1. Moving From Pathology to Person
Chris Summerville, D.Min., CPRP
Chris@mss.mb.ca
7th Annual Pacific Forensic Psychiatry Conference
March 30 - April 1, 2011
Vancouver, BC
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2. Disclosures
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*No declarations.
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4. A. It is not easy going crazy or losing your mind.
Mental illness is an experience!
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5. The Evolution of the Disability
A person is diagnosed
with a mental illness
Mental
Illness
Mental
Illness
Person EventuallyGives Up

Learned Helplessness

6. Loss of Choice Making Skills 7. Increased harm & Risk 8. Decreased StrengthsResults In:

Shame

9. Fear 10. Uncertain FutureMental
Illness
Living In Our Culture Loss of:

Hopes & Dreams

11. Belief in self 12. Connections Mental
Illness
Mental
Illness
Iatrogenic Effects

Culture of Control

13. Hierarchy w/client on Bottom

Low Expectations

LostOpportunities:

Education

14. Life Roles 15. Choice Making Skills
Mental
Illness
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16. B. Traditional models of care have focused on illness and symptom reduction.
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17. Contrast Person Centred with an Illness Centred System
PC:The relationship is the foundation.
IC: The diagnosis is foundational.

PC:Begin with welcoming outreach and engagement.
IC: Begin with illness assessment.

PC:Services are based on personal suffering and help needed.
IC: Services are based on diagnosis and treatment needed.

PC:Services work towards quality of life goals.
IC:Services work towards illness reduction goals.

PC: Treatment and rehabilitation are goal driven.
IC:Treatment is symptom driven and rehabilitation is disability driven.

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18. PC: Personal recovery is central from beginning to end.
IC:Recovery from the illness sometimes results after the illness and then the
disability are taken care of.

PC: Track personal progress towards recovery .
IC:Track illness progress towards symptom reduction and cure.

PC: Use techniques that promote personal growth and self responsibility.
IC:Use techniques that promote illness control and reduction of risk of damage
from the illness.

PC: Services end when the person manages their own life and attains meaningful
roles.
IC:Services end when the illness is cured.

PC: The relationship may change and grow throughout and continue even after
services end.
IC:The relationship only exists to treat the illness and must be carefully restricted
throughout keeping it professional.
(Ragins, 2008)
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19. Two Types of Power
Vs.
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20. Two Types of Programs
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21. Treatment approaches that focus on symptom remission/reduction:
Being in control;
Offering professional support;
Managing symptoms; and
Being paternalistic.
Dr. Jacqueline M. Feldman, MD, Professor and Behavioural
Neurobiology at the University of Alabama
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22. Person Centred Treatment
The foundation of a good treatment is a good
relationship, not a good diagnosis.
The purpose of mental health treatment, including
medication, is not just to treat mental illnesses. Its to
help people with mental illnesses have better lives.
Medications should be quality of life goal directed
instead of symptom relief directed
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23. C. People using mental health services lie on a spectrum.
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24. D. How did this pathologizing of person come about?
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25. Why has mainstream psychiatry been slow to embrace the recovery model? Part of this had to do with some of the ways psychiatrists had been trained in psychiatric diagnoses. For example, in the text of the Diagnostic and Statistical Manual of Mental Disorders, ed. 3 (DSM-III) was a statement implying that a diagnosis of schizophrenia was not compatible with any kind of recovering of social or vocational functioning: "A complete return to premorbid levels of functioning in individuals diagnosed with schizophrenia is so rare as to cast doubt upon the accuracy of the [schizophrenia] diagnosis.
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26. This approach was taken, in part, to guide clinicians away from diagnosing patients with transient symptoms as having schizophrenia. An unintended and unfortunate consequence of DSM-III criteria for schizophrenia was to reinforce an atmosphere of therapeutic nihilism. The net effect was the widespread acceptance of a model of treatment that emphasized relapse prevention and stability as being the primary goals of treatment.
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27. The underlying belief for most clinicians was that while psychotic symptoms are treatable and relapse prevention possible, once stable, patients were unlikely to improve beyond the current level of symptomatic and functional improvements. The focus on stability with the assumption that further improvement is not possible can be considered to be a "maintenance model" of treatment.
(Weiden, 2010)
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28. E. A New Paradigm: The primary aim of mental health services is to promote personal recoveryand social inclusion.
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29. The goals, our goals should be:
Help people achieve personal recovery.
Gain a quality of life.
Create environments in which recovery can take place and flourish.
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30. F. What is Recovery?
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31. Minimizing the impact of
mental illness
Maximizing well being
Therefore......
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32. Recovery as wellness involves:
Social
Environmental
Intellectual
Occupational
Physical
Emotional
Spiritual
Financial
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33. Recovery is being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms. It is about having control over and input into your own life. Each individuals recovery, like his or her experience of the mental health problems or illness, is a unique and deeply personal process.
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34. The most widely used definition ofpersonal recovery is from Anthony (1993)
a deeply personal, unique process of
Changing ones attitudes, values, feelings,
goals, skills, and/or roles. It is a way of living
a satisfying, hopeful, and contributing life
even within the limitations caused by illness.
Recovery involves the development of new
meaning and purpose in ones life as one
grows beyond the catastrophic effects of
mental illness.
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35. Recovery themes
Identity formation: mental illness is one facet of a more differentiated self
Autonomy/self-agency: greater capacity for self-initiated action
Hope: renewed sense of possibility
Supportive, healing relationships: professional and personal
Enhanced role functioning: employment, parenthood, etc.
(Mancini, 2008)
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36. The Five Stages of Recovery
Moratorium A time of withdrawal characterised by a profound sense of loss and hopelessness;
Awareness Realisation that all is not lost and that a fulfilling life is possible;
Preparation Taking stock of strengths and weaknesses regarding recovery and starting to work on developing recovery skills;
Rebuilding Actively working towards a positive identity, setting meaningful goals and taking control of ones life;
Growth Living a meaningful life, characterised by self-management of the illness, resilience and a positive sense of self.
(Andresen, Caputi & Oades, 2006)
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37. Five Stages in the Recovery ProcessLarry Fricks, 2007
There are times when a person...
Impact of Diagnosis
Life is Limited
...is overwhelmed
...has given in to
...the
Disabling Power
of a
Psychiatric Diagnosis
Symptoms
Stigma
Self Image
...is moving beyond
...is questioning
...is challenging
Actions for Change
Change is Possible
Commitment to Change
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38. Components of the recovery process.
Finding and maintaining hope believing in oneself; having a sense of personal agency; optimistic about the future;
Re-establishment of a positive identity finding a new identity which incorporates illness, but retains a core, positive sense of self;
Building a meaningful life making sense of illness; finding a meaning in life, despite illness; engaged in life;
Taking responsibility and control- feeling in control of illness and in control of life.
(Andresen, Oades & Caputi, 2003)
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39. G. What are the working implications and working practices?
(How do you do know that you are a recovery-oriented practitioner?)
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40. Key characteristics at a practitioner level
Openness
Collaboration as equals
A focus on individuals inner strengths
Having hopeful expectations (Hopefulness like hopelessness is contagious.)
Reciprocity
A willingness to go the extra mile.
Relationship skills of empathy, caring, acceptance, mutual affirmation, encouragement of responsible risk-taking, and a positive expectation for the future.
(Borg & Kristiansen, 2004)
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41. 12 Aspects of Staff Transformation
Looking Inward and Rebuilding the Passion.
Building Inspiration and Belief in Recovery.
Changing from Treating Illnesses to Helping People with Illnesses Have better lives.
Moving from Caretaking to Empowering, Sharing Power and Control.
Gaining Comfort with Mentally Ill Co-Staff and Multiple Roles.
Valuing the Subjective Experience.
Creating Therapeutic Relationships.
Lowering Emotional Walls and Becoming a Guiding Partner.
Understanding the Process of Recovery .
Becoming Involved in the Community .
Reaching Out to the Rejected.
Living Recovery Values.
(Ragins, 2009)
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42. Top Ten Tips for Recovery Oriented Practice.
Actively listen to help the person to make sense of their mental health problems?
Help the person identify and prioritise their personal goals for recovery not professional goals?
Demonstrate a belief in the persons existing strengths and resources in relation to the pursuit of these goals?
Identify examples from my own lived experience, or that of other service users, which inspires and validates their hopes?
Pay particular attention to the importance of goals which take the person out of the sick role and enable them actively to contribute to the lives of others?
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43. Identify non-mental health resources friends, contacts, organisations relevant to the achievement of their goals?
Encourage self-management of mental health problems (by providing information, reinforcing existing coping strategies, etc.)?
Discuss what the person wants in terms of therapeutic interventions, e.g. psychological treatments, alternative therapies, joint crisis planning, etc., respecting their wishes wherever possible?
Behave at all times so as to convey an attitude of respect for the person and a desire for an equal partnership in working together, indicating a willingness to go the extra mile?
While accepting that the future is uncertain and setbacks will happen, continue to express support for the possibility of achieving these self defined goals maintaining hope and positive expectations?
(Shepherd, 2007)
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44. Ranking of Professional Competencies by Consumers, Consumer Providers and Providers
1. Having genuine respect for clients.
2. Having clients develop skills to cope and manage psychiatric conditions.
3. Seeing clients as persons apart from diagnosis and symptoms.
4. Helping clients to accept and value themselves.
5. Listening to clients without judgement.
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45. 6. Believing in clients potential to recover.
7. Trusting the authenticity of clients experiences and accounts.
8. Being accessible to clients when they need help.
9. Caring about clients.
10. Understanding clients.
(Russinova, Rogers, Ellison & Lyass, 2011)
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46. The most mental health care practitioners can do is offer recovery-oriented care in support of the persons efforts toward his or her recovery while enhancing the persons access to opportunities to learn how to manage his or her condition and pursue his or her own hopes, dreams, and aspirations.
-Dr. Larry Davidson, Ph.D.
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47. See 100 Ways to Support Recovery: A guide for mental health professionals by Mike Slade, 2009 foundhttp://www.mentalhealthshop.org/products/ rethink_publications/100_ways_to_support.html?shortcut=100ways#
See How to Recognize a Recovery-Oriented Practice by Davidson, Tondora & OConnell, 2010 at http://www.wapr.info/Bulletins/WAPR_bull_26-27_apr2010.pdf
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48. H.Measuring Recovery in Mental Health Services
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49. The Recovery Promoting Relationship Scale (RPRS)
http://www.nasmhpd.org/general_files/publications/Hospital%20CEO%20Toolkit/Updated%20PDF%20Toolkit/1.3%20Recovery%20Promoting%20Relationships%20Scale%20RPRS%20Manual3.pdf

Developing Recovery Enhancing Environments Measure (DREEM)
Article: http://pb.rcpsych.org/cgi/content/full/31/4/124#REF2
Information available from:Hugh.Middleton@eastmidlands.csip.nhs.uk

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50. Recovery Star
http://www.mhpf.org.uk/recoveryStarApproach.asp
The Illness Management and Recovery
Available at: http://store.samhsa.gov/product/SMA09-4463
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51. Personal Recovery and Mental Illness: A Guide for Mental Health Professionals.Mike Slade. Cambridge University Press. 2009.
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52. Living Outside Mental Illness: Qualitative Studies of Recovery in Schizophrenia. Larry Davidson. New York University Press, 2003.
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53. THANK YOU
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