27 Jun 2012 - Here is a lightning tour and potted history of mental health care and treatment. There is also an introduction to the Recovery Model and why the recovery model is good news.
Mental Health and Mental Illness are always in the media these days. All too often the reasons are negative. So, without further ado, lets get the bad news out the way first.
- Every Increasing numbers of people in the West suffer from Mental Illness (Due in part to more pressured lifestyles, increased recreational drug use and greater alcohol consumption)
- A common public misconception is that those with mental illness will probably be violent and dangerous
- The amount of prejudice against mental illness today in all countries is far too high
- Prejudice is much worse in some countries than others (partly because mental illness is not understood or the concept is in conflict with the local culture)
- Diagnosis of metal illness can difficult and subjective – You can’t simply scan or test for most forms of Mental Illness
- There is also a constant debate amongst mental health professionals about whether particular conditions, such as personality disorder, actually exist
What is Mental Illness?
A mental disorder or mental illness can be thought of as a psychological or behavioural pattern that causes distress or disability that is not a normal part of the culture of the affected person.
The understanding and diagnosis of mental health conditions has changed over time and across cultures, and there are still variations in the classification of mental disorders from country to country.
Over a third of people across the globe report meeting criteria for the major categories of mental illness at some point in their life. These categories include anxiety disorders such as phobias and obsessive compulsive disorders.
Then there are mood disorders such as depression and bipolar disorder that embraces both depressive and manic episodes. There are also psychotic disorders including schizophrenia, and delusional disorder. Other categories of mental illness include personality and eating disorders.
Institutions and Asylums
Until the end of the last century, in Europe and America, people with serious mental illness tended to be institutionalised. They would either be hidden away at home or detained in an asylum.
Some of these institutions may have provided good care and, since the Victorian era included lots of activities such as gardening, workshops, arts and crafts and even a brewery.
However, one of the key goals of these asylums appeared to be the separation of the mentally afflicted from the rest of society; a kind of mental apartheid.
Care in the Community?
From the 1960s onwards, in the western world, there has been a gradual shift away from these huge institutions with prison-like walls towards 'care in the community'. In my own country, the UK, these old asylums are either closed or have turned into more conventional hospitals.
Unfortunately one of the key drivers for change was and is money. Beds in old fashioned asylums were expensive and leaving the mentally ill to be more independent is more cost effective but also has disadvantages.
Coupled with this approach, is a tendency to over prescribe medication in order to 'control' the condition. Prescribing drugs is cheaper than delivering therapy or training the sufferer to either control their condition or overcome it. The drugs companies also have a vested interest in prescription drug-based treatments.
Please understand, I'm not suggesting a return to old-fashioned asylums. However, I am concerned that adequate funding is available to make sure care in the community is allowed to work properly. In other words, it really is caring!
In my own country the mentally ill can still end up institutionalised, not by an asylum, but because they are unable to return to the workplace. They can often find themselves isolated and lonely and It is no coincidence that a relatively large proportion of the mentally ill end up sleeping rough or in prison.
Typical Care Facilities
The Recovery Model
So what about the Recovery Model? Why is it such good news for those who need help?
To many it may seem like common sense. In the recovery model someone who is deemed mentally ill is encouraged to take responsibility for their own recovery. The patient (or Service User in UK NHS jargon) is a consumer who chooses their own route to recovery.
The central assumption is that most people are capable of moving towards a full or partial recovery from their mental health condition. In other words no one should ideally be abandoned with only a lifelong drugs cocktail to consume.
But what do we mean by Recovery?
Recovery can be seen as a positive personal journey towards fulfillment in life. For some this will mean a complete recovery from the original condition.
It may mean being able to hold down a job and live more or less independently of the health care system and even being able to function without medication. Along the way the person will typically gain a sense of self-worth, find supportive relationships and empowerment.
They will also feel included in society and acquire skills (self management) enabling them to cope with their original condition.
Self-management means learning what triggers episodes, what reduces symptoms and having a say in ones own treatment including which drugs to take.
The idea of the Recovery Model isn't new. It originated with Alcoholics Anonymous and the 12 steps to recovery and was originally firmly routed in the Christian Faith. The scope was later broadened to include other faiths and those with no faith at all. It is also applied to other addictions such as gambling and recreational drug taking.
For Alcoholics Anonymous, the centrality of 'God' was changed to 'a Higher Power' to broaden its application in a multi-cultural society. Today's Recovery Model as applied to mental health recognises the importance of spirituality in recovery and encourages those on the path to recovery to explore their spirituality.
Clearly not everyone will be able to embrace this ideal and there is no intention to force anyone to follow this model.
For those able and willing to accept the challenge, however, there is the hope of facilitating real change in their own life and being empowered to take control of their own destiny.
The recovery model changes the patient/practitioner relationship putting the individual at the centre, managing their own recovery and the medical practitioners become more facilitators.
The model is currently being adopted in many countries including the USA and Europe simply because it is accepted that traditional mental health treatments have not always been particularly successful.
You may wonder what prompted me to write this. Well someone close to me was diagnosed with Bipolar Disorder some years ago and her gradual recovery very much followed this model.
She went from being an inpatient on a psychiatric ward to returning to University and becoming a health care professional specialising in mental health. She is now working very successfully at changing the lives of those with mental health difficulties and is a champion of the recovery model.
She still has the diagnosis but for most of the time is able to manage her own condition and focus on helping others at the same time.
Amy Shannon on September 09, 2017:
Pretty awesome way to describe these illnesses. Not 100% certain which one I actually have- but , am sure one applies to me
Brian Leekley from Bainbridge Island, Washington, USA on June 13, 2014:
Up, Useful, and Interesting.
The situation re care of the mentally ill and public prejudices is similar here in the USA.
This program might interest you: Corporation for Supportive Housing - Frequent Users Systems Engagement (CSH - FUSE). Google on:
BLUEPRINT FOR FUSE THREE PILLARS AND NINE STEPS
Kate McBride from Donegal Ireland on September 16, 2012:
This hub has a lot of information in it which was very interesting to read. Voted it up and useful
meloncauli from UK on May 11, 2012:
I know this hub was written some time ago now but the so called recovery model has upset many service users in the UK. It hasn't affected those who have recently become mental health service users so much, but for those who have been long term users it has been a dreadful affair. Many have spent decades being told they absolutely need intensive psychiatric support for it to be almost switched off recently. I know people who have apparently needed 3 community workers to help them with weekly issues and then suddenly they only have one. This has all hit these long time users very hard.
megni on May 09, 2012:
Great and useful hub.
schoolgirlforreal on April 30, 2012:
Excellent and accurate hub, voted up!
Dr. Gary L. Sidley from Lancashire, England on April 10, 2012:
I've just stumbled upon your hub Rik and found it an interesting read.
You are right to highlight the Recovery approach as a positive element within western psychiatric services. Unlike much of the psychiatric system, which is stigmatising, passivity inducing and damaging (physically and emotionally), the Recovery philosophy provides a flicker of hope.
Also,great to hear the inspiring story of your friend.
felixtroll2 from Manitowoc, WI on February 29, 2012:
uniquearticlesbuz from USA on December 01, 2011:
Thanks its very useful news.......:))
Kim Harris on June 19, 2011:
Thanks for the detailed explanation of the recovery model Rik. The same is true in the US. People with mental illness and substance abuse problems make up a large portion of our jails and prisons. Many are in nursing homes at a very young age or are homeless. While there are certainly individual rights to consider before institutionalizing someone against their will, the toll of mental illness on families and society is tremendous. I favor having more effective institutions where a person can begin their recovery if needed; and return to society when they are able to function in society. Economics and politics plays a significant role in this equation too.
Not Applicable on May 26, 2011:
Look at all the people who were succesfull at what they were doing until Corporate Psychologists decided they were better off without them. Cutting the incomplete cuts costs and gains profits. What is this, Sharia? In Germany alone; 44% of potential working class cannot return to building a career because of new Psychological Classification- and Assault Models. Psychiatry and Psychology etc. belongs at the Doctors Office and people should be free to choose their own Psychologist, not a Corporate Nazi. All the imagined- and enforced so called indirect cost models have been created by corporations. It is a shaded area of Corporate Profiling and should be considered illegal. Hopefully there will be a future European law that protects people's Private Medical Data and Human Rights. Basically; if Corporations Diagnose and encase individuals by evaluating them Medically and Psychologically, individuals responsible go to Jail. Full Stop.
Rik Ravado (author) from England on February 24, 2011:
Thanks funky for reading and commenting!
funky23 from Deutschland on February 22, 2011:
thx your article is great
Rik Ravado (author) from England on December 05, 2010:
Thanks for sharing your experience - Even in the UK I gather there are those in mental health care who really believe in the Recovery Model and those who pay lip service but don't really get it. I agree with what you say about personality disorder - labelling people may sometimes be convenient for the medics but it isn't always helpful to those labelled - better to help people get 'well' rather than stigmatising them with an unhelpful label!
Nordy from Canada on December 04, 2010:
Applause for you, fantastic hub and I cant agree with you more. I worked in community mental health in the uk for 7 years before moving back to Canada, and I am still struggling to adjust to the medical model here. What I liked about the recovery model is the idea that you are treating a person, not just a set of symptoms. Medications aren't nearly as effective (alone) as we are often lead to believe. I've also noticed that systems who endorse medical models seem to be much quicker to label people with personality disorders than those who use a recovery model. Of course I have no evidence base for this theory, just my own experience. Thanks for a great hub!
Rik Ravado (author) from England on November 22, 2010:
Good point Kathryn - all part of a recovery strategy!
kathryn1000 from London on November 22, 2010:
I was watching Leonard Cohen on you tube and I believe he has been depressed much of his life.Yet he has written poetry,songs,and novels.So finding an outlet is a good thing.
Rik Ravado (author) from England on November 17, 2010:
lex - thanks for stopping by and glad you enjoyed!
lex123 on November 15, 2010:
Very informative hub. You must have put lots of efforts in writing this hub. Glad to know your reason for writing this hub and your friend's recovery. I'm sure it will be useful for many.
Rik Ravado (author) from England on September 28, 2010:
Recover Today - thanks for your encouraging comments.
lambservant - glad you enjoyed this. She does and she is still fighting her corner to make a difference for others with mental health problems!
Lori Colbo from Pacific Northwest on September 27, 2010:
wonderful Hub Rik. Your friend is blessed to have a friend like you who takes the time to learn about her illness. I hope and am sure she appreciates you. This information is excellent. Thank you.
RecoverToday from United States on May 01, 2010:
This is very useful information. It is important to remember that mental illness is an illness like any other. You have done a good job of describing the recovery model. Excellent work.
Rik Ravado (author) from England on March 22, 2010:
MOW - Thank you so much for your generous comments. Yes recovery is about self-management and also putting the 'patient' at the centre (rather than the medical staff)
myownworld from uk on March 22, 2010:
Great hub...and completetly agree that the recovery model has a very compassionate approach to it. I'm studying for a psychology degree at the university of london (also working for mentally disabled people) so you can imagine how much I must have loved your hub! I've actually printed it out and going to share it in class tmrw. Thank you for sharing it :)
Rik Ravado (author) from England on March 13, 2010:
Dame Scribe - Yes, its about time. Many talented and famous people have mental health issues but the public and the media often don't seem to understand. In the UK the tabloid newspapers will often label someone as 'bonkers' or a 'nutcase' rather than trying to understand their suffering.
Dame Scribe from Canada on March 08, 2010:
Mental health is slowly losing it's negative connotations and making acceptance easier for some. Great points!