1 empowerment & recovery in mental illness presenters: horst peters program coordinator,...
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Empowerment & Recoveryin Mental Illness
Presenters:Horst Peters
Program Coordinator,Partnership for Consumer
Empowerment
Brandi RandellPartnership 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.
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Introduction
Why talk about Empowerment?
Why talk about Recovery?
Why are mental health consumers teaching this?
What is Partnership for Consumer Empowerment?
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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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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.
Introduction
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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.
Introduction
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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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Medical / Clinical
Social Science
Experiential
Customary / Traditional
A balanced understanding of mental illness
Knowledge Resource Base
A New Framework for Support 1993
Mental Illness is:
Population without genes for mental
Illness
Loss / Stress
Emotionally Distressed
Person
Emotional Healing
Cycle of Healing for People not Mentally IllFisher and Ahern (1999)
Balanced & Whole
Loss / Stress
Severe Emotional Distress
Insufficient supports & coping
Mentally Ill
Mental Illness Mental Illness CycleCycle
Fisher & Ahern (1999)Fisher & Ahern (1999)
Mentally Ill
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Mental Illness
The Lived Experience
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DANGEROUS ?
DANGEROUS ?VIOLENT ?VIOLENT ?
UNPREDICTABLE ?UNPREDICTABLE ?IRRESPONSIBLE ?
IRRESPONSIBLE ?
DISTRESSED ?DISTRESSED ?FRIGHTENED FRIGHTENED ?
CONFUSED ?CONFUSED ?
ANGRY ?ANGRY ?POTENTIAL TO
POTENTIAL TO GROW AND
GROW AND CHANGE ?
CHANGE ?WHAT DO YOU SEE?WHAT DO YOU SEE?
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Stigma and Myths
Dangerous
Irresponsible
Dependent
Incompetent
Etc.
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His
tory
Fam
ily
Friends
Work
EducationSexu
alityP
olit
icsSpirit
uality
Hopes & Dreams
Values & Beliefs
PERSON
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Family
Work
History
Values
Spirituality
Friends
Education
Politics
Mental
Illness
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“You’re 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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EDUCATION
His
tory
Fam
ily
Friends
Work
Education
Sexuality
Po
litic
s
Spiri
tual
ityHopes & Dreams
Values & Beliefs
Illness / Disability
Person
Vulnerability
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• Self-concept
• Self-efficacy
• Hopes and Dreams
• Emotional Impact
• Major Social Roles
• Engagement with “helping systems”
Impact of Mental Illness
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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 person’s 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
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…
Learned Helplessness
The more the system takes control of our lives and choices, the more
helpless, disempowered, irresponsible, and dependent we
learn to become…
The System Takes Control
Therefore professionals within the system must
take responsibility for us and our life choices…
The Prophecy is Fulfilled
As we become experts in being helpless
patients, the central barrier is reinforced.
* Deegan P. (1992)
The Cycle of Disempowerment and Despair *
Self-Destroying Cycleadapted from D. Fisher &
L.Ahern, 1999
Broken Brain
Incompetence
Powerless
Fragmented / Machine-like Impairment
Det
erio
rati
on
De
co
mp
ens
ation
Social Exclusion
Coerced Compliance
Alienated
Fearful / Delusional
Institutional Control
Life Meaningless
Hopeless Helplessness
Rehabilitation Cycleadapted from D.Fisher & L. Ahern,
Rehabilitation Model, 1999
ILLNESS (deficit
management)
Knowledge(illness)
Resources
(illness
management)
Skills(illness coping)S
uppo
rts
(illn
ess
man
agem
ent)
Behavior
Management
Sympto
m
Man
agem
ent
Compliance
Education
Relapse Prevention
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What helps and what hinders
“I cannot think of anything more destructive of one’s sense of worth as a human being than to believe that the inner core of one’s being is sick – that one’s 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
EMPOWERMENT
NO OPTIONS
NO CHOICE
NO VOICE
NO CONTROLNO DIGNITY
NO RESPONSIBILITY
NO HOPE
NO NO
RECOVERY
RECOVERY
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Brandi Randell
Personal Story
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Self Injury Beyond the
MythsBrandi 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 it’s 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 doesn’t 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 Chamberlin’s: A Working Definition of empowerment. (Link)
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 does not mean cure!
Recovery
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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 couldn’t 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 couldn’t 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 couldn’t bring Robert back
“Let’s remember the pill is the ultimate downsizing. Let’s 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 life’s stresses,
and many people have found the professional’s
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/newsreleases/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 involves CHANGE!
Change at a systems level;
Change at the service level;
Most importantly, change at a
personal level!
Recovery
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Self empowering recovery is a personal reengagement with the process of life through…
Reclaiming responsibility for one’s 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 one’s 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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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
Recovery requires that we make choices
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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.
Recovery requires that we make choices
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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!
Recovery requires that we make choices
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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)