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					Empowerment & Recovery
    in 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    1
       Overheads and Resources


        www.cmhamanitoba.ca

Go to Partnership for Consumer Empowerment pages
and then the resources pages.




                                                   2
             Introduction

   Why talk about Empowerment?

   Why talk about Recovery?

   Why are mental health consumers
    teaching this?

   What is Partnership for Consumer
    Empowerment?
                                       3
                        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.”
                                                                   4
         “ 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
                                                                               5
                      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.
                                                                   6
                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.
                                                   7
         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.
                                                              8
             Objectives

   What is mental illness?

   What is the experience like?

   What helps and what hinders?


                                   9
   What is Mental Illness?



   What is Mental Illness caused by?




                                        10
             Mental Illness is:


   Genetic predisposition + Loss / Stress / Trauma

Insufficient Knowledge, Supports, Coping, Resources



                                       Toews 1998


                                                      11
             Mental Illness is:
Medical /       Social      Experiential      Customary /
Clinical       Science                        Traditional




     A balanced understanding of mental illness

                         Knowledge Resource Base
                         A New Framework for Support 1993   12
Cycle of Healing for People not Mentally Ill
                    Fisher and Ahern (1999)

               Population without
                genes for mental
                    Illness




Emotional Healing                             Loss / Stress




                      Emotionally
                      Distressed
                        Person
                            Severe
                           Emotional
                            Distress
 Insufficient supports
       & coping                                  Loss / Stress




Mentally Ill
                  Mentally Ill                        Balanced
                                                      & Whole



               Mental Illness Cycle
                         Fisher & Ahern (1999)
 Mental Illness


The Lived Experience




                       15
FRIGHTENED ?
    ANGRY ?
DISTRESSED ?

 CONFUSED ?
        WHAT DO YOU SEE?
                       16
           Stigma and Myths

   Dangerous
   Irresponsible
   Dependent
   Incompetent
   Etc.



                              17
PERSON




         18
          History




Mental
Illness   Education



                      19
  “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.”




                              20
Values & Beliefs
                   Person   Work




                                   21
Impact of Mental Illness

• Self-concept

• Self-efficacy
• Hopes and Dreams
• Emotional Impact
• Major Social Roles
• Engagement with “helping systems”
                                      22
23
24
25
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



                                            26
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.                            27
What Helps & What Hinders?




                             28
      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

                                           29
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
  The Prophecy is         one is irrational and crazy. Thus all of the     The System Takes
      Fulfilled            thoughts, choices, expressions, etc., of             Control
                           persons who have been diagnosed with
As we become experts           mental illness can be ignored…            Therefore professionals
   in being helpless                                                      within the system must
 patients, the central                                                   take responsibility for us
 barrier is reinforced.                                                   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)
                     Self-Destroying Cycle
                adapted from D. Fisher & L.Ahern,
Institutional                1999                      Social
  Control                                             Exclusion


                                             Alienated
       Fragmented /
       Machine-like       Impairment


                            Broken
                             Brain
                                                     Fearful /
          Life                                      Delusional
       Meaningless        Incompetence

                                                      Coerced
 Hopeless                          Powerless         Compliance
Helplessness
   Rehabilitation Cycle
adapted from D.Fisher & L. Ahern,
   Rehabilitation Model, 1999




          Knowledge
             (illness)



          ILLNESS
             (deficit
          management)
        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


                                                        33
         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

                                                  34
                   NO OPTIONS


EMPOWERMENT                NO CHOICE

               NO VOICE


                          NO DIGNITY
  NO CONTROL

               NO RESPONSIBILITY

   NO HOPE
Brandi Randell


         Personal Story




                          36
  Self Injury
Beyond the Myths
    Brandi Randell
      2007/06/07


                     37
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.




                                                   38
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.
                                                                       39
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

                                                      40
 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.       41
Self injury is NOT
 Attention Seeking
 Manipulation
 For pleasure
 A group activity
 Cool, A trend
 An adrenaline rush
 A failed suicide attempt



                             42
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.


                                                         43
What doesn’t help.
 Judgment placed on individuals.


 Medical professionals who are unable to cope with
  their own feelings.

 Improper medical care.


 Psychological evaluations




                                                      44
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




                                                          45
Recovery is possible!

 With proper supports.

 Self-determination.

 Having the choice is crucial to recovery.




                                              46
Empowerment




              47
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.
                                              48
   See Judi Chamberlin’s: A Working
    Definition of empowerment. (Link)




                                        49
    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)
   Recovery




Recovery does not mean cure!


                               51
             Recovery

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



                                             52
       Recovery is Real
People do recover!
 Schizophrenia           -   60-70%
 Anxiety Disorders       -   80%
 Bipolar Disorder        -   80%
 Major Depression        -   60%
 Personality Disorders   -   ?


                                       53
54
55
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

                                                       56
Recovery is NOT an outcome of mental
      health services and supports!

         Mental health service
    and support outcomes must be
environments that facilitate recovery!

                                         57
      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.”



                                               58
      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?”


                                               59
     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.”
                                               60
  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)
                                                  61
            Fundamental Components
                  of Recovery

    Self-Direction                     Strengths-Based

    Individualized                     Peer Support

    Empowerment                        Respect

    Holistic                           Responsibility

    Non-Linear                         Hope

    SAMHSA Consensus Statement on Mental Health Recovery Feb 2006
    http://www.samhsa.gov/news/newsreleases/060215_consumer.htm     62
    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)     63
Recovery
 Recovery involves CHANGE!
    Change at a systems level;
    Change at the service level;
    Most importantly, change at a
     personal level!


                                     64
     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.

                                                          65
Recovery and
empowerment
 require us to
move beyond
 helpless and
   hopeless
  victimhood.




                 66
      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.



                                                                   67
     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
                                                     68
    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.



                                                          69
      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!



                                                               70
Knowledge
which cannot or
is not put into
action is not
empowering !




                  71
    Recovery requires Action
    We 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.
                                                                   72
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.



                                               73
DO YOU HAVE A DREAM ?


                        74
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.




                                                  75
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”.



                                                       76
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



                                                    77
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)
                                                                     78

				
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