Empowerment & Recovery in Mental Illness Presenters: Horst Peters

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
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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.
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.
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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 Ill
Fisher and Ahern (1999)
Population without
genes for mental
Illness
Loss / Stress
Emotional Healing
Emotionally
Distressed
Person
Insufficient supports
& coping
Mentally Ill
Severe
Emotional
Distress
Loss / Stress
Mentally Ill
Mental Illness Cycle
Fisher & Ahern (1999)
Balanced
& Whole
Mental Illness
The Lived Experience
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FRIGHTENED
ANGRY ? ?
DISTRESSED ?
CONFUSED ?
WHAT DO YOU SEE?
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Stigma and Myths

Dangerous

Irresponsible

Dependent

Incompetent

Etc.
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PERSON
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History
Mental
Illness
Education
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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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Values & Beliefs
Person
Work
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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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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
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The Cycle of Disempowerment and Despair *
The Central
Attitudinal Barrier
The Prophecy is
Fulfilled
As we become experts
in being helpless
patients, the central
barrier is reinforced.
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 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 Cycle
Institutional
Control
adapted from D. Fisher & L.Ahern,
1999
Fragmented /
Machine-like
Alienated
Impairment
Broken
Brain
Life
Meaningless
Hopeless
Helplessness
Social
Exclusion
Fearful /
Delusional
Incompetence
Powerless
Coerced
Compliance
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
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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
34
NO OPTIONS
EMPOWERMENT
NO CHOICE
NO VOICE
NO DIGNITY
NO CONTROL
NO RESPONSIBILITY
NO HOPE
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 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.
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.
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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
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
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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)
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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 selfdetermination; 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!
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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
 Anxiety Disorders
 Bipolar Disorder
 Major Depression
 Personality Disorders
-
60-70%
80%
80%
60%
?
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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!
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.”
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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

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
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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)
63
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 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.
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.
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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 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.
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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)78