Health Promotion Well Being Recovery - Nancy Brookes
Content
Achieving Achievin g Certific Certification: ation: The Psychiatric Mental Health Review Course
Promoting Health, Well‐Being and Recovery February 8, 2013
Nancy Brookes,
RN; PhD; CPMHN( C) [email protected]
Windhorse Principle Inherent in every person there is a natural healing impulse, a motivation toward health & wholeness. This motivation can be ignited & strengthened in an environment where an attitude of hope & a belief in each person's potential for growth is pervasive. At the heart of an individual’s recovery from mental disorder is the restoration of personal, social, & environmental connections
Presentation Overview A Quick Trip Through: • He Heal alth th and and heali healing ng • Ment Mental al He Heal alth th • Env Enviro ironmen nment, t, cul culture ture • The power power of language and how words can wound wound • Stigma, Stigma, prej prejudice udice and di discrim scriminatio ination n as a barrier barrier to recovery • Re covery • He Heal alth th promo promoti tion on • We Well ll-b -bei eing ng • Resi Resili lien ence ce • Sel Sel f ca rre e • Lo Lots ts of of re reso sour urce ces s
Health and Healing Health, a resource for everyday life, is a positive concept emphasizing social and personal resources as well as physical, spiritual and mental capabilities Health and healing are about wholeness. Health is about creating wholeness. Healing is about repairing and restoring wholeness. Individuals, families and communities are more likely to take charge of their lives and build a sustainable future for themselves and their children when they believe in themselves; focus on the positives in their situation; are treated with respect; are given the help, support, and resources to come up with their own solutions to t heir problems. It is about people transforming their everyday lives and bringing hope and renewal
A Question or Two • What does health health mean mean to y you? ou? • How do y you ou thin think k care is affected affected wh when en we focus on health vs illness?
Environment & P&MHN • Psych Psychiatric iatric a and nd mental health nursing nursing is embedded within the broader physical and social environment whose organization and characteristics affect care, quality of life and treatment • The P&MH nurse promotes promotes healthy and enab enabling ling environments that support healing • The P&MH nurse advocates, advocates, both within within the me mental ntal health system and society as a whole, for relevant environmental and policy changes that will promote and sustain optimal mental health
Environment As Context • Quality of environment has significant impact upon human health (CNA, 2000) • Our task is tto o provide conditions under which people may to heal themselves, or be healedhealed- as Florence Nightingale remarked - “by nature or by God.” God.” • People grow grow up, develop develop & heal within their their many physical physical,, cultural and social environments environments – contexts: Home, school, work, social, hospital, health care system.. • Environments Environments mul multilay tilayered ered including including biological, biological, external, external, social, cultural, interpersonal • Healing environments work principally by supporting coping with stress
Environments • Nighti Nightingale ngale quality of person’s person’ environment nt holds key to–health and healings environme • Complex relationship relationship btw pe person rson and environments • Integral – person essential essential part part of environment environment & environment essential part of person • Environ Environments ments inc include lude in internal, ternal, e external xternal,, and the social and cultural milieus in which person lives. A person dwells in multiple environments, often at same time • Environ Environments ments & experien experiences ces ca can n be hea health lth promoting and support health, or they can be toxic and detrimental to health
Culture • A word ab about out cu cultur lture e – int integra egrated ted thr through oughout out • A number of programs programs ava available ilable to enhance enhance cultural competence see for example MHCC Cultural Awareness Tool • A cau cautio tion n – impo importan rtance ce of know knowing ing tthe he person/family/community, avoid possible stereotyping based on understanding of the culture
MHCC Cultural Awareness Tool https://kec.mentalhealthcommission.ca/mental_health_tools_and_resources
Tool is designed as a first step to provide comprehensive information on all aspects of culturally sensitive care. Does noton all provide comprehensive information aspects of culturally sensitive care. Based on the use of this tool the hope is that health and mental health practitioners will further develop their own knowledge concerning culturally sensitive care Mental Health Commission of Canada
Mental Health vs Mental Illness Mental illnesses are disorders that cause a serious disturbance in thinking, emotions or behaviour (one in five; one in three) Depression, Bipolar disorder, Schizophrenia, Anxiety disorders, Personality disorders, Eating disorders [new DSM – V ... ...]]
Mental health often described in negative terms – absence of mental illness, or societal norms and regulations Notice – rarely hear “mental “mental illnes illness” s” anymore – odd terms such as mental health diagnosis – oxymoron!
Mental Health Mental health is defined as the capacity of the individual, the group and the environment to interact with one another in ways that promote subjective well-being, the optimal development and use of mental abilities (cognitive, affective and relational), the achievement of individual and collective goals consistent with justice and the attainment and preservation of conditions of fundamental equality.
Mentall Heal Menta Health th - huma human n face “Mental health is the capacity of each and all
of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well being that respects the importance of culture, equity, social justice, interconnections and personal dignity.” The Human Face of Mental Health and Mental Illness
Mental Health Health - WHO Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community. World Health Organization
Two Continuum Model • Mental Mental health health continu continuum: um: two po poles les – optimal optimal mental health, poor mental health; respective demands & contributions of person, group & environment balanced so they support values and objectives expressed in definition of mental health • Mental disorder disorder co continuum ntinuum:: one end po point int extr extreme eme severity of symptoms (distress & impairment), other would be complete absence of symptoms or effects – range of different symptoms p present resent to varying degrees Mental health for Canadians: Striking a balance (1988) (1988) • Flou Flouri rishi shing ng (CAMH)
Stigma • Stigma re refers fers to negative negative a attitud ttitudes es (preju (prejudice) dice) and negative behaviour (discrimination) • Include Includes: s: havi having ng fixedand ideas an and d judgemen judgements; stereotyping, fearing avoiding what wets; don’t understand • Mental Health Commission Commission of Ca Canada nada – National Mental Health Strategy – one of two priority areas – stigma among health care professionals
Stigma is... • a complex idea that involves attitudes, feelings & behaviour • a word ref referring erring to the the negati negative ve “mark” attach attached ed to people who possess any attribute, trait or disorder that marks that person as different from “normal” people. This “difference” “difference” is viewed as undesirable and shameful, and can result in people having negative attitudes and responses (prejudice and discrimination) toward another person Adapted from O’Grady, C. (2004). Stigma as experienced by family members of people with severe mental illness: The impact of participation in selfhelp/mutual aid support groups. Unpublished doctoral dissertation, University of Toronto.
Stigma: The Facts What is stigma? • Stigma ((or or preju prejudice) dice) describ describes es a negative negative and unfavourable attitude. • Stigma c causes auses those those living living with a mental iillness llness to to be labelled, stereotyped, and feared.
What is discrimination? • Discr Discriminat imination ion is the action tha thatt results from from stigma. stigma. • It is how you ttreat reat those those living wi with th mental health health issues issues because of how you think about them.
Why does it matter? • Many peopl people e living with with mental ilillness lness say the stigma stigma is worse than the illness itself. • Stigma iis s seen as one of the key barriers barriers preventing preventing people people from seeking help.
Stigma = prejudice + discrimination
Beyond the Label Quiz Recovery Attitudes Questionnaire
Things you can do to stamp out stigma (Beyond the Label)
1. Acknowledge the prevalence of mental health and substance use problems. 2. Try to “walk in the shoes” of a person who is stigmatized. 3. Watch your language. 4. Monitor media & openly critique stigmatizing material. 5. Respond directly to stigmatizing material with a letter to the editor. 6. Speak up about stigma to friends, family & colleagues. 7. Be aware of your own attitudes and judgments.
Person-centered alternatives t o Person-centered commonly used words and phrases Worn-out language
Language that promotes acceptance, respect, &uniqueness
• •
yo u' u'r e jju u st st De Deco comp mpen ensa sati ting ng
• •
•
M ani anipu pull ati ativ ve
•
• •
Crazy Co mp mp li an an t
•
No onc ncom ompl plii ant ant
•
•
Re si si st st a an nt
•
• •
You You ar are em more ore th than an Not him/ him/hersel herselff to today; day; he/she is experiencing symptoms Resou Resourceful rceful;; re really ally trying to g get et help Unique Might Might no nott be confi confiden dentt abo about ut personal choices or decisions; afraid Begin Beginning ning to th think ink for him/herself; m /herself; taking personal responsibility Not o open pen tto; o; ch choos ooses es not not to; has has own ideas
Alternative Alternativ e Lang Language uage Worn out phrases
Recovery language
•
Fr Freq eque uent nt flyer flyer
•
•
Ent itit le le d
•
• •
Bas el el in e Unmo Unmoti tiva vate ted d
• •
•
He lp lpl es es s
•
Us User er of syst system em
• •
Gives Gives us many oppo opportuni rtunities ties to intervene and support Awar Aware e of of rig right hts s What a person person looks looks like when doing well Has other other interes interests; ts; b bored ored;; doesn’t know how to begin Una Unawa ware re of ca capab pabili ilitie ties s Re Resou source rceful ful,, goo good d self self advocate
Source URL:
http://www.behavioral.net/article/tools-transforming-language
“It’s Just Behaviour” • My perso personal nal ffavo avouri urite te – of course whatever it is – it is behaviour • How might might we change our language language around this phrase? Suggestions?
“Once I became my diagnosis there was no one left to recover” The language used and the stories and meanings that are constructed have great significance as mediators of the recovery process. These shared meanings either support a sense of hope and possibility, or invite pessimism and chronicity
Recovery Knowledge Inventory Encourages conversations about the recovery process & the meaning of resiliency and wellness
http://www.acbhcs.org/wellness_test/wellness_inventory.htm
Mental Health Commission of Canada, Recovery Recovery …involves a process of growth and transformation as the person moves beyond the acute distress often associated with a mental health problem or illness and develops new-found strengths and new ways of being. Mental Health Commission of Canada, 2010
Recovery Transformation • Potenti Potential al to to tra transform nsform the system system • Peop People le re recove coverr – we pr provi ovide de rec recove overy ry oriented service and care • Not to be mist mistaken aken fo forr a pass passing ing fad • roots str stretch etch to tthe he birth of psychi psychiatry atry in the 18th century. As its • Reintrod Reintroduction uction intended to bri bring ng about fundamental transformation of mental health “a revolution in care” • Not si simply mply a new word to be use used d in describing current practices.
What is Recovery? SRN – recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and roles. It is a way of living a satisfying, hopeful and contributing life, even with the limitations caused by 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, 1993) SAMSHA - Recovery is a process process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.
Recovery • • • •
There is no set time time requirement requirement for for recovery, recovery, Recognized Recognized as an individuali individualized zed process process Each person’s person’s journey journey of of recov recovery ery is unique and Each person person in recovery recovery chooses chooses suppor supports, ts, ranging ranging from clinical treatment to peer services that facilitate recovery • Recovery Recovery involves involves a proc process ess of growth and transformation • Person Person with a mental mental health health problem problem or illness illness develops develops strengths and new ways of being • People are are empowered empowered and supported supported to a activ ctively ely engage in their own journey of well-being.
Four Major Domains Support Recovery - SAMH SAMHSA SA:: • Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way; • Home Home:: a stable and safe place to live that supports recovery; • Purpose Purpose:: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and • Community: relationships and social networks that provide support, friendship, love, and hope.
• Recovery Recovery means means different different things to different different people - is a very personal experience - may not mean an absence of symptoms - it does mean living a fulfilled life in which which persons have control over their own wellbeing and recovery. Some important thoughts and ideas about recovery: • Recovery Recovery is a journ journey ey not a destination destination • All of us have recovered recovered from from something something in in our lives lives • Many of the the things that that help us to recover recover are tthe he same for everyone • It is most most helpful to to identify identify ourselves ourselves acc according ording tto o strengths and wellness rather than problems and illness • Relationship Relationships s based on hope hope and trust trust and a belief belief in the possibility of recovery very important.
The Principles of Recovery UK and US • Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems. • Recovery represents a movement away from pathology, illness and symptoms to health, strengths and wellness. • Hope is central to recovery and can be enhanced by each person seeing how they can h ave more active control over their lives (‘agency’) and by seeing how others have found a way forward. • Self-management is encouraged and facilitated. The processes of self-management are similar, but what works may be very different for each individual. No ‘one size fits all’.
The Principles of Recovery UK and US con’t • The helping relationship between clinicians and patients moves away from being expert / patient to being ‘coaches’ ‘coac hes’ or ‘partners’ ‘partners’ on a journey of discovery. discovery. Clinicians are there to be “on tap, not on top”. • People do not recover recover in in isolation. isolation. Recovery Recovery is closely closely associated with social inclusion and being able to take on meaningful and satisfying social roles within local communities, rather than in segregated services. • Recove Recovery ry is about discovering – discovering – or re-discovering – a sense of personal identity, separate from illness or disability.
National (US) Consensus Statement on Mental Health RECOVERY • Se Self lf dir direc ecti tion on
• St Stren rengt gth hb bas ased ed
• Indi Individ viduali ualized zed and person-centred • Em Empo powe werm rmen entt
• Peer Peer s sup uppo port rt
• Holi Holist stic ic
• Hope
• Resp Respec ectt • Respo Respons nsib ibil ilit ity y
• No Nonn-li line near ar www.samhsa.gov
Principles of Recovery • • • • • • • •
Pe Pers rsonon-dri drive ven; n; Occurs Occurs vi via a many pathw pathways ays;; Is ho holi list stic ic;; Is supp supporte orted d by peer peers; s; Is support supported ed through through relatio relationships; nships; Is cultura culturally-ba lly-based sed and and influence influenced; d; Is supported supported by addressi addressing ng tra trauma; uma; Involves Involves individual individual,, family, family, and community community strengths and responsibility; • Is base based d on rresp espect; ect; and • Em Emerg erges es from from ho hope. pe.
Engagement Beliefs • Re Reco cover very y is possible • Change is inevitable – nothing lasts • Ultimately people know what is best for themselves • People People p poss osses es a all ll the the resources needed to begin the recovery journey • Th The e pers person on is is th the e teacher , we are learners • We need need tto o be curious – learn what needs to be done to help the person now! www.tidal-model.com
What People Tell Us Helps •
Educating oneself about about the illness. illness. Identifying symptoms an and d reviewing choices for managing those symptoms and making decisions about how to manage those symptoms that works best. Making choices choices about medications: find out a about bout the side-effects of each, as well as, the effects of withdrawing (stopping use of) certain medications. Recording symptoms in a notebook while taking medication and use this to support or oppose continued use of a particular drug.
•
• • • • •
These choicesrecords for you.can be used to work with doctors regarding the best Exploring non-medication and non-medical non-medical approaches to mana managing ging symptoms and maintaining mental health. Learning various coping coping strategies strategies and activities such as medita meditation, tion, relaxation techniques, prayer, prayer, or hobbies that can help to reduce stress; joining clubs and organizations. Seeking employment and self-employment self-employment support programs. Seeking mutual mutual aid opportunities such as self-help self-help gr groups, oups, community kitchens and food banks. Learning to make the most of socia all assistance programs, lo low w cost transportation.
LET'S TALK ABOUT SOLUTION SOLUTIONS S Recovery Conversations
The Recovery Recovery Conversation focuses on strengths and the potential for self-determination instead of acceptance accepta nce of limitations that perpetuate feelings feelings of helplessness and hopelessness. • • • • • • •
begi begins ns by focusing focusing on the per person son inste instead ad of the prob problem. lem. focus is on empoweri empowering ng the person person includes includes a dynamic dynamic planni planning ng ph phase ase Risks and and outc outcomes omes ar are e held in mutual mutual partner partnership ship framed in the context of the person's person's streng strengths ths and action plan Special Special attention attention giv given en to building building resi resilien lience ce concludes with a mutual assessment assessment of the pro process cess and progress
Source URL: http://www.behavioral.net/article/lets-talk-about-solutions
What is a Wellness Recovery Recovery Ac tion Plan ® (WRAP®) The Wellness Recovery Action Plan ®, or WRAP® is An evidence-based system Used world-wide by people who are dealing with mental health and other kinds of health challenges & By people who want to attain the highest possible level of wellness Developed by people who have a lived experience of mental health difficulties; people who were searching for ways to resolve issues that had been troubling them for a long time. WRAP® involves listing your personal resources, your W ellness Tools, and then using those resources to develop Action Plans to use in specific situations which are determined by you. WRAP® is adaptable to any situation. WRAP® also includes a Crisis Plan or Advance Directive. Wellness Recove Wellness Recovery ry Action Action Plan - Mary Ellen Copeland
www.mentalhealthrecovery .com/aboutwrap.php
Structure of Framework for Support Purpose: To ensure that people with serious mental health problems live fulfilling lives in the community • 3 fundamental assumptions & 3 conceptual models • Provision of services & supports to people with mental illness needs to be reformed & restructured(CRB restructured(CRB – rethinks nature of services & supports) • Most basic ways we think about & understand MI needs to be rere-examined & changed (KRB – focus on di diverse verse kinds of info) • Way consumers seen as people needs to be changed & enriched - focus on capacities (PRB – consumers as actors who can direct their ow n recovery process) own
Community Resource Base Map Housing Self Help & Consumer Organizations
Income Mental Health Services
Family & Friends
Person
Work
Generic Community Services & Groups
Education
Knowledge Resource Base Map Recognition Of Diversity Experiential Knowledge Social Acc eptan ce & Inclusion
Customary/Traditional Knowledge
Transforming Mental Health Our Understanding Literacy Of Mental Illness Medical/ Social Science Clinical Knowledge Knowledge Enriched Range of Services Service s & Supports
Personal Resource Base Map Hope Practical Understanding of Understanding illness
Resilience
Positive Sense of Self
Being in Control of Your Own Life
Confidence
Inclusion & Belonging
Purpose & Meaning
Well Being
Social/Determinants of Health Determinants of health Determinants health:: A range of personal, social, economic and environmental factors that determine the health status of individuals or populations Social environment, social supports networks and social connectedness Physical environments Income and income distribution, social status Gender, age and culture, biology & genetics Food security Affordable and adequate housing Employment, working conditions, unemployment & employment security Access to health services, services, personal health practices practices and coping Education
Both Health Promotion & Mental Health Promotion • • • • • • • • • •
focus on the enhancement enhancement of well-being well-being rather rather than on illness address the population as a whole, whole, including including people experiencing risk co conditi nditions, ons, in the the con context text of e everyd veryday ay life are orie oriented nted toward taking action on the d determinants eterminants o off health broaden broaden the fo focus cus to include include protecti protectiv ve e facto factors rs include a wide range of strategies strategies (e.g.: communication communication,, education education,, policy development, organizationa organizationall change, change, community community development development and loc local al acti activiti vitie es) s) acknowledge and reinforce reinforce the competencies of the population encompass th the e health and social fields as we wellll as med medical ical services Joubert et al., 1996
Health Promotion in Mental Health Mental health promotion – actions taken to maximise the mental health and wellbeing of populations by: - improving improving social, physi physical cal and economic environments - strengthening strengthening the understand understanding ing and skills of individuals in ways that support their efforts to achieve and maintain mental health
Mental Health Promotion • Mental health health promotio promotion n is the process process of of enhancing enhancing the capacity of individuals and communities to take control over their lives and improve their mental health. Mental health promotion uses strategies that foster supportive environments and individual resilience, while showing respect for culture, equity, individual choice, social justice, interconnectedness and personal dignity. • Social Determinants Determinants o off Health are are at the forefro forefront nt of health promotion The Human Face of Mental Health and Mental Illness in Canada. Public Health Agency of Canada. 2006.
Mental Health Health Promotio Promotion n - Canada • Way ba back ck in 1988 Me Mental ntal Hea Health lth for Canadians: Striking the Balance provided driving force for placing mental health within a health promotion framework • Otta Ottawa wa Ch Charte arterr – pro promote mote indi individ vidual ual & collective health; develop healthy public policy, reorient health services, build individual skills, create supportive environments & strengthen community action
A Word About Prevention • Prevention Prevention of me mental ntal illness illness an and d addictions addictions focuses on measures taken to prevent problems and illnesses, by addressing risk factors as well as protective factors for individuals, groups and communities. • Mental Mental il illne lness ss preventi prevention on – actions taken to reduce the impact or prevent the initial onset of mental illness • Mental illness treatment – actions taken to remedy a mental illness or to lessen its ill effects.
health ealth promoti promotion on - WHO Mental h • Mental health health promotion promotion involves involves actions actions to to create living conditions and environments that support mental health and allow people to adopt and maintain healthy lifestyles. These include a range of actions to increase the chances of more people experiencing better mental health. • A climate climate that resp respects ects and protect protects s basic civil, civil, political, socio-economic and cultural rights is fundamental to mental health promotion. Without the security and freedom provided by these rights, it is very difficult to maintain a high level of mental health.
Protective Factors • Childho Childhood: od: positive positive early childhood childhood experiences experiences,, maternal attachment • Education: accessible • Empathy • Empowerment and self-determination • Family: resilience, parenting competence, positive relationship with parents and/or other family members • Personal resilience and social skills • Physical health • Services: accessible quality health and social services • Spirituality
www.health.vic.gov.au/mentalhealthpromotion
Risk Factors • TRAUMA • Alcohol and drugs: drugs: access access and abuse abuse • Displacement Displacement:: refug refugee ee and asylum-se asylum-seeker eker status status • Disa Disabi bili lity ty • Educati Education: on: llack ack of of access access • Family: Family: fragmentation fragmentation,, dysfun dysfunction ction and c child hild neglect, neglect, post-natal depression • Ge Gen n et eti cs cs • Phy Physi sica call il illn lnes ess s • Phy Physic sical al inactiv inactivity ity www.health.vic.gov.au/mentalhealthpromotion
Three Most Significant Determinants of Mental Health 1. Social inclusion 2. Freedom from discrimination & violence 3. Access to economic resources
(Keleher & Armstrong, 2006; Mental Health Promotion in Ontario: A Call to Action, 2008)
Pathways to Recovery Pathways to Recovery translates the evidence‐based practice of Strengths Model into a self ‐help approach Before B efore I heard of Pathways, my ‘ mental mental illness’ defined me. When I first began the workbook, I realized my ‘ recovery recovery’ defined me. By the time I finished Pathways, I realized I could define my own life. ”
“
What is the evidence base for the Strengths Approach? The Strengths Approach was the subject of more than 10 f ormal research studies. It is considered an evidence-based practice because it has been found to promote positive outcomes for people with psychiatric disabilities. The Strengths Approach has been proven to keep people in the community and helps them meet their goals. [email protected]
Strength-Based Care Considers whole person (we respond as whole persons) Focuses on what is working and functioning well, what the person does best, and what resources people have available Nurses support what is working to help people cope, develop, grow, thrive, and transform Places person and family as the focus and centre of care, problems best understood when situated in context and understood within person’s personal history, culture, belief system, and values of what is important and what holds meaning for them Gottlieb, L. (2013). Strengths-Ba Strengths-Based sed nursing care Health and healing for person and family. New York: Springer
Voluntary National Standard Standard o f Canada for psychological health and safety in the workp lace released released • Toronto, Ontario, January – The Mental Health Commission of Canada January 16, 2013 –
(MHCC), … have officially released Canada’s first national standard designed to help organizations and their employees improve workplace psychological health and safety. • The National Standard of Canada titled Psychological Health and Safety in the Workplace – Prevention, promotion promotion and guidance to staged implementation is a voluntary standard focused on promoting employees’ psychological health and preventing psychological harm due to workplace factors. • “One in five Canadians experience a mental health problem or mental illness in any given year and many of the most at risk individuals are in their early working years. Canadians spend more waking hours at work than anywhere else,” says MHCC President and CEO Louise Bradley. “It’s time to start thinking about mental well‐being in the same way as we consider physical well‐being, and the Standard offers the framework needed to help make this happen in the workplace.”
http://www.mentalhealthcom .mentalhealthcommission.ca/SiteCollection mission.ca/SiteCollectionDocuments/January_ Documents/January_2013/MHCC_St 2013/MHCC_St http://www andard_MediaRelease_ENG.pdf
Well Being/Wellness Face To To Face With Mental Wellness - MHCC MHCC Physical, mental, emotional, spiritual health/wellness as well as a sense of belonging and purpose www.mentalhealthcommission.ca What BETTER BETTER feels like – Mood Disorders Soci Society ety of Canada (well-being) www.mooddisorderscanada.ca/page/what-better-feels-like
Face To Face With Mental Wellness A series of videos created by Alex Burr, a project designed to put a face to mental illness in the 21 st Century. In partnership with Students for Mental Wellness and The Lowdown (Vancouver-based mental health speakers bureau) One story: Joe Roback. A personal uplifting story of Joe Roback, who lives with Bipolar Disorder. Joe has had a strong recovery and attends Simon Frazer University in Burnaby, Canada. He is an avid chess player, musician and volunteers with many mental health organizations MHCC – www.mentalhealthcommission.ca – www.mentalhealthcommission.ca
Well Being/Wel Being/Wellness lness - Healt Health h
Physical – get a physical, manage chronic illness, illnes s, do you have a problem? – exerci exercise se (move), eat well, and get your sleep, look good, feel better Mental (brain) Health - Healthy brains, brains, Active mind, Help for your memory Emotional - Name it, Self talk, talk, Stress relief, relief, Emotional safety – your own feelings, relationships, emotional time bombs
• • • • • • • • • •
Spiritual Wellness
Heal Healing ing you yourr spir spirit it Wort Worthy hy o off kind kindnes ness? s? Be Belo long ngin ing g Har Harm mo off sti stigma gma Hur Hurts ts fr from om th the e pas pastt To Too o mu much ch to s soo oon n Sel Self h hel elp p Fi Find ndin ing g purpo purpose se Fee Feelin ling g useful, useful, fe feels els go good od Take Takes s tim time e
www.mooddisorderscanada.ca/page/what-better-feels-like www.mooddisorderscanada.ca/page /what-better-feels-like
Resilience Recovery Well-Being • Most of us find that that tough tough stuff comes at at us ever every y day. • You can either either let it negatively negatively impact impact you you or you can get through the tough stuff and use what you have learned in those instances to help you in the future. • Resiliency Resiliency is is the ability ability to bounc bounce e back from setback setbacks s or challenges. • Resiliency Resiliency isn't isn't a "thing," "thing," it's a combinat combination ion of skills skills and/or abilities that can help you get through setbacks or challenges. In short, resiliency is something you do. • "Resiliency "Resiliency is is individualiz individualized. ed. It looks looks different different for eac each h of us” • Three most common themes are family family,, fai faith th and perseverance; act as first line of defense for someone facing a challenge. http://resiliencycanada.ca/
"Seven Resiliencies." 1. Insight 2. Independence 3. Relationships 4. Initiative 5. Creativity 6. Humour 7. Morality http://www.magellanhealth.com/training/resiliencyM1/index.htm
Hinders Resilience • Making decisions decisions ffor or us • Developing Developing our service service pl plans ans for us • Reminding Reminding us of our limitations limitations • Trying Trying to contro controll us • Reminding Reminding us of past fa failure ilure • Viewing us us through the llens ens of our diag diagnosis nosis – as an illness
Helps Resilience •
Be happ happy y tto os see ee us • Answer our phone calls and ret urn messages in a timely manner • Get excited about our plans • Help us figure out how to make our plans work • Support us in being accountable for our plans • Help us find resources to carry out our plan • Relate to us as a “partner ” instead of a “patient. ” This will allow you to experience us as a credible participant in our quest for recovery and resilience.
Resiliency Re siliency Checkpoin t For each pair choose the one that best describes you: A. tend to view c challenges hallenges as oppo opportunities. rtunities. B. IChallenges are often a result of bad luck. A. I can find hum humour our in diffficult ficult situ situations. ations. B. There is nothing funny about difficult situations. A. I do not not dwell o on n the n negative. egative. I focus on the positiive. ve. B. All I encounter is negative. A. I am comforta comfortable ble with ambiguo ambiguous us or uncertain uncertain situations situations.. B. I can’t function without knowing what is going to happen next. A. My strruggles uggles h have ave made made me a stronger stronger,, more insightful nsightful person. B. My struggles have been a direct result of other people’s actions. To score - for every A answer you have selected, give yourself 5 points, and for every B answer you have selected, give yourself 1 point. Scoring: 21-25 ....... You are very resilient. 17 ............ You are doing quite well. 13 ............ Not bad, but you could benefit from enhancing some of your skills. 9 .............. You need more skills! 5 .............. We need to get started right away!
http://www.magellanhealth.com /training/resiliencyM1/index.htm index.htm http://www.magellanhealth.com/training/resiliencyM1/
Advice From Experts – Resilience . • Auth enti cit y: Get to know yourself, and express your uniqueness in ways that
• •
•
•
•
are meaningful to you and can be appreciated by others. Let yourself bounce any way that works for you. Yes, when it ’s time to rebound, it really is “ All about you.” Initiative: This is about us taking the lead in our own recovery, and our own development of resilience. We need others to help us, but we must take the lead. Spirituality: Developing spiritual competence helps us sustain resilience. It provides a way for us to understand our purpose, and to have meaning in our live. Flexibility: This is about rolling with the punches, and being open to new ideas. The more we can be flexible, the less apt we are to break if we are dealt a hard blow. Rather, we ’ll learn to bend and grow in a new way. Forgiveness: Holding on to grudges and blaming others will never help us move forward. This uses up too much energy – energy that could be spent on moving forward instead of rehashing the past. Curiosity: This has to do with being willing to try ne w things, to take calculated risks, to move out of our comfort zone and into new ways of being. www.magellanhealth.com/training
Burn Bright Bright - Build your your own resilience resilience •
Save ene energy rgy by encouraging encouraging us us to manage manage ourselv ves, es, instead of trying to control us.
•
Be in a goo good d mood an and d stay optim mistic istic ab about out our recover recovery. y.
•
stay in re relatio lationship nship with with us; we can be be much be better tter com company pany th than an the paperwork!
•
When we slip ip and slide, don’t see this as a failure on your part or on ours. This is all part of our learning to be resilient by t rial and error.
•
If you ca can, n, share y your our own story of resiliience ence with us. I can’t tell you what a valuable step this would be for all of us!
It’s practically impossible to engage in these activities if you have a negative attitude (are resentful, disrespectful, disrespectful, cranky, etc.) So you can see how supporting us in our recovery may require you to do some recovering of your own www.magellanhealth.com/training
10 Self Care Strategies The art of valuing yourself involves: 1. Taking care of self by trusting own process 2. Being assertive 3. Embracing your polarities 4. Recognizing & dealing with own grief & loss 5. Learning to let go 6. Choosing "nourishing" vs. "toxic” friends 7. Dealing constructively with your anger 8. Taking care of your body 9. Making your home a haven 10. Developing meaning & purpose in life Bunker, 1992
Windhorse Principle Inherent in every person there is a natural healing impulse, a motivation toward health & wholeness. This motivation can be ignited & strengthened in an environment where an attitude of hope & a belief in each person's potential for growth is pervasive. At the heart of an individual’s recovery from mental disorder is the restoration of personal, social, & environmental connections
Resiliency and Recovery E-Learning Center www.magellanhealth.com/training Recovery E ‐Courses Recovery e‐course 1: Recovery is Real Recovery e‐course 2: Self ‐determination Fuels Recovery Recovery e‐course 3: The Language of Recovery Recovery e‐course 4: Planning that Promotes Recovery Recovery e‐course 5: Let's Start Living Large Recovery e‐course 6: The Resiliency Factor Resiliency E ‐courses Resiliency e‐course 1: Getting Past the Tough Stuff Resiliency e‐course 2: The Power of Resiliency Resiliency e‐course 3: Growing Your Resiliency Resiliency e‐course 4: Recapping Resiliency
Recovery Resources Mental Health Commission of Canada https://kec.mentalhealthcommission.ca/mental_health_tools_and_resources Scottish Recovery Network [email protected] www.scottish recovery.net Substance Abuse & Mental Health Services Administration SAMHSA [email protected] • Center for Psychiatric Rehabilitation , www.bu.edu/cpr • NAMI: National National Alli ance on Mental Illness 800-950-NAMI (6264), www.nami.org • National Empowerment Center , 800-POWER2U or 800-769-3728, www.power2u.org(Patricia (Patricia Deegan) www.power2u.org • The National Mental Health Health Consumers’ Self-Help Clearinghouse, Clearinghouse, 800-553-4539, www.mhselfhelp.org Recovery Knowledge Questionnaire Resiliency Canada http://resiliencycanada.ca/ http://www.acbhcs.org/wellness_ http://www.acb hcs.org/wellness_test/wellness_in test/wellness_inventory.htm ventory.htm Tools for transforming language. Behavioral Healthcare Source URL: URL: http://www.behavioral.net/article/ havioral.net/article/tools-transforming tools-transforming-language -language http://www.be another source on the respectful use of language see http://uspra.org/files/public/langG s/public/langGuidelines.pdf uidelines.pdf http://uspra.org/file Challenging the Public Stigma of Mental Illness: A Meta-Analysis of Outcome Studies. http://bit.ly/KenPopeMetaAnalay sisReducingStigma ma http://bit.ly/KenPopeMetaAnalaysisReducingStig 104 Studies Studies of reslilience publish ed in 2012 (citations & excerpts): http://bit.ly/KenPopeResilienceResources
Resources
Mental Health Commission of Canada www.mentalhealthcommission.ca Changing directions, changing lives. Mental Health Strategy for Canada • Towa Toward rd Recove Recovery ry and Well-Bein Well-Being: g: A Framework Framework for a Mental Mental Healtth h Strategy for Canada • Volun Voluntary tary Nati National onal Standard Standard of Canada for psy psycholog chological ical health health and safety in the workplace released http://www.mentalhealthcommission.ca/SiteCollectionDocuments/January_2 013/MHCC_Standard_MediaRelease_ENG.pdf Centre for Addiction and Mental health www.camh.ca CAMH Knowledge Exchange http://knowledgex.camh.net Canadian best practices portal for health promotion and chronic disease prevention www.phac.gc.ca/cbpp CMHA Mental health promotion tool kit http://www.cmha.ca/mh_toolkit/intro/index.htm Evidence-based mental health promotion resource (VicHealth)
www.health.vic.gov.au/healthpromotion/downloads/mhr_social.pdf Gottlieb, L. (2013). Strengths-Based nursing care. Health and healing for person and family. New York: Springer Interactive Domain Model of Best Practices IDM Best Practices website at www.idmbestpractices.ca National Network for Mental Health (NNMH) http://www.nnmh.ca/
Some Principles Governing PersonEnvironment Transactions • Person’s Person’s genoty genotype pe or genet genetic ic make-u make-up p determi determines nes responsiveness to environment • emotional Person’s Person’s biolog biology, stre stress ssand level level, , moods, and statesy,affect are affected by interactions with environments • Environm Environments ents are are modi modifiab fiable le • Environment Environment & sp specifi ecific c experie experiences nces of person person can alter biological structures, such as brain • Person’s Person’s reli reliance ance on environme environment nt rela related ted to health, age, & vulnerability
Quotes "A community is commonly understood to be about relationships; it’s not a place. A neighbourhood is a place, but community is about people’s relationships.“ John McKnight, 1990 Bettelheim: The physical environment is the“ the“house of the spirit”” and it is the “spirit underlying the physical spirit structures and their furnishings which is of the greatest importance”” (In Cotton & Gerty, 1984) importance “The limits of my language . . . mean the limits of my world.” - Ludwig Wittgenstei Wittgenstein n (1963) • Especially at times of great personal crisis, people need to retire from everyday life. It is as if they are retiring to some quiet, & often distant place, to review their experiences; to prepare for the time when they will reenter the arena of life (Deegan, 1990; 1996)
What People Tell Us Helps • •
• • • • •
Educating oneself about about the illness. illness. Identifying symptoms an and d reviewing choices for managing those symptoms and making decisions about how to manage those symptoms that works best. Making choices choices about medications: find out a about bout the side-effects of each, as well as, the effects of withdrawing (stopping use of) certain medications. Recording symptoms in a notebook while taking medication and use this to support or oppose continued use of a particular drug. These records can be used to work with doctors regarding the best choices for you. Exploring non-medication and non-medical non-medical approaches to mana managing ging symptoms and maintaining mental health. Learning various coping coping strategies strategies and activities such as medita meditation, tion, relaxation techniques, prayer, prayer, or hobbies that can help to reduce stress; joining clubs and organizations. Seeking employment and self-employment self-employment support programs. Seeking mutual mutual aid opportunities such as self-help self-help gr groups, oups, community kitchens and food banks. Learning to make the most of socia all assistance programs, lo low w cost transportation.
Recovery Notes • The langua language ge used and the the stories stories and mea meanings nings that that are constructed have great significance as mediators of the recovery process. These shared meanings either support a sense of hope and possibility, or invite pessimism and chronicity. • The developm development ent of recoveryrecovery-based based services services emphasises emphasises the personal qualities of staff as much as their formal qualifications. It seeks to cultivate their capacity for hope, creativity, care, compassion, realism and resilience. • Family a and nd other supporter supporters s are often crucial crucial to recovery recovery and and they should be included as partners wherever possible. However, peer support is central for many people in their recovery. Adapted from Recovery – Concepts and Application cation by Laurie Davidson, the Devon Recovery Group.
What is discrimination? Discrimination is a prejudicial act, such as denying someone employment, housing, accommodation or other services because of the person’s race, colour, citizenship, culture, ethnic origin, marital or family status, sexual orientation, disability, age, gender, economic situation and so on. It may be covert or systemic, intentional or unintentional. An act of discrimination is a violation of an individual’s human rights and may be prosecuted under the Ontario Human Rights Code.
Effects of stigma • prejudice & discrimination (in medical care, housing, employment) • negative feelings about self (self-stigma); (self-stigma); for example, believing the negative stereotypes generated by society and media messages • tendency to avoid seeking help, and to keep symptoms & substance use a secret • social isolation and/or constricted constricted social support network • pov povert erty y • depression depression • loss of hope for recovery recovery • sui suicid cide. e. – Adapted from Po Pompili, mpili, M., Mancinelli, Mancinelli, I. & Tatarelli, R. (2003). Stigma as a cause cause of suicide. British Journal of Psychiatry, 183(2), 173–174,
Sets of Value Systems Sets of values
Examples of values
• Per Person sonal/ al/cul cultur tural al
• Always Always do th the e ri right ght thing thing • There are rewards rewards in wo working rking hard
• Et Ethi hica cal/ l/mo moral ral
• Peop People le have hav e thetorrigh ight t to make make choices related care • Peop People le have have righ rightt to be treat treated ed with respect & dignity • health is a right, state should provide & pay for it • Health care a priv privilege; ilege; people are are responsible for taking care of Gottlieb (2013) selves
• Politic Political/ al/reli religiou gious s Doctrinal/ideological
Collaborative Relationships FROM focusing on deficits TO working with person’s strengths FROM doing for the person TO working with the person FROM focusing on disease and its treatment TO focusing on living and coping with challenges and adverse events FROM the nurse as teacher TO both person & nurse as learners FROM measuring set of specific outcomes TO allowing person to determine own goals & own measures of success Gottlieb (2013)
