Promoting Recovery in Mental Health Nursing


Steve Trenoweth

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  • Back Matter
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  • Copyright

    Transforming Nursing Practice

    Transforming Nursing Practice is a series tailor-made for pre-registration student nurses. Each book in the series is:

    • Affordable
    • Mapped to the NMC Standards and Essential Skills Clusters
    • Full of active learning features
    • Focused on applying theory to practice

    Each book addresses a core topic and they have been carefully developed to be simple to use, quick to read and written in clear language.

    Core Knowledge Titles

    Becoming a Registered Nurse: Making the Transition to Practice

    Communication and Interpersonal Skills in Nursing (3rd Ed)

    Contexts of Contemporary Nursing (2nd Ed)

    Getting into Nursing (2nd Ed)

    Health Promotion and Public Health for Nursing Students (2nd Ed)

    Introduction to Medicines Management in Nursing

    Law and Professional Issues in Nursing (4th Ed)

    Leadership, Management and Team Working in Nursing (2nd Ed)

    Learning Skills for Nursing Students

    Medicines Management in Children's Nursing

    Microbiology and Infection Prevention and Control for Nursing Students

    Nursing and Collaborative Practice (2nd Ed)

    Nursing and Mental Health Care

    Nursing in Partnership with Patients and Carers

    Palliative and End of Life Care in Nursing

    Passing Calculations Tests for Nursing Students (3rd Ed)

    Pathophysiology and Pharmacology for Nursing Students

    Patient Assessment and Care Planning in Nursing (2nd Ed)

    Patient and Carer Participation in Nursing

    Patient Safety and Managing Risk in Nursing

    Psychology and Sociology in Nursing (2nd Ed)

    Successful Practice Learning for Nursing Students (2nd Ed)

    Understanding Ethics in Nursing Practice

    Understanding Psychology for Nursing Students

    Using Health Policy in Nursing

    What is Nursing? Exploring Theory and Practice (3rd Ed)

    Personal and Professional Learning Skills Titles

    Clinical Judgement and Decision Making for Nursing Students (2nd Ed)

    Critical Thinking and Writing for Nursing Students (3rd Ed)

    Evidence-based Practice in Nursing (3rd Ed)

    Information Skills for Nursing Students

    Reflective Practice in Nursing (3rd Ed)

    Succeeding in Essays, Exams & OSCEs for Nursing Students

    Succeeding in Literature Reviews and Research Project Plans for Nursing Students (3rd Ed)

    Successful Professional Portfolios for Nursing Students (2nd Ed)

    Understanding Research for Nursing Students (3rd Ed)

    Mental Health Nursing Titles

    Assessment and Decision Making in Mental Health Nursing

    Critical Thinking and Reflection for Mental Health Nursing Students

    Engagement and Therapeutic Communication in Mental Health Nursing

    Medicines Management in Mental Health Nursing (2nd Ed)

    Mental Health Law in Nursing

    Physical Healthcare and Promotion in Mental Health Nursing

    Promoting Recovery in Mental Health Nursing

    Psychosocial Interventions in Mental Health Nursing

    Adult Nursing Titles

    Acute and Critical Care in Adult Nursing (2nd Ed)

    Caring for Older People in Nursing

    Dementia Care in Nursing

    Medicines Management in Adult Nursing

    Nursing Adults with Long Term Conditions (2nd Ed)

    Safeguarding Adults in Nursing Practice (2nd Ed)

    You can find more information on each of these titles and our other learning resources at Many of these titles are also available in various e-book formats, please visit our website for more information.


    Sometimes revolutions are noisy and devastating, but sometimes they start quietly, in the places where people are subject to continual difficulty and distress. The recovery movement could be seen as just such a revolution. To say that successful implementation of the recovery model, in its original form, could transform services is not unreasonable; though there have been, and are, many challenges inherent in doing this. The tension that exists between the recovery approach and the continually dominant bio-medical model is not ignored in this book and it provides a balanced view of a complex subject. The book also goes some way to suggesting solutions to some of these challenges and suggests ways in which you, as nurses, can implement the model and support the approach in a way that will promote the likelihood of success. The book provides practical exercises that will help the reader to develop a stronger understanding of the recovery approach, the challenges of implementing it and opportunities to explore your own values and beliefs.

    Much of the material in the first five chapters is usefully, and very powerfully, summarised in the last two chapters. Three key features of this book are, firstly, pointing out the power differential that exists in mental health care and the impact that this has on assisting service users to have control over their own lives, an essential element of the recovery process; secondly, the fundamental importance of nurses being human beings, exploring the common humanity of people and recognising that both staff and service users come up against mental distress during their lives, experiences that can be shared and explored to aid recovery; and thirdly, a call to action to the reader as a citizen of the community not just as a nurse to advocate for those in distress, to take a stand for equality and to discourage the co-option of the model to suit the needs of services rather than service users.

    If you are a student nurse, a newly qualified nurse or even a nurse of some years standing looking for tips to update your portfolio of skills, this book will stand you in good stead for practice. It can be read as a whole but can also be dipped into section by section as you come across situations in practice, perhaps, that warrant further exploration of that particular subject. Engaging with this book will help you to become a more effective and safe practitioner of the art of mental health nursing, enhancing your ability to promote the recovery approach in health care and help those in mental distress to find renewed hope and personal power so they may once again live a life they feel is worth living.

    Sandra WalkerSeries Editor

    About the Editor and Contributors


    Steve Trenoweth has been a mental health nurse for 26 years. He has worked in a wide variety of mental health settings before entering higher education in 2003. He is currently a senior lecturer at Bournemouth University. He has authored several books, chapters and articles in nursing and health care, and is an editorial board member of the British Journal of Mental Health Nursing. He is a trustee of Project Nurture, a Dorset-based charity committed to enriching and enhancing the natural and built environment for those who are suffering from the effects of social exclusion and mental health difficulties.


    Wasiim Allymamod is a qualified nurse working in an acute service of a London mental health trust. He qualified from the University of West London with a first class honours degree in mental health nursing in 2008. His interests are cognitive behaviour therapy, positive health and mental wellbeing and psychosocial interventions.

    Teresa Clark works for Certitude, a not-for-profit organisation that provides personalised support for people with learning disabilities, autism and mental health needs in London. She currently manages an employment, training and education service for Barnet, Enfield and Haringey Mental Health Trust's North London Forensic Service. The service was commissioned in response to the trust's acknowledgement that forensic patients require a personalised re-enablement approach to encourage and promote a successful transition into their communities. She is responsible for developing and facilitating an experts by experience programme within Chase Farm Hospital and a public involvement programme at the University of West London. The public involvement programme was created to assist the university to implement their public and carer involvement strategy through utilising members of the community who have had first-hand experience of the health care and mental health system to be involved in the training and development of their students. She is a trustee for Key Changes, a London-based charity that provides music engagement and recovery services in hospitals and the community for young people and adults experiencing mental health problems.

    Sandra Connell qualified as a registered psychiatric nurse in Ireland in 2003, working for a short period in inpatient rehabilitation before moving into services in the community in Ireland. In 2010, Sandra registered with the NMC as a registered nurse in mental health; since moving to England Sandra has worked as a lecturer. She is a lecturer in mental health at Middlesex University and links with Barnet, Enfield and Haringey University Trust and is the service user educator co-ordinator for the mental health team at Middlesex University.

    Sally Gomme currently works for West London Mental Health Trust and has also worked for many years in the voluntary sector. She has worked in project management and development but over the last twelve years has mainly taught and lectured in mental health with a focus on recovery and culture change. In her current role she is developing a Wellbeing Network in Hounslow, which has a non-clinical approach based on connecting people and strengthening communities.

    Nicky Lambert is an associate professor at Middlesex University, where she is Director of Teaching and Learning for Mental Health, Social Work and Integrative Medicine. She is registered as a specialist practitioner (NMC) and is a senior teaching fellow with the HEA. She has a professional Twitter feed: (@niadla) and is keen that all people with an interest in mental health engage together as a community to support good practice and challenge discrimination.

    Phil Morgan is the lead for recovery and social inclusion for Dorset HealthCare University NHS Foundation Trust and co-lead for Dorset Wellbeing and Recovery Partnership, a partnership between Dorset HealthCare and the Dorset Mental Health Forum, which is a local peer-led third sector organisation. Phil is committed to exploring how recovery principles can shape our learning about ourselves, others and the organisations that we work within. Phil also works as a consultant for ImROC.

    Rachel Perkins is senior consultant, Implementing Recovery through Organisational Change Programme (ImROC). She is also co-editor of the journal Mental Health and Social Inclusion and deputy chair of Equality and Human Rights Commission Disability Committee. In 2010 she was voted Mind Champion of the Year and awarded an OBE for services to mental health.

    Helen Robson is a clinical nurse specialist for inpatient services within Berkshire Healthcare NHS Foundation Trust. She previously worked as a senior lecturer in mental health nursing at the University of West London for several years. She qualified as an RMN in 1992 and her clinical experience has been within both forensic mental health services and acute inpatient services.

    Francis Thompson is a lecturer in mental health nursing, Faculty of Health and Social Work at the University of Plymouth. Francis has worked in a variety of clinical areas across inpatient and community services including older adults, the National Psychosis Unit and addictions services. He held a number of senior management roles in London where he focused on practice improvement and nursing education before moving into his current post as an associate professor of mental health nursing with Plymouth University.

    Alison Tingle works part-time as the research development lead in the College of Nursing, Midwifery and Healthcare at the University of West London. In addition, Alison works part-time in the Policy Research Programme, a national research funding programme within the Department of Health's Science Research and Evidence Directorate. Her responsibilities include commissioning high quality, research-based evidence relevant to mental health to meet the needs of ministers, national policy makers and health and social care system partners.


    I would like to thank Teresa Clark and particularly the service users at Certitude for their support of this project. Thanks also to Alex Clabburn and Richenda Milton-Daws at Sage for their patience and guidance.

    We are grateful to service users from Certitude for supplying many of the voices heard across the chapters.

    Thanks go to Dr Lioba Howatson-Jones for permission to base the case study in Chapter 2 (Ash and George, pages 23–4 of this book) on a case study (‘Naeve's critical incident experience’) in Chapter 10 of her book Reflective Practice in Nursing (3rd edition, Sage, 2016).

  • Glossary

    Alzheimer's disease:

    the most common form of dementia characterised by progressive memory loss, confusion, disorientation, and problems with decision-making and reasoning skills.


    the structure in the brain thought to be linked to both fear responses and pleasure.

    auditory hallucinations:

    an abnormal experience resulting from an underlying biological dysfunction which requires medical care and treatment.

    biomedical model:

    conceptualises health and illness biologically.

    biopsychosocial model:

    identifies how psychological and social experiences combine with biological factors to affect the course of illness and health outcomes.

    cognitive behavioural therapy:

    a talking therapy that supports coping and problem-solving by changing the way people think and behave.


    not only geographical community where people live but:

    • communities of identification: people who the person sees as being like them for example, helping someone to access a particular faith community or lesbian/gay community;
    • communities of interest: people who share interests with the person, for example, political parties, sporting or arts activities;
    • e-communities and opportunities: the internet contains a wealth of information and possibilities for contact, and e-exclusion simply compounds the exclusion that is so often a consequence of mental health challenges thus rendering the person further isolated and alone;
    • peer communities: peer-led groups and organisations as well as individuals within the person's network who share similar challenges.

    Community Treatment Orders (CTO):

    set out the terms under which a person must accept medication and therapy, counselling, management, rehabilitation and other services while living in the community.

    complete recovery:

    where an individual returns to their level of functioning before they experienced mental ill health, often implying that the person has been ‘cured’ or recovered.


    a neurotransmitter involved in controlling the brain's reward and pleasure centres.

    frontal cortex:

    the frontal part of the brain which is thought to control motor function, problem-solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior.


    the structure in the brain thought to be at the centre of emotion, memory and the autonomic nervous system.


    the view that sees our health being influenced by interconnected social factors, physical, psychological, emotional and spiritual dimensions of self.


    goal-directed thinking in which the person is able to find routes to desired goals and is motivated to use those routes.


    the dehumanising, psychological and mental health effects of living for a long time in an institution where the demands on the institution take precedence over the needs of the individual.

    Johari window:

    a technique for understanding ourselves that we, and others, may or may not see.


    the judgements, often negative, made by a community about an individual/individuals whose behaviour violates social norms.

    mental wellbeing:

    comprises our subjective mental health, happiness, hope and optimism and life satisfaction, positive psychological functioning, resilience to adversity, autonomy and a sense of control over one's life, self-awareness and acceptance, and supportive and interpersonal relationships.

    person-centred approach:

    based on the work of Carl Rogers, this approach puts the patient/ service user at the heart of care processes and stresses the importance of democratising decision-making and the human experience of health care, as well as evidence-based treatments and interventions.

    personal values:

    personal standards and moral judgements about what is important in life.


    a personal, unique process of changing one's attitudes, values, feelings, goals, skills and/or roles with the aim of developing a satisfying, hopeful and contributing life even with limitations caused by mental health problems.


    the ability to bounce back or positively adapt in the face of significant adversity or risk.

    responsible clinician:

    the mental health professional who has overall responsibility for the care and treatment of service users being assessed and treated under the Mental Health Act.

    safety plan:

    co-created risk management plans which address risks and concerns from everyone's perspective; are explicitly directed towards helping the person to take back control themselves and do the things they value; and use all the resources available including the expertise of the individual and those who are close to them.


    a mental health condition characterised by hallucinations, delusions, disorganised thoughts and behaviour changes.


    the belief in one's ability and capabilities when required by any given situation.

    social exclusion:

    the exclusion or expulsion of individuals from the prevailing social system and its rights and privileges.

    social inclusion:

    the active involvement of individuals in their communities and society as citizens which bestows benefits and rights.

    social recovery:

    emphasises social support, realistic planning, significant working relationships, encouragement, appropriate treatment, choice and self-management.

    spoiled identity:

    an identity that causes a person to experience stigma.

    Stress Vulnerability Model:

    the model developed by Zubin and Spring (1977) which identifies how the mental health and wellbeing of people diagnosed with schizophrenia and their ability to cope at times of adversity is influenced by inherited genetic background and life experiences and external stressors (such as significant life events like deaths, divorce, financial problems and so on).

    therapeutic relationship:

    a supportive, person-centred alliance between a service user and health care professional.

    Tidal Model:

    based on the work of Barker (2001); places interpersonal relations at the heart of nursing practice.


    any factor that can be controlled, changed or measured.


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