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Schizophrenia: Recovery Oriented Mental Health Services-An Overview
Schizophrenia is a psychiatric illness that is associated with disruptions in cognitive, emotional, psychosocial and occupational functioning of individuals diagnosed with it (Chien, et al, 2013). Historically schizophrenia was dealt with in an extremely inhuman way. Those suffering from it were contained and marginalized, subjected to coercive and inhuman treatment. In the beginning of 20th century, there were different approaches tried by Freud, Jung and their peers to deal with schizophrenia. Post World War II, schizophrenia was treated as any other illness with pharmacological intervention and medical models. The current approaches to schizophrenia recovery are centered on the human rights perspective and deinstitutionalization. This essay focuses on one such approach viz., Recovery Oriented Mental Health Services which has its basis on six principles that helps a person suffering from schizophrenia lead a life as close to normal as possible. Using the real-life experience of Ms. Sandy Jeff, this essay showcases the positive effect and normalization of people suffering from schizophrenia by implementing the recovery oriented mental health service model. The literature for this essay was obtained by conducting a systematic search using online data bases such as Google Scholar, PUBMED, and You Tube.
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Schizophrenia is a serious mental illness that can show various signs and symptom such as psychotic symptoms (e.g. hallucinations, delusions, etc), negative symptoms (e.g. anhedonia, apathy) and impaired cognitive functioning (Mueser, et al, 2013). In Australia, it is estimated that 45% of the population in the age group of 16-85 years will experience some mental disorder in their life. Of these Anxiety disorders (e.g. social phobias) were the most prevalent affecting 14% of the population, followed by Affective disorders such as depression which accounts for 6.2% of the population , Substance use disorders such as alcohol dependence accounts for 5.1%, and other mental disorders such schizophrenia accounts between 1.5-3% of the net population (AIHW, 2018).
Sandy Jeff is a prize-winning Australian poet and writer who has been battling with schizophrenia for a long time. She was diagnosed with schizophrenia when she was 23 years old. She had a dramatic turnaround at the age of 40 when her first book of poems was published. In her own words “Life began at 40, 17 years after the psychotic hell with nothing happening, no purpose in life, no reason to get out of bed and no hope” (SomethingInCommonAus, 2013). She had a rather tough childhood with an alcoholic mother, an abusive father and a budding mental disorder recalls Sandy in her interview (Pearson, 2010).
Decades later, Sandy found her purpose in life with her writings and poems; she describes it as pivotal to her life. She urges people to have more empathy and extend support to the patients suffering from mental illness. Sandy has lived with schizophrenia for over thirty five years; having experiencing it first hand, she helps others suffering from the disease by educating and sharing her experience on living and coping with mental illness.
Sandy has published over 5 books of poems. Her work mainly focuses on penning down her experiences and day to day struggle with schizophrenia. In this essay, two of her poems are highlighted which give a brief glimpse of her struggle with the illness, yet retaining her sense of humour to survive the darkness of the disease. In the poem ‘The Madwoman in This Poem’, Sandy speaks about being alone with no one by her side, how thoughts of ending her life and fighting depression are an everyday affair. Even though she is educated and have anything she wants, the constant feeling of being less than equal to others, inferior makes her do things that a normal person could never contemplate. She is alone and has constant hallucinations of imaginary characters-stars, people beyond her reach being part of her life. The line between reality and hallucination is blurred and she is unable to distinguish reality from dreams or nightmares, making it quite a rollercoaster of a ride (Jeffs, 2013). In her other poem ‘Medicated’, Sandy takes a quirky stance on the medicines she is on to take care of the clinical symptoms of the disease. She simultaneously converts the names of her 21 medicines to verbs. There is sense of humour in her pain. Lines such as “when I was Risperidoned? I lactated like a cow" or “I was Lithiumed? and Epilimed? to even my pendulum” show the humour in the anxiety she experiences each day (Jeffs, 2012).
Principles of recovery oriented mental health practice
For a person suffering from mental health the term recovery is not synonymous with cure, instead it hold a broader meaning i.e. having a practical outlook on one’s life; understanding one’s abilities and disabilities, having hope with a never give up attitude, leading an active life, having meaning and purpose to life, a positive attitude and leading a life as normal as possible. Adapted from the Hertforshire NHS foundation Trust Recovery Principles, UK- the following are the six principles
Uniqueness of the individual
Attitude and rights
Dignity and respect
Partnership and communication
The recovery principles provide a key to normalizing a person suffering from schizophrenia. The framework of this is based on 17 capabilities that are grouped under five fields of practice known as ‘practice domains’.
Domain 1- Promoting a culture and language of hope and optimism- This ensures a person feels welcome, safe and wanted and forms the central idea behind the recovery-oriented practice
Domain 2- person 1st and holistic- this places the person suffering from mental health issues 1st and central i.e. pivotal to the entire process thereby giving it a holistic approach.
Domain 3- Supporting personal recovery-the person defines what his/ her goals of recovery are and this is central part rather than just being a byproduct.
Domain 4- Organisational commitment and workforce development- Having an organised structure helps streamline the process as having workforce that is skilled, equipped and know what to do helps create and sustain an environment for a recovery-oriented practice.
Domain 5- Actions on social inclusions and the social determinants of health, mental health and well being- standing up against stigma and discrimination, ensuring the mentally ill person is given the same human right and treatment as any other human. Treating him/ her with the dignity and self-respect they deserve. (Australian Health Ministers’ Advisory Council, 2013).
According to Sandy key point in normalizing a mentally ill people is by providing them with a purpose; she further adds that the stigma attached to mental illness ought to be done away with to help people fit in. She further urges people to give mentally ill person responsibilities that have substance, but also cautions that the latter may need help and support. Her advice to everyone is that one cannot just hand a responsibility to the mentally ill person and then turn their back, only to come and point finger when the person flounders. This must be refrained.
Stigmatization of a mentally ill person is the worst kind of treatment and no-one deserves it. She describes how things are too tokenistic and mentally ill people bear the brunt of it majority of the times. She also has a word of caution to refrain from telling a mentally ill person or someone suffering from schizophrenia that “it is all in their head”- of course it is all in their head, but it is very real for them and should not be treated lightly (SaneAustralia, 2017).
Treating a mentally ill person with humanity and compassion is the most ideal thing a person can to make them feel better and getting them on the road to recovery. Sandy’s personal experience and documentation of her life and recovery follows the Recovery Principle, with all the key factors in place making it a sound working model with proof of concept.
However, though there are many positives, there are few negative factors or abuses that are associated with the recovery principle viz., (i) recovery is the latest model- so everyone wants to get on the bandwagon, with more peers being added, the focus from the mentally ill person is shifting and not being person centric as it was originally intended to be, (ii) not for “my patients”- some clinicians argue that either their patient’s are too ill or do not come under the purview of recovery, which is not the case as it can be applied for in a wide range of scenarios, (iii) compulsory detention and treatment aid recovery- compulsory “taking care” of individuals who cannot take care of themselves, defeats the holistic approach of recovery, (iv) recovery orientation means closing service- this is not the case as recovery is non-linear and services need to be available to re-engage with people when needed, (v) recovery is about making people independent and normal, again this is misinterpreted. Recovery is all about “getting better” or having a right to participate in regular life as an equal citizen be it in civic or economic life and (vi) contribution to society happens only after the person has recovered- work done whether household, paid or voluntary has a bearing to society. A mentally ill person is capable of contribution with guidance and support without having to undergo discrimination, self-stigma or anticipated discrimination that leads to high unemployment rates (Slade, 2014)
Schizophrenia is a very real, critical illness. However, with a more humane approach and support a person suffering from this disease has a fair chance of leading a normal life. The inspiring life of Sandy Jeffs shows us the power of determination and grit. Finding one’s passion and keeping at it could possibly be a turn-around factor for a patient suffering with mental illness such as schizophrenia. The recovery oriented mental health service model is definitely a way forward in providing a life of dignity and self-reliance to those suffering from schizophrenia. Though there are few hiccups that could make one wonder about the effectiveness of this method, however extraordinary cases such as Sandy Jeff’s is a living testimony of the proof of concept.
AIHW. (2018) Mental health services in Australia. Retrieved from https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/summary/prevalence-and-policies.
Australian Health Ministers’ Advisory Council. (2013). A National framework for recovery-oriented mental health services: guide for practitioners and providers. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/content/mental-pubs-n-recovgde
Chien, W. T., Leung, S. F., Yeung, F. K., & Wong, W. K. (2013). Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care. Neuropsychiatric Disease and Treatment, 9, 1463–1481. http://doi.org/10.2147/NDT.S49263.
Grant, P.M., Bredemeier, K., & Beck, A.T. (2017). Six month follow-up of recovery-oriented cognitive therapy for low functioning individuals with schizophrenia. Psychiatric Services. 68 (10), 997-1002. https://doi.org/10.1176/appi.ps.201600413
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Mueser, K.T., Deavers, F., Penn, D.L., & Cassisi. (2013). Psychosocial treatments for schizophrenia. Annual Review of Clinical Psychology.9:465-497. https:// doi.org/10.1146/ annurev-clinpsy-050212-185620.
Pearson, A. (2010) Sandy Jeffs on her poetry, madness +rec Retrieved from https://www.youtube.com/watch?v=BKgAeHQ-IFQ.
Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., Perkins, R., Shepherd, G, Tse, S ., & Whitley, R. (2014). Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems. World Psychiatry, 13(1), 12–20. http://doi.org/10.1002/wps.20084
SaneAustralia (2017). What not to say to someone with schizophrenia? Retrived from https://www.youtube.com/watch?v=n5lCc_9gmP0
Sandy Jeffs. (2012) Medicated and Mcmadness. Retrieved from http://centreformedicalhumanities.org/medicated-and-mcmadness/
Sandy Jeffs. (2013) The mad women in this poem. Retrieved from http://centreformedicalhumanities.org/the-madwoman-in-this-poem/
SomethingInCommonAus. (2013). Sandy Jeffs. Retrived from https://www.youtube.com/watch?v=pEszvWRsgZg