Transcript Recovery Politics: Tensions and Opportunities

Recovery Politics: Tensions
and Opportunities
Kate Storey &Tanya Shute
The Centre for Building a Culture of Recovery
Making Gains: Toronto, November 2, 2009
Fair Notice:
Our work is embedded in an understanding
of recovery that seeks to educate and
advocate for personal and system reform
that includes: equity, respect, and personal
responsibility.
Our message emerges from a critical
perspective that requires deep questions about
relevance and serious consideration of
alternatives.
What about the word recovery?
" a deeply personal, unique process of
changing one’s attitudes, values, feelings,
goals, skills and/or roles. It is a way of living
a satisfying, hopeful, and contributing life
even with limitations caused by the illness.
Recovery involves the development of new
meaning and purpose in one’s life as one grows
beyond the catastrophic effects of mental illness.”
Author deliberately obscured
hmmm
" a deeply personal, unique process of
changing
one’s attitudes , values ,
feelings, goals, skills and/or roles.
It is a way of living a satisfying, hopeful, and
contributing life
even with limitations caused
by the illness.
Recovery involves the development of new
meaning and purpose in one’s life as one grows
beyond the catastrophic effects of mental illness.”
How about…
“…recovery principles and values describe
the treatment services
that our clients
use to manage their symptoms
and
live independently
in the community of
their choice”
Author deliberately obscured
One more
Recovery is the personal process that people with mental
illness go through in gaining control, meaning and purpose
in their lives
. Recovery involves different things for
different people. For some, recovery means the complete
absence of the symptoms of mental illness
. For
others,
recovery means living a full life in the
community while learning to live with ongoing symptoms.
The goal of many mental health services and treatments is
now recovery.
This wasn’t always the case. In the
past, mental health professionals told people with mental
illness and their families that most illnesses got worse over
time. People were told to lower their expectations.
• Recovery is a process. Not a place. It is about
recovering what was lost; rights, roles, responsibilities,
decisions, potential and support. It is not about
symptom elimination but about what an individual
wants, how they can get there and how others can
help/support them to get there. It is about rekindling
hope for a productive present and a rewarding future –
and believing one deserves it. Recovery involves people
having a personal vision of the life they want to live,
seeing and changing patterns, discovering symptoms
can be managed and doing it, finding new ways and
reasons, doing more of what works and less of what
doesn’t. Recovery is about reclaiming the roles of a
“healthy” person, rather than a “sick” person. Recovery is
about getting there.
~ Laurie Curtis – CMHA Barrie/Simcoe
The Centre for Building a Culture of Recovery
defines recovery as:
…the hard work a person does him or herself, with the
kindness and compassion of the people they choose to
support them – in an environment that acknowledges and
believes in their potential for wellness. ©
We use the language “person in recovery” or
person with lived experience.
Recovery is the person’s
hard work. They realize
recovery through
relationships – with
people they choose.
Our recovery perspective insists that people
understand and choose the services and
supports that they have experienced as,
and/or believe to be, effective.
This might include use of clinical/medical or
rehabilitation services, or it may include peer
support and self help, or people may choose
to use or not use any formal services and
supports.
understand and choose…..
• Equity requires that people are informed
and free to question, challenge debate,
then decide.
• Without equity – information provided to
people will be filtered, cleansed or
restricted
• Without equity people will not be free to
risk - to make the same mistakes as
everyone else
• Equity requires professionals to re-think
their liabilities, policies and protocols
Appreciating equity
requires clinicians to
consider how they
privilege knowledge
and experience.
Can one embrace
equity while harboring
doubts about
competence and
capacity?
These reflective
questions are essential
to shifting to recoverysupporting practice
and policy.
What about real choice…..
What happens when people question?
What are the real risks (let’s not be naïve)
What are the effects of requesting a
change to service – like a change of
psychiatrist, case manager?
What about declining medication?
What about harm reduction?
What about the hours of service…..the
activities and programs?
Freedom to choose is complex
The conventional system must invite,
welcome and genuinely expect choice
People in recovery must trust that their
choice will be heard and respected.
Freedom to know, believe and choose
requires self confidence and
comfort…..empowerment
• Empowerment is frequently misunderstood.
• We use the word empowerment NOT
empowered or empowering
• Empowerment correctly articulates the critical
difference between the beneficent bestowal of
power to have-nots from haves and what we
think is more important: the personal realization
of power.
Empowerment is the cornerstone to
self-responsibility and self-advocacy
It means the freedom to make real and true choice. The
freedom to risk making mistakes. The responsibility for
those decisions – and for our behaviours.
Beware of “partnerships” that hold
un-equal power; We must appreciate the
impact of systemic power and oppression.
People must be free to self advocate, not reiterate
expected (conscious or unconscious) social expectations
Because recovery embraces
the wisdom of lived experience,
self-help and peer support
is an essential component:
Self-help and Peer Support acknowledge the value of personal lived
experience as a demonstration of hope, recovery and ongoing
personal growth and transformation.
Self help and Peer Support respects choice & self-responsibility within
an intentional relationship of negotiated risk.
The self-help and Peer Support relationship supports the person to
explore, question, challenge, decide and exercise his or her free
choice.
The self-help and peer support relationship supports the development
and exercise of self-advocacy.
The self-help and Peer Support is a distinct non-clinical relationship
that is an alternate to, or compliment to, conventional services.
Leadership and Advocacy by people in
recovery is required for system reform.
• Conventional providers and
leaders must listen deeply and
critically to the experiences of
people in recovery.
• People told the Kirby commission
that “the most devastating impact
on their lives came not from the
illness itself but from the way
others, including clinicians treat
them.”
We will all be supporting recovery when ….
a person has the full information they require to
legitimately question, challenge, debate and
genuinely consider if they will accept or decline
both conventional services or peer supports
when our society tolerates
personal difference and
respects human rights
…and when our system believes in the potential
of people to be responsible for their health and
wellness
Organizations,
programs and clinicians
can be/ must be:
recovery supporting.
This is not semantics – there is a critical difference in how
we apply meaning to our work and our responsibilities as a
result of our language. Clinicians have a valuable role to
play serving people in recovery who choose their service
– but this work is not “doing” recovery…..
it is the work of supporting a person’s recovery
What would an equitable, just and truly
recovery-supporting system look like?
• Multiple and Non-clinical points of access
• No requirement for screening, labeling,
diagnosing, and illness/disability language
• Equal access to funded and autonomous selfhelp and peer support
Inclusion – housing, education,
employment – and factors that
support them such as
childcare and transportation
Human rights
.
Questions?
Comments?
Discussion!
.
Medical/Clinical Model
Assessment
Diagnosis of illness or
disorder
Treatment
Prognosis
Chronicity
Example:
Crisis intervention
Psychosocial/Rehab
Model
Assessment &
Diagnosis
Assessment of skill
and capacity
Assessment of
Strengths
Long-term planning
Intensive Support
Community oriented
Crisis planning
Recovery
Self awareness
Personal responsibility
Strengths & Resources
Choice
Autonomy
Wellness
Education
Leadership
HOPE
Distress awareness,
negotiation & support
POWER BALANCE
Care & Control
Expert
Professional
“patient”
Client-centred or
oriented
Skill training/
Building
“client”
Autonomous
choice &
leadership
“person”