Achieving Certification: The Psychiatric Mental Health Review Course

Promoting Health,WellBeing andRecovery

February 8, 2013

Nancy Brookes,

RN; PhD; CPMHN( C) nancy.brookes@theroyal.ca

Windhorse Principle
Inherent in every person there is a natural healing impulse, a motivation toward health & wholeness. This motivation can be ignited & strengthened in an environment where an attitude of hope & a belief in each person's potential for growth is pervasive. At the heart of an individuals recovery from mental disorder is the restoration of personal, social, & environmental connections

Presentation Overview
A Quick Trip Through: Health and healing Mental Health Environment, culture The power of language and how words can wound Stigma, prejudice and discrimination as a barrier to recovery Recovery Health promotion Well-being Resilience Self care Lots of resources

Health and Healing

Health, a resource for everyday life, is a positive concept emphasizing social and personal resources as well as physical, spiritual and mental capabilities Health and healing are about wholeness. Health is about creating wholeness. Healing is about repairing and restoring wholeness.
Individuals, families and communities are more likely to take charge of their lives and build a sustainable future for themselves and their children when they believe in themselves; focus on the positives in their situation; are treated with respect; are given the help, support, and resources to come up with their own solutions to their problems. It is about people transforming their everyday lives and bringing hope and renewal

A Question or Two
What does health mean to you? How do you think care is affected when we focus on health vs illness?

Environment & P&MHN

Psychiatric and mental health nursing is embedded within the broader physical and social environment whose organization and characteristics affect care, quality of life and treatment The P&MH nurse promotes healthy and enabling environments that support healing The P&MH nurse advocates, both within the mental health system and society as a whole, for relevant environmental and policy changes that will promote and sustain optimal mental health

Environment As Context
Quality of environment has significant impact upon human health (CNA, 2000) Our task is to provide conditions under which people may heal themselves, or be healed - as Florence Nightingale remarked - by nature or by God. God. People grow up, develop & heal within their many physical, cultural and social environments contexts: Home, school, work, social, hospital, health care system.. Environments multilayered including biological, external, social, cultural, interpersonal Healing environments work principally by supporting coping with stress

Environments
Nightingale quality of persons environment holds key to health and healing Complex relationship btw person and environments Integral person essential part of environment & environment essential part of person Environments include internal, external, and the social and cultural milieus in which person lives. A person dwells in multiple environments, often at same time Environments & experiences can be health promoting and support health, or they can be toxic and detrimental to health

Culture
A word about culture integrated throughout A number of programs available to enhance cultural competence see for example MHCC Cultural Awareness Tool A caution importance of knowing the person/family/community, avoid possible stereotyping based on understanding of the culture

MHCC Cultural Awareness Tool

https://kec.mentalhealthcommission.ca/mental_health_tools_and_resources

Tool is designed as a first step to provide comprehensive information on all aspects of culturally sensitive care. Does not provide comprehensive information on all aspects of culturally sensitive care. Based on the use of this tool the hope is that health and mental health practitioners will further develop their own knowledge concerning culturally sensitive care
Mental Health Commission of Canada

Mental Health vs Mental Illness

Mental illnesses are disorders that cause a serious disturbance in thinking, emotions or behaviour (one in five; one in three)
Depression, Bipolar disorder, Schizophrenia, Anxiety disorders, Personality disorders, Eating disorders [new DSM V ...]

Mental health often described in negative terms absence of mental illness, or societal norms and regulations Notice rarely hear mental illness anymore odd terms such as mental health diagnosis oxymoron!

Mental Health
Mental health is defined as the capacity of the individual, the group and the environment to interact with one another in ways that promote subjective well-being, the optimal development and use of mental abilities (cognitive, affective and relational), the achievement of individual and collective goals consistent with justice and the attainment and preservation of conditions of fundamental equality.

Mental Health - human face

Mental health is the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well being that respects the importance of culture, equity, social justice, interconnections and personal dignity.
The Human Face of Mental Health and Mental Illness

Mental Health - WHO

Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community.
World Health Organization

Two Continuum Model

Mental health continuum: two poles optimal mental health, poor mental health; respective demands & contributions of person, group & environment balanced so they support values and objectives expressed in definition of mental health Mental disorder continuum: one end point extreme severity of symptoms (distress & impairment), other would be complete absence of symptoms or effects range of different symptoms present to varying degrees Mental health for Canadians: Striking a balance (1988) Flourishing (CAMH)

Stigma
Stigma refers to negative attitudes (prejudice) and negative behaviour (discrimination) Includes: having fixed ideas and judgements; stereotyping, fearing and avoiding what we dont understand Mental Health Commission of Canada National Mental Health Strategy one of two priority areas stigma among health care professionals

Stigma is...
a complex idea that involves attitudes, feelings & behaviour a word referring to the negative mark attached to people who possess any attribute, trait or disorder that marks that person as different from normal people. This difference is viewed as undesirable and shameful, and can result in people having negative attitudes and responses (prejudice and discrimination) toward another person
Adapted from OGrady, C. (2004). Stigma as experienced by family members of people with severe mental illness: The impact of participation in selfhelp/mutual aid support groups. Unpublished doctoral dissertation, University of Toronto.

Stigma: The Facts

What is stigma?
Stigma (or prejudice) describes a negative and unfavourable attitude. Stigma causes those living with a mental illness to be labelled, stereotyped, and feared.

What is discrimination?
Discrimination is the action that results from stigma. It is how you treat those living with mental health issues because of how you think about them.

Why does it matter?

Many people living with mental illness say the stigma is worse than the illness itself. Stigma is seen as one of the key barriers preventing people from seeking help.

Stigma = prejudice + discrimination

Beyond the Label Quiz Recovery Attitudes Questionnaire

Things you can do to stamp out stigma (Beyond the Label)

1. Acknowledge the prevalence of mental health and substance use problems. 2. Try to walk in the shoes of a person who is stigmatized. 3. Watch your language. 4. Monitor media & openly critique stigmatizing material. 5. Respond directly to stigmatizing material with a letter to the editor. 6. Speak up about stigma to friends, family & colleagues. 7. Be aware of your own attitudes and judgments.

Person-centered alternatives to commonly used words and phrases

Worn-out language
you're just Decompensating Manipulative Crazy Compliant Noncompliant Resistant

Language that promotes acceptance, respect, &uniqueness

You are more than Not him/herself today; he/she is experiencing symptoms Resourceful; really trying to get help Unique Might not be confident about personal choices or decisions; afraid Beginning to think for him/herself; taking personal responsibility Not open to; chooses not to; has own ideas

Alternative Language
Wornoutphrases
Frequent flyer Entitled Baseline Unmotivated Helpless User of system

Recoverylanguage
Gives us many opportunities to intervene and support Aware of rights What a person looks like when doing well Has other interests; bored; doesnt know how to begin Unaware of capabilities Resourceful, good self advocate

Source URL:

http://www.behavioral.net/article/tools-transforming-language

Its Just Behaviour

My personal favourite of course whatever it is it is behaviour How might we change our language around this phrase? Suggestions?

Once I became my diagnosis there was no one left to recover

The language used and the stories and meanings that are constructed have great significance as mediators of the recovery process. These shared meanings either support a sense of hope and possibility, or invite pessimism and chronicity

Recovery Knowledge Inventory

Encourages conversations about the recovery process & the meaning of resiliency and wellness

http://www.acbhcs.org/wellness_test/wellness_inventory.htm

Mental Health Commission of Canada, Recovery

Recoveryinvolves a process of growth and transformation as the person moves beyond the acute distress often associated with a mental health problem or illness and develops new-found strengths and new ways of being. Mental Health Commission of Canada, 2010

Recovery Transformation
Potential to transform the system People recover we provide recovery oriented service and care Not to be mistaken for a passing fad roots stretch to the birth of psychiatry in the 18th century. As its Reintroduction intended to bring about fundamental transformation of mental health a revolution in care Not simply a new word to be used in describing current practices.

What is Recovery?
SRN recovery is a deeply personal, unique process of changing ones attitudes, values, feelings, goals, skills, and roles. It is a way of living a satisfying, hopeful and contributing life, even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in ones life as one grows beyond the catastrophic effects of mental illness (Anthony, 1993) SAMSHA - Recovery is a process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.

Recovery
There is no set time requirement for recovery, Recognized as an individualized process Each persons journey of recovery is unique and Each person in recovery chooses supports, ranging from clinical treatment to peer services that facilitate recovery Recovery involves a process of growth and transformation Person with a mental health problem or illness develops strengths and new ways of being People are empowered and supported to actively engage in their own journey of well-being.

Four Major Domains Support Recovery - SAMHSA:

Health: overcoming or managing ones disease(s) as well as living in a physically and emotionally healthy way; Home: a stable and safe place to live that supports recovery; Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and Community: relationships and social networks that provide support, friendship, love, and hope.

 Recovery means different things to different people - is a very personal experience - may not mean an absence of symptoms - it does mean living a fulfilled life in which persons have control over their own wellbeing and recovery. Some important thoughts and ideas about recovery: Recovery is a journey not a destination All of us have recovered from something in our lives Many of the things that help us to recover are the same for everyone It is most helpful to identify ourselves according to strengths and wellness rather than problems and illness Relationships based on hope and trust and a belief in the possibility of recovery very important.

The Principles of Recovery UK and US

Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems. Recovery represents a movement away from pathology, illness and symptoms to health, strengths and wellness. Hope is central to recovery and can be enhanced by each person seeing how they can have more active control over their lives (agency) and by seeing how others have found a way forward. Self-management is encouraged and facilitated. The processes of self-management are similar, but what works may be very different for each individual. No one size fits all.

The Principles of Recovery UK and US cont

The helping relationship between clinicians and patients moves away from being expert / patient to being coaches or partners on a journey of discovery. Clinicians are there to be on tap, not on top. People do not recover in isolation. Recovery is closely associated with social inclusion and being able to take on meaningful and satisfying social roles within local communities, rather than in segregated services. Recovery is about discovering or re-discovering a sense of personal identity, separate from illness or disability.

National (US) Consensus Statement on Mental Health RECOVERY

Self direction Individualized and person-centred Empowerment Holistic Non-linear Strength based Peer support Respect Responsibility Hope

www.samhsa.gov

Principles of Recovery
Person-driven; Occurs via many pathways; Is holistic; Is supported by peers; Is supported through relationships; Is culturally-based and influenced; Is supported by addressing trauma; Involves individual, family, and community strengths and responsibility; Is based on respect; and Emerges from hope.

Engagement Beliefs
Recovery is possible Change is inevitable nothing lasts Ultimately people know what is best for themselves People posses all the resources needed to begin the recovery journey The person is the teacher, we are learners We need to be curious learn what needs to be done to help the person now!
www.tidal-model.com

What People Tell Us Helps

Educating oneself about the illness. Identifying symptoms and reviewing choices for managing those symptoms and making decisions about how to manage those symptoms that works best. Making choices about medications: find out about the side-effects of each, as well as, the effects of withdrawing (stopping use of) certain medications. Recording symptoms in a notebook while taking medication and use this to support or oppose continued use of a particular drug. These records can be used to work with doctors regarding the best choices for you. Exploring non-medication and non-medical approaches to managing symptoms and maintaining mental health. Learning various coping strategies and activities such as meditation, relaxation techniques, prayer, or hobbies that can help to reduce stress; joining clubs and organizations. Seeking employment and self-employment support programs. Seeking mutual aid opportunities such as self-help groups, community kitchens and food banks. Learning to make the most of social assistance programs, low cost transportation.

LET'S TALK ABOUT SOLUTIONS Recovery Conversations

The Recovery Conversation focuses on strengths and the potential for self-determination instead of acceptance of limitations that perpetuate feelings of helplessness and hopelessness.
begins by focusing on the person instead of the problem. focus is on empowering the person includes a dynamic planning phase Risks and outcomes are held in mutual partnership framed in the context of the person's strengths and action plan Special attention given to building resilience concludes with a mutual assessment of the process and progress

Source URL: http://www.behavioral.net/article/lets-talk-about-solutions

What is a Wellness Recovery Action Plan (WRAP)

The Wellness Recovery Action Plan, or WRAP is An evidence-based system Used world-wide by people who are dealing with mental health and other kinds of health challenges & By people who want to attain the highest possible level of wellness Developed by people who have a lived experience of mental health difficulties; people who were searching for ways to resolve issues that had been troubling them for a long time. WRAP involves listing your personal resources, your Wellness Tools, and then using those resources to develop Action Plans to use in specific situations which are determined by you. WRAP is adaptable to any situation. WRAP also includes a Crisis Plan or Advance Directive.
Wellness Recovery Action Plan - Mary Ellen Copeland

www.mentalhealthrecovery.com/aboutwrap.php

Structure of Framework for Support

Purpose: To ensure that people with serious mental health problems live fulfilling lives in the community
3 fundamental assumptions & 3 conceptual models Provision of services & supports to people with mental illness needs to be reformed & restructured (CRB rethinks nature of services & supports) Most basic ways we think about & understand MI needs to be rere-examined & changed (KRB focus on diverse kinds of info) Way consumers seen as people needs to be changed & enriched - focus on capacities (PRB consumers as actors who can direct their own recovery process)

CommunityResourceBaseMap
Housing
Self Help & Consumer Organizations

Family & Friends

Income
Mental Health Services

Person

Work

Generic Community Services & Groups

Education

KnowledgeResourceBaseMap
Recognition Of Diversity Customary/Traditional Knowledge Social Transforming Mental Health Acceptance Our Understanding Literacy & Inclusion Of Mental Illness Medical/ Social Science Clinical Knowledge Knowledge Enriched Range of Services & Supports Experiential Knowledge

Personal Resource Base Map Hope

Practical Understanding of illness

Positive Sense of Self

Resilience
Purpose & Meaning

Being in Control of Your Own Life

Confidence
Inclusion & Belonging

Well Being

Social/Determinants of Health
Determinants of health: A range of personal, social, economic and environmental factors that determine the health status of individuals or populations
Social environment, social supports networks and social connectedness Physical environments Income and income distribution, social status Gender, age and culture, biology & genetics Food security Affordable and adequate housing Employment, working conditions, unemployment & employment security Access to health services, personal health practices and coping Education

Both Health Promotion & Mental Health Promotion

focus on the enhancement of well-being rather than on illness address the population as a whole, including people experiencing risk conditions, in the context of everyday life are oriented toward taking action on the determinants of health broaden the focus to include protective factors include a wide range of strategies (e.g.: communication, education, policy development, organizational change, community development and local activities) acknowledge and reinforce the competencies of the population encompass the health and social fields as well as medical services
Joubert et al., 1996

Health Promotion in Mental Health

Mental health promotion actions taken to maximise the mental health and wellbeing of populations by: - improving social, physical and economic environments - strengthening the understanding and skills of individuals in ways that support their efforts to achieve and maintain mental health

Mental Health Promotion

Mental health promotion is the process of enhancing the capacity of individuals and communities to take control over their lives and improve their mental health. Mental health promotion uses strategies that foster supportive environments and individual resilience, while showing respect for culture, equity, individual choice, social justice, interconnectedness and personal dignity. Social Determinants of Health are at the forefront of health promotion
The Human Face of Mental Health and Mental Illness in Canada. Public Health Agency of Canada. 2006.

Mental Health Promotion - Canada Way back in 1988 Mental Health for Canadians: Striking the Balance provided driving force for placing mental health within a health promotion framework Ottawa Charter promote individual & collective health; develop healthy public policy, reorient health services, build individual skills, create supportive environments & strengthen community action

A Word About Prevention

Prevention of mental illness and addictions focuses on measures taken to prevent problems and illnesses, by addressing risk factors as well as protective factors for individuals, groups and communities. Mental illness prevention actions taken to reduce the impact or prevent the initial onset of mental illness Mental illness treatment actions taken to remedy a mental illness or to lessen its ill effects.

Mental health promotion - WHO

Mental health promotion involves actions to create living conditions and environments that support mental health and allow people to adopt and maintain healthy lifestyles. These include a range of actions to increase the chances of more people experiencing better mental health. A climate that respects and protects basic civil, political, socio-economic and cultural rights is fundamental to mental health promotion. Without the security and freedom provided by these rights, it is very difficult to maintain a high level of mental health.

Protective Factors
Childhood: positive early childhood experiences, maternal attachment Education: accessible Empathy Empowerment and self-determination Family: resilience, parenting competence, positive relationship with parents and/or other family members Personal resilience and social skills Physical health Services: accessible quality health and social services Spirituality www.health.vic.gov.au/mentalhealthpromotion

Risk Factors
TRAUMA Alcohol and drugs: access and abuse Displacement: refugee and asylum-seeker status Disability Education: lack of access Family: fragmentation, dysfunction and child neglect, post-natal depression Genetics Physical illness Physical inactivity www.health.vic.gov.au/mentalhealthpromotion

Three Most Significant Determinants of Mental Health

1. Social inclusion 2. Freedom from discrimination & violence 3. Access to economic resources

(Keleher & Armstrong, 2006; Mental Health Promotion in Ontario: A Call to Action, 2008)

Pathways to Recovery
Pathways to Recovery translates the evidencebased practice of Strengths Model into a selfhelp approach
Before

I heard of Pathways, my mental illness defined me. When I first began the workbook, I realized my recovery defined me. By the time I finished Pathways, I realized I could define my own life.

What is the evidence base for the Strengths Approach? The Strengths Approach was the subject of more than 10 formal research studies. It is considered an evidence-based practice because it has been found to promote positive outcomes for people with psychiatric disabilities. The Strengths Approach has been proven to keep people in the community and helps them meet their goals.
pathways@ku.edu

Strength-Based Care
Considers whole person (we respond as whole persons) Focuses on what is working and functioning well, what the person does best, and what resources people have available Nurses support what is working to help people cope, develop, grow, thrive, and transform Places person and family as the focus and centre of care, problems best understood when situated in context and understood within persons personal history, culture, belief system, and values of what is important and what holds meaning for them
Gottlieb, L. (2013). Strengths-Based nursing care Health and healing for person and family. New York: Springer

Voluntary National Standard of Canada for psychological health and safety in the workplace released

Toronto,Ontario,January16,2013 TheMentalHealthCommissionofCanada (MHCC), haveofficiallyreleasedCanadasfirstnationalstandarddesignedto helporganizationsandtheiremployeesimproveworkplacepsychologicalhealth andsafety. TheNationalStandardofCanadatitledPsychologicalHealthandSafetyinthe Workplace Prevention,promotionandguidancetostagedimplementationisa voluntarystandardfocusedonpromotingemployees psychologicalhealthand preventingpsychologicalharmduetoworkplacefactors. OneinfiveCanadiansexperienceamentalhealthproblemormentalillnessin anygivenyearandmanyofthemostatriskindividualsareintheirearlyworking years.Canadiansspendmorewakinghoursatworkthananywhereelse, says MHCCPresidentandCEOLouiseBradley.Itstimetostartthinkingaboutmental wellbeinginthesamewayasweconsiderphysicalwellbeing,andtheStandard offerstheframeworkneededtohelpmakethishappenintheworkplace.
http://www.mentalhealthcommission.ca/SiteCollectionDocuments/January_2013/MHCC_St andard_MediaRelease_ENG.pdf

Well Being/Wellness
Face To Face With Mental Wellness - MHCC Physical, mental, emotional, spiritual health/wellness as well as a sense of belonging and purpose www.mentalhealthcommission.ca What BETTER feels like Mood Disorders Society of Canada (well-being)
www.mooddisorderscanada.ca/page/what-better-feels-like

Face To Face With Mental Wellness

A series of videos created by Alex Burr, a project designed to put a face to mental illness in the 21st Century. In partnership with Students for Mental Wellness and The Lowdown (Vancouver-based mental health speakers bureau)
One story: Joe Roback. A personal uplifting story of Joe Roback, who lives with Bipolar Disorder. Joe has had a strong recovery and attends Simon Frazer University in Burnaby, Canada. He is an avid chess player, musician and volunteers with many mental health organizations MHCC www.mentalhealthcommission.ca

Well Being/Wellness - Health

Physical get a physical, manage chronic illness, do you have a problem? exercise (move), eat well, and get your sleep, look good, feel better Mental (brain) Health - Healthy brains, Active mind, Help for your memory Emotional - Name it, Self talk, Stress relief, Emotional safety your own feelings, relationships, emotional time bombs

Healing your spirit Worthy of kindness? Belonging Harm of stigma Hurts from the past Too much to soon Self help Finding purpose Feeling useful, feels good Takes time

Spiritual Wellness

www.mooddisorderscanada.ca/page/what-better-feels-like

Resilience Recovery Well-Being

Most of us find that tough stuff comes at us every day. You can either let it negatively impact you or you can get through the tough stuff and use what you have learned in those instances to help you in the future. Resiliency is the ability to bounce back from setbacks or challenges. Resiliency isn't a "thing," it's a combination of skills and/or abilities that can help you get through setbacks or challenges. In short, resiliency is something you do. "Resiliency is individualized. It looks different for each of us Three most common themes are family, faith and perseverance; act as first line of defense for someone facing a challenge.
http://resiliencycanada.ca/

"Seven Resiliencies."
1. Insight 2. Independence 3. Relationships 4. Initiative 5. Creativity 6. Humour 7. Morality
http://www.magellanhealth.com/training/resiliencyM1/index.htm

Hinders Resilience
Making decisions for us Developing our service plans for us Reminding us of our limitations Trying to control us Reminding us of past failure Viewing us through the lens of our diagnosis as an illness

Helps Resilience
Be happy to see us Answer our phone calls and return messages in a timely manner Get excited about our plans Help us figure out how to make our plans work Support us in being accountable for our plans Help us find resources to carry out our plan Relate to us as a partner instead of a patient. This will allow you to experience us as a credible participant in our quest for recovery and resilience.

Resiliency Checkpoint
For each pair choose the one that best describes you: A. I tend to view challenges as opportunities. B. Challenges are often a result of bad luck. A. I can find humour in difficult situations. B. There is nothing funny about difficult situations. A. I do not dwell on the negative. I focus on the positive. B. All I encounter is negative. A. I am comfortable with ambiguous or uncertain situations. B. I cant function without knowing what is going to happen next. A. My struggles have made me a stronger, more insightful person. B. My struggles have been a direct result of other peoples actions. To score - for every A answer you have selected, give yourself 5 points, and for every B answer you have selected, give yourself 1 point. Scoring: 21-25 ....... You are very resilient. 17 ............ You are doing quite well. 13 ............ Not bad, but you could benefit from enhancing some of your skills. 9 .............. You need more skills! 5 .............. We need to get started right away!

http://www.magellanhealth.com/training/resiliencyM1/index.htm

Advice From Experts Resilience

.

Authenticity: Get to know yourself, and express your uniqueness in ways that are meaningful to you and can be appreciated by others. Let yourself bounce any way that works for you. Yes, when its time to rebound, it really is All about you. Initiative: This is about us taking the lead in our own recovery, and our own development of resilience. We need others to help us, but we must take the lead. Spirituality: Developing spiritual competence helps us sustain resilience. It provides a way for us to understand our purpose, and to have meaning in our live. Flexibility: This is about rolling with the punches, and being open to new ideas. The more we can be flexible, the less apt we are to break if we are dealt a hard blow. Rather, well learn to bend and grow in a new way. Forgiveness: Holding on to grudges and blaming others will never help us move forward. This uses up too much energy energy that could be spent on moving forward instead of rehashing the past. Curiosity: This has to do with being willing to try new things, to take calculated risks, to move out of our comfort zone and into new ways of being. www.magellanhealth.com/training

Burn Bright - Build your own resilience

Save energy by encouraging us to manage ourselves, instead of trying to control us. Be in a good mood and stay optimistic about our recovery. stay in relationship with us; we can be much better company than the paperwork! When we slip and slide, dont see this as a failure on your part or on ours. This is all part of our learning to be resilient by trial and error. If you can, share your own story of resilience with us. I cant tell you what a valuable step this would be for all of us!

Its practically impossible to engage in these activities if you have a negative attitude (are resentful, disrespectful, cranky, etc.) So you can see how supporting us in our recovery may require you to do some recovering of www.magellanhealth.com/training your own

10 Self Care Strategies

The art of valuing yourself involves: 1. Taking care of self by trusting own process 2. Being assertive 3. Embracing your polarities 4. Recognizing & dealing with own grief & loss 5. Learning to let go 6. Choosing "nourishing" vs. "toxic friends 7. Dealing constructively with your anger 8. Taking care of your body 9. Making your home a haven 10. Developing meaning & purpose in life
Bunker, 1992

Windhorse Principle
Inherent in every person there is a natural healing impulse, a motivation toward health & wholeness. This motivation can be ignited & strengthened in an environment where an attitude of hope & a belief in each person's potential for growth is pervasive. At the heart of an individuals recovery from mental disorder is the restoration of personal, social, & environmental connections

Resiliency and Recovery E-Learning Center

www.magellanhealth.com/training
RecoveryECourses Recoveryecourse1:RecoveryisReal Recoveryecourse2:SelfdeterminationFuelsRecovery Recoveryecourse3:TheLanguageofRecovery Recoveryecourse4:PlanningthatPromotesRecovery Recoveryecourse5:Let'sStartLivingLarge Recoveryecourse6:TheResiliencyFactor ResiliencyEcourses Resiliencyecourse1:GettingPasttheToughStuff Resiliencyecourse2:ThePowerofResiliency Resiliencyecourse3:GrowingYourResiliency Resiliencyecourse4:RecappingResiliency

Recovery Resources
Mental Health Commission of Canada https://kec.mentalhealthcommission.ca/mental_health_tools_and_resources Scottish Recovery Network info@scottishrecovery.net www.scottishrecovery.net Substance Abuse & Mental Health Services Administration SAMHSA samhsa@service.govdelivery.com Center for Psychiatric Rehabilitation, www.bu.edu/cpr NAMI: National Alliance on Mental Illness 800-950-NAMI (6264), www.nami.org National Empowerment Center, 800-POWER2U or 800-769-3728, www.power2u.org (Patricia Deegan) The National Mental Health Consumers Self-Help Clearinghouse, 800-553-4539, www.mhselfhelp.org Recovery Knowledge Questionnaire Resiliency Canada http://resiliencycanada.ca/ http://www.acbhcs.org/wellness_test/wellness_inventory.htm Tools for transforming language. Behavioral Healthcare Source URL: http://www.behavioral.net/article/tools-transforming-language another source on the respectful use of language see http://uspra.org/files/public/langGuidelines.pdf Challenging the Public Stigma of Mental Illness: A Meta-Analysis of Outcome Studies. http://bit.ly/KenPopeMetaAnalaysisReducingStigma 104 Studies of reslilience published in 2012 (citations & excerpts): http://bit.ly/KenPopeResilienceResources

Mental Health Commission of Canada www.mentalhealthcommission.ca

Changing directions, changing lives. Mental Health Strategy for Canada Toward Recovery and Well-Being: A Framework for a Mental Health Strategy for Canada Voluntary National Standard of Canada for psychological health and safety in the workplace released http://www.mentalhealthcommission.ca/SiteCollectionDocuments/January_2 013/MHCC_Standard_MediaRelease_ENG.pdf Centre for Addiction and Mental health www.camh.ca CAMH Knowledge Exchange http://knowledgex.camh.net Canadian best practices portal for health promotion and chronic disease prevention www.phac.gc.ca/cbpp CMHA Mental health promotion tool kit http://www.cmha.ca/mh_toolkit/intro/index.htm Evidence-based mental health promotion resource (VicHealth)

Resources

www.health.vic.gov.au/healthpromotion/downloads/mhr_social.pdf
Gottlieb, L. (2013). Strengths-Based nursing care. Health and healing for person and family. New York: Springer Interactive Domain Model of Best Practices IDM Best Practices website at www.idmbestpractices.ca National Network for Mental Health (NNMH) http://www.nnmh.ca/

Some Principles Governing PersonEnvironment Transactions

Persons genotype or genetic make-up determines responsiveness to environment Persons biology, stress level, moods, and emotional states affect and are affected by interactions with environments Environments are modifiable Environment & specific experiences of person can alter biological structures, such as brain Persons reliance on environment related to health, age, & vulnerability

Quotes
"A community is commonly understood to be about relationships; its not a place. A neighbourhood is a place, but community is about peoples relationships. John McKnight, 1990 Bettelheim: The physical environment is the house of the spirit spirit and it is the spirit underlying the physical structures and their furnishings which is of the greatest importance importance (In Cotton & Gerty, 1984) The limits of my language . . . mean the limits of my world. - Ludwig Wittgenstein (1963) Especially at times of great personal crisis, people need to retire from everyday life. It is as if they are retiring to some quiet, & often distant place, to review their experiences; to prepare for the time when they will rereenter the arena of life (Deegan, 1990; 1996)

What People Tell Us Helps

Educating oneself about the illness. Identifying symptoms and reviewing choices for managing those symptoms and making decisions about how to manage those symptoms that works best. Making choices about medications: find out about the side-effects of each, as well as, the effects of withdrawing (stopping use of) certain medications. Recording symptoms in a notebook while taking medication and use this to support or oppose continued use of a particular drug. These records can be used to work with doctors regarding the best choices for you. Exploring non-medication and non-medical approaches to managing symptoms and maintaining mental health. Learning various coping strategies and activities such as meditation, relaxation techniques, prayer, or hobbies that can help to reduce stress; joining clubs and organizations. Seeking employment and self-employment support programs. Seeking mutual aid opportunities such as self-help groups, community kitchens and food banks. Learning to make the most of social assistance programs, low cost transportation.

Recovery Notes
The language used and the stories and meanings that are constructed have great significance as mediators of the recovery process. These shared meanings either support a sense of hope and possibility, or invite pessimism and chronicity. The development of recovery-based services emphasises the personal qualities of staff as much as their formal qualifications. It seeks to cultivate their capacity for hope, creativity, care, compassion, realism and resilience. Family and other supporters are often crucial to recovery and they should be included as partners wherever possible. However, peer support is central for many people in their recovery.
Adapted from Recovery Concepts and Application by Laurie Davidson, the Devon Recovery Group.

What is discrimination?
Discrimination is a prejudicial act, such as denying someone employment, housing, accommodation or other services because of the persons race, colour, citizenship, culture, ethnic origin, marital or family status, sexual orientation, disability, age, gender, economic situation and so on. It may be covert or systemic, intentional or unintentional. An act of discrimination is a violation of an individuals human rights and may be prosecuted under the Ontario Human Rights Code.

Effects of stigma
prejudice & discrimination (in medical care, housing,
employment) negative feelings about self (self-stigma); for example, believing the negative stereotypes generated by society and media messages tendency to avoid seeking help, and to keep symptoms & substance use a secret social isolation and/or constricted social support network poverty depression loss of hope for recovery suicide.
Adapted from Pompili, M., Mancinelli, I. & Tatarelli, R. (2003). Stigma as a cause of suicide. British Journal of Psychiatry, 183(2), 173174,

Sets of Value Systems

Setsofvalues
Personal/cultural Ethical/moral

Examplesofvalues
Always do the right thing There are rewards in working hard People have the right to make choices related to care People have right to be treated with respect & dignity health is a right, state should provide & pay for it Health care a privilege; people are responsible for taking care of selves Gottlieb (2013)

Political/religious
Doctrinal/ideological

Collaborative Relationships
FROM focusing on deficits TO working with persons strengths FROM doing for the person TO working with the person FROM focusing on disease and its treatment TO focusing on living and coping with challenges and adverse events FROM the nurse as teacher TO both person & nurse as learners FROM measuring set of specific outcomes TO allowing person to determine own goals & own measures of success Gottlieb (2013)