Assessing Recovery-Orientation in Community Mental Health Teams in Québec

Background and purpose: The 2005 Québec Government’s Mental Health Action Plan (MHAP) resulted in a shift in the location of outpatient mental health services from hospital-centric care to community-based care. In addition, the MHAP suggested that this community-based care become more ‘recovery’ orientated. Concurrently, the MHAP calls for the use of a results-oriented managerial approach that is technocratic and outcome-focused in order to ensure efficiency. These competing demands for a patient-centered recovery focus and a technocratic ‘outcome’ focus are not easily reconcilable. This is especially the case as these policy imperatives were broad in scope and did not detail precisely what action should be taken on the ground to enhance a recovery orientation. As such, the general objective of this study was to assess the developing recovery-orientation within community mental health teams in Québec from the perspectives of both social workers and their managers in those teams. The specific aims were to: (a) explore the relationship between the desired recovery approach and conventional social work practice; and b) to develop a better understanding of how institutional context affects the establishment of a recovery-oriented approach among social workers.

Methods: This qualitative exploratory study consisted of 11 semi-structured interviews with social workers and their managers in two community mental health teams, recruited via snowball sampling. Two key informants were also interviewed. All interviews were transcribed verbatim and analyzed using techniques of thematic analysis. As such, broad themes were progressively determined from the data.

Results: Practicing from a recovery orientation was a shared ideal among participants. However the meaning and expression of this ideal was shaped by macro and meso level factors such as the external emphasis on ‘outcomes’. The results suggest that both the recovery approach and conventional social work practice share common values; however, they indicate that although most participants claim to have always adhered to the values found in the recovery orientation, organizational and structural pressures, such as a focus on outcome measures, are of greater concern for participants than the implementation of a recovery orientation. The results indicate that certain aspects of work organization, such as flexibility, autonomy, reflexivity, training, and interdisciplinarity are appreciated and interpreted as facilitators of recovery-oriented practice. However these may be limited by systemic constraints.

Conclusions and Implications: This exploratory study confirms the need to pay more attention to the development of a recovery orientation in community mental health teams in Québec.  The results suggest that recovery-oriented systems will be difficult to develop in a result-oriented technocratic paradigm. Participants reported that opposing messages were given to them in terms of how they should practice. If a recovery orientation in policy is going to successfully be translated into practice, greater structural and organizational support of recovery is needed.