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Recovery with Ron and Karen Coleman

Ron and Karen Coleman presented their offbeat approach to recovery in mental health to audiences of service users, nursing students, mental health professionals and academics at a series of events in Wolverhampton and Coventry.

“RECOVERY ISN’T the job of the NHS,” declares Ron Coleman provocatively, to an audience made up of NHS staff and nursing students.“Instead, we need to create recovery communities.”

And Ron should know: he spent 13 years, in and out of psychiatric services, and now provides training to professionals, consultancy services to managers, and a recovery house for service users.He works alongside his wife Karen Taylor, who brings her background in psychiatric nursing to their professional partnership.

Ron and Karen visited the West Midlands recently to speak at two events hosted by the MERIT Vanguard partnership, meeting mixed audiences of professionals, nursing students, service users and carers in both Wolverhampton and Coventry, and a group of service users in Sandwell.

The pair start by challenging their audiences to describe recovery.The responses are unsurprisingly wide-ranging: ‘progression’, ‘feeling better’, ‘coping’, ‘fun’, ‘fulfilment’, ‘acceptance’, ‘freedom from discrimination and stigma’ and ‘choice’ are some of the words and concepts which come up more frequently.Karen summarises all of these: ‘living’.But she also observes that 10 to 15 years ago, many people would have given a more clinically focused response, often relating to a reduction in symptoms.Karen argues strongly that recovery must also incorporate those times when people feel less good in themselves.

“You can’t,” says Ron, “change the fact that a person has had negative experiences.”Violence and abuse become a part of the person’s experiences, Ron argues, so it is important to accept experiences and voices whenever they exist.Shame and guilt are two of the most common emotions associated with negative experiences, and much of service users’ distress can be traced back to the emotions they experience.Karen suggests that the NHS isn’t always very good at dealing with unwelcome emotions, often using medication to deal with them, and that a new approach may help to promote recovery.

Ron and Karen set out four steps, which make up the acronym COPS: Choice, Ownership, People and Self.By making the choice to break free of what they call the ‘illness trap’, Ron and Karen argue that it gives service users ownership of their life and their condition.Clients can also make decisions about the people they surround themselves with, which allows them to make more, and better, time for themselves.The ‘illness trap’ persuades service users that they are the problem, reinforcing their perceptions through a sly combination of their emotional imbalance, their belief systems and the assorted phases following their diagnosis.By encouraging clients to shift their mode of thinking, and often changing the story they tell about themselves, Ron and Karen believe that the illness trap can be overcome.

While Ron is often frank about his mental health – “Schizophrenia was the worst career move I ever made,” he jokes – Karen is also candid about the experiences she has enjoyed during her career and the things she has learned.“By the end of today,” she assures the nursing students, “I intend to convince you that everything you have ever been taught is worth challenging, and maybe turn it on its head.”Karen tells the audience, for instance, that she was taught not to “do emotions” with people experiencing psychosis, but that her professional experience led her to believe otherwise.

Much mental health care, the pair insist, comes down to choices for professionals: “Every single worker can do maintenance work on their clients’ mental state, or they can do something different which can lead them to a state of recovery.”This is particularly important, they argue, when families’ most frequent cause of anger is that they don’t see their loved one recovering.“You don’t promote recovery through a piece of paper or a risk assessment,” insists Karen, whilst Ron is more challenging: “Systems aren’t created for clients, and I won’t congratulate the system.When things go right, it’s only what I expect.”

Ron and Karen also demonstrate a little of the technique they might use when working with a service user who hears voices.They ask whether each voice is a positive or negative one, and whether it has a name (either where the voice is that of a known individual, where the hearer names it, or indeed where the voice makes its name known to the hearer).

What of the future?Ron and Karen both have strong opinions, and encourage participants from all backgrounds to share their views too.Karen believes that recovery communities in the real world would make all the difference to service users.“We have Neighbourhood Watch schemes; why not Neighbourhood Care, made up of people who support one another through tough times?That’s the sort of thing we need to create,” she says.A participant working in community mental health services was equally direct: “All services need to get better at showing the difference we make, and not just for the commissioners’ benefit.”A service user who is now employed as an advocate adds: “I’m the first person in my family to make a career out of my breakdown.It just doesn’t feel like a job.”

Ron, who is forceful in his belief that service users can control their own destiny, cites a famous example to encourage people to seize their future: “The defining moment in US civil rights was when Rosa Parks sat on that bus.Only we can demand our right to be ‘normal’.Remember: there is no ‘them’ and ‘us’.There is only ‘us’.”

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