Recovery, community care and self harm and suicide

recovery

changed over time due to the medical model of mental illness. misunderstanding led to a view that serious mental illnesses were dangers.

Goffman - the importance of the structure of mental health care in shaping peoples lives

pre patient, patient, and post patient

Serious mental illnesses (SMI)

Biomedical understandings of mental illness and the negative effects of institutional treatment resulted in an understanding of SMI that largely failed to consider recovery a possibility. Far different from the views of SMI today – which understand recovery as both a possibility and a goal. Recovery is “a process of change through which individuals improve their

health and wellness, live a self-directed life, and strive to reach their full

potential”

the move to community care

began during 1950s, Advocates and people who were writing about their own recovery made the public more aware of the dehumanizing conditions of being institutionalized. deinstitutionalization - new laws established improving care, and advances in medication. but this resulted in more homelessness

the rise of the consumer movement

Social and political developments have given people with SMI more control over their lives and greater levels of inclusion in society. An effort by people with mental illness to establish control over psychiatric treatment and the severe social stigma that attends a psychiatric diagnosis.

“Psychiatric survivors

• application of psychiatric labels had just as profound of

effects on patients as the symptoms associated with their diagnoses

“Consumers”

an attempt to shift the focus of mental health care from

psychiatrically controlled treatment to services guided by consumer choice

current perspective on recovery

is governed by a social model that is focused on consumers’ attempts to negotiate the limitations of SMI and barriers to social inclusion. Alliances that have formed between those who consider themselves consumers of mental health services and the psychiatric profession have assured that biomedical views are still alive within the debates regarding how to define (and treat) recovery. there are two major models of recovery - 1. provider directed and 2. consumer centered

provider-directed recovery

as an outcome, rooted in biomedical model. it is measured in two ways - 1. a complete remission of symptoms 2. reaching the goals set out by a mental health professional (ex - medication compliance). this can be problematic in some ways - ignores 30+ years of social and political stuggles by consumers by shifting control back to the psychiatric profession, SMIs cant always make a complete remission, and ignore every day experiences of living with SMI

consumer-centered recovery

recovery as a process. treats SMIs similar to disability, rather than an illness - focusing on quality of life, parenthood, and empowerment rather than complete remission. it is more popular among advocate groups. it shifts from the medical treatment to consumer attempts to address the issues caused by SMIs and to meet their goals - larger concern on consumers access to rights and inclusion, recognizes that recovery is unique and attempts treatment needs to fully involve consumer, and recognizes the best setting for recovery in the community. guiding principles - hope, person driven, many pathways, holistic

pharmaceuticalization

This consumer mentality has also fed into the development of a relatively recent phenomenon. A process whereby pharmaceutical intervention is increasingly understood to be a necessary part of medical intervention

features that will be found in recovery models

1. is this person centered rather than illness centered. 2. recovery programs move from being professionally driven to client driven. 3. build strength for them to deal with their own problems

SMI and addiction

Recovery-focused research in both of these areas tends to concentrate on either mental health or substance abuse recovery, while largely ignoring interactions between the two. Recovery in addictions is almost always looked at as an outcome, namely abstinence. Because mental illness is treated as a disability, the symptoms of SMI are viewed as something consumers need to learn to live with, while the disease symptoms of addiction (i.e., substance use) are viewed as something from which consumers need to be “cured.”

factors demonstrated to be central to the recovery process

1. social stress - importance on coping, social support, and mastery over MH have on outcomes. 2. social integration - positive and negative influences social roles, community ties, and social support. 3. Social stratification – association between social inequalities and mental health disparities. 4. Stigma – power that negative cultural views can have on people who are diagnosed.

meaning and experience of recovery

the continued use of biomedical approaches rooted in the disease concept of addiction. Needs to be greater efforts to understand recovery as it is experienced in consumers’ everyday lives. The majority of research conducted on mental health recovery today continues to investigate it as an outcome defined by medical professionals.

understanding the context of care

Connections between the social structure and mental health outcomes - focused on the way in which different structural arrangements expose different social groups to varying amounts of stress. Recovery from mental illness is generally guided by some form of institutionalized

treatment modality or programming (thru doctor/therapist). Organizations that provide mental health services link consumers to the larger social structure through their policies and practices, which are constructed through larger political and professional processes. The interaction between - characteristics of the individual, the characteristics of the environment and the exchange between the two can hinder or promote recovery.

Durkheim has two core principles of suicide

1. the structure of suicide rates is a positive function of the structure of a group or class of peoples social relationships and those 2. that social relationships vary according to their level of integration and moral regulation of society. The more denser the relationship, the more integrated the society becomes. counter - Integration and regulation can coexist and in

fact likely co-determine place-based vulnerability

four types of suicide

egoistic, altruistic, anomic, and fatalist

egoistic suicide

absence of social integration -

Altruistic suicide

occurs when social group involvement is too high.

Anomic suicide

lack of social regulation and it occurs during high levels of stress and function.

Fatalist suicide

when individuals are kept under tight regulation

exposure to suicide

1. from media reports of suicide (esp parents or celebrities) and 2. personal role models are seen to increase risk of suicide. believed to be 'socially contagious'

social contagion

The spread of behaviours, attitudes, and affect through crowds and other types of social aggregates from one member to another.

clusters

non-random increases in suicidal behaviours in close temporal or geographic proximity. contagion effect - suicidal behaviours in one or more individuals promote or increase the likelihood of the occurrence of subsequent behaviours in others

“Werther effect”

contagion of suicidal behaviour following a highly publicized suicide

“Papageno effect”

media may present constructive coping strategies for suicidal ideation or emphasize messages of hope regarding adverse life circumstances

suicide prevention strategies

1. contact with providers 2. effective mental health care 3. feelings of strong connections to individuals 4. and problem solving and resolution skills

social inclusion

no definition but its a socially inclusive society would have people feeling valued, where differences and rights are respected, and basic needs are met. THey are able ot live in dignity and voices heard. and meaningful participate social, economic, cultural, and political systems. two types - economic dimension and non material dimensions (contributing to the social aspects of society )

social inclusion and health

both physical and mental health are influenced by how connected you are to your community/friend group. pathways are multiple, complex and multi-directional. they are shown to affect health by providing different forms of social support, meaningful roles, and access to resources or intimate one and one contact.

types of exclusion

exclusion from social production - most of this is when you cannot afford it . economic exclusion - cannot finding paid work . social inclusion - discrimination, marginalization, education underachievement and crime.

social exclusion

socially excluded people are more likely to - be unemployed, have less access to health and social services, and to means of furthering their education. they are increasingly segregated into neighborhood's. and lack power.

4 aspects of social exclusion

1. denial of participation in civic affairs 2. laws and regulations prevent participations 3. systemic forms of discrimination 4. denial of social goods

social connectedness

can increase feelings of security and decrease or buffer stress. higher cognitive and physical functioning in older adults through engagement. connections and relationships linked to increased social support, disconnectedness linked to poor mental health. social networks can influence of and adherence to, health promoting behaviours leading to better health outcomes.

stack - why suicide is rising in US but falling in Europe

two factors - weakening of the social safety net (programs designed to provide assistance and supports) and increasing income inequality.