| Mental Health Empowerment, Partnership and | | | | illness and lives. And the service must stop holding the |
| Recovery: Ideal or Reality? | | | | illness for them, and start holding the hope. Not the |
| Mao Tse-Tung is not an obvious inspiration for the | | | | recovery, though, because the recovery is the context: |
| empowerment, partnership and recovery of mental | | | | it holds us. |
| health services and service users but it was reading | | | | Embracing recovery will transform the way staff and |
| "Mao - The Unknown Story", the astounding biography | | | | services work. Services, like its service users, may go |
| by Jang Chung and her husband of Red China's | | | | through stages of self-acceptance, self-awareness, |
| infamous tyrant that I found a quotation that sums up | | | | self-forgiveness and be willing to release old |
| for me the attitude most conducive to both: "Ideals are | | | | preconceptions and patterns. Service users should be |
| important, but reality is even more important." In my | | | | trained to support each other in recovery and support |
| opinion, which is admittedly uninformed in many ways | | | | recovery of services. Service users can be experts |
| and only that of a self-educated service user, without | | | | not only about themselves but also services in general. |
| recovery - of the service and its staff, and service | | | | Already we hear about very successful peer |
| users alike - there can be no empowerment and | | | | mentoring and other service user projects that support |
| without equality there can be no partnership worthy of | | | | and train the mentally ill to recover each other. It isn't |
| the name. What does the service really mean by | | | | that we want to remove you. We want to work with |
| these words and expect of itself, and of its users? If | | | | you. |
| service users are genuinely empowered, how does | | | | For some it is tempting to criticise the mentally for |
| their relationship with themselves, each other and the | | | | daring to hope for recovery. They are entitled to do |
| service and its staff change? Is partnership | | | | so, but often these critics do not understand that most |
| synonymous with equality, or merely a new expression | | | | mentally ill people are harsh self-critics and without |
| of an old hierarchy? | | | | good reason unlikely to give themselves the benefit of |
| When we use it in this new context, what do we | | | | the doubt. Experience of mental illness of any severity |
| mean by "recovery"? Meta Services, an American | | | | breeds poor self-esteem, corrupted confidence and |
| organisation who have helped pioneer mental health | | | | fractured faith in oneself and life in general. Indeed, |
| recovery peer support, define recovery as | | | | many of us don't have any faith in the idea of |
| "Remembering who you are and using your strengths | | | | recovery. Coming to recovery is, for many of us, a |
| to become all you are meant to be." | | | | road neither straight nor comfortable to tread, but even |
| Closer to home, England's campaigning advocates of | | | | if it is a vain dream, recovery is one worth having. |
| recovery, rethink say, "Recovery can be defined as a | | | | Waking from it cannot be much worse than the |
| personal process of tackling the adverse impact of | | | | nightmare of futility that many mentally ill people live in. |
| experiencing mental health problems, despite their | | | | Empowerment and partnership need not be |
| continuing or long-term presence. Used in this sense, | | | | complicated concepts in application, but firstly |
| recovery does not mean "cure"" | | | | touchstones of humanity and simplicity. If you allow |
| There different definitions demonstrate that recovery | | | | service users to really be heard, to express what they |
| can mean many things. One of its defining qualities, so | | | | want, and treat them foremost as people rather than |
| to speak, is just this diversity, where the individuality of | | | | patients, then the change necessary can happen |
| the experience and perception of recovery is reflected | | | | naturally. I am not deluded enough - and believe me, I |
| in the variety of its definitions. In the same way, to the | | | | am no stranger to delusion - on this subject to think |
| degree that service users are empowered by | | | | that a magic wand exists. What encourages me, on |
| services, they must empower themselves: by | | | | the contrary, is that my own experience and that of |
| redefining their role, redefining their past, present and | | | | others points to a process that can take root, grow, |
| future, and by redefining their recovery, in ways | | | | and then flourish in the hardest ground. And we say, |
| appropriate, different and meaningful. To the degree | | | | simply, let us work with you more. |
| that service users are partnered by services they | | | | One way in which this can begin is by encouraging and |
| must partner - say, befriend - themselves and each | | | | supporting services and service users in questioning |
| other, and partner services, with a new sense of | | | | themselves and each other. It is still sometimes the |
| capacity, responsibility and potential. | | | | case that staff know little or nothing about those they |
| The degree of individual or collective service user | | | | look after. It is essential that staff begin to talk with |
| involvement, assuming empowerment and partnership | | | | service users and not only to them. Interaction |
| as outcomes of same, is determined by answers to | | | | between staff and services and services users can |
| questions such as "Is the user involved in decisions | | | | begin to involve genuine. The mentally ill have stories to |
| about their own care or service plan?" Now, how do | | | | tell about themselves, each other and others not ill as |
| we answer this, honestly, in a context expanded by | | | | they are that are worthwhile and revealing. The |
| empowerment and partnership priorities and in addition | | | | mentally ill, like some other marginalised and maintained |
| informed by a commitment to recovery? In my | | | | conditional members of society are often difficult to |
| experience - by no means definitive, I admit - care and | | | | understand and empathise with, relate to and relax |
| service plans are often subject to incompletion due to | | | | around, but they are some of the most unusual, raw |
| time and caseload pressures on staff. Paperwork | | | | and paradoxically alive individuals you will encounter. |
| must be streamlined and possibly parts of it completed | | | | What matters most is that individuals be given the |
| by service users with minimal mediation; the latter has | | | | opportunity and support and encouragement |
| usefully been done in the past. If the care plan is about | | | | necessary to recover to the point of which they are |
| the service user then why shouldn't they support their | | | | capable. Each recovery is unique and important, no |
| service by contributing to it with more than verbal | | | | matter how it is achieved. Recovery is little evidenced, |
| answers? That's equality. It's empowering. It's real | | | | which is unfortunate because the skepticism about its |
| partnership, and without fanfare. | | | | reality might be challenged by in-depth, service-led |
| Another question asked is "Does the user have any | | | | statistics. Service users must be heard, not just |
| influence over the way that these services are then | | | | listened to and patronised, both in an out of the service, |
| delivered?" The choice of the word "influence" here | | | | and in a sense even more when they have left it for |
| intrigues me. Why should a service user have forever | | | | greater health. How did they do it? What combination |
| to be satisfied with merely "influencing" service | | | | of personal, professional, medical and other factors |
| delivery? Shouldn't empowerment bring real partnering | | | | supported or triggered what is often genuinely a |
| in service development and the active encouragement | | | | transformation? |
| of the training and employment of service users in the | | | | Recovery is, in a sense, a map that creates itself as it |
| service? | | | | is used. There is an initial design, but it reveals itself as |
| Empowerment and partnership are, for me, precursors | | | | plastic and mutable. Recovery is a chameleon and just |
| to and also the results of recovery. And powerful tools | | | | as some mental illness is characterised by a knotty |
| to give service users but, if you like, recovery is the | | | | and detrimental shifting of shapes of identity, so in a |
| engine room where they can really gain steam. | | | | more positive way recovery is in part a process of |
| I didn't always think this. In fact, I came to the idea of | | | | ongoing reinvention and metamorphosis. It asks a great |
| recovery by accident. At a time of resurgent illness, | | | | deal of us but can repay in kind. And there are many |
| casting around for empathy and support, I | | | | surprises. The recovery map has another side. As it |
| unexpectedly found myself on a webpage devoted to | | | | leads us to increased wellness and accommodation |
| service user articles, including those by influential | | | | with ourselves and the world outside our minds, it also |
| pioneers such as Pat Deegan, Helen Glover and Wilma | | | | can hold threats: as we get better, it is not always |
| Boevink. Having heard nothing of recovery, I wondered: | | | | obvious or easy in what ways we live with our |
| Why weren't all service being exposed to this hopeful, | | | | emergent recovered selves. We have more |
| healing and most of all self-actualising message? Why | | | | self-awareness, more responsibilities - to ourselves |
| wasn't this material available as a matter or priority to | | | | and others - and more risks to take. This is why I feel |
| service users? And why wasn't local practise - | | | | it is important to work with recovering (and other) |
| because elsewhere it has grown and grown into a | | | | service users in a way that can acknowledge, without |
| formidable force for practical, tangible change - lined up | | | | validating, their doubts and fears. For example, where a |
| with such a powerful context for good? | | | | relapse occurs, which can often signal a significant dip |
| It has become my conviction that embracing the | | | | in self-confidence and belief in the recovery process, it |
| recovery context and process is, at this time and for | | | | can be acknowledged - without defeatism - that it has |
| some time to come, the best chance mental health | | | | happened and had even severe consequences. What |
| staff, services and service users have of transforming | | | | shouldn't happen is a validation thereby that it is able to |
| the way we look at, live and work with mental illness | | | | derail recovery. This attitude is essential to master for |
| and transform it into sustainable mental health. | | | | both the one recovering and those supporting them. |
| Empowerment and partnership should be synonymous | | | | One way or another we're all going to recover and |
| with recovery. I am not interested in being empowered | | | | that includes local mental health services. The |
| or partnered on principle. I am interested in being well | | | | necessity of recovery will ensure this outcome. The |
| and acting from that with new intent. This assumes | | | | only question is: how fast? |
| new strength. Do service users have such strength? | | | | Equality can take many forms. Lately I have asked |
| I have had the unusual role, for a service user, of | | | | myself: What is the service that I am offering that you |
| co-facilitating recovery trainings to local mental health | | | | are using? My service is that I am mentally ill, I am open |
| service staff. It's worth noting that in itself this is a | | | | to you, I permit myself to be treated and supported by |
| powerful example of how services are changing, and | | | | you... I am therefore clear that you are also my service |
| that I am grateful for the opportunity it gave me to | | | | users. I want it acknowledged for all service users that |
| meet and share experiences with local mental health | | | | just as we use the service, so the service uses us. |
| staff, many of whom I know are now actively involved | | | | And this gives a basic equality. |
| with embracing and creating the recovery context for | | | | Empowerment and partnership are given meaning |
| and with their service users. At one point, during one | | | | primarily by practical and simple measures. By making |
| training, when discussing care plans, staff present | | | | services users, in essence, part of the service, but in a |
| were asked what strengths they feel service users | | | | new, more active and dynamic role. The primary |
| possess and demonstrate. Silence ensued, with the | | | | objective of empowerment and partnership can only |
| dozen or so staff at best bemused, at worst | | | | be this kind of shift. If only the service changes, no |
| indifferent. As the sole service user in the room, and | | | | matter how dramatically for the better, there will still be |
| although generally benign on my service and treatment, | | | | imbalances. The service will be better, which is good, |
| I became irate. Were those engaged with commitment | | | | but the service users will still only be its beneficiaries, |
| and caring for the mentally ill really at a loss to identify | | | | which may also be good but which does little to |
| any strength in them? Even to many working for their | | | | elevate them from a position of dependence and |
| welfare and interested in serving them better, are the | | | | types of inferiority. And it's crucial that we develop in |
| mentally ill fundamentally helpless, the occasional, | | | | parallel, and accept that service users are not at the |
| incidentally admirable "survivor" notwithstanding? | | | | moment widely aware of or enthused by a new |
| Many, including those who treat and support them- and | | | | recovery context. So we need to be patient with each |
| the mentally ill themselves, frequently - see the | | | | other, too. Most of us in the service still need it. This |
| mentally ill as weak. Yet survival of serious mental | | | | whole exercise is about reframing, not rejecting. |
| illness, living with it and recovery from it summon | | | | That's why, in order for real change to take place, |
| honesty and resourcefulness, coping strategies and | | | | service users have to empower and partner each |
| adaptations bespeaking invention and determination, | | | | other meaningfully. These mutually empowered service |
| uniqueness and just plain stubbornness. There is | | | | users then have a foundation and strength able to |
| nothing weak about the mentally ill. Strangely, the | | | | support growth of equality with the service. Many feel |
| struggle by the individual against their illness - supported | | | | this is unworkable, but ways are now being innovated |
| or not - confers upon them a degree of | | | | to make this possible and they are succeeding. |
| empowerment in itself. (As for an analogy for | | | | One of the most popular lately is "peer mentoring". This |
| partnership in this situation, well, as one bipolar, I can | | | | embodiment of mutuality. simply facilitates giving and |
| say with equanimity that it comes from none other | | | | receiving help and support with respect based on a |
| than one of my three selves.) The mentally ill can have, | | | | shared experience. In the UK organisations like the |
| therefore, a strange kind of freedom services and | | | | Scottish Recovery Network and Recovery Devon |
| staff don't; this is why we should be talking to each | | | | produce similar definitions. Peer mentoring presumes |
| others as equals and partners, not only to be equitable, | | | | empathy, which is vital to service user healing. As |
| but to learn from each other and merge the | | | | service users we can expect and experience much |
| experience and knowledge we share. I know that this | | | | sympathy from staff and medical professionals but |
| is happening more and more and has to an extent | | | | rarely, if ever, empathy. It's not fair to expect from |
| always happened; now it needs to become practise. | | | | those whose experience does not include our own, it |
| Over the recovery trainings I was taken, unexpectedly | | | | would be patronizing and disingenuous, at best |
| and spontaneously, on a journey of great personal | | | | contrived. From each other it is natural. Understanding |
| significance and professional value. It caused me to | | | | through the personal experience of having "been |
| re-evaluate and examine all of my experience since | | | | there", genuine engagement, sharing personal recovery |
| my diagnosis. It made me wonder: All the time we are | | | | experiences: these are all powerful ways service |
| told that mental illness is on the rise, more are | | | | users can support and empower each other. Focusing |
| depressed, stressed, anxious, more self-medicate, | | | | on each person's strengths and potential or actual |
| self-harm. Mental health care costs are set to rise | | | | wellness and promoting recovery through relationship |
| steeply. Soon more than half the population of this | | | | and friendship, these are ways to make ourselves |
| country will be statistically mentally ill. And then, who will | | | | better and stronger, and able to participate fully as |
| the mentally ill be? More and more of us seem to be | | | | partners. |
| and claim to be mentally ill, if only mildly depressed. | | | | The next step might be peer mentoring programs |
| Once the mentally ill are definitively in the majority we | | | | where those with lived experience of mental illness |
| will be able to say that truly the lunatics have taken | | | | mentor fellow service users. The two-way traffic here |
| over the asylum. And what will that mean for those | | | | is simple and effective, as the specialist's own |
| who run the asylum? Who dictate its policy and | | | | recovery is strengthened through service. These |
| procedures? It's a question I lay open to you. Where | | | | mentors or peer support specialists help others |
| will we be, and what will mental illness be? We will be | | | | recover through engagement, hope, and mutual |
| living a world of mental illness, not a world with mental | | | | relationship and friendship. And this helps the |
| illness. The fundamental distinction that has informed | | | | organization and system recover. Moving from "mental |
| mental health care for generations - that there are | | | | patient" to colleague redefines our roles and |
| more of "us" than "them" - will have gone. We will | | | | boundaries. Significantly, as staff work alongside |
| finally be equal and this knowledge will slowly but | | | | people in recovery, staff find new hope. |
| inexorably alter our relationship to each other. | | | | It's time there was more awareness of national and |
| Whenever service users become well and are | | | | international developments in service user involvement. |
| recovering there are ripples and resonances felt by | | | | In England, Scotland, Northern Ireland, and abroad in |
| those around, and this includes in services. As the | | | | Canada, the United States, New Zealand and many |
| service user becomes more stable, strong and | | | | more practical application of the ideas of |
| confident, services, staff, family and friends and | | | | empowerment, partnership and the reality of recovery |
| partners all feel it and may question themselves. For all | | | | are often far advanced by comparison with our own. |
| concerned this is a constructive process, if at times | | | | Delivering services around the needs and wants of |
| disconcerting, and where the service is concerned it is | | | | service users; embedding service user involvement in |
| yet another instance where the processes of the | | | | mental health commissioning and whole service |
| service user mirror their service, in the sense that as | | | | redesign; involving service users in setting goals and |
| the service empowers and partners service users, its | | | | outcome measures and delivering user led services: all |
| role will be questioned, challenged and transformed, too. | | | | of these can be considered. |
| It is this mirror process that has so much to teach | | | | Empowerment is not just an idea, it is essential. Let's |
| service users and their service about what they have | | | | see services empowered - self-empowered - to |
| in common and share, usually without even realising it. | | | | change. Let's have real partnership, between agencies, |
| Recovery will pull in the service and force it to recover | | | | and between services and its service users. Ideals |
| its perspectives and preconceptions. Empowering | | | | may be comforting, and reality harsh, but we service |
| service users is a great aim, and partnership a crucial | | | | users are no strangers to harsh realities. For some of |
| outcome, but if it is going to be truly meaningful then | | | | us, it has formed almost all of our experience. |
| the service has to be aware that what is being asked | | | | Recovery is not just a model or a process or a |
| is not just change for its own sake or even for the | | | | concept or a practise or a context. Recovery does |
| service users' sake, but change for the sake of an | | | | not happen just through services, as in the case of |
| important principle: service users are equal now. This is | | | | service users, but also to services. It is a necessity for |
| what I mean: | | | | service users and their best and most realistic hope |
| Just as, at the moment, the service is only just | | | | for restored happiness and new wholeness. If we will |
| awakening to and acknowledging its need to recover, | | | | take this journey together - the best hope for a new |
| service users are likewise only becoming widely | | | | way or working and being with your service users - |
| aware of the need for seeking their own recovery. | | | | the opportunity to recover ourselves and each other is |
| Neither is at fault. In order to work effectively with their | | | | here. I know we can do it, and in fact today, being |
| service, service users must take ownership of their | | | | here, it's clear we have already begun. |