health promotion well being recovery - nancy brookes
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Promoting Health,Well
Being
andRecovery
February 8, 2013
Nancy Brookes, RN; PhD; CPMHN( C)[email protected]
Achieving Certification:
The Psychiatric Mental Health
Review Course
Windhorse Principle
Inherent in every person there is a naturalhealing impulse, a motivation towardhealth & wholeness. This motivation canbe ignited & strengthened in anenvironment where an attitude of hope & abelief in each person's potential for growthis pervasive. At the heart of an individualsrecovery from mental disorder is therestoration of personal, social, &environmental connections
Presentation OverviewA Quick Trip Through:
Health and healing
Mental Health
Environment, culture
The power of language and how words can wound
Stigma, prejudice and discrimination as a barrier torecovery
Recovery Health promotion
Well-being
Resil ience
Self care
Lots of resources
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Environment As Context Quality of environment has significant impact upon humanQuality of environment has significant impact upon human
healthhealth (CNA, 2000)(CNA, 2000)
Our task is to provide conditions under which people mayOur task is to provide conditions under which people mayheal themselves, or be healedheal themselves, or be healed-- as Florence Nightingaleas Florence Nightingale
remarkedremarked -- by nature or by God.by nature or by God.
People grow up, develop & heal within their many physical,
cultural and social environments contexts: Home, school,
work, social, hospital, health care system..
Environments multilayered including biological, external,
social, cultural, interpersonal
Healing environments work principally by supporting copingHealing environments work principally by supporting coping
with stresswith stress
Environments Nightingale quality of persons environment
holds key to health and healing
Complex relationship btw person andenvironments
Integral person essential part of environment &environment essential part of person
Environments include internal, external, and thesocial and cultural milieus in which person lives. Aperson dwells in multiple environments, often atsame time
Environments & experiences can be healthpromoting and support health, or they can be toxicand detrimental to health
Culture
A word about culture integrated throughout
A number of programs available to enhance
cultural competence see for example MHCC
Cultural Awareness Tool
A caution importance of knowing theperson/family/community, avoid possible
stereotyping based on understanding of the
culture
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MHCC Cultural Awareness Tool
https://kec.mentalhealthcommission.ca/mental_health_tools_and_resources
Tool is designed as a first step to providecomprehensive information on all aspectsof culturally sensitive care. Does notprovide comprehensive information on allaspects of culturally sensitive care.
Based on the use of this tool the hope is thathealth and mental health practitioners willfurther develop their own knowledgeconcerning culturally sensitive care
Mental Health Commission of Canada
Mental Health vs Mental Illness
Mental illnesses are disorders that cause a seriousdisturbance in thinking, emotions or behaviour (onein five; one in three)
Depression, Bipolar disorder, Schizophrenia, Anxietydisorders, Personality disorders, Eating disorders [newDSM V ...]
Mental health often described in negative terms absence of mental illness, or societal norms andregulations
Notice rarely hear mental illness anymore oddterms 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.
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Mental Health - human face
Mental health is the capacity of each and all
of us to feel, think, and act in ways thatenhance 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 andpersonal dignity.
The Human Face of Mental Health and Mental Illness
Mental 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 health continuum: two poles optimalmental health, poor mental health; respectivedemands & contributions of person, group &environment balanced so they support values andobjectives expressed in definition of mental health
Mental disorder continuum: one end point extreme
severity of symptoms (distress & impairment), otherwould be complete absence of symptoms or effects range of different symptoms present to varyingdegrees Mental health for Canadians: Striking a balance (1988)
Flourishing (CAMH)
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Stigma
Stigma refers to negative attitudes (prejudice)
and negative behaviour (discrimination) Includes: having fixed ideas and judgements;
stereotyping, fearing and avoiding what wedont understand
Mental Health Commission of Canada
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 referring to the negative mark attached topeople who possess any attribute, trait or disorderthat marks that person as different from normalpeople. This difference is viewed as undesirableand shameful, and can result in people having
negative attitudes and responses (prejudice anddiscrimination) toward another person
Adapted from OGrady, C. (2004). Stigma as experienced by family members ofpeople with severe mental illness: The impact of participation in self-help/mutual aid support groups. Unpublished doctoral dissertation, University ofToronto.
Stigma: The FactsWhat is stigma?
Stigma (or prejudice) describes a negative andunfavourable attitude.
Stigma causes those living with a mental illness to belabelled, stereotyped, and feared.
What is discrimination? Discrimination is the action that results from stigma.
It is how you treat those living with mental health issuesbecause of how you think about them.
Why does it matter? Many people living with mental illness say the stigma is
worse than the illness itself.
Stigma is seen as one of the key barriers preventing peoplefrom seeking help.
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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 to
commonly used words and phrases
Worn-out language
you're just
Decompensating
Manipulat ive
Crazy
Compliant
Noncompliant
Resistant
Language that promotes
acceptance, respect,
&uniqueness
You are more than
Not him/herself today; he/she isexperiencing symptoms
Resourceful; really trying to get
help Unique
Might not be confident aboutpersonal choices or decisions;afraid
Beginning to think for him/herself;taking personal responsibility
Not open to; chooses not to; hasown ideas
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Alternative Language
Wornoutphrases Frequent flyer
Ent it led
Basel ine
Unmotivated
Helpless
User of system
Recoverylanguage Gives us many opportunities to
intervene and support
Aware of rights
What a person looks like when
doing well
Has other interests; bored;doesnt know how to begin
Unaware of capabilities
Resourceful, good self
advocate
Source URL:
http://www.behavioral.net/article/tools-transforming-language
Its Just Behaviour
My personal favourite of course whatever itis it is behaviour
How might we change our language aroundthis 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 recoveryprocess. These shared meanings either
support a sense of hope and possibility, or
invite pessimism and chronicity
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Recovery Knowledge InventoryEncourages 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
Recoveryinvolves 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 Potential to transform the system
People recover we provide recoveryoriented service and care
Not to be mistaken for a passing fad
roots stretch to the birth of psychiatry in the18th century. As its
Reintroduction intended to bring aboutfundamental transformation of mental health -a revolution in care
Not simply a new word to be used indescribing current practices.
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What is Recovery?
SRN recovery is a deeply personal, unique process ofchanging ones attitudes, values, feelings, goals, skills,
and roles. It is a way of living a satisfying, hopeful andcontributing life, even with the limitations caused byillness. Recovery involves the development of newmeaning and purpose in ones life as one grows beyondthe catastrophic effects of mental illness(Anthony, 1993)
SAMSHA - Recovery is a process of change wherebyindividuals work to improve their own health andwellness and to live a meaningful life in a community oftheir choice while striving to achieve their full potential.
Recovery
There is no set time requirement for recovery,
Recognized as an individualized process
Each persons journey of recovery is unique and
Each person in recovery chooses supports, ranging fromclinical treatment to peer services that facilitate recovery
Recovery involves a process of growth andtransformation
Person with a mental health problem or illness developsstrengths and new ways of being
People are empowered and supported to activelyengage in their own journey of well-being.
Four Major Domains Support Recovery
- SAMHSA: Health: overcoming or managing ones disease(s)
as well as living in a physically and emotionallyhealthy way;
Home: a stable and safe place to live thatsupports recovery;
Purpose: meaningful daily activities, such as ajob, school, volunteerism, family caretaking, orcreative endeavors, and the independence,income and resources to participate in society; and
Community: relationships and social networksthat provide support, friendship, love, and hope.
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National (US) Consensus Statement on
Mental Health RECOVERY
Self direction
Individualized and
person-centred
Empowerment
Holistic
Non-linear
Strength based
Peer support
Respect
Responsibility
Hope
www.samhsa.gov
Principles of Recovery Person-driven;
Occurs via many pathways;
Is holistic;
Is supported by peers;
Is supported through relationships;
Is culturally-based and influenced;
Is supported by addressing trauma;
Involves individual, family, and communitystrengths and responsibility;
Is based on respect; and
Emerges from hope.
Engagement Beliefs
Recovery is possible
Change is inevitable nothing lasts
Ultimately people know what is best forthemselves
People posses all the resources needed to
begin the recovery journey The person is the teacher, we are learners
We need to be curious learn what needs to bedone to help the person now!
www.tidal-model.com
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What People Tell Us Helps Educating oneself about the illness. Identifying symptoms and reviewing
choices for managing those symptoms and making decisions about howto manage those symptoms that works best.
Making choices about medications: find out about the side-effects ofeach, as well as, the effects of withdrawing (stopping use of) certain
medications. Recording symptoms in a notebook while taking medicationand use this to support or oppose continued use of a particular drug.These records can be used to work with doctors regarding the bestchoices for you.
Exploring non-medication and non-medical approaches to managingsymptoms and maintaining mental health.
Learning various coping strategies and activities such as meditation,relaxation techniques, prayer, or hobbies that can help to reduce stress;joining clubs and organizations.
Seeking employment and self-employment support programs.
Seeking mutual aid opportunities such as self-help groups, communitykitchens and food banks.
Learning to make the most of social assistance programs, low costtransportation.
LET'S TALK ABOUT SOLUTIONS
Recovery Conversations
The Recovery Conversation focuses on strengths andthe potential for self-determination instead ofacceptance of limitations that perpetuate feelings ofhelplessness and hopelessness.
begins by focusing on the person instead of the problem.
focus is on empowering the person
includes a dynamic planning phase
Risks and outcomes are held in mutual partnership framed in the context of the person's strengths and action plan
Special attention given to building resilience
concludes with a mutual assessment of the process and progress
Source URL: http://www.behavioral.net/article/lets-talk-about-solutions
What is a Wellness Recovery ActionPlan (WRAP)
The Wellness Recovery Action Plan, or WRAP is
An evidence-based systemUsed 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 healthdifficulties; 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 Wellness Tools, and
then using those resources to develop Action Plans to use in specificsituations which are determined by you. WRAP is adaptable to anysituation. WRAP also includes a Crisis Plan or Advance Directive.
Wellness RecoveryAction Plan - Mary Ellen Copeland
www.mentalhealthrecovery .com/aboutwrap.php
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Structure of Framework for SupportStructure of Framework for Support
Purpose: To ensure that people with seriousPurpose: To ensure that people with seriousmental health problems live fulfilling lives in themental health problems live fulfilling lives in the
communitycommunity 3 fundamental assumptions & 3 conceptual models3 fundamental assumptions & 3 conceptual models
Provision of services & supports to people with mentalProvision of services & supports to people with mentalillness needs to be reformed & restructuredillness needs to be reformed & restructured(CRB(CRB rethinks nature of services & supports)rethinks nature of services & supports)
Most basic ways we think about & understand MI needsMost basic ways we think about & understand MI needsto be reto be re--examined & changedexamined & changed (KRB(KRB focus on di versefocus on diversekinds of info)kinds of info)
Way consumers seen as people needs to be changed &Way consumers seen as people needs to be changed &enrichedenriched -- focus on capacitiesfocus on capacities (PRB(PRB consumers asconsumers asactors who can direct their own recovery process)actors who can direct their ow n recovery process)
CommunityResourceBaseMapCommunityResourceBaseMap
Self Help &
Consumer
Organizations
Family &
Friends
Mental Health
Services
Generic
Community Services
& Groups
Housing
Education
Income WorkPerson
KnowledgeResourceBaseMapKnowledgeResourceBaseMap
Experiential
KnowledgeCustomary/Traditional
Knowledge
Social Science
Knowledge
Medical/
Clinical
Knowledge
Transforming
Our Understanding
Of Mental Illness
Recognition
Of Diversity
SocialAcc eptan ce
& Inclusion
Enriched Range of
Services & Supports
Mental Health
Literacy
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Purpose &
Meaning
Inclusion &
Belonging
Practical
Understanding of
illness
Positive
Sense of Self
Hope
Well Being
ConfidenceResilience Being in Control ofYour Own Life
Personal Resource Base Map
Social/Determinants of Health
Determinants of 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, personal health practices and coping
Education
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Both Health Promotion & Mental Health
Promotion
focus on the enhancement of well-being rather than on illness
address the population as a whole, including people experiencing
risk conditions, in the context of everyday life are oriented toward taking action on the determinants of health
broaden the focus to include protective factors include a wide range of strategies (e.g.: communication, education,
policy development, organizational change, community development and local activities) acknowledge and reinforce the competencies of the population
encompass the health and social fields as well as medical services
Joubert et al., 1996
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Health Promotion in Mental Health
Mental health promotion actions taken to
maximise the mental health and wellbeing of
populations by:
- improving social, physical and economic
environments
- strengthening the understanding and skills of
individuals in ways that support their efforts to
achieve and maintain mental health
Mental Health Promotion Mental health promotion is the process of enhancing the
capacity of individuals and communities to take controlover their lives and improve their mental health. Mentalhealth promotion uses strategies that foster supportiveenvironments and individual resilience, while showingrespect for culture, equity, individual choice, social
justice, interconnectedness and personal dignity.
Social Determinants of Health are at the forefront ofhealth promotion
The Human Face of Mental Health and Mental Illness in Canada.Public Health Agency of Canada. 2006.
Mental Health Promotion - Canada
Way back in 1988 Mental Health for
Canadians: Striking the Balance provided
driving force for placing mental health within
a health promotion framework
Ottawa Charter promote individual &collective health; develop healthy public
policy, reorient health services, build
individual skills, create supportive
environments & strengthen community action
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A Word About Prevention
Prevention of mental illness and addictionsfocuses on measures taken to prevent problems
and illnesses, by addressing risk factors as wellas protective factors for individuals, groups andcommunities.
Mental illness prevention actions taken toreduce the impact or prevent the initial onset ofmental illness
Mental illness treatment actions taken toremedy a mental illness or to lessen its illeffects.
Mental health promotion - WHO
Mental health promotion involves actions 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 that respects and protects basic 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 Childhood: positive early childhood 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
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Risk Factors TRAUMA
Alcohol and drugs: access and abuse
Displacement: refugee and asylum-seeker status Disabil ity
Education: lack of access
Family: fragmentation, dysfunction and child neglect,
post-natal depression
Genetics
Physical illness
Physical inactivity
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 RecoveryPathways to Recovery translates the evidencebased practice of
Strengths Model into a selfhelp approach
Before I heard of Pathways, my mental illnessdefined me. When I first beganthe workbook, I realized my recoverydefined me. By the time I finishedPathways, 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 formal
research studies. It is considered an evidence-based practicebecause it has been found to promote positive outcomes for peoplewith psychiatric disabilities. The Strengths Approach has beenproven to keep people in the community and helps them meet theirgoals.
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Resilience Recovery Well-Being
Most of us find that tough stuff comes at us every day.
You can either let it negatively impact you or you can getthrough the tough stuff and use what you have learned in
those instances to help you in the future. Resiliency is the ability to bounce back from setbacks orchallenges.
Resiliency isn't a "thing," it's a combination of skills and/orabilities that can help you get through setbacks orchallenges. In short, resiliency is something you do.
"Resiliency is individualized. It looks different for each of us
Three most common themes are family, faith andperseverance; act as first line of defense for someone facinga 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 for us
Developing our service plans for us
Reminding us of our limitations
Trying to control us Reminding us of past failure
Viewing us through the lens of our diagnosis
as an illness
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Helps Resilience Be happy to see us
Answer our phone calls and return 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 apatient. This will allow you to experience us asa credible participant in our quest for recoveryand resilience.
Resiliency Checkpoin tFor each pair choose the one that best describes you:
A. I tend to view challenges as opportunities.B. Challenges are often a result of bad luck.
A. I can find humour in difficult situations.B. There is nothing funny about difficult situations.
A. I do not dwell on the negative. I focus on the positive.B. All I encounter is negative.
A. I am comfortable with ambiguous or uncertain situations.B. I cant function without knowing what is going to happen next.
A. My struggles have made me a stronger, more insightful person.B. My struggles have been a direct result of other peoples actions.
To score - for every A answer you have selected, give yourself 5 points, and for every Banswer 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
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 anyway 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 ourlive.
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 ahard blow. Rather, well 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 new things, to take
calculated risks, to move out of our comfort zone and into new ways of being.
www.magellanhealth.com/training
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Burn Bright - Build your own resilience Save energy by encouraging us to manage ourselves, instead of trying to
control us.
Be in a good mood and stay optimistic about our recovery. stay in relationship with us; we can be much better company than the
paperwork!
When we slip and slide, dont 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 can, share your own story of resilience with us. I cant tell you what
a valuable step this would be for all of us!
Its practically impossible to engage in these activities if you have a negative
attitude (are resentful, 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 StrategiesThe 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 PrincipleInherent in every person there is a natural
healing impulse, a motivation towardhealth & wholeness. This motivation canbe ignited & strengthened in anenvironment where an attitude of hope & a
belief in each person's potential for growthis pervasive. At the heart of an individualsrecovery from mental disorder is therestoration of personal, social, &environmental connections
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Resiliency and Recovery E-Learning
Center
www.magellanhealth.com/training
RecoveryECoursesRecoveryecourse1:RecoveryisRealRecoveryecourse2:SelfdeterminationFuelsRecoveryRecoveryecourse3:TheLanguageofRecoveryRecoveryecourse4:PlanningthatPromotesRecoveryRecoveryecourse5:Let'sStartLivingLargeRecoveryecourse6:TheResiliencyFactor
ResiliencyEcoursesResiliencyecourse1:GettingPasttheToughStuffResiliencyecourse2:ThePowerofResiliencyResiliencyecourse3:GrowingYourResiliencyResiliencyecourse4:RecappingResiliency
Recovery ResourcesMental Health Commission of Canada -
https://kec.mentalhealthcommission.ca/mental_health_tools_and_resources
Scottish Recovery Network [email protected] www.scottish recovery.netSubstance Abuse & Mental Health Services Administration SAMHSA -
[email protected] Center for Psychiatric Rehabilitation , www.bu.edu/cpr
NAMI: 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 Deegan)
The National Mental Health Consumers Self-Help Clearinghouse,800-553-4539,www.mhselfhelp.orgRecovery Knowledge Questionnaire -
Resiliency Canada http://resiliencycanada.ca/http://www.acbhcs.org/wellness_test/wellness_inventory.htm
Tools for transforming language. Behavioral Healthcare Source URL:http://www.behavioral.net/article/tools-transforming-languageanother source on the respectful use of language see
http://uspra.org/files/public/langGuidelines.pdfChallenging the Public Stigma of Mental Illness: A Meta-Analysis of Outcome Studies.
http://bit.ly/KenPopeMetaAnalaysisReducingStigma104 Studies of reslilience publish ed in 2012 (citations & excerpts):
http://bit.ly/KenPopeResilienceResources
ResourcesMental Health Commission of Canada www.mentalhealthcommission.caChanging directions, changing lives. Mental Health Strategy for Canada Toward Recovery and Well-Being: A Framework for a Mental Health
Strategy for Canada
Voluntary National Standard of Canada for psychological health and safetyin the workplace releasedhttp://www.mentalhealthcommission.ca/SiteCollectionDocuments/January_2013/MHCC_Standard_MediaRelease_ENG.pdf
Centre for Addiction and Mental health www.camh.caCAMH Knowledge Exchange http://knowledgex.camh.net
Canadian best practices portal for health promotion and chronic diseaseprevention www.phac.gc.ca/cbpp
CMHA Mental health promotion tool kithttp://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 forperson and family. New York: Springer
Interactive Domain Model of Best Practices IDM Best Practices website atwww.idmbestpractices.ca
National Network for Mental Health (NNMH) http://www.nnmh.ca/
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Some Principles Governing Person-
Environment Transactions Persons genotype or genetic make-up determines
responsiveness to environment Persons biology, stress level, moods, and
emotional states affect and are affected byinteractions with environments
Environments are modifiable
Environment & specific experiences of person canalter biological structures, such as brain
Persons reliance on environment related tohealth, age, & vulnerability
Quotes"A community is commonly understood to be about
relationships; its not a place. A neighbourhood is aplace, but community is about peoples relationships.John McKnight, 1990
Bettelheim: The physical environment is theBettelheim: The physical environment is thehouse of thehouse of thespiritspirit and it is theand it is the spirit underlying the physicalspirit underlying the physicalstructures and their furnishings which is of the greateststructures and their furnishings which is of the greatestimportanceimportance (In Cotton & Gerty, 1984)(In Cotton & Gerty, 1984)
The limits of my language . . . mean the limits of my world.- Ludwig Wittgenstein (1963)
Especially at times of great personal crisis, people needEspecially at times of great personal crisis, people needto retire from everyday life. It is as if they are retiring toto retire from everyday life. It is as if they are retiring tosome quiet, & often distant place, to review theirsome quiet, & often distant place, to review theirexperiences; to prepare for the time when they will reexperiences; to prepare for the time when they will re--enter the arena of lifeenter the arena of life (Deegan, 1990; 1996)(Deegan, 1990; 1996)
What People Tell Us Helps Educating oneself about the illness. Identifying symptoms and reviewing
choices for managing those symptoms and making decisions about howto manage those symptoms that works best.
Making choices about medications: find out about the side-effects ofeach, as well as, the effects of withdrawing (stopping use of) certainmedications. Recording symptoms in a notebook while taking medicationand use this to support or oppose continued use of a particular drug.These records can be used to work with doctors regarding the bestchoices for you.
Exploring non-medication and non-medical approaches to managingsymptoms and maintaining mental health.
Learning various coping strategies and activities such as meditation,relaxation techniques, prayer, or hobbies that can help to reduce stress;joining clubs and organizations.
Seeking employment and self-employment support programs.
Seeking mutual aid opportunities such as self-help groups, communitykitchens and food banks.
Learning to make the most of social assistance programs, low costtransportation.
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Recovery Notes The language used and the stories and meanings that are
constructed have great significance as mediators of therecovery process. These shared meanings either support a
sense of hope and possibility, or invite pessimism andchronicity.
The development of recovery-based services emphasisesthe personal qualities of staff as much as their formalqualifications. It seeks to cultivate their capacity for hope,creativity, care, compassion, realism and resilience.
Family and other supporters are often crucial to recovery andthey should be included as partners wherever possible.However, peer support is central for many people in theirrecovery.
Adapted from Recovery Concepts and Application by Laurie Davidson, the DevonRecovery Group.
What is discrimination?
Discrimination is a prejudicial act, such as denying
someone employment, housing, accommodation or
other services because of the persons 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 individuals
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); for example,believing the negative stereotypes generated by society andmedia messages
tendency to avoid seeking help, and to keep symptoms &
substance use a secret
social isolation and/or constricted social support network poverty
depression
loss of hope for recovery
suicide. Adapted from Pompili, M., Mancinelli, I. & Tatarelli, R. (2003). Stigma as a cause of
suicide. British Journal of Psychiatry, 183(2), 173174,
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Sets of Value SystemsSetsofvalues Personal/cultural
Ethical/moral
Political/religiousDoctrinal/ideological
Examplesofvalues Always do the right thing
There are rewards in working hard People have the right to make
choices related to care
People have right to be treatedwith respect & dignity
health is a right, state shouldprovide & pay for it
Health care a privilege; people areresponsible for taking care ofselves Gottlieb (2013)
Collaborative Relationships
FROM focusing on deficits TO working with personsstrengths
FROM doing for the person TO working with theperson
FROM focusing on disease and its treatment TOfocusing on living and coping with challenges andadverse events
FROM the nurse as teacher TO both person & nurseas learners
FROM measuring set of specific outcomes TOallowing person to determine own goals & ownmeasures of success Gottlieb (2013)