Wirral Mind Recovery

Positive Mental Health Group

2007-09-12T06:55:00.000-07:00

Positive Mental Health Meeting

Written by Bob Knowles

ANYONE WHO WISHES CAN USE THIS MATERIAL TO START A GROUP. WE ARE HAPPY FOR YOU TO GET IN TOUCH WITH US AT WIRRAL MIND AND WE WILL GIVE YOU ANY ADVICE OR ASSISTANCE AND THE BENEFIT OF OUR EXPERIENCE SO FAR

On Wirral, we have developed a Positive Mental Health meeting. It is open to all-comers. It is attended by experts by experience, ‘service users’, carers, paid staff who work in mental health, and people – just ordinary people who are interested in improving their mental health and approach to life, by giving and receiving ideas and group support from other similar people.

The following will give you an idea of what the meetings are about and how they run. It may look at first sight to be a bit wordy and complicated but when it’s running it seems to flow very well. The structure is important because if there are lots of groups all over the place, similar to 12 Step Programmes , you will feel at home and secure as a participant where ever you go. And the structure helps avoid the meeting drifting all over the place. It remains focussed on things that help.

These are the things that we found work best for the meeting.

The meeting lasts an hour and a half.

It starts on time and punctuality is encouraged, but people who are unavoidably late are welcome to join.

Chairs should be arranged in a circle and should be as far as possible at the same height.

Water and/or squash is available at the beginning of the meeting but making tea and coffee is not encouraged because it can delay the start of the meeting and often gives one of two people extra duties when they should be concentrating on themselves.

One person should be identified as Group Facilitator the week before, whose job it is to open the meeting and ask another group member to read the Problem and the Solution. The Group Facilitator is also there to be the main person dealing with any particular problems that arise. The meeting is designed to provide an opportunity for those who are currently able to work on their Recovery. It is not likely to be appropriate for people who are currently experiencing high levels of distress, who are likely to get appropriate support from others, before regaining their ability to benefit from the Positive Mental Health Meeting.

There are three ways in which the meeting might proceed.

The main way is for the sharing and development of recovery ideas around a particular topic. One person should be identified as the lead for sharing the week before. This person can decide to talk and share thoughts and feelings about an issue of topic of their own choice for others to follow. This person is likely to talk about this topic for 5 to 10 minutes before opening up to other group members for their sharing. As the beginning of the meeting it is hoped that all group members will have something to say and that they are encouraged to do this without interruption from other group members, so that they can develop their own ideas and be listened to. After this initial sharing the group moves on to developing ideas more conversationally about ways in which they have learned to cope and deal with any of the issues raised to achieve steps towards their recovery.

From time to time, perhaps one meeting in four, it will be decided we before to have a Step Meeting. The weekly Facilitator will suggest that the group looks the next week at one of the Steps to Recovery that underpin the meeting. Again one person is identified to lead around the step and the others are invited in the rest of the meeting to share their experiences and ideas around that step.

Again, by mutual agreement, the group can choose to concentrate in the next meeting on a particular problem that one of the group members is having. The group member will begin by explaining the problem and their reaction to it, and the meeting will provide an opportunity for all group members to pool ideas together about how the individual group member and they themselves, if they have similar concerns, might move forward positively.

When there is about 5 to 10 minutes remaining, the Facilitator will begin to conclude the meeting by asking the identified member to read The Solution. After this the Facilitator will read the closing statement and draw the meeting to a close. After the meeting has formally closed members of the group can talk with one another individually, make cup of tea or coffee, if the arrangements with the owners of the building allow this.

The meeting’s facilitator accepts the responsibility, with the help and support of any or all of the members, to deal with any member who is clearly too distressed on the day to join in the meeting, who becomes distressed in the meeting, or who says things that indicate that their safety or the safety of others is at risk. In this instance members of the meeting accept that in extreme circumstances the facilitator or others may make contact with appropriate mental health professionals to ensure safety.

Meeting structure – Aide memoire

The Chair starts by reading the Opening Statement
The Chair may also read The Problem, or ask if there is anyone else that might like to read it and also to read the Solution at the end.
The member who has agreed to lead the meeting around a topic then shares their thoughts. During this time members are asked to listen without interruption.
When the topic leader has finished, the meeting is open to any or all members of the group to share their thoughts, feelings and personal reflections around anything that the topic has stimulated for them. This is a part for personal reflection and while people are talking, it is asked that others simply give the speaker their best attention and listen without comment.

During this part, which might last 20-30 minutes members are encouraged to share thoughts and feelings as they wish. People can talk more than once, provided they are not inadvertently blocking the sharing of others. It is hoped that all members of the group will speak even if it is only briefly. This reflects the importance we give to everyone’s contribution, and encourages those who have found it difficult to speak safely about themselves to take this opportunity.

After people have shared in this way, the Chair will say that the meeting is now opening up to become a discussion about the ideas and actions that might be used to grow and recover in relation to the general topic area. These ideas might be those that members have used themselves, heard about, read about, or experienced through others.
Five minutes before the end of the meeting, the Chair will either read the Solution, or ask the other member to read it.
The Chair will then finish the meeting by reading the Closing Statement.

Opening Statement by a Group Member

Hello my name is _______. Welcome to the Positive Mental Health Group. If there are any newcomers, a particular welcome to you.

We believe that all people have difficulties and distresses, These have affected us and continue to affect us today. This meeting aims to give people the opportunity to meet, discuss and find positive, useful solutions to these distresses. In this way we can move towards achieving our full potential and a better quality of life for ourselves.

In coming to this group, you will realise that you are not alone. We all have had distresses in our lives. Many of us have not found safe places or people to talk about our difficulties, without being judged or controlled and have become isolated. We have often felt uncomfortable or even ashamed of our feelings and kept them secret.

In the meeting we break these patterns. We are safe to talk about what has happened to us and what is happening now, get in touch with our feelings and realise that all our experiences are valuable parts of our growth, which we can now take further. The group will accept that your experiences and your feelings are real and that you are not reacting to something you imagined.

Everyone in the meeting is equally important and we leave labels like "professional; manager; service user; patient" outside. We hope that by meeting with other like-minded people we will start discover more of our full potential, start freeing ourselves from the past and changing our lives positively. In the meeting we look at ourselves as we are, honestly and openly. We look at how we respond to difficulties and how we might change our approach and make more positive choices.

This meeting will be in two halves. In the first half we will discuss an issue that is important to recovery. During this part we do not allow crosstalk or advice giving, so each person can talk freely and without comment, one-liners, or interruptions. This will create a safe place to share thoughts and feelings. Crosstalk can easily undermine safety by recreating previous experiences of not being heard, being criticised or belittled.

In the second half of the meeting we may choose to concentrate on a particular person’s concerns or topic that has importance to them. The idea is to share as many ideas as we can to address the concerns positively. To achieve safety, we ask that what you hear at the meeting you leave at the meeting. Please respect the privacy of what is shared.

For the first half of the meeting, which may last around an hour we ask you to keep your sharing to about five minutes, so that everyone has the opportunity to speak.

Now, let's go round the room and introduce ourselves by first name only and, if we choose to, a brief description of how we feel today.

The Problem is then read aloud by a person at the meeting.

Even though emotional distress is common and a concern to everyone, the way that it is interpreted and treated does not usually tap into our human potential for recovery. There is often an expectation that the best hope is for us to accept our distress or receive treatment that just allows us ‘to get by’. We are sometimes expected to maintain this for the whole of our lives.

Mental health needs have also been seen as evidence of weakness or defects in people. They have often been described as the results of our faulty chemistry. As a consequence most of us hide our difficulties from others, even from those we are closest to.

In the community mental distress can produce fear based on ignorance. This can lead to discrimination and harassment. It has also meant that opportunities to consider our difficulties and find solutions as human beings are limited. The result can be that we withdraw into ourselves. We become afraid or ashamed of our own thoughts and feelings. Our self-esteem and confidence suffer and we can become dependent on others.

In our meeting we will try to address these issues, step-by-step, looking at ways in which we can take greater responsibility for ourselves and support one another to promote better mental health and recovery. We believe that there is a much wider range of positive ideas to bring to bear on mental health and that coming out of isolation is the best starting point.

At the end of the meeting a member of the group will read The Solution

As this meeting becomes a safe place for you, you will find freedom to express yourself, and free yourself from blockages and negative thinking and be more able to make positive decisions about your future. You may also pick up ideas from other people, and become someone who is able to make new decisions and try out new patterns of thinking and behaviour.

We believe that our recovery begins when we risk moving out of isolation. We hear ideas and strategies that help us and go forward, starting with us developing a better relationship with ourselves, based on gentleness, humour, love and respect.

We also have the suggested 12 steps to Recovery in Mental Health that can help focus our growth.

So, we meet to share our experiences, strength and hope with each other. We learn to restructure our thinking and become free to make healthy decisions as actors, not reactors. We progress from hurting, to healing, to hope. We take more responsibility for our own lives. And, as we look around we will see others who have an understanding and acceptance of our thoughts and feelings and who are there to encourage and support us in this.

Closing Statement by the facilitator or a Group Member

In closing, I would like to say that the opinions expressed here were strictly those of the person who gave them. Take what’s useful for you and leave the rest. The things you heard were spoken in safety and should be treated as completely confidential.

The welcome we have for each other in this group is special and real. We believe that whatever your problems, there are others in the group who have had similar experiences. We believe that however well or badly we feel our lives are going, there is always the opportunity for growth and improvement. There is certainly no situation too difficult to be bettered and no unhappiness too great to be lessened, by taking positive choices and positive actions. Ideas of how to cope, deal with problems, grow and recover from other people who have experienced distresses are the most valuable tools we can use.

Finding solutions together with other like-minded people can help us all improve our mental health and the quality of our lives.

Thank you for coming and we hope that you come back.

12 Steps to Wellbeing

Cultivate and pass on Hopefulness in your life

Learn out about ways you can keep yourself well

Admit there are things in your life that are a problem for you and take action to address these problems

Find out what you want from life and learn ways to tell others how you intend to get there

Get some support from positive people

Take a good look at yourself and take responsibility for your own change

Cultivate healthy thinking

Cultivate healthy behaviour

Cultivate healthy relationships

Give yourself time

Pass positive ideas and attitudes on to others

Get on with your life

We use these 12 Step ideas, which have been adapted 'Changes', whose website is well worth a look.

Wellness Recovery Action Plan

2007-09-12T06:47:00.000-07:00

WELLNESS RECOVERY ACTION PLANS

Known as WRAPs

A way of recovering from emotional and mental distress

People who experience emotional distresses or ‘psychiatric symptoms’ are often keen to find safe, effective things that they can do for themselves that will improve their wellbeing and quality of life.

One way that people are finding useful is WRAP.

WRAP can help you keep yourself well. It guides us how to identify and monitor our signs and symptoms and encourages the use of safe, personal skills, supports and strategies to reduce or eliminate the impact of distressing experiences.

WRAP is not meant to replace professional support but to compliment it, though it has been found to shift the focus in mental health towards a self management approach and away from dependency.

Who is this booklet for?

WRAP is useful for everyone. It is a way of maintaining an improving your quality of life on a daily basis. It’s particularly useful if your well-being is being threatened by life events. WRAP puts you firmly in the driving seat in your life, not in the passenger seat, nor in the back of the car and certainly not in the boot!

What is Wrap?

WRAP is a plan that helps you focus on the detail of what you can do for yourself, when you want to improve your emotional, mental, physical and social well-being - however difficult or stressful your life is currently. WRAP can also be used in many other situations, such as dealing with a physical illness or disability, improving or ending a relationship, dealing with an addiction, losing weight, looking after yourself at work, keeping yourself well when you are a carer, moving house, anything....

How Can You Help Yourself with Wrap?

WRAP is based on the fact that you know yourself best. You are your own expert by experience on what brings you down or makes life difficult and equally you know best the ways you can live life to the full. No one else can tell you what to do to make yourself feel good. Remember it is you that knows yourself best. Of course other people’s ideas and useful therapies may be of immense value to you as part of your Plan.

Wellness Recovery Action Plans have been used across the world and have enabled millions of people to take control of their lives, in a way they previously thought impossible.

How do you get started?

WRAP invites you to write things down about yourself. So, most people start by getting themselves a ring binder, a set of section dividers and some blank paper.

People find that starting their WRAP is best done when they're feeling okay, they are in comfortable surroundings and have a bit of time to think. There is no time pressure with WRAP, you can take as long as you like. And if you find WRAP useful, you'll go on adding to it, so it never stops.

People find that developing and using WRAP with someone else or a number of other people is important. Sharing ideas about wellness is a good way of learning and growing.

WRAP is based on a number of key Recovery concepts

Hope - people with mental health problems DO get better

Personal responsibility – you are in charge of your own life and can make choices that will improve your wellbeing

Self advocacy – you can work out what you want from your life and can let people know about what that is and how you intend to get there

Education – learning about wellness and wellness tools from pamphlets, books, the internet, and most importantly directly from other people is important

Support – we all need the support of positive people we can be ourselves with

A WRAP plan is split up into a number of sections. This booklet will introduce you to the framework of WRAP. If you want to know more about it there are some ideas about getting further information at the back of this booklet.

Section 1

Wellness Tools.

These are the things that you do to keep yourself well, and the things you do to help yourself feel better when you don't feel well. You may have discovered them yourself or learned about them from others. Most of them are simple, safe and free.

Examples might include:

Going for a walk
Listening to music
Talking with a good friend
Taking a hot bath
Going for a swim
Meditation
Digging the garden
Writing a diary or a journal
Going to the cinema with a friend

Recently in a group of 20 people working on their WRAPs, between us we came up with 180 wellness tools that we were using!

What I'm like when I'm well

It is important for us to know who we really are when we're well. Some people have been stressed or distressed for so long that they've almost forgotten. Making a list of our positive characteristics helps us see ourselves for who we really are. The rest is really a reaction or a defence against stress and difficukly. It also helps us see the person that we might like to get back to being. For most people this is a collection of adjectives like….

calm, curious, fun, optimistic, quiet, outgoing, sociable, practical, vulnerable, silly, busy....

……but only you can describe yourself!

Section 2

Daily Maintenance Plan.

This is a collection of things you know that you need to do for yourself every day, to keep yourself feeling good and well. Of course, they are different for everybody and the following are examples

Eat three healthy meals

Take some exercise

Spend at least a quarter of an hour in peace and quiet

Talk to somebody I can feel real with

You also might make a list of things that you might need to do, especially if things are getting difficult, such as

Get a massage
Spend time with a good friend
Get a haircut
Get more sleep
Plan some fun

You can also put in this WRAP section other helpful reminders

‘New Wellness Tools that I would like to try’

‘New Wellness Tools that I am trying now’

‘Things I should like to avoid or cut down on.’

Supporters.

One of the most effective to dealing with difficulty or uncomfortable feelings is to reach out and get the support of a good friend, telling them how you are feeling or sharing an activity with them.

Many of us do have loving family members and good friends who like us, listen to us and readily give us support. They may be with us when we need to express our feelings, without judging or criticising us. But it is a common experience that when we start feeling unwell, a lot of us begin to feel quite isolated and alone. Sometimes we start to believe we are the only people in the world this is happening to and were on our own. And sometimes, we even isolate ourselves - not answering the phone and not reaching out to make contact with our supporters, for example. In your WRAP, you can identify your supporters and carers and what they have to give you, so you never need feel alone.

You are likely to be a supporter yourself too of course. In recovery everyone is a giver and receiver - of support, ideas and knowledge. You have a lot more to offer to others than you can imagine. You can become a ‘recovery guide’ for others, even when you are using your Plan to keep yourself well in the face of difficulty.

Section 3

Triggers

So, now you have plenty of Wellness Tools to use - plenty of ways in which you can maintain your emotional, physical and social well-being - now to make a plan of how these tools can be used when life gets difficult.

WRAP invites you to look at your triggers - actions, situations or people outside of yourself that may make you feel uncomfortable. They may make you think that you are at risk of “getting ill". But actually these are normal reactions to events in our lives. And if we don't respond to them, or deal with them in some way, they might actually cause our distress to get worse.

Triggers can be anything, here are some examples

The anniversary of a loss
Not getting enough sleep
Being judged or criticised
A physical illness
Family friction
Spending too much time alone

Triggers Action Plan

Now we know what our triggers are, we can make a plan to deal with each of them, if they come up, to stop them provoking a more serious reaction in us. So, for example, you might…

Make sure you do everything on your Daily Maintenance Plan
Call a supporter and ask them to listen, while I talk to the situation
Do some breathing or relaxation exercises
Try working on changing my negative thoughts to positive ones
Take some exercise, go for a walk

Section4

Early Warning Signs

In spite of our best efforts at reducing our distress, we still might begin to notice some early warning signs. These are our experiences inside of ourselves - thoughts and feelings. Everyone has different early warning signs in their reaction to triggers - so it is important to identify what yours are.

Again, these Early Warning Signs may make you think you are “getting ill", and they could be considered "symptoms", but they are in fact normal reactions to stressful situations. Some early warning signs that people have reported are…

Anxiety
Forgetfulness
Feeling slowdown or speeded up
Being obsessed with something that really doesn't matter
Increased irritability
Increased smoking
Weepiness
Feeling worthless or inadequate
Feeling abandoned or rejected
Racing thoughts

Early Warning Signs Action Plan

Now that you know what your early warning signs are, you can make a plan to deal with them. You can make a list of things you must do such as…

Do everything on your Daily Maintenance Plan, whether you feel like it or not
Tell a supporter or counsellor about your feelings
Spend at least an hour doing something from my Wellness Tools list

When things are getting worse or breaking down

At this stage, you must act to prevent crisis, and you need to use more of your wellness tools.

The next section lists the sort of signs that you know show that things are getting even more difficult for you. They might include……..

Staying in bed all day
Drinking more
Cutting yourself off from friends and supporters
Not eating
Not sleeping
Feeling that there is no hope

If any of this type of thing comes up for you, you do need a plan. It might include things such as……

Get in touch with your doctor or other health or social care professional
Phone and talk for as long as you need to one of your main supporters
Make arrangements to be with somebody until you are feeling better
Take action, so that you cannot hurt yourself - perhaps giving your medicines, chequebook or car keys to a supporter

Section 5

Crisis Planning

If you have been unable to return to wellness by using the Wellness Recovery Action Plan, you might need to make a Crisis Plan. This is important if you are very unwell. It is likely to be a time when others have to step in and take care and responsibility for you and parts of your life. This might be a time when you are in hospital for example. This Crisis Plan is a little more complicated and you would certainly need to do it along with other people. A Crisis Plan is a list of instructions and wishes that you would hope would guide other people's actions to support you.

For example it might include such things as….

Ask my friend or supporter to pick up the children
If I am anxious, it helps if you take me for a walk
If I talk about harming myself, please do everything to make sure that I am safe
I may need sleep and I'm okay about being given a sleeping pill

Section 6

Post Crisis Planning

In your WRAP, you may wish to write down a plan for when you are returning to your normal life after a crisis - a timetable by which you can successfully take back control of your life. It is important for this part of the plan to recognise the pace at which you want to go - not too quickly or slowly - so that you can heal and mend in a way that is best for you.

It is a time when getting the help of your supporters is likely to be very important.

HOPE

IS THE KEY TO RECOVERY

If you want further information about WRAP and you have the Internet look at…..

www. mentalhealthrecovery.com

www.SeftonRecoverygroup.org.uk

http://home2.btconnect.com/wirralmind/

You could order an English version of The WRAP Book (ISBN: 0-9549295-0-0)

Look on the Wirral Mind website on the Training link to see if there are any workshops coming up

Acknowledgements

WRAP has been developed by Mary Ellen Copeland

It does get better

2007-09-06T07:32:00.000-07:00

It Does Get Better

If you're troubled, it will pass.

If you're unhappy, it won't last.

If you're low, you will come up.

If you talk too much, you will shut up.

If you're silenced, the words will flow.
If you're lost, you will see a way to go.
If you're lonely, you will find a friend.
If you're skint, someone will lend..

You what you need to get by today.
It does get better, believe me when I say this;
As it does improve,
Really there is Nothing to lose.

It does set better; don't forget that

it's a passing phase; it's where you're at.
But things will change for you one day
and you can rest and lay

A weary head on to life once more.
Be happy, just open the door.
Let life in; forget this hell.
This is recovery, you will be well.

One day; believe me it's true.
And it always starts within YOU

Recovery...What helps?

2007-09-06T07:30:00.000-07:00

PEOPLE WITH MENTAL DISTRESSES DO RECOVER.

BUT WHAT HELPS?

For years, psychiatry has been sending out messages of hopelessness about the chances of recovering from many mental disorders.

Certain diagnoses have usually been associated with a lifetime of illness and disability.

This view assumes that severe mental distresses are not something person has, but it is something person is - as if every part of the person has been taken over by the condition. As if the person's whole identity has been occupied by an alien being, that is completely uncontrollable.

There is however plenty of research findings challenging this point of view:

Many people do recover, even from very severe mental disorders.

There is hardly any instance in which it can be said that the person, who shows signs of severe mental disturbance, is wholly or completely disturbed. There are always parts of the personality and remain intact and develop independently of the "illness".

Many people develop ways of coping with their symptoms and are able to live self-reliant and wholly meaningful lives.

Many people, with the right support and treatment, develop beyond what had earlier been expected from a person with a "chronic illness".

Good reasons for optimism

Schizophrenia is the diagnosis most consistently associated with a chronic lifelong illness. In certain psychiatric circles patients who recover after having been diagnosed schizophrenic, are thought to have been given the wrong initial diagnosis! For if they had had schizophrenia then they couldn't have otherwise recovered!

Today several studies indicate that between half and two thirds of all people diagnosed as having schizophrenia do recover - are ‘symptom free’ – sometimes with medicines and sometimes without them. So, it is certain that patients diagnosed with other diagnoses of ’mental illness’ and emotional distress – bipolar disorder, depression, anxiety and so on - can also recover.

Recovering

To recover can mean different things in contemporary research and among people themselves. Recovery is not regarded as an endpoint but as a process, the reassertion of an independent relationship to the self and to one's own life.

Some patients recover socially, though still continue to experience certain symptoms which could be regarded as a mental disorder. Perhaps they still hear voices or have visions, but they find they are not troubled by them or maybe not troubled to the same extent or in the same manner as before. They have found a way to cope with their voices. They may remain in contact with mental health services for support and received medication in low doses. They may still receive some support from the social services. But this does not prevent them from living a satisfactory life, having friends, studying and perhaps having a job or meaningful employment.

Many patients recover totally - that is they no longer experience any symptoms of disorder or distress and do not receive any treatment. They live an ordinary life and no longer need to turn to psychiatry or the social services for help to deal with their mental or emotional problems.

Recovery seems to be a real possibility, even after years of having a severe mental disorder.

What helps?

Many of the treatment interventions psychiatry can offer do bring some relief. But they can also give rise to painful experiences. The same can be said about interventions by the social services. Some patients recover thanks to specialised support, counselling, psychotherapy and/or medication. But other studies indicate that a proportion of people who recover from, for example, schizophrenia, have not been helped to any appreciable extent by these forms of intervention, seen over the long-term.

“In Vermont, rehabilitation was offered to a group of patients who remained behind in the mental hospital when the other patients with a better prognosis were discharged. They were considered the "hopeless cases". An effort was nevertheless made on their behalf. The year was 1956. 30 years later, 82% of those who had been diagnosed as having schizophrenia were living independent lives in the community. The majority had formed friendship ties with the care givers, who had helped them to make a place for themselves in the local community." (Harding et al 1987)

Many people recover! How is this possible?

There is a lot we know today about what the people, who have recovered, say has helped them on their way. Significantly, there doesn't seem to be a single way, any one kind of intervention that suits everyone. On the contrary the crucial factor seems to be that they have each found their own way. They found the strength of will, determination and support they needed to find a way that works and feels best for them themselves. The right response from the start is vital.

Today, there is considerable evidence to show that the right response from the start can interrupt the illness at an early stage or ameliorate its course. By the right response, we mean that mental health staff, carers, loved ones and other people experiencing distresses in supportive relationships are sensitive to the person's own way of understanding the problem. It is important that help is provided as far as possible in the individual's home and community setting, that the time spent in institutional care is as short as possible and that the lowest possible dosage of medication is prescribed. The individual's social network, family, friends, relatives, may also play an important role, both on their own and together in partnership with psychiatry and the social services. There is no reason why mental problems should result in social isolation.

Early intervention is important. But even people with a long history of mental disorder do recover. Research has shown that after a number of years painful experiences tend to stabilise. Individual people in their surroundings develop ways to cope with ‘symptoms’ in order to live as good a life as possible. Individuals become independent in relation to the illness. A process of recovery has begun.

Contrary to common belief, people with severe mental disorders are seldom completely unaware of their difficulties. Often they know that they "shouldn't" be hearing voices, that they "shouldn't" be acting in a certain way, or that possibly not everyone is against them, not everyone wants to get at them.

People cannot be reduced to their symptoms and diagnoses. Like everyone else, those who experience mental distresses also have many other sides to their personality, other interests, areas of knowledge, abilities, wants, hopes and dreams.......

There are many areas of the personality that are not affected by the person’s distressing experiences or delusions. People seek solutions to their problems, solutions that others might perceive as symptoms. Some people might feel that it is less distressing to isolate themselves rather than endure the insecurity and anxiety they experience when meeting other people.

So everyone’s route to Recovery – a better quality of life -is different. And this goes for ALL human beings, because we all have times of change and difficulty, when our self esteem and our ability to maintain wellness and good quality of life are challenged. And there are hundreds of “wellness tools” available to all of us – safe, simple, practical ways, in which we can maintain or improve our wellbeing if we choose.

Hope

For many people with a mental disorder, one crucial factor for their recovery is Hope. Hope for a different life in the future. To hope might seem unrealistic, when the strong message is often given that people with problems, especially intense and very uncomfortable ones, have to accept being mentally distressed for the rest of their lives. That they shouldn’t expect to work again, that they are going to be in need of help, that there relationships are going to be difficult. But none of these messages is likely to be true.

Hope generates the will to change. And this, under the right circumstances and with the right support, can open up a range of possibilities. At first, the changes are probably only slight. Small changes in daily routines, so small and other people may not even notice them. Nevertheless, to the people with mental distresses, these changes prove that there is much in their situation that can be different. They are able to direct their own lives. They are not completely helpless in dealing with personal problems. They can hope to regain power and control over their lives.

It is the small changes that keep hope alive and strengthen that part of the person struggling to create a better life.

Some of the people recovering from mental disorders talk about having made a decision. Perhaps the decision was "only" to ignore certain symptoms. Consequently, although they still have uncomfortable or bizarre experiences, these no longer play such a dominant role in their lives.

Or they might have decided to do something different, to take a risk and see if they can handle being amongst "normal" people - to dare to take risks even though progress might be only one small step at a time.

Hope can be owned and passed on by everyone in the mental health system. But it is given and received most profoundly from other people who are in recovery themselves. Those who are starting their recovery journeys say that meeting with others, who have had the same or similar experiences and who have recovered, grown and prospered as people, are the most inspiring sources of hope. These people are Experts by Experience, who have walked the walk and now have wisdom to give to others on their journey.

And we are all capable of such inspiration ourselves whether we are paid professionals, carers, managers, supporters or just people!

Other people

Other people play an important role in the recovery process. They have support, wisdom, ideas, hope, friendship, laughter and much more to offer.

They can also keep hope alive, when the distressed person has lost all hope and just wants to give up, by being there for the other person. Simply being there - without insisting that the person who is currently in a bad way should pull themselves together, get on with their life, or get active. It means being there for the other person and accepting that they have difficulties but also strengths and resources.

Family members, who persevere and do not abandoned their loved ones, stand for continuity. They are a strong thread in the other person’s life. They have shared times of joy and times of sorrow and this enables them to help the person to link together different parts of his or her personal history. Close family members can also stand for all-important material and practical support, both in daily life and times of crisis.

Professional helpers in psychiatry and social services may also be a contributing factor in recovery. But people who have recovered seldom described their way back to an independent life as a result of a specific treatment intervention. What has mattered is often something else – authentic encounters. When professional helpers dare to cross the imaginary line separating them from their patients and relate as human beings, both on a journey through life, open to the individual’s personal struggle, to the person’s life. When they expressed interest concerning such simple questions as “when you help yourself, what do you usually do?”, or “ What do you want to do in your life”, when they risk putting aside traditional institutional rules and routines.

When they have the courage to offer something else besides treatment and supportive measures. When they can accept what the distressed person has to give as well as receive.

“If I have to look for what I call a lifeline, then I guess it’s my mum - and our clashes. She has never given up, even when I have screamed at her. Despite all the traumatic experiences we had earlier, she never gave up. That is what’s meant the most”.

People, who have recovered, stress the importance of being part of a mutual relationship with one or more others. To no longer be a person who is always on the receiving end. To experience what it is like to be givers well as receivers. Just to give something to someone else. This is a tremendous step on the road towards recovery.

There is a great risk that what the professionals look for most of all is progress defined in terms of the treatment plan and are only willing to acknowledge “the healthy side”, disregarding a person’s suffering and their distressed side. But both sides go into making up the whole individual.

And there are many others – fellow patients, friends and brief acquaintances – who can contribute to the recovery process. Recovery invites new mutually supportive relationships with all these.

Medication

For many patients medication is important. But equally, for many of them, having to take the drugs prescribed by psychiatrists, is a frightening experience. Sometimes they are given very high doses without explanation. Seldom patients are fully informed about what effects the drugs are supposed to have and what side-effects they could expect.

Some are given medicine, and only medicine. And they are not given medicine as part of a personal relationship with a doctor or nurse. They are rather given medicine as a substitute for a personal relationship. And in the worst case, medication is a battlefield where patient and psychiatrists are fighting against each other.

Sometimes administering the medicine is reduced to a routine act, which gives the patient no chance to discuss the possibility of gradually reducing the dosage. An injection every third week, and that’s that.

People who have recovered also talk about the kinds of drugs that have helped them regain control over their lives. Here the medication is often prescribed as part of a joint effort on the part of clinical staff and the patient – a real partnership. According to patient’s stories, medication can be seen as something more than simply chemical substance introduced into the body. Medication works best when it is used in a personal context, when the people who take the medicines are informed, involved and have control.

Good places

The recovery process needs support. This support can be found in places where individuals feel accepted, both of their problems and for their dreams and personal resources too.

Social services and psychiatry can provide good places: clubs and meeting places, supported housing, occupational and recreational opportunities, to get people going again. They can support the development of self-help groups, which are a great source for recovery. And there are places that are open to everyone, such as community colleges and voluntary organisations.

Good places are places where a person can be one way and then the other. They can be themselves. They are places where a person is not regarded as “mentally disturbed”. Nor do they feel obliged in these places to always act “healthy” - and only “healthy” - secretly hiding their suffering from the others.

The recovery process

Recovery is not a straightforward process. Not everything can be accomplished in one day. It is about the recapturing of oneself – a painful process often marked by two steps forward and one step back. Long periods when nothing at all seems to happen then suddenly interrupted by a leap forward.

There may be more going on under the surface during these long periods than meets the eye. It may be a time when a person composes themselves and prepares themselves for the next step. Training for it, working it out and preparing to try new ways of being and behaving. Sometimes this training happens when people are on their own. At other times they might be in the company of others. But in either casethe fear of falling is often very much present. Support is crucial here.

Many people who have or have had mental distresses talk about a deep sense of loneliness. Few people, if anyone, have wanted to, or been able to be with them during difficult episodes.

Like all human beings, people with distresses are searching for a meaning behind what they have experienced in the past or are still going through.

It is important to find meaning, an explanation of why one’s life has turned out the way it has. But it is also important to find out what can be done to change. It is not a question of finding a ‘one and only truth’ in life – just a meaning for yourself. What has meaning to one person may not have meaning to another. But finding a meaning, an explanation that bears up under pressure, seems to have the power of truth and that is what helps. Distressed people, who recover, have different explanations for what has happened to them and how they have overcome it.

“We do remember that even when we had given up, there were those who loved us and did not give up. They did not abandon us. They were powerless to change us and they could not make us better. They could not climb the mountain for us but they were willing to suffer with us. They did not overwhelm us with their optimistic plans for the future, but they remained hopeful despite the odds. Their love for us was like a constant invitation, calling us forward to be something more than all of this self-pity and despair. The miracle is gradually I began to hear and respond to this loving invitation”

Patricia Deegan1988

There are many explanations - some refer to talk about their childhood, others about deep psychotherapeutic revelations, others talk about the harm caused by medication, about how they have been disempowered or even abused emotionally by the system, still others are pleased to have eventually found “the right medication” or to have found a way of living without it. For still others, the thread is a vital personal or intimate relationship and how the support of important people has led to the turning point.

Although one explanation often dominates, it is not uncommon for people to combine explanations. What they all have in common is that they have succeeded in finding meaning in their lives and meaning to life.

What can be done?

What we have learned is that we have to expand our knowledge. We must all do this together – in partnership - with people who have experienced mental distresses.

No person is only or completely mentally disturbed - no one is ill all of the time. Most patients recover. By realising this, we are laying the foundations for being of some help in the recovery process of others - that is by our continuing to hope.

Hope is essential to persons with mental problems. It is also important for people in the person’s surroundings to be able to convey their own hope. Revealing that they are people who refuse to give up, especially when a sense of helplessness is most overwhelming.

People with mental distresses often develop many of their own strategies for coping with their symptoms. It can be important to them that their efforts are recognised and they get support to improve them, but it is also important that they learn from other people strategies. Sharing ideas is a powerful route to recovery. Using the expertise we all have learned throughout our lives to keep well and learning more wellness tools from others is important too.

Nevertheless, each person has to find his or her own way and his or her own way of understanding.

It is the responsibility of psychiatric care, local authorities and social services, to work together to develop a wide variety of activities, services and opportunities – a range of activities, treatment interventions and support measures, from which the individual can choose whatever works best for them. Currently the range is far from wide. Most people don’t know where or how to learn about recovery and wellness.

If they really want to succeed, it is the responsibility of psychiatry and social services to make it possible for staff to establish long-term relationships with patients. Being a mental health worker is not “a technical job” but a human one. It should be borne in mind that people who have recovered from mental disorders seldom attach any importance to specific forms of treatment or support measures, the systems or therapeutic approaches they have experienced.

Instead they talk about the people, the individuals, who have taken their side in their struggle.

Alain Topor

Bob Knowles, Training Manager

Wirral Mind, 90/92 Chester Street, Birkenhead CH41 5DL 0151 512 2200

If you want to know more about Recovery…

www.mentalhealthrecovery.com

http://home2.btconnect.com/wirralmind

www.recoverydevon.co.uk

www.changes.org.uk

www.rethink.org

NIHME Statement on Recovery

2007-06-13T02:42:00.000-07:00

Recovery

Historically, people with mental illness were often not expected to recover. For example, people with schizophrenia were generally perceived as having a poor outlook, having to live their lives in a uniformly downward spiral of persistent symptoms.

This perception has influenced the public view of people diagnosed as having mental illness, as being ultimately unable to take control of their lives and to recover. Services of the future will talk more about recovery as they do about symptoms and illness now.

We need to create an optimistic, positive approach to all people use mental health services. The vast majority have real prospects of recovery - if they are supported by appropriate services, driven by the right values and attitudes.

The mental health system must support people in settings of their own choosing, enable access to community resources including housing, education, work, friendships - or whatever they think is critical to their own recovery.

NIHME Guiding Statement on Recovery January 2005

What is Recovery?

2007-06-13T02:41:00.001-07:00

What is Recovery?

WHAT IS RECOVERY?

The Government report that 20% of the population of the UK has a significant mental health problem that any one time. A conservative estimate. In areas of social disadvantage this could be as high as 50% of the population. Prescriptions for psychotropic medicines account for a quarter of the NHS drugs budget.

On Wirral this means that between 30,000 and 50,000 people have significant mental health needs. There is no way that the mental health services, as they are currently configured, could begin to cope with these numbers. It would be impossible for the government to fund appropriate numbers of services and workers from taxation. The only viable alternative is a change of culture - a change in the way we as citizens respond to each other's mental health needs and how the community provides better opportunities for recovery and inclusion.

Most believe that this culture change will only take hold when users become leaders and are seen to be experts by their own experience, with power and influence in the process. Statutory agencies and service user groups have talked about ‘user’ participation, involvement, and empowerment for years. And there have been improvements and developments, thanks to the efforts and energies of a small group of experts by experience. Recovery could well bring things together and drive things forward in a way that we could only have dreamed about just a few years ago.

So everyone seems to want the same thing - a vibrant, responsive, positive, involving, preventative mental health culture and ‘services’ based on the real needs of the people. A mental health culture that is hopeful in all its parts and works from positive principles.

Recovery may have a major impact in this process.

To begin with Recovery is a set of ideas and practices that has grown from and is now owned by peoople who use service and survivors – experts by experience. One such champion of Recovery is an American woman, Mary Ellen Copeland. Mary Ellen was diagnosed with bipolar disorder, a serious mental health condition. She reports that she asked her psychiatrist for information about how others with this condition coped. She was dismayed that neither he nor any members of the professional team were able to point her in the direction of such information. Lots of information about medicines, health and safety but not how real people cope and take control of their lives. She advertised for service users to send her ideas from their own experience of maintaining and improving their quality of life. She was overwhelmed by the response. She collected this information and has now written a number of books about Recovery, using this material, directly gained from experts by experience themselves. Many of her ideas can be seen on mentalhealthrecovery.com. These ideas are now being picked up by people experiencing mental health problems around the globe.

Recovery has two strands. One is the work that individuals can choose do for themselves to take charge of their lives. This enables people to manage their own needs (become self agents) and maintain their wellness. This usually involves using Wellness Recovery Action Plans, a self management tool that many find powerful and positive. Many have found that this has greatly increased their opportunities, got them in touch with other people working towards their own recovery goals and has increased their confidence and hope. Many have found that they have grown as people, well past the point that they previously considered their goal of "getting back to normal".

The second strand is the growth of recovery opportunities in the community and changes in the delivery of services. Service users have found that self-help groups, peer counselling, and involvement in awareness and anti-stigma campaigns have been enormously beneficial.

Statutory and voluntary agencies are already involved in Recovery, because it can produce positive changes for professional staff as well, not only in their work but in their personal lives. Paid professional people need to feel hopeful too!

Recovery is beginning to grow on Wirral. There is a Recovery Steering Group, which meets regularly and consists of experts by experience, carers and professionals of all sorts. There is a programme of Wellness Recovery Action Planning and plans to run workshops on Wellness Tools. Many statutory agencies like Wirral Social Services and the Cheshire and Wirral Partnership Trust are helping to promote Recovery. More and more people are using WRAP to help themselves and each other.

Recovery works when experts by experience and people who use mental health services are in the driving seat. With hopefulness anything is possible.

BobK 2007

Simon's Recovery Journey

2007-06-13T02:38:00.000-07:00

Hope

Initially there was none. Direct quote from my consultant –

“You will never work again”…...

“….bipolar disorder is cyclical therefore, there could be recovery, though insignificant because of inevitable relapse.’

And because he was the expert, I believed him.

For ten years I did not consider beginning any relationships with women. I was told there was no hope of real and lasting recovery – I didn’t want to subject anyone else to the horrors of the illness I was suffering at that relatively early stage.

In Wellness Recovery Action Planning training – which I shall mention briefly later – we liken this experience to the metaphor of being blindfolded, gagged and bound in the closed boot of a car. I didn’t know what was happening, I was very frightened, I cant see where I am going – I have no control of where, how quickly, how long the journey. That’s how I felt from day one. In other words ‘abandon hope all who enter here’

There are some real negatives to having a bi-polar disorder. Unless you/your family are substantially wealthy, bi -polar disorder ruins you financially. I have been in debt to 10s of thousands of pounds over the 21 years but I have never been declared bankrupt - even though have been on benefits for most of the time I have paid it back. When manic or even hypomanic, its very easy to talk even the most experienced financial advisor to give you a large loan, several credit cards etc. - believe me I did it!

The turning point for me came with a change of psychiatrist who actually asked me what I wanted from life and listened to me. A fantastic occupational therapist began visiting me. It took her 6 months to restore my confidence and self esteem, which were zero. At this point, I couldn’t leave my parents’ house, not even to go into the garden. I had stayed mainly in my bedroom for approximately 12 months.

The more I achieved, the more I was able to achieve and the more I began to feel confidence and hope for the future.

Hope is the key to recovery.

Personal Responsibility and Self Management

I was told that whatever I did to keep myself out of hospital, because bi-polar disorder is cyclical there was actually nothing I could do to avoid relapse leading to re-admission.

You possibly won’t believe this but I am actually in the middle of a relapse now and do I look as though I need to be in hospital? On Tuesday of this week I was allowed home from a social services residential establishment where I was using one of their crisis beds to help me self manage my condition. (ironic really because I work for social services now!). Due to what I have learnt recently I now know that a full blown relapse is avoidable.

This time I recognised the early warning signs that I was becoming ill. It is then that I used the tools from my Wellness Toolbox.

Lack of sleep is an early warning sign for me. It is the one thing that exacerbates my illness the most, especially in hypomania. Sleep deprivation studies have shown that if you deprive anyone of sleep they begin to experience psychotic symptoms such as auditory and visual hallucinations so how much more is it going to affect me who is vulnerable to these type of symptoms anyway!

The difference now is it’s crucial to recognise the early signs of my illness because I have too much to lose by relapsing. I have 3 jobs – I work for social services in a community day centre, I sit on the NHS Acute Services Forum and am a consultant for a disability consultancy service that educates the general public – starting ideally at secondary school level - about mental health issues to stop prejudice and ignorance really before it begins. I was also recently engaged and I moved into my own flat. Learning to manage my illness and recognise when I might need some help is crucial to building my future.

Education

My education regarding bi-polar disorder began with my uncle Jim. He was a Senior consultant radiologist at Huddersfield royal infirmary. He could access any information I needed from any NHS source or from the university with which he originally studied. Pointing people in the direction of information about their condition is really important, I certainly found it helpful as when you know what is happening there is less to fear. But, and it is a big but, a lot of the information doesn’t give you much hope! It wasn’t until I started to find out about wellness recovery that I really realised that there are things I can do to help myself and things that I can do to regain wellness.

The wonderful OT taught me square breathing, physical relaxation [tensing and relaxing different muscle groups] and mental relaxation [walking in fields or my girlfriend and myself in the Maldives!]. This is a coping strategy that has helped me to deal with my anxiety that I get when I am starting to feel unwell.

And another great OT – yes there are many professionals who do help lots! - taught me approximately a dozen methods of combating my auditory hallucinations.

I must mention at this point that I am a trombone player of 30 years now. If I don’t employ any of the techniques that I learned, the only times I don’t have the hallucinations are when I’m sleeping or when I am playing my trombone. When stress increases they become louder – at times they are screaming at me - but I have learnt to cope with them and can feel well despite them. Also, to go back to sleep deprivation – the voices can become hell as my sleep becomes less but with education I now understand what is happening and can tell myself that its not surprising that I’m feeling this way after only sleeping 4 hours in the last 60!

Self Advocacy

I have been constantly given the message that healthcare professionals are the experts and the only people who know about my illness.

When I asked one consultant could he explain my condition to me and how the various meds I was prescribed worked, he told me he didn’t think I was of the intelligence to understand what he would be explaining to me! My first job was working at Unilever research doing research chemistry – including biochemistry and organic chemistry!!

How things can change! I am now referred to as an ‘expert by experience’ - my opinion is sought because of my 21 years experience of the healthcare system and my relationship with my consultant psychiatrist, CPN, OT, social worker, key worker in day services is more of a partnership than a professional expert versus patient one. I am listened to more and this has empowered me. People now recognise my expertise regarding my experience of bi-polar disorder – my experience is my own and I am the expert on my own journey!

Support

In the first stages of bi-polar disorder you lose many if not all of your friends – it’s easier for them that way.

I’m lucky! During the 21 years of my illness I couldn’t have been more supported by my family who have been, and continue to be, excellent in that respect.

I am now beginning to rebuild my network of friends. Mary Ellen Copeland [who has a bi-polar disorder and who conceived the concept of Wellness recovery Action Planning] advocates a network of at least 5 people, at least one of whom should be able to offer support at any one time. It’s important to be able to talk to someone if you need to but also to share a laugh, go to the gym or just hang out. For me this is ongoing.