In the chaotic world of mental health services, a powerful phenomenon is, like an angry sloth, very gradually making itself known. The Recovery Model is slowly but surely affecting the way services operate and how its victims- I mean users- are treated, as its obvious benefits gain credence among care workers and policymakers. Although there’s still much work to be done, this is very good news. The voice of the disfranchised service user is finally being heard; or at the very least, their letters are actually being read.
So, what does ‘recovery’ actually mean? Can it even be defined? Ron Burgundy would probably have a crack: ‘I believe it’s an old, old wooden ship that was used during the Civil War era’. Well, Ron would be partially right, in the sense that it has whatever meaning an individual ascribes to it. Ok, so I’m stretching it a bit but the point is recovery is not a simple endpoint shared by everyone experiencing problems to aim for. At the risk of sounding like a polo-neck wearing motivational speaker, recovery is the journey, not the destination.
As a young man well acquainted with Depression, her best mate Anxiety and the overbearing parent that is NHS Mental Healthcare from a service user’s perspective, I have learned quite a lot about what recovery means to me (the hard way, I might add). Having also worked in said services- both community and inpatient- for six years, I have also learned a little about the common threads of recovery that apply to most people, as well as the numerous barriers- or ‘psychiatrists’- that can get in the way of these components finding form.
One important aspect of recovery was revealed to me the day I decided- independently- that I would stop taking the three different medications that had been overzealously prescribed by my psychiatrist at the time. Regardless of what I was told about ‘misattribution of depressive symptoms as side effects of medication’ I felt I was right; the drugs I was taking were, on the balance of things, causing more harm than good. A few months after I had finished my tapered withdrawal, my view was vindicated as the side-effects that had previously rendered me useless for hours at a time subsided.
I felt slightly angry that I had been allowed- encouraged in fact- to keep taking a powerful cocktail of drugs that had done me no discernible good for over two years, but the overriding feeling was empowerment; I was now in charge. I realised then that, rather than being a mere ‘patient’ under the care of an ‘expert’, I was and always will be the expert of my own mental well-being. Sure, I would need guidance and support in finding my way, and would inevitably cock up some decisions from time to time, but I had found a renewed sense of both sides of the recovery coin- freedom and responsibility- in taking control of my own recovery. Cashback.
Since then I have generally managed to use mental health services as they should be used: ‘on tap’ rather than ‘on top’. In fact, I’ve realised that this is the best way to use everyone’s support, including friends and family. Having anyone on top of you, other than your partner (with whom I find ‘on top on tap’ to be the best scenario), will only serve to diminish your sense of ownership and control that is so central to living a life that you- and no-one else- deems to be meaningful. I’ve also learned that different friends and family members offer different things, and all are great when their help is sought at the right times; some are good at listening to me mid-meltdown without judgement, others are good at sitting with me in comfortable silence watching the football, others still are good at giving me frank ‘have a word with yourself, mate’ advice and some are good at… tennis. (I like tennis).
Accordingly, it’s a pretty well established fact now that mental health services need to be set up in such a way to best provide the support sought by each individual service user. Patricia Deegan, one of the Godfathers (Godmothers?) of the Recovery model, often uses the analogy of a seedling desperately trying to grow in an inhospitable climate; rather than there being something fundamentally wrong with the seedling, it is the environment that needs to change in order for the plant to gain the necessary nourishment to grow. We can’t all be cacti… or holly bushes, or conifers, or eucalyptus (or any other evergreen plant I found listed in the ‘Evergreen’ Wikipedia page).
Moving on from this slightly strained metaphor, there is now a growing recognition from within the NHS and other service providers (soon to be ‘other service providers… oh, and the NHS’ if Cameron’s reform bill takes its expected route) that things need to change. A large NHS Trust in London I used to work for as well as a few others across the country have started to crank up the Recovery agenda. They know that service users’ views need to be taken seriously, and the design of new initiatives (like ‘peer support’ programmes, for example) or the adaptation of existing ones should be service user-driven; and people with mental health problems need to be involved at every level, from leading patient satisfaction surveys to wearing power suits and eating salmon and cream cheese sandwiches in board meetings with the rest of them .
Services also need to become more permeable, so that someone can access support from a mental health worker- whether a nurse, occupational therapist, doctor or psychologist- when it’s actually needed, rather than as it currently stands, where once someone is deemed well enough, they’re discharged and the support disappears. It’s hardly surprising then that service users often get stuck in a system when they know it’ll take another major crisis to receive any support again. Rachel Perkins, best described as the Pep Guardiola of the current movement in the UK, described the situation in terms of the ‘secure base phenomenon’ during our Recovery training. Like an infant to its mother, she said, the more we have a secure base- support as an when we need it- the more we are likely to explore the world around us and eventually roam away from the base entirely. If you feel your support could be taken away at any moment, you’re naturally going to cling on to it for dear life, becoming ‘dependent’ on mental health services.
Things are steadily improving in the mental healthcare environment, but certain factors remain steadfastly in place preventing faster progress. Risk aversion is one of them; the on-going fear of newspaper headlines of the ‘Lunatic allowed to escape from local nuthouse jumps off cliff’ variety, means that clinicians and managers alike are often incredibly reticent to allow people the freedom required to start taking control of their lives. Another serious issue is the natural resistance that comes whenever a profession’s role in the larger picture comes under threat. Many psychiatrists are progressive, open to change and embracing of service user-led initiatives, but many are also clinging on to their decaying power as ‘lead expert’ who always knows best, regardless of what the patient thinks.
Another, slightly more subtle problem exists as well. The vast majority of staff who work in mental health do so because they genuinely want to help people. As a result, a common story often ensues: when someone comes to them in dire need and feeling hopeless, they adopt what Deegan calls the ‘frenzied saviour role’. This means that the more the service user despairs, the more the helper engages in shallow optimism, the more one withdraws, the more the other intrudes, the more the one gives up, the harder the other tries. This process is exhausting and often ultimately fruitless. In fact, a common result is that the exhausted helper feels frustrated at the service user’s ‘lack of progress’ despite all their efforts, which turns to anger, blame on the service user and eventually hopelessness in their ability to ever get better. At this point, they either run away and join the circus (or the ‘private sector’ as it’s otherwise known) or continue to work, but growing increasingly cynical and callous.
This type of burnout resulting from nothing but good intentions is so common within mental healthcare that it’s probably not overstating it to say it’s the norm, certainly in some areas like inpatient hospitals. What’s the alternative? Well, often, when I feel like shit, there’s nothing better than someone sitting alongside me with my shit (just to clarify, this is just a metaphor; things never got that bad). It may seem perverse but, while I always appreciate the kind sentiment, being optimistically told that things will get better without any substantial recourse to reality or an attempt to see things from my experience never really makes me feel as good as when I’m told ‘life sounds pretty crap for you right now’. It’s this approach of ‘sitting with you in the dark’ and waiting patiently until someone feels ready to tell you how you can help them that truly helps people on their recovery journey.
People need three things to make recovery a reality: hope, control and opportunity. Hope comes from others retaining hope in you, no matter how crap things become, so that you can gradually regain your own sense of hope in yourself. Control comes from being empowered by those around you to take your own autonomous decisions about what you’re going to do with your life. Opportunity is afforded when you’re given a stake in your community, your environment and future. For example, 80% of people with serious mental health problems say they want paid work, but a far smaller proportion are given this opportunity. One service user told Patricia Deegan: ‘I can tell you the definition of empowerment: it’s a decent paycheque at the end of the week’.
Recovery also involves lots of hiccups; it’s not a straight upward line. It’s entirely possible to be gripped by the worst your mental health problem can throw at you while still moving along the recovery journey. Learning from each of these experiences and applying the lessons to further encounters is the hallmark of recovery.
I apologise if I come across as preachy, but my real intention is to make anyone reading this who may have accessed mental health services to always keep the Recovery Model on the agenda when seeking help: is the support you’re getting promoting hope, control and opportunity?