Training and awareness-raising of mental health professionals from the recovery model
Implementing a transformative model like recovery involves various actions. The inclusion of peer support and the shift in the objectives of existing services have been some of the most visible. Perhaps less visible, however, are the training and awareness-raising activities for professionals in the field. Motivating change requires, at a minimum, explaining the proposed changes and conducting activities where these professionals can connect with the desires of service users for a different kind of care.
From a pedagogical perspective, these activities combine objectives ranging from acquiring knowledge about the recovery model and understanding its fundamental concepts to the practical application and critical analysis of real-life situations. As with the model in general, another distinctive feature is the participation of people with lived experience of mental distress. This participation translates into activities where staff can connect with needs not met by the biomedical care model and learn about the alternatives offered by the recovery model. Replacing paternalistic practices focused on symptom relief, which hinder the development of life plans, with collaborative practices where the user's preferences are central to all interventions can serve as an example of the message conveyed by these activities.
Albert Sala Argüello
The spread of the model , particularly in Anglo-Saxon countries and Western Europe, has consolidated and expanded the role of affected individuals in training and awareness-raising activities. Initially, these individuals were primarily former users of the services where the activities took place. Their main function was to provide personal accounts of their experiences with the care they received. However, the expansion of the first-person narrative movement and the incorporation of the peer support agent role facilitated their inclusion as trainers with responsibilities for pedagogical planning and even leadership of large-scale training implementation projects.
The scope of these activities has been very broad. The number of professionals who have participated in the pioneering countries of the recovery model can be counted in the hundreds of thousands, including mandatory training campaigns in various territories. The complexity of the activities has increased, evolving from training and awareness sessions lasting a few hours to complex, large-scale organizational transformation processes lasting several months, such as the recent REFOCUS and GetREAL projects.
Is it possible to change practices in mental health care?
Our association, the First-Person Mental Health Research Group of the Catalan Federation of First-Person Mental Health Entities - VEUS , has contributed to the training of hundreds of professionals at the national and international levels through the program "Beyond Recovery: Towards Rights-Based Mental Health Care." The content of this program includes four modules:
- Alternatives to diagnosis: From nosologies to shared experience.
- Goal formulation and establishment: From symptom reduction to recovery.
- Rights-based mental health care: collaborative practices, respecting preferences and advance directives.
- Promoting mutual support: Integrating the figure into the system.
Regarding the impact of these activities, a recent systematic review with meta-analysis conducted by our research group (Eiroa-Orosa and García-Mieres, 2019) illustrates that these types of activities have a clear influence on beliefs and attitudes, while the effect on practices is less clear and highly heterogeneous . It is important to note that most studies measuring behavioral variables have done so within the context of large-scale projects like those mentioned above. This raises the question of whether, beyond changing beliefs and attitudes, it is possible to change practices, even when sufficient resources have been invested.
Some qualitative studies offer information that can illustrate the results of our meta-analysis. These analyses discuss the tensions between top-down, management-led changes and bottom-up or team-initiated changes. In the large-scale projects mentioned, although the intention was to implement bottom-up organizational changes, it is clear that the professionals involved had serious doubts about the institutional commitment to making real changes. This connects with other concepts already addressed in smaller projects with significant participant involvement, such as hope and autonomy. Some of the large-scale projects attempt to systematize and implement changes that initially occurred spontaneously in a highly committed transformative environment. As with the achievements of other social movements, systematizing bottom-up processes, even considering the idiosyncrasies of each context, involves some contradictions, such as the difficulty in emulating the intrinsic motivation that arises originally.
This seems to be happening in a context where institutions are sending contradictory messages. On the one hand, they allocate funds to projects of this kind, but on the other, they don't provide real support for the changes to occur and be sustained.
Training and raising awareness among professionals are fundamental elements for implementing the recovery model . As in other areas, the participation of those affected is essential. This involvement occurs both from service users and from first-person activists with training experience. The impact of the activities is clear in terms of beliefs and attitudes, although less so in practices. This difference is likely due to resistance to change at the organizational level. Therefore, the involvement of all professionals, both those dedicated to care and those in management, is crucial for the transformations to crystallize into care based on the creation of full citizenship projects.
Featuring
