“They tried to bury us. They didn’t know we were the seeds.” (Mexican proverb)
Mental health conditions in Scotland are described in terms of recovery and social inclusion, yet many people still experience stigma and are socially disabled by their mental health problems.
Over the last decade Scottish Government policies have endeavoured to tackle this and enhance peoples’ opportunity for recovery through the development of organisations such as the Scottish Recovery Network and the See Me campaign. In addition the role of mental health nursing has been reviewed to hold the values of Rights, Relationships and Recovery.
This article will examine transformation at a fundamental level within Mental Health Nursing in Scotland by focussing on two individuals, their reflections and their journeys.
What is Recovery?
For over 25 years we have considered that recovery in mental health can be defined in non-medical terms. Patricia Deegan (1988) has spoken of her recovery and describes it as a process whereby people challenge, rather than accept, being socially disabled by their mental ill health and recover a new sense of self.
Through the words of Deegan (1996) and others with lived experience we have guidance as to what makes a difference. This includes a society more wide stream and accepting of variation; as recovery is neither a process of getting better or becoming more normal, rather it is our vocation to embrace becoming more deeply human.
In 2000, I was working as a hospital based mental health nurse (called a psychiatric nurse in those days). I had not heard of recovery. A forward thinking manager at work invited someone from America to speak to my team. I don’t remember the speaker’s name but I do remember what was said.
People can recover from mental illness. This is not achieved by symptom reduction but in a personal way through developing a new sense of oneself in sight of one’s own unique experiences.
I began rethinking the framework by which I understood mental illness. There was little information to work from and no access to the internet back then.
In 2004 the Scottish Recovery Network was established and the internet was a little more accessible. I started to read about recovery and talk to people I worked with to see if I could help them recover this sense of self rather than focussing on managing their mental illness.
In 2004 I began a job resettling long term patients back into the community after many years of institutionalised care. I was amazed at how well people adapted to life outside an institution. They had been so debilitated in hospital but soon I was wondering if it was the illness or the environment that was the biggest barrier to their ability to move on. However it soon became apparent that the biggest change required was my own low expectations of others.
It was suggested to me that I should go to a week long residential course on “Working to Recovery” run by Karen Taylor and Ron Coleman. The course was a rocky start for me as I felt I had little in common with others in the room. The group consisted of support workers, carers, social workers, service users and occupational therapists. The only people I identified with were the mental health nurses and even that was limited.
During the course I realised that something very fundamental about me, the real me, had been altered since joining the nursing profession in 1982 and I didn’t like what I had become. It is a long story but suffice to say that week changed my life, personally and professionally, and I am now an activist for mental health recovery and the anti stigma campaign.
The example above shows the early buds of change in Tayside. It seems strange to think about it now but there seemed to be little support for this approach at the time. These brave individuals were among the early adopters of the recovery movement that we now take for granted.
The Story of Attitudes and Values
Mental health problems affect 1 in 4 of the general population and can affect anyone, similar to other health conditions such as heart disease and cancer. However the reactions of family, friends, neighbours, work colleagues and employers can be harder to deal with than the illness itself leading many people to keep mention of the illness to themselves; further compounding the problem, its impact and stigma.
Nursing values in 2015 aim to place people at the centre of care, listen to them and not base practice on assumptions about what people need. We want to view people as the experts in their experience and appreciate the contribution of families and carers.
The Angus Story
A recent project within the Angus Adult Mental Health Service saw Penumbra and the Integrated Mental Health Service work in partnership to ask people with a lived experience of mental ill health to design a cover for the new Mental Health Strategy. The result is striking and transformative and led to the creation of the lighthouse below which provided a meaningful title page and reference point for the service.
The Story of Education and Work
In the 1980s it wasn’t unusual to talk about “The Sick Role”. Unlike people with a broken leg or heart failure who were expected to leave the role after a short length of time, no such expectation existed for our patient group.
Now in 2015 the National Health Service is providing supported employment places for people. Indeed, the NHS commissions services to provide opportunities for work, education and training. We are seeing people regaining a sense of purpose, a sense of self and challenging workplace stigma just by being part of others day to day lives. Working and earning money does amazing things for people’s self esteem.
In conclusion, the journey of mental health nursing since the year 2000 and its place within healthcare today is significant but so is the transformation of societal attitudes and values relating to individual mental health and wellbeing.
As we enter 2015 it’s time to speak out about the true nature of mental health conditions. Key messages being, there is hope, there is evidence and people can and do recover from mental health problems. Stigma makes no sense.
If you want to read Patricia Deegan’s articles mentioned in this blog you can find them here.
Deegan PE (1988) Recovery: The lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 9(4), pp 11-19
Deegan PE (1996) Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 9(3), pp 92 – 97
Sharlaine Walker is Planning Manager (RMN) in the Adult Health and Social Care Integration Team in Forfar. You can follow Sharlaine on Twitter @swalkerRMN
Emma Lamont is a Nurse Lecturer in the Division of Mental Health Nursing and Counselling of Abertay University in Dundee. You can follow Emma on Twitter @EmmaAbertay