Applicability of the Principles of Empowerment and Recovery of the Mentally Ill in Practice - Essay Example

 Applicability of the Principles of Empowerment and Recovery of the Mentally Ill in Practice Mental illness is a condition that affects many peopleglobally. In general terms, mental illnesses are disorders that stem from the brain and affect the normal functioning of an individual. According to Thornicroft et.al (2011) a person’s thinking, actions, feelings, and relationship with others may be jeopardized by a brain disorder. There are many types of mental illnesses including: bipolarity, depression, panic attacks, obsessive-compulsive disorder, and schizophrenia among others. 1.0 Scenario One afternoon, a man in his late 20s was brought in for medical attention. For the purpose of confidentiality, we shall name him Andrew (not his real name). Andrew could not keep still and he kept on moving from one point to another, talking to imaginary people. The people who brought him to the hospital were his colleagues at work, who claimed that he had become very hostile, attacking everyone at the office and accusing them of trying to ruin his life. They claimed that he had also started talking to himself and repeatedly saying “they want to kill me”. Andrew was immediately taken to the psychiatrist ward for examination, while I was instructed to get more information about his actions from his colleagues. The workmates told me that in last few months, they had observed some abnormal behavior in their colleague, but had dismissed the actions. For example, he would show up at work late, looking tired and had started withdrawing from his workmates. They also claimed that he could no longer meet deadlines and that he often did substandard work. After the discussion with the patients’ colleagues, I called his family before going to check on the progress of the patient. The psychiatrist informed me that they had sedated him to ease his agitation. I explained to him all the observances noted by Andrew’s colleagues and the doctor suspected that this could be a case of schizophrenia. As we were talking, Andrew’s wife and sister came in looking very worried. The doctor explained the patient’s condition to them and asked them to offer any information they deemed useful. The wife explained how Andrew a father of two and an accountant had started acting weird about the same time the previous year. He would often withdraw from his wife and children, he would become easily agitated if the children did anything wrong, and would act unmoved even if the children cried for attention. The wife also explained how in recent days Andrew had become very attentive to the safety of his family, claiming that someone was out to harm them. He would lock all the doors and constantly look out through the window to see whether someone was watching them. Andrew’s sister also explained how as a teenager, Andrew had suddenly lost all zeal for life. He no longer engaged in activities he had previously enjoyed. She explained that Andrew stopped playing rugby; his social life degenerated and he became withdrawn from his family. He did not seem to have any direction in life; neither did he know what career he wanted. Meanwhile his family attributed all this to adolescence and hoped it would pass. They did not expect Andrew’s condition to deteriorate to the present situation; neither did they attribute it to a mental disorder. At this point it was absolutely clear that indeed Andrew was suffering from undifferentiated schizophrenia. When Andrew woke up he was much quieter and seemed to act more normally, except that he denied ever doing all the things that his colleagues had pointed out. He was not ready to face up to the fact that he was mentally ill and was still in denial. According to Warner (2004) it is common for people suffering from schizophrenia to deny their mental condition. Later on, the psychiatrist asked if I wanted to be involved in empowering Andrew to recover from his illness and I was only too willing. This was going to involve application of the principles of empowerment in ensuring Andrew’s recovery. 2.0 Meaning of Recovery In this context, recovery means the ability of a patient to focus on managing their condition and having hope of living a fulfilled life, regardless of continued mental problems (Brown, 2001). The recovery process involves a change in one’s perception of life including goals, roles and attitudes. According to CSIP (2007) in the recovery model, the patient adopts a new model of life in which their mental condition does not inhibit their success in life. In this case, the patient is empowered to live their life meaningfully and purposely, as if their mental condition did not exist (Linhorst, 2006). Empowerment in this context means that the mentally ill person does not rely on the opinion of others on how to make their life successful (Videbeck, 2010). An empowered person is able to take charge of the lives; treatment and care, without having to rely on family, community or medical practitioners. Under the empowerment model of recovery, there are guiding principles on how a patient can achieve this. We seek to determine whether the said principles are can be fully implemented in medical practice, particularly on Andrew’s case. 2.1 Principles of Empowerment and Recovery 2.1.2 Patient Autonomy versus Paternalism One of the principles of empowerment and recovery is that the patient needs to be in full control of the management of their mental condition. According to the American Psychiatrist Association (2003) mental institutions should design their systems to ensure that the mentally ill do not rely on external conditions to manage their illnesses. Accordingly, medical practitioners only role is to give encouragement and hope to the mentally ill person and help them reintegrate back to the society. In such instances, therefore, the practitioner loses their control over the patient. The mode of treatment that the user chooses is what practitioners will follow. Going by this notion, our only responsibility to Andrew was to give him hope that his condition would get better, if he only decide to make it so. However, this proved very challenging because Andrew could not accept his condition, leave alone talk about it and sometimes even showed signs of violence if someone insisted on talking to him. It was obvious that Andrew really needed medical treatment, but this would be against the principles of empowerment and recovery. According to Wallcraft (2009), a user reserves the right to decide the treatment procedure that is going to be administered on them. 2.1.3 Family Support Advocates of the empowerment model also insist on the importance of family being there to support the mentally ill person (Gould, 2010). Accordingly, we called in Andrew’s sister and wife, but what unfolded was total drama. He started accusing them of placing him in a mental institution so that they could use up all his money. Andrew said that it was a plot hunched by the whole family and his colleagues to eliminate him. At this point it was becoming increasingly apparent that neither the medics, nor family and colleagues could convince Andrew that all was going to be well. I and the psychiatrist had tried not to be paternalistic towards Andrew and instead were like coaches trying to coach him towards self determination and recovery. This was however, hindered by the fact that he could not allow anyone to come near him or talk to him. 2.2 Therapeutic Intervention Our last option lay in taking Andrew to a support group for people living with schizophrenia. Andresen, Oades and Caputi (2003) emphasize on the role of support groups in providing empowerment to people with mental illnesses. There was a unit at the hospital that held sessions to enable people with mental illnesses accept their condition and lead a meaningful life beyond their condition. Later on, it was apparent that the session had had an impact on him. He could now talk to his wife although not fully about his actions and why he felt compelled to act in the way he did. This was a major leap in the road towards recovery. Despite the fact that Andrew still could not accept his mental illness, the fact that he could try to justify some of his actions which he had previously denied represented hope. Andrew now needed a lot of support to facilitate his recovery and reintegration into the society. He was free to choose whether he wanted to be confined in the hospital or he was ready to go back home. His wife could also be consulted in instances where Andrew might suffer relapses and could not make coherent decisions on his own. 2.3 Life outside Mental Health Services Whatever mode of treatment Andrew chose, we as practitioners were there to encourage him and his family to follow through. We let Andrew know that life would continue beyond his illness and that reintegration into the society was possible. Continuous therapy would help Andrew accept his condition. Accordingly, we gave Andrew a list of support groups within his area of residence that would help him deal with the illness. Andrew’s family was also urged to be very supportive of Andrew in the recovery process. As already mentioned, families play a major role towards the recovery of a mentally ill person, by giving love and support to such a person. 2.4 The Risk Involved Medically speaking, however, Andrew was still frail and at risk of suffering more frequent relapses or his condition could worsen. A doctor’s opinion at this point would be that Andrew be retained at the hospital for personalized care and monitoring. But then again, the empowerment model suggests that the patient be given full autonomy in deciding how to be treated. I tend to think it is in situations like this that Elder, Evans and Lizette (2009) urges medics not to follow the principles of empowerment and recovery blindly, yet there is risk involved. He urges practitioners to be realistic in some situations that they think the patient is making an uninformed decision. Proponents of the empowerment model of recovery hold that once a person goes through the recovery process, they can get back to their former life and continue normally (Amering and Schmolke, 2009). However, evidence shows that the time lost when the person has been mentally ill can never be recovered and a person loses out on a lot during their life time. For example, the years that Andrew lost as an isolated teenager cannot be recovered now. Many mentally ill people, therefore, live life wishing they could get back that part of their life that they lost while they were unable to mange their illness. 2.5 Medication and Recovery On medical grounds, I am a witness that it is very hard to fully operate on the principles of empowerment and recovery. Cases like Andrew’s need medical intervention, especially in instances where he gets very agitated or violent towards people around him. That is why I think that the evidence-based method and the empowerment one could work well together. According to Nelson, Lord and Ochocka (2001) as the mentally ill person is encouraged to take control of their life and make it meaningful, they should also be on medication to suppress the recurrence of relapses. The only problem comes in when the patient regards medication as more of a problem than the illness itself. Some patients may refuse to be medicated arguing that the medicines would aggravate their situation. Luckily for us, Andrew did not mind being medicated, if that was one of the ways to get him to recover. 3.0 Ideologies in Mental Healthcare Andrew’s case proved that the medic is rendered powerless to exercise their knowledge of how to handle brain disorders under the empowerment model. For example, we could not decide for Andrew that he needed to stay at the hospital a bit longer in order for his condition to be stabilized. Brown (2010) writes that consumer autonomy in resolution is emphasized by advocates of the empowerment and recovery approach. Therefore, it was up to Andrew and his family to decide what kind of treatment best suited him. Our role was to help Andrew towards recovery using whichever mode of treatment he chose. From my experience; it appears that the role of the practitioner in recovery using empowerment is minimized to following the patient’s wants and rights. Farkas (2007) is of the opinion that service delivery is sometimes hindered by the principles of empowerment and recovery. Sometimes, the practitioner is forced to conform to the wishes of the patient, even though the latter may be in contrast to the practitioner’s better judgment. From a personal point of view, overreliance on the empowerment model of recovery creates a vacuum in practice. Jacobson and Greenley (2001) state that medics are denied the chance to practice their scientific knowledge on mental health management when using the empowerment and recovery model. I think that the empowerment model should provide room for other approaches of dealing with mental illnesses. Shives (2008) advocates for the use of approaches in mental illness treatment that were developed after 1990, which was the start point of advanced research in brain disorders. Corrigan et.al (2008) advocate for the use of the evidence-based approach in metal illness management. This model attaches importance to the need for scientifically proven treatment of brain disorders. A mentally ill person in as much as the recovery model dismisses it, is a weak person with needs that the individual or community cannot handle without scientific medication. Vandiver (2009) proposes the integration of evidence-based methods to the recovery and empowerment approach, if mental illness is to be dealt with in totality. Important lessons from Andrew’s case My experience with Andrew at the hospital taught me a lot of valuable lessons. For one, mental illness is a condition that affects a person, but may take years to finally show. It was clear that Andrew had suffered a brain disorder in his teenage but it took almost fifteen years for the symptoms to finally display undifferentiated schizophrenia. This means that most teenagers may be suffering form brain disorders but their actions are dismissed for normal adolescent misbehavior. I think parents and relatives should pay more attention to their children to avoid cases like Andrew’s. From a medical perspective, the applicability of the empowerment and recovery model, though preferred by many consumers is challenging for the practitioner. Allowing the user to make all the decisions and reducing the role of the medic to just support sometimes could jeopardize the well being of the mentally ill person. That is why I still hold the opinion that the recovery model should incorporate medication and the evidence-based approach to mental healthcare. 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