Posted by: ayrshirehealth | March 13, 2013

The relevance of resilience in healthcare by @ang_rowe

The relevance of resilience in healthcare

“Life’s a bitch and then you die”. Whilst I don’t generally subscribe to this pessimistic view of life, I have it heard it said on more than a few occasions by different people. Having been a Children’s Hearing(1) member for more than 20 years, I do believe that some people have more than their fair share of adversity and challenges in life – if there’s such a concept as ‘fair share’ of adversity.

deprivationOver the years, many of the children and families I’ve seen have been blighted by poverty and catastrophic life events. Many living in damp housing in not so desirable neighbourhoods where there are high levels of anti-social behaviour, and drug and alcohol misuse.

Many of the children and young people have been witness to domestic violence, subject to sexual abuse, sometimes physical abuse and very often, physical and emotional neglect.

It is always very sad to remove a child from their birth parents but in some instances it is vital for their safety, wellbeing and development. What always amazes me though is the number of children who live in these dreadful circumstances and grow and develop in spite of these adversities. The young person who is living with a drug misusing parent, who doesn’t wake them for school in the morning, shows little interest in their education and yet, despite this, the young person is achieving academically, has developed good relationships with peers and teachers at school, and by all accounts, seems to be doing well. What’s different about these young people?

What makes them more resilient?

What is resilience?

Resilience is a dynamic process whereby individuals exhibit positive behavioural adaptation when they encounter significant adversity, trauma or significant sources of stress (2). Essentially, they thrive or succeed when you don’t expect them to.

What forms the foundation of resilience?

The first tranche of research on resilience focused mainly on individuals and the strengths and skills they possessed to overcome adversity. Anthony described this as the “invulnerable child (3)”.  Newer theories focus on individuals, but also the social determinants of health and systems more broadly.

Research has shown that relationships form the foundation of resilience and that these relationships are set in the broader context of family, peers, schools, community, social networks and policy.


Personal skills, experiences and upbringing are essential to our resilience but these are intertwined with the resilience of the communities in which we live and the economic circumstances we face.

Resilience develops as people grow, gain knowledge and insight, and develop self-management skills.

The American Sociologist Antonovsky and other researchers have recognised that not all people facing similar circumstances have the same outcomes (4). The salutogenic model focuses on the capacities and resources that people have which positively impact on their health and wellbeing.  The approach describes how some people have a ‘sense of coherence’; that is they have the ability to understand their situation, have reasons to improve their health, and have the power and resources to cope with stress and adversity.

What relevance does this have to healthcare?

There is evidence to show that individuals with good social relationships and support networks have less cognitive decline with ageing, show greater resistance to infectious diseases and a better prognosis when facing chronic and life-threatening illnesses, and also live longer (5).

Self managementGood relationships, a sense of belonging and community participation are all linked to good health. For some people these relationships don’t exist and research suggests that these are key for overcoming adversity and for general wellbeing. As a result, individuals can feel disempowered, unable to effect change and become reliant on services.

I was talking to a psychiatrist recently about the challenge of measuring outcomes and how he could confidently say he was making a difference, especially in instances where people had been engaged with services for a number of years (we were talking over 10 years).

He said that he had just introduced the use of mood rating scales and asked people who had seen him to complete one following a consultation. From the people he asked, he noted that their mood generally improved following a consultation. Now I know that after meeting up with a good friend my mood is generally lifted. So I wondered what the difference was? That is not to undermine the valuable job psychiatrists do, but I wonder whether we need to be better at distinguishing when statutory services are necessary and when other types of support might be more suitable?

How do we build these structures and support networks?

The Christie report (6) in 2011 reinforced the need for new ways of working in the public sector. Christie felt that a key objective of public service reforms should ensure that “public services are built around people and communities, their needs, aspirations, capacities and skills, and work to build up their autonomy and resilience”.

Qualities of resilience can very often go unacknowledged – we need to build on the assets already present within communities (7). The public sector must be better at mobilising and working alongside the support networks at a local level.

Routinely gathering robust evidence to show that we are making a difference is vital. As it stands, we probably have too many examples of the “So, what?” question about the impact of public services on their intended beneficiaries.

Life is never going to be a bed of roses (or whatever analogy you would choose to describe it), but if we can build on existing assets within individuals and communities to reinforce resilience, it can be less of a bitch.

This weeks ayrshirehealth blog was by @ang_rowe (Angela Rowe) is a Quality Lead Facilitator who works in the Quality, Governance and Standards Unit in NHS Ayrshire & Arran

Next week @simonSRN Director of Scottish Recovery Network is guest writer in his first blog for ayrshirehealth


1. Children’s Hearings are part of the legal and welfare systems in Scotland. On 15 April 1971, Children’s Hearings took over from courts most of the responsibility for dealing with children and young people who commit offences or who are in need of care and protection. A Children’s Hearing is a lay tribunal of three members which considers and makes decisions on the welfare of the child or young person taking into account all the circumstances.
2. Luthar, Suniya S; Cicchetti, Dante; Becker, Bronwyn (2000). The Construct of Resilience: A Critical Evaluation and Guidelines for Future Work. Child Development 71 (3): 543-562.
3. Anthony, E.J. (1987). Risk, Vulnerability, and Resilience: An Overview. In E.J. Anthony & B.J. Cohler (Eds.), The Invulnerable Child (pp.3-48). New York: Guildford Press.
4. Antonovsky, A. Unraveling The Mystery of Health – How People Manage Stress and Stay Well, San Francisco: Jossey-Bass Publishers, 1987.
5. Cohen & Janicki-Deverts D. Can we improve our physical health by altering our social networks? Perspectives in Psychological Science 2009;4:375-378.
6. Christie C. Commission on the Future Delivery of Public Services. APS Group Scotland; 2011.
7. Asset Based Approaches for Health Improvement: Redressing the Balance. Briefing Paper 9. Glasgow Centre for Population Health. October 2011.


  1. Great piece Angela, which will resonate for those who have been working with people from a strengths based perspective. The levels of resilience and courage demonstrated by people who have endured the most appalling abuse and trauma is both astonishing and humbling. Oddly enough assessments do not yet universally routinely seek to capture the range of strengths, skills and resources that individuals posses, which is most curious given that their future capacity to flourish will be built on the very resilience that has carried them through life’s difficulties so far. Perhaps as a society we don’t yet have a full vocabulary for the strengths that underpin resilience thus ensuring that these factors are frequently overlooked even though they are hiding in plain sight.

    • Thanks John. As you say, I’m always humbled too at the strength many people display in terrible circumstances. Absolutely agree that we’re not yet assessing the full range of skills and resources that people have at their disposal which have got them through life so far. The solutions we find ourselves, with some help at times, are so much more

  2. […] The relevance of resilience in healthcare by Angela Rowe on the Ayrshire Health blog. […]

  3. […] also her first time on Weekly Blog Club. Her very thought-provoking post tackled a tough topic. In The relevance of resilience in healthcare, she considered how some remarkable children and young people manage to get through very […]

  4. […] Ayrshirehealth blog, this time by @ang_rowe as it also focused on children and young people.  The relevance of resilience in healthcare considers the importance of resilience in young people and how relationships (family, peers, […]

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