Foundations
Student 2025
1.3Leadershipcoachingtransformingmentalsystemsfromtheinsideout.pdf
International Coaching Psychology Review ● Vol. 4 No. 1 March 2009 25 © The British Psychological Society – ISSN: 1750-2764
THE TRADITIONAL STEREOTYPE of a person with a mental illness in a mental hospital is not one that is usually
congruent with the stereotype of a high func- tioning leader. In fact, some coaching psychologists and proponents of positive psychology may use the ‘positive focus’ of their endeavours to conveniently sidestep the sustaining challenges of serious mental illness. The organisational and personal challenges within mental health systems and personal recovery from mental illness are however major opportunities for effective leaders to have an impact. Important ques- tions emerge. What leadership is required at organisational, staff and patient levels in the area of serious mental illness? What oppor- tunities does the recovery movement bring?
What does this all have to do with coaching psychology, leadership coaching and applied positive psychology?
In this paper we will introduce the ‘recovery movement’ in mental health that is challenging the policy and practices in many nations regarding mental health service provision (Slade, Amering & Oades, 2008). Key aspects of this movement will be related to components of positive psychology, partic- ularly Dweck’s (2006) construct of a growth mindset and the strengths focus.
The Collaborative Recovery Model (Oades et al., 2005) is then introduced as a staff development model for mental health practitioners, working with people with serious mental illness. The model was specif- ically designed to be consistent with the
Leadership coaching transforming mental health systems from the inside out: The Collaborative Recovery Model as person-centred strengths based coaching psychology Lindsay G. Oades, Trevor P. Crowe & Melanie Nguyen
Mental health service provision is being transformed by a call for ‘recovery oriented care’. Rather than the traditional medical meaning of cure, the term ‘recovery’ refers to the personal and transformational process of patients living with mental illness, moving towards a preferred identity and a life of meaning – a framework where growth is possible, and the fixed mindsets around diagnoses such as schizophrenia are challenged. At an organisational level, however, organisations and their service providers have typically operated on a framework that is fixed in terms of the potentialities of the mental health patients. This paper describes the ongoing transformation of a large tertiary inpatient mental health unit in Ontario, Canada, through a parallel staff and patient implementation of a person-centred strengths based coaching framework, known as the Collaborative Recovery Model (CRM). Consistent with developments in positive psychology, the model focuses on strengths and values, goals and actions, within a coaching framework, with an emphasis on the alliance between staff and patient, and the growth potential of the patient. By using the principles of coaching psychology, mental health staff members are leading change in the organisation by personal use of the principles and practices that they are also using to coach patients. The leadership and organisational change challenges are described and future directions are discussed.
Keywords: positive leadership, strengths coaching, mental health recovery, growth mindset.
26 International Coaching Psychology Review ● Vol. 4 No. 1 March 2009
recovery movement due to its strength, goals and growth focus. The use of the CRM is conceptualised as a form of person-centred strengths coaching. The use of a parallel process is then introduced, in which mental health staff use the same protocols (e.g. strengths/values identification, goal setting, action planning and homework) as the patients. That is, patient coaching by staff mirrors the coaching staff receive in both process and form. Staff members are empow- ered to use the positive principles of leader- ship coaching in their personal and professional life, and with their patients. This leadership from ‘the inside-out’ (Bianco-Mathis, Nabors & Roman, 2002) is consistent with the personal responsibility emphasised within the recovery movement (Andresen, Oades & Caputi, 2003). Specific examples are then provided of coaching patients and how this method is different from traditional mental health care.
The challenges of transforming mental health service provision are then described with specific reference to coaching staff in a large inpatient mental health unit in Ontario, Canada, and how coaching may be used to overcome poor transfer of training. It will be argued that the concept of ‘positive leadership’ is particularly relevant to the challenges of mental health organisations- due to their vulnerability to burnout and scepticism regarding human potential (Cameron, 2008; Kase, 2009). Future direc- tions for this unit are described.
Mental health recovery, positive psychology and the growth mindset Slade, Amering and Oades (2008) assert that whilst there has been a significant increase in the use of the term ‘recovery’ in English speaking mental health systems, that there is a need for conceptual clarity around the term. These authors refer to ‘clinical recovery’ as the definition traditionally used in mental health services, which refers to sustained remission. The authors argue that this locates the term within an illness frame of understanding, and equates recovery with
long-term reduction or ideally removal of symptomatology, accompanied by functional improvement. The second definition, ‘personal recovery’, emerged from patients who have lived with long term illness. This definition emphasises the individualised, lived experience. To assist clarification of the definition of recovery, particularly personal recovery, Slade et al. (2008) offer a consensus statement involving 10 principles and descriptions as follows: (1) Self-direction – Consumers lead, control, exercise choice over, and determine their own path of recovery; (2) Individualised and Person- Centred – There are multiple pathways to recovery based on the individual person’s unique needs, preferences, and experiences; (3) Empowerment – Consumers have the authority to exercise choices and make deci- sion that impact their lives and are educated and supported in so doing; (4) Holistic – Recovery encompasses the varied aspects of an individual’s life including mind, body, spirit, and community; (5) Non-linear- Recovery is not a step-by-step process but one based on continual growth with occa- sional setbacks; (6) Strengths-Based- Recovery focuses on valuing and building on the multiple strengths, resiliency, coping abilities, inherent worth, and capabilities of the individual; (7) Peer Support – The invaluable role of mutual support in which consumers encourage one another in recovery is recognised and promoted; (8) Respect – Community, system, and societal acceptance and appreciation of consumers - including the protection of consumer rights and the elimination of discrimination and stigma – are crucial in achieving recovery; (9) Responsibility – Consumers have personal responsibility for their own self-care and journeys of recovery; and (10) Hope – Recovery provides the essential and moti- vating message that people can and do over- come the barriers and obstacles that confront them.
Examination of the 10 principles of personal recovery outlined by Slade et al. (2008) reveals convergence with the assump-
Lindsay G. Oades, Trevor P. Crowe & Melanie Nguyen
Leadership coaching transforming mental health systems from the inside out
International Coaching Psychology Review ● Vol. 4 No. 1 March 2009 27
tions of positive psychology, with ‘strengths based’ and ‘hope’ being the most obvious overlaps. Resnick and Rosenheck (2006) have described parallel themes and potential synergies between recovery and positive psychology, with particular emphasis on strengths. The importance of hope in personal recovery was documented by Andresen, Oades and Caputi (2003), paral- leled by Hope Theory (Snyder, 2000) within positive psychology literature. Likewise Joseph and Linley (2008) have developed the concept of post-traumatic growth, partic- ularly relating to post-traumatic stress. Keyes’ (2002) work on flourishing and the mental health continuum has significant conceptual consistency with personal recovery.
Dweck (2006) differentiates between the fixed mindset and the growth mindset. People with fixed mindsets believe that their basic qualities like intelligence or talent are fixed traits. They may then spend time docu- menting their intelligence or talent rather than developing it. They may also believe that talent alone creates success, without effort. Dweck contrasts the fixed mindset, with a growth mindset. A person with a growth mindset believes that his/her most basic abilities can be developed through hard work, leading to a love of learning and resilience.
It is our proposition that mental health systems and diagnosis of serious mental illness, such as schizophrenia, have rein- forced fixed mindsets, that is ‘a person with schizophrenia cannot function because of the illness, it is fixed’. The ‘recovery’ move- ment, however, a term co-opted by mental health patients to say it is ‘our recovery’ so ‘we will use the term how we please’ has began to emphasise that growth and devel- opment is possible, despite symptoms of illness. The challenge remains, however, to change the mindset of staff and patients who may have developed fixed mindsets about the abilities of patients. The existence of a medical condition is not being questioned here, rather the assumptions around the person’s abilities with the medical condition
is at question. The leadership question is how to transform mental health organisa- tions and cultures towards such a change.
The CRM now described emphasises the growth focus of recovery, and directly includes training on staff and patient mindsets towards developing abilities. This focus, combined with a strengths coaching framework are applied positive psychology principles in action within environments and organisations that are not construed as positive.
Collaborative Recovery Model as person-centred strengths coaching psychology Oades et al. (2005) first described the CRM as a model that assists clinicians to use evidence based skills with consumers in a manner consistent with the recovery move- ment. In its origin the CRM informed the CRM training programme and was focussed directly on training mental health staff. The model has now expanded to be used as a staff development programme, involving training and coaching. Moreover modules of self-development for consumers (Oades et al., 2008) have been developed, as has carer components and the need for whole of organisation transformation has been recog- nised. The key principles and components of the CRM are illustrated in Table 1.
Observation of Table 1 will reveal that only Guiding Principle 1 makes any refer- ence to illness (i.e. Recovery) and the rest of the model, based within a collaborative rela- tionship, is effectively a goal striving cycle- consistent with previous life coaching with a hope focus (Green, Oades & Grant, 2006). It is for this reason we refer to it also as a person-centred (Joseph, 2006) and strengths based coaching model (Linley & Harrington, 2006a, 2006b).
Crowe et al. (2006) reported significant improvements in staff attitudes when trained in the CRM. However, Uppal et al. (in press) report the significant difficulties in transfer of training in multiple Australian mental health services aiming to implement this model. For this reason, a coaching pro-
28 International Coaching Psychology Review ● Vol. 4 No. 1 March 2009
gramme has been implemented with staff to supplement the training component. More- over, protocols have been revised to further emphasise the coaching nature of the inter- vention itself.
The training and coaching competencies for mental health staff are illustrated in Table 2. In addition to the six modules of training, there are three modules for recovery champions (i.e. the group respon- sible for initiating and sustaining organisa- tional change). Table 2 also illustrates the explicit inclusion of the growth mindset, which we view as central to staff development if recovery oriented care is to be possible.
Table 2 refers to three key protocols, illustrated in Figure 1, to assist implementa- tion of the coaching model (Oades & Crowe, 2008). The ‘Camera’ is a simple strengths and values clarification exercise that is used in collaboration with mental health consumers, and used for the professional development of mental health staff. Coachees are asked to list a personal strength or value clockwise around the ‘lens’ of the camera and then indicate how effec- tively they have been utilising that strength, or implementing that value in the last 30 days. The ‘Compass’ is a visioning and goal setting instrument, adapted from previous work on the CRM (Clarke et al., 2006), based on established goals striving evidence (Sheldon & Elliott, 1998, 1999; Sheldon, 2001). The ‘Compass’ assists people to set specific, measurable, realistic and time- framed goals by asking them to identify three levels of goal attainment, for a goal that is consistent with values identified
within the ‘Camera’. The ‘MAP’ is an action planning instrument based on behavioural change and homework principles (Kelly et al., 2006). The ‘MAP’ includes identifying specific actions required to achieve one of the goals listed in the ‘Compass’, identify barriers to that action, possible solutions, and aspects of social support and how the actions will be monitored. The protocols are deliberately colourful, simple and non- pathologising in contrast to standard medical record forms.
To a practicing coaching psychologist, working with individuals in life coaching, workplace or executive coaching, the imple- mentation of the Camera, Compass, MAP is likely to appear straightforward. To imple- ment these, however, in an inpatient mental health unit, with a long tradition of medical assumptions represents significant organisa- tional change, requiring significant leader- ship. One key strategy has been the use of ‘parallel process’. This concept has been well established in supervision of psychotherapy (Grey & Fiscalini, 1987; McNeill & Worthen, 1989; Miller & Twomey,1999). Originally, the key idea was that processes occurring between a therapist and client were likely to be mirrored, often unconsciously between the supervisor and the therapist. In our view, as CRM is a coaching model, we believe that many of the issues that staff report with consumers, become reflected in how they related with their own coaches or supervi- sors, and indeed in their sense of hopeful- ness, growth orientation, motivation and sense of empowerment. Moreover, in such settings, patients and staff may still carry
Table 1: Key components of the Collaborative Recovery Model.
Guiding Principle 1 Recovery as an individual process
Guiding Principle 2 Collaboration and autonomy support
Component 1 Change Enhancement
Component 2 Strengths and values clarification
Component 3 Collaborative Visioning and Goal Striving
Component 4 Collaborative Action Planning and Monitoring
Lindsay G. Oades, Trevor P. Crowe & Melanie Nguyen
Leadership coaching transforming mental health systems from the inside out
International Coaching Psychology Review ● Vol. 4 No. 1 March 2009 29
Ta bl
e 2:
T ra
in in
g an
d Co
ac hi
ng C
om pe
te nc
ie s
fo r
th e
Co lla
bo ra
ti ve
R ec
ov er
y M
od el
.
Pr ac
ti ti
on er
Re co
ve ry
a s
an in
di vi
du al
pr oc
es s
(G ui
di ng
P rin
ci pl
e 1)
Co lla
bo ra
ti on
a nd
a ut
on om
y su
pp or
t (G
ui di
ng P
rin ci
pl e
2)
Ch an
ge E
nh an
ce m
en t
(C om
po ne
nt 1
)
Ps yc
ho lo
gi ca
l r ec
ov er
y as
a st
ag ed
in di
vi du
al p
ro ce
ss in
vo lv
in g:
(i)
h op
e; (i
i) m
ea ni
ng ;
(ii ) i
de nt
it y;
(iv
) r es
po ns
ib ili
ty .
Th e
‘sy st
em o
f re
co ve
ry ’
co nc
ep t.
Th e
‘fo cu
s of
r ec
ov er
y’ co
nc ep
t.
W or
ki ng
a lli
an ce
. Po
w er
a nd
e m
po w
er m
en t.
Re la
ti on
sh ip
r up
tu re
. Au
to no
m y
su pp
or t.
Ba rr
ie rs
t o
co lla
bo ra
ti on
. W
or ki
ng w
it h
re la
ti on
sh ip
dy na
m ic
s.
St ag
e of
p sy
ch ol
og ic
al re
co ve
ry .
D ec
is io
na l b
al an
ce .
M ot
iv at
io na
l r ea
di ne
ss a
nd re
si st
an ce
. Ps
yc ho
lo gi
ca l a
nd b
as ic
ne ed
s. N
eg ot
ia te
d ne
ed s.
Im po
rt an
ce a
nd c
on fid
en ce
. Fi
xe d
ve rs
us G
ro w
th M
in ds
et .
Pr ot
oc ol
: S ho
rt In
te rv
ie w
St ag
es o
f Re
co ve
ry (S
IS TR
). Sk
ill : T
o ex
pl ai
n th
e st
ag es
of r
ec ov
er y
to a
m en
ta l
he al
th c
on su
m er
. At
ti tu
de : A
‘g ro
w th
m in
ds et
’ – ho
pe fu
ln es
s to
w ar
ds c
on su
m er
s’ ab
ili ty
to s
et , p
ur su
e an
d at
ta in
pe rs
on al
ly v
al ue
d lif
e go
al s.
Sk ill
: D ev
el op
a nd
m ai
nt ai
n a
w or
ki ng
a lli
an ce
. At
ti tu
de : P
os it
iv e
to w
ar ds
ge nu
in e
co lla
bo ra
ti on
.
Pr ot
oc ol
: M ot
iv at
io na
l in
te rv
ie w
in g,
p ar
ti cu
la rly
de ci
si on
al b
al an
ce .
Sk ill
: U se
d ec
is io
na l
ba la
nc e
te ch
ni qu
es ap
pr op
ria te
t o
as si
st co
ns um
er t
o cl
ar if
y am
bi va
le nc
e re
ga rd
in g
ch an
ge .
Em pl
oy s
th e
pr in
ci pl
e, in
al l i
nt er
ac ti
on s
an d
ac ro
ss al
l p ro
to co
ls , t
ha t
ps yc
ho lo
gi ca
l r ec
ov er
y fr
om m
en ta
l i lln
es s
is a
n in
di vi
du al
is ed
p ro
ce ss
.
Em pl
oy s
th e
pr in
ci pl
e, in
al l i
nt er
ac ti
on s
an d
ac ro
ss al
l p ro
to co
ls , o
f m
ax im
um co
lla bo
ra ti
on a
nd s
up po
rt of
c on
su m
er a
ut on
om y.
En ha
nc es
c on
su m
er ch
an ge
b y
sk ilf
ul a
nd u
se of
m ot
iv at
io na
l en
ha nc
em en
t ap
pr op
ria te
to t
he s
ta ge
o f
re co
ve ry
o f
th e
co ns
um er
.
Ro le
p la
y in
p ai
rs in
vo lv
in g:
(a ) u
se o
f SI
ST R
as m
ea ns
to p
la nn
in g;
(b ) E
xp la
na ti
on a
nd cl
ar if
ic at
io n
to c
on su
m er
an d
ca re
r in
u nd
er st
an d-
ab le
la ng
ua ge
o f:
– st
ag es
o f
ps yc
ho lo
gi ca
l re
co ve
ry –
fo cu
s of
r ec
ov er
y –
sy st
em o
f re
co ve
ry .
Ro le
p la
y in
p ai
rs in
vo lv
in g
th e
ex pl
an at
io n
an d
cl ar
if ic
at io
n to
c on
su m
er an
d ca
re r
in un
de rs
ta nd
ab le
la ng
ua ge
th e
m ea
ni ng
o f:
– a
co lla
bo ra
ti ve
re la
ti on
sh ip
– ov
er co
m in
g re
la ti
on sh
ip ru
pt ur
es .
Ro le
p la
y in
p ai
rs t
o co
nd uc
t of
a d
ec is
io na
l ba
la nc
e ex
pl or
at io
n, fo
cu ss
in g
on w
he th
er t
o w
or k
to w
ar ds
r ec
ov er
y or
no t,
an d
ot he
r co
nf lic
ti ng
m ot
iv at
io ns
- el
ic it
in g
so m
et hi
ng in
e ac
h qu
ad ra
nt t
ha t
in cl
ud es
fu nc
ti on
al a
nd s
ig ni
fi ca
nt ot
he r
co st
s or
b en
ef it
s.
● D
oc um
en t
tr ai
l o f
co m
pl et
ed S
IS TR
. ●
Co ns
um er
r ep
or t
of
ex pl
an at
io n
of re
co ve
ry f
ro m
s ta
ff .
● Co
ns um
er r
ep or
ts o
f st
af f
be ha
vi ou
rs (e
.g . C
on su
m er
Ev al
ua ti
on o
f Co
lla bo
ra ti
ve Re
co ve
ry M
od el
, Re
co ve
ry Se
lf -A
ss es
sm en
t) .
● Co
ns um
er R
at in
g of
W or
ki ng
A lli
an ce
In ve
nt or
y (o
r si
m ila
r) .
● Co
ns um
er r
ep or
ts o
f st
af f
be ha
vi ou
rs
(e .g
. C on
su m
er Ev
al ua
ti on
o f
Co lla
bo ra
ti ve
Re co
ve ry
M od
el ,
Re co
ve ry
Se lf
-A ss
es sm
en t)
.
● D
oc um
en t
tr ai
l o f
co m
pl et
ed d
ec is
io na
l ba
la nc
e pr
ot oc
ol s.
M od
ul e
Kn ow
le dg
e Do
m ai
ns Pr
ot oc
ol , S
ki lls
a nd
Co m
pe te
nc y
Tr ai
ni ng
E xe
rc is
e St
af f
Pe rf
or m
an ce
At ti
tu de
s M
an ag
em en
t In
di ca
to rs
30 International Coaching Psychology Review ● Vol. 4 No. 1 March 2009
Ta bl
e 2:
T ra
in in
g an
d Co
ac hi
ng C
om pe
te nc
ie s
fo r
th e
Co lla
bo ra
ti ve
R ec
ov er
y M
od el
(c on
ti nu
ed ).
Co lla
bo ra
ti ve
v al
ue s
an d
st re
ng th
s id
en ti
fi ca
ti on
(C om
po ne
nt 2
)
Co lla
bo ra
ti ve
li fe
v is
io ni
ng an
d go
al s
tr iv
in g
(C om
po ne
nt 3
)
Co lla
bo ra
ti ve
a ct
io n
pl an
ni ng
an d
m on
it or
in g
(C om
po ne
nt 4
)
Va lu
es c
la rif
ic at
io n.
St re
ng th
s id
en ti
fi ca
ti on
.
Pe rs
on al
li fe
v is
io n.
Va lu
ed d
ire ct
io ns
. G
oa l i
de nt
if ic
at io
n, s
et ti
ng an
d st
riv in
g. M
ea ni
ng /m
an ag
ea bi
lit y
tr ad
e- of
f. Au
to no
m ou
s go
al s.
Pr ev
en ti
on a
nd P
ro m
ot io
n go
al s.
Pr ox
im al
a nd
d is
ta l g
oa ls
.
H ea
lt h
be ha
vi ou
r ch
an ge
. Ac
ti on
p la
nn in
g. H
om ew
or k.
Se lf
-e ff
ic ac
y. M
on it
or in
g. Se
lf -m
an ag
em en
t.
At ti
tu de
: T o
ta ke
p ar
ti al
re sp
on si
bi lit
y fo
r ro
le in
in te
ra ct
io na
l a sp
ec ts
o f
m ot
iv at
io n.
Pr ot
oc ol
: ‘ Ca
m er
a’ v
al ue
s an
d st
re ng
th s
cl ar
if ic
at io
n m
et ho
d. Sk
ill : A
ss is
t a
co ns
um er
t o
el ic
it p
er so
na l v
al ue
s an
d st
re ng
th s
an d
as se
ss h
ow w
el l t
he y
ha ve
b ee
n im
pl em
en te
d re
ce nt
ly .
At ti
tu de
: T o
va lu
e re
fl ec
ti ve
e xe
rc is
es no
tw it
hs ta
nd in
g cu
rr en
t di
ff ic
ul ti
es o
r sy
m pt
om s.
Pr ot
oc ol
: ‘ Co
m pa
ss ’ v
is io
n an
d go
al s
tr iv
in g
m et
ho d.
Sk ill
: E lic
it m
ea ni
ng fu
l vi
si on
a nd
m an
ag ea
bl e
go al
s. At
ti tu
de : T
o be
p er
si st
en t
w it
hi n
th e
fa ce
o f
ob st
ac le
s.
Pr ot
oc ol
: ‘ M
AP ’ a
ct io
n pl
an ni
ng m
et ho
d. Sk
ill : T
o as
si st
w it
h th
e de
ve lo
pm en
t of
co m
pr eh
en si
ve a
ct io
n pl
an s.
As si
st in
g co
ns um
er s
to cl
ar if
y va
lu es
a nd
st re
ng th
s an
d th
en u
ti lis
e th
em in
t he
h er
e an
d no
w .
Pe rs
is ts
f le
xi bl
y an
d co
lla bo
ra ti
ve ly
w it
h th
e co
m po
ne nt
s w
it hi
n th
e Co
m pa
ss t
o as
si st
r ec
ov er
y by
w ay
o f
th e
de ve
lo pm
en t
of a
n in
te gr
at ed
m ea
ni ng
fu l l
iv e
vi si
on , v
al ue
d di
re ct
io ns
, m
an ag
ea bl
e go
al s,
w hi
ch pr
ov id
e a
br oa
de r
pu rp
os e
fo r
ac ti
on s.
Sy st
em at
ic al
ly a
nd co
lla bo
ra ti
ve ly
a ss
ig ns
ac ti
on s,
an d
m on
it or
s pr
og re
ss t
ow ar
d ac
ti on
co m
pl et
io n
an d
go al
s, to
en ha
nc e
se lf
-e ff
ic ac
y of
co ns
um er
.
Ro le
p la
y in
p ai
rs o
n as
si st
in g
a co
ns um
er t
o us
e th
e Ca
m er
a –
fo llo
w in
g al
l s te
ps .
Ro le
p la
y in
p ai
rs o
n as
si st
in g
a co
ns um
er t
o us
e th
e Co
m pa
ss –
fo llo
w in
g al
l s te
ps .
Ro le
p la
y in
p ai
rs o
n as
si st
in g
a co
ns um
er t
o us
e th
e M
AP –
fo llo
w in
g al
l s te
ps .
● D
oc um
en t
tr ai
l o f
co m
pl et
ed C
am er
a pr
ot oc
ol s.
● D
oc um
en t
tr ai
l o f
co m
pl et
ed C
om pa
ss
pr ot
oc ol
s. ●
Te am
-b as
ed pe
rf or
m an
ce a
ss es
se d
by
G oa
l- IQ
a ud
it o
f fi
le s
to
ex am
in e
qu al
it y
of g
oa ls
do
cu m
en te
d in
ca
se n
ot es
.
● D
oc um
en t
tr ai
l o f
co m
pl et
ed M
AP
pr ot
oc ol
s.
M od
ul e
Kn ow
le dg
e Do
m ai
ns Pr
ot oc
ol , S
ki lls
a nd
Co m
pe te
nc y
Tr ai
ni ng
E xe
rc is
e St
af f
Pe rf
or m
an ce
At ti
tu de
s M
an ag
em en
t In
di ca
to rs
Lindsay G. Oades, Trevor P. Crowe & Melanie Nguyen
Leadership coaching transforming mental health systems from the inside out
International Coaching Psychology Review ● Vol. 4 No. 1 March 2009 31
Ta bl
e 2:
T ra
in in
g an
d Co
ac hi
ng C
om pe
te nc
ie s
fo r
th e
Co lla
bo ra
ti ve
R ec
ov er
y M
od el
(c on
ti nu
ed ).
Pr om
ot in
g Re
co ve
ry
Tr ai
ni ng
R ec
ov er
y
Co ac
hi ng
R ec
ov er
y
Re co
ve ry
o rie
nt ed
c ar
e. Co
ns um
er p
ar ti
ci pa
ti on
m ov
em en
t.
Tr an
sf er
o f
tr ai
ni ng
. Ex
pe rie
nt ia
l L ea
rn in
g Th
eo ry
. Ba
si c
gr ou
p fa
ci lit
at io
n.
Ev id
en ce
b as
ed c
oa ch
in g.
G RO
W m
od el
o f
co ac
hi ng
. Pa
ra lle
l P ro
ce ss
.
At ti
tu de
: T o
va lu
e ‘sm
al l
ac ti
on s’
be tw
ee n
th e
m ee
ti ng
s of
s ta
ff a
nd co
ns um
er s
(b et
w ee
n se
ss io
n ac
ti vi
ty ).
Sk ill
: T o
pr om
ot e
a ‘g
ro w
th m
in ds
et ’ t
ow ar
ds h
um an
de ve
lo pm
en t.
At ti
tu de
: T o
po ss
es s
a ‘g
ro w
th m
in ds
et ’ t
ow ar
ds hu
m an
d ev
el op
m en
t.
Sk ill
: T o
co m
m un
ic at
e th
e pr
in ci
pl es
a nd
r el
at ed
pr ac
ti ce
s of
r ec
ov er
y to
m en
ta l h
ea lt
h w
or ke
rs in
a m
an ne
r un
de rs
ta nd
ab le
t o
th em
. At
ti tu
de : T
o vi
ew a
du lt
le ar
ni ng
a s
m ut
ua l s
ha rin
g of
id ea
s.
Sk ill
: T o
as si
st c
ol le
ag ue
s pa
st ‘s
tu ck
p oi
nt s’
in re
co ve
ry o
rie nt
ed p
ra ct
ic e
in s
ho rt
m ee
ti ng
s. At
ti tu
de : T
o va
lu e
th e
au to
no m
y of
t he
c oa
ch ee
.
M ai
nt ai
ni ng
a p
os it
iv e
an d
ho pe
fu l a
pp ro
ac h
to t
he ph
ilo so
ph y
of r
ec ov
er y
or ie
nt ed
c ar
e de
sp it
e: (a
) c rit
ic is
m t
ha t
it is
ov er
ly o
pt im
is ti
c; (b
) t ha
t it
w ill
n ot
w or
k in
a pa
rt ic
ul ar
u ni
t be
ca us
e co
ns um
er s
ar e
‘to o
si ck
’.
To b
e ab
le t
o co
m m
un ic
at e
th e
ke y
as pe
ct s
of t
he re
co ve
ry p
hi lo
so ph
y an
d it
s im
pl ic
at io
ns f
or c
on su
m er
s, ca
re rs
, m en
ta l h
ea lt
h w
or ke
rs a
nd o
rg an
is at
io ns
.
To a
ss is
t co
lle ag
ue s
in t
he ir
pe rs
on al
a nd
p ro
fe ss
io na
l de
ve lo
pm en
t in
a m
an ne
r co
ns is
te nt
w it
h w
or ki
ng w
it h
a co
ns um
er .
To r
ol e
pl ay
a s
it ua
ti on
w it
h sc
ep ti
ca l c
ol le
ag ue
s re
ga rd
in g
op po
si ti
on t
o re
co ve
ry o
rie nt
ed c
ar e
th at
it is
: ( a)
a f
ad ;
(b ) ‘
po lly
an na
is h’
; (c
) p ro
vi di
ng f
al se
h op
e –
an d
de m
on st
ra te
r ef
le ct
iv e
lis te
ni ng
a nd
a p
os it
iv e
st at
em en
ts , u
se m
ot iv
at io
na l e
nh an
ce m
en t
st ra
te gi
es .
To r
un a
g ro
up t
ra in
in g
se ss
io n
w it
h co
lle ag
ue s
– an
d pr
ov id
e a
vi de
o sa
m pl
e w
it hi
n co
ac hi
ng w
it h
se lf
- ev
al ua
ti on
f ro
m c
oa ch
ee .
To c
on du
ct c
oa ch
in g
se ss
io ns
w it
h co
lle ag
ue s
an d
re ce
iv e
fe ed
ba ck
, s el
f ev
al ua
ti on
a nd
t o
m od
if y
ba se
d on
f ee
db ac
k.
● D
em on
st ra
te d
pa rt
ne rs
hi p
w it
h co
ns um
er /p
at ie
nt
ad vo
ca cy
g ro
up s
re ga
rd in
g re
co ve
ry
or ie
nt ed
c ar
e de
liv er
y. ●
Re fl
ec ti
ve jo
ur na
l do
cu m
en ti
ng t
im es
w
he n
in di
vi du
al
‘sp ok
e up
t o
pr om
ot e
a gr
ow th
m in
ds et
’.
● N
um be
r of
t ra
in in
g ho
ur s
co nd
uc te
d. ●
Pa rt
ic ip
an t
ev al
ua ti
on
of t
ra in
in g.
● W
ill in
gn es
s to
c om
pl et
e pe
rs on
al C
am er
a,
Co m
pa ss
, M AP
. ●
M ea
su re
o f
‘c oa
ch in
g al
lia nc
e’ r
at ed
b y
co ac
he e.
M od
ul e
Kn ow
le dg
e Do
m ai
ns Pr
ot oc
ol , S
ki lls
a nd
Co m
pe te
nc y
Tr ai
ni ng
E xe
rc is
e St
af f
Pe rf
or m
an ce
At ti
tu de
s M
an ag
em en
t In
di ca
to rs
Co lla
bo ra
ti ve
R ec
ov er
y Ch
am pi
on
32 International Coaching Psychology Review ● Vol. 4 No. 1 March 2009
Figure 1: Camera, Compass and MAP Coaching protocols within CRM.
Lindsay G. Oades, Trevor P. Crowe & Melanie Nguyen
Leadership coaching transforming mental health systems from the inside out
International Coaching Psychology Review ● Vol. 4 No. 1 March 2009 33
internalised stigma regarding mental illness; closely related to the fixed mindsets already discussed.
The parallel process strategy being used with CRM is for staff to use the Camera, Compass and MAP as part of their own professional development coaching – exactly the same protocols that they are asked to used with mental health consumers. This is the use of leadership coaching principles with self and with patients leading from the inside-out (Bianco-Mathis, Nabors & Roman, 2002). Bianco-Mathis et al. (2002) describe a coaching leadership model that includes ‘Coaching the Leader Within’ – coaching a leader on the alignment of who and what he/she is and wants to be ‘Coaching the Leader with Others’ – the leader in relation- ship with others; and ‘Coaching the Leader with the Organization’ – coaching the leader to lead change and transform the organiza- tion. This leadership coaching framework fits closely with the use of CRM with staff and patients at the mental health organisation to be described further.
There is an implicit normalising rationale here that staff and patients all have strengths, values, goals, actions, and require a growth mindset. This is significantly different from historical paternalistic assumptions of psychiatric care. Couley and Oades (2007) have described how many mental health teams feel that they are also in recovery, searching for a growth focus. This difference represents the leadership chal- lenge to implement recovery oriented care. This is now discussed.
Developing recovery oriented care: Leadership coaching for transformation Davidson et al. (2006) have described the top 10 concerns about recovery in mental health services, with the first concern being that recovery oriented care increases expo- sure to risk and liability. Further concerns include a perception that it may devalue professional expertise, and increase the need for resources. In addition to issues
related to recovery specifically, there is the general challenge of implementing change- particularly the transfer of training problem. The transfer of training problem is well established, and becomes more difficult with complex interpersonal skills, as required in service industries such as mental health systems (Gist, Stevens & Bavetta, 1991). There are multiple challenges to transfer- ring evidence-based recovery practices into routine practice and we found that mental health workers endorse institutional constraints as the most frequent barriers to transfer of the CRM training into practice (Deane et al., 2006; Uppal et al., in press). Institutional constraints include elements such as insufficient staff (e.g. ongoing recruitment and training) and positive rein- forcement for patients, restrictive adminis- trative practices, inadequate resources and funding, poor data management, and poor alignment of organizational values/goals to staff training. It has been consistently reported that training transfer and diffusion of innovation are significantly influenced by these elements (e.g. Rogers, 2003; Turner & Sanders, 2006).
We have observed many instances where there is strong managerial and organisa- tional support for recovery oriented prac- tices, yet clinicians have still not implemented skills in practice. If institu- tional constraint barriers are not the main factor preventing transfer of training, it may be philosophical or attitudinal opposition of staff toward practice change. The top 10 concerns encountered in implementing recovery-oriented care include potential challenges to the beliefs and philosophical orientation of staff (Davidson, 2006). For example, recovery philosophy encourages increased self-management and autonomy amongst patients. This raises concerns amongst mental health workers that recovery increases risk-taking by patients and exposes providers to risk and liability. Since traditional care models tend to be predomi- nantly risk aversive, it is possible that this philosophy may be a barrier to implementa-
34 International Coaching Psychology Review ● Vol. 4 No. 1 March 2009
tion. Alternatively, it has the potential to be a facilitator for those staff with whom it resonates. Many mental health staff report recovery-oriented values, but based on previous evidence, the transfer of recovery- based training into clinical behaviour has been poor.
In the same way that personal recovery research and practice may be informed by positive psychology principles, the discipline of positive organisational scholarship (Cameron, Dutton & Quinn, 2003) and specifically positive leadership (Cameron, 2008) provide useful frameworks to under- stand the organisational challenges in devel- oping recovery oriented mental health services. Positive leadership emphasises the need for positive climate, positive relation- ships, positive communication and positive meaning. For this reason, the implementa- tion of a strengths-based coaching model (Collaborative Recovery Model), in parallel for staff and patients is consistent with the positive leadership model. The mental health organisation in Ontario, Canada, and this implementation process is now described.
The mental health organisation is a large tertiary inpatient mental health facility in Ontario, servicing approximately 330 adoles- cent, adult and elderly inpatients and over 440 outpatients with enduring mental illness, particularly schizophrenia spectrum disor- ders. The organisational employs 1200 staff, with 700 clinical staff including nurses, occu- pational therapists, psychiatrists, psycholo- gists, recreational therapists, service providers who have been patients and social workers. The 500 non-clinical staff including house- keeping, maintenance and administration.
In November, 2008, the organisation embarked on a new initiative, ‘Recovery and Rediscover – the Shared Journey’. Consistent with the parallel process of growth described, the staff professional develop- ment training and coaching (‘rediscovery’) is being run directly alongside changes to the service delivery model (i.e. to be recovery focussed). The positive leadership
involves a commitment to training all 1200 staff in the principles of the Collaborative Recovery Model, including growth mindset, hope, etc. This educational initiative was offi- cially launched in January of 2009 and will be implemented throughout the hospital over the next 18 months, bringing patients, clinical and non-clinical towards a common desired goal: a recovery-based organization. All clinical staff will receive a five-day training module followed by ongoing work- place coaching. The practice model for patients will mirror this coaching through the use of the CRM. Recovery champions were nominated from each unit, and have received the training and coaching described in Table 2 and the protocols illus- trated in Figure 1.
In addition to the CRM being a coaching model used in parallel, within the organisa- tion there is a clinical coaching role which will provide support for clinical practice as inter-professional teams work to integrate the recovery philosophy into the everyday care that they provide. Historically, mental health clinicians have felt undervalued regarding the highly specialized care and skill set needed to work with patients with mental illnesses. As staff continue to work in environments with increasingly people who have acute illness, staffing issues, unpre- dictable and potentially volatile situations, the opportunity for positive and transforma- tional leadership is crucial. Change agents (such as an Advanced Practice Nurse/ Clinical Coach or a Recovery Champion) influence practice and collaboration through direct relationships with patients and through supportive and consultative roles with staff. These individuals are all acting explicitly as leadership coaches, whilst all staff and patients are encouraged to employ the principles of coaching psychology, and lead themselves.
Broader organisational initiatives have also included changing policy documents to reflect the positive growth recovery language, including recovery based metrics into balanced scorecard reporting, changing
Lindsay G. Oades, Trevor P. Crowe & Melanie Nguyen
Leadership coaching transforming mental health systems from the inside out
International Coaching Psychology Review ● Vol. 4 No. 1 March 2009 35
electronic documentation to reflect the model. Staff incentives and recruitment are also currently being examined to explore their congruence with the recovery and growth orientation. The patient advocacy groups are also being supported to interpret and implement the programme.
The implementation of the programme is being evaluated over an 18-month period with a repeated measures design, focussing initially on staff outcomes, to be followed by examination of patient outcomes and satis- faction.
Conclusion The principles and practices of coaching psychology, particularly leadership coaching, combined with those of positive leadership can have important applications, including environments that would be stereotypically thought of as clinical and not growth oriented, namely tertiary inpatient mental health units. This paper has described how coaching psychology, positive psychology and positive leadership can be combined with an emerging movement in mental health service provision, the recovery movement. The appli- cation in this environment rejects any asser- tion that coaching psychology or positive psychology only applies to ‘non-clinical’ populations, claiming rather that they repre- sent a collection of attitudes, concepts and practices that value growth.
The authors Lindsay Oades School of Psychology & Illawarra Institute for Mental Health, University of Wollongong, NSW, Australia.
Trevor Crowe Illawarra Institute for Mental Health, University of Wollongong, NSW, Australia.
Melanie Nguyen Whitby Mental Health Centre, Whitby, Ontario, Canada.
Correspondence Dr Lindsay Oades School of Psychology, University of Wollongong, NSW, Australia 2522. E-mail: [email protected]
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