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Stories Submitted thoughts and stories Same old problem, same old solution?
Stories Submitted thoughts and stories Same old problem, same old solution?
Same old problem, same old solution? |
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hospital | male | practice development | recovery focused practice | service provider | statutory mental health services (+) | statutory mental health services (-) | voluntary mental health services
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Author: Derek McLeod-Petrie Published: 06 January 2006 In this paper Derek McLeod-Petrie (Mental Health Improvement Co-ordinator for NHS Grampian Public Health Unit) considers recovery in a historical context and asks if it is, in fact, a new idea. The views expressed are personal and may not reflect the view of NHS Grampian. When I was a student nurse, Barton’s (1959) Institutional Neurosis and Goffman's (1961) Asylums were required reading. These books were around twenty years old then; I don’t know if they’re still required reading, but maybe they should be. Barton described the role of psychiatric hospitals adding to the disabilities caused by mental disorders. Goffman introduced the concept of institutionalisation as a negative function of organisations which primarily function to deliver their own choice of services, rather than services which meet the expressed needs of their client group; both changed the face of psychiatry forever. When I qualified it was in a hopeful era, and we believed that individualised community care would solve all the problems that were left over from old, institutional influences; naïve, I know. In many ways, the recovery ‘movement’ seems to be still fighting that fight. This is interesting and perplexing at the same time. Mental health services have moved on in leaps and bounds over the past twenty years; many supportive mental health services have moved into the voluntary sector and out of a psychiatric setting altogether. There seem to be much greater levels of service-user and carer influence on mental health services generally. This begs the questions; “What is there still to do?” and “What is recovery anyway?” Jacobson and Curtis (2000) describe Recovery as an active, liberatory process through which a mentally ill person can reclaim their own life in all its aspects, and as a sound philosophical base for psychiatric services. They see it as characterised by uniqueness, hope, choice, meaning and personal control. It can have a spiritual aspect and is seen as the manifestation of empowerment. This process is not necessarily reflected in experience of contemporary mental health services. Barker (1999, 2001, 2003) has criticised them eloquently for taking a narrow medical perspective, giving little credence to the personal experience, knowledge and expertise of the person in resolving the disorder. While Barkers position as an academic and mental health nurse may not be recognised by many in the psychiatric profession, Flowerdew (1997), a psychiatrist, has argued that patients do not actually like psychiatric services; they find them stigmatising, impersonal, discontinuous, difficult to navigate or influence and powerfully in control of the care process. More recently, a qualitative paper from the Highland User Group (2004) described reasons why they were reluctant to see a psychiatrist. They found it frightening, there are felt to be personality clashes, culture clashes, intimidating or bullying attitudes, issues with authority and credibility, privacy, accessibility, status, control, stigma, lack of continuity and awkward consequences. They felt that the care was often not holistic, was dismissive of personal opinions, and has low expectation for the future. I think it would be harsh to argue that the work of Barton and Goffman has as much significance for mental health services now as it did in the 1960’s. However, it is difficult to argue that it has no significance at all, given the cross-section of views expressed by Barker, Flowerdew and the Highland User Group above. There is a lot to do, and recovery as described above does seem to offer solutions to the described problems of using contemporary mental health services. These are old problems, and a pertinent question is, “Does recovery offer a new solution?” Tones (1998, 2003) has written extensively about health promotion as a radical activity. Health, he argues, is a positive state, an essential commodity for a socially productive life and affected by social and environmental determinants. Progress in promoting health depends on rectifying inequalities in health and empowering individuals and communities to do so. He argues that health promotion should be:
It is possible to find a similar resonance in earlier work. Hopton (1995) has described the work of Frantz Fanon, a revolutionary French-Algerian psychiatrist and social scientist of the 1950’s. Fanon’s social psychology located the origins of mental distress in social injustice and oppression. He argued that mental health could be improved by helping the distressed person to identify the oppressive forces in their life and to take action against them. Hopton (1995) argues for a model of mental health nursing based on Fanons’ ideas. He envisages mental health work which would challenge existing social, political, historical, structural, ideological and interpersonal factors. It only requires a modest conceptual leap to see the similarities between this argument and an orthodox, modern model of mental health promotion such as Macdonald and O’Hara (1996). Macdonald and O’Hara proposed ten elements, which serve to promote or demote mental health in individuals and communities. This can be represented in the following table.
This model proposes levels at which interventions can be made to promote mental health: Individual or Family, Community, Organisation or National level. It is therefore possible to identify and plan mental health promotion activity to address specific elements at specific levels. This allows for far-reaching personal, interpersonal, community, organisational and national changes to be made. The level of empowerment, or the level of power, required to make change increases across this hierarchy. This model considered, as a recovery tool, has obvious usefulness. The level of power required to apply it fully to the promotion of the mental health of those diagnosed as mentally ill would be considerable, however. This implies that the success of the Recovery Network will mean significant political power being exercised by groups representing those so diagnosed. So, is recovery a new solution? I’m arguing, as you see, that it is not, and that the ideas which support it are orthodox, mainstream and really quite old. Developing recovery-based mental health services simply means the comprehensive promotion of the mental health of those diagnosed as mentally ill. Such services will embody the five key strategies of the Jakarta Declaration (WHO 1997):-
Psychiatric services, for historical reasons, have concentrated on treating those they define as their own client group - “the mentally ill”. Health Promotion services have concentrated on promoting the mental health of those who aren’t mentally ill, and accepted the idea that the “mentally ill” are someone else’s concern. This is a fundamentally stigmatising idea and reflects an inequality in health provision. Does it imply reduced personhood and citizenship for anyone with a psychiatric diagnosis? I hope the Scottish Recovery Network heralds a joined-up and inclusive way of working that makes clear it does not. If you’d like to share your thoughts or experiences of recovery then contact us on This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 0141 240 7790 to discuss. References:Barker ,P.. A brief introduction to the underpinnings of the tidal model (1999) at http:// www.tidalmodel.co.uk/philosophyx.html. Barker, P. The Tidal Model: developing an empowering, person-centred approach to recovery within psychiatric and mental health nursing. Journal of Psychiatric and Mental health Nursing Vol8(3) June 2001. Barker,P. The Tidal Model: psychiatric colonisation, recovery and the paradigm shift in mental health care. International journal of mental heath nursing. Vol 12 (2) June 2003 Barton, R. Institutional Neurosis. 1959 Flowerdew, J. Cracks in the mental health service or why patients do not like their therapist, in Promoting Mental Health. Stark, C and Killoran-Ross, M.(Eds.) 1998. Goffman, E. Asylums , 1961. Highland User Group: Psychiatrists. July 2004 Hopton, J. Towards a critical theory of mental health nursing .Journal of Advanced Nursing. Vol 25(3) March 1997 Click here to go back to previous page McDonald, G., & O’Hara, K. (1998) Ten Elements of Mental Health, Its Promotion and Demotion: Implications for Practice. Society of Health Promotion Specialists Tones,K. Mental health for all, the empowerment dimension in Promoting Mental Health. Stark, C and Killoran-Ross, M.(Eds.) 1998. Tones, K. Health Promotion. Oxford Text Book of Public Health . 2003 |
Story Tags
activism community/socialising/inclusion coping strategies creativity depression employment (+) exercise female hospital male medication medication (-) peer support (informal) and befriending seeing things differently self knowledge/learning/growth self management sense of self support from family support from friends support from mental health professionals supportive spouse/partner taking control talking therapies voluntary mental health services volunteering Story disclaimer
The stories presented here are for information only. They are meant to inspire hope and show that recovery can and does happen. The stories highlight various examples of recovery and we do not advocate any of these experiences as the ‘right’ way to recover. Recovery is an individual and unique process, each person must decide for himself or herself what will work for them. Please carefully consider any decisions you make about your own recovery and consult with someone you trust if you feel unsure. See our Submit Your Thoughts pages for details on how to submit a story to us or you can contact us.
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