Recovery approach to Risk Workshop

Tuesday, I was fortunate enough to be given a free spot (as a broke, voluntary peer worker) in Mary O’Hagan‘s workshop at the MHCSA. Ah! So wonderful! Inspiring me that I’m on an important path with my passion for Peer Work, and challenging me to take my thinking even further. She conceptualized a much broader perspective of risk than we usually see in Mental Health Services – not just that people are at risk perhaps of self harm or suicide, but also at risk of hopelessness, disempowerment, loneliness… subtle but powerful risks we all face. She also encouraged us to examine the risks of a risk adverse approach to life, what that costs us and the constricted lives we lead when we become afraid of risks and thus unable to grow.

I was so excited I felt like Hermione wanting to leap out of her seat with her hand in the air at every question! Some of the practical tools about how to engage risk and engage at risk people without just giving up on them or taking control away from them were really fantastic. I wish we had had another couple of days to explore these concepts in more depth because the paradigm shift is quite profound. At one point my table was given an exercise, described a woman in a really difficult catch 22 situation and asked how we would intervene. The scenario is that the woman was hoarding ‘junk’ which was a serious immediate fire risk (eg papers stashed over the pilot light on the gas stove), a health hazard with degrading and composting items, causing serious trouble with her neighbours due to the smell, and going to get her evicted very shortly. She was completely against having anything removed or even moved around to safer places within the apartment and continuing to add to the hoard on a regular basis.

At first I just felt hopeless, I know that the situation is desperately urgent and the woman is at risk of losing her hoard and becoming homeless which may very well set off a profound mental health crisis. The need for urgent change combined with what sounded to me like an extremely high need for control over her environment are such an impossible conflict. My first thoughts were of removing her from the house to hospital or another place and fixing and cleaning it for her. The pointless and desperate power play we would be caught in at that point would almost certainly end with the woman self destructing in some way.

Then we started to think more creatively about it and break it down into different areas. Some issues – like the fire hazard, were urgent and non negotiable. Clear, immediate change was needed. But even there we didn’t have to do the obvious and force her to clear the stove. Someone in the group suggested turning off the pilot light or temporarily disconnecting the gas to her apartment. That’s one urgent problem solved without dominating her. The next step I felt was to get her some support for whatever was driving the behaviour – anxiety, grief, trauma issues, OCD… if we made the issue the behaviour we were pretty doomed, if we could get help for what was driving the behaviour maybe we could settle it down. The high need for control always sparks concerns for me about possible trauma history – and at that point I’m looking for ways to help meet that need, exaggerated though it may be, rather than trample it.

I felt that a peer relationship would be crucial, I suggested calling around the peer networks to see if we could find someone who had themselves had trouble with hoarding and was doing better to call in and befriend this woman. Many people who struggle with behaviours like this are deeply ashamed, isolated, and confused by their own behaviour. Having the experience normalised, having someone else around who ‘gets it’ and can also incidentally, probably offer some great suggestions to us as the workers, can make all the difference in the world.

We also suggested that framing any change or intervention should be done not through the lens of our perception of the needs and risks (her relationship with her neighbours is going to collapse, she is going to become homeless, she is at risk of a breakdown of some kind), but within the framework of her goals and what is important to her – so instead of talking about keeping her house we would be talking about helping her keep her belongings (which of course she would lose with her house). That is currently her goal and focus – it may change over time, but at the moment that is what is important to her.

Suddenly we had an approach that was not controlling or coercive, that took the situation seriously and managed the high immediate risks, and that had a change of success. I was really excited about this! We were also asked what the risk to her might be resulting from our intervention. I felt that the biggest risk of this approach might be that working around her high need for control may inadvertently re-enforce the need and make the behaviour worse. I don’t think there would be a very high chance of that, generally I’ve found that people with exaggerated needs of some kind get a great deal of relief when they are accommodated and learn how to meet those needs while living in a less than ideal world – there’s a lot of negotiation and creative problem solving involved in that! There can be such a huge relief in being allowed to have a struggle or challenge of some kind instead of just being under constant pressure to get over it and have it sorted out. But people do react differently to things and I felt if what she needed was reassurance, was someone to come in and help her contain her behaviour, then treating her as if her anxiety were legitimate or her compulsion reasonable may possible amplify it.

I am so excited by these ideas around the opportunities that risks present us, around the understanding that freedom, dignity, and reciprocal relationships are foundations of mental health and if we want to support people’s recovery we have to find better ways of building these into our services! My experience as a ‘consumer’ has frequently been that dignity is the price at the door for any support or assistance you get. Freedom and equal, mutual relationships are also pretty rare finds and very precious when you do find them in mental health services. I am more committed to Peer Work than ever.

I had a very busy, exciting and inspiring day! I had some wonderful conversations with people, there’s the possibility of a few opportunities opening up – like perhaps a chance to give a talk with Tafe. I also rabbited about the Dissociative Initiative and talked to Mary about our groups Bridges and Sound Minds – she’s interested in the framework we’re using as she’s involved in trying to set up some peer groups back in New Zealand. Goodness gracious, how strange the world is when the movers and shakers of the mental health world want my opinion about something!!

I also have very exciting art news – I’m going to be in the Fringe!! The Cracking Up comedy show needed another person and I’ve been invited on board. I’m so excited! I get a badge! I get passes to events! I get something great on my art resume! I get some training! I get to perform with some really awesome people!

I’ve flown to Melbourne safely and landed, all is well except for the slight hiccup that I’ve had a very busy week, I’m quite sleep deprived, fairly dissociative and somewhere between exuberant and hypomanic which is far too wired and excited to sleep. I wish all the good news and exciting possibilities didn’t happen at once like this, it completely fries my brain and I can hardly take any of it in. One really exciting event per week please, certainly not 6 in a day! Still, as far as life goes, it’s a pretty damn awesome problem to have.

My talk on Thursday is progressing well, the powerpoint is set and done, I reordered a bit to make sure it would all make sense to people totally new to dissociation. I still can’t seem to get it down below the 25 minute mark (I only have 20 mins) which is deeply frustrating. I’ve already badly condensed talking about my personal experiences and cut out the poems. It’s being forced to be more a clinical talk than I want – the personal side of it is so important. But, without the clinical framework, the personal information can just become sensational and not educational which is absolutely not what I want. Essentially I’m trying to cram four talks into one here – Introducing Dissociation, Introducing DID (or Multiplicity), Managing Dissociation, and My Personal Story. Each of those could comfortably be a an hour talk or a days! One day when I offer to give a talk they’ll give me a whole day to do a workshop instead of accepting the abstract and knocking down my allocated time! 🙂 Not that I’m whining, I’m so terribly excited to be here, to have the abstracts accepted and the conference fees waived and Mifsa have agreed to reimburse my travel costs and I’m being kindly hosted by a friend for the duration – otherwise it simply wouldn’t be possible with bills to pay off. All day I’ve been thoroughly enjoying saying “I’m flying to Melbourne tonight to give a talk”. 🙂

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