The Importance of Relationship in Recovery-Oriented Practice

This paper aims to analyze the value benefits that a meaningful relationship has for the sufficiency of the recovery principles in mental health. It focuses on each principle of recovery and scrutinizes whether there is any way a therapeutic relationship has an impact. Case scenario included.

Running head: Mental health nursing
The Importance of Relationship in Recovery-Oriented Practice
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Mental health nursing 1
Abstract
This paper aims to analyze the value benefits that a meaningful relationship has for the
sufficiency of the recovery principles in mental health. Various health professionals have
debated on the issue of therapeutic relationships and its impacts on the principles of mental
recovery. The various opinions from different professionals have produced some beliefs
regarding therapeutic relationships. Despite that, all beliefs end with a similar position that a
meaningful relationship is necessary as it works as framework for aligning the recovery
principles. Others state that recovery principles would never be possible to implement if at all
there was no constructive therapeutic relationship. In other words, everything about mental
health recovery dwells on a meaningful relationship. Following this trend, this paper wants to
take a comprehensive look by focusing on each principle of recovery and scrutinizing whether
there is any way a therapeutic relationship has an impact. In making this scrutiny effective, this
paper will focus on a particular case scenario in a mental health setting.
Keywords: Dignity, Human Rights, Recovery, Mental, Consumer

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The Importance of Relationship in Recovery-Oriented Practice
People living with severe mental problems are sometimes hard to introduce into a
treatment or even keep them in the procedure. In a general sense, poor engagement to any
relationship whether business or education would lead to poor outcomes, and so does a
therapeutic experience. However, a poor engagement in a therapeutic relationship will have
worse clinical results. Some variables that may affect a relationship in mental health are the
therapeutic alliance itself, care accessibility, client’s trust and the severity of the illness. As the
aim of this paper is to analyze how a meaningful relationship sets a proper ground for laying the
principles of mental recovery, an understanding of these variables can also help practitioners in
introducing a maintaining a therapeutic relationship.
Case Scenario
The case encountered was for a female patient, 30 years old. This patient was referred to
us by a local clinic. For the sake of patient’s confidentiality, this paper will refer to the patient as
Mrs. Brown, and her husband, Mr. Brown. While investigating Mrs. Brown’s case, we
discovered that except for her, all the rest of the family members had been registered in our
health care center for their health services. However, it was our first-time meeting Mrs. Brown.
Additionally, Mrs. Brown together with the rest of the family members has difficulty in speaking
English as they are immigrants and have lived in Australia for just two years. Mr. Brown
disclosed to us that Mrs. Brown gave birth to a baby boy two months ago. Mr. Brown also
disclosed that Mrs. Brown nowadays seems unhappy about anything, she looks even reluctant
everything, she wants to stay in bed, does not want to take care of the baby and frequently keeps
saying that her stomach hurts. The husband also disclosed that the rest of the family have started
thinking that Mrs. Brown is becoming lazy since she is avoiding household chores. The husband

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also confessed that Mrs. Brown has never disclosed anything about her past medical records.
Thus Mrs. Brown’s records about her psychiatric history remained unknown. I was appointed to
this case since I was the one who could understand the family’s local language, and hence I acted
as an interpreter.
Discussion of the Recovery Principles
According to (Department of Health, 2010), the principle of patient’s uniqueness
requires the care givers to recognize that consumers are unique. Care givers should give the
patients the possibility of developing their exclusive strengths while also encouraging them to
take their responsibilities. While looking at the uniqueness of the patient, (Department of Health,
2010), advices on the evaluation whether the provided care is routinely focusing on the
assessment and discussion with the consumer on the benefits of the physical health as well as the
overall well-being. The guide also advises on a check on the possible effects caused by trauma
during the consumers’ life with the disorder. According to (Slade, Amering, & Oades, 2008)
recovery is something personal which involves modifying someone’s beliefs, attitudes, goals,
feelings, skills, values and roles. The work of (Slade, Amering, & Oades, 2008) further states
that the principle of uniqueness is characterized by finding the consumers’ strengths and
capabilities, the social and meaningful roles that satisfy the individual, and then mobilizing.
From this understanding, it is clear that if recovery is personal, then it involves the
caregiver’s active participation which introduces the notion of meaningful relationship. The work
of (Salzmann-Erikson, 2013) brings the idea of a constructive relationship by explaining
recovery as an inner process, which requires an external contribution from other people (care
providers). The work states that the participation of these people should be meaningful and social
activities. Similarly, meaningful relationship is seen in the work of (Kogstad, Ekeland, &

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Hummelvoll, 2011) by taking recovery as a process that needs external support, and mental
health practitioners who are focusing on communications and promoting dignity. The work of
(Rapp & Goscha, 2011)then states that recovery-oriented practices have various recovery-
focused components which include collaborative approaches for managing illness, relationships
with formal and informal caregivers, peer support, client support to taking responsibilities, and
the interventions that facilitate the building of self-esteem, well-being, and self-efficacy.
In the case of Mrs. Brown, the uniqueness of the family is first identified by recognizing
their unique language. The failure to understand English is not taken as their weakness, but rather
a mean of building a relationship by bringing someone who can understand and talk their ‘home’
language.
According to (Department of Health, 2010), the principle of real choice requires the
healthcare providers to provide conclusive information that can support the patient and the carers
to making informed decisions. The healthcare provider should also help the consumers by
discussing tough choices that they are about to make. On the same, the healthcare professional
should understand these tough choices that the patient and the carer are making by looking at
them in his or her perspective. Lastly, (Department of Health, 2010), states that the health
professional should welcome the consumers together with their family members and provide
them with all the information and support that is entirely adequate to them.
In this regard, the work of (Matthias, Salyers, & Frankel, 2013) brings the concept of
shared decision-making (SDM). This work recognizes the relationship as central to the patient
and the care provider SDM. According to (Matthias, Fukui, & Salyers, 2017), SDM focuses its
attention on clinical encounters which initiate the discussions regarding treatment choices begin.
According to the authors, SDM does not only rely on the beginning of treatment choices, but it

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relies on the whole clinical encounter. Other than the two, SDM relies broadly on the patient-
provider relationship. (Salyers, et al., 2009) explained the same idea under the concept of patient
activation. According to the authors, a positive relationship translates to enhanced levels of trust,
reduced burden of emotions, and increased satisfaction. This work suggests that positive
relationships where a patient is activated to make treatment choices are predictors physical
health.
In our case with Mrs. Brown, we suspected that she had postnatal depression. As Mrs.
Brown was not that less responsive to the consultation, and she preferred the translation from the
community clinic she was attending; we allowed that service of an independent translation. Mrs.
Brown also preferred that translator since she was a female nurse.
The principle attitudes and rights requires the care provider to understand that patients
have their rights both the human rights and consumer rights. Besides, it needs the provider to
promote these rights apart from just respecting them (Australian Health Ministers' Advisory
Council, 2013). The rights also place an obligation on the care provider to behave in a manner
that conveys respectful attitude to the patients and their carers together with fair treatments
(Department of Health, 2010). Lastly, this principle places to the prover an obligation to
encourage the patient and their carers to keep social connections with their families and friends
(Department of Health, 2010).
According to (Aggarwal, 2016), the society has restrictive attitudes regarding mental
illnesses. People perceive mentally ill people as people with no right or people who can never
make rational choices. These are the prejudices that make it difficult for people with mental
illness to state what they need. In addition, (Wyder, Bland, & Crompton, 2013) states that
recovery is only possible when external conditions like human rights, a culture that supports

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healing, and recovery-oriented practice are present. The work (Wyder, Bland, & Crompton,
2013) continues to state that positive relationships are important to the recovery as an
environment that is intimidating, unsafe, and stigmatizing will make the patients and their carer
insecure causing them to drop the treatment.
In the case of Mrs. Brown, we started by asking her about her physical health, the health
of the baby, and the wellbeing of the family. Such questions seemed to make her feel that we
were listening to her hence creating a rapport. Also, we did not want her to feel ashamed, so we
avoided direct questions about her depression. For instance, we resulted in asking her about how
often she felt bothered by feelings of hopelessness or depressed in the past one month. Other
questions were like how often she felt bothered by feelings of little or no pleasure or interest in
doing some things.
This principles of dignity and respect looks at whether the provider’s regard to the
consumers. It looks at whether the provider welcomes the consumers to the service, whether he
creates a safe environment, and whether the provider listens and supports the consumers to
define the recovery ambitions.
According to (Wright, 2010), nurses encourage the emaciated consumers to take their
treatments. The persuasion works in an environment with friendship, authenticity, warmth,
kindness, and respect for the patients and carers' dignity which are the main key players. (Wyder,
Bland, Blythe, Matarasso, & Crompton, 2015) then explains this notion that a patient nurse-
patient relationship is the overall foundation of the nursing practice. In the case of Mrs. Brown,
we handled her with respect and treated her with dignity. When she said she was comfortable
with having a female translator, we understood that providing her with that requirement was part
of caring for her dignity.

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This principle of partnership and communication requires health officers to seek
consumers or carers involvement in the recovery process proactively (Australian Health
Ministers' Advisory Council, 2013). The care provider is needed to check if he or she actively
facilitating the recovery goal by bringing other amenities and supports. It also advises that
providers should offer services and support that helps the carers or family members of the patient
in playing a quality caring role (Department of Health, 2010).
Like as mentioned above, recovery is a process. And according to (Topor & Denhov,
2012), recovery comes through a relationship which fosters healing by facilitating the patient’s
access to support, opportunities, and support. The (Topor & Denhov, 2012) belief connects to
(Strong, Sutherland, & Ness, 2011) idea that recovery-oriented practitioners who work in
partnership with care users walk with the users supporting them through the process in helpful
and conversational relationships. The work of (Strong, Sutherland, & Ness, 2011) further states
that in mental health, conversations and relationships are inseparable substances. In the same,
(Anderson, 2012) states that a collaborative relationship stimulates quality conversations
between the service user and the practitioner and which translates to a quality relationship.
In our case, Mrs. Browns’ family engagement was crucial. We also understood the
hierarchies that existed within her family and considered them because leaving them behind
could have made them withhold some information. We also understood that the rest of the family
members did not understand her feeling, and hence it was paramount to conduct training. We
also encouraged other health practitioners seeing Mrs. Brown always to visit her in time prevent
delay of services. Ultimately, we closely monitored the welfare, health and cared Mrs. Brown’
baby.

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Evaluation principles require the professionals to use consumer feedback for improving
their services. This part also involves evaluation of recovery outcomes, improvement of
treatment, support and care, evaluation whether professionals engage family members in the
recovery outcomes assessments, provision of training on recovery-oriented practice, and
implementation of recovery across in all levels of service. Other evaluations include assessing
the adequacy of tools, resources, training, and evaluating recovery capabilities among others
(Department of Health, 2010).
According to (Slade, Amering, & Oades, 2008), consumers play a crucial role directing
and shaping services. Their participation in the evaluation provides an element for the creation of
new policies, provides updates for the old systems, and provides a chance for the improvement
of the care. Assessments allow users to direct and shape services to meet their specific needs.
According to (Hayward & Ayres, 2011) the involvement of the users in the evaluation requires an
already developed therapeutic relationship. The better the relationship, the higher the users’
participation in providing their voices.
For the sake of evaluation, we organized visits to her home to assess the conditions of
care and assessing bother her physical and emotional well-being. In light of Mrs. Brown’s
symptoms, we appointed specialists in perinatal services to be visiting her home. We also
scheduled follow up appointments to keep checking her overall health.
In the implementation of mental recovery principles, we meet some core challenges. For
instance, many professionals, as well as the users, have problems with adjusting from the from
contemporary practice approaches. The work of (Shera & Ramon, 2013) describes this shift as
transforming or a transformational shift. For example, the principles of recovery require holistic
expertise instead of the traditional practice that pays greater attention to the clinician approaches

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which relies much on medication. Like any other human system, it is easier to adopt the
principles rhetorically without adjusting the practice systems (Mental Health Commission of
Canada, 2009). The art of saying you have adjusted whereas the actions are still the same old
practice.
Stigma is another barrier to recover, and this is both professional and societal. And
professional. According to (Australian Medical Association, 2012), like any other person, even
mental health specialists attach a stigma to the mental health patients. This warning comes as
after the study that was done by the ( Mental Health Council of Australia[MHCA], 2011) which
found that mental health consumers experience considerable levels of stigma while seeking
treatment, and this stigma has no difference from the one they meet from the general population.
While we tried as much to eliminate stigmatization, sometimes patients perception of a
professional and a client makes them feel inferior.
Another barrier faced when implementing the mental health recovery principles is
problems with resource allocation. According to the report released by (Melbourne University,
2016) some of the resource dilemmas mental health professionals face in resource allocation are
lack of resource allocation which is appropriately going to mental health as a whole instead of
allocating them as government spending or general health expenditures. There is also a problem
with geographical allocation of resources for mental health consumers among others. With
minimal resources, we could not schedule as much required home visits to the patient’s homes.
The minimal resources sometimes make printing of reading materials hard as you have to stay
within the budget.

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Conclusion
This paper aimed to discuss the importance of relationship in recovery-oriented practice
in mental recovery. To provide in-depth explanations, this paper used a case scenario of Mrs.
Brown who was suffering from postnatal depression. Through this scenario, the paper went
through the six principles of recovery-oriented practice as it detailed their applications.

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