Paradigm Shift for Family, Whānau on Psychosis could

translate to recovery for us all

Leigh MurrayISPS NZ Conference

17th October 2014

25+ yrs supporting close whanau in mental distress

Moved from trying to make ‘him/her recover’ to ‘providing support that allows him/her to work on their own recovery’

Understanding ‘mental illness’ is no longer my goal

My priority is maintaining a respectful supportive relationship with family, whānau members

My Personal Family, Whānau Experience

If you want small changes in your life, work on your attitude. But if you want big and primary changes, work on your paradigm. Stephen Covey

All families and whānau have access to family peer support and recovery education.

Model 3.8 Comparing the old with the new Traditional Services Recovery-based servicesViews of Madness Pathology/no meaning Crisis of being/fully human experience

Philosophy Treatment/paternalism Recovery/self determination

Language Medical, objective, ‘They’ Personal, subjective, ‘We’

Service users Passive recipients Active agents and leaders

Families Unsupported and grieving Supported and supportive

‘Destination Recovery’ 2008 MHF position paper

Concerned ‘Lets get some help’ How & where you access help often

influenced by cultural norms

As whānau we start off

Bio medical influences on whānauas observed by consumers

Consumers observed families adopting uncritical acceptance of what they’re told by clinicians or read about a bio-medical interpretation of mental illness

Family’s denial of childhood adversity & trauma was seen as derived from attachment to bio medical model

(H. Barnett & A. Barnes, 2010)

What we see depends mainly on what we look for - John Lubbock

Bio medical influences on Family, Whānau Most first person accounts of families in literature

are deeply depressing stories about grief/loss/shame/stigma/stresses & burdens of caring.

The grief seemed to be deepened by hopelessness about recovery, often based on the assumption of an irreversible illness. “I looked up schizophrenia in our medical book. After reading their information I didn’t see much hope (Kagigebi,1995, As cited in In J.Geekie.,P. Randal, D.Lampshire & J.Read (Eds.), 2012, p 207)

The notion of an incurable disease led in turn to the belief that the burden of caring & all stresses involved would be endless.

(J. Read & L. Magliano, Experiencing Psychosis, P 207, 2012)

Walk Away

Stigma

Not wanting to be burdened

Too busy

If this is a serious illness what can I do?

Leave it to experts & system

What you see depends on what you thought before you looked Eugene Taurman

Taking too much responsibility for others & avoiding it for one-self.

• Want to help & alleviate distress

• Burnt out

• Your whanau member wants you to solve their problems

• Guilt

Reinforced by mental health services & society

If your whānau member is ‘sick’ with a ‘mental illness’ it makes sense to become their ‘carer’.

- ‘Medication Monitors’ - ‘Eyes & Ears of Service’ - ‘Mental Health Act’ IMPLICATIONS FOR RELATIONSHIP?

‘Carer’ not consistent with recovery

If as adults we depend heavily on those close to us but can’t return this support, we are certain to find ourselves angry with our benefactors and with ourselves a great deal of the time.

When we over-depend on another person we see ourselves and are seen by others as inadequate & inferior compared to the one we depend upon.

(GROW article)

Anger can accompany overdependence

Drama Triangle (Blame Culture)

Persecutor

Reality-Act in own interests

Persecutor Characteristics-Others suffer on account of their behavior

Discounts- The victim doesn’t matter

.

Persecutor Rescuer

Rescuer

Reality- Concern for victim

Characteristics-Take over thinking/problem solving

Discount- Victim can’t solve his/her problem

Victim

Victim

Reality- Suffering/potentially suffering

Victim Characteristics- Believe they don’t have resources to solve their problem Neediness is so acute it prevents them solving problems

Discount- I can’t solve this

Media/MoH

scrutiny

Reports/reviews

recommendations

Avoid riskResources diverted

from innovation

Serious IncidentsMistakes

Complaints

HDC/DHB/MPs

Drivers of a risk focused culture (L.Murray)

The Winner’s Triangle (Learning Culture)

AssertiveSupportive

Vulnerable

Assertive

Reality- Act in own interests

Assertive characteristics- Ask for what they want & say no to what they don’t want

Give feedback & initiate negotiation

Skills- Assertiveness skills

Caring

Reality- still concerned for vulnerable person

Caring Characteristics- Do not do the thinking or problems solving

Skill-Listening & self-awareness skills

Vulnerable

Reality- Still vulnerable/potentially vulnerable

Vulnerable Characteristics- own thinking & for problem solving

Skill- Problem solving & self-awareness skills

Looked at websites“Supplying information about mental illness”“Support for families, friends & caregivers of people with a mental illness”“…provide recovery and a quality of life to their loved one who has a mental illness” Providing ‘recovery’ to someone is not possible.

However listening & support can make a positive difference

Contracted services for whanau

The voyage of discovery is not in seeking new landscapes but in having new eyes. Marcel Proust

To support recovery, whānau need to understand what recovery is.

- Cultivating hope, respect & acceptance- Focusing on strengths- Facing your own dark emotions - Tolerance of uncertainty- Dignity of risk- Being emotionally honest & valuing own wellbeing

A leaflet on mental illness & self care is probably not going to help us as whānau get there.

Different approaches required

Advocacy at a systemic level – NDFWA (Family Advisors)

Real-time Feedback Skilled support for whānau after suicide More resource for acute recovery focused options Evidenced based programmes like DBT Family

Connections

What could change things?

Services believing whānau can learn, grow & change

Whānau themselves believing they can learn, grow & change

Whānau taking a lead in recovery focused education for whānau

At a societal level - respect for each others vulnerability & differences

What could change things?

A ‘Paradigm shift’ may be thought of as change from one way of being to another. It does not just happen, but rather it is usually driven by agents of change.

whanaupeers4recovery@gmail.com

If not me ‘who’? If not now, ‘when’?