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A recovery approach to substance abuse or mental disorder supports and emphasizes an individual’s potential for recovery. The recovery approach to mental illness can be considered as a personal journey instead of a set outcome. A recovery approach involve developing a sense of self and a secure base, cope skills, social inclusion, empowerment, supportive relationships, and meaning. Recovery concept is also referred to as recovery-oriented practice or recovery model. 

This paper presents a clinical audit of the physical environment at the Tamaki Oranga Recovery Centre using recovery-oriented principles and concepts. This clinical audit will specifically focus on the reception facilities at Tamaki Oranga Recovery Centre.

1: Identify the Issue

The main goal of mental health recovery is helping individuals on their journey to function regardless of their disability. The recovery approach of Mental Health normally focuses on the processes by which individuals with mental disorder actively create meaningful lives, despite the presence of intermitted or continuous and pervasive mental illness (Gawith & Abrams, 2006). Recovery can only be said to be happening when individuals are living well in the absence or presence of their mental illness and losses associated with it such as poverty, isolation, discrimination, and unemployment. However, recovery does not indicate that individual will return to full health or acquire all their losses, rather it indicate that these individuals can live well within the society despite their disability (Mental Health Commission, 1998).

Te Tahuhu: Improving Mental Health 2005-2015: The Second National Mental Health and Addiction Plan have outlined the strategic direction for Mental Health and addiction services which are based on recovery-oriented principles and concepts. This provides the Government policy and priorities for Mental Health and Addiction  (Ministry of Health, 2005).  It also identifies ten challenges that must be overcome for the health and addiction sector to develop and thrive (Ministry of Health, 2005).  The challenges identified by Te Tahuhu: Improving Mental Health 2005-2015: The Second National Mental Health and Addiction Plan are also supported by Te Kokiri: The Mental Health and Addiction Action Plan 2006-2015 which identify the specific actions to be implemented by the year 2015 (Ministry of Health, 2006). Actions developed by this document include strengthening the links between primary health care and services, developing inter-sectorial activities supporting recovery, and implementation of initiatives that identify the importance of whanau/families (Ministry of Health, 2006).

The ministry of health commission document titled Te Hononga 2015: connecting for greater wellbeing, provides a picture of what the society might look like by the year 2015 if challenges identified in Te Tahuhu and actions provided in Te Kokiri are implemented (Mental Health Commision, 2007). That is, the commission’s document supports the strategy laid out by the government on mental health. This document also provides all the districts health boards within the country with a cohesive vision for the mental health sector. 

In short, Te Hononga assures the nation how the society might look like based on social inclusion and wellbeing. In such a society, services, systems, service users, whanau/families, and communities will experience greater levels of connectedness (Mental Health Commision, 2007). Individuals experiencing mental disorders will feel supported by health specialist and other people while working together to assist in their recovery.

Anyone experiencing a mental disorder should be treated equally to others as he/she is more important than the diagnosis. These individuals and their whanau/families will understand that critical emergency care can be provided if required, and they will have an alternative of responsive, high quality, community based services when required. Through this, individuals experiencing mental disorders will be in a position to obtain jobs, study, acquire decent housing, as well as participating fully in the society without fear of stigma or discrimination (Mental Health Commision, 2007). Families with people experiencing mental illness will be supported and they are also expected to be supporting their family members who are experiencing distress. When all this is achieved people will be in a position to live a lively, hope filled lives. 

Te Hononga documentidentifies mental health as the basis that helps people to function efficiently in their deeds, which enable us to value each other in the society despite our differences. Mentally healthy people should devise ways of recognising some signs that might indicate that someone might possibly be suffering from a mentally disorder. For instance, people who are mentally healthy are not likely take time off work or school, have impaired psychosocial functioning or high health needs etc. mentally healthy individuals understand what they need from life, learn from adversity, and fell close and connected with their families and friends.

In favor of children and young individuals to grow and develop beyond the misfortune of mental illness, achieve their full potential and preside over a meaningful life, it is crucial that a mental health service is based on recovery values and concepts; person orientation, self-determination, person involvement and choice (Farkas et al., 2005).

Person involvement is said to occur when consumers are engaged as a participant in planning, designing, evaluating and implementing their facilities (Farkas et al., 2005). Person orientation recognizes the individual, their strengths, personality, limitations and talents (Farkas et al., 2005). The main focus of growth potential is hope, the capacity for recovery and growth for a child or young person (Farkas et al., 2005). Self-determination promotes choice and working in partnership as opposed to coercion (Farkas et al, 2005).

This clinical audit presents a comparison of the reception facilities against the recovery-oriented principles and concepts of person orientation, person involvement, self-determination and growth potential.

Overview of the reception facilities:

Tamaki Oranga Recovery Centre is located in South of Auckland, next to the Auckland Spinal Rehabilitation Unit. The facility assists in rehabilitation of men experiencing severe mental illness. It provides a 20 bed inpatient rehabilitation unit. The front entrance has a double glass door that requires a swipe card to get in and out of the unit. Once you enter through the front entrance, the reception area is right in front of you. There are three 3 doors on the right hand side of the reception area. Each door is labeled to the health professional who occupy those rooms. One room is shared by a social worker and a doctor, the other one is occupied by a psychologist and the last one is allocated to the team manager.

The reception area has a large square old mercury lighting fittings, pale pink vinyl floor, and all doors are blue colored. The walls in the whole rehabilitation unit are painted with pale grey paint. The blue doors have an old style locks at the bottom though its use is unnecessary because there is a simple modern lock system which is located at a different height of the door (middle of the door). Few paintings are done on the walls but they are too old and dull. 

The color of the furniture in the outside sitting area is blue (blue and black seem to be the preference colors in the unit). An old safe which was obtained from King Seat Hospital is still present in the waiting area and it is not in use. Flyers are hanged on the walls and are not properly placed or organized.

All visitors, service users and whanau are not allowed to smoke when they are within the rehabilitation unit as one way of striving to promote an environment that support wellness and recovery in all aspects of care. They can hold on to their smoking items and smoke at a distance outside the rehabilitation unit. 

2: Audit Criteria

  1. Are consumers engaged as a participant in the planning, development and evaluation of the rehabilitation unit?
  2. Does the rehabilitation unit encourage self-determination and choice?
  3. Are the facilities in the rehabilitation unit fully inclusive, person oriented and not disgraceful?
  4. Does the rehabilitation unit reflect capacity for recovery, hope and growth?

3: Observe Practice

Information was obtained from:

  1. Nurses
  2. Consumers
  3. Receptionist
  4. Social Workers
  5. Observation


Method of collecting information used was Verbal communication with the staff and mental health consumers in the unit.

4: Compare Facilities to Criteria

Criteria 1:


The reception area is committed to involvements that support the health and wellbeing of the consumers. All visitors, service users and whanau are not allowed to smoke when they are within the rehabilitation unit as one way of striving to promote an environment that support wellness and recovery in all aspects of care. They can hold on to their smoking items and smoke at a distance outside the rehabilitation unit. The rehabilitation unit is also offering nicotine replacement therapy to the consumers who identify themselves as smokers. This indicates that the reception facility is involving consumers in the development of a nicotine replacement therapy by not allowing them to smoke when they are in the Rehabilitation Centre. There a number of researches which indicate that when consumers are involved in designing their own facilities, involvement and outcomes are better (Balcazar, Keys, Davis, Lardon & Jones, 2005; Majumder, Walls & Fullmer, 1998; McKenzie, Norrish, Parker & Frampton, 2009).

Feedback form pamphlets are also available at the reception for feedback and complaints. These forms are cleared by independent staff from Middlemore Hospital. This indicates that consumers are involved in the care they receive and if they are not happy with the standard of treatment and care they receive, they are free to raise this issue. Each client at Tamaka Oranga Recovery Centre is supported and assisted in an individual plan of recovery. The goals are always based on individual needs in consultation with individual clients (Counties Manukau District Health Board, 2010). There are different levels of consumer participation which ensures that services offered to the consumers are responsive to the needs of individuals. Examples of different levels of consumer participation include the service or unit level, the treatment and care level, and the organization level (Mental Health Commission, 2002). 


Although consumers are allowed to participate in some sections as we have seen above, consumer participation is not fully incorporated into the Tamaka Oranga mental health system. According to Mental Health Commission (2002), consumer participation requires “positive attitude and behavior towards consumers that acknowledges their right to participate”. Consumer participation should be put into consideration in all Mental Health facilities since it empowers both the individuals and the organization involved (Ministry of Health, 1995). According to my observation, feedback forms are given at the initial stage of entering the service but are not promoted to be used to improve service delivery to the clients.  Tamaka Oranga Recovery Centre staffs to support the use of feedback forms to critique or criticize their services. If the staffs can involve consumers in analyzing their services, I believe their responses can help them a lot in improving their services. This is a clear indication that consumers are not involved in planning, developing or evaluating the reception facilities. According to the information obtained from one of the health professionals, feedback form pamphlets are not actively used; probably the consumers are unaware of its existence or its purpose. Consumers should be involved in the planning, evaluation and implementation at every level of the mental health service in order to ensure that services are responsive to the needs of individuals (Gawith & Abrams, 2006). 

Criteria 2:


There are flyers hanged on the walls at the reception area where one of them contains "The Code of Health & Disability Services Consumers' Rights". The consumer rights which are highlighted by this flyer include: privacy and respect, confidentiality, fair treatment, acceptance of your practices and beliefs, dignity and independence, information allowing someone to make choices about the treatment they receive, a right to have your questions being answered, choice about participation in research and teaching, your complaints should be taken seriously (Counties Manukau District Health Board, 2010). There is a notice board in the reception area with poster of support services and a feedback form pamphlet sample.  Support services to be provided to the consumers should also include practical assistance as well as support for philosophical reflection (Mental Health Commission, 2004).


Services offered at Tamanga Oranga Recovery Centre do not provide an optimal range of choices. Complementary and alternative treatments should be made available within the rehabilitation unit. According to Mental Health Commission (2004), services offered in a rehabilitation unit should give priority to offering an optimum range of choices.  Some choices which should be available in the rehabilitation unit include community, hospital or home based acute services (Mental Health Commission, 2004).

Tamanga Oranga Rehabilitation Centre is only offering hospital based acute services, therefore, limiting consumer’s choices. It is recommended that this Rehabilitation Centre to start offering all the services so that consumers can have a wide range of options. Having limited choices is denying people to make their choices. Denying individuals an opportunity to make their choices results in harming them (Deegan, 2002). Consumer choices should be valued because they are the corner stone of the empowerment process (Deegan, 2002). When consumers are able to make their personal choices from a range of options, there is a possibility that their choices will improve their lives in one way or another. Another aspect of valuing consumer choices is that it helps the direct service workers do their jobs easily. That is, consumer choices shape and drive their jobs since their job is to support the consumers in achieving their goals (Deegan, 2002).

The reception facilities do not reflect self-determination because information about services and treatment is not available. One of the consumers suggested that information about the services offered in the rehabilitation unit should be readily available in the flyers or notice boards. However, this is not the case in Tamaka Oranga. Information about medication information is not easily available. Consumers need to enquire with the doctor or health professional for information to get medication information. Effective Rehabilitation Centre Mental Health Services use their resources and facilities to educate their consumers and whaanau (Leather, Beale, Santos, Watts & Lee, 2003; Mroczek, Mikitarian, Viera & Rotarius, 2005). A recovery-focused facility enforces right 6 and 7 of The Code of Health and Disability Services Consumers’ Rights and ensures that service-users are fully informed, able to make informed choices and give informed consent (Health and Disability Commissioner, 1996). This includes explanations about conditions, available options, assessment of risks, side effects, benefits, costs, estimated time frames, results of tests and procedures, recommendations, the right to honest and accurate answers to questions about the identity and qualifications of staff and how to obtain a second opinion (Health and Disability Commissioner, 1996). Age appropriate information should be available that informs service-users about the service, confidentiality, rights, mental health conditions and behavioral issues, treatments, medications and what the staff do; occupational therapists, social-workers, nurses, doctors, psychologists.

According to one of the health professionals “Environment itself cannot promote best outcome of recovery unless we the workers look at duty of care. Duty of care is looking at the best possible outcome for the client.  We are an MDT (nurses, social workers, OT, psychologist, psychiatrist) and we should be doing our best (with help of each professional) for the consumer”.

Criteria 3:


Recovery-focused environments create a pleasant, respectful and welcoming first impression where the consumers and their whaanau experiences a service that is person-orientated, fully inclusive and not disgraceful (Slade, 2009). To be fully inclusive the facilities at the service need to represent and reflect the ethnic population it serves (…District Health Board, 2011). According to one of the health professional, elimination of seclusion rooms at Tamaka Oranga has been a significant project. Offering alternatives to seclusion and improvement of the environment have had a positive effect. This project ensured that, the reception facilities are not causing disgraceful to consumers or rather stigmatizing the consumers.  

The reception area has an institution feel to it. This is right through the unit because of the choice of colors used (paint, door color, vinyl floors). It has gotten better than before because of items such as flower being placed in the reception area (only in reception area), and some painting. Tamaki Oranga is more of a house rather than a hospital even. The receptionist has a uniform but has arrangement with management to wear casual uniform. This is to normalize the environment as much as possible.    


Information obtained from one of the health professionals indicates that the carpet was recently replaced, but it is now dark and dull in color creating a physical environment that is not conducive. The mercury lighting fitting should be replaced with small lights in order to create a homely environment. Doors and walls in the reception area are fitted with similar colors; changes should be made so that they can be painted with contrasting colors that will look more appealing to the eyes.

Two of the consumers told me that they would be comfortable while waiting in the reception area if the sofas had cushions. I also spoke to a health professional to understand what happened to the sofas cushions and I received a response that there were cushions on those sofas, but they either disappeared or were wore out.  Consumers would like cushions in the main unit lounge area in the sofa.

The consumers also complained that there is only one form of game (pool table), they would be more satisfied if there are more games around the unit such as board games. Since they would like the unit to be more like a home to them, they also recommended that they should be vases and fresh flowers around the unit. The two consumers were also not satisfied with the sofa since it looked more of a lounge but not an ordinary sofa. It is a very hard plastic form of sofa that needs to be replaced. A health professional in the rehabilitation unit suggested that a gentle music could be playing at the background because it can assists in relieving mental stress of some service users.  

Some consumers suggested that vinyl corridors and rooms floors around the wings should be changed to carpet citing a reason that even though vinyl is easier to clean it is normally cold as compared to carpet. Consumers also recommended some changes in the toilets. The current ones are the old types which consumers are not used to, they prefer to use the modern type toilets and that is the reason why they are recommending some changes.  Outside the reception area there is a filing cabinet next to the unit entrance door. This cabinet is used to store medical records, but this is not the right place to store such crucial information. Some consumers also suggest that there should be some cool music playing in the reception area.

Although most consumers seem not to be satisfied with the reception facilities within Tamaka Oranga Rehabilitation Centre, it would be advisable to provide consumer oriented features rather than redesigning facilities to accommodate separate waiting areas to meet the preferences of different individuals who receives services from this unit. According to Tivorsak et al. (2004), providing consumer oriented services is more effective than redesigning the facilities to accommodate different consumer preferences.

Criteria 4:


According to consumers hope, recovery and growth is vital for healing and establishing a new sense of purpose (Jacobson & Curtis, 2000). It is widely acknowledged that art stimulates an emotional response that is therapeutic and healing. Representational nature art is hanging on the reception walls, the corridor and in other general rooms.


According to Mary O’Hagan an international leader on the recovery approach and the New Zealand Mental Health Commissioner from 2005 to 2007 ( Te Pou, 2007), a recovery-focused Mental Health facility needs to be in a natural and safe environment to promote hope, recovery and growth (O'Hagan, 2007).

The movement in environmental health care design stems from research showing that healing environments in health settings can reduce stress, increase satisfaction, improve mood and promote recovery (Leather, Beale, Santos, Watts & Lee, 2003; Mroczek, Mikitarian, Viera & Rotarius, 2005) Extensive research shows environmental colors and emotional associations can facilitate recovery and growth however color preferences vary amongst individuals which leads overseas researchers to believe that culture and context is a major influence in preferences (Park, 2009).

Research shows that service-users and whaanau that identify with others experiences of Mental Health through recovery narratives can be a powerful contributor to the recovery process, normalizing past and present experiences, de-stigmatizing Mental Health, instilling hope and promoting growth (Schon, 2010).

When service-users and their whaanau identify with other service-users and peers as positive role models this helps develop emotional insight, encourages hope, helps individuals with mental ilness to acknowledge their ability to cope, take control of their life, develop a sense of self-worth and live well in the presence or absence of their mental illness despite difficulties (Schon, 2008).

5: Key Recommendations

  • Change the color of the furniture
  • Paint the walls using a different color
  • Paint the doors using a different color
  • Inform service-users about the feedback form pamphlet when arriving at reception
  • Vinyl should be replaced with a carpet
  • Provide appropriate games in the reception area
  • Change lighting fittings from mercury to small round lights. Mercury is cheaper but it represents hospital like atmosphere
  • Remove safe from the corner.
  • Have a notice board for flyers.


An effective mental health systems use a psycho-environmental approach to reflect the values and principles of its services such as person involvement, person orientation, growth potential and self-determination. Facilities that are person centered, inclusive, cultural and holistic may remove barriers that prevent people engaging in mental health services. Reforming the facilities at the service provides an opportunity to connect with the whaanau, children and young people of the district and to reflect the major shift in mental health services and facilities towards holistic health, wellbeing and a culture of recovery and wellness, that is provided by a workforce that delivers evidence based practice effectively at the interface between cultural and clinical practice services.

Recovery can only be said to be happening when individuals are living well in the absence or presence of their mental illness and losses associated with it such as poverty, isolation, discrimination, and unemployment. However, recovery does not indicate that individual will return to full health or acquire all their losses, rather it indicate that these individuals can live well within the society despite their disability (Mental Health Commission, 1998).

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