A national framework for recovery-oriented mental health services: guide for practitioners and providers

Capability 3A: Promoting autonomy and self-determination

Page last updated: 2013

Recovery-oriented mental health practice and service delivery affirms a person’s right to exercise self-determination, to exercise personal control, to make decisions and to learn and grow through experience. Personal safety is upheld and service models are implemented that reduce if not eliminate the need for coercion.

Core principles

  • Staff interactions with people using mental health services promote increased personal control.
  • Mental health services have a responsibility to respect people as partners in decisions affecting their mental health care.
  • People’s personal experiences, understandings, priorities and preferences shape decision making concerning service responses.
  • Mental health services ensure the safety and promote the wellbeing and personal growth of people and commit to reducing, if not eliminating, coercion and involuntary interventions.

Characteristics

Values and attitudes

Mental health practitioners and providers...
  • affording primacy to the wishes and views of a person accessing the service
  • respect people’s right to self-determination
  • support people’s decision making and respect their choices

Knowledge

Mental health practitioners and providers...
  • understand autonomy as fundamental to recovery
  • understand both recovery possibilities and limitations when coercion, seclusion and restraint are used
  • understand the importance of minimising involuntary practices like seclusion, restraint and involuntary treatment, and know how to reduce these practices
  • understand the importance of positive learning and positive risk taking to recovery
  • know ways to help people determine what happens in a future crisis, for example, by using advance directives
  • know mental health consumer advocacy and carer groups, and support their involvement in service delivery and decision making Top of page

Skills and behaviours

Mental health practitioners and providers...
  • actively inform people of their rights in service settings, support them in exercising those rights and remove barriers to their exercise of rights
  • help people to enhance their skills for informed decision making, including skills for obtaining, evaluating and applying information
  • engage with people in ways that heighten a person’s sense of self-agency and personal control
  • help people to identify personal aspirations, goals and intrinsic motivators, including what’s important for the person, what they want out of life, what they see as their most pressing challenges and difficulties, and what they want to do and change as a matter of priority
  • create nurturing environments where people feel sufficiently safe to challenge themselves, take positive risks and strive for growth

Recovery-oriented practice

Mental health practitioners and providers...
  • emphasise personal autonomy and self-determination in assessment processes and forms
  • use recovery and wellbeing planning tools that have been developed by and validated through lived experience
  • remove service barriers to people engaging in tasks of daily living
  • collaboratively explore strategies for avoiding coercion
  • promote the use of person-held service records Top of page

Recovery-oriented leadership

Mental health practitioners and providers...
  • incorporate and uphold principles of autonomy and self-determination in service policies and procedures
  • develop and implement evidence-based service models, models of care and practice skills that reduce coercion and the use of seclusion and restraint
  • ensure that any limitations on a person’s choice, autonomy and self-determination are least restrictive as possible and removed as soon as practicable
  • maximise opportunities for autonomy and self-determination in referral, assessment, service coordination and discharge policies and procedures.

Opportunities

  • Establish opportunities for wellbeing resources to be designed and developed by people with a lived experience.
  • Establish on-site recovery programs—training and education delivered by people with experience of mental health issues www.nottinghamshirehealthcare.nhs.uk/our-services/local-services/adult-mental-health-services/recovery-education-college.
  • People can conduct their own research and prepare their own wellness and recovery plans, family plans, crisis prevention plans and advance directives using computer hubs and internet cafes. Top of page

Resource materials