Like any field, Mental Health has its own language and uses certain words in specific ways. If you’re new to the field, this can be confusing and frustrating. If you’re currently on the fringes of the Mental Health field, you will probably have heard the word recovery banded about a bit, with no one ever really explaining what it means. In the general culture, to have recovered from something means you’re completely better, cured. The recovery model uses the word in a different way, to mean that people with Mental Illnesses still have something to offer, still have rights, and can still live meaningful lives – whether they get completely better, live with and manage their condition, or remain very unwell. The recovery model was moving away from some of the issues with the medical model. Like anything, some people like it and some don’t. I like the model itself a lot, but the way it is implemented can leave something to be desired. Unfortunately, I don’t think we’re ever going to find models that are so perfectly designed we can’t screw them up.

What is a recovery focused service supposed to look like? There’s some great ideas and articles about this out there. I like the work of Marianne Farkas, who in this article sums up the recovery approach into four main values.

This means not seeing people just as ‘sick’ or mentally ill, but recognising that outside of that role, they are whole people with many different characteristics. This is very important to me, whenever I have a new worker of some kind of in my life, the relationship begins very role-bound. As quickly as I can I move towards a relationship that has two unique people in it, rather than a ‘service provider’ and ‘service user’. By that I don’t mean that it becomes inappropriate or unprofessional. Rather, that I am seen as more than just ‘someone with a mental illness’ and we move away from that unpleasant dynamic of me needing help and having no answers, and them having all the answers and needing no help. I’m always more comfortable when there are two humans in the room!

Person involvement means including me in all stages of services, how they are planned, created and delivered. The ‘patient’ role favoured by the medical model is a very passive one, I as the patient go in for treatment and hopefully come away cured. My job is to turn up on time and follow instructions. In mental health this passivity is painfully destructive. Firstly, selling the idea to people than someone else can fix your mental illness is cruel. Recovering from a mental illness is an active affair! No one can pluck it out of you. The more you engage, the more you learn about your situation, and develop awareness of what works for you, what makes you worse, what keeps you stable and well, the better the outcome often is. That doesn’t mean doing this alone! But a passive patient in mental health can give no useful information to the people who work with them. The service providers are ‘flying blind’ and reduced to guesswork about what the person needs and what approach might work. Collaboration, where you are in the drivers seat as much as possible, and their role is support you, encourage you, keep you safe, and help you access resources, that is about recovery.

Self Determination

This means having choices! The right to choose one service over another, to refuse services that you don’t like, and to be allowed opinions about your own care. The medical model doesn’t just invite a passive approach, it often requires it and punishes any other response. People are assessed on the basis of their ‘treatment compliance’, how submissive and agreeable they are. Being labelled as ‘non-compliant’ can cause you major problems with getting help, doctors may refuse to treat you or hospitals to admit you, you may have problems with Centrelink, and the public health system is not geared towards choice – staff rotate on their own rosters and you don’t have much power to request to stay with someone you got along with. In fact trying to access the same person can be interpreted as attempting to ‘manipulate’ the system and be another ‘non-compliant’ act, even though most of us understand that good rapport is important and changing service providers regularly is very stressful and tends to result in fragmented care. Choice is about understanding that people are different, there are ‘horses for courses’ and allowing people to settle with providers and approaches that work for them.

Hope

Sadly, this is an easy value to lose. Those who constantly work with the most unwell, disadvantaged people can lose sight of hope. Carers or staff begin to think of all people with mental illnesses as being profoundly disabled. Discouragement sets in, and people with illnesses start to be set up for failure, being told things like ‘schizophrenia is a degenerative disease, you’re only going to get worse’, ‘it’s very unlikely you’ll ever be able to work again’, ‘you’re a hopeless case’. Despair and frustration characterise the conversation between service providers and users, and the level of animosity can become very deep and very entrenched. Hope isn’t supposed to be naivete, but an awareness that things can change for all of us. The most profoundly unwell person still has growth potential! And those of us doing great have the potential for illness. Current roles of ‘well’ and ‘sick’ are not permanent, they may even be exchanged over time. This awareness helps us to interact in a more humble and respectful manner. People can remain stuck and overwhelmed for many years before something clicks inside. I know people who’ve spent many years in hospital and been told they would never recover who are now living independently. Things can change, roles can change, and service provision should always be about nurturing that potential for growth, not making the environment so hostile and depressed that it has little chance of taking root.

I’m pretty keen on all these ideas and I’d love to see more of all of them in our services. In my experience, we’re using the terms but not always understanding just how profound the power shift is supposed to be. There’s still a long way to go in improving the quality of mental health services and developing systems that are designed to be flexible, adaptive and responsive to individual needs. At the moment we often have systems that are limited and restricted, with some awesome people struggling to work within them. Getting your degree – or diagnosis, can be like being invited to a war. You’re given your uniform and told what side you’re on, and from that point forwards everything is ‘them’ and ‘us’, and no one is rewarded for seeing the other point of view. There is a better way, and I think recovery values are part of this.

During the Inquiry into Mental Health and Workforce Participation, myself and a few colleagues talked at Parliament House and we were asked some great questions. I love being asked great questions, it shows that the other person was really listening and engaged with you. And then I get all excited and my brain buzzes as I try to engage back and come up with good, useful responses framed in a way that will make sense. Between the nerves and the excitement, it’s a bit like skydiving! We ended up sending in a letter with a more detailed reply afterwards to make sure we’d really answered everything. I thought I’d share the gist of some of this with you.

Q: What would have helped you to access education or employment when you initially became unwell?
A. For myself, I really needed targeted support on campus at university that was geared to assist people with mental illness and multiple disabilities. One of the difficulties with the disability sector is that it often operates on a limited framework, assuming only one condition per person. For people like me with difficulties in more than area, support can be limited and fragmented. The kind of support I have needed on campus is a safe place to retreat to – be that a quiet room, a group meeting area, a small cafe or space in the library. For me it needs to be small, quiet, out of the way, open all hours and easy to get to. Libraries have traditionally been my safe haven, but uni libraries are very large and confusing and I tend to get lost in them!

I also needed someone I could talk to who was willing to provide emotional support while I oriented myself and became more comfortable on campus. I struggle in new environments and with lots of strangers around. The counselling I accessed during my time at uni was unsuitable. The counsellor was extremely anxious about my mental illness, geared for short term goal-oriented counselling, and outraged that I was just seeking emotional support from them. A better understanding of the nature of mental illness would have been very helpful.

Similarly, making more disability friendly the other pathways back to work and study would have been very helpful, such as volunteering and short courses. Helping people like me to feel useful, connected and to find a road back to our study and work goals is crucial.

Another thing that’s often overlooked is that good mental health is built upon a foundation of stability and security. Mental illness can arise from major life challenges, and can create major life challenges. Many people with severe mental illnesses also face complex issues such as homelessness, family breakdown and domestic violence, isolation, drug and alcohol issues, and physical disability. All these contribute to instability and make maintaining work or study extremely difficult. It may not seem intuitive to support employment for people with a mental illness by providing services such as appropriate housing, but this kind of foundational, practical support is key to creating the kind of life where day to day survival is less consuming, so there is time for the pursuit of education and work goals.

Making it easier to link into services would have been incredibly helpful. As a young person I was given no information about my mental illness, local services available to me, and I had no idea there were things I could do to improve my mental health. My doctor or the university could have provided this kind of information, or a referral helpline could allow people to find out about services in their area. Making support services more friendly and accessible would also help. I was initially extremely afraid of the mental health system and deeply intimidated by the labels. It took a mixture of courage, exhausted indifference, and desperation for me to be willing to walk into buildings with words like “Mental Illness” on them. Many of the services available are also very restricted in the kind of support they provide and who they accept as clients. Many services provide support based on the label of your condition, for those of us with poorly funded conditions or rare ones, we can really struggle to find anyone to look out for us. Even if you can access a service, growing older, moving house into a new postcode, getting a new diagnosis, or becoming homeless can all see you become ineligible and exited from the system. Flexible and tenacious support is key. Had I been linked to a PHaMs worker back then, things may have been very different.

Reducing fear and stigma in the community will also make it easier for people with mental illnesses to seek early help and stay engaged. School aged education about mental illness, self care, early warning signs, and hope for recovery could help students struggling with emerging mental illnesses to recognise their condition, know where to go for help, and feel more comfortable about doing so. The opportunity to connect with Peer Workers who have come through mental illness can help enormously to encourage people that a mental illness is not the end of the world.

Q. What can the Government do to encourage employers to employ people with a mental illness?
A. Far more powerful than telling the business world how they should be including people with mental illnesses in their workforce is to model how it can be done. This would normalise the practice and show commitment to meaningful inclusion. There are already people within Government departments who are managing a mental illness, and they could be approached as a resource to develop policies around the employment of people with a mental illness. If the Government leads the way by supporting people with a mental illness within their own workforce, other organisations and employers are more likely to follow this example.

FaHCSIA has models such as PhaMs that require Peer Workers, so having experienced a mental illness is a prerequisite of the position. The Government could ensure that current and future models be designed to have the same requirements, for example respite services, community based mental health programs, Centrelink, or Medicare. Include Peer Work positions in service agreements, then follow up, review and support organisations to implement them.

Education, training, and ongoing support for employers about managing a workforce containing people with a mental illness will help to reduce some of the fears that employers have. An example of this is the Remind Education Program. Ideally, this kind of training should be provided by people with a mental illness themselves – this will reduce stigma and create jobs directly for those individuals. A helpline for employers may be an appropriate format for providing ongoing support.

Peer Workers play a crucial role in raising awareness and reducing stigma. Peer Work positions value the ‘on the job training’ of people who have learned to manage a mental illness, so that it in some way stacks up when compared with people who have theoretical training. The Peer Work Program can be supported as a pilot model for the employment of people with a mental illness. This model can then be expanded to be used for the employment of people with a mental illness in any role.

Lastly, creating safety nets so that people with a mental illness can manage episodes of illness without losing their jobs or having crucial tasks left undone will promote employer confidence and employee security. For example, having a disability employment support who make a staff member available to fill the individuals role should they become unwell. Less pressure on staff with a mental illness can lead to greater productivity.

Q. What are the risks to Peer Workers? For example, are they similar to those faced by Peer Workers in the Drug and Alcohol sector?

A. I found this a really interesting question. The risks to the health of Peer Workers in the field of Mental Health are very different to those faced by recovered addicts/alcoholics who work in the Drug and Alcohol sector. The development of a mental illness is quite different from the addiction model. There is nothing ‘tempting’ about spending time with people with a mental illness. I’m also not aware of any evidence that spending time as a peer with people with a mental illness will in any way make someone more vulnerable to mental illness or a decline in their mental well-being. That certainly hasn’t been my experience, on the contrary, being part of my groups has been of tremendous benefit to me!

Having said that, Peer Workers do have risks to manage. Some of these are simply the kind that anyone in the workforce has, such as coping with life stressors or balancing work and family responsibilities. There are also some issues that are particularly relevant to anyone working in the mental health sector, such as the possibility of burn out, and the importance of minimising vicarious traumatisation. Lastly there are some issues specific to the role of Peer Worker. Peer Workers have a ‘foot in both worlds’ as it were, partly staff and partly consumers within the mental health system. Membership to more than group in this way can be stressful, particularly at times when those groups are in conflict and each is demanding the exclusive loyalty of the Peer Worker. As the role is relatively new, sometimes Peer Workers work under unclear job descriptions, experience workplaces that don’t model good mental health practices, or struggle with a lack of support from management. Sometimes Peer Workers can be under extra pressure to prove they are managing their mental illness. Boundary issues can be difficult to negotiate, and some Peer Workers have lacked access to relevant training and support.

My experience has been that Peer Workers often report that their work is part of their recovery journey rather than a risk to it. In work environments that are supportive and well matched to their skill set, Peer Workers can flourish. The opportunity for employment and the chance to give something back is a meaningful part of the recovery process. Peer Workers can also appreciate the transformation of experiences that have previously been a liability into an asset.