Empowerment & Recovery in Mental Illness

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Empowerment Recoveryin Mental Illness

• Presenters
• Horst Peters
• Program Coordinator,
• Partnership for Consumer Empowerment
• Brandi Randell

Partnership for Consumer Empowerment is a program
of the Canadian Mental Health Association,
Manitoba Division
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Overheads and Resources

• www.cmhamanitoba.ca
• Go to Partnership for Consumer Empowerment pages
  and then the resources pages.

3
Introduction

• Why talk about Empowerment?
• Why talk about Recovery?
• Why are mental health consumers teaching this?
• What is Partnership for Consumer Empowerment?

4
More for the Mind a study of psychiatric
services in Canada

• In no other field, except perhaps leprosy, has
  there been as much confusion, misdirection and
  discrimination against the patient, as in mental
  illness Down through the ages, they have been
  estranged by society and cast out to wander in
  the wilderness. Mental illness, even today, is
  all too often considered a crime to be punished,
  a sin to be expiated, a possessing demon to be
  exorcised, a disgrace to be hushed up, a
  personality weakness to be deplored or a welfare
  problem to be handled as cheaply as possible.

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• more than two thousand personal stories
  submitted to the Standing Senate Committee on
  Social affairs, Science and Technology by
  Canadians living with mental illness, and their
  families, make clear that these words continue to
  ring true.

Out of the Shadows at Last. Final report of the
Standing Senate Committee on Social Affairs,
Science and Technology. May 2006
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Introduction

• New Paradigm for Mental Health
• Prognosis of Doom replaced with the Reality of
  Hope Well-being is Achievable!
• Persons with psychiatric disorders are no longer
  passive recipients of behaviour symptom
  management oriented services.
• Choice, self-determination, and personal
  responsibility are key elements of recovery.
• Expertise of consumers is recognized and valued.

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Introduction

• Partnership for Consumer Empowerment developed
  out of a Manitoba Health, Mental Health Division,
  professional development seminar which was
  designed for mental health service providers to
  learn about this new paradigm from mental health
  service users.

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Value of Consumer Voice

• To the people of Canada, I say welcome us into
  society as full partners. We are not to be feared
  or pitied. Remember, we are your mothers and
  fathers, sisters and brothers, your friends,
  co-workers and children. Join with us and travel
  together with us on our road to recovery.
• Roy Muise (May 2005). Opening quote in the
  final report of the Standing Senate Committee on
  Social Affairs, Science, and Technology Out of
  the shadows at last. May 2006.

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Objectives

• What is mental illness?
• What is the experience like?
• What helps and what hinders?

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• What is Mental Illness?
• What is Mental Illness caused by?

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Mental Illness is
Genetic predisposition Loss / Stress / Trauma
Insufficient Knowledge, Supports, Coping,
Resources
Toews 1998
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Mental Illness is
Medical / Clinical
Social Science
Experiential
Customary / Traditional
A balanced understanding of mental illness
Knowledge Resource Base A New Framework for
Support 1993
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Cycle of Healing for People not Mentally
IllFisher and Ahern (1999)
Population without genes for mental Illness
Loss / Stress
Emotional Healing
Emotionally Distressed Person
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Mental Illness CycleFisher Ahern (1999)
Severe Emotional Distress
Insufficient supports coping
Loss / Stress
Mentally Ill
Balanced Whole
Mentally Ill
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Mental Illness

• The Lived Experience

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VIOLENT ?
POTENTIAL TO GROW AND CHANGE ?
FRIGHTENED ?
ANGRY ?
Contributing member of Community ?
UNPREDICTABLE ?
DISTRESSED ?
DANGEROUS ?
IRRESPONSIBLE ?
CONFUSED ?
WHAT DO YOU SEE?
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• Stigma and Myths
• Dangerous
• Irresponsible
• Dependent
• Incompetent
• Etc.

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History
Family
Values Beliefs
Friends
PERSON
Work
Hopes Dreams
Education
Spirituality
Sexuality
Politics
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Family
History
Work
Politics
Friends
Values
Mental Illness
Education
Spirituality
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Youre at the point of discovering yourself and
something comes in and identifies you without
your consent. As a culture we have not yet
recognized the courage it takes to live with this
extra piece of life that is lived every day.

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History
Family
Friends
Illness / Disability
Vulnerability
Person
EDUCATION
Work
Values Beliefs
Education
Hopes Dreams
Sexuality
Spirituality
Politics
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Impact of Mental Illness

• Self-concept
• Self-efficacy
• Hopes and Dreams
• Emotional Impact
• Major Social Roles
• Engagement with helping systems

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Helping (?) Systems
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Helping (?) Systems
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Helping (?) Systems
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Impact of Illness

• Loss of Sense of Self
• Loss of Connectedness
• Guilt
• Shame
• Isolation
• Loss of Power
• Loss of Valued Role
• Loss of Hope
• Spaniol et al 1999

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Impact of Illness

• People are trying to cope with
• The catastrophe of mental illness and multiple
  and recurring traumas.
• Trauma from the illness and trauma from how they
  are treated.
• Negative professional attitudes.
• Lack of appropriate assisting skills of
  professionals.

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What Helps What Hinders?
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What helps and what hinders

• The social power to define and categorize
  another persons experience is not a power to be
  ignored. in order to support persons who are
  trying to recover, we must attend to the fullness
  of their experiences, and not be distracted by
  their medical diagnoses.
• McGruder 2001

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The Cycle of Disempowerment and Despair
The Central Attitudinal Barrier People with
psychiatric disabilities cannot be
self-determining because to be mentally ill means
to have lost the capacity for sound reasoning. It
means one is irrational and crazy. Thus all of
the thoughts, choices, expressions, etc., of
persons who have been diagnosed with mental
illness can be ignored
The Prophecy is Fulfilled As we become experts
in being helpless patients, the central barrier
is reinforced.
The System Takes Control Therefore professionals
within the system must take responsibility for us
and our life choices
Learned Helplessness The more the system takes
control of our lives and choices, the more
helpless, disempowered, irresponsible, and
dependent we learn to become
Deegan P. (1992)
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Self-Destroying Cycleadapted from D. Fisher
L.Ahern, 1999
Social Exclusion
Institutional Control
Alienated
Fragmented / Machine-like
Impairment
Broken Brain
Deterioration
Decompensation
Fearful / Delusional
Life Meaningless
Incompetence
Coerced Compliance
Hopeless Helplessness
Powerless
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Rehabilitation Cycleadapted from D.Fisher L.
Ahern, Rehabilitation Model, 1999
Relapse Prevention
Behavior Management
Knowledge (illness)
ILLNESS (deficit management)
Supports (illness management)
Skills (illness coping)
Symptom Management
Compliance Education
Resources (illness management)
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What helps and what hinders

• I cannot think of anything more destructive of
  ones sense of worth as a human being than to
  believe that the inner core of ones being is
  sick that ones thoughts, values, feelings, and
  beliefs are merely the meaningless symptoms of a
  sick mind What the concept of mental illness
  offered me was scientific proof that I was
  utterly worthless, and would always be worthless.
  It was just the nature of my genes, chemistry and
  brain processes something I could do nothing
  about.
• John Modrow How to become a schizophrenic

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What helps and what hinders

• The science of psychiatric diagnosis and
  treatment is neither objective, nor neutral nor
  value free. Rather, it is a social process open
  to bias and influenced by the larger social,
  political, and cultural milieu.
• McGruder 2001

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NO OPTIONS
NO RECOVERY
EMPOWERMENT
NO CHOICE
NO VOICE
NO DIGNITY
NO CONTROL
NO RESPONSIBILITY
NO HOPE
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Brandi Randell

• Personal Story

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Self Injury Beyond the Myths

• Brandi Randell
• 2007/06/07

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Why I am speaking out.

• You should know this because I self Injure - I
  could be the person sitting next to you, your
  best friend, a family member an acquaintance or
  maybe even you.

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What is Self Injury?

• Also known as Self Harm, Self Abuse, Self
  Mutilation, Self Inflicted Violence
• Self Injury is a coping mechanism.
• Self injury on its own is not a mental illness
  but can be a symptom of several diagnosis.
• An individual harms their physical self to deal
  with emotional pain, or to break feelings of
  numbness by arousing sensation, to make
  flashbacks stop, to punish the self and stop
  self-hating thoughts, or to deal with a feeling
  of impending explosion.

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Some forms of Self Injury

• Although cutting is the most common form of Self
  Injury, burning and head-banging are also very
  common.
• Other forms include biting, skin-picking,
  hair-pulling, hitting the body with objects or
  hitting objects with the body and deliberately
  breaking bones

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• To someone who has never deliberately hurt
  themselves, self injury may seem completely
  negative, destructive and unnecessary.
• It is hard to understand how someone can choose
  to inflict harm upon themselves which is
  something we all try to avoid.

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Self injury is NOT

• Attention Seeking
• Manipulation
• For pleasure
• A group activity
• Cool, A trend
• An adrenaline rush
• A failed suicide attempt

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Who is likely to self injure?

• Their ages typically range from early teens to
  early 60s, although they may be older or younger.
• The incidence of self injury is about the same as
  that of eating disorders, but because it's so
  highly stigmatized, most people hide their scars,
  burns, and bruises carefully.
• Some people who Self injure manage to function
  effectively in demanding jobs.
• People who self injure come from all walks of
  life and all economic brackets.

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What doesnt help.

• Judgment placed on individuals.
• Medical professionals who are unable to cope with
  their own feelings.
• Improper medical care.
• Psychological evaluations

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What helps people who self injure?

• CHOICE
• Supportive people
• Many therapeutic approaches have been and are
  being developed to help people that self injure
  learn new coping mechanisms and teach them how to
  use those techniques instead of self injury.
• Help lines
• Medications

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Recovery is possible!

• With proper supports.
• Self-determination.
• Having the choice is crucial to recovery.

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Empowerment
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• Empowerment is an issue of social justice and
  refers to the process that people go through to
  gain or regain the power and control over their
  own lives that is necessary for dignity and
  self-determination. It requires that people have
  access to the means and opportunity to assume
  responsibility for their own lives and well-being.

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• See Judi Chamberlins A Working Definition of
  empowerment. (Link)

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The person most likely to get well to become
empowered is the person who feels free to
question, to accept or reject treatment, and to
communicate with and care for people who are
caring for him Ultimately, patient empowerment
is a matter of self-determination it occurs when
a patient freely chooses his or her own path to
recovery and well-being. It is the job of mental
health services to provide an environment of
personal respect, material support, and social
justice that encourages the individual person in
this process. Clay (1990)
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Recovery
Recovery does not mean cure!
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Recovery

• the obstacles to recovery are enormous, but the
  greatest obstacle is simply that people think one
  cannot recover!
• www.recoverywisconson.com

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Recovery is Real

• People do recover!
• Schizophrenia - 60-70
• Anxiety Disorders - 80
• Bipolar Disorder - 80
• Major Depression - 60
• Personality Disorders - ?

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• Mental Health Recovery is a journey of healing
  and transformation enabling a person with a
  mental health problem to live a meaningful life
  in a community of his or her choice while
  striving to achieve his or her full potential.
• - National Consensus Statement
  on mental health recovery
• SAMHSA 2006

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• Recovery is NOT an outcome of mental health
  services and supports!
• Mental health service
• and support outcomes must be
• environments that facilitate recovery!

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Newsweek article medications alone couldnt
bring Robert back

• the more we emphasize medications as key to
  recovery, the more we overlook what is at least
  as important people working with people on a
  long-term basis.

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Newsweek article medications alone couldnt
bring Robert back

• What does it matter if one medication is
  superior to another if people have no safe place
  to live, and therefore no opportunity to work, no
  choice of treatments and no access to dedicated
  individuals who are being paid decent wages to
  work with them?

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Newsweek article medications alone couldnt
bring Robert back

• Lets remember the pill is the ultimate
  downsizing. Lets find resources to give people
  afflicted with mental illness what all of us
  need fellow human beings upon whom we can depend
  to help us through our dark times and, once
  through, to emerge into gloriously imperfect
  lives.

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Recovery

• Recovery does not occur
• by learning to avoid all of lifes stresses,
• and many people have found the professionals
• advice to avoid stress to be unhelpful.
• Deegan (2004)

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Fundamental Components of Recovery

• Self-Direction
• Individualized
• Empowerment
• Holistic
• Non-Linear

• Strengths-Based
• Peer Support
• Respect
• Responsibility
• Hope

SAMHSA Consensus Statement on Mental Health
Recovery Feb 2006 http//www.samhsa.gov/news/news
releases/060215_consumer.htm
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Recovery

• In a recovery oriented approach, the focus is on
  the person in the context of their life. The
  measure of success is not simply an absence of
  symptoms or reduction in inpatient admissions. In
  a recovery-oriented approach, success is also
  measured by how well we are able to pursue the
  things that give our lives purpose and meaning.
• Deegan (2004)

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Recovery

• Recovery involves CHANGE!
• Change at a systems level
• Change at the service level
• Most importantly, change at a personal level!

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Self empowering recovery is a personal
reengagement with the process of life through

• Reclaiming responsibility for ones own life.
• The achievement of better health.
• The development of purpose, fulfillment,
  happiness and usefulness that everyone seeks.
• The reconnection with personal dreams and
  passions.
• The realization of ones inner potential.

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Recovery and empowerment require us to move
beyond helpless and hopeless victimhood.
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Recovery requires that we make choices

• Choose to believe that it is possible to have a
  better life.
• Choose to hope again.
• Choose to believe we are more than the sum total
  of our diagnosis, problems, failures and
  dysfunctions.
• Choose to believe that we have skills, talents,
  knowledge, and the ability to grow and change.

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Recovery requires that we make choices

• Choose to believe that we are capable human
  beings that deserve dignity, love, and happiness
  in our lives.
• Choose to believe that we have the ability and
  power to address our dissatisfaction with our
  disabling and disempowering circumstances.
• Choose to forgive.
• Choose to accept forgiveness

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Recovery requires that we make choices

• Choose to believe that we need not live in fear
  of our thoughts, feelings and perceptions. To be
  truly alive is to experience the full range of
  emotions, thoughts and expressions.
• Choose to believe that the process of growth and
  healing requires us to step forward and take
  risks. Failures and successes are an integral
  part of the human experience and are essential to
  learning.

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Recovery requires that we make choices

• Choose to be responsible for our lives our
  thoughts, feelings, opinions, beliefs,
  behaviours, and their consequences.
• Choose to change the behaviours, thoughts,
  beliefs, etc. in our lives that are a barrier to
  our recovery.
• Choose to take action!

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Knowledge which cannot or is not put into action
is not empowering !
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Recovery requires ActionWe must move from
Beliefs to Action

• Develop an Action Plan
• In developing my action plan, I can ask myself a
  variety of questions
• What are my problems, issues or concerns? What do
  I want to change about my life now?
• Given these challenges, what do I want to happen?
• How can I accomplish what I want to happen?
• What supports and resources do I have? What do I
  need?
• What do I want to do with my life?
• What do I have to do to reach that goal?
• Etc.

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I believe successful recovery requires me to
connect with my dreams and/or passions
regardless of how outrageous or unrealistic
(delusional?) they may seem at the time. I need
to explore them and then choose to pursue or
revise and/or redefine them.
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DO YOU HAVE A DREAM ?
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Dreams or Delusions ?

• Hold onto that delusion. Most people call them
  plans.
• Psychiatry has no label for delusions of
  grandeur that come to pass.
• R.R. Fieve MD.

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My dreams cannot LIVE beside those who wish to
hold onto doubts. I cannot DREAM where people
are forever preoccupied with reality, with how
things are.
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I cannot HOPE where people insist that what I
desire can never come to pass, where merely
discussing it is off base, where seeing things
as they are is more important than envisioning
how I would like them to become
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I require the freedom and self-determination To
proceed under my own power, To succeed or
fail Through my own efforts, To have my dreams
and visions Meet the risk and uncertainty of
daily life. This is RECOVERY
adapted from Alan Lunt 2000 (used by
permission)