Good News About Mental Health Disorders, Mental Illness and the Recovery Model
27 Jun 2012 - Here is a lightning tour and potted history of mental health care and treatment. There is also an introduction to the Recovery Model and why the recovery model is good news.
Mental Health and Mental Illness are always in the media these days. All too often the reasons are negative. So, without further ado, lets get the bad news out the way first.
- Every Increasing numbers of people in the West suffer from Mental Illness (Due in part to more pressured lifestyles, increased recreational drug use and greater alcohol consumption)
- A common public misconception is that those with mental illness will probably be violent and dangerous
- The amount of prejudice against mental illness today in all countries is far too high
- Prejudice is much worse in some countries than others (partly because mental illness is not understood or the concept is in conflict with the local culture)
- Diagnosis of metal illness can difficult and subjective – You can’t simply scan or test for most forms of Mental Illness
- There is also a constant debate amongst mental health professionals about whether particular conditions, such as personality disorder, actually exist
What is Mental Illness?
A mental disorder or mental illness can be thought of as a psychological or behavioural pattern that causes distress or disability that is not a normal part of the culture of the affected person.
The understanding and diagnosis of mental health conditions has changed over time and across cultures, and there are still variations in the classification of mental disorders from country to country.
Over a third of people across the globe report meeting criteria for the major categories of mental illness at some point in their life. These categories include anxiety disorders such as phobias and obsessive compulsive disorders.
Then there are mood disorders such as depression and bipolar disorder that embraces both depressive and manic episodes. There are also psychotic disorders including schizophrenia, and delusional disorder. Other categories of mental illness include personality and eating disorders.
Institutions and Asylums
Until the end of the last century, in Europe and America, people with serious mental illness tended to be institutionalised. They would either be hidden away at home or detained in an asylum.
Some of these institutions may have provided good care and, since the Victorian era included lots of activities such as gardening, workshops, arts and crafts and even a brewery.
However, one of the key goals of these asylums appeared to be the separation of the mentally afflicted from the rest of society; a kind of mental apartheid.
Care in the Community?
From the 1960s onwards, in the western world, there has been a gradual shift away from these huge institutions with prison-like walls towards 'care in the community'. In my own country, the UK, these old asylums are either closed or have turned into more conventional hospitals.
Unfortunately one of the key drivers for change was and is money. Beds in old fashioned asylums were expensive and leaving the mentally ill to be more independent is more cost effective but also has disadvantages.
Coupled with this approach, is a tendency to over prescribe medication in order to 'control' the condition. Prescribing drugs is cheaper than delivering therapy or training the sufferer to either control their condition or overcome it. The drugs companies also have a vested interest in prescription drug-based treatments.
Please understand, I'm not suggesting a return to old-fashioned asylums. However, I am concerned that adequate funding is available to make sure care in the community is allowed to work properly. In other words, it really is caring!
In my own country the mentally ill can still end up institutionalised, not by an asylum, but because they are unable to return to the workplace. They can often find themselves isolated and lonely and It is no coincidence that a relatively large proportion of the mentally ill end up sleeping rough or in prison.
Typical Care Facilities
The Recovery Model
So what about the Recovery Model? Why is it such good news for those who need help?
To many it may seem like common sense. In the recovery model someone who is deemed mentally ill is encouraged to take responsibility for their own recovery. The patient (or Service User in UK NHS jargon) is a consumer who chooses their own route to recovery.
The central assumption is that most people are capable of moving towards a full or partial recovery from their mental health condition. In other words no one should ideally be abandoned with only a lifelong drugs cocktail to consume.
But what do we mean by Recovery?
Recovery can be seen as a positive personal journey towards fulfillment in life. For some this will mean a complete recovery from the original condition.
It may mean being able to hold down a job and live more or less independently of the health care system and even being able to function without medication. Along the way the person will typically gain a sense of self-worth, find supportive relationships and empowerment.
They will also feel included in society and acquire skills (self management) enabling them to cope with their original condition.
Self-management means learning what triggers episodes, what reduces symptoms and having a say in ones own treatment including which drugs to take.
The idea of the Recovery Model isn't new. It originated with Alcoholics Anonymous and the 12 steps to recovery and was originally firmly routed in the Christian Faith. The scope was later broadened to include other faiths and those with no faith at all. It is also applied to other addictions such as gambling and recreational drug taking.
For Alcoholics Anonymous, the centrality of 'God' was changed to 'a Higher Power' to broaden its application in a multi-cultural society. Today's Recovery Model as applied to mental health recognises the importance of spirituality in recovery and encourages those on the path to recovery to explore their spirituality.
Clearly not everyone will be able to embrace this ideal and there is no intention to force anyone to follow this model.
For those able and willing to accept the challenge, however, there is the hope of facilitating real change in their own life and being empowered to take control of their own destiny.
The recovery model changes the patient/practitioner relationship putting the individual at the centre, managing their own recovery and the medical practitioners become more facilitators.
The model is currently being adopted in many countries including the USA and Europe simply because it is accepted that traditional mental health treatments have not always been particularly successful.
You may wonder what prompted me to write this. Well someone close to me was diagnosed with Bipolar Disorder some years ago and her gradual recovery very much followed this model.
She went from being an inpatient on a psychiatric ward to returning to University and becoming a health care professional specialising in mental health. She is now working very successfully at changing the lives of those with mental health difficulties and is a champion of the recovery model.
She still has the diagnosis but for most of the time is able to manage her own condition and focus on helping others at the same time.
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