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Conceptualising Recovery In Mental Health Rehabilitation

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Question:

Discuss about the Conceptualising Recovery in Mental Health Rehabilitation.
 
 

Answer:

Introduction:

Mental well-being and mental health are the prime aspects of a person’s life. WHO statistics have shown that 15 % of the world population suffers from some or the other mental illness. Psychological problems and mental health illness contribute to reduce the quality of life and opportunities for a person. In this essay we would discuss how mental health issues plague the adults in New Zealand. According to a survey conducted for the year 2012-2013 one in every 6 adults is suffering from some mental disorder or illness in New Zealand. These illnesses can be as common as anxiety, bipolar disorder and depression. According to this survey about 200, 000 adults that are around 6 % of the adult population of the country suffers from psychological distress. The highest rate of 24% has been noted for adult women between 35-44 years of age. In this essay the chosen age group are woman age between 35 to 45 years of age, this age were characterized  by Erikson as generatively verses self-absorption. In general at this stage the middle adulthood tend to be the most productive age towards family, qualification as profession and high social contribution in society to supporting the next generation. On the other hand  the feel of frustration and unrealistic goals in life can create self-absorption. If we look deeper middle age women tend to be the subject of  reproductive experience of possible pregnancy , infertility and menopause at this strange and early in life. These issue may have the impact on woman physical and mental health  such as depression , anxiety, post-traumatic stress disorder and others mental illnesses.

Many researchers have concluded through their studies that social environment is the factor that is prominent in the development of many mental developments. In the recent decades social exclusion/ inclusion has come up numerous times when discussing about social disadvantage. Numerous researches in Europe and UK have been conducted to determine the link between social exclusion and disability but not many studies have been done on the link between social exclusion and mental health issues. According to the paper presented by Susan Cuthbert titled “Mental health and Social Inclusion concepts and Measurements” adults suffering from mental health issues are the most excluded group in the society.

 

This exclusion affects their everyday lives as they are not able to enjoy their life in community and the society. The Mental Health Foundation of New Zealand and Like Minds, Like Mine conducted a research under the title “Respect costs nothing” in the year 2004 that reports about the discrimination that the people experience if they suffer from mental illness in the society. People with health issues reported discrimination on all levels in their lives whether it be education, housing, employment in the hands of their family, friends and community. This discrimination forces them to feel excluded from social gatherings and thus preventing them to take part in many activities. Let’s first understand what social inclusion means, it is a multidimensional and complex process that involves the denial or lack of resources, services, goods and rights which in turn leads to the inability to take part in activities and to form normal relationships. Only a small portion of the society is subjected to this discrimination that affects the quality of life of these individuals (Levitas, 2006), (Levitas R, 2007). Social inclusion depends on four systems that are legal and democratic system, the labor market, community system and family and the welfare system. The person only feels a sense of belonging when all the four systems are there. These four systems are equally crucial and important. Social inclusion also depends on the two concepts of rights and participation. When social inclusion has a right based approach citizens are excluded when they are deprived of their citizenship right. This refers to the economic, civil, cultural and social rights of the individuals in the community. The citizens have these rights that are present in international as well as domestic legislature. Huxley in the year 2012 highlighted through his research that right based approach is important in mental health (Huxley P, 2012). It is due to the fact that if a person is excluded that he is being denied his right that he or she is entitled to. These rights include political and civil rights that they are being denied. The mental health legislature in the New Zealand states that even during treatment these individuals have the right to be treated with respect and dignity whether the treatment is involuntary or voluntary. A participatory approach is the one that focuses on the extent of participation of the individual in their social environment. This approach involves the identification of the activities through which a person is involved in the community and society around them. Some of these activities could be work, education and social interaction with family and friends. Employment is a large component of any one’s life but barriers like self-stigma and discrimination affects it. Self-stigma occurs due to lack of self-esteem and confidence which is a result of the discrimination a person faces in the society (Crisp A. H., 2000) (Thornicroft G., 2007). There are also some overlapping concepts  with social inclusion some of which are poverty, social model of disability, recovery, quality of life and discrimination (Silver H, 2003). Social inclusion is a more wider and broader term for deprivation in context to poverty. Poverty is material, economic and resource based deprivation that is in total contrast to social inclusion (Morgan C, 2007).

In social inclusion loss of meaningful relationship, discrimination and loss of roles occurs that affects the mental well-being of a person (Link B, 2004). Another overlapping concept to social inclusion is “Social model of Disability” which states that a person suffering from some kind of disability is a disadvantage to the society. Sayce through his research showed the link between the social model of disability and social inclusion (Sayce, 2000). He stressed how people with mental health issues can only achieve social inclusion when our society changes. Other researchers as Repper and Perkins have also supported the need of social reintegration as the most important factor for recovery in mentally ill (Perkins, 2003). These researchers have focused on the society who excludes these people rather than just concentrating on the excluded. Recovery which is living in the absence or presence of a mental illness is used in different ways. It is also used to define the personal journey that a person takes to get well. Social inclusion is included in social recovery but many argue that recovery is linked to medical model and individual pathology. Discrimination and social inclusion are strongly linked as they give rise to one another. Discrimination stands for the unfavorable treatment of a person from another person in similar circumstances or situation. It can be both indirect and direct. This barrier to social inclusion prevents a person to participate in everyday activities and to exercise their rights. There are numerous other barriers to social inclusion such as self-stigma, lack of support and mental impairment. (Hills, 2002)

 


The Blue print II is a bold vision that focuses on improving the mental well-being and health of all New Zealanders. It is a ten year recovery approach that is independent and evidence based advice from the Mental Health Commission of New Zealand. Through this recovery model everyone will participate in protecting the mental well-being. This approach will focus on people who have addiction issues along with mental health problems. It will also focus on indigenous people where Whanau or well-being involves the equal participation of their family members. There are numerous priorities in this model as the Mental Health commission has realized that we need to respond earlier in order to provide a good start to children associated with addiction issues. This model especially focuses on adults that suffer from addiction and mental health issues as these individuals need support to return to normal functioning, to be independent and to remain healthy. The Mental health commission has realized that minor changes won’t do any good but a “stepped care” approach is needed to promote self-care. This can only be achieved through ensuring that the ringfence funds that were set in blueprint I stage are flexible enough  to extend  and integrate all specialist, community and primary services. The monitoring of the model will be done through regular sector visits and public reporting that provides information about the progress at service and population level. The Blueprint I which was published in the year 1998 provided services to the 3% most severely affected people with addiction and mental health issues. But with Blueprint II the Mental Health Commission is broadening the focus through inter agency partners and broader healthcare. This recovery model is also not a government policy same as the Blueprint I as it is an independent advice by the Mental Health Commission of New Zealand. Through 1998 to 2005 with the Blueprint I the policy focus was on severely mentally ill people but there is an acknowledgement in the society about the needs of people who are suffering from moderate and mild mental health issues. The mental health addiction strategy TeTehuhu (2005-2015) along with the associated plan Te Kakiri (2006-2015) has broadened the focus from severely affected. Since the year 2005 there is a constant progress in development of primary mental health initiatives that promotes self-help activity such as “Like minds, like mine”, destigmatisation campaign and The National Depression. Along with this government agencies has increased their focus on addiction and mental health issues by launching initiatives that influence care of young people and support them to get back on the workforce. Adults with addiction and mental health issues are encouraged to take part in building of their own treatment plans. This recovery model has a people directed and people centered approach which works well in partnership with people who suffer from addiction and mental health issues. The model that was already developed and introduced in Blueprint I has only grown stronger with the introduction of Blueprint II. The need to provide stronger partnership in services along with information, self-determination in shaping policies at national level has been recognized.

 


The central point of any social inclusion strategy or initiative is the belief that individuals suffering from mental health issues will make a positive and practical contribution to their surroundings. Arguably the most crucial group to consider in partnership in mental health services formation is the “Service users” (Gawith, 2006).The Ministry of Health strategic document titled “Rising to the challenge 2012-2017: Mental Health and Addiction Service Development plan continues to focus on recovery. Lurie in the year 2005 stated that New Zealand in a way changed the direction as to how mental health policies were formulated and designed. It was in the year 1994 that the New Zealand government following the trend of introducing strategic plans introduced “Looking Forward: Strategic directions of The Mental Health services plan. Another plan “Moving forward: The National Mental Health Plan for More and Better services in 1997” was introduced that focused on the resources needed. In the year 1998 “Like Minds, Like mine” was set up that increased the awareness about mental illness through media programs and campaigns. But it was only in the year 2014 that “Te Tahuhu, our lives in 2014” that was a New Zealand Mental Health and Addiction plan focused on service users visions. This document was about the Tangata whaiora who is a person seeking wellness. It included the statement that mentally ill people wanted a society and Whanau that values them as participating members who have the same opportunities and rights. Te Tahuhu had an associated plan that was Te Kokiri that provided services that especially focused on the needs of community, Whanau/ family and the service providers. All these strategies and policies emphasize the tenets of social inclusion and stress on the fact that all citizens should have equal opportunities to take part in the society, have productive relationships and involvement in the workforce. These plans focused on building of partnerships between NGO’s, mental health services users, clinical provider services and the Ministry of Health. They also highlighted the partnership between education, justice, social services, correction, housing, and employment.

Therapeutic relationships and nursing has been the topic of numerous studies since the 1950’s. A continued commitment to work in partnership with the mental health patient is needed by every nurse who work with these individuals. Partnership in Coping is a recovery model that was designed in Australia that applied the recovery oriented approach to nursing practice. This model draws on the holistic perspective of mental health nursing (Lloyd C, 2008). Where the nurse has numerous informal contacts with the patient, has a positive and healing relationship with the client and has knowledge about the patient (Webb, 2013). This model focuses on the strengths of the service users. This model focuses on the notion that patient has the understanding about their needs. The nurse should work in collaboration with the patient and consider their cultural beliefs and background (Beggs, 2013). It emphasizes the service user involvement in their recovery. It draws on the commitment of nursing that therapeutic relationships work well in partnership. This partnership of two people working together in order achieve a common goal works well in mental healthcare (Wand T, 2015). Nurses need to support their patients in understanding their experiences as they should refrain themselves to explain the experiences for the patients (Lowe, 2001). The informal nature and holistic approach are the most crucial aspects of nursing that are needed when working with mental health patients. This model is about six steps which include development of conditions that facilitates the user, identify the concern of the patients, negotiate the goals with the service users, identify the strategies that the patient is using to cope and offer new ones if they are unable to identify the strategies for themselves, apply these strategies and measure the outcome(Martensson, et al., 2014). In each of these steps there is a clear involvement of the service user in their recovery.  A nurse should focus on negotiated care and in the development of a dependable and consistent relationship with the patient. Best way to evaluate patient need in mental health is to focus not only on physical health but the social support interaction for example:- family and  social contact, such as friends and community contribution. Encourage and providing an ongoing support from  mental health profession team can enhance  patient's recovery and promoting social inclusion(Repper, 2010)

 

Conclusion

The people who suffer from mental illnesses need psycho-social assistance along with clinical care. They need the support of their family, health professionals and friends to encompass interpersonal relationships, work, education, leisure activities, housing, transport and income. The recovery process for them is a self-directed transition towards a meaningful life but they need continuous support to achieve it. This support involves a range of services, opportunities, social inclusion and responsibility. Therefore to provide an effective mental health care an integration is needed in primary, secondary and tertiary services at all levels. Social stigma, and discrimination faced by the mentally ill are barriers to their recovery therefore awareness is needed in the society. Responsibility and empowerment are key aspects of recovery which  health professionals should always focus on (Drinkwater, 2013). They should work on the notion that mentally ill are capable of understanding their needs and can work along with them to recover well. As through this essay we came to know social inclusion is linked to a person’s recovery it is crucial that the discrimination that these people experience in the society should be minimized (Diener, 2011). This discrimination is impacting their lives and preventing them to enjoy and function normally. It is a basic human right to have relationships with other people but discrimination and stigma prevents the mentally ill to practice this right.

 

References

Beggs, G. (2013). Nimbin: An alternative culture, an alternative clinical approach – an integrated community mental health – drug and alcohol nurse practitioner approach. International Journal of Mental Health Nursing, 65-69.

Crisp, A.H,  Gelder, M.G, Rix, S.,  Meltzer, H. I, & Rowlands, O.J,  (2000). Stigmatisation of people with mental illnesses. British Journal of Psychiatry, 177(1), 4–7.

Diener, E. &. Chan, M.Y (2011). Happy people live longer: Subjective well-being contributions to health and longevity. Applied Psychology: Health and Well-being, 3(1), 67-74.

Drinkwater, V. (2013). Collaborative approach to the management of acute behavioural disturbance. International Journal of Mental Health Nursing, 31(2), 6.

Gawith, L. P. (2006). Long Journey to recovery for Kiwi consumers:Recent developments in mental health policy and pratcice in New Zealand . Australian Psychologist , 140-148.

Hills, J. L. (2002). Understanding social exclusion. Oxford: Oxford University Press.

Huxley P, Evans S, Madge S, Webber M, Burchardt T, McDaid D,& Knapp M. (2012). Development of a social inclusion index to capture subjective and objective life domains (Phase II): psychometric development study. Health Technol Assess., 16(1), 1-24

L., Sayce. (2000). From Psychiatric Patient to Citizen: Overcoming Discrimination and Social Exclusion. . London: Palgrave.

Levitas R,  Pantazis, C,  Fahmy, E,  Gordon, D, Lloyd,E,& Patsios, D, (2007). The Multi-Dimensional Analysis of Social Exclusion. Bristol: University of Bristol.

Levitas, R. (2006). The concept and measurement of social exclusion. Bristol: Policy Press.

Link B, & Phelan JC (2004). Fear of people with mental illness: the role of personal and impersonal contact and exposure to threat or harm. Journal of Health and Social Behaviour. , 45(1), 68-80.

Lloyd, C., Waghorn, G., & Williams, P. (2008). Conceptualising Recovery in Mental Health Rehabilitation. The British Journal Of Occupational Therapy, 71(8), 321-328. 

Lowe, J., & Struthers, R. (2001). A Conceptual Framework of Nursing in Native American Culture. Journal Of Nursing Scholarship, 33(3), 279-283.

Martensson, G., Jacobsson, J., & Engström, M. (2014). Mental health nursing staff's attitudes towards mental illness: an analysis of related factors. Journal Of Psychiatric And Mental Health Nursing, 21(9), 782-788.

Morgan, C., Burns, T., Fitzpatrick, R., Pinfold, V., & Priebe, S. (2007). Social exclusion and mental health: Conceptual and methodological review. The British Journal Of Psychiatry, 191(6), 477-483. 

Repper, J. and Perkins, R. (2003). Social Inclusion and Recovery. Edinburgh.: Balliere Tindal.

Repper, J. (2003). Adjusting the focus of mental health nursing: Incorporating service users' experiences of recovery. Journal Of Mental Health, 9(6), 575-587.

Silver H,&  Miller, S.M. (2003). Social exclusion: the European approach to social disadvantage. Indicators, 45(2), 1-17.

Thornicroft, G., Rose, D., Kassam, A., & Sartorius, N. (2007). Stigma: ignorance, prejudice or discrimination?. The British Journal Of Psychiatry, 190(3), 192-193. 

Wand, T., D'Abrew, N., Barnett, C., Acret, L., & White, K. (2015). Evaluation of a nurse practitioner-led extended hours mental health liaison nurse service based in the emergency department. Australian Health Review, 39(1), 1.

Webb, K. C. (2013). Expanding the clinical practice domains and developing collaborative models of care - The mental health nurse and family based treatment (FBT) for young people and their families who are experiencing anorexia nervosa or bulimia nervosa. International journal of mental health nursing , 3-4.

Mental Health Commission. November 1998. Blueprint for Mental Health Services in New Zealand: How things need to be. Wellington: Mental Health Commission.

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