A mental health service user's perspective on the 'Recovery Model'

I would certainly not describe myself as 'recovered', although that is a term and a concept developed by service users as a far back as 1995. It was introduced as a concept to challenge those who would set us apart from others, denigrate us in society. It was an attempt we made to be better understood and accepted.

The response to the concept of 'recovery' has been mixed. It is now adopted as the new model in mental health, no reference or credibility has been given to the service users like myself who initiated the whole concept through giving talks on mental illness around the country, taking questions and answers and so on. Framing mental illness as an understandable phenomenon to everyone. Some of my first thoughts and writings on the subject are in documents archived by the National Perception Forum.

That reality and history has been obscured and, under the recovery model, we are treated as if we are stupid and have to be pushed and cajoled into work as part of our 'recovery'. It doesn't seem to occur to those administering 'recovery' that we do actually live in the community now, so many of us know where and how to find jobs. Many of us have already tried with varying degrees of success to work, we do not need to be pushed around.

The ultimate aim in the 'recovery model' is to discharge us from mental health services and the mental health remit altogether, the 'logic' being that we have 'recovered'. That is dubious and lacks understanding of mental illness, emotional distress and the ensuing disability.

After a true breakdown, we do not ever really recover, as I have not. It still remains that I would dearly like to have a close relationshiop with another person, but that ( which many people may take for granted) is a near impossibility for me. I cannot watch TV as it either bores me to distraction, or I have uncontrollable fits of crying. Emotionally, I cannot cope with being around children. I cannot go out easily therefore I stay in on my own. I cannot go out at night, and have a poor understanding of money. I have auditory, visual and tactile hallucinations, panic attacks, night terrors, panic attacks at night and I self harm, the scars are there for all to see. Then there are permanent physical health problems from the long term use of psychotropic drugs including mood stabilisers, problems such as diabetes, oedema, weight gain, muscle stiffness which leads to a sedentary lifestyle and exacerbates problems.

The 'Recovery Model' now adopted is highly patronising, it assumes we know nothing and that there is nothing wrong with us, therefore there is no duty of care, but we do still have to take medication.

What I would like to know, now that I have expressed a little of what it is like from a service users perspective, is how do the staff feel about constantly making us do their work for them? I will give an example ( although there are plenty of examples like this), it will hopefully make it clear; groups are set up in the community to help mental patients, like a 'walk and talk' group, or a 'walking group', we are then told that we will then (after a period of time) have to run it ourselves. It is because it is an 'aid' to our 'recovery', and we should not get dependant on services. Is it such a terrrible sin to depend on others? ( and are we very bad children if we let this happen?). According to the recovery model, it should not be, we should not be dependent on anyone for anything. Are we not human then? Surely as human beings it is acknowledged that we are social beings and not solitary, does this not apply to menatally ill people too? How come we as mental health service users should have nothing, no support, no day centre, no care ... only medication? Told to do voluntary work? This is not 'recovery', it is more like 'exploitation'.

Treatment and care has come full circle to what was there before, but now, there is actually much less support.

This is known as 'Ego Documentation', here is my up to date version.

Throughout my life, I have felt on the one hand a great love for the world, for people and animals, but also a deep concern. An example of this is how I feared nuclear holocaust in the 1980's; to the extent that I was inconsolable for a long time, my sister managed to talk me round, eventually, when I finally opened up to her and said what was wrong.

Around this time too, I made a decision that I would probably not bring any children of my own into the world as I felt that life was already hard for me and would be getting worse, I did not want them to suffer as I did. I was also feeling that I had no choice but to become active in politics in order to stop the attacks on our livelihoods, ( this was around the time of the Miner's strike; Margaret Thatcher's heyday). It was a fear I had ( maybe irrational, maybe not), that if I became a target because of my views, I did not want to have children who might be used by others as a way of getting to me, forcing me to cease political activism.

As I got more deeply involved in politics, I became bent on being part of destroying the existing system ( capitalism) and that was it. I was singular in this aim, I did realise that it might be a little over the top, but I rationalised this by thinking and believing it was my role in life, that I was a bit like Kali ( the dark destroyer from Hinduism) or that I would emanate her. Such single mindedness may have also been compensation too. An escape and outlet for the unhappy and failed close relationships I experienced that seemed to feature in my life.

Another element was that I felt responsible for many people's spiritual or emotional deaths. On tackling other peoples political beliefs, I would strip them of their own belief systems, attempting to bring forth an understanding of the world as a class system. Any defence of the system was met with contempt and derision from me, I made it clear that a position of defending the system was unacceptable to me. I was highly destructive in many respects.

There were so many issues, political and philosophical that I was unfamiliar with and may not have fully appreciated or understood, but I always did my best to understand theoretical concepts and historical events. I was though, developing a vicious tongue and a heavy burden, in the sense that I felt like all the world's problems were on my shoulder.

So this was me; unhappiness and failed/ failing relationships, anger at the injustice in the world ( which was enhanced by being a political activist, by being more and more exposed to examples of cases of injustice), a combination of emotions that ran so deep within me and it could not go on, so I flipped out and had a nervous breakdown, or, a spiritual death.

This experience made me extremely flat ( zombie like even) and it did feel like I was in Hell. I still had a sense of humour and a sense of love for others and for humanity. Although it was hard to hang on to those things at times, I did manage it and I survived (to tell the tale).

S.A.D

Giving is easy, I enjoy it.

But it seems I have lost the art of receiving. It is very hard for anyone to give anything to me, be it physical, mental, material or spiritual.

I am hard work for people I know.

Its like I gave up on thinking or feeling that any one could or should give anything to me. Not out of arrogance that I am better than anyone else and their gifts or their praise or whatever, but, tragically I felt I was undeserving.

Around my siblings I would act like I wasn't there even, they had permisson from me to carry on as if I was invisible, so that I would not be a bother to them, its so sad, sometimes I cry about it.

Society vs mental illness

It is hard for people who have never experienced madness to understand what is going on, what it is all about and indeed how best to help that person.

First of all it is something that requires a lot of intervention, and specialist intervention too. We have been cast out in the past, but you cannot wish us away; not accept any responsibility for being part of the society that caused the problems in the first place. It could even amount to individual responsibility for causing emotional and personal trauma in another. If someone suffers emotionally in tribal societies for example, the whole tribe gets together to discuss the problems, they sit down and the first question they ask is what have we done to have caused distress for this person. Rather than cast us out, vilify us, reject us, why not take a good look at yourselves and also look at what we have endured through living in this unbalanced and degrading world we live in?

The sort of intervention necessary when someone is emotionally distraught and they have no knowledge themselves that they suffer from bouts of madness, is to get them to a safe place, somewhere away from the environment where they are suffering unbearably in. Then yes, there may well be a role for some theraputic medication, but in no way should this be the be all and end all of treatment. As it has been discovered already, talking is of paramount importance and time and effort should be put into this activity. Education is pivitol too, teaching people about what the symptoms of madness are, help that person accept it. Then there is art and craft; providing an outlet for the upset and trauma and a medium for communication ( something that I will be going into more depth with in a future post).

There is much talk about 'recovery' and I want to be absolutely clear about this because it was not a term invented by profesionals although they were quick to jump on the bandwagon with all that it mean't to them. For profesionals, mainly senior management it mean't effectively ceasing all treatment and resources for the mentaly ill, a denial even that they had anything that was different about them, apparently we are no different to anyone else now. Funny that, how come we feel, act and behave differently then? Service users invented the term 'recovery', it was a way they had come to understand their difficulties, and the transition they had made from sanity to madness, a way they could hook onto their past and recover an identity that would not render them as useless, second class citizens, written off of and out of society completely.

We wanted to be part of mainstream life ( who doesn't) but of course we are different, just as deaf people are deaf, blind people are blind, learning disabled have a learning disability, we are mentally ill. Once you have crossed that line into insanity, most of us will experience it again and for those who only have it once ( it is very rare) they never ever forget it although in order to fit into to mainstream society they expertly cover it up, however that memory and the pain will never leave.

Madness, or mental illness is not about loss of or lack of intelligence, it has nothing to do with intelligence, there are many people with learning difficulties who also suffer with insanity due to the frustrations they have. There are also highly intelligent people who suffer it. Insanity is not about intelligence, it is an emotional disorder, emotional deficit or emotional over load. Being broken emotionally is life changing and very serious, in fact none of us ever recovers as such, none of us ever can become 'normal' again, that is a person who has no knowledge of what insanity is like. Once broken, or insane, you are a changed person, permanently changed and more vulnerable. A vulnerability that stays with you for life.

I know it is very hard for the mentally ill to accept that they are vulnerable as sometimes they feel they have extra strength and are opposite to the perception of vulnerable, they feel themselves to be strong. Now of course we are strong, but we are also vulnerable. Every breakdown is unique and every persons experience of madness is unique to them and on each occasion. Therefore I thought the best way to attempt to explain how we are vulnerable is to describe it in myself.

It is not easy, but here goes ... I am highly suspicious of others, we could go into what caused this or even just accept that it might be something I was born with; a personality trait if you like. Anyhow I am also inquisitive, sensitive and intelligent and they might be good traits to have, but couple that with a highly suspicious nature and you get explosions, outbursts and misunderstandings. Medication plays its part in subdugation, but the state never fully leaves me. It renders me vulnerable in many ways, but one is that this combination of emotions in extreme tips over to paranoia and I am and become a danger to others. I have never physically attacked anyone ever, but others can sense my unease and it requires intervention from others in order for the pain I am in to be alleviated. I also get very depressed because of this and because I am very sensitive and at times when the depression is accute I am a danger to myself.

There are many people with similar problems, and the way we are, the emotional problems we endure are undoutely exacerbated by the society we live in. The high levels of competiton for example for jobs, housing, qualifications and so on all raise our emotional deficit or overload and make it harder for us to cope, but as I have said before and written about many times over, although we need others perhaps more than people without emotional problems need others, we do also have much to offer life, and if others and society can see and accept what we have to offer, rather than just see us as a problem, it would be for the good of all. Accepting us as we are into mainstream life with all our needs and vulnerabilites would have a very positive effect for us all, for society and for human kind.

Cannabis use among the mentally ill

I am not suggesting that people use cannabis, personally I think there is a lot to be said for sobriety, but the way mental health practitioners are using the issue of cannabis use as a stick to beat people with mental health problems is wrong.

They (the practitioners) don't seem to realise that people who use a mind altering drug such as cannabis know and understand that they are experiencing increased levels of emotional things, like anxiety. However, they might actually feel that they are enjoying their altered state of mind even if its bad. Exactly the same goes for alcohol.

One of the major problems of cannabis is not necessarily the mind altering qualities, but the illegality of it. Some studies have shown that it is widely used and by people who have some mental problems to begin with. It is probably unlikely that they cause them in the first place. But problems with cannabis are definitely increased by the criminal circles that surround its supply. This can lead to absolutely tragic outcomes for some people with them being sucked into either harder drugs and /or prostitution.

It would be better to put resources into the community such as social projects involving sport, art and craft for example than the situation that exists now of threatening to withdraw services and resources in the community for people with mental health problems. People who take cannabis currently face discrimination from mental health services; with an emphasis on provision rather than punishment, the future could be brighter for both service users and professional alike.

Black Sabbath

It is supposed to be a lethal combination, the smoking of marijuana and someone with a diagnosis of a mental illness and certainly the advice given to us (mental health service users) is to steer well clear from it. We are never given any more information than that. It is bad for us and there are examples of people to whom it has caused a mental illness.

I have already written about this in an article that was published in a magazine called 'percetions', one of the arguments being that no-body actually knows what came first, the mental health problem or the smoking of marijuana. We are never offered any scientific explanation about what the drug actually does and how it therefore creates or exacerbates mental illness. The reason why we are not given an explanation, and only told to not do it, or else have whatever scant services we have taken away from us is probably because the drug affects each one individually and there are also enormous variations in the drug itself.

It could be the dynamics and relationships that people have with one another in the small groups or the circle of smokers that people find such a strain. Or the dealers or the pushers, not to mention the pressure on people of it being illegal.

I have smoked it on and off since I was eighteen, introduced to it by my Jamaican guy. Neither of us fared very well in life concerning our mental health but to put it all down to the substance would be belittling our life histories and our separate personalities. We both had our own insecurities and were drawn to each other personality wise because we were and are very deep and analytical thinkers. The drug enhances this and that is what we enjoy about it.

So I was always told since I was a kid that my problem was that I thought too much. Well we have got Grey matter for a reason, and I always did enjoy exercising mine. We should not only be true to ourselves, but also try to enjoy life as much as possible. So marijuana fits on both of those accounts.

But here is the rub. It is so easily abused in this society we live in, first by it being made illegal and all the degradation that goes with that, secondly the pressures and etiquette of group smoking. I never was one for etiquette you know, so I have either smoked it just with a boyfriend, or latterly just on my own. These days or in my recent past I found smoking it alone preferable although this was something that the dealer that I used to have found very difficult,as I could make a very small amount last a very long time.

But my mistake I made was that I let it become a habit. I didn't think about it, I just did it; every day for two maybe three years. That is a serious abuse of the drug, and I paid for it. My mental health did deteriorate, I wouldn't be bothered to do much around my flat to keep it clean and tidy, and worst of all by the time I was forced to give it up, I was getting very adverse reactions to it indeed. Such as getting and enjoying a 'high' for no longer than about two minutes if I was lucky, followed by hours of crippling anxiety, heart palpitations and severe depression.

This is not the drug itself, but its abuse.

But I do believe that what I experienced need not be the case, that the drug can be medicinal for people including alleviating mental health disorders and problems, although yes people would need to be extra vigilant and careful with it when using it for those purposes.

For a start it should only be used occasionally, and when it is truly needed,of course that is for each individual to decide, but just as prescription drugs are and can be abused, like valium for example when used on a regular basis, the same applies to marijuana. There are probably similarities between the two in terms of the effect they have on people.

Marijuana lifts the spirits and relaxes you, its effects can last for a long time, much longer than valium, therefore in order to treat it right, you should make sure that the effects have subsided completely and for a long while before you think of doing it again. also, just as Valium should only be used when necessary i.e when you are perhaps over stretched, stressed and maybe in a state. Marijuana will work if used similarly.

It is because I was a lucky girl and found a small amount in the high street the other day that I have been given one more chance to experiment with this drug and hopefully get it right this time, by not allowing it to run and ruin my life and by treating it with the impeccable respect that it deserves.

So I have thought about what purpose it can serve and have come to the conclusion that I will use this small amount to help me to practice the sabbath. A day of relaxation and rest, on the Sunday because not much happens then anyway, hopefully it will help me get into the habit of resting one day a week which I am sure will do my health good.

I have no intention of having a dealer again, so when this small amount is done, that will be it for better or worse, although I will always hope for the day when it becomes legal.