

What is the difference between a job and work? Some people can not hold down a job but can participate, there was a lot of emphasis that we must reinvent this kind of participation, to reinvent jobs and employment that works for homeless people with mental health needs.

Some people expect something when they have a love and belonging, they have interest, having belonging in a job.

Money can be linked to dignity - it is one kind of exchange.

Outreach / Proximity 

The key work everyone held here is RELATIONSHIPS

We know things take time, recovery, creating relationships, outreach teams might be more focuses on treatment. With relationships you can give choices and options for individuals users with regards to what they want.

The relationships we have is very important.

 If we aim to have a job as a target there are some people who will not or ever be able to work.

 We must recognise and accept the difference and never forget those who can not work.

 Key Words of Recovery Pillar

To facilitate the capacity to recover

Empowerment  - to take their lives into their own hands an opportunity to control their own life. There was much discussion on the use of the word empowerment. Empowerment is an external action, but it is also a two way relationship, it can drive someone to recovery but recovery can also lead someone to empowerment.

Cooperatives

Reinvent jobs

Staff Care

Recovery is another process, staff can get frustrated. Staff need to be trained and given the tools to clearly understand that treatment doe not equal recovery.

WORKSHOP ON RECOVERY  (2)        Facilitator   and  Rapporteur : PANAGIOTA FITSIOU

Introduction

Why have we Recovery like a pillar in the interventions with people homeless with mental illness?

Which is the role of Recovery action in the interventions with people homeless with mental illness?

Wich are the tasks and the targets of Recovery action in the interventions with people homeless with mental illness?

The definition is very broad and maybe vague, but could be described as "to live a meaningful life in the community of your choice and strive to achieve your potential".

Being able to recover, means self-regulate oneself and live in one's own house.

Recovery is a process and a personal journey, we respect people's choices and the time needed to return in meaningful life.

Some people become homeless because of mental illness and /or adverse childhood experiences. It is not just a "homeless" situation, we also have to address impairments and provide options to meet different needs.

However, there are obstacles to this process. Some people are stuck to vicious cycles because we offer them solution that do not fit to their needs.

First to listen, then to offer!

Recovery should be transversal in all interventions.

The role of recovery is to install hope, to give positive perspective (of course not unrealistic), to support to connect and discover opportunities, to respect needs and choices, focus on strength and self-determination, focus not on symptoms but on own resources.

Recovery rights

Can we highlight specific rights on Recovery? Do specific rights on Recovery exist?

Recovery is a different approach and "paradigm". We keep in mind the United Nations' Convention on the Rights of People with Disabilities, which means a shift from medical to social model of disability. Recovery is supported by other basic rights: right to housing, to access to health services, access to basic goods, the right to live independently in the community of your choice, to participate to community life and being included as an equal member of the society.

Best practices we experienced in our visits

Not more than 3 examples

1.   The Social Cooperatives of Limited Liability (SCOLL - KoiSPE in Greek), which are Private Law Entities, with limited liability of their members,  were instituted by L. 2716/1999 "Development and Modernization of Mental Health Services and other provisions "(Government Gazette 96 A / 17.05.1999) of the Ministry of Health for the" Development and modernization of mental health services ". The SCOLL have  a commercial nature and can develop any economic activity supporting it by vocational training programs for their members, as well as sheltered laboratories, and Supported employment Pertaining to the Social Cooperative Enterprises, economic migrants, refugees and mentally ill individuals are among those groups that are being provided for by the Law 4430 of 2016. So, they are a special form of cooperatives, since they are both productive/commercial units and also Mental Health Units.

Purpose and Aims

The activities of SCOLL aim:

·         To ensure the viability of the enterprise and the continuous creation of new employment positions;

·         To be active in the local open market

·          To maintain a balance between the entrepreneurial strategy and the social aims;

·         To fight and eliminate the social stigma, through – among others - the creation of a work identity and the improvement of the financial position of the Cooperative’s members;

·         To establish cooperation with the family and the therapeutic framework and provide counselling support to the members;

·         To provide continuous education and vocational training to its members with psychosocial problems;

·         To provide continuous education and vocational training to its staff and collaborators - mental health professionals, so as to contribute to the employment of people with special needs, disadvantaged and psychosocially challenged.

2.   
Invisible Tours, the social tour

In September 2014, the “Invisible tours” social project was launched.  It is a social tours program based in the capital of Greece, Athens, in which homeless people become tour guides -and indeed, community leaders- in a very different kind of a city walk. This is a tour that does not take people to Acropolis and the archaeological treasures of the city but leads them through the backstreets of central Athens. As is the case with other social tours organized by street papers all over the world (Hamburg, Basel, London, Munich etc), the tour introduces visitors to some of the important social and solidarity institutions of the Greek capital (soup kitchens, day centers, drug rehabilitation centers, homeless shelters etc). The guides provide information on the types of services offered by each institution as well as how they themselves have experienced or are still experiencing homelessness. The goal of these social tours is to energize the person who is leading the tour and to create new ways for him/her to support himself/herself, providing new training and educational opportunities and supporting them to move a step closer to social (re)integration.

We have to be careful not to stick with the label of homeless and  "sell"  this idea!

Networking

Is it possible for Recovery professionals partecipate in the network?

How Recovery professionals can cooperate with the other professionals involved in the interventions with people homeless with mental illness? Which are the most critical issues in this cooperation? Which are the most strength issues in this cooperation?

How can Recovery professionals partecipate/build the multidisciplinary network?

Recovery is a totally different approach and "paradigm", so you have to encourage this approach in every team and inspire colleagues to see throught this perspective and really support people towards this direction.

The needs of people are diverse and complex. So networking is neccessary in order to offer choices.

It is a person-centered approach and we need a tailor-maide plan (not step by step, but according to choices, potentials and impairements) .

It is important to facilitate with formal and informal associations and community resources.

Outreach/proximity

How can the outreach/proximity approach be used like a tool in the interventions with homeless people with mental illness?

Which are the specific methodology in the outreach/proximity aproach that can be a strenght in the Recovery interventions?

Outreach and proximity means we have to be proactive, to meet people where they are and give priority to the needs they express.

Provide rapid responses to needs, give access and clear pathways.

Be careful not to "trap" people into vicious cycles of training...We have to re-invent job and empower people to follow their pathways.

We should focus on real jobs.

Key words of Recovery Pillar

Connecting, empowerement, personal choices, hope and potentials, real job, active position.

Staff Care

Which are the staff care action more effective for the Recovery professionals working with homeless people with mental illness?

Which are the most critical issues in their work? Which are the most strength issues in their work?

Give space to teams for reflection, team approach, mentallity and culture of networking, communication within the team, in order to support staff and facilitate to understand that recovery process takes time, so we have to deal with frustrations, steps back and forward and at the same time respect people's own recourses. 

A team has to be supported to be  flexible.

Another issue is that teams have to empower people, while working in a difficult and "hostile" environment  regarding job (fewer opportunities and unemployment). We have to be optimist, install hope but not being unrealisitic...).