Helping Clients Achieve

All of us depend on good mental health to thrive but probably few of us ever consider what good mental health means in reality. Ironically there is no medical definition of sane - but a clear definition of insane.

For many people who have experienced "mental health diffiuclties" a sense of isolation and lonliness is a real issue that affects their recovery or the managing of their difficulties.

Sometimes a "good enough recovery" is all that can be hoped for by the client and only the client will truly know when that point is in sight. For some it will be "just able to feel less afraid of people" for others it will "to know what is real and what is not". There are many instances of people who have suffered great trauma or depression being able to make small steps of recovery following a small change in their environment or following an interaction with someone who connected with the person rather than with the problem.

People with mental health difficulties may have lost their way somewhat but with a different map they may be able to be encouraged to reach a different location if not the original one.

Visit some short-stay psychiatric units and you will see people wandering aimlessly around in their own lost world with little more than a blaring television and choking cigarette smoke to distract them before they are given their medication. These units are often chaotic, nosiy places which excerabates feelings of insecurity and fear.

It could well be that these patients have had a nervous breakdown or they have suffered trauma that has thrown them off balance, but whatever the cause of their problem –the only resource they will be given is an expensive, drug that may be the wrong dosage for a condition that is notoriously difficult to determine. Some units, of course, offer Art group or other activities but I am not aware of any "focused" itinerary that encourages stimulation or movement throughout the day.

Patients will be supervised while they are on the unit by staff who are paid to “monitor” them – not talk to them or engage them in any activity – just monitor them until they are called in to a room full of silent professionals who will enter and leave the room at any given time without apology or comment, while the psychiatrist asks the patient questions about the patient’s progress. That is the only time anyone will tap into the patient’s expertise.

Let us leave there and go across to the Drug & Alcohol Rehabilitation Unit – usually run by a group whose ethos is founded in religion and whose patients will soon learn to understand the principle that “there is a power greater than me” and that the patient will never be “a recovered addict“ only ever a "recovering addict”.

This patient will spend their day in Group, talking about their Life Story (recounting all the bad things that happened to them and which may have led them to substance misuse). If they attempt rehabilitation a couple of times in their lives – they will have to recount their Life Story afresh every time. They will then spend their evenings, wandering about, watching TV, talking with other addicts and queue up for their medication at the end of the evening before they go to bed.

These very expensive resources are allowed to flourish without any insistence on review or overhaul or even evaluations in order to continue to be funded.

Imagine now if you will, a Solution Focused Brief Therapy model being used in a short stay Psychiatric Ward or Rehabilition Unit while patients are waiting for assessment following admittance because of depression or suicide attempt.

Patient arrives – greeted with respect and courtesy by staff (therefore fostering a feeling of safety which will further add to mental and emotional security.

Patient is asked to describe how things are for him or her

Patient is then asked what would tell him that things are getting better or that his coping strategies are working

Patient is then listened to

Patient is involved in conversations about what recovery would look like; small steps that would tell him he was achieving recovery at all.

Patient is subconsciously encouraged to look at and think about a healthier state of mind

Patient is engaged in healthy activity with other people (even just being encouraged to join in a group song can get more air in to the lungs!).

Whether its in the GP surgery or in short-stay psychiatric units – opportunities to talk about tomorrow rather than only focusing on yesterday should always be offered.

A healthy approach to working collaboratively with mental health patients might be to connect with the whole person; ask about "exceptions" to their current state and ask about preferred futures.

Just as surgeons of today look with incredulity at the methods of the surgeons of the past – tomorrow’s mental health professionals will surely do the same.

We are not experts in the mental health field but we do believe that there is only one expert of a mental health difficulty and a mental health recovery and that is the patient.© Eileen Murphy 2006
For details of training courses for Mental Health staff - please contact us at info@brief-therapy-uk.com or Telephone us on 0208 542 9310