Brisk walking can help shed excess weight

About 10,000 cases of breast and bowel cancer could be prevented each year in the UK if people did more brisk walking, claim experts.

The World Cancer Research Fund scientists say any moderate activity that makes the heart beat faster should achieve the same.

 For example, data suggest 45 minutes a day of moderate exercise could prevent about 5,500 cases of breast cancer.

 Physical exercise helps prevent obesity, which is a cancer risk factor.

 The WCRF team stress in their report that it is the total time spent being active that is important. You do not need to set aside half an hour each day to exercise. Shorter bouts of activity will be just as beneficial as long as they add up to the same, the charity says.

 You can reduce your cancer risk just by making small changes”  Dr Rachel Thompson World Cancer Research Fund

Alongside brisk walking, other activities that would count include cycling or swimming at a leisurely pace, dancing, gardening and vacuuming combined with other housework, says the WCRF.

 Their head of science, Dr Rachel Thompson, said by making small changes to their daily routine people could achieve significant health gains.

 ”There is now every strong evidence that being physically active is important for cancer prevention.

 ”Even relatively modest increases in activity levels could prevent thousands of cancer cases in the UK every year.

 ”These figures also show you do not have to go to the gym every day to benefit.

 ”You can reduce your cancer risk just by making small changes and this is highlighted by the fact that so many cancer cases could be prevented through something as simple as brisk walking.

 ”By taking up walking as a hobby or even walking to the shops instead of taking the bus or car, people can make a real difference to their health.”

 Henry Scowcroft, science information manager at Cancer Research UK, said: “You don’t have to be an athlete to reduce your cancer risk.

 ”There’s solid evidence that certain cancers – including breast and bowel cancer – are less common in people who do regular, moderate exercise such as brisk walking.”

 bbc – www.bbc.co.uk/news/health

Have you got lots of stuff at home that you don’t use, but haven’t got round to sorting out or getting rid of?  Why not do a  Car Boot Sale?  These are held regularly in most areas and you will no doubt find that there is one local to you, normally on a Sunday morning.   You will be charged an amount (usually about £7 for your car) and whatever else you make is a bonus.  Items don’t go for a massive amount, but you’ll be surprised how quickly the amount will add up and whatever you make is in your pocket.

Another way of making money utilising the things you have in your own home is to sell them on Ebay.  This will probably make you more money than a Car Boot Sale but it is quite time-consuming getting organised.  You need to take photos (on a digital camera) of the things you want to sell, anything from clothes to jewellery to DVD’s – anything in fact at all! and upload them onto the site, then you write a short description and list the items!  You can list them on the site from three days to a week, it’s probably best to have the listing finish on a Saturday or a Sunday so that more people are around to browse the site.  You may get asked questions about your goods – so don’t list them then go on holiday!!  You are charged a small fee for listing them.  You also need to set up a paypal account (so need a bank account) so you can have your monies paid into this account!  You charge your buyers for postage and it is normal practice to mark this up so you make a bit of profit on it!  You need to weigh the items before you list them and then check on the Royal Mail site so you know how much to charge!  Have a look on the Ebay site if you’ve not used it before, there are plenty of tips and advice on the site to get you started.

Another way of making money based from home is to become a Mystery Shopper.  This is where you are paid to go into a shop or restaurant, or store anonymously,  and complete a detailed questionnaire making an evaluation of the service your receive, whilst pretending to be an ordinary shopper.  You’ll need to have a good memory and eye for detail, be reliable and look smart and presentable.  You also need access to a computer. You can google ‘mystery shopping’ or try the following websites: www.Secret-Shoppers.co.uk   www.retaileyes.co.uk  or www.mysteryshoppers.co.uk

How to not gain weight on holiday

A parents helpline run by a youth mental health charity is expecting a large rise in calls this September, as kids head back to school.

Wirral Mind is looking into starting and supporting a Self-Help OCD Group on Wirral.

Would you be interested for yourself?

Do you work with people with OCD and would like to tell them about the possibility of another group starting?

If you feel that an OCD Self-Help/Support Group may be of interest to you, we would like you to get in touch with us.

Please contact:
Gill Kenwright, Support Development Coordinator

Wirral Mind: 0151 512 2200

Email: support@wirralmind.org.uk

In my opinion, having regular – holiday’s from your own head – and from being mentally pre-occupied and internally focussed upon anxious stuff – and actively choosing to steel-forth out into the outside and real world –  literally into the fresh air and wide open spaces is a great PRACTICAL antidote to winter gloom and other pervading and worrisome stuff – and we want NOW to start Advocating this coming autumn and winters APEx Walking Season!

As last year, the following stuff applies: 

You should have joined the AiW’s – APEx Club or be the guest of a Member  (please speak to Matt Williams for Club info and membership) – and please don’t forget that APEx’s philosophy is to celebrate good mental health and shared humanity – not labels and boundaries – we all of us have distressing times, we mostly all have needs to feel included and valued and we all can really look forwards to realising opportunities to share enjoyable and affirming experiences with like-minded folk in good company and in uplifting natural settings – so APEx is equally there for anyone who cares to join us irrespective of labels, roles or vocational responsibilities/leanings – APEx Activity Leaders facilitate activities  to extend our general duty of care as regards making the walks safe, and they themselves have a range different personal life- experiences  as regards mental distress..  This bringing together of folk free for labels and distinctions is key to APEx’s values and aims and helping bring down the walls of the “Them and Us.”  

(On request, we can help with the following equipment) All  walkers must have suitable and sufficient -              

                                                                                                Walking boots or walking shoes – trainers are not be acceptable unless they are “Approach” or trail shoes

                                                                                                Rucksack –

                                                                                                Waterproof jacket

                                                                                                Food and drink sufficient for a days outdoors activity

                                                                                                Any relevant medication

                                                                                                Emergency contact details – supplied to Matt Williams on the day!

We cannot find a minibus for this year (unless anyone knows of one we can definitely use?)  So, unless we hire one from a Van-hire company and that would make the trips almost prohibitive costs wise (van hire diesel etc) – so we have decided upon the following:

Using Public Transport to look at what is available and doable within an hour or so from Wirral and that is still beautiful, engaging and suitably interesting – and hopefully a bit of a  different environment from everyday life on Wirral..

The theme for  forthcoming season of walks will be “Marching Along the Marches” – using Public Transport – focussing upon  -  The Bidston to Wrexham Line –  to help organise a number of walks along the borderlands of North East Wales.

This will mean that we will have to arrange to meet slightly earlier to catch the train from Bidston, and that we will not get back till about 5 or 6 o’clock in the early evening – the costs of the day will include you paying your Train Fare (return) any bus fares plus a bit of extra money to cover any extra-curricular coffee or snacking opportunities encountered along the way..  So probably about 15-20 quid per walking day should cover costs.

 The walks have been planned to steadily and incrementally increase in terms of physical expenditure (but certainly none of the walks are intended to be overly demanding and are well within the scope of most)   – starting with:

1.        Sunday 5^th September – Errddig and the Clywedog Valley  – a beautiful 6 mile walk from Wrexham train station  through sublime Parklands round (National Trust) Erdigg Stately home and the little river running through it – this will surprise folk by the beauty of such rural and parkland landscapes so close to a biggish town centre

2.       First weekend October – Bersham to Minera Circuit Walk– a gentle, very gentle, up-hill walk from the gentle meadows of Bersham (one the 18^th Century – industrial epicentre of the “Iron –Mad” Wilkinson empire – an interesting Industrial entrepreneur who made iron goods from his Bersham Foundary – including water pipes and canons – developing new processes and techniques during the early industrial revolution and, it is rumoured, selling weapons/ordnance to both sides during England’s warring-spat  and resulting contretemps with France and  proving that commercial opportunism and profiteering without due moral regard existed long before the recent,  short-termist, profiteering of folk  in the banking and other commercial sectors – When you see the meadows, that 200+ years ago were at the very cutting edge of industrial innovation and industrial manufacturing – I think that you will find it very hard to imagine the unhealthy noisy, dirty “built-up” industrial scene (as nearly all the buildings and related stuff have been reclaimed by agriculture and nature – so much so that Industrial Archaelogy is having to be relied on to unearth and help retell Bershams Chapter in the Industrial Revolutions historic tale!) Once at the top of the gentle climb along a well trodden path and a couple of miles up from Bersham – you  will have extensive views from – Snowdonia to the west – the Irish Sea and Wirral to the North, Lancashire, Cheshire and Derbyshire Pennines to the East and Shropshire and the hazy distant beginnings of the English Midlands (Including the Long Mynd) to the south East – it should be a lovely walk!

3.       Minera to Watkin Tower Walk (and Back) – Depending on what weather the 2^nd weekend in November Brings (13^th   or  14^th?) – We will again get the train to Wrexham and a bus to Minera and Walk over the moors to the Watkin Tower – a steady 10 miler over moorland paths and along forest trails – this walk feels moody and very remote in the autumn with the full aspect and feel of a Welsh upland walk – but again always close to civilisation and public transport links!  Scenery  is varied – a stiff walk but well worth it!

4.       Christmas/Midwinter Walk 11^th December – The “Fastness” of Dinas Bran from Llangollen and the Dee valley – the shortest of our coming walks – but with a quite steep climb up-to the stark and brooding remains of the castle of Dinas Bran – If you haven’t been before, it really will take your breath away – the harshness of the ruined remains staked hard atop the dome of the hill, the windy and  quite strenuous walk-up to the castle and the breathtaking sublime views down from the top – This old Welsh castle stands guard over Llangollen – a  frowning sentinel looking down over the Vale of the River Dee as it has for hundreds of years since the bitter wars between the Welsh and English that menaced the Welsh-Marches (as the borderlands between England and Wales were called) for centuries. Here we are a mere 3 or 4 miles from the ancestral home of Owain Glyndwr – a key heroic figure in medieval Welsh history and in its longstanding brawl with its Anglo-Norman neighbours and their attempts to harry, conquer, dominate and then assimilate Wales and its distinct Celticness into Englishness – and you will see this long fought over landscape at its best from the hilltop castle..    No matter what the weather – this 3 mile walk is bracing, thought provoking and atmospheric – once back in Llangollen it is hoped that we can find somewhere to  “Feast- drink-and – be-merry”  in one of the (hopefully) suitably “decked-out”  and festive local hostelries before getting the bus back to Wrexham and the train back to Bidston.

5.       January – TBC – Southport to Crosby long Coastal Walk

6.       Feb – TBC – weather dependant – either start of Offa’s Dyke Path on North Wales Coast or a circuit walk from the start of the sandstone Trail – Frodsham/Helsby? Or A walk from Near Trevor – over the famously renowned Telford – Pontcysltte Aquaduct to Chirk Castle –  along the canal towpath and surrounding country paths..

7.       2nd weekend March 2011 – Esclusham and Worlds End walk – a strenuous 14 miler  – which by then will be accomplishable if you have done the other walks – Celebrating the return of longer days and the returning warmth of the sun – if we get decent spring weather – this walk will really cap- the walking season off – stunning Limestone cliff scenery (rivalling Malham – in North Yorks) spring and birdsong filled deciduous woodland, windswept heather moorland and after a long day, beckoning and walk-finishing views down into the vale of Dee Llangollen  and the Berwyn mountains beyond – this walk is a challenge but  doable by those who have livened up and turned gloomy winter into a really  positive time to build up fitness and spend sociable times with kindred-spirits enjoying short but energetic daylight hours in the great outdoors – we will be able to soothe tired feet in the cold waters of the River Dee before catching the bus back to Wrexham..

Autumn and winter, and the loss of daylight, can with the right resolve be transformed from feeling gloomy and oppressing –  by regular pockets of  really sociable outdoors exercise – into being fantastic and fun charged with great experiences and with stuff to look forward to and leaving batteries fully recharged with wellbeing and contentment enough to last until the next time..

 Last year we (the APEx Walking Club) were out in literally  all-weathers and shared some really great times and experiences together  - the walks that spring to mind straight away were the Rivington Pike – sublime Views walk – that showed just how small the nip of land that we call the North-West of England really is  -The Great Orme “Bouts of Blinding Sunshine and battering Blizzards (sweeping in off the Irish Sea) Walk,”  back in February and the Springtime at Aber Falls  - Sun Warmed Saunter around the Northern Coastal foothills of the Carnedds –  Right beside the spectacular waterfall – we sat sunning ourselves in shirtsleeves in balmy long forgotten warmth – at the bottom of the sizeable but steadily melting remains of big meter thick bank of old mountain snow (that had probably been there for months – given last winter’s cold) just a mere couple of days or so after the long hard winter had finally relented and softened its grip on the landscape  .. Great stuff!!

Advocacy in Wirral’s Positive Mental Health Group provides a safe place for people to share their anxieties or concerns.

Anyone who feels they’ll benefit from our supportive group is very welcome to come along.

http://www.aiw.org.uk/recovery-group.html

The Group runs on

Mondays from 5pm to 6.30pm

at 66, Woodside Business Park,
Shore Road, Birkenhead, CH41 1EL

It was set up—and is run—by people who’ve experienced themselves the pressures that day-to-day life can bring.

The group focuses on positive strategies for recovery from mental ill-health.

The Positive Mental Health Group is part of Advocacy in Wirral’s recovery project.  We believe that all people have difficulties and distresses. These have affected us and
continue to affect us today.

We aim to find  positive, useful solutions to these distresses. In this way we can move
towards achieving our full potential and a better quality of life for ourselves.

To find out more about the Positive Mental Health Group, ring

Paul Etherington on 0151 650 1530

or e-mail paul.etherington@aiw.org.uk This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Following a successful trial earlier this summer, Advocacy in Wirral’s Food4GoodMood Cafe has re-opened it’s doors to happy customers in Victoria Central Hospital, Wallasey.

The cafe offers a wide range of food and drink designed around the idea that what we eat can affect our mood.  There’s plenty of science to back this up, and as a mental health charity we’re pleased to be providing a new service that we’re sure will be popular with visitors to the community hospital.

Cafe manager Lisa Shaw is looking forward to developing the range of soups, sandwiches, cakes and pastries on offer.

Pictured here (from left to right) are cafe assistants Tracey Wallace and Helen Gore, together with Lisa.

The cafe will be part of AiW’s social enterprise, Building Bridges, and the hope is that it will create jobs at the same time as providing extra income to our charity.

Feedback after the earlier trial has been taken on board, and the cafe now offers a full range of speciality coffees, including cappucino, espresso and latte, which is sure to be a hit with visitors.

So, why not pop by and sample the fare?  The cafe can be found on the first floor at VCH in Mill Lane, Wallasey and is open Monday to Friday between 10am and 3pm.  Follow the smell of freshly-baked cakes and you won’t go far wrong!

The announcement came as a result of the Watergate scandal involving illegal snooping and other activities by members of the president’s staff, targeting political opponents.

Revelations in the press of a White House-orchestrated coverup, combined with the sworn testimony of Nixon staff members before a televised Senate investigative committee, had led to the collapse of political support for Nixon in Congress.

This is the remarkable impromptu speech Nixon made at his resignation amid the tremendous emotional strain of leaving the presidency in disgrace.

“And as I leave, let me say, that is an example I think all of us should remember. We think sometimes when things happen that don’t go the right way [...] We think that when someone dear to us dies, we think that when we lose an election, we think that when we suffer a defeat that all is ended. We think, as Theodore Rossevelt said, that the light had left his life forever. Not true.

It is only a beginning, always. The young must know it; the old must know it. It must always sustain us, because the greatness comes not when things go always good for you, but the greatness comes and you are really tested, when you take some knocks, some disappointments, when sadness comes, because only if you have been in the deepest valley can you ever know how magnificent it is to be on the highest mountain. “

Richard Nixon (1974)

Listening to this I was reminded of my own attitude towards all that has befallen me. To experience real happiness and feel like you are on the top of  the highest mountain you must have experienced the darkest times.

I recently had a short bout of crippling depression but suddenly one morning I woke up feeling good. I spent that day, and many after, counting my blessings and appreciating every little thing in this wonderful natural world we live in.

So when I’m in the darkest place there is still a little light shining to remind me that THIS WILL PASS (my personal mantra) and one day I will again feel on top of that mountain and experience real happiness again.

In the modern world everyone seems to be striving for constant happiness through consumerism and endlessly chasing money and status and power. Those brought up with vast wealth never really appreciate a ten pound note that can be spent on a treat for yourself. So those of us who really suffer can also really find happiness when there are periods of wellness. And really appreciate this in a way the privileged never can.

Just not being unhappy brings the greatest joy to me.

                                                                                               Phoenix August 2010

Stress in childhood has long-term effects say psychologists

Adversity and stress early in life leads to long-term ill health and early death, a group of psychologists warn.

A series of studies suggest that childhood stress caused by poverty or abuse can lead to heart disease, inflammation, and speed up cell ageing.

 The American Psychological Association meeting heard that early experiences “cast a long shadow” on health.

One UK expert said more and more evidence was suggesting a physical impact of stress in childhood.

In one study, researchers from the University of Pittsburgh looked at the relationship between living in poverty and early signs of heart disease in 200 healthy teenagers.

Interactions with others then become a source of stress, which can increase arousal, blood pressure, inflammation levels and deplete the body’s reserves”

They found that those from the worst-off families had stiffer arteries and higher blood pressure.

 A second piece of research by the same team showed children from poorer homes were more likely to interpret a series of mock social situations as threatening.

 They also had higher blood pressure and heart rates and higher hostility and anger scores during three laboratory stress tasks.

 It backs other research showing a link between a stressful childhood and future cardiovascular disease, said study leader Professor Karen Matthews.

 She said unpredictable and stressful environments lead children to be “hyper vigilant” to perceived threats.

 ”Interactions with others then become a source of stress, which can increase arousal, blood pressure, inflammation levels and deplete the body’s reserves.

 ”This sets up risk for cardiovascular disease.”

 Abuse

Another study presented at the conference showed that childhood events such as the death of a parent or abuse can make people more vulnerable to the effects of stress in later life and even shorten lifespan.

 Researchers at Ohio State University looked at a group of older adults – some of whom were carers for people with dementia. 

They measured several markers of inflammation in the blood which can be signs of stress, as well as the length of telomeres – protective caps on the ends of chromosomes which have been linked to age-related diseases. 

The 132 participants also answered a questionnaire on depression and past child abuse and neglect.

 A third study reported some sort of physical, emotional or sexual abuse during childhood.  Those who did face adversity as children had shorter telomeres and increased levels of inflammation even after controlling for age, care-giving status, gender, body mass index, exercise and sleep.

 Study leader Professor Janice Kiecolt-Glaser, said: “Our latest research shows that childhood adversity casts a long shadow on one’s health and can lead to inflammation and cell ageing much earlier than for those who haven’t experienced these events.

 ”Those reporting multiple adversities could shorten their lifespan by seven to 15 years,” she added.

 Dr Andrea Danese, a clinical lecturer at the Institute of Psychiatry in London, said such studies had to be interpreted carefully because there is a chance that people do not recall their childhoods accurately and you can only show an association not prove causality.

 ”But that doesn’t mean I don’t believe these results. “The evidence is quite consistent.  “It’s already been established that childhood stress has an effect on mental health and it now seems like it has an enduring effect on physical health.”

He said that stress causes an increase in inflammatory proteins which could underpin the physical consequences suggested by the research.

In this article taken from ‘Pendulum’ the journal of MDF the Bipolar Organisation (www.mdf.org.uk) Clare Dolman evaluates the pros and cons, and if you decide to go ahead, how to maximise the chances of staying healthy.

The usual worries of a mother-to-be – can we afford a baby?  Is our home big enough? How will it affect my career? – pale into insignificance compared to the difficult decisions that a bipolar woman faces.  Can I risk it?  Should I stop my medication before getting pregnant?  Should I try to breastfeed?  Should I prepare myself and my family for the possibility of having to go into hospital when the baby is born?

So many questions, and though most health professionals are careful not to pressurize women with bipolar into remaining childless, the risks are very real and potentially so serious that it would be irresponsible to ignore them.

As a bipolar mother of two, who had postpartum psychosis (PP) after my first birth but not my second (when I was much better prepared), I think the  most important thing you can do if you are thinking of having a baby is to inform yourself, take the risks seriously, and prepare yourself as thoroughly as possible – hopefully you’ll be fine and have a wonderful experience, but if not, you will have put things in place so that swift action can be taken to help you and your family cope.

So let’s start by facing the hard facts and move onto the positive, practical steps you can take to maximise your chances of staying well.

Women with bipolar disorder are at a very high risk of having a severe episode of illness in relation to pregnancy and childbirth – this is much more likely than for women without bipolar.

They are more likely to experience postnatal depression and/or an affective episode during pregnancy but, most alarmingly, they are at risk of having postpartum or puerperal psychosis: this occurs with 25-50% of deliveries to bipolar mothers (Craddockn & Jones I, 2001).

Puerperal psychosis (PP) usually manifests itself very quickly after giving birth, typically within a few days – and takes the form of:  increased agitation and irritability; extreme mood swings; decresed sleep and greater confusion; delusions, often about the baby; and/or hallucinations.

Many readers probably recognise the similiarity to an extreme ‘mixed affective’ episode of bipolar, but the severity of the symptoms can be unusually dangerous both for the mother and her baby.

In addition, the possibility of it happening it often missed, especially when the woman has been well for many years.  If, as a woman with bipolar disorder, you are at greater risk of a psychotic episode being triggered by childbirth, you need to be fully aware of the risks in your own case, and discuss them fully with a perinatal psychiatrist.

According to Dr Ian Jones, of the Mood Disorders Research team at Cardiff University, ‘women are 23 times more likely to be admittted to psychiatric hospital with bipolar disorder in the month following delivery than at any other time in their life – a bipolar tendency is specifically and strongly linked to the triggering of severe episodes by childbirth.’

Why should this be so?  ‘We do have some clues – we know that genetic factors are important, and it is likely that the big hormonal changes that occur in the first post-partum week are involved,’ says Dr Jones.  ‘Sleep disruption may play an important role in some women.  However for severe postpartum psychosis the evidence suggests that biological factors may play more of a role than may be the case for less severe episodes of mood disorder occuring at this time.’

When weighing up the risk factors, it is important to be aware if a relative has suffered PP, as this significantly increases the risk.  Also more problems are encountered with first pregnancies than subsequent ones, but this may be because (like me) greater precautions were taken after having a bad experience the first time round.

So you’ve discussed your personal level of risk with the most informed health professionals you can get access to (preferably a specialist perinatal psychiatrist), and your partner and family, and you’ve decided to go ahead.

Perhaps the most important decision to make before trying to get pregnant concerns your medication: whether to stop; whether there is something less teratogenic (harmful to the developing foetus) that you can take if you need to.

Sodium Valproate and carbamazepine, for example, are known to carry quite a high risk of causing abnormalities, and there are also risks with lithium, though these may have been over-estimated in the post, and it can be used – especially in the second and third trimester, if the risk of an episode is high.

There is good evidence that, if a mood stabilizer is to be discontinued, a very gradual reduction is best (Virguera et al 2007).  This can improve the prospects of staying well, even if you need to resume medication after the critical first trimester.

This is why it is so important to plan your pregnancy and consult your psychiatrist; if a bipolar woman doesn’t discover until the second or third month that she is pregnant and, in a panic. stops her medication abruptly, she may be doing more harm than good, as the most serious period of risk to the foetus has already passed and her attempt to protect her baby may unwittingly increase the risk of relapse.

Even if you stay well without medicinal help while pregnant, you need to consider all possible scenarios once the baby is born, and think about your options in advance.  For example, the best thing for many women is to resume their normal medication.

More studies are clearly needed, but the limited data that exists suggests taking lithium immediately after birth, for instance, can reduce the risk of a severe recurrence.

The decision to take medication is complicated if you are very keen to breastfeed, but again it requires a careful weighing up of the pros and cons.

So, apart from making the most informed decisions you can about medication, what else can the bipolar mother-to-be do to minimize the likelihood of the birth triggering an episode?

~ minimise stress – whether that means taking more time off work if you possibly can, or practising yoga or meditation to stay calm.

~ try to avoid major life changes like moving house, often on the agenda because of needing more room, but might be better to wait a year or so, the baby won’t mind!

~ make a pregnancy or birth plan preferably in consultation with your psychiatrist, which includes regular reviews of your mental state.

~ sleep is of paramount importance during and after birth.

~ organise help for when you have the baby.  If you can, plan to have someone do the night feeds for at least a fortnight when you get home: a maternity nurse or a relative.

~ consider the pros and cons of breastfeeding in your situation.  I was keen to do it, but in retrospect, it would have been wiser to bottle-feed and start on lithium immediately my daughter was born.

~ Don’t have too many visitors and try to get home to a more relaxing atmosphere as soon as you are able to.  Involve your partner so he/she can judge whether you are getting over-tired.

Some of this is common sense, but perhaps the most important advice is to be informed and plan ahead.  The 2007 NICE guidelines recognised the need to help women in this situation, avocating a ‘specialist multi-disciplinary perinatal service in this locality’.  But unfortunately so far such provision is patchy at best.

It goes without saying that you need to be as physically healthy as you can; don’t smoke, drink, etc., do moderate exercise; but don’t put pressure on yourself to be ‘the perfect mum’.  It’s not the end of the world if you don’t breastfeed, or you need some extra help.

To be the best mother to your child for the whole of their life, you need to take really good care of yourself around the birth.  If you are confident that you are well prepared, you are much more likely to be able to stay well, relax and enjoy your baby.

Useful Websites

The ‘Bipolar Disorder’ section on this website gives good advice about the pros and cons of different medications under ‘Reproductive Health Issues’ www.bipolar-foundation.org

Other sites for more general advice and support include:

The Association for Post-Natal illness                                             www.apni.org

Support for women with any perinatal illness                              www.mothersvoice.org.uk

Local support from other mums                                                         www.netmums.com/pnd/

Royal College of Psychiatry information                                        www.rcpsych.ac.uk

BBC – good on postnatal depression                                        www.bbc.co.uk/health/conds/postnatal

http://www.critpsynet.freeuk.com/LITERATUREREVIEWFinal.htm

 A review of a sample of recovery literature, implications for practice and systems change Piers Allott, Mental Health Recovery Educator and Senior Research Fellow Linda Loganathan, Mental Health Recovery Educator and Research Assistant Centre for Community Mental Health, University of Central England in Birmingham.

“But now I look back on it with a real sense of achievement. It was a 24-carat crack-up and I’m proud of the fact I got through it, rebuilt myself, did ok as a journalist again, and went on to do what I do now. I couldn’t have done what I’ve done in this job without believing what I believe very strongly, and being tough-minded, focussed, mentally and physically fit. I feel the breakdown and the recovery played a big part in all that.”

Alastair Campbell, the prime minister’s director of communications and strategy in Sunday Times Magazine, Sunday 6th January 2002.

 INTRODUCTION

The concept of recovery and development of recovery orientated services and practices are well advanced in other parts of the world and particularly in a significant number of states in the US and in New Zealand. The concept in the UK is only just beginning to be recognised and is demonstrated, in the last 12 months, through the significant number of conferences on the subject. Given this, the principal author approached the West Midlands Mental Health Development Team with a view to developing a British perspective on recovery. A small amount of funding support was provided to deliver three pieces of work; a) to train as a mental health recovery educator and deliver one mental health recovery training b) produce a literature review and c) complete a sample of interviews with people in the West Midlands about their recovery experiences. The principal author trained as a mental health recovery educator with Mary Ellen Copeland in the US in November 2000 and delivered the first two day Wellness Recovery Action Plan (WRAP) training in January 2001. This training was so successful that it led to calls for ways of disseminating the information particularly from service users and family members and led to the establishment of the Recovery Network within the West Midlands. The Recovery Network was launched at a two day ‘Focus on Recovery’ conference in May 2001 and at the end of 2001 had nearly 200 members. This paper is the literature review and a sample of interviews will be completed by April 2002. In addition the principal author brought together an ‘International Conference on Recovery Research, Evaluation and relationship to Outcomes’ that was addressed by international ‘experts by experience’ and by training in October 2001 that was focussed on Local Implementation Team Leads, members of the national Expert Group on Outcomes and members of the Development Team for the National Institute for Mental Health in England. It is hoped that this paper will add to the swiftly developing interest and knowledge base on recovery in the West Midlands and the United Kingdom.

BACKGROUND.

Recovery from severe and persistent mental illness is a concept which has arisen out of the developing consciousness of the rights of marginalized and socially excluded people beginning with the civil rights movement in the 1960’s and 1970’s. Recognition of the position of women and black people in western societies led to a growing consciousness and resulting anti-discriminatory legislations which attempt to redress the balance and ensure protection of the rights of these groups. Developing consciousness within groups of disabled people has had similar outcomes in the ‘Americans with Disabilities Act’ and the ‘Disability Discrimination Act’ in the UK. However, people with diagnosed mental illnesses remain marginalized in the UK as in many other countries. However, the slowly developing national and international service user movements are beginning to raise a new consciousness of the possibility of recovery from serious mental illness. In the UK the Government has recently approved the main planks of its new policies for mental health; Modernising Mental Health Services, The National Service Framework for Mental Health and the NHS Plan that together state a clear and comprehensive plan for mental health services that places people who use services and their family members at the centre of service planning, development and delivery. It demands service users and family members are involved as equal partners at every level, to ensure that new services are responsive to needs. This will provide the frameworks within which recovery orientated services can be conceived, planned and implemented. Historically, people with mental illness were not expected to recover. People given diagnoses of schizophrenia were seen by mental health professions as having a poor prognosis with the illness taking a uniformly downwardly spiralling course. Emil Kraeplin at the beginning of the 20th Century judged the outcome of ‘schizophrenia’ to be so poor that he named the ‘disorder’ “dementia praecox,” or premature dementia. Negative perceptions of severe and persistent mental illness have been maintained for many years and, it could be argued, have contributed to the development of stigma in western societies. This has influenced the public view of people diagnosed mentally ill as being ‘unable to take control over their own lives’. By implication this means that people diagnosed with ‘mental illnesses’ are ‘dangerous’ resulting in often negative public and public service responses. Such negative expectations and experiences have severely affected the lives of people who have mental health experiences and those who support them, their families and friends. Such negative expectations continue to exist in the UK today and many of the people treated by psychiatry are placed in a position of ‘learned helplessness’ (Deegan, 1992) by the mental health system within which such negative beliefs and attitudes provide little or no hope of recovery. Hope and the Possibility of Recovery It is as a result of the developing ‘consumer’ movement in the United States and other countries, such as Sweden, in the late 1970’s and early 1980’s that pioneers among people who experienced mental health problems, and their resultant ‘treatment’ within the mental health system, were able to record their experiences. People like Judy Chamberlin, with the publication of her book ‘On Our Own’ (Chamberlin, 1978), led the way in telling their stories. Writings about recovery by people who have experienced mental distress have grown significantly since the 1980’s (Deegan, 1988; Leete, 1989) and have mushroomed in the 1990’s so that there is now a very significant literature of writing by people with recovery experiences. In addition, professionals have become interested in this rich literature and begun more clearly to identify the meaning of ‘recovery’ and seek ways in which this new information can contribute to better and more effective ‘treatment’. However, much of the literature and research in this field has been carried out by professionals in countries other than the UK (Davidson, 1992; Tooth, 1997; Topor, 1998) and tends to be inaccessible, published in journals difficult to obtain or papers that are unpublished. Recovery is a concept that has been introduced by people who have recovered from mental health experiences rather than one that the majority of mental health professionals have conceived, believed and promoted. Some personal definitions of recovery include: “Recovery is a process, a way of life, an attitude, and a way of approaching the day’s challenges. It is not a perfectly linear process. At times our course is erratic and we falter, slide back, regroup and start again . . . .The need is to meet the challenge of the disability and to re-establish a new and valued sense of integrity and purpose within and beyond the limits of the disability; the aspiration is to live, work, and love in a community in which one makes a significant contribution.” (Deegan, 1988, p. 15). “Having some hope is crucial to recovery; none of us would strive if we believed it a futile effort . . .I believe that if we confront our illnesses with courage and struggle with our symptoms persistently, we can overcome our handicaps to live independently, learn skills, and contribute to society, the society that has traditionally abandoned us.” (Leete, 1989). The evidence of recovery from severe mental illness is not new as the following table of results from seven follow-up studies of people diagnosed with schizophrenia demonstrates (Table 1 below). Table 1 Results from seven follow-up studies of patients with the diagnosis schizophrenia. No. of Patients Length in years% Subjects Recovered and/or improved significantly Bleuler 1968, Zurich 208 23 53-68 Ciompi & Muller 1980 Switzerland 290 37 57 Tsuang et. al. 1979, Iowa, US 186 35 68 Huber et. al. 1980, Germany 502 22 56 Ogawa et. al. 1987, Japan 140 27 57 Harding et. al. 1987, Vermont, US 269 32 68 DeSisto et. al. 1995, Maine US 99 35 49 Source: META Services, Inc. Arizona, 2000 – After Harding – http://www.metaservices.com/Articles/recovery.pdf “These studies have consistently found that half to two thirds of patients significantly improved or recovered including some cohorts of very chronic cases. The universal criteria had been defined as no current medications, working, relating well to family and friends, integrated into community and behaving in such a way as to not be able to detect having ever been hospitalised for any kind of psychiatric problem.” (Harding, 1994) However, even given this evidence, the concept of recovery within the UK is still very limited. The majority of people served by the mental health system in the UK are given little hope of recovery from their experiences when the staff who work with and support them have little if any knowledge about recovery or about ways in which recovery can be supported. The concept of recovery within professional circles in the United States became more recognised following the publication of ‘Recovery from Mental Illness: The guiding vision for the 1990s’ in which William Anthony synthesised the writings of people with experience of recovery in his definition: …a person with mental illness can recover even though the illness is not “cured”… [Recovery] 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 one’s life as one grows beyond the catastrophic effects of mental illness (Anthony, 1993) Recovery has been described in many different ways as a process, an outlook, a vision, a guiding principle. Instead of focussing on symptomatology and relief from symptoms, a recovery approach aims to support an individual in their own personal development, building self-esteem, identity and finding a meaningful role in society. Recovery does not necessarily mean restoration of full functioning without support, including medication; it does mean developing appropriate supports and coping mechanisms to be able to deal with mental health experiences rather than being given supports by mental health services, traditionally known as rehabilitation. Recovery as a new Paradigm within the Context of Research – The New Paradigm and Prevailing Knowledge It is important to take a contextual view of recovery as a developing new paradigm. Thomas Kuhn, a historian of science, offers insights about how emergent knowledge begins to challenge prevailing knowledge within the scientific field. (Kuhn, T. S. 1970) If a person diagnosed with a serious mental disorder can recover without psychiatric intervention or using unorthodox methods, fundamental assumptions of the necessity of treatment and services from the mental health field are challenged. A scientific revolution is in the making. Paradigm shifts are a necessary part of life. Things do change and we need to adjust to change. Recovery research is mirroring the process of life and our understanding of self. It may appear to be fragmented and uncoordinated, but shares many commonalities with individuation. ‘There is no linear evolution; there is only a circumambulation of the self.’ (Jung, C.J. 1965) The current stage of research into recovery from serious mental illness Kuhn would describe as exploratory. Discoveries are random. Sometimes research is just ‘puzzling’. As people begin to integrate new information, research begins to establish itself as ‘normal’ and is part of a ‘coordinated and coherent view and is aimed at fine-tuning the ingredients of effective and accepted practice.’ (Knight 2000:8) This may take many years and is often an arduous process. Kuhn argues that there is no way to measure ‘progress’ in research. Real progress, the paradigm shifts are totally revolutionary. It usually takes a long time to effect a paradigm shift, often about 20 years. Different phenomena are seen as important to explain, making it impossible to objectively determine which one is better. Chronicity and Serious Mental Disorder Topor (2000) examines the questioned paradox. If a chronic illness is expected to have a long life span, usually extending to the whole of a persons lifetime, recovery presents a challenge to the idea of chronicity in relation to schizophrenia and other serious mental disorders. ‘The image of the schizophrenic as someone qualitatively different from other people, occurs in diverse psychiatric traditions and underscores the notion that the total breakdown of the ego is the foremost reason for chronicity.’ (Topor 2000) In addition the term ‘chronically ill’ is attached to people whose illnesses have been long-term ill and long-stay patients in psychiatric hospitals. Being admitted to a hospital for psychiatric treatment was for a long time a simple criterion of chronicity. Problems occur where in recent years it has become possible to offer treatment, care and support through crisis resolution and home treatment teams in peoples natural communities that is as effective or better than hospitalisation. Definitions of chronicity remain attached to people with diagnoses of serious mental illness despite contrary evidence. With deinstitutionalisation and the closure of psychiatric hospitals, functional disability replaced chronic illness as a new criterion. ‘The cause of chronicity, which has long been sought within the individual (biological or psychological characteristics) is not inherent in the illness itself, a part of the natural order, but rather is clearly connected with the person’s life in society.’ (Topor 2000) Stigmatisation ensures that people whom psychiatry defines as chronic assume psychiatry’s definition of themselves thus creating a self fulfilling prophecy (Becker, H.S, 1963). The label of chronicity produces behaviour expected of chronically mentally ill people. Extreme environmental stressors may produce symptoms similar to those associated with mental illness. (Bettelheim, 1943) The chronic course of development in the condition is not inherent in the illness, but as a result of the lifestyle of the patient. Thus the biography becomes the biology.

RECOVERY – PROCESS OR GOAL?

Definitions of recovery within the literature and the consumer movement in the USA have broadened our understanding of the concept of recovery. At its simplest recovery can be defined as ‘a subjective experience of having regained control over one’s life.’ (Knight 2000) The achievements of those who have recovered embrace hope, empowerment and social connectedness Schizophrenia is generally thought of as a chronic illness and it would therefore constitute a contradiction in terms to find a higher percentage of diagnosed people who have recovered. However, it has been clearly demonstrated that nearly 50-70% of people with a diagnosis of schizophrenia do recover but rather than simply a condition or state, recovery is more, it is: ‘a process of a new self image, an ego that is not completely subjected to the illness, an ego that means that the patient is not entirely helpless in relation to the illness.’ (Strauss et al, 1987) This ego is not restored to a state prior to the illness. In the active role of recovery the goal is not normalisation but: ‘a way of living a satisfying hopeful and contributing life, even within the limitations caused by the illness.’ (Anthony 1993) With an emphasis on the subjectivity and psychological aspects of recovery, there is a danger that ‘the recovery process becomes as long-lived as chronicity.’ (Topor 2000:43) In aiming to provide a singular consumer definition of recovery from schizophrenia, which proved impossible, many people maintained that they considered themselves to be just ‘getting on with their lives’. (Tooth et al, 1997)

RECOVERY THEMES

A service user-run business in Ohio was asked by a county mental health board to develop and implement an evaluation strategy to identify strengths and weaknesses in the county mental health system. These service users agreed that recovery was important, and generated a list of indicators, as well as ways professionals could be evaluated based on their impact on the recovery process – both positive and negative. These indicators, used in a pilot study in Ohio and in Maine with service users/survivors who had been admitted to the state institution at least once in the last seven years, were rated from most important to least important similarly by both groups. (Ralph, Lambric, & Steele, 1996; Ralph & Lambert, 1996) Ohio consumers rated the indicators in this order. The top four were the same top four rated by Maine consumers: The ability to have hope Trusting my own thoughts Enjoying the environment Feeling alert and alive Increased self esteem Knowing I have a tomorrow Working with and relating to others Increased spirituality Having a job Having the ability to work Ridgeway (2001) analysed four early consumer recovery narratives (Lovejoy, 1984; Deegan, 1988; Leete, 1989; Unzicker, 1989) with a constant comparative method to find common themes. These themes are as follows: Recovery is the reawakening of hope after despair Recovery is breaking through denial and achieving understanding and acceptance Recovery is moving from withdrawal to engagement and active participation in life Recovery is active coping rather than passive adjustment Recovery means no longer viewing oneself primarily as a mental patient and reclaiming a positive sense of self Recovery is a journey from alienation to purpose Recovery is a complex journey Recovery is not accomplished alone – it involves support and partnership In a review of recovery literature, Ralph (2000) identified four dimensions of recovery found in personal accounts. These are: internal factors – those factors which are within the consumer, him/herself such as the awakening, insight, and determination it takes to recover; self-managed care, an extension of the internal factors where consumers describe how they manage their own mental health and how they cope with the difficulties and barriers they face; external factors which include interconnectedness with others, the supports provided by family, friends, and professionals, and having people who believe that they can cope with and recover from their mental illness; and empowerment – a combination of internal and external factors – where the internal strength is combined with interconnectedness to provide the self-help, advocacy, and caring about what happens to ourselves and to others.

RECOVERY FROM SERIOUS PSYCHIATRIC ILLNESS, INCLUDING SCHIZOPHRENIA.

 Tooth et al (1997), using Personal Construct Theory, examined recovery from schizophrenia from a consumer perspective. Longitudinal studies reviewed by Harding et al found a recovery or significant improvement rate of between 46 –68% of patients with schizophrenia (Harding et al 1987). Harding et al. have identified ways of separating out the residual effects of the disorder from the effects due to institutionalisation and other associated factors. McGory (1992) and Anthony (1993) also identify stigma, restricted choices, low self-expectation as factors contributing to chronicity in people with serious mental illness. The Tooth et al (1997) study was designed to answer the following questions:- What factors do consumers who identify themselves as recovered from schizophrenia consider the most important in their recovery? What factors are reported most frequently? What factors identified by the consumer group are similar to those identified in the outcome literature? What factors identified by the consumer group are different to those identified in the outcome literature? What do consumers define as recovery from schizophrenia? Sixty participants were screened for a previous diagnosis of schizophrenia and were recruited through advertisements in local newspapers, through hospitals and consumer groups. Participants had to be self identified as recovered from schizophrenia. Fifty-seven men and women between the ages of 20 and 65 participated in the research. Using individual interviews and focus groups, participants were asked to identify what they considered the most important factors in their journey of recovery and what was helpful. The results were then systematically analysed. Eight categories were identified as follows: The process of coming to terms with the disorder Activities that were helpful Environmental factors Medication Aspects of themselves that were helpful Their network Hospitalisation Factors which did not facilitate recovery The role of self was the most frequently reported theme, with the person’s determination to get better and manage their illness. Accepting the illness, identifying the crisis response and working with their ability to recover from the illness emerged as significant themes. Participants identified the importance of their social network and having friends who affirmed them and their experiences regardless of the illness. Taking action, facing problems and making choices are consistent with the notion of ‘internalised personal agency’ (Tomm in Tooth et al 1997:53) Over time in the struggle to recover, participants had externalised the problem of schizophrenia and moved beyond the limitations of the illness. From responses in focus groups, 53% of participants named optimism and hope for recovery as significant. An equal number reported stigma as a negative aspect. Forty-nine percent identified the importance of spirituality in their recovery and a majority of participants identified a turning point in their journey of recovery. Topor et al (1997) have made an in-depth study of ‘turning points’ on the journey of recovery from serious psychiatric illness. In selecting participants, only people are included who had an absence of admission into institutional care for a period of at least two years prior to the interview. Although at the time of the interview some participants were in touch with psychiatry, individuals were living a ‘normal life’ in society. Five persons were interviewed using a semi-structured interview guide, two women and three men between the ages of 32 and 51 years. Three had received a diagnosis of schizophrenia and two were diagnosed for personality disorders and affective psychosis. Two of the informants can be considered as recovered and three as socially recovered. Warner (1994) distinguishes between ‘social recovery’ and complete recovery. Social recovery implies that the former patient functions socially, but may still display some clinical signs of disorder such as hearing voices or having certain paranoid delusions. Recovery is regarded as a process (Deegan, 1988) and the former patient may still pay regular visits to psychiatric outpatient care for medication and/or therapy. Complete recovery implies that the former patient no longer displays any psychotic symptoms and has returned to the pre-illness level of functioning. (Warner, 1994) The analysis of the transcripts used grounded theory methodology. One theme in particular – ‘turning points’ emerged as dominant in the five narratives. The results which emerge from this study go in some way to address the issue of recovery and chronicity. A ‘turning point’ and ‘the upward journey is not a straightforward linear process’ (Topor 1997:15) The breakdown and hitting bottom involves a descent to a place which ‘is characterized by feelings of impotence and the loss of a sense of identity’ (Topor 1997:8) The façade that had covered over the emptiness has collapsed. The qualities/characteristics of being in that place at rock bottom involve hopelessness and a gulf between the role and the individual, which can no longer be bridged. ‘I saw everything as completely hopeless I didn’t have much faith that I could ever come out of it as a whole person … but I didn’t have any choice either …Stopping therapy and going back to the way it was before wasn’t a real option for me … so I felt like, all I could do was follow through … to the bitter end. (M) (Cited in Topor et al, 1997:10) At the ‘turning point’, a number of factors stand out as playing a crucial role. These may take the form of a fortuitous external event or a personal decision. Often the common agent of change is a ‘significant other’ or ‘good persons’. These may be friends, relatives, treatment staff, a particular medicine, a pet or God. These catalysing events come together in the form of an unexpected change in circumstances that force the individual to make a decision. ‘I think it was finally getting the right medication that enabled me to find my way out of this. It helped me to start doing things for myself. Because I didn’t feel suffocated by the medication, it didn’t rob me of my energy …. I didn’t have to be injected, I could take it myself. I was the master over my own medication.’ (Cited in Topor 1997:12) The most significant element of a ‘turning point’, which need not be dramatic, is a change in how individuals perceive themselves in relation to their symptoms and condition and their own lives. The goal of regaining one’s sense of self is often a slow process and can take a long time. In maintaining the journey of recovery, people emphasise the role their own will, their own efforts, play. Other people are ‘conveyors of hope and acceptance’. When they are professionals, they do something more or something different than their professional role requires of them. They break the rules to form a reciprocal relationship. Coincidences play an important role in recovery. It is a journey that cannot be planned, is highly individual and connected to the individual’s particular life history.

RECOVERY SKILLS AND SELF CARE STRATEGIES.

 Research carried out amongst those who live with psychosis without psychiatry reveals that in general self-help begins long before help from others and to a large extent remains effectively independent of it. (Bock 1999) It is not about coping mechanisms in the sense of generalised techniques, but about strategies developed within the context of the individual’s complex biography/narrative. ‘… from looking carefully at the biographies it is quite clear, that self-help is an immensely complex and very individual process and that the individual protective mechanisms change character in the course of time.’ (Bock 1999:286) [‘Eine genauere biographische Betrachtung macht hingegen deutlich, dass Selbsthilfe ein ungeheuer komplexerund sehr individueller Prozess ist und dass die einzelnen Schutzmechanismen im Lauf der Zeit mehrfach ihren Charakter veraendern.’] Bock conducted in-depth interviews with 34 people who had persistent and recurring psychotic experiences. The group subdivides into those who previously had no experience of psychiatry and those who had experience of psychiatry or only occasional contact. Using a grounded theory approach, the work seeks to give the psychotic experience an anthropological perspective. Grasping emerging points is like ‘a collage’. ‘Psychotic experience is recognised as a form of journey of contradiction and social compromise, an ambivalent condition, at the same time incompatibility, finally an illness which contains the seed of health in it. (Bock 1999: 15-16) [Erkennbar wird die Psychoseerfahrung als eine sehrspezifisch menschliche Form der Gratwanderung, deszweifelnden Widerspruchs und des sozialen Kompromisses, als ein Zustand der Ambivalenz und der Gleichzeitig von Unvereinbarem, schliesslich als eine Krankheit, die den Keim der Gesundung in sich birgt. This experience is not an illness, but may be an existential crisis providing the opportunity or even the function of encompassing a new inner balance. In the process, changes or alterations will be experienced as unburdening or even a loss, but are at the same time sometimes also an expression of erecting a new identity. Many of the skills required to manage their own lives and their emotional distress can be acquired once people begin to believe in their own capacity to recover, to develop self belief. Self-managed care may include a range of strategies, including holistic remedies, spirituality, physical exercise, creativity and medication. Medication may be a voluntary tool among many used in a personally informed way to assist recovery. The principles of individual choice and self-determination are central to an understanding of what helps people recover. ‘I’m on lithium and I should be coming off it next month. I’m trying to go it alone … My doctor’s agreed to let me try it. I lived without it for 35 years. Why should I accept the fact that I have to take lithium for the rest of my life? (Campbell & Schraiber 1989) Bock speaks of ‘pragmatic defence mechanisms’ that help people cope. These may include smoking, play, work or the absence of work, a reduction in stimulation, meditation and creativity. Journaling or keeping a diary may be helpful in making life connections and honouring feelings (Reeves 2000). Creativity helps with expressing feeling, relaxing and being absorbed. Music, pets, gardening and walking in nature also assist recovery (Strategies for Living 2000). Spirituality often plays a role in recovery by providing a meaning or purpose to life, a reason for living, peace and comfort. Recovery itself is a ‘spiritual journey – a matter of the heart’ (Deegan 1996) In addition to lifestyle changes, there are many internal changes in awareness of the self that assist recovery. Self-acceptance, accepting one’s own humanity and the attainment of peace, play an important role. (Bock 1999) ‘I have to be kinder to myself and not expect miracles. I know its about a process of development which requires time, that every development has its downside and that I have to learn to live with it.’ [Ich muss gnaediger mit mir selbst umgehen und darf keine Wunder erwarten. Ich weiss ja, dass es sich um einen Entwicklungsprozess handelt, der Zeit braucht, dass jede Entwicklung auch ihre Rueckschlaege.] CAN WE MEASURE RECOVERY? Since the experience of recovery from mental disorder is such a uniquely personal and diverse experience we need to approach its measurement with great caution. Who has the right to define recovery as applied to one individual person? What one person may consider to be recovery may not be acceptable to another. The central issue is recognising the importance of the subjective experience of the person rather than applying external professional or societal expectations of recovery to any individual except when behaviour becomes damaging to the individual or society. Recovery is closely related to the concept of empowerment that grew out of the consumer movements particularly in the USA and Europe . Research studies are few, although some of the research on self-help touches on empowerment. It is a combination of self-determination to gain control over one’s life, the creation of an environment in which this can happen and the building of services and policies which support empowerment. The Well-Being Project (Campbell & Schraiber 1989), a landmark effort conducted by mental health consumers, is a multi-faceted study to define and explore factors promoting or deterring the well-being of persons diagnosed with mental illness in California. Using quantitative survey research, focus groups and oral histories, the research found that nearly 60% of the clients surveyed indicated that they could always, or most of the time, recognise signs or symptoms that they are having psychological problems. The most favoured coping and help-seeking strategies were: to write down thought or talk the problem out (50%) eat (52%) call or see friends (52%) relax, meditate, take walks or a hot bath (54%) call or go to see a mental health professional (62%) Attempts to measure recovery are fairly recent and not yet well developed in terms of the exploration of themes and concepts of recovery. Some research and recovery models focus more on outcomes, others on recovery as a process. There is an inherent dilemma/contradiction in attempting to quantify and categorise coping mechanisms whilst at the same time recognising that: ‘What in one period of life may be helpful or is at least necessary, can become a hindrance/obstacle’ (Bock 1999) [Was in einer bestimmten Lebensphase hilfreich oder zumindest notwendig war, kann in einer anderen Lebensphase zum Hindernis werden] However, now that ‘Recovery Practices’ are becoming policy in developing service systems in a significant number of states in the US and nationally in New Zealand (http://www.mhc.govt.nz/ ), the need to measure the effectiveness of these systems and practices requires some means of measuring recovery. Therefore, attempts are being made to develop instrumentation to achieve this and in Ohio in the US, they have built recovery outcomes into their systems wide outcomes measurement system. A Compendium of nineteen Recovery and Recovery-Related Instruments has been brought together under the title ‘Can We Measure Recovery? by Ralph et. al (2000). The following instruments are three that have been developed and further instruments are currently in development. Recovery Attitudes Questionnaire developed by a team of mental health consumers, professionals and researchers in Ohio, USA, identified that: ‘recovery is possible and needs faith and recovery is difficult and differs among people’ (Ralph et al 2000:8) Personal Vision of Recovery Questionnaire (PVRQ)(Ensfield, Steffen, Borkin, & Schafer, 1998) was designed to measure consumers’ belief about their own recovery. This was developed by a team of consumer and professional researchers. Analysis revealed the five main factors of recovery to be: support personal challenges professional assistance action and help-seeking affirmation Making Decisions Empowerment Scale (Ralph et al 2000) developed by a group of consumers with consultant researchers revealed five factors relating to empowerment and recovery: self efficacy/self-esteem power – powerlessness community activism righteous anger optimism, control over the future Other measurement instruments concluded that quality of life and independent social functioning are most likely to be related to personal empowerment while organisational empowerment is more related to involvement in work, both paid and volunteer. The Recovery Advisory Group (http://www.mhsip.org/recovery/ ) Model of Recovery focuses both on external influences of recovery and the internal, individual recovery process. It is a reflection of consumer survivor published and unpublished literature and the personal experiences of members of the Advisory Group. It recognises that the achievement of well-being or wholeness is not linear but is a process of stages that go toward well-being. These stages are: Anguish, Awakening, Insight, Action Plan, Determined Commitment to become well Well-being/Empowerment All stages may not be experienced by everyone, nor does a person complete one stage before going to another. Recovery is viewed as both internal and external. Internal aspects of recovery include: cognitive, emotional, spiritual and physical. The external dimensions consist of a person’s action and reaction to external influences or interactions with people and situations as they move across, round and through stages of recovery. The internal journey continues within the context of the external world and its influences. Recovery is unique to each individual and therefore it is essential to remember this when attempting to measure people’s experiences. The centrality of experience is so important that involving people with similar experiences is essential to informed data collection and instrument development.

IMPLICATIONS FOR PRACTICE AND POLICY.

Research has shown that for the majority of people, relationships with professionals and mental health service delivery is key to recovery. Where this is positive, it allows the development of people’s dreams and goals for recovery. ‘It came through that she wasn’t just in it for the money or you know she wasn’t up herself, I’m the psychiatrist, you’re the patient sort of thing. She treated me like an equal person and just, I always saw her true person coming through sort of thing. (Tooth et al. 1997) Deegan (1996) and Glover (1999) both emphasise the importance of hope. This requires mental health professionals to appreciate: ‘the deep existential struggle that the person in despair is living through.’ (Deegan 1996) Barker, a professor of psychiatric nursing, with experience as a psychiatric nurse and academic, has developed a conceptual model for the development of acute services entitled ‘The Tidal Model. (Cowan 1999:18) The person is the story and their environment is likened to the ocean. It may be calm or stormy. There may be rocks or lighthouses. The purpose of professional intervention is to help the person concerned to understand their own story and to assist the person to change the direction the story is taking. Saleeby (1992), a social worker, developed an Ecology Model, drawn from the biological sciences, emphasising the need for a healthy environment for organisms to develop well. This was further developed at Kansas University and is variously known as the Kansas or Strengths Model (Rapp 1998). It demands from mental health workers a conceptual leap to stop assessing for and identifying problems, deficits, sickness or being unwell. ‘It demands that the created environments for people with severe and persistent mental illness are overtly enabling rather than entrapping.’ (Cowan 1999) Changing mental health services will require that they be founded on ‘recovery based competences’ (New Zealand Mental Health Commission 2000 – They would not be an add-on to current training, but would require a fundamental change in training. In New Zealand a list of competencies has been developed by service users drawing on a range of information sources. They focus among others on understanding recovery principles and experiences, equality and social inclusion, recognising self-determination, acknowledging and supporting the service user movement and family support. In addition to the training of professionals, gaps in service provision have been identified in the UK. These include more easily accessible services in a crisis, particularly out of office hours and emergency care overnight, more talking and complementary therapies and a greater awareness of the diverse needs of people from minority ethnic communities (Mental Health Foundation, 2000). Weaver (1998) states: “As a provider here’s what you might need to think in order to assist a consumer with recovery: I will stop trying to control the consumer’s life My professional success is based on the consumer’s recovery progress I listen to, believe, and value what the consumer says I will not treat a consumer any different than anyone else I have in-depth knowledge about and sympathy for the consumer’s disability I will not allow a consumer to become overly dependent upon me I can give a consumer hope or helplessness – it is my choice I see potential in the consumer I serve as a “coach” not as an authoritative mental health professional I will not become discouraged when a consumer fails or rejected when a consumer succeeds I will take care of my whole being – dealing truthfully and realistically with the spiritual mental, emotional, and physical aspects of my life.” The consumer group in Ohio mentioned earlier developed a set of statements to rate the impact of mental health professionals on their recovery. In a pilot study, clients in the mental health system rated these from most to least impact like this. Encourage my independent thinking Treat me in a way that helps my recovery process Treat me as an equal in planning my services Give me freedom to make my own mistakes Treat me like they believe I can shape my own future Listen to me and believe what I say Look at and recognize my abilities Work with me to find the resources or services I need Are available to talk to me when I need to talk to someone Teach me about the medications I am taking. Key issues identified in consumer personal accounts are validations of these, for example, encouragement, belief in abilities, empowerment (e.g. treating as equal in planning for and delivery of services), listening and believing, and free choice. Implementing Recovery Oriented Practice There are a number of developing approaches to implementing recovery oriented practice with the largest scale implementation being the Ohio Consumer Outcomes Initiative (http://www.mh.state.oh.us/initiatives/outcomes/outcomes.html) in which they have built recovery into their information technology based outcomes system that functions from individual case management and enables the aggregation of information at a state level. Perhaps the fastest growing individual approach to mental health recovery is the self-management framework developed by Mary Ellen Copeland in Vermont, USA (www.mentalhealthrecovery.com). The Wellness Recovery Action Plan (WRAP) is a simple yet powerful self-help system based on increasing awareness, improving self-care and strengthening supports. The following is a brief outline of the framework: Five foundations of recovery Hope, Personal Responsibility, Education, Self-Advocacy, and, Developing & Maintaining a Support System. Wellness Tools Activities, routines, thoughts & behaviours that maximise wellness and minimise symptoms include: reaching out for support, peer counselling, maintaining an ongoing dialogue with health and social care professionals, planning the day, stress reduction and relaxation techniques, focusing exercises, diversionary activities & fun, journaling, exercise, sleep, being outside, increasing or decreasing stimulation, and the act of stopping to analyse the situation to make a thoughtful decision on how to proceed. Writing a Plan Writing a plan must be entirely under the control of the individual who plans to use it, when they are well or feeling alright and with help from their supporters if they wish. Mental health staff, family members and friends can provide support, feedback and encouragement. The process can be lengthy and must be done at the individual’s own pace. Sections of the Plan Daily Maintenance — What I do each day, when I am feeling well. Triggers – What are my triggers & what is my response to each one. Early Warning Signs – What are early warning signs for me, and what is my action plan for each one. When Things are Breaking Down – How do I know? Breaking down list and responses / action plan. Crisis Plan – How to know when I am well, crisis symptoms, supporters phone list, medications, treatments, treatment facilities & respite care, supporters’ roles, what to do if I am a danger to myself or others, and how to know when my supporters no longer need to use this plan. Self-management of mental health issues and wellness are an essential component of recovery-oriented services. “Patients can only be fully involved in their treatment if they have the requisite knowledge and skills. And if the health professionals who treat them recognise those skills and knowledge, working in partnership to devise and implement individual pathways of care.” Department of Health (September 2001) Self-management began in the 1970’s for people with chronic physical conditions in the US but not until the late 1980’s and early 1990’s with regard to people who experience mental health problems. Development and evaluation of self-management is in its early stages in the UK where it has arisen out of the July 1999 White Paper, Saving Lives: Our Healthier Nation and the NHS Plan in July 2000 that set out the Governments vision for a new, more patient-centred NHS and confirmed a commitment to help people with long-term conditions maintain their health and improve their quality of life through an Expert Patients Programme. There are a number of self-management information resources and tools now available in the UK that include: Wellness Recovery Action Planning, the Manic Depression Fellowship Self-Management Training Programme and self-management books and resources for people who hear voices and self harm (Working with Voices and Working with Self-harm, Handsell Publishing). There are also a number of developing service-user run crisis and recovery support services that operate in ‘recovery’ oriented ways that recognise the importance of self-management (e.g. CHANGE). The authors believe from their knowledge of the research outlined in this paper and elsewhere, on recovery from ‘mental disorder’, that if our services recognise the importance of self-management as an adjunct to other mental health treatment approaches, and provide hope for recovery to its service users, then the effectiveness of services will be significantly increased. “The challenge for the NHS, working in partnership with patient organisations and other governmental departments… is to bring about a fundamental shift in the way in which chronic diseases and long–term conditions are managed – a shift which will empower and liberate patients to play a central role in decisions about their illness.” The Expert Patient – A new approach to Chronic Disease Management. Department of Health, September 2001 Conclusion It is clear that the recovery movement being led by people with experiences of mental disorder and their family members can make a very positive contribution to the effectiveness of the services being delivered. It therefore highlights the need for the investment of resources to carry out research into what helps people’s recovery from mental disorder, including self-management, in order to begin delivering the most effective recovery oriented services as part of the development of services within the current policies being implemented nationally in England. However, the innate tension that exists within the concept of recovery from mental disorder is not easily resolved. It is both a process and an outcome, it may be measurable and it is immeasurable. The research reviewed demonstrates the paradox. It will take time and patience, amidst the confusion, to persevere with research into recovery and learn from the personal knowledge gained through the uniqueness of peoples own struggles with their experiences and discoveries of effective coping mechanisms and strategies for wellness. We should take comfort in knowing that emergent paradigms are always like this. For our service systems we must recognise that: “Recovery requires the right atmosphere or organizational climate in your mental health organization – one that is sensitive to consumers, and values independence of the individual. It allows consumers to risk, to fail. It holds that every consumer has a right to the same pleasures, passions, and pursuits of happiness that we have. It looks at potential, not deficits.” Weaver (1998)

REFERENCES.

 Anthony, W.A. (1993) Recovery from mental illness: The guiding vision of the mental Health service system in the 1990’s. Psychosocial Rehabilation Journal Becker, H.S. (1963) ‘Outsiders’ The New York Free Press Bock, T. (1999) Lichtjahre, Psychosen ohne Psychiatrie, Psychiatrie-Verlag, Bonn, Bettelheim, B. (1943) Individual and mass behavior in extreme situations, in Bettelheim, B. 1980 Surviving and other essays, New York: Vintage Books. Chamberlin, J. (1978). On our own: Patient-controlled alternatives to the mental health system. New York: McGraw-Hill. Campbell J & Schraiber R. (1989) The Well-Being Project, Mental Health Clients Speak for Themselves, California Department of Mental Health. Available from: (http://www.pie.org/mimhweb/pie/database/GetArticle.asp?value=1601 ) Cowan, C (August, 1999) Women and Health, a Critical Literature Review of Recovery in Mental Health and Gender, unpublished Davidson, L. & Strauss, J.S. (1992). Sense of self in recovery from severe mental illness. British Journal of Medical Psychology, 65, pp 131-145. Deegan P.E. (1996) Recovery as a Journey of the Heart, Psychosocial Rehabilitation Journal 19 (3) Deegan, P.E. (1992) The independent living movement and people with psychiatric disabilities: Taking back control over our own lives. Psychosocial Rehabilitation Journal, 15 (3), 3-19. Deegan, P.E. (1988) Recovery: The lived experience of rehabilitation, Psychosocial Rehabilitation Journal 11 (4) Department of Health (1999) Saving Lives: Our Healthier Nation. Department of Health (2000) NHS Plan Department of Health September 2001 The Expert Patient – A new approach to Chronic Disease Management. Ensfield, Steffen, Borkin, & Schafer (1998) Personal Vision of Recovery Questionaire. Cincinnati, OH: University of Ohio Glover H. (1999) Challenging Mental Impotence, A Perspective from Queensland, Australia, edited Allott P, Centre for Community Mental Health, UCE Harding, C.M. et al (1987) The Vermont longitudinal study of persons with severe mental illness, 1 Methodological study sample and overall status 32 years later. American Journal of Psychiatry Harding, C.M., & Zahniser J.H. (1994) Empirical correction of sevenm myths about schizophrenia with implications for treatment. Acta Psychiatr Scand 90 (suppl 384) 140-146 Jung, C.T. (1965) Memories, dreams, reflections (p 196) New York. Vintage Press. Knight, J. M.A.T., M.S., (March 1, 2000) Recovery Education for Adults with Severe Mental Disorders: Current Models, efficacy Studies and Suggestions for Improvement Kuhn, T. S. (1970) The structure of scientific revolutions (2nd ed.) Chicago: Univ. of Chicago Press Leete, E. (1989). How I perceive and manage my illness. Schizophrenia Bulletin, 8, 605-609. Lovejoy, M. (1984). Recovery from schizophrenia: a personal odyssey. Hospital and Community Psychiatry, 35, 809-812. McGorry, P.D. (1992) The Concept of Recovery and secondary prevention in psychotic Disorders. Australia and New Zealand Journal of Psychiatry New Zealand Mental Health Commission (November 2000) Realising Recovery, Through the Education of Mental Health Workers, Recovery Based Competencies and Resources (http://www.mhc.govt.nz/Publications/Publications/Recovery_Competencies.pdf ) Ralph, R. O. (2000) Recovery. Psychiatric Rehabilitation Skills, Vol.4, No.3, winter Ralph, R. O. Kidder, K. and Phillips, D. (2000) Can We Measure Recovery? A Compendium of Recovery and Recovery-Related Instruments. The Evaluation Center@HSRI www.hsri.org/eval/eval.html Ralph, R.O., Lambric, T.M., & Steele, R.B. (1996) Recovery Issues in a consumer developed evaluation of the mental health system. Presentation at 6th Annual Mental Health Services Research and Evaluation Conference, Arlington, VA, February, pp.1-13 Ralph, R. O. & Lambert, D. (1996) Needs assessment survey of a sample of AMHI consent decree class members. Portland, ME, Edmund S. Muskie School of Public Service, University of Southern Maine. Rapp, C. (1998) The strengths model: Case management with people suffering form severe and persistent mental illness. NY: Oxford University Press. Ridgway, P. A. (2001). Re-storying psychiatric disability: Learning from first person narrative accounts of recovery. Psychiatric Rehabilitation Journal Vol. 24, No 4, pp 335-343. Reeves A., (2000) Recovery, an Holistic Approach, Handsell Publishing Saleeby D (Ed.) (1997) The ecology perspective in social work practice (2nd ed.) New York: Addison-Wesley Longman Strauss, J.S., Harding, C.M., Hafez, H., Lieberman P. (1987) The role of the patient in recovery from psychosis, in Strauss, J.S., Boker, W. & Brenner, H. (eds) Psychosocial treatment of schizophrenia, pp 160-166, New York: Hans Huber. The Mental Health Foundation (2000) Strategies for Living with Mental Illness Tooth, B. et al (1997) Recovery from Schizophrenia: A Consumer Perspective Final report to Health and Human Services Research and Developments Grants Program, December 1997, unpublished Topor A. (2000) Chronic Illness(es) and Recovery, November 2000, unpublished Topor A. et al (1998) The road back – Recovering from severe mental disorders. Report from a pilot study. Stockholm: FoU-enheten/psykiatri, VsSSO, Report No 4 Topor A. et al (1997) Turning Points, On the Road to recovery from serious psychiatric Illness, unpublished Unzicker, R. (1989) On my own. A personal journey through madness and re-emergence. Psychosocial Rehabilitation Journal Warner, R. (1994). Recovery from Schizophrenia: Psychiatry and Political Economy. 2nd Edition. New York. Routledge. Weaver (1998) Case Management Conference in Oklahoma Working with Voices and Working with Self-harm, Handsell Publishing Mary Ellen Copeland Wellness Recovery Action Plan (WRAP) Peach Press This literature review has been completed by the Centre for Community Mental Health at the University of Central England in Birmingham as part of the social inclusion project of the West Midlands Partnerships for Mental Health. The creation of the Centre is primarily aimed at providing a vehicle for the involvement of local expertise alongside our wider network of national and international expertise to help deliver a new paradigm in mental health care; generating, disseminating and supporting best practice, both at an organisational and individual level. Central to the work of the Centre is a belief that recovery is possible for everyone with diagnoses of serious mental illness and that in order to deliver recovery-oriented services, the involvement of people with lived experiences of mental distress are critical at every level of service planning, delivery and evaluation. The CMHP is based within the Faculty of Health and Community Care, Butler Building, Westbourne Road, Edgbaston, Birmingham B15 3TN Tel 0121 331 7111 Fax 0121 331 7168 and email ccmh@uce.ac.uk and www.ccmh.uce.ac.uk Cite as: Allott, P. & Loganathan, L. ‘Discovering Hope For Recovery From A British Perspective – A review of a sample of recovery literature, implications for practice and systems change’ West Midlands Partnerships for Mental Health, Birmingham www.wmpmh.org.uk

The Wirral Farmers’ Market is run entirely by volunteers, and is held on the second Saturday of every month, beginning at 9am.

The market is constantly expanding from traditional farm produce of meats, cheese, vegetables and fruit to chocolate, beer, cakes and bread.

Find out more at www.wirralfarmersmarket.co.uk

Wirral Farmers’ Market was awarded the national 2007 BBC Radio 4 Food and Farming Award for the best Farmers’ Market in the UK.

Dates open in 2010

http://www.visitwirral.com/site/food/markets

Afternoon Tea

The Wirral Food and Drink festival takes place on the Bank Holiday weekend - Sunday 29th and Monday 30th August at Claremont Farm in Bebington. The festival is now in its fifth year, and has grown to be one of the most successful food events in the country. This year’s event is set to be bigger than ever and Event Organiser and full-time farmer Andrew Pimbley is greatly enthused by Wirral’s food offer .

‘2010 is Wirral’s Year of Food, so this has given us an even greater opportunity to promote Wirral, its producers and our wonderful food offering.’

With more producers than ever, live cooking demos, music and entertainment, this eagerly anticipated festival at Claremont Farm is not one to be missed!

www.claremontfarm.co.uk

Wirral Food and Drink Festival, 29th & 30th August, Claremont Farm, Old Clatterbridge Road, Bebington.

A better response to depression

http://www.guardian.co.uk/lifeandstyle/2010/aug/07/a-better-response-to-depression