Promoting recovery in mental health - Essay Example

Introduction In the process of recovery from a state of mental disability, motivation can play a key role. The beauty of the concept, motivation, is that it comes from supportive relationships as well as from one's inner resources as well. Before going into the multi-faceted aspects of the concept, motivation, and its applications in the process of recovery, the theoretical premises of recovery need to be understood well. One unique feature associated with the concept of recovery has been that this concept was mainly developed by people who had one or other mental illness and had survived that. Anonymous (1989), Deegan (1988), McDermott (1990), Ralph (2000; 2004) and Unzicker (1989) had been theoreticians to name a few, who had such a 'lived experience'. For example, Deegan (1988, p.11) has been very careful to posit 'recovery' in opposition to the concept of rehabilitation and he opined that “psychiatrically disabled adults do not “get rehabilitated” but rather they recover a new and valued sense of self and of purpose.” It was in the last two decades of twentieth century that the concept of recovery evolved from consumer/survivor/ex-patient movement (Office of the Surgeon General and various United States Government agencies, 1999). The consumer/survivor/ex-patient movement has been described by Jacobson and Curtis (2000) as a “grass-roots, self-help and advocacy initiative with overtly political goals” who had summed up this definition from Brown (1981), Chamberlin (1984; 1990) and Everett (1994). The concept of recovery thus stemmed from the idea of psychiatric rehabilitation which envisaged the process of recovery as inclusive of friends, relatives, community and the society as a whole (Ramon, Healy and Renouf, 2007). The most revolutionary part of this concept has been that the ownership and reliability of the recovery concept rested with the consumer at the primary level while at the same time growing as a comprehensive professional approach to mental health (Deegan, 1988). Engagement of the consumer Active engagement from the side of the consumer has been the key part of the concept of recovery. Deegan (1988, p.11) has defined recovery as a “lived or real life experience of persons as they accept and overcome the challenge of the disability.” According to Deegan (1988, p.12), recovery is a process which helps “the disabled persons... [to]... become active and courageous participants in their own rehabilitation project.” It was the lack of civil and human rights for mentally disabled and ill persons, that prompted this kind of a customer-based approach (Jacobson and Curtis, 2000). It was an activist movement which wanted to replace the professionals with the consumer as the pivotal point of recovery and giving the ultimate role to the community in the process of recovery (Jacobson and Curtis, 2000). Collaboration The recovery model views the development of functional abilities as a “product of interactions between the individual and the environment” (Anthony, Cohen and Fracas, 1990). Here, recovery is viewed as a “path, rather than a destination” and it is understood as a unique path for each individual (Jacobson and Curtis, 2000). Jacobson and Curtis (2000) have also stressed the role of collaberation in this process when they said, “in contrast to the passivity of being a patient or a voiceless recipient of services, recovery is active and requires that an individual take personal responsibility for his or her own recovery, often in collaboration with friends, family, supporters, and professionals.” The first person accounts in this regard have also been appreciative of the role of social and community support in recovery and have cited both positive and negative examples (Anonymous, 1989). Cognitive and psychosocial interventions The foundation for the incorporation of the concept of recovery into the realm of mental health has to be put in place by the respective state governments by way of relevant policy framework (Jacobson and Curtis, 2000). More importantly, the whole conceptual framework needs to be redesigned based on such policies rather than renaming the existing policies (Jacobson and Curtis, 2000). It can be seen that in many of the cases of successful recovery, it has been one or more consumer activists who gave the first break to the patient (Anonymous, 1989). Cognitive and psycho-social interventions like, self-help projects, social support, writing down of own experiences by the consumer, personal networking, involvement in spiritual activities and discourses, and professional help have been the major contributors to recovery (Anonymous, 1989). Values and user perspectives The values associated with recovery have to be developed on an individual level and also in relation with the community and the society (Anonymous, 1989). Providing the consumer a group identity and the conscious effort by a society to keep away from oppressing and marginalizing psychiatric patients have to be the core value of the concept of recovery (Jacobson and Curtis, 2000). Deegan (1988) has described as the “corner stones of recovery”, “hope, willingness and responsible action.” These three elements have to the basis of the user perspective for recovery to get initiated and progress. Beegan (1988) has also been careful to suggest that instead of the modern values based on “individualism, competition, personal achievement and self-sufficiency”, the values of cooperation and “group achievement” have to be stressed in the process of recovery. This is because the so-called 'modern values' may become incoherent with the mental realities and capabilities of the concerned person. Evidence based practice The basic approaches and principles of recovery have been formulated based on solid evidence (Ahern and Fisher, 2001). Mosher (1999) and Martenson (1998) have shown that there was high rate of recovery when elements like hope and social connection were incorporated into the treatment. The yardstick to measure evidence-based recovery has been set as the constant maintenance of the situation which includes, “symptom reduction and medication compliance” (Ahern and Fisher, 2001). But Ahern and Fisher (2001) have also pointed out that the extent of integration with the community can be taken as a more relevant and real bench mark for evidence. Recovery within a UK context Coleman (1999) has been instrumental in introducing the concept of recovery in United Kingdom. It was in 2005 that the National Institute for Mental Health in UK accepted the recovery model and started incorporating it into the mental health treatment as well as in education (NIMHE, 2005). The official assignment of a support time and recovery worker to give professional support to the customers has been another unique step taken by the UK government (NIMHE, 2005). The guiding statement on recovery has given an all-encompassing definition to recovery which has listed the meanings of recovery in the following way: 1) A return to a state of wellness (eg., following an episode of depression); 2) Achievement of a personally acceptable quality of life (eg., following an episode of psychosis); 3) A process or period of recovering (eg., following trauma); 4) A process of gaining or restoring something (eg., one's sobriety); 5) An act of obtaining usable resources from apparently unusable sources (eg., in prolonged psychosis where the experience itself has intrinsic personal value); 6) To recover optimum quality of life and have satisfaction with life in disconnected circumstances (eg., dementia) (NIMHE, 2005). Recovery of mentally disabled persons through motivation is analyzed in this discussion by way of the conceptual analysis model developed by Rodgers (1993;1994). This method includes steps, defining the concept, explaining the purpose of the analysis, summarising the uses of the analysis, defining the attributes, constructing a model case, constructing additional cases, which include, borderline, related, contrary, invented and illegitimate, creating a service user led session on wellness recovery action planning (WRAP), identifying antecedents and consequences and defining empirical references. Concept Analysis: Motivation Defining motivation Hull (1952) had theorized that motivation arises from deprivation of the needs of a human being which drove him/her to engage in some kind of action until the need was fulfilled. In the context of recovery, the significance of motivation is that it is the stepping stone to initiate the very process. Intrinsic and extrinsic motivation have been the two components of motivation defined by researchers and individual differences and environmental factors have been discussed as the two major variables of motivation (O'neil and Drillings, 1994, p.2). Thus motivation can be viewed as a combination of other two recovery concepts, namely, hope and social inclusion policy. Gardner (2001) has explained that motivation emerges from the attitudes inside a group and also out of an attraction for a given language and culture. Gardner (2001) has also broken down the concept of motivation into three components which are the attitude towards learning, desire to learn and the effort that is imparted in the process. The connection between motivation and self-esteem has also been a very meaningfully assertive one (Rogers, 2003, p.66). All these definitions do suggest that, in order to implement a recovery process, both external and internal motivation are very important factors. Purpose of the analysis This analysis has to be useful to both consumers and service providers to apply the concept of motivation in their initiation of a recovery process in a mental health scenario. A motivational intervening approach has to be formulated so that it includes all the possible interventions at individual level from the side of the customer as well as at professional, social and community level from the side of professionals, friends, relatives, the community and the society. Uses of the concept The concept of motivation can be used to help the customer to set personal goals and build hope, desire and an attitude to work for it. As the level of motivation increases, the personal goals can also move ahead in the direction of progress. This will in turn, heighten the hope, desire and effort to achieve the goals as well. The intrinsic process of motivation will be a driving force for the achievement of the goals while the extrinsic motivation can act as a catalyst that sustains it. Both these processes can act in a mutually supportive way as well. When, there is a lack of intrinsic motivation, it can be rekindled by its extrinsic counterpart. Defining attributes Defining attributes have been the major characteristics of a concept which help to understand it in all its complexities and intricacies and also which are ever-present in any discussion of the concept, as constant features (Rodgers, 1989). A few synonyms for motivation have been, ambition, desire, drive, inspiration and interest (Reverso, 2008). The underlying meanings of this concept indicate an impulse to change towards a positively viewed outcome. The application of this concept relates to cognitive and affective processes, self esteem, and an ability to command control. But the major defining attributes of this concept has been the individual differences and environmental factors. a) Individual differences Individual differences can again be categorized into two major parts as they arise from either the “trait of the individual” or “the state of the individual” ((O'neil and Drillings, 1994, p.2). This second part is again connected to the specific and immediate environmental situations as well as the intensity of a trait in an individual (O'neil and Drillings, 1994, p.2). For example, if an individual is prone to unnecessary doubt, the state of mind of such an individual will always be more vulnerable to even a motivating gesture from a less known person. But if an individual has a trait of unconditionally believing others, even a normal pleasant behavior from an outsider can motivate him/her in a wonderful way. One positive aspect of intrinsic motivation is that the individual traits can be made use of in such a way as to transform them into catalysts for motivation. For example, an individual trait of obsession with a particular colour can be utilised as a motivation variable to promote creative activities like painting or art work. b) Environmental factors The most influential environmental factor in the context of motivation has been the other people ((O'neil and Drillings, 1994, p.3). Motivational variables like, “self-confidence, persistence, risk-taking, and anxiety” have been found to be highly influenced by the attitudes and behavior of other people by researchers (O'neil and Drillings, 1994, p.3). The positive aspect of this attribute has been that social mediation can be effectively utilized to motivate people undergoing recovery process, and thereby opens up a possibility of mediated and easy recovery. c) Boundary conditions One less useful aspect of motivation has been that the variables involved have a habit of existing in boundary conditions, where it gets ambiguous whether the expression related to the variable is sheerly emotional or whether it is cognitive (O'neil and Drillings, 1994, p.3). There have also been other less explored variables in connection with motivation. Unzicker (1989) has described parentalism as an inhibitory factor against motivation. A model case The case of a 22-year old woman, Amanda, with a personal trait of very low self esteem, and not trusting herself and also any body around her can be revealing for this analysis. The girl has been exceptionally beautiful and shy in her appearance and she was married to a 27-year old lawyer after a brief period of courtship. But after marriage, the husband realized that she had no confidence to complete her studies, she had no trust in her capabilities, and she could not accept any body, even her husband as a close confidante. She always kept her financial accounts separate from his and she was extremely unaware of and uninterested in his rights as a husband. Though she was gifted a car by her husband, and though she learned driving and acquired the necessary documents, she did not have the courage to drive the car in a public road. She was always confused and in doubt, which made her incapable of completing even very simple daily scores. This case was tackled by the professional concerned through recovery method and both intrinsic and extrinsic motivation was employed in the process. The husband was encouraged to motivate her to build self esteem in her and to help her in finishing in her studies. He stayed awake with her while she studied and shared her home work. Secondly, the woman's positive and helpful personal traits were identified by the service provider. She was encouraged to do modeling for an advertisement firm which eventually also helped her to overcome her stage fear when she had to face her teachers with assignments and interviews. The service provider took the role of an unconditional supporter, even when she wronged her husband by showing childish selfishness in always putting her wishes over his. Even when she mistrusted the service provider, there was no reciprocation of the feeling from the other side. She was given total trust by the service provider which was a long drawn process but became an effective tool in helping her learn how to trust others. The husband and relatives also gave her small gifts when she showed even the slightest care and concern for them. In this way, motivation was provided both intrinsically and extrinsically and there was an amazing improvement in her situation. Additional cases: Borderline, related, contrary, invented and illegitimate There has also been this case of a 12-year old girl, Natalie, who had a very high level of anxiety. She had been keeping away from any kind of public contact out of fear of getting mocked or being emotionally bullied by others. Her fear was so real that she even refused to play with other kids and did not even want to host her birthday party. Her parents were greatly worried and they took her to the service provider. But in this case, the parentalism was so high that it was very difficult to motivate her into a process of recovery. In another case, there was this case of a teenager boy who had become obsessed with pornographic picture viewing on Internet so that he could never concentrate in his studies. He had become very much paranoiac about the interventions of his parents and had tried to kill them even. Here, it was a very complicated situation and the recovery model fell short of handling the complexities of this case. Wellness Recovery Action Plan 1. What is my self-conception of well ness. 2. Things to do to sustain the feeling of wellness 3. Additional things which can be done 4. What kind of symptoms show that I am getting unwell 5. Which are the internal and external triggers that disturb my feeling of well ness 6. How do I react to such triggers 7. How can I tackle those triggers if they happen 8. Early warning signs that I know of and others have reported 9. Motivating people whom I can approach in crisis and their phone numbers 10. The people whom I want to avoid in a crisis and why 11. The medications that I have to take 12. Medicines that have to be avoided until there is a very serious crisis 13. Medicines that have to be avoided at any cost 14. Actions that have to be avoided at any cost 15. A community plan for my recovery Antecedents of motivation The primary antecedent to motivation has to be the existence of a supportive group around the patient. The awareness of that group in different aspects of mental health and motivation and the love and care that the members of this group has towards the patient are extremely important. The level of understanding as well as patience of the members of this group is also valuable. The willingness of the patient to accept hope and external support is yet another critical factor. The ability of the patient to accept one's own limitations is a crucial element in the process of recovery. The person has to feel at home in the community and view one's personal achievements as the achievement of the group and vice versa. Consequences of motivation There have been a great number of personal testimonies which showed that motivation can bring about recovery in mental health situations (Anonymous, 1989; Ahern and Fisher, 2001; Mosher, 1999; Martenson, 1998). Motivation will speed up the recovery process, and help the assimilation of the individual into the community's fold. The self-esteem of the individual is enhanced by motivation which will have a positive impact on his/her performance level also. 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. Anthony, W, Cohen, M and Frakas, M 1990, Psychiatric rehabilitation, Centre for Psychiatric Rehabilitation, University of Boston, Boston. Coleman, R 2004, Recovery: an alien concept, P & P Press, Illinois. Deegan, PE 1988, 'Recovery: the lived experience of rehabilitation', Psychosocial Rehabilitation Journal 11 (4). Gardner, R.C. (2001). 'Language learning motivation: the student, the teacher, and the researcher', Texas Papers in Foreign Language Education, 6, 1-18. Hull, C.L 1952, A behaviour system: An introduction to behavior theory concerning the individual organism, Yale University Press, New Haven, CT. 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. Martenson, L 1998, Deprived of our humanity, Voiceless Movement, Geneva. McDermott, B 1990, 'Transforming depression', The Journal, 1(4), 13-14. 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. Office of the Surgeon General and various United States Government agencies 1999, Mental health: a report of the surgeon general, Section 10, Overview of Recovery. O'neil, H.F and Drillings, M 1994, Motivation: theory and research, Routledge, London. 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. Reverso 2008, Motivation synonyms, Dictionary.reverso.net, viewed 7 January 2011, Rodgers, B. L. 1989, 'Concepts, analysis and the development of nursing knowledge: the evolutionary cycle', Journal of Advanced Nursing, 14, 330-335. Rogers, B 2003, 'Behaviour recovery: practical programs for challenging behaviour and children with emotional behaviour disorders in mainstream schools', Aust Council for Ed Research, Camberwell, Victoria. Unzicker, R 1989, 'On my own: a personal journey through madness & re-emergence', Psychosocial Rehabilitation Journal, 13(1),71-77. Read More