What is self-management?
Self-management is the name given to a set of approaches that aim to enable people to take control and manage their own health and wellbeing.
Self-management is about putting people in the “driving seat” and supporting them to lead their own recovery.
The Scottish Government Self-Management Strategy for Scotland is clear that self-management is not a replacement for services. It is about working with people to provide the right support at the right time to enable people to choose how they want to live.
There are a wide range of self-management approaches, resources and tools. This is important as it helps people tailor their approaches to their needs, circumstances and wishes at different times in their life and recovery.
Recovery and self-management
Self-management has always been a key part of the recovery approach in Scotland. SRN’s 2005 Narrative Research project clearly identified the importance of a person taking responsibility for their own wellbeing. It is a vital part of building/re-building identity and gaining hope, confidence and thereby self-esteem and self-efficacy on the recovery journey.
Wellness Recovery Action Planning (WRAP)
SRN have supported the development of WRAP in Scotland. WRAP is a self-management tool used in many countries around the world to help individuals take more control over their own wellbeing and recovery. It emphasises that people are the experts in their own experience and is based on the premise that there are no limits to recovery.
Relationships are integral to the human experience and connecting with others is vital to our health and wellbeing. People who experience mental health problems describe the importance and value of sharing experiences with others who have had similar experiences.
This is described as peer support: a relationship of mutual support where people with similar life experiences offer each other connection and understanding as they move through difficult or challenging experiences. In mental health this may be in relation to:
- Experiencing mental health problems
- The struggle and emotional pain that can accompany the associated feelings of loss, hopelessness and disempowerment
- Experience of navigating services and support
“Peer support is a system of giving and receiving help founded on the key principles of respect, shared responsibility, and a mutual agreement of what is helpful.” Mead et al (2001)
Why peer support is important to recovery
SRN describe recovery as “being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms.” This is a holistic view that focuses on individual wellness, going beyond the more limited reduction of symptoms.
Peer support is important to recovery because it’s a relationship that provides opportunities to share experiences and learn from each other on a mutual and equal basis. Peer support focuses on health and recovery rather than illness and disability and in so doing can provide evidence and hope that people can live a full and meaningful life.
The many faces of peer support
Peer support can be experienced in many different ways. From the informal sharing of knowledge and experience through to the formalised peer support worker role within services.
Whilst there are different forms of peer support, they all share a common ethos based on equality, mutuality and empowerment. Central to this is hope, the belief that people can and do live full and meaningful lives.
Connections and friendships
There are many opportunities to contribute to and benefit from peer support. Firstly, and most importantly, there is the peer support that people offer and receive through connections and friendships. Reciprocal relationships where we are able to talk freely and openly about our experiences knowing that we are more likely to be accepted and understood. This is the starting point for understanding the value and function of peer relationships.
Mutual/self-help support groups provide opportunities to meet with others who share similar experiences. They can be found both independent of and within services. A common way to recognise a shared experience is through diagnosis, and many groups have been started by people with a particular diagnosis seeking to relate to others with a similar diagnosis, like Bipolar Scotland, Action on Depression, and BEAT. Others focus on a common experience, like Hearing Voices groups and self-harm.
Digital peer support
The digital age is a developing resource for peer support.
Social media provides a great platform for people to engage in peer support and is invaluable especially for those who find it challenging to meet with others face to face.
Some people affected by mental health issues have developed their own interactive websites and share their experiences via blogs and vlogs. Facebook and Twitter are other useful websites. You can follow SRN on Twitter.
Another form of peer support is collective advocacy, where groups of people meet to campaign on issues of importance to them. In mental health, the focus ranges from access to and quality of services through to the right to be treated as an equal citizen. The peer support is focused on change for the majority with the added benefit of the supportive nature of being part of a group. Voices Of eXperience (VOX), the national mental health service user led organisation, can provide information on local collective advocacy groups.
The most formal peer relationship is peer working. There is a growing workforce of peer workers across the mental health sector. Peer workers can be employed directly within services and teams or by user-led organisations. There is also a growing development of volunteer peer roles that people can access support from.
The peer worker role involves:
- Developing mutually empowering relationships;
- Sharing personal experiences in a way that inspires hope;
- Offering hope and support as an equal
“There is a great deal of strength gained in knowing someone who has walked where you are walking now and who now has a life of their own choosing. In this way it is different to support work” Peer Worker
SRN provide support and a wide range of free resources to help peer working.
There are many ways in which people express their emotions and experiences. For example, if you’ve ever put pen to paper to work through difficult feelings, you might already know how powerful words can be. In fact, creating and taking control of your own story – in whatever form – can help people affected by mental health problems to experience recovery.
You can share your story, read about other peoples’ experiences, watch recovery videos and listen to podcasts at Stories and experiences.
Other ways people express themselves include visual arts, music, dance and theatre. The annual Scottish Mental Health Arts and Film Festival is a national showcase aimed at supporting the arts and challenging preconceived ideas about mental health.
Knowledge is power. Having a good understanding of your mental health and what support is available can put you in the driving seat of your recovery. This might be about getting basic information about resources and services or accessing more opportunities like courses or training, which are increasingly being made available at places like recovery colleges.
If you’re using mental health services, you should expect them to work in a rights-based and recovery focused way. This should include:
- Getting the right kind of help at the right time
- Fitting in with your individual needs and circumstances
- Supporting your plans and goals
- Recognising that you have skills, strengths and abilities as well as needs
- Encouraging and supporting self-help and self-management
- Helping you connect with your community
- Encouraging and acting on service user and carer involvement
- Listening and responding to you with empathy
If you think your service could be more recovery focused, you can introduce them to the Scottish Recovery Indicator (SRI 2), an online development tool designed to help you get the very best from your mental health service.
Independent advocacy services are designed to help people share their views and participate in decision-making when they may feel unable to.
Patient Opinion is another way you can share your views and provide feedback to services you have used.
The Charter of Patient Rights and Responsibilities has information about what your rights are when using NHS services. The Patient Advice and Support Service (PASS), run by the Scottish Citizens Advice Bureau (CAB) Service, can support patients, carers and families in dealings with the NHS. To find out more about accessing mental health services visit NHS Inform.
Many things can help recovery. Getting involved with a group or organisation that helps people to have a voice can be very empowering. Voices Of eXperience (VOX), the national mental health service user led organisation, have opportunities to get involved and can point you in the direction of local groups.
You might also be interested in taking part in the See Me ‘Movement for Change’, which aims to end mental health discrimination. There is also a growing online community of people sharing views and experiences and offering digital peer support. Many use Facebook and Twitter. You can follow SRN on Twitter.
Rights for Life is another opportunity to get involved in a national movement intended to achieve real, sustainable, transformational change to the way that people affected by mental health problems enjoy human rights.