Mental Health services in the UK are now geared towards the recovery model, and there is also an increasing drive from the government for those in receipt of long term disability benefits to return to work. Whilst most people who do not have a mental health problem will think this is not before time, I am meeting increasing numbers of long term service users who are becoming extremely worried by the thought of premature discharge from the mental health services.
Having used the services myself for many years, and being caught up in the support that the mental health system appeared to give me, I can understand how difficult the recovery transition process is. The framework of help that is offered to those with long term mental illness, has slowly been remolded over recent years, and there now seems to be a distinct feel of sifting out all who are not deemed to be severely mentally ill.
It was not unusual for people with chronic anxiety disorder problems, behavioral problems and intermittent bouts of severe depression to have had pretty much the same amount of service support as those with schizophrenia or bipolar disorder for example. Such perceived “lesser” mental health difficulties can be extremely debilitating in their chronic state, and befitting of the much needed support.
If a person has suffered with any of these types of illness for many years, it is testament to the fact that psychiatry often does not have the answers for cure. Is it then fair to push these people towards becoming non dependent, when for years they have been brainwashed into thinking that they have an “illness” that warrants such medical attention?
What is Mental Health Recovery?
I believe that the government, the psychiatric services and the long term service users may all disagree with what constitutes “recovery”.
If we look at a panic disorder sufferer who has social phobia and has a tendency to become depressed, she/he might only consider themselves recovered when they have absolutely no panic attacks, have conquered their phobias and not felt depressed for a considerable time. The government insists that such people with these problems can still be considered for work, even if it is just voluntary work, and mental health services are beginning to reflect this attitude.
There seems to be quite a lot of pressure on people who have had a mental illness diagnosis for many years, to suddenly become mentally equipped to handle a job and detach themselves from the support they have been used to.
Fear of Failure
On the surface of things, the actual idea of encouraging mental health service users to look closely at their abilities, utilize those abilities and head towards discharge from the system, sounds positive. Sadly, having suffered myself in the past, I know that it is sometimes not as clear cut as that. Having talked to some service users who sometimes have a measure of improvement, but intermittent relapses, their worries about recovery and discharge seem to be:
- What if I keep getting poorly again?
- What if it all comes back and I can’t cope?
- I feel a lot better sometimes but don’t think I could hold down a job
- What if I try to work and it fails?
- I have had support for so many years; I don’t think I can manage alone
- If I am discharged I will immediately lose the benefit money and that’s scary
- Everyone will suddenly expect me to be “normal” and I would feel pressured
- Will I be forced straight into work if I am discharged?
Staying Recovered may be Difficult
Even for those who do indeed feel “recovered”, if they have had support for a very long time, the discharge transition may seem quite smooth, but problems can emerge some time later. A very stressful life event may be all that it takes for anyone who has been discharged from services to need the same services again. Of course we are all open to this fact, and there are means to be reprocessed back into the mental care service.
The word “recovery” used within mental health terms is open to various interpretations. For you to become an active member of society may be the aim of the professionals contemplating your discharge, but there must be adequate provision in place to support a person through the process. This is the area that I feel is going to be the main problem.
I chatted to a lady last week who has seen a measure of improvement in her mental state over the last couple of years and she is coming up for discharge. She told me that although she welcomes not being reliant on services any more, she has had the distinct impression that the professionals involved in her care were trying to hurry the discharge procedure along. If she voiced a concern, she felt that concern was being brushed under the carpet without fully addressing it.
Planning Discharge from Mental Health Services
A person, who is being prepared for a discharge from all elements of psychiatric services, after many years of being a user of that service, will probably feel some apprehension, a sense of vulnerability and perhaps even fearful. This may be more acute if the proposal for discharge comes from a familiar worker or psychiatrist. Many people, who have been using community based support, get to know those involved in their care very well. I can remember years ago, that one of my community workers seemed like a close friend. So, these “patients” are not only leaving the service, but people they may have become quite close to.
Because I know there may be an element of fear attached to discharge from mental health services, I also recognize that being kept fully informed and understanding the discharge process is important to a service user. I can find no guidelines or policy laid down to explain the process of discharge that meets this need. I will update this should I find such information.
It may be advisable to ask if you can have a review of, or see your care plan to be fully up to date with what's actually happening.
As it stands, when a person is deemed to be a suitable candidate to work towards discharge, they may be asked to look at the recovery star with a worker.
This star helps you and your mental health worker to ascertain what areas need to be addressed prior to discharge. It looks at ten areas concerning:
- Managing mental health
- Physical health and self-care
- Living skills
- Social networks
- Addictive behavior
- Identity and self-esteem
- Trust and hope
Working towards identifying your weak or vulnerable areas is very important, and you should find this very helpful..
What if I am Confused about my Discharge?
How to Cope with Discharge Procedure
So, let’s assume you know you have made some progress and your mental illness may not be so severe that it warrants continuous involvement with the services. If you are worried where this improvement may lead, and your mental health team seems to be insisting it’s time to work towards discharge, you may need to do the following:
Ask questions, which may include:
- How discharge policy works
- How it may affect benefits
- What to do if a sudden relapse occurs
- Telephone numbers for appropriate charitable bodies for support
- Any medication issues
If you are worried about anything at all, you must inform your mental health officer, community worker or psychiatrist. If you feel the process is going too fast for you, then you must raise this also.
Useful online links for Mental Health Recovery
- Mental Health Recovery Center:The Main Place
Community mental health promoting recovery
Make a personal plan
Try to plan at least the first three months following discharge. Write a “things to do” list that you know will keep you busy in the early stages, when you might be feeling a little lost. You could perhaps look to offering your time voluntarily to a good cause. This will help integrate you back into society and give you some much needed skills and confidence. You could even look into taking a vocational course, but if you don’t feel able to go to college you could look into distance learning as another option.
Embrace your Discharge
Even if things seem a little odd at first, you should remember that once upon a time your illness was probably much more severe, and even if there are still elements of self-doubt, you can address these issues and move onwards and upwards. Remember that there is nothing to fear because your general doctor can get you the help you need should that need arise.
See the discharge as a starting point for the rest of your life. You may well begin to see just how much you relied on the support after discharge, and start to recognize strengths in you that you didn’t think existed. Build on those strengths, but don’t expect too much from yourself too quickly. Try to embrace your discharge with enthusiasm.
Useful Tools for Recovery
Christopher Jay Thompson from Fort Worth, TX on July 30, 2015:
Many people with anything more serious than depression will most likely always need mental health services. A large amount of mentally ill people will always be mentally Ill. I think the UK is heading towards a crisis of mentally ill homless people, simply because your government simply doesn't want to deal with them. I font believe your government of medical industry has any clue what they are dealing with when it comes to mental illness. An I thought the mental health care system in the United States was bad.
meloncauli (author) from UK on December 03, 2012:
Stay on that soap-box gsidley! Spread the word, raise awareness....it's the only hope there is of change for the good!
Dr. Gary L. Sidley from Lancashire, England on December 02, 2012:
Yes you may have a point, meloncauli; my suggestion that a return to paid work for most existing service-users might have been a tad unrealistic (particularly, given the current economic climate).
A major problem in psychiatric services is that many professionals don't understand what "recovery" means, wrongly assuming that it is the same as "cure" and getting back to full time employment. For me (and I suspect you too) it is about much more than this. Recovery is about optimism that a person can achieve a worthwhile/meaningful life irrespective of their mental health problems. Recovery is about empowerment and truly seeing the service-user as the expert. Recovery is about normalising people's experiences (rather than stigmatising them with invalid diagnostic labels). Recovery is about balanced relationships with professionals.
But you know all this already, so I'll get off my soap-box!
meloncauli (author) from UK on December 02, 2012:
Thanks for your comment and vote gsidley.
I am not sure about it being a realistic goal for most sadly! I know the problems I faced after so many years as a "patient". Stigma and discrimination are still out there in huge chunks for one thing. The support in getting work is still lacking also. It's hard for a person who hasn't had a mental health problem to get work these days, and voluntary work seems to be the keen proposal by services including the job center.
That's where I see most who will be discharged going...having to work for nothing because they have no fresh skills, references, and a fear that they might not be dependable. So "cheap labor" is the understatement!
I think it all sounds great too, but I am a realist and don't have confidence in the mental health system and today's current job climate to accommodate these newly discharged people. In my opinion, it will be a lot more jobless people. Unemployment and financial hardship alone can cause people to become depressed!
I am of course talking about those who have been treated as "mentally ill" for a very long time. If a person thinks they are only worthy of a job where you don't get paid, then that in itself is discriminatory and can be felt as futile. There will be a minority who can make it work for them, but my guess is it will be a minority.
Embracing discharge is more about learning who you really are again, finding your skills ( albeit you will often be left to your own devices to find and hone these skills). Some may also have been affected by long term medications. There used to be a disability officer at the job center who you could meet up with and who would help you define the route back into employment. When I was discharged, I was given a standard interview and the only thing offered was the voluntary route! I took that route at first but I don't think many will, and there are only so many voluntary positions too!
Dr. Gary L. Sidley from Lancashire, England on December 01, 2012:
Another great hub addressing a hot topic in the mental health field.
My favourite definition of recovery goes something like, "achieving a meaningful and worthwhile life irrespective of mental health problems and disabilities."
So recovery doesn't always have to be about getting back into paid employment (although this should be a realistic goal for most).
The recovery movement is one of the few positive themes in current psychiatric services that I can get excited about. It strives to promote hope and a genuine valuing of individual experiences - things that are blatantly missing from much of western psychiatric services.
meloncauli (author) from UK on November 30, 2012:
Thanks for your comment Leah....I agree, it can be a very frightening time.
Leah Lefler from Western New York on November 30, 2012:
Being discharged has to be a frightening aspect of care for many who receive mental health services. I love your reassurance that if more help is needed the GP can always refer a person back to services.