Recovery, Occupations and Serious Mental Illness:

A Case Study Amee Le M.Sc. OT, B.A.Sc. (Hons)

Supervisors:Terry Krupa & Carol Mieras

Agenda

1. Introduction2. Objectives & Research Question3. Method4. Results: Case Study & Photo Novella5. Discussion, Implications, Limitations6. Implications & Conclusion7. References

1. Introduction

Recovery A personal journey…

4 Domains of Recovery:

1. A Sense of empowerment or control2. Knowledge of one’s illness and treatments 3. Satisfaction with life quality 4. Hope and optimism for future

Bullock et al, 2000; Deegan, 1988; Deegan, 1993; Resnick et al, 2004)

Why study Recovery and Activities/Occupations?

Recovery and Activities/Occupation Overlap between benefits of engaging in

activities/occupations and the description of the recovery process

Reclaiming control, maximizing potential Level of activities/occupational participation related to the

stage of illness individuals with schizophrenia are in (Brown, 1998; Nagle et al, 2002)

Engaging in activities/occupations has the potential to reduce symptoms (Halford et al, 1995: Mairs & Bradshw, 2004)

2. Current Study: Objectives

The primary goal is to examine the pathways from being uninvolved to becoming involved in meaningful activities.

Central Research Question:What are the processes of occupational engagement for persons who have been marginalized from occupation in the context of serious mental illness?

3. Methods

Grounded Theory & Case Study Approach Submitted and Received Ethics Approval

Procedure1. Three Interview with the primary participant

(audio recorded and transcribed verbatim)2. Interview with two secondary participants3. Extensive chart reviews4. Photo Novella

To Ensure Quality and Trustworthiness: Audio trail

Continued Reflexivity

Member-checking

Familiarity with medical chart

Participants

Ages 25-60 diagnosed with a serious mental illness

(schizophrenia, major affective disorder)

Recipients of a Mental Health Services in Kingston

Identified as disengaged in activities/occupations for 6 months previously

Currently demonstrating recovery

4. Results

Case Study: Bill 45 year old man from Kingston Current diagnosis of bipolar disorder In the mental health system for over 27 years Worked at a many jobs Been through the criminal/forensic system a few times Receives ODSP for over 27 years and is also on CPP Living in a group home but wants to move out with a roommate Is a father to 4 children but recently divorced Expressed a great belief in Christianity and a higher power

Thematic Map

Six Themes Emerged

1. Living with Consequences2. Balance and Structure3. Sense of Spirituality4. Importance of Friendship 5. Caring Supportive People6. Bearing Witness

Living with Consequences A person takes responsibility for his life choices, good or

bad. Negotiation - let go of the past negative situation to find a new meaning.

“And forgetting, and another thing that I am moving away from is forgetting the past. And, work on the areas that defeat me and going close to god, and you know, that is what I want to do I want to move close to god. And forget the past, and press on”

Picture not shown to protect the identity of the

participant.

Picture not shown to protect the identity of the

participant.

Living with Consequences

“My kids are what keeps me going. I don’t know what I would do if I didn’t have my kids and I was going through a lot of the things I am going through now. Like, I am trying, I know I have made mistakes, I know am not the dad I should be, but I am trying my hardest to keep contact with them and visit them whenever I can and tell them I love them on the phone all the time. I pray for them, like I just feel blessed to have my wonderful children, you know.”

Balance and Structure Daily routine is very important to keep a person

occupationally and socially engaged.

It is a great effort trying to find a balance in a person’s activities and daily routine; too much vs. too little activities.

“Now I am finally umm, get the structure I need in my life. Because we all need structure, we all need something to do, some place to go, someplace to you know, try to help people, or, do what you have to do.”

Sense of Spirituality Acknowledging that there is a higher being allows a person to attribute

living with a mental illness to a connection with god where he is able to find meaning in his life ups and downs.

Acceptance of religion into his heart; recognition and acceptance of illness through a higher power.

(Reflecting on early psychotic episode, attributes it to a higher power)A: How did you make sense of the things you saw at that time?

“I didn’t make sense of it because I couldn’t make sense of it. It was like, and like, I know god answers prayers, because like umm, I knew that, umm whatever I was going through at that time, it must have had to happen, to draw me to where I am today.”

Importance of Community as a Place to Belong“I go to church here still once in a while. I was out there, I try to get there as

many Sundays as I can. .. I used to take my children plus some of their friends, they were great kids. I used to take my kids there for Survivor on Wednesday night or Kids Club or whatever it was called and I would stay for bible study…”

Importance of Friendship Friendships allow the person to feel a connection to

another human being.

Friends provides emotional support during difficult times.

“They’re always there, they’re always talking to me, they’re always trying to pick me up. I am not always chippering, and sometimes I get down on myself too much.”

Picture not shown to protect the identity of the participant.

Picture not shown to protect the identity of the participant.

Importance of Friendship

“Well, the people who stay like, he’s seen me through some tough times...But like, a friend, I find a fiend that will stick with you like no matter what happens or what situation you find yourself in. I find a good friend will comfort you when you are down…umm…you know like, just be there for you whenever you need.”

Caring and Supportive People The importance of caring people: services are important

when provided by caring people.

“You know, wherever we all, like wherever we’re from and what we have done and who we are at time, it’s important to need somebody and have somebody to care, and that is all I see around here. Around ### Street is caring people, and that is what we need more of, a caring community. It doesn’t matter where you come from, what walk of life you are or it doesn’t matter what nationality, we all need the love and the forgiveness and that like, you know like, we all need each other. ”

Importance of Supportive People“And this is #### Street where, I’ve been involved since 1981-82 which is 28-29 years…I am very pleased with the people here because they have helped me out throughout the years. And I thank the good lord for each one of them and I just, you know like, if it wasn’t for this place I don’t know where I would be.”

Bearing Witness People often find it helpful to tell their stories to increase other’s

understanding of what it is like to have a mental illness.

“One thing I am moving towards, I am moving towards, maybe umm, getting more wisdom and understanding and helping others, now, and being encouraging to others”

This experience can often be validating of one’s own experiences with the ups and downs of a mental illness.

“What I can do to improve myself or to help others, you know, to have a better understanding of the illness and the understanding that it’s not all bad. There’s some good times there are some bad times.”

Bill’s Present Occupational Profile

■ Attends local mental health service centre Monday – Thursday■ Afternoons:

Monday = Computer classTuesday = ChoresWednesday = Bible study Thursday = Spiritual group

■ Weekends = time with children & attend church services■ Has a bus pass to travel around the city■ Writes in his journal daily■ Living in an apartment with a roommate■ Expressed interest in becoming involved in committees

Future: Bill wants to become a better dad and live for his children so they can have a father. He wants to help people, especially people with mental illnesses. He has a goal to repay back his financial debt.

6. Implications

How do these processes inform practice? Importance of support, sensitivity and hope Importance of promoting a balanced life Importance of support for spiritual practices Involving the person in peer support networks Importance of meaningful roles Distinguishing between symptom vs. experience Recognizing that there are multiple truths & create

opportunities for people to tell their stories

Limitations

Sample Homogeneity: sample limited to the Kingston area

Limited only to people who are receiving services

6. Conclusion

The findings of this study contribute to the conceptualization of the processes of occupational engagement for persons who have been marginalized from occupations in the context of serious mental illness.

7. References Brown, C. (1998). Comparing individuals with and without mental illness using the daily activities checklist. Occupational Therapy Journal

of Research, 18(3, 84-98. Bullock, W.A., Ensing, D.S., Alloy, V.T., & Weddle, C.C. (2000). Leadership education: evaluation of a program to promote recovery in

persons with psychiatric disabilities. Psychiatric Rehabilitation Journal, 24, 3-12. Carlson, L.S., Rapp, C.A., McDiarmid, D. (2001). Hiring Consumer-Providers: Barriers and Alternative Solutions. Community Mental Health

Journal, 37(3), 199-213. Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner D. & Tebes, J. K. (1999). Peer Support among Individuals with Severe

Mental Illness: A review of the Evidence. American Psychological Association, 6, 165-187. Deegan, P. (1988). Recovery: the lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 11(4), 11-19. Deegan, P.E. (1993). Recovering our sense of value after being labeled mentally ill. Psychosocial Nursing and Mental Health Services,

31(4), 7-11. Dixon, L., Krauss, N. & Lehman, A. (1994). Consumers are service providers: the promise and challenge. Community Mental Health

Journal, 30, 615-625. Franits, L.E. (2005). Nothing about us without us: searching for narratives of disabilities. The American Journal of Occupational Therapy,

59, 577-579 Halford, W., Harrison, C., Kalyansundaram, M., Moutrey, C. & Simpson, S. (1995). Preliminary results from a psychoeducational program

to rehabilitate chronic patients. Psychiatric Services. 46, 1189-1191. Jacobson, N. & Greenley, D. (2002). What is recovery? A conceptual model of recovery. Psychiatric Services, 52, 482-485. Mairs, H., Bradshaw, T. (2004). Life skills training in schizophrenia. British Journal of Occupational Therapy. 67, 217-224. Mead, S. & Copeland, M. E. (2000). What Recovery Means to Us: Consumers’ Perspectives. Community Mental Health Journal, 36, 315-

328. Mowbray, C.T., Moxley, D.P., Thrasher, S., Bybee, D., McCrohan, N., Harris, S. & Clover, G. (1996). Consumers as Community Support

Providers: Issues Created by Role Innovation. Community Mental Health Journal, 32, 47-67 . Nagle, S., Cook, J., & Polatajko, H. (2002). I’m doing as much as I can: occupational choices of persons with mental illness. Journal of

Occupational Science, 9, 72-81 Resnick, S.G., Fontana, A., Lehman, A.F., & Rosenheck, R.A. (2004). An empirical conceptualization of the recovery orientation.

Schizophrenia Research, 75, 119-128. Solomon, P. (2004). Peer Support/Peer Provided Services Underlying Processes, Benefits and Critical Ingredients. Psychiatric

Rehabilitation Journal, 27, 392-401.