Every week, in supervision with my student, we pick a theory, article, piece of legislation or policy, to discuss at length. Last week, we spoke briefly about the recovery model in mental health services and she asked that we discuss it in more depth this week and particularly if and how the model can be used when working with people who are suffering from a deteriorating dementia, particularly when there are organic causes.
Recovery is about ‘getting better’, ‘functioning better’ and how can this allay with an illness that is chipping away at cognition.
It was an interesting question and one that I’ve looked at in various ways at different stages. I did a brief literature search and found a couple of useful articles that both seemed to suggest a similar approach.
Recovery is not necessarily about ‘cure’. ‘Getting better’ can have lots of meanings and it doesn’t always mean getting back to place where one was before diagnosis or deterioration. It shows though how narrowly sometimes the models are perceived and how some of the workings within older adult services are ignored or bypassed when they might not ‘conveniently’ fit.
Recovery then in this sense can be used to work towards an optimum – but that figures as it should be what we are doing in any situation!
The article that we were able to discuss was ‘Recovery Approach to the care of people with Dementia’ (Martin G ‘Journal of Psychiatric and Mental Health Nursing’ (16:7 2009) which unfortunately is not available free but can be accessed through university journal collections or libraries.
It linked the recovery model to the person-centred approach which is more commonly used in different format and worked the model into where a person is at, empowerment through advocacy (and much broader advocacy than the legal provision of IMCAS (and IMHAS)) and talked a lot about the models presented in Kitwood’s ‘’Dementia Reconsidered’ which emphasises the importance of ‘personhood’ and retaining an individual and personal approach to people who have dementia (which shouldn’t be coming as a surprise as this is a basic tenet of human dignity which is so often forgotten in some care settings).
I wonder how much it is an attempt to fit a group who have not traditionally been able to meet the criteria of ‘recovery’ in some of the most obviously apparent settings into a hole and whether it is a fair jump to make from ‘recovery’ in the sense of putting the person at the centre of their own care and decisions to moving to the issues that arise when that person lacks capacity.
There are useful lessons to be taken. I think social work sometimes suffers by trying to fit all situations into previously presented ‘models’ and that sometimes is at odds with the need to think creatively and individually. That is partly a reason for my preference for postmodern models and strengths-based perspectives on social work theories.
It doesn’t matter what area you are working with, you can find strengths to draw on and that allows for a more individual approach.
In some ways, links can be made (and were in the article) between medical and social models with the medical models seeming to put the disease around the person and the social models putting the person in the centre with a corner of disease. In some ways, this can be paralleled as far as perceptions of dementia are concerned and can be seen clearly in the NHS’ new campaign to show individuals with dementia and emphasise the personhood rather than the disease – the tagline being ‘I have Dementia, I also have a life’.
I think it’s interesting to see how the move towards the social model or perhaps, in this context the ‘recovery’ or person-centred model is now being broadened to a media campaign and likewise to a move towards individual budgets.
To those who say that theory has no place in social work training, which should be ‘practical’ or those who may say that the theory is ‘out there’ and not used in day to day practice – I present two very real examples of ways that a theoretical model and approach affect our day to day working – obviously we would hope that it happens on an individual basis but the extension of Individualised budgets (in an ideal world, in any case) which put the person rather than the ‘need’ at the centre of support planning and the campaigns which focus on personhood, we can see the practical implications of shifting paradigms and uses of theoretical bases.
Incidently, I had a copy of Kitwood’s book knocking around in the office. I hadn’t opened it for a while, but I came back to it when preparing for the supervision session. I can’t recommend it highly enough – since first picking it up, I’ve come across lots of books about ways of working with dementia, approaches etc. I haven’t come across anything that comes close to it though. Maybe (and I still am reading it!), I will come back to a full review at some point.
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Fighting Monsters 
“To those who say that theory has no place in social work training”
This was actually the written question I had when I went for the MSc interview (it wasn’t phrased exactly like that, but it was about whether theory has any place in social work.)
Fascinating read, though. I mean your blog, not my written test 😉
I fin dit interesting how you consider the recovery model as it fits older people with cognitive decline. I personally am not involved with dementia, but I find a similar controversy when applying the recovery model to developmental disabilities. I am autistic but institutionalized in mental health, and we’re currently implementing the recovery model. I applied to take part in the to be started recovery group, and this got me thinking whether “recovery” is applicable to me, while I hav eno plans of getting into a less care intensive placement anytime soon. Then I thought about hwo recovery can mean living with your illness/disability and still livcing a quality life, by your own standards, rather than living a high quality life by society’s standards.
Of course, it gets more complicated when mental incapacity is involved, as is often the case in dementia. However, I do feel that recovery can take place on a smaller scale there, too. Indeed, there are links to the person-centered and “experience-directed” (as the Dutch word is) models.
Dementia is a health matter not a social matter.
The medical model should always be appropirate NOT the social model.
The social model is merely to present it as a ‘soclal service’ for means testing and charging.
Recovery doesn’t come into Dementia planning at all.
No one recovers, most are left to their own devices as anyone with the desease is placed into ‘social’ responsibility on every opportunity, therefore will have undoubtably many many unmet needs, as they cannot and do not have any responsibility for ‘health matters’.
As long as the ‘social services’ are willing to carry on accepting the many ‘health defined responsibilites being re-defined as ‘social’ just to keep their jobs, people are merely piggy in the middle.
Social Services/Local Authorities assess only to fulfill their own requirements, tick boxes, internal/external targets as outlined in the ‘cutting Costs’ piece.
i repeat once again, the ‘nature’ of social work nowadays is only to meet internal targets, in order to maintain one’s own heirarchy of need.
Agency & temporary staff should never be let near anyone in NEED and especially the inernal computer systems storing the information of all people in both social or health dliemmas, it is a scandal itself that all services are presently ‘commissioned’ / ‘ provider functioned’ / ‘outsourced’.
The pursuit of profit from people in NEED, either from the medical model, sick, ill infirm, OR the social model, frail, elderly, disabled, is a national scandal.