NHS Reset is a new NHS Confederation campaign to contribute to the public debate on what the health and care system should look like post-COVID19.
In this blog, part of a series of comment pieces from NHS Confederation members and partners, Peter Molyneux argues that if talk about the COVID-19 recovery is going to be meaningful, the principles of connectedness, hope, identity, meaning and empowerment have to be key.
It's good that the NHS feels able to begin to talk about recovery in the context of COVID-19. Of course, concepts such as these can be engaging or distancing, as we all take different meanings from words – and "recovery” is no different.
As Niall Dickson discussed in his blog last week, it’s likely to have a number of phases to it in terms of: a) recognition of the sacrifices made and the innovations introduced, ensuring that we embed positive changes b) rebuild, so that we get back to the delivery of elective care, and c) reset, so that we are doing everything we can to help people achieve their best potential.
One way of further unpacking the concept of recovery would be to adopt the approach we use in mental health. Here, the emphasis on an individual's journey to recovery is a very personal process and is linked to their neighbourhood and community.
There are a number of ways used to define recovery, but most focus on connectedness, hope and optimism, identity, meaning and purpose, and empowerment1:
1. Connectedness – reciprocal relationships with others who believe in your potential to recover and mutual support
2. Hope – belief in yourself and your ability to persevere through adversity and setbacks
3. Identity – recovery of a sense of self and the acceptance of lost opportunities and time
4. Meaning and purpose – may involve recovering a meaningful social or work role, or developing a new role
5. Empowerment – appropriate housing, access to care and support, and an asset-based approach to strengths.
We will need to understand the trauma that occurs in individuals and which affects populations, which will be experienced in different ways. The commitment in the Long Term Plan on population health will now need even greater focus on population mental health, both in terms of health and care and the economic and social impacts. Sussex is already being hit hard by the impact of the pandemic on Gatwick, as well as the cancellation of events which are the engine-room of the seasonal economy. This is affecting unemployment rates and will have a resulting economic and social impact on population health.
This implies discussing how we can achieve a more systematic approach to population mental health. There are some fantastic examples of places where this is happening, but it is patchy and fragmented. So across systems, we need to co-produce with communities and wider civil society ways in which we can support individuals but also reduce some of the underlying causes of mental distress – and the unequal way in which this is distributed across populations and communities.
Individual placement support (IPS) employment services that support people with mental health problems to attain and retain employment are ideally placed to respond to people grieving for lost family and friends and/or lost employment. These are due to expand as part of the Long Term plan and can play a key role here. There is likely to be increased investment in other employment services, but research from Italy has shown that this needs to look therapeutically at the whole person. We could explore investing in employment support with a therapeutic element based on the principles of IPS running alongside IPS services.
As anchor institutions, or as part of anchor systems, we have a real opportunity to look at our supply chains in terms of goods and services. We will all be looking to reshape our services and hence our workforce needs. There's a real opportunity to create the job roles that local people can do and to work in partnership to reduce income inequality, address our workforce challenges and improve population health.
Those of us running healthcare organisations across our local systems will (not now, but at some point) need to recognise that we are going to be among the very few employers whose headcount has stayed stable or increased at this time, and will need to look at how we can realistically support community recovery. While our first priority must be to look after the health and wellbeing of our staff and patients, we also have a responsibility to the places and neighbourhoods in which they live.
Helping everyone to achieve their best potential is key to recovery for staff, for patients, for communities. If talking about recovery is going to be meaningful, then the principles of connectedness, hope, identity, meaning and empowerment are key.
Peter Molyneux is chair of Sussex Partnership NHS Foundation Trust and a member of the Mental Health Network board. Follow him on Twitter @peterjmolyeux and the trust @withoutstigma
1 Leamy et al ,The British journal of psychiatry: the journal of mental science 199(6):445-52 · December 2011.
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