Within the Specialist Rehabilitation Service, a key process is to work with consumers to identify their personal strengths and values, in striving towards enhancement of meaning and purpose in life. This same process can be applied to inform recovery orientation in service development.
Team processes embed values and strengths-based practices in several ways: i. through using the Life Journey Enhancement Tools (LifeJET) (Oades & Crowe, 2008) as the basis of team goal setting annually; ii. Team members completing their own professional LifeJET; iii. focusing on aspects of recovery by sharing recovery narratives at each team meeting, and iv. using therapeutic and creative strategies within supervision and meetings to explore personal strengths.
Authenticity in practice is supported through the learning that comes from experiencing and embodying the same processes and strategies that clinicians are responsible for facilitating with consumers in their recovery. As a result, the team is focussed on the collective vision driven by meaning, passion and motivation, just as we seek to do in our work with consumers.

The challenge arises, how do you know if a service is recovery orientated? There is limited quantitative research and data on how to determine if a service is “recovery orientated”, or the degree to which they are. O’Connell, Tondora, Croog, Evans and Davidson (2005), developed the Recovery Self Assessment (RSA) to attempt to address these types of gaps. Perceptions of recovery focus interventions can be different between service users, family and mental health staff, thus the RSA gathers data from a variety of sources to present a holistic picture of perceive recovery –orientated practices of a service. The Liverpool and Fairfield Mental Health Therapy and Recovery Service (TARS) team used the RSA in a quality improvement project with the goal of measuring how recovery-oriented practice is perceived to be implemented by the team. Baseline information was gathered in 2011 and changes implemented to improve the recovery orientation of TARS. The RSA was completed again in August 2013 and July 2015 to monitor any changes in the perceived recovery –orientated practice of TARS. The RSA has been a useful tool in measuring how recovery oriented the team is perceived to be and the data collected used to drive changes to advance towards providing a more recovery focused service.

In July 2014 there was a homicide on the acute psychiatric unit in the Illawarra Shoalhaven local health district. Homicides in acute care psychiatry are very rare events and have been associated with, psychosis, a history of violence or dementia however the root cause analysis of this event identified consumers sharing a room as a cause of the event. 50 % of the Illawarra Shoalhaven acute mental health care beds are shared rooms. While in NSW, the Mental Health Outcomes and Assessment Tools includes the assessment of a variety of risks, it does not include the assessment of risk associated with room sharing. A review of the literature failed to identify any shared room risk assessments. The need to better understand decisions regarding consumers sharing a room and the documentation of these decisions is essential to ensuring the risk associated with room sharing is minimized. Contemporary mental health practice requires that decisions regarding room sharing are consumer orientated, transparent and evidenced based. An initial focus group with mental health nurses identified that decisions about who does or not share a room are complex and an ongoing process that includes such disparate information as a history of violence to the volume of snoring. This paper outlines the development of a shared room risk assessment tool and the implementation of this tool within one district.

Aim: To describe differences in service use for self-reported mental health problems between community-dwelling urban and rural residents aged 55 years and older.
Methods: Using data from one urban and one rural cohort of participants randomly recruited from electoral roll, cross-sectional associations between socio-demographic, health status and service use variables were examined using hierarchical logistic regression. Geographical location was categorised as major cities, inner regional and outer regional to very remote. Statistical significance level: p<0.01.

Results: Of 2974 participants (mean age 69.4 years, 54% female, 29% non-urban), 18% (n=509) contacted at least one professional (general practitioner, psychiatrist, psychologist, mental health nurse, drug and alcohol counsellor, pharmacist) for mental health problems in past 12 months (22% major cities, 13% inner regional, 6.3% outer regional to very remote). Factors independently associated with contact were moderate (adjusted odds ratio [AOR] 3.3, 99%CI 2.0, 2.5) and high (AOR 6.0 99%CI 2.6, 13) psychological distress compared to low distress, and geographical remoteness (AOR 0.25, 99%CI 0.12, 0.53 for outer regional to very remote compared to major cities). Other service use, including internet treatments and predicted service need will be detailed.

Conclusions: Greater remoteness is associated with lower rates of professional service for mental health problems.