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What happens when the professional doesn't sit across from the client, but works and learns with them?
An Australian-first Recovery Camp is creating an environment where therapeutic relationships can be built from the ground up.
Or when we look at mental health in terms of lived experience, instead of statistics.
When we see humans as … humans, and focus on their strengths rather than their illness. An Australian-first Recovery Camp is doing exactly that, immersing students with people suffering from mental illness to create an environment where therapeutic relationships can be built from the ground up.
On the brink of an anxiety attack, the latch releases causing her to dip and swing up to the other side. Back and forth she sways until the movement eases and, by the time her feet plant firmly on the ground, tears are running down her face.
"It was such a rush going through my body and a feeling of accomplishment," Marley says. "The giant swing was very scary for me, but my team encouraged me to get up and try it. I went right to the top, went into a panic attack and came down crying, but I had completed that path I had never done before."
It might sound like a thrilling team-bonding day, but mental health professionals from UOW carefully selected each activity at the five-day retreat.
Recovery Camp, held at YMCA Camp Yarramundi, located in stunning bushland north-west of Sydney, is a non-traditional form of therapy for people with a lived experience of severe mental illness. Marley, aged 31, has lived with depression and anxiety for most of her life. She enjoyed the camp so much she went back for a second time and has signed up for a third.
Socialising, exercising and getting out and about comes naturally for most people, but Marley says it can sometimes be a challenge for people with mental illness. The camp gave her the opportunity to be pushed outside her comfort zone.
"I was nervous to talk to people, because I was put in a group without my friends," she says. "We all met and talked about what we had done at the camp, everyone is really friendly, especially the nurses. They help you when you're down, they were even braiding the girls' hair and just really take care of you."
For Marley, the camp was really beneficial to her state of mind. Through the trivia, bush dancing, dress-ups and various other activities, it was a time when she completely forgot about her illness. She made new friends and learned new ways of calming herself down.
"It’s good to know there are other people in the same boat. We all have different types of mental illness."
- Marley Mahe
She experienced ups and downs over the five days, but by the time it was over she felt accepted and more confident. She recalls one night where she was upset and the nurses stayed back with her to talk things through and cheer her up in ways she hadn't thought of. Even though Recovery Camp had to end, her battle still continues, but she says she feels better equipped to manage her illness.
Marley left with new experiences, memories, friends and skills - which has had a lasting impact on her mental health. "I've kept in contact with friends I made. We love seeing each other again at camps," she says.
"It's good to know there are other people in the same boat, we all have different types of mental illness. A camp like this has made a huge difference, it changed me a lot and made me feel good. I tell everyone about it, lots of people have asked questions and put their name down - they have all thanked me."
Marley says she wasn't the only one to benefit from the camp. She hopes the nurses gained a valuable experience from her as well. "I think they learned from us too. I told them about the centre I go to," she says. "The camp and the nurses had a really big impact on me. It's really awesome."
"We just laugh. Your face aches from laughing after a while." That was a part of Caroline Picton's experience at Recovery Camp in 2014.
She was a third-year nursing student at UOW's Bega campus when she went there on clinical placement, because it seemed like it would be a fun opportunity.
Little did she know it would change the course of her career. Beforehand, Caroline knew she wanted to be a nurse in the emergency department. She had a five-year plan, took all the right steps and studied the right course and subjects.
Participants were involved in a range of high adrenaline and relaxing activities at Recovery Camp.
But this unique placement turned her plan on its head. Caroline likely wouldn't have considered specialising in mental health if it weren't for Recovery Camp, which uncovered a passion of hers she didn't even know existed.
"I had no intention of doing mental health nursing, but it was so good to hear people's lived experiences," Caroline says. "Those opportunities don't come around often, where you get to be so inspired, work in the area and give back. Too often we look at numbers, but we need to hear what people are experiencing."
She isn't the only student who found value in the innovative placement opportunity. Instead of the classic nurse-client set-up, the immersive learning experience, which brings people together, was something unforgettable for other students too.
"Recovery Camp highlighted what I think is integral in nursing, to focus on the humanity of a person and not the illness."
- Josie Aitken
UOW nursing student Josie Aitken says it was unlike any clinical placement she had been on. "Recovery Camp highlighted what I think is integral in nursing, to focus on the humanity of a person and not the illness," she says. "I saw the entirety of a person, their fears, their strengths, their beliefs, their values and their personality. The relaxed environment allowed this magical process to happen."
For Barbara Thiele, who also studies nursing, the placement was a "revelation".
"They tell their stories in such matter-of-fact ways, as though it is a normal and everyday occurrence to have deep depression to the point where life is no longer worth living, or to have been badly abused as a child," she says.
"Just from observation over the week, the camp gives the consumers new focus, a different way to approach life, and most importantly, acceptance and lots of fun."
Caroline Picton is a Registered Nurse who did her Bachelor of Nursing (Honours) on Recovery Camp. Photo: Paul Jones
Caroline returned to the camp in 2015 after being asked to do research for her Honours by the camp's founder, UOW Professor of Mental Health Nursing Lorna Moxham. She hopes to return next year to do her PhD, pending acceptance.
"This has given me so many opportunities and UOW has recognised this passion," Caroline says. "Recovery Camp has been the foundation for so much growth, professionally and personally. It's been an incredible journey speaking with people and hearing the troubles they go through.
"By understanding, we can help ease their transition back into the community, and from that stems people's determination to do things and get motivated." Through her research, Caroline found the camp helped people who are often socially isolated develop relationships. She says one of the main themes that stood out through her interviews was a feeling of connectedness.
"Some people said for the first time in their lives they felt a connection," she says. "When you're feeling anxious or depressed, it can be hard to get out of the house and make friends." The camp helped Caroline become confident in developing therapeutic relationships, skills she now uses at her work. It was also an opportunity for research and innovative learning.
She says she learned from the patients and saw the ways in which people can sometimes draw conclusions before hearing what it's really like to live with mental illness.
"Nursing is about compassion, relationships and being there for someone during the most difficult time in their life," she says.
"A lot of people don't have positive experiences when they aren't well, but even though the camp is finished for the people I interviewed, it's still in their story."
Nursing students and participants enjoy outdoor activities at Recovery Camp.
Professor Lorna Moxham vividly remembers sitting at her desk on a warm summer day when the idea came to her. She was looking out her window at the duck pond trying to find a way to provide more clinical placement opportunities for nurses.
Having previously been on the national Mental Health Nurse Education Taskforce, she was reflecting on research that identified the lack of mental health content in the Bachelor of Nursing curriculum but also the lack of clinical exposure.
It was at that desk where Recovery Camp, for people with mental illness, was born. "I thought it was a long shot as a week away fully immersed with people who have a serious mental illness as a clinical placement was way outside anything that had been done before," she says.
"I love my clinical area and want students to be exposed to positive role modelling and have really good clinical placements. I really want them to value mental health nursing and 'convert' them into this specialist discipline area.
"There is an awful lot of research, including some that I have published, about the effects of clinical placement on attitude, intention to work in an area and nurse identity."
Professor Moxham had come across a similar idea when she worked at Central Queensland University, but it was on a much smaller scale, wasn't interdisciplinary or embedded in research, and didn't continue to run.
It had been in the back of her mind, until she won a grant from the NSW Interdisciplinary Clinical Training Networks (ICTN) and brought the concept to life. Professor Moxham says with support from UOW, the first Recovery Camp was run in 2013.
Professor Lorna Moxham, who founded the ground-breaking mental health camp. Photo: Paul Jones
The innovative retreat has since operated a further four times and became part of UOW's Global Challenges Program. It has won several awards for interdisciplinary research, community engagement and education training.
Professor Moxham says they now take about 26 students and 30 consumers at each camp. "Our point of difference was the interdisciplinary nature. We measure the camp's success from the carers and consumers perspective and from the student perspective too," she says.
"Heaps of research has come out of it, it's had numerous peer reviews published and has been presented at national and international conferences." Students from nursing, psychology, dietetics and exercise physiology attend camp, enabling them to experience mental health care and treatment that is community-based and recovery-oriented.
They work with each other, hear solutions and recommendations from different viewpoints and learn to value the lived experience of consumers. For nursing students, the experience can count as a mental health clinical placement as part of their degree.
Professor Moxham says the camp is based on the idea of therapeutic recreation, where both high adrenaline and relaxing activities, including giant swings, flying foxes and Tai Chi, were thoughtfully put together to create a place where therapeutic relationships are formed.
The activities act as a gateway to start conversations. "Consumers are open, they talk about what it's like to be taken to hospital, how they deal with their voices and about involuntary admission to mental health facilities," she says. "Students see people who are very vulnerable."
The effects have been profound for both student and consumer; so much so that a student started a GoFundMe page to raise $500 to help the camp continue to run. A group of clients also started a walking group following their experience.
But there was one woman who Professor Moxham says found some of her very best friends at Recovery Camp. "She was getting married and had no one to be her bridesmaids, but she met other ladies who became her bridesmaids," she says. "How do you quantify this in terms of being therapeutic?"
Several papers and research that has gone into the camp suggest it is effective on a number of fronts. Professor Moxham says for the carers of people with mental ill-health, it provides respite.
"One mum said she gets to do things she doesn't normally do, like going out for dinner, visiting a friend or being able to attend appointments," she says. "The carers are always hugely grateful because it is hard for them to tell their loved one that they need a break."
The investigatory team that conducts research at Recovery Camp. Dana Perlman, Susan Sumskis, Lorna Moxham, Renee Brighton, and in front, Ellie Taylor and Christopher Patterson.
Research on the benefit for students suggests they leave Recovery Camp with increased confidence in forming therapeutic relationships. Professor Moxham suspects this is due to the close immersion.
Students have also statistically shown to have significantly less stigmatizing attitudes toward people with mental illness than when they entered. Professor Moxham says consumer experiences were also measured before and after camp, as well as three months later.
"They spoke about having a better quality of life and how the camp contributed to their personal recovery," she says. "They made friends at the camp, so weren't as socially isolated afterwards."
While the early results are encouraging, Professor Moxham hopes the program will continue to run and take on larger cohorts, so researchers can gain a better idea of how the concept of Recovery Camp could help address the urgent national and global issue of mental illness.
Interested in nursing? Learn more about studying nursing at UOW.