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Recovery and carers

Joanna Fox

Anglia Ruskin University

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Presentation outline

• What the recovery experience might be like

• A personal journey of recovery

• New research: Carers and recovery

• Carers’ journey of recovery

• How recovery might translate into practical caring

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1. What is recovery?

• Recovery is defined as a personal process of overcoming the negative impact of diagnosed mental illness / distress despite its continued presence.

• NIMHE (2004) Emerging Best Practices in Mental Health Recovery

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Exercise – what is recovery?

• Have a go at the attached exercise to think a little bit about the experiences of recovery…

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2. Recovery – a personal journey

• Breakdown at university• Friendship• Re-building• Faith – there must be a reason?• Family members• Mentorship• Something to do• Direction• Personal steel• Career

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3. What ‘services’ helped me

• Holistic understanding• Challenging at my level• Looking at my strengths• Being positive• Always stretching me• Full time education as a student then returning

to further training as a social work student• Cognitive Behaviour Therapy to re-construct my

‘negative’ ways of thinking

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Experiences of being cared for

• By a mother– Supportive but sometimes smothered– An advocate

• By a father– Slightly more detached– More career focused

• By a husband– Supported by an equal– Knowing I am never alone but always encouraged– A relationship of choice

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4. Elements affecting the recovery experience

• Hope, confidence and optimism• Diagnosis• Self-acceptance, responsibility, belief and esteem• Self-efficacy• Self-awareness• Negative identity and low expectations• Stigma – spoiled identity• Thriving – growth beyond the label• Powerlessness – removal of identity• Reclaiming power and self-determination• Physical image• Sexual Identity• Creative identity• Cultural, social and community identity• Group identity – activism• Spiritual identity

Brown, Wendy. and Kandirikirira, Niki. (2006). Recovering mental health in Scotland. Report on narrative investigation of mental health recovery.Glasgow, Scottish Recovery Network.

http://www.scottishrecovery.net/content/mediaassets/doc/Recovering%20Identity.pdfaccessed on line 27.10.06

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5. The recovery model

Anthony (1993. p. 13) defines recovery as:“a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/ or roles. It is a way of living a satisfying, hopeful and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness”.

Anthony WA (1993) Recovery from mental illness: the guiding vision of the mental health service system in the 1990s,

Psychosocial Rehabilitation Journal, 16, 11-23

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6. New research on carers and recovery

• An exploration of the role of carers in the recovery of people with schizophrenia

• Formative research• Participatory• User-led

– Delivery of a training programme to heighten their knowledge and awareness of recovery

– Finding out how caring might be different from a recovery perspective

– Evaluating the effectiveness of the training and seeing if recovery might be an effective model to support carers’ experiences

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7. What I think recovery can bring to caring

• Positive challenge

• A belief – improvement is possible– you have to work with someone’s strengths

and not with their weaknesses– change is always possible– You are never stuck, you have to keep on

fighting

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• Carers journey of recovery

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a. Recognition of griefRecognition that grief is important• Consolation, comfort, kindness, and hope is

needed• Achieving tranquillity, by whatever means, is a

major objective along the recovery highway.• And then everything seems OK, for a while,

until the next time.• This leaves you on tender-hooks, alert for any

sign of change.• You realise your role as a carer as well as being a

family member

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b. When services become involved

• Services must listen and respond to carers• Carers must be involved and included in

planning and treatment. You often know the client in a different way – having lived, loved, worked, and had fun with them, maybe all their life.

• Carers must be helped to consider their own needs

• Be real and honest.

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c. Detaching with love

• Setting boundaries – not tolerating abuse from anyone. – Mental illness is not an excuse.

• Consider your own needs • Risk – allowing the person to face the consequences of their

actions. i.e. no longer rescuing. – If we keep rescuing we may create dependency – People may keep on with their self destructive behaviour and not find

the help they need. • Developing faith – the person is on his / her own personal

journey.• Developing trust – they can handle their life and its

challenges – with support. They are not helpless.• Letting go of total responsibility for ‘caring’

– by developing good relationships with professional staff – Engaging other family members or friends

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d. Setting a vision or goal for recovery of relationships

• What could this look like?

• Have a ‘good relationship’, – see each other regularly, – enjoy each others company, – and lead our own lives.

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e. Vision for carers’ personal recovery

• Carers leading a full life, able to maintain equilibrium in face of the ups and downs of the person you care for and about.

• Ability to detach with love; “I am not abandoning you. I am trusting you to find your own recovery path when you are ready. I am here to help you when I can”.

• Acceptance of what is. Life isn’t going the way you thought it might and all your feelings: anger, guilt, depression, sadness, bargaining and acceptance are part of the grieving process and have been acknowledged and integrated.

• Joy can return.

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How does recovery translate into caring?

(FROM MY EXPERIENCE)

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1. In the beginning… • Underlining any positive changes that you see to

the service user– You have been happier today– You couldn’t have done that last year

• Keeping the person occupied in things they want to do, sometimes things that take up time– Going out shopping– Going out for a walk

• Providing structure– Trying to get the person involved in things that might

keep them occupied but things they can do at certain times

– Finding a balance between ‘organising them’ and encouraging them

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2. In the middle…

• Enabling them to discover what might lead them to recovery– Offering support but using personal expertise to know

when to let the person do their own things

• Not setting the bar too high– Challenging at their level but not too high– Taking into account the need to enable the person to

be occupied but also enabling them to discover for themselves

• Keeping focused on hope and optimism– But trying to avoid being patronising

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3. As they move towards recovery…

• Enabling problem solving

• Enabling them to discover things for themselves but helping them to remember and discover this optimism

• Being there but remember your own life…

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Recovery belongs to us all

• “Recovery is not a gift from doctors but the responsibility of us all… We must become confident in our own abilities to change our lives; we must give up being reliant on others doing everything for us. We need to start doing these things for ourselves. We must have the confidence to give up being ill so that we can start becoming recovered”. Coleman 1999[1]).

•[1] Coleman R (1999) Recovery: An alien concept. Gloucester: Hansell