Published in Kingstown College Coaching Magazine 2019/2020
Within this paper, current strategic developments within Mental Health Care will be outlined. This will be followed by a discussion on how the principles of Coaching interconnect with that of the Recovery approach. The benefits to be gained by educating Mental Health Professionals (MHP’s) on Coaching as a strategy to assist them in implementing the Recovery framework in its true essence will then be discussed.
Author: Dr Patsy Mc Sharry
Qualifications: RGN; RMN; BA Nurse Education; MSC in Nursing and PhD in Health Promotion and Health and Wellness Coach, Mental Health and Well Being Coach
Position: Lecturer in Nursing and Health Studies, St Angelas College Sligo which is a college of NUI Galway.
Concept of Recovery
The Recovery approach is firmly established within mental health care policy for a considerable period of time now. Back in 2006, The Vision for Change policy document was published which was seen as the road map to guide Irish Mental Health Care practice and policy away from a traditional medical model approach to care towards a Recovery approach. According to Anthony (2000), Recovery is a process; a vision; a belief which infuses a system which providers can hold for service users grounded on the idea that people can recover from ‘mental illness’, and that the service delivery system must be constructed based on this knowledge”. Although this approach is now embedded in mental health policy and guidelines, the evidence for the implementation in practice is not as widespread as the policy suggests. The culture of traditional mental health practice has been slow to change to match the policy. In recognition of this, in 2017, the government published a National Framework for Recovery in Mental Health (HSE, 2017). This framework advocates the need for the service user and their lived experience to be central to the process. They also stipulate the need for co-production between service user and practitioners. The framework stipulates a need for an organisational wide commitment to the development of a Recovery oriented mental health service. And the need for supporting Recovery orientated learning and practice across all stakeholder groups. The framework draws on work by Leamy and Slade (2011) who identified five processes that people with mental health find essential for Recovery. These processes are “Hope” (having a belief that life will and can get better), “Connectedness” (within community and not being isolated because of illness) “Identity” (identity in life beyond that of service user), “Meaningful Role” (building on strengths and skills to have fulfilling and esteem building activities in life) “Empowerment” (having information, choices and confidence to make decisions on own life). Many of these Recovery processes are encapsulated within a Coaching approach.
Concept of Coaching
Coaching draws from an eclectic mix of underlying theoretical foundations such as motivational interviewing, client directed counselling, positive psychology, and appreciative inquiry. Application of a Coaching approach also includes application of tools drawn from mindfulness based interventions and cognitive behavioural theory. Bora et al (2010) state that Coaching grew out of theories of Rogerian counselling from a humanistic perspective. They point out the link with the transport metaphor put forward by Starr (2008) and the idea of a stage coach or rail coach symbolising that Coaching is about transportation from one place to another. Thus Coaching is future based and involves being transported from one place to another through development and growth. This concept is reflected in the process an individual undergoes in establishing an identity beyond that of service user within the Recovery model.
Huffman (2016) suggests Health Coaching is based on evidence-based clinical interventions such as motivational interviewing to facilitate behaviour change, the transtheoretical model of change, goal setting, active listening, aggregation and trending of health outcome metrics, and prevention.
In a systematic review by Wolever et al. (2013) Health and Wellness Coaching is described as a patient centred process that is based on behaviour change theory and is delivered by health professionals from various backgrounds. The Coaching process entails goal setting determined by the patient, encourages self-discovery in addition to content education and incorporates methods for developing accountability in health behaviours.
Regardless of the various definitions that exist, Ammentorp et al (2013) describe the commonalities that exist within different descriptions of Coaching within the literature such as the core assumption that people have an innate capacity to grow and develop, a focus on constructing solutions and a focus on goal attainment processes. All of which are directly relatable to a Recovery approach to care.
More specifically to Coaching for Mental health and Well-being, Kingstown College within their description of their Mental health and Well Being Coaching Diploma, describe the philosophy of such Coaching as coming from a place that recognizes that every individual has potential to lead a fulfilling life, whether in the absence and/or presence of a mental health problem.
What Coaching can offer MHP’s
It is clear that much overlap exists between the principles and processes of Coaching and those of the Recovery framework. MHP’s will thus be expected to implement this framework and be familiar with these processes and skilled in facilitating their development within the client.
Traditionally MHP’s operated from a medical model and were seen mainly as the experts in the professional/client relationship and offered advice and treatment to clients under their care. Under a clinical model of care clients received a particular mental illness diagnosis and relevant care and treatment were then administered in order to treat this diagnosis. Thus, it is anticipated that MHP’s may be challenged by the necessary philosophical and procedural changes that is required from them in order to fully embrace and implement a Recovery approach to care. Application of a Coaching perspective is proposed as a mechanism to assist MHPs with the philosophical shift required to implement the Recovery framework.
Overlap between Recovery and Coaching
Bora et al. (2010) outlines several areas of overlap between Recovery and Coaching philosophies based on the literature. Many of these areas are reflected within the Recovery Framework described above. Firstly, Recovery is about building a meaningful life with or without the presence of mental illness. Coaching also comes from the perspective that individuals are not broken and do not need to be fixed. Rather Coaching helps individuals to tap into their innate resourcefulness to discover what they truly want. Secondly, from a Recovery perspective the expert patient relationship shifts to one of partnership and co-production as is reflected in the framework outlined above, likewise the Coaching relationship is one of a partnership of equals. Thirdly, Hope is central to the Recovery approach and nurturing that hope is a key role for the MHP. From a Coaching perspective, the coach believes that the client possesses all the resources and skills they need to change what they want.
Fourthly, Recovery represents a move away from a focus on problems to a focus on strengths. Coaching also operates from a strengths based perspective with appreciative inquiry being one of its underlying theoretical foundations.
Fifthly, from a Recovery perspective there is an understanding that clients are individuals and will have different approaches to self-management and no one size fits all. From a Coaching perspective, the coach creates a clearing for the client to generate their own solutions and all individuals are responsible for the results they generate.
Sixthly, Recovery is about discovering an identity separate to that of an identity based on their mental illness. Coaching compliments this process as it is future focused and comes from the perspective of the past does not dictate the future Bora et al. (2010) suggest that during Coaching, although past stories and experiences are acknowledged, Coaching is about facilitating the client to generate new stories and unlocking potential.
Seventhly, Recovery emphasises the importance of clients discovering meaning in life and life purpose, on the other hand Coaching urges us to explore and discover our life’s purpose.
Supporting a positive risk taking in a safe environment with the combination of MHP expertise and Coaching philosophy.
Within a Coaching framework, as a relationship of equals, the MHP is required to respect the clients’ autonomy and empower them to take control of their own lives. In this way the process encourages the concept of positive risk taking deemed necessary within a Recovery approach. Coaching supports this process. However, a tension could exist for MHP’s between facilitating and allowing a client to take control and self-manage when this might represent a possible risk to the clients’ safety. As care givers, MHP’s are charged with a duty of care to protect and maintain client safety. As the concept of positive risk taking is an inherent component of the Recovery approach itself, MHP’s are required to encourage appropriate risk taking. The fact that MHP’s have the skills needed to assess and monitor mental status makes them ideally placed to facilitate this process in as safe an environment as possible. In this way, clients’ get an opportunity to experiment with possible strategies in a safe environment, all the while being encouraged and supported by a health care professional who is also a qualified Coach who conveys a steadfast belief in their inherent worth and resourcefulness.
Conclusion
In conclusion from the above description, it is clear that the philosophy of Coaching has much in common with the philosophy of Recovery. Coaching can assist MHP’s in facilitating their clients to move through the Recovery process from Recovery to discovery of personal inner strengths and resources and towards a redefinition of a more resilient identity. MHP’s coming from a Coaching perspective can empower their client’s to take back control for themselves and support them towards a fulfilling and meaningful life with or without the existence of mental illness. Coaching is therefore proposed as a strategy to assist in making a Recovery approach a reality in Mental Health Care Practice. In this way, well intentioned policy will become more than rhetoric lip service.
References
Anthony, W.A. (1993). Recovery from mental illness: The guiding vision of the mental health system in the 1990’s. Psychosocial Rehabilitation Journal, 16(4), 11-23.
Ammentorp, J., Jensen, H. and Uhrenfeldt, L. (2013). Danish health professionals’ experiences of being coached: A pilot study. Journal of Continuing Education in the Health Professions, 33 (1), 41–47.
Bora, R., Leaning, S., Moores, A. et al (2010) Life Coaching for mental health Recovery: the emerging practice of Recovery Coaching. Advances in Psychiatric Treatment, 16: 459–67.
HSE, Government of Ireland (2006) A Vision for Change: Report of the expert group on Mental Health Policy www.hse.ie/eng/services/Publications/Mentalhealth/VisionforChange.html
HSE, Mental Health Division (2017) A National Framework for Recovery in Mental Health http://www.hse.ie/eng/services/list/4/Mental_Health_Services/advancingRecoveryireland/nationalframework-for-Recovery-in-mental-health/
Huffman, Melinda H. (12 May 2016). “Advancing the Practice of Health Coaching”. Workplace Health & Safety. 64 (9): 400–403. doi:10.1177/2165079916645351. PMID 27174131.
Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework for personal Recovery in mental health: Systematic review and narrative synthesis. British Journal of Psychiatry, 199(6), 445–452. doi:10.1192/bjp.bp.110.083733
Starr J (2008) The Coaching Manual. The Definitive Guide to the Process, Principles and Skills of Personal Coaching. Prentice Hall.
Wolever RQ, Simmons LA, Sforzo GA, et al. A systematic review of the literature on health and wellness Coaching: defining a key behavioural intervention in healthcare. Glob Adv Health Med 2013; 2:38–57. doi:10.7453/gahmj.2013.042
By Patsy McSharry
Patsy McSharry is a Registered General Nurse, a Registered Mental Health Nurse, has a Masters in Nursing Studies from UCD and a PhD in Health Promotion from NUIGalway. She is also a qualified Health and Wellness Coach from Well coaches International, and a qualified Mental Health and Well Being Coach from Kingstown College. Patsy is currently employed by St Angelas Collage as a Lecturer in Nursing and Health Studies. She is involved in the undergraduate education of nurses and also heavily involved in the running of a Post Graduate level 9 Diploma in Applied Health and Wellness Coaching for professionals in the healthcare arena. Patsy is a lecturer on a postgraduate course in Community Mental Health Nursing for Registered Mental health Nurses.
