Promoting Recovery in Mental Health - Essay Example

?Introduction We, the humans are group animals who feel at home only in the company of our relatives and peers. It is in this context that, social inclusion can play a great role in assisting recovery from mental illness. The traditional way in which we have treated mentally disabled persons was to isolate them and see them as lesser human beings. The fear of the unknown had ruled the emotions towards people who behaved differently. The stigma associated with mental illnesses arose from this same fear. But even in the civilized society, this stigma has remained more or less the same. On the other hand, the study of human psychology has academically advanced beyond treating mental illnesses as simply clinical cases which need medication and partial or full isolation from the society. The concept of psychiatric rehabilitation was introduced in mid-1970s and the concept slowly evolved to absorb more fresh air and democracy through the next decades (Pratt, Gill and Barret, 2007, p.13 of the preface). A more recent development that happened to this concept has been the notion of psychiatric recovery, which evolved in late 1980s (Deegan, 1988). Pratt, Gill and Barret (2007, p.111) have expressed the essence of this concept by saying, “the idea of recovery represents optimism about the future.” Recovery model in psychiatric treatment has been the product of the brave research work undertaken by persons who had walked through the dark alleys of mental illness, and had come out of them with a new spirit of freedom and self-determination (for e.g., Anonymous, 1989; Ralph, 2004; Unzicker, 1989; Deegan, 1988). It was based on the models of “recovery from physically handicapping conditions, a number of researchers and scholars have helped to develop a concept of recovery for severe mental illness” (Pratt, Gill and Barret, 2007, p.111). Further refining this concept, the idea that “psychiatrically disabled adults do not “get rehabilitated” but rather they recover a new and valued sense of self and of purpose,” was developed by Deegan (1988, p.11). Two major aspects of the recovery concept have been the idea of “lived experience” and the “consumer/survivor/ex-patient movement” ( Davidson, Rakfeldt and Strauss, 2010, p.214). Here, the mentally ill person is assisted to take command of his/her own situation and he/she is no more totally at the mercy of others, whether they be psychiatric professionals, friends, relatives or institutions. This is the first step towards accepting a mentally ill person as a person having equal rights with a ‘normal’ person. And this is where the recovery concept of social inclusion comes in as the most important factor. Brown (1981), Chamberlin (1984), Jacobson and Curtis (2000), and Everett (1994) have been the major theoreticians who had developed the concept of recovery into a practical psychiatric practice. The basic tenet, to which this concept owes its emergence, is the idea that human interaction, love and mutual understanding are the core values of existence. In curing a mental illness of a person, his/her friends, family, neighborhood, community and the society have a responsibility to share (Ramon, Healy and Renouf, 2007). Deegan (1988) has drawn attention to the fact that the notion of recovery from mental illness is now a twofold intervention where, the patient has to take up one’s own responsibility and all the same, professional help is available for him/her to further the recovery. In particular, customer involvement has been the most important segment of the concept of recovery. This customer-first theory was an outcome of an era when mentally ill patients were victims of superstition and where they were deprived even of the basic human rights (Jacobson and Curtis, 2000). Out of this bleak situation, the mentally disabled persons gradually learned to raise their voice and to initiate a social movement (Jacobson and Curtis, 2000). The collaboration approach is also part of the recovery model. The scope of this concept includes, “education, consumer and family involvement, support for consumer-operated services, emphasis on relapse prevention and management, incorporation of crisis planning and advance directives, innovations in contracting and financing mechanisms, definition and measurement of outcomes, review and revision of key policies, and stigma reduction initiatives” (Jacobson and Curtis, 2000). The social and community support in recovery is the common factor for almost all these key elements (Anonymous, 1989). A combination of cognitive and psycho-social interventions for the recovery model has been largely based on small group interpersonal trainings (Halligan and Wade, p.57). Values and user perspectives including hope, motivation, self confidence, and group achievement have to be instilled in the minds of the disabled persons, if the recovery model has to be successful (Deegan, 1988). Evidence based practices such as decisions based on reduction of symptoms, constant compliance of medicine usage, and the level to which the disabled person is able to identify with the community, have to be adopted ((Ahern and Fisher, 2001; Mosher, 1999). The recovery concept which was popularized in UK by Coleman (1999) was incorporated in 2005 into the mental illness treatment system by National Institute for Mental Health (NIMHE, 2005). Walker and Avant (1995) model is employed in this analysis to prepare a plan for the recovery of mentally ill persons through the concept of social inclusion. This model has the following steps in its application: 1. Select the concept 2. Determine the purpose of the analysis. 3. Identify all the uses of the analysis. 4. Define the attributes, 5. Constructing a model case, and additional borderline, related, contrary, invented and illegitimate, cases. 6. Identify the antecedents and consequences 7. Define empirical references. (Walker and Avant, 1995, p.37) Concept Analysis: Social Inclusion Selecting and defining the concept: social inclusion Social inclusion is selected as the key concept for recovery because of the evidences that have come out of such approaches. Repper and Perkins (2003, p.29) have pointed out that “those diagnosed with a significant mental illness are amongst the most excluded in society.” It is in this backdrop that these researchers and others have suggested, social inclusion should include, “fostering the hope that is necessary if people are to move beyond mere survival and to thrive, and enabling people to access those activities and relationships that give their lives meaning” (Repper and Perkins, 2003, p.9 of the preface). Purpose of the analysis This analysis is done to understand the role of social inclusion in recovery from mental illnesses. This is also to help the patient to regain self confidence, to go about leading a normal and happy life and to carry out all social responsibilities in an expected manner. Yet another purpose is to help mental health professionals to develop tools and methods to use the concept of social inclusion in treatment of mental illnesses. Defining attributes Defining attributes are the characteristics of social inclusion which surface again and again and consistently in the cases that are studied (Walker and Avant, 1995). The examples in the existing literature have shown that the major attributes are a sense of belonging, better bonding and community level participation. Different usages of social inclusion and the different meanings that this concept acquires in different contexts have become evident from these examples (Ahern and Fisher, 2001; Anonymous, 1989; Deegan, 1988). A model case There was a woman who had come to me for treatment with a problem of seeing non-existing people and talking to them. She knew that she had a problem but she was not able to stop responding to the people she sees and the voices that she hears. I decided to Treat her based on a recovery model in which I will focus on the element of social inclusion. The client was 28 years of age. She was married and was a mother of a 5-year old child. Her husband and parents were very much worried about her situation. The problem had started when she was left alone most of the time in a lonely house after her husband got transferred to a remote town ship. There were rumors in their new neighborhood that there was some supernatural phenomenon in the house that they lived. When she also started behaving differently, the belief strengthened. But the positive thing about this woman was that she was very open to treatment and she was ready to take responsibility of her situation. First of all I told that I believed her and that her experiences were real as far as she and me were concerned. Thus I could make her trust me. Then I organized group sit in sessions in that house at nights in the form of merry gatherings with five of her women friends and two neighboring women who were willing to cooperate. This group discussed the stories that had been spread regarding the house and they examined the visions and sounds experienced by the patient as well. The patient also narrated each and every vision and sound that she had been hearing. Every member of this group was encouraged to take the stories very lightly and elicit some funny things out of them. When these sessions were repeated a number of times in a time span of two months, a gradual change in my patient became visible. She was regaining her confidence and she could approach her problem with less apprehensions. Also the neighboring women helped her to mingle with the people in her neighborhood and they also developed a warm attitude towards. After six months, my patient was still hearing voices and having visions but she was in control of her spontaneous responses to them. She knew how to live with them and behave normally. But I could not cure her completely. I could only help her to cope with the idea that she is different through social support and inclusion. It was through the Care Programme Approach (CPA) that I could find the local support and funds for carrying out the whole process of the socially inclusive treatment. Care Programme Approach is the “policy framework” and the network of trusts who work in mental health area combined to assist processes through which patients are treated in UK (Thornicroft, 2001, p.159). Additional cases: Borderline, related, contrary, invented and illegitimate I had to deal with another case where the patient had no visible problems but her family members including her children were complaining that she was very indifferent to them. They said that it was as if she lived in a very detached world of her own. This was a borderline case in which she was showing this slightly deviant behavior from her childhood itself. As a child she was separated from her mother at the age of 2 years because of her mother’s death and she had lived with a distant relative. This might have been the reason for her inability to make connections with others. In this case social inclusion therapy was not much successful because she was very reluctant to mingle with people. Another related case was that of a 40 year old man who was a severe alcoholic and was withdrawn totally from social life. There was this contrary case as well, in which the patient was a 12 year old boy who ran away from his home many times and liked to spend his life in the street with antisocial gangs. An example for an invented case also had come to me. A 35 year old woman had come to me telling me that she has been under treatment for schizophrenic behavior for the last 4 years. But after two, three sessions with her, I could find out that she was trying to emotionally blackmail her divorced husband and elicit money from him by pretending that she had a problem. Antecedents of social inclusion The antecedents of social inclusion are the willingness of the community to help the patient, the existence of real love among the members of the family and at least some degree of comprehension of one’s own problem on the side of the patient. A common understanding among the community that is involved that the recovery process is going to be a long drawn one, and total cure is impossible, in another important antecedent. Consequences of social inclusion Social inclusion can work miracles in the recovery process. This has been proven beyond doubt from the real life experiences narrated by many patients and psychiatrists (Anonymous, 1989). A beautiful aspect of social inclusion is that the community gets prepared to accept that people are different and have different degree of mental capabilities. This will in the long run enhance tolerance levels inside a society and will strengthen social ties. Wellness Recovery Action Plan –Self prepared checklist for the patient 1. How do I define wellness 2. In what mental state do I feel that I am well 3. How can I sustain wellness 4. From what symptoms can I know that I am loosing my wellness 5. Which factors trigger loss of wellness for me. 6. Usually how do I react to them 7. To what extreme can my loss of wellness escalate 8. How can I keep myself cool in the presence of the triggers 9. Which are the initial signs that I am not being able to cope with my problems myself 10. Who are the people who can help me in such a situation 11. At what condition should I take medicines 12. Which medications do I need 13. Being in which group can help me to recover easily from my mental disturbance 14. What kind of social and community level activities do I need to participate in to speed up my recovery 15. Which of these have been the most effective References Ahern L and Fisher, D.B 2001, 'Recovery at your own PACE (Personal Assistance in Community Existence)', Journal of Psychosocial Nursing, 24:22-32, 2001 Ahern, L and Fisher, D.B 2002, 'Evidence-based practices and recovery', Psychiatric Services, 53: 632-633. Anonymous 1989, 'How I've managed chronic mental illness', Schizophrenia Bulletin,15,635- 640. Brown, P 1981, ‘The Mental Patient’s Rights Movement and Mental Health Institutional Change’, International Journal of Health Service, 11(4): 523-540. Chamberlin, J. 1984, ‘Speaking for Ourselves: An Overview of the Ex-Psychiatric Inmates’Movement’, Psychosocial Rehabilitation Journal, 8(2): 56-63. Coleman, R 2004, Recovery: an alien concept, P & P Press, Illinois. Davidson, L., Rakfeldt J. and Strauss, J. 2010, The roots of the recovery movement in psychiatry: lessons learned, New Jersey: John Wiley and Sons. Deegan, PE 1988, 'Recovery: the lived experience of rehabilitation', Psychosocial Rehabilitation Journal 11 (4). Everett, C.A. 1994, ‘The Economics of Divorce: The Effects on Parents and Children’, London: Routledge. Halligan P.W. and Wade, D.T. 2005, ‘The effectiveness of rehabilitation for cognitive deficits’, Oxford: Oxford University Press. Jacobson, N and Curtis, L 2000, 'Recovery as policy in mental health services: strategies emerging from the states', Psychosocial Rehabilitation Journal, Vol.23, No.4, 333-341. Mosher, L 1999, Soteria House and other alternatives to acute psychiatric hospitalization. Journal of Nervous and Mental Disease 187:142-147. NIMHE 2005, Guiding statement on recovery, National Institute for Mental Health in England, London. Pratt, C.W., Gill, K.J. and Barret, N.M. 2007, Psychiatric rehabilitation, Massachusetts: Academic Press. Ralph,R 2000, 'Recovery: psychiatric rehabilitation skills', 4,480-517. Ramon S, Healy B, Renouf N March 2007, Recovery from mental illness as an emergent concept and practice in Australia and the UK, Int J Soc Psychiatry 53 (2): 108–22. Repper, J. and Perkins, R 2003, Social Inclusion and Recovery: A Model for Mental Health Practice, Philadelphia: Elsevier Helath Sciences. Thornicroft, G 2001, Measuring Mental Health Needs, London: RCPsych Publications. Unzicker, R 1989, 'On my own: a personal journey through madness & re-emergence', Psychosocial Rehabilitation Journal, 13(1),71-77. Walker, L.O and Avant, K.C 1995, ‘Strategies for Theory Construction in Nursing’, Norwalk, CT: Appleton and Lange. Read More