Friday, 25 March 2011

Care & support can hinder recovery - revisited

Care and support are not the only models or frameworks for mental health recovery. The establishing or re-establishing of what Dr. Pat Deegan refers to as 'valued social roles' can be held back by a mental health system that often encourages the client to choose 'a career in mental health' (Pat Deegan).

A career in mental health means living longterm on benefits and longterm marginalisation from mainstream life. A career in mental health will identify symptoms, diagnoses, medication and team support but will often leave out aspirations, goals, priorities.

Where access to mainstream is encouraged, it can often be through projects or programmes which take place in special settings or are designed for people with mental health conditions. So the marginalisation continues.

Where the retardation of an individual's access to mainstream is most acutely felt often lies conversely in the areas where there is the most 'support'.  Nowhere is this more clearly visible  than in secondary residential care. 

Whereas the main thrust of residential care in mental health is on clients' independence, the system often works to block individual progress.  Mental health residential teams expend a lot of effort and do a lot of work encouraging their clients to seek independent opportunities in mainstream life.  Unfortunately, the desire to do these activites may not derive from the client him or herself and the contact with mainstream is delayed, deferred or postponed sometimes indefinitely. 

Where a client is goaded into mainstream in this way, he or she will sometime be bussed or  taxied in to the mainstream venue, accompanied by a key worker.  But no amount of buses, taxis or key workers can replace the simple presence of individual personal motivation. 

In secondary care, a  client's last-minute postponing of the scheduled meeting with mainstream is also commonplace - often postponing three, four or five times.  The assumption by services that an able-bodied physically-well individual should need to be accompanied to a local venue by a carer or key worker at all times, seems to me profoundly patronising.

A genuine return to mainstream can only take place in mainstream. This is where the role of the bridge builder comes in. A client who has worked with a mainstream bridge builder identifies goals and priorities for him or herself. It is the bridge builder's job to signpost or link the client up with mainstream venues appropriate to the client's life choices. The amount of support a client may request from there on is determined only by the client.

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