Applying Strengths Model principles to build a rural community-based mental health support service and achieve recovery outcomes

Abstract

Introduction: The Personal Helpers and Mentors (PHaMs) service is a non-clinical, community-based Australian Government initiative aimed at increasing opportunities for recovery for people whose lives are severely affected by mental illness. Using a strengths-based recovery model, PHaMs caseworkers support and mentor people 'at risk of falling through the gaps' between state funded clinical treatment services and federally funded social services (such as supported housing, education and employment). While there is evidence that PHaMs realises its aim in metropolitan areas, little is known about how services are developed and function in low resource rural settings and what outcomes are achieved. These questions were addressed in a case study of a PHaMs service in a rural town in the state of New South Wales, Australia. Methods: Data were collected from two sources: local service documents prepared for staff orientation and operational purposes, and records and reports of service participants' performance and achievements. Participants' gains in wellbeing, recovery goals, and the target outcome areas of increased access to services, increased personal capacity and self-reliance, and increased community participation, were gathered from self-reports. The Role Functioning Scale was used as a measure of caseworker ratings of participants' adaptive functioning. The qualitative data were examined for semantic content and underlying themes. The quantitative analyses involved repeated measures and between-groups comparisons of uncontrolled pre-test-post-test and retrospective pre-test data. Results: From commencement of the service in October 2009 to June 2014, an estimated 31% of the people living with severe mental illness in the local government area had accessed the PHaMs service (N=126; mean age 31.9 years; 42% male, 27% Aboriginal). The document analysis revealed that despite a lack of detail on how a PHaMs service should be developed or delivered, by focusing on the goal of client recovery, and taking a strengths-based rather than a deficit approach to the human and other resources that were available, the PHaMs service was established and is maintained by applying Strengths Model principles and being committed to teamwork and interagency respect. Caseworker ratings of participants who had completed an Individual Recovery Plan indicated significant gains in adaptive functioning, including improvements in physical health and wellbeing, management of symptoms, accommodation, vocational skills development and increased community involvement. Conclusions: Strengths-based recovery services offered by a rural PHaMs service can assist Australians with severe mental illness to achieve meaningful gains towards recovery. Furthermore, a Strengths Model approach to service development and operations - one that recognises individual abilities and prizes interpersonal relationships and teamwork - can maximise the potential of local human and other resources, and serve as a solution to resolving apparent service gaps and perceived deficits in rural and regional areas.