Jonathan Gadsby is a mental health nurse, currently working in the Bristol Early Intervention for Psychosis Service, UK

The Recovery Star is a “tool for supporting and measuring change when working with adults of working age who are accessing mental health support services”.^[1]

History

The Recovery Star was devised in 2007 by the Mental Health Providers Forum, in consultation with Triangle Consulting, an “outcomes measurement” company, who have worked on a number of voluntary sector and governmental projects. It was launched in May 2008. The Recovery Star is a revised version of a tool created by Triangle Consulting for use within a homelessness charity, called the “Outcomes Star”.^[2]

Ideology

The Recovery Star appears to draw on a number of existing ideas within different therapeutic approaches, such as Solution Focused Therapy, Cognitive Behavioural Therapy and Motivational Interviewing, and whilst the content of the Recovery Star may be seen as uncontroversial, it is designed to support the Recovery model which is the term used to describe a fundamental ideological shift within mental health services which is currently taking place within the UK – that a person with a mental disorder should not be institutionalised and seen as having a life-long condition, but rather is experiencing something which may be recovered from, or managed in such a way as to allow a fulfilling and enjoyable life.

Structure

Essentially the Recovery Star is a method of focussing therapeutic conversation onto ten different areas of human need and experience. These ten areas are; Managing Mental Health, Self-care, Living skills, Social networks, Relationships, Addictive behaviour, Responsibilities, Identity and self-esteem and Trust and hope. These are arranged in a star shaped diagram. The use of a star shape helps to indicate a philosophy that each of these areas are given equal importance in the goal of achieving better mental health, and also provides a visual representation of strengths and weaknesses – this latter part becomes evident after the client has completed an assessment of each area of the star, rated themselves, and recorded the result on the diagram.

Measuring, and supporting change

The rating system is much less subjective than might be more usually associated with Solution Focussed scaling approaches, but instead encourages the client to match themselves against statements and ideas along a ten-point “ladder of change”. For example, a client making an assessment about their level of self-care might identify with the statement, “I don’t look after myself but occasionally I realise I feel awful” and therefore decide they are at number 2 on the ladder. After following through some plans and discussion the subject, they might “read” that point of the Star once again, and now identify with the statement, “I’m working with someone to feel better” – and thus decide they are on point 4. Each “ladder” has statements relating to the specific point of the star, but they all follow the same pattern. A generic “ladder of change” makes this clear – change occurs as people move from “stuck” through “accepting help” to “believing”, “learning” and finally “self-reliance”. Movement up each ladder is clearly linked both to feeling better and in a very direct way to having more personal responsibility and increased independence in the area described. However, it also makes the role of the therapist explicit too – to engage in a way that helps someone who seems “stuck” to identify problem areas, and then to accept help, but with independence as the firm goal. The Recovery Star is not “client centred” in the sense that Carl Rogers used that term (ref), but rather a guide to therapeutic work. It encourages self-assessment and goal setting, and indeed could be used as either a self-help tool or within a group setting, although its intended use is within a therapeutic relationship between client and councillor (ref). The client is invited to chose the order of the ten areas within the discussion. It is suggested that to discuss all ten areas (one “reading” of the star”) should take between 45 minutes and 2 hours. The Recovery Star uses carefully chosen language to make complex subjects such as “self-esteem” more understandable. Use of the Recovery Star

The Mental Health Providers Forum estimate that 70 – 80% of their members have started to use the Recovery Star in some way. This is a large list of voluntary sector mental health organisations operating in England, including large national organisations such and Mind and housing and support providers such as Carr-gomm and Second Step (ref). Also, a number of mental health NHS trusts have expressed interest and received training. It is impossible for the Mental Health Providers Forum to accurately know the take up of the Recovery Star, as they have made all the material downloadable from the internet in any country, anonymously and free of charge.

Efficacy and Research

As yet the only evident research into the efficacy of the Recovery Star is the pilot scheme set up by it’s creators. This is an as yet unpublished BAME (Black and Minority Ethnic) trial of the Recovery Star across three English cities. Clearly more data is required to establish the effect of using the Recovery Star with users of both statutory and non-statutory mental health service providers.

Data Collection

The Recovery Star literature includes suggestions about how the outcome measures could be collected and used to measure it’s efficacy across a client group, and the focus on measurable outcomes lends itself to both qualitative and quantitative data collection. Also, the Mental Health Providers Forum provides an confidential online data collection tool, which can collate the amount of change measured for individuals and across a client group (ref).