Life is fragile.
We can all be struck down by mental health challenges.
Then what do I do?
Should I keep it to myself, fearing of being stigmatized,
diagnosed with a mental disorder and having to take medication?
Or perhaps I should seek help from those around me?
How can I recover and continue living with my challenges?
Now imagine Grethe.
She has a managerial position, she is married
and socially active in various circles, with friends and organizations.
Suddenly, everything falls apart.
Grethe gets divorced and goes on sick leave,
her friends stop calling her and pass her in the street without saying hello.
She isolates herself and is unable to participate in her various social circles.
Grethe seeks help for her mental health issues.
She is given a diagnosis and offered psychoactive drugs
and a list of therapists in private practice whom she can call.
All of them have waiting lists of a year.
Grethe gives up and stops going out and being with other people.
This example shows that the relationship between Grethe as a person
and her life situation is an essential part of living life to the full.
Once you experience mental health challenges
that restrict you, the process of capturing
how to live with these challenges starts.
What is needed in terms of practical and emotional factors
to enable you to live with the things that you find challenging?
Mental health problems are the world’s number one public health issue.
The UN states this categorically in three different reports.
They write that people who experience mental health issues have
– and I quote:
‘... been exposed to exclusion, neglect, coercion and abuse,
and are seen as deviating from prevailing cultural, social and political norms’, unquote.
The reports state that the psychiatric model
is outdated and must be replaced.
According to the UN, a paradigm shift is needed.
So, what are the specific problems with the psychiatric model?
First, the pharmaceutical industry is making huge profits from psychoactive drugs.
Their annual income from sales and use of these drugs
amounts to hundreds of millions of kroner.
Often, they have little effect and cause great harm.
Medication also tends to be the only treatment option
given to people with mental health issues.
Second, the power relations in the field of mental health are skewed.
Psychiatrists and psychologists are at the top of the professional pyramid.
They control the truth about
what is the best and proper treatment for those with mental health issues.
Furthermore, the professionals tend to pay too little attention
to the opinions of the users themselves.
The help offered is often decided without the users
being consulted or allowed to contribute.
Many users have their own experiences of the kind of help
that has been helpful previously, and professionals ought to listen to this.
The failure of professionals to focus on the users’
living conditions, social circumstances and human rights is yet another problem.
Instead, the help is individualized.
This means that it is based on the premise that something
is intrinsically wrong with the person,
and no attention is paid to the ways in which social,
economic, and relational factors affect their mental health.
Third, we are short on local services and easily available help.
We need open, social meeting places with a low threshold, that welcome everybody.
This could be local meeting places with a café
and opportunities to participate in activities such as walking in nature,
music, physical exercise, reading groups and so on.
Those who use these meeting places should decide what activities and services are provided.
The UN reports also point to increasing social disparities
as the main cause of mental problems in our current age.
Living with little food or money,
with no work or lodging, in loneliness and physical isolation
gives rise to mental health problems in our own country and all over the world.
Less social disparity, more equality and fairness
will be the main drivers of change.
Given that the psychiatric model and its approach to addressing
mental health problems are outdated, what can we do?
This is where Recovery comes in!
Recovery means ‘to recover from mental problems
and be able to live with them’.
Recovery is about us as people
and the living conditions in which we find ourselves.
Recovery is a rebellion against being perceived
and treated as ‘ill’ and unreliable.
People who experience mental health problems should not
be treated in psychiatric institutions where they are pathologized and overmedicated.
When people are in psychiatric institutions,
we see only a small part of them.
How can we understand a person’s mental problems when
he or she is far away from their family, friends, work, and everything familiar to them?
As a concept and movement, Recovery started in the 1960s
as part of the civil rights movement in the United States.
The movement demanded that all American citizens
should have the same rights and opportunities,
and this struggle also included persons with mental problems.
‘The Psychiatric Survivor Movement’
fought for survival and against oppression, social stigmatization,
and exclusion, and became part of the civil rights movement.
They documented extensive abuse, coercion, and overmedication
of inhabitants with mental problems.
Similar struggles took place in other Western countries,
with the same demands for equal rights and opportunities,
social, political, legal, and human security, and respect.
Today, Recovery continues to rebel against stigmatization, marginalization
and social exclusion of people who experience mental health problems.
First: Recovery means to challenge psychiatric knowledge
and treatment through diagnoses and categorizations.
Second: Recovery means to highlight and address the violations
and injustice that have been inflicted on people with mental problems as individuals
and as a group – in families, local communities, services, and society.
Third: Recovery has a liberating force
and gives people the courage to act.
Fourth: Recovery creates communities that enable people to live
with the challenges that life confronts them with.
As people, we are born into relationships,
we live in relationships and we die in relationships.
The number of our relationships is not what counts –
but the quality of the relationship.
In fact, for those who have experienced mental health problems,
it is sufficient to have one strong, positive relationship to another person.
This could be a friend, a significant other or a mental healthcare professional.
Our mental health unfolds in our relationships
with our family, friends, work, economy, home, and society.
We also engage in relationships with animals, nature, culture,
our neighbourhood, and society.
It is essential for our mental health to have a home;
not merely a place to live, but a place to call home.
A place where I can close the door,
feel safe and know that this is where I belong.
Many studies have shown that having a home
is completely essential in Recovery.
Engaging in life’s different relationships means engaging in communities.
Communities that are inclusive, that value diversity and show care and compassion.
People who experience mental health issues
report that engaging with a community has been crucial for them.
Many feel overjoyed at entering a safe community
that welcomes them as they are, and where they
can develop solidarity and friendship with others.
People who have reached a turning point –
meaning their lives change for the better –
often mention very concrete actions
and experiences that helped bringing about the change.
It could be going out into nature,
finding a new friend, a dog, a significant other or a new health professional.
Mental healthcare professionals also provide concrete examples
when describing how to work in a Recovery-oriented way.
It might be having an ice cream together in a park, going for a walk,
discussing an author they both like and sharing their interest in music.
One day, Grethe in the example above
is contacted by a woman who also has struggled with mental health issues.
This woman tells Grethe that along with some others, she has started a football team
for girls and women with mental health issues.
They meet once a week for a training session,
followed by lunch together.
Grethe has never played football before.
‘It doesn’t matter,’ the woman says.
‘We can meet at your place and go to football ground together.’
Reluctantly, Grethe agrees to join.
This will be the first step in her Recovery process.
In the football team, she gets to feel that together we are less alone.
Recovery happens between people –
within and around a completely ordinary, and yet completely special community.
When Grethe participates, she is more than just Grethe as an individual –
she is the community and Grethe.
Research about Recovery shows that the simple is often the best.
Unfortunately, I find that Recovery-oriented services sometimes are made
too complex, and quite unnecessarily.
The service provision can be so complicated as to be out
of step with what the users themselves want.
It is often forgotten that small things that mental healthcare professionals do,
can in fact be perceived as big and important by the users.
For example, this could be a ride home or a friendly smile,
being shown trust, a professional who stays longer than planned,
or even comes along to a concert or a football match.
Sometimes, Recovery can be seen as really simple.
Often, these simple and highly effective aspects of Recovery
are adapted to the requirements for standardization and equal treatment that are set by the mental healthcare services.
The importance of the small, simple steps therefore often lose out
to services that should be the same for all –
with no adaptation to each individual.
The Recovery process starts on a small scale with a big question:
What is important to you?’
In this way, I am invited to work with the things that are
important to me in my life in order to recover.
Recovery is not about standing alone
on your own two feet without anybody else.
Recovery is more than just coping with life
and realizing our potential.
Such an individualized version of Recovery
implies that we should strive for maximum independence
and separate ourselves from communities.
Life is relational and is lived relationally.
Recovery is about hanging out with people
and being a part of various communities.
In the football team, Grethe experiences a turning point
and finds out how it is possible to work on her recovery.
She experiences inclusion – and trust –
in a community of women which is caring and accepting.
Being in the company of others who have also experienced
mental health issues gives her strength.
And not least: people who have experience of how they can learn
to live with mental health challenges –
alone and in the company of others.
The physical activity also helps Grethe feel
that she lives better with her mental – and physical – health.
Recovery is about the simplicity and greatness in inviting someone into community and helpful relationships.
Your wishes and your own insight into what might be helpful
and supportive are the starting point,
together with ensuring your rights and fulfilling your obligations.
The person who is living in Recovery
must be in the driver’s seat –
professionals and others should support the person in these efforts.
All those who wish to be helpful must walk alongside
this person – not in front.
Such persons could be family, friends,
colleagues, professionals or neighbours.
Development of Recovery-oriented services
happens in collaboration with users,
relatives, professionals, leaders and decision makers.
And: we must constantly consider whether our Recovery practices
and Recovery-based services in fact
represent the best and most liberating aspects of the Recovery tradition.
We need to ensure that the Recovery services are not
adapted in such a way that everything just continues
unchanged – in the same way as it has always been.
Summing up:
As humans, we are stronger together –
humans need humans.