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Table 1 Program: collaborative pathways to recovery, resilience and independence, utilising MHRS framework

From: Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU)

Client priorities Assessment a In situ and individual interventions Client and family/carer groups Community support linkages
• Mental health & self-reliance
• Physical health & self-care
• Daily living skills & self-management
• Social networking & community participation
• Access to education & employment
• Healthy meaningful relationships
• Coping strategies to reduce risk of addictive behaviours
• Skills to self-manage daily responsibilities
• More satisfying sense of self
• Improved sense of hope & trust
• Insight, coping skills, situational factors/capacity
• Stage-of-change
• Physical health/status
• Personal self-care skills (eg, diet, lifestyle, dental, podiatry & medical)
• Domestic self-care & community skills
• Social skills
• Vocational & educational support needs
• Sexual health
• Cognitive functioning
• Psychological health
• Comorbidity issues
• Addictive behaviours
• Adherence skills
• Quality of relationships
• Day-to-day functioning
• Positive recovery focus reinforces strengths
• Encourages coping strategies, self-advocacy & positive risk taking
• Service provision promotes self-reliance, self-care & positive role modelling
• Milieu encourages self-respect & maintenance
• Supportive culture reflects individual & social values
• Facilitates trusting relationships with staff
• Motivational interviewing
• Cognitive behaviour therapy & counselling
• Skills development & cognitive remediation
• Behavioural interventions
• Relapse prevention
• Self-esteem building
• Social activities
• Education: mental health, medication & lifestyle
• Managing mental health b
• Medication
• Goal setting/review b
• Shopping/meal planningb
• Healthy lifestyles
• Budgeting
• Relaxation/stress management b
• Social skills, community access BBQ, hobby startersb
• Wellness plan
• Drug & alcohol education
• QUIT interventions
• Vocational education training & employment
• Recovery Star discussion
• Discharge planning
• Family connection c
• Mental health education c
• Accommodation services (eg, supported housing)
• Education & employment services
• Community, family & welfare services (eg, Community access, Centrelink, relationship & financial counselling, meals on wheels, ARAFMI, clubs, volunteer programs)
• Mental health & substance use services (eg, Supported Recovery, Community Managed and Non-government Organisations, community mental health, early psychosis, psychiatrists, allied health)
• Health services (eg, GP, dietary, dental, sexual health, recreational & cultural)
• Internet services (eg, SANE Australia, Black Dog Institute)
  1. Note: MHRS Mental Health Recovery Star, ARAFMI Association of Relatives And Friends of the Mentally Ill
  2. aConducted to assist in building a comprehensive recovery plan
  3. bGroup programs offered on repeat occasions per week
  4. cGroup programs offered outside of usual business hours to facilitate optimal carer/family involvement
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