Empowerment & Recoveryin Mental Illness Presenters: Horst Peters Program Coordinator, Partnership for Consumer Empowerment Brandi Randell Partnership for Consumer Empowerment is aprogram of the Canadian Mental Health Association, Manitoba Division
Overheads and Resources www.cmhamanitoba.ca Go to Partnership for Consumer Empowerment pages and then the resources pages.
Introduction • Why talk about Empowerment? • Why talk about Recovery? • Why are mental health consumers teaching this? • What is Partnership for Consumer Empowerment?
More for theMind; 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.”
“ 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
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.
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.
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.
Objectives • What is mental illness? • What is the experience like? • What helps and what hinders?
What is Mental Illness? • What is Mental Illness caused by?
Mental Illness is: Genetic predisposition + Loss / Stress / Trauma Insufficient Knowledge, Supports, Coping, Resources Toews 1998
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
Cycle of Healing for People not Mentally IllFisher and Ahern (1999) Population without genes for mental Illness Loss / Stress Emotional Healing Emotionally Distressed Person
Mental Illness CycleFisher & Ahern (1999) Severe Emotional Distress Insufficient supports & coping Loss / Stress Mentally Ill Mentally Ill Balanced & Whole
Mental Illness The Lived Experience
VIOLENT ? POTENTIAL TO GROW AND CHANGE ? FRIGHTENED ? ANGRY ? Contributing member of Community ? UNPREDICTABLE ? DISTRESSED ? DANGEROUS ? IRRESPONSIBLE ? CONFUSED ? WHAT DO YOU SEE?
Stigma and Myths • Dangerous • Irresponsible • Dependent • Incompetent • Etc.
History Family Values & Beliefs Friends PERSON Work Hopes & Dreams Education Spirituality Sexuality Politics
Family History Work Politics Friends Values Mental Illness Education Spirituality
“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.”
History Family Illness / Disability Vulnerability Friends Person EDUCATION Values & Beliefs Work Education Hopes & Dreams Sexuality Spirituality Politics
Impact of Mental Illness • Self-concept • Self-efficacy • Hopes and Dreams • Emotional Impact • Major Social Roles • Engagement with “helping systems”
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
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.
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 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)
Self-Destroying Cycleadapted from D. Fisher & L.Ahern, 1999 Institutional Control Social Exclusion Alienated Fragmented / Machine-like Impairment Broken Brain Deterioration Decompensation Fearful / Delusional Life Meaningless Incompetence Coerced Compliance Hopeless Helplessness Powerless
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)
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
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
NO OPTIONS NO RECOVERY EMPOWERMENT NO CHOICE NO VOICE NO DIGNITY NO CONTROL NO RESPONSIBILITY NO HOPE
Brandi Randell Personal Story
Self Injury Beyond the Myths Brandi Randell 2007/06/07
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.
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.
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
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.
Self injury is NOT • Attention Seeking • Manipulation • For pleasure • A group activity • Cool, A trend • An adrenaline rush • A failed suicide attempt
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.
What doesn’t help. • Judgment placed on individuals. • Medical professionals who are unable to cope with their own feelings. • Improper medical care. • Psychological evaluations
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
Recovery is possible! • With proper supports. • Self-determination. • Having the choice is crucial to recovery.
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 meansand opportunityto assume responsibility for their own lives and well-being.
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)