Monday, December 16, 2013
Putting Dignity First in Mental Health
Written and Reposted with permission by Guest Blogger: EDUARDO VEGA
Putting Dignity First
Many variables affect people in their ability to recover from mental illness and manage mental health conditions. There is not one program, service, support or medication that will work for all, or that will work for many for an extended period of time. Intuitively we know this to be true, although many are still driven by the dream of a ‘silver bullet’, a perfect medication or treatment, or even an ideal array of services that could perfectly match all our communities needs.
We do not know if science will progress to the level of a ‘cure’ or prevention for mental illness— if it is even possible to so radically alter the biogenetic vulnerability factors that predispose some to mental illness as to significantly reduce its prevalence in the world.
We do not know if we can ever be free of the impacts of trauma, stigma, abuse, discrimination, poverty, and violence and all that they contribute to the manifestation of psychiatric symptoms in our communities, and the barriers they represent to recovery.
We do know a few things. We know that some things almost always make a difference to people living with mental health challenges. We know that hope is the greatest fuel for recovery, that without it the best services and supports in the world are futile. We know that people can accomplish almost anything with enough hope, and can achieve almost nothing without it.
But we have not talked enough about dignity in mental health. About its role in connection to recovery and resilience, about its centrality in the nexus of relationships that links every one of us to each other. About dignity as a human right that should be foremost in all our interactions with all people. Or about the many myriad of ways in which systems, public media and individual attitudes work to diminish the dignity of people affected by mental illnesses every day.
Some people grow up with a sense of purpose, with agency and confidence—perhaps because it was inculcated in them by great parents or their culture or faith. Some seem to gain dignity by association with status, position, class or wealth, which perhaps is false in some ways.
Some of us had to learn about dignity from others. Seeing it in their eyes or their actions when faced with insult and adversity.
I learned about dignity from friends struggling to put a few months of sobriety together, from hundreds of people who were homeless, from more than a few newly released convicts, and from the many I’ve known who continue to face down the pain, shame and stigma of mental illness to retain regain whole and meaningful lives.
I also learned about how people seek out dignity, and how they avoid its opposite at a profound and almost reflexive level. How the indignity that went along with things I was ‘giving’ to people ‘in need’ could more detrimental than I anything I could positively ‘provide.’ I learned from people who were in more desperate circumstances than I could ever imagine that honoring their personal dignity was much more important than ‘providing’ them a service.
You don’t have to spend time in a inpatient psychiatric ward to have a sense of how often one’s dignity can be undermined in services. But a few snapshots can help—
· You called for help because you were desperate and felt like dying and couldn’t be safe. When help came they pointed guns at you, put you in handcuffs, took you away in the back of the police car while all your neighbors watched.
· Perhaps you came in voluntarily, feeling completely anguished or out of control, then a few days later you find your status had been ‘switched’ to involuntary and that the papers you signed meant you had given up your rights to refuse medications you didn’t like.
· You’re in your room where there in no privacy from your roommate—multiple times of day staff, nurses, sometimes even students come in unannounced, begin asking you questions, often the same questions you’d already answered several times.
· You go to “art group” in which the art activity consists of large nubby crayons and children’s coloring books even though its is an adult/geriatric ward and the average age is over fifty.
· You ask for a pen or pencil so you can write in your journal and are told you can only use them while someone watches you at the nurse’s station— and that they are too busy to do so.
· You find that your privileges for phone calls or cigarette breaks were removed because you failed to attend enough ‘groups’
· You ask where the policy for restoring privileges is and are informed that this is a ‘staff decision made at rounds’.
· You tell your prescriber about the debilitating side effects of the medications your taking. In response she rolls her eyes, saying ‘you’ll get used it’ or ‘nobody has all of those’.
Stigma? -yes. Discrimination? yes— but to most people these things that happen every day are just plain insults to a dignity they may be already struggling to maintain.
If we put Dignity First all these things things that drive people into despair, that magnify the fear shame and self-doubt that so often accompany mental illness, all these can be wiped away.
So people won’t seek death by suicide or painful isolation as more dignified than supports for their recovery.
When we put Dignity First we approach people as deserving and seeking more from us than ‘care’ or services. We recognize people are challenging us to respect them first and then to bolster their opportunities to respect themselves. By listening and engaging with the intention to understand what that would require, we challenge our assumptions and the power relationships inherent in health care that work against people’s dignity. And that, as a result, drive many people away. Putting Dignity First we understand that recovery needs to include recovering from the indignities that they’ve suffered as a result of their symptoms, their situations and the messages they’ve received from others and their society about what it means to have a mental health condition.
In putting Dignity First we know that honesty, hope and sincerity are our best resources for engaging people who so often have lost their dignity. We help by offering resources, skills and services that people want to use, rather than ‘providing’ them with the services we have and rejecting them if those do not fit.