The New Hampshire Asylum for the Insane, now known as New Hampshire State Hospital (NHH), opened in 1842, after 12 years of planning. Located in Concord, NH, the asylum was funded by a $9500 grant from the city which was utilized to purchase 120 acres. Originally, the Asylum was not a state entity; patients who could afford to paid $2.25 per week and those who could not afford payment had their fees paid by their home communities. The Asylum also accepted patients from neighboring states who paid an extra $.25 per week. After reading about the Asylum on several websites, including the 2012 History of Psychiatric Hospitals by Paul Shagoury, Director of Psychology, NHH, ( https://www.dhhs.nh.gov/dcbcs/nhh/documents/nhh-history-shagoury.pdf ) and New Hampshire’s Department of Health and Human Services’ website ( https://www.dhhs.nh.gov/dcbcs/nhh/history.htm ), it appears that this Asylum was indeed built on the Kirkbride premise. Photos on the NH website demonstrate a central
Selecting an "aha" moment in this course was incredibly difficult, so I will mention two "aha" moments and proceed to describe one in more detail. First, the transformative power of hope, as mentioned by Fisher and Deegan, although not an "aha" moment per se, is of critical importance to those of us entering the counseling profession. Second, in Chapter 5 of our text, American sociologist, Erving Goffman, noted how an institution's culture shapes an individual. Goffman "was impressed by the degree to which an institution and its all-engrossing culture limited and shaped, if not strictly determined, human interactions, behavior and eventually a person's own internal sense of identify" (Davidson, Rakfeldt, and Strauss, 2010, p. 148). Ergo, the institutional culture of the mental hospital, much more than the patient's illness, drastically shaped its inhabitants. Schizophrenia researchers, Wing and Brown, later called this phenomenon institutionalism. Institutionalism is important in recovery because it clearly demonstrates the importance of society, particularly culture, on an individual's opportunity for recovery. Was this concept perhaps the precursor to the centrality of culture in effective counseling?
ReplyDeleteI too found it difficult to select just one "aha" moment. I did find a number of key concepts that I feel are essential in working in the human services field. In Module 6- Poverty and Community, Then and Now, I found what I consider to be take aways to impact current and future practice. I found the Jane Addams' model of person as agent as being the most enlightening. I used the text pages 66-98 as my primary source.
ReplyDeleteSome of the key concepts from this approach is that persons with a mental illness need to be active agents in their own care. They also need to have reciprocal relationships in which they can be a helper as well as receive help. In the previous history, it was assumed that persons with a mental illness needed to be removed from their current situation in order to be helped. In Addams' way of thinking, a person does not need to be removed from their current environment. It is important to help persons with a mental illness in their current environment rather than remove them and then take away their freedom. A key aspect of this approach is to ask the person what kind of assistance that they need rather than to make both assumptions and decisions for them. It is also important to consider what another person in a similar situation might need.
While the concept of agency stood out for me, it also confirmed some of what I already believed about how to help a person with or without a mental illness. A key question that I find unanswered is how do we apply some of these ideas in our current system of care?
Nancy
Nancy,
DeleteIt has been a fast-paced year and some change, I have been in nearly all of your classes for the past year. As you position yourself for your practicum it is unlikely that I will see you in another class, however I hope I do. It is great to read about your aha moment this semester I like the aspect in that you share that clients are their best advocates for their own care. I believe within time you will find that answer on how to apply some of the ideas in our current system of care. One thing that I ponder about is that we are continually growing in our field, and that we may not have all the answers within a given period of time but we can assist one another in finding a solution for issues and concerns in patient care.
It is hard to choose just one “take away” from this course. So if I have to, I’ll choose something that encompasses many of my take aways! I think having a client-centered approach to mental health treatment is very important. The client should be seen as the expert of their own life and should be in control of their treatment plan. Their provider should educate them about their options, including medications they could take with specific information provided about these drugs and if there are any harmful effects/side effects of any kind. The client should also be educated about natural remedies that may be as beneficial as a medication, or even more beneficial (such as exercise, eating healthy, mindfulness techniques, psychosocial counseling, etc.). With all the information being provided, the client should then be able to decide what their treatment plan looks like. While I am not very familiar as to what a typical session with a psychiatrist looks like, from what I can gather from our course work—there can sometimes be very little dialogue. I would think the psychiatrists would need to create more of a rapport with their clients. If they were to utilize intentional peer support, that could drastically change their relationship with their clients.
ReplyDeleteHey Heather- incorporating a client-centered approach as best practice in mental and rehabilitation services is so critically important. I agree totally is that the client should be seen as the expert, "decider" of their own services and destiny. Clients may need supportive others who are advocates such as family and friends - to assist with decision making.
DeleteCongratulations and Best Wishes, Heather !!!! We did it !
I'm really big into metaphors. I think whenever you mold a concept into a novel storyline, you end up viewing the original idea a little differently or with more clarity. In my introductory video for this class, I used a house building metaphor for mental illness. So I will end the class with a picture metaphor to illustrate how I currently understand the state of recovery-oriented care for people with SPMI, as a result of the readings, videos, text, and discussion we have had during this class.
ReplyDeleteA pixel is a basic unit of color. The more pixels in an image, the more clearly you can see the image. To see all the fine details of a very complex and stunning image, you would need to have thousands of pixels in the frame. Recovery is obviously a very complex painting. The act of recovery relies on social supports, internal strength and commitment, state and national legislation, community services, positive clinical culture, and effective mental health care practitioners who support humane, loving, civil rights-based, recovery-oriented care.
As we moved through the history of mental health care in this class, there was clearly no image for recovery in the care of people with SPMI. The image of recovery was composed of a single pixel. As we went through the era of Poussin and Pinel, we added a few pixels to the image but not nearly enough to even remotely resolve the image of recovery. With Dorothea Dix and Jane Addams, we added perhaps a dozen more. We might have believed that we added more pixels to the image of recovery when mass deinstitutionalization occurred in the sixties, but I would argue that perhaps we just changed the color of the existing pixels.
I believe we continue to add pixels to the image of recovery, slowly but surely. We add a pixel with every legislative act, like the Mental Health Parity and Addiction Equity Act of 2008, which facilitates better mental health care. We add a pixel for every USM graduate that enters the field armed with a cultural mindset of kind, humane, person-centered practice. We add a pixel for every NAMI education course that helps people understand that people with mental illness are not lazy, stupid, or violent. Mental health care providers may disagree, from time to time, on what pixels to add in order to fully resolve the image of recovery. For example, Dr. Mosher clearly has a different view of recovery than does NAMI or NIMH. But we are adding pixels, nevertheless.
Which brings me to my single takeaway from this class. Some comments and viewpoints I have encountered in the discussion forums of this class, combined with the apparent disputes rumbling between the factions about what recovery means and how medication plays a role (i.e. Dr. Mosher and his quarrel with his peers) have made me realize that, in practice, we are still very far from seeing the fully resolved image of recovery. If we need 400,000 pixels to see every fine detail in the Renaissance painting that is the recovery movement, we have perhaps a quarter of that.
Our job will be to continually add pixels with every decision we make as patients, counselors, nurses, teachers, parents, siblings, and community members.
Hands down my biggest inspiration and take-aways, which re-inspired me were the works of Pinel, Pussin and Jane Addams. Imagine that in the late 1700's- early 1800's, that there could be human services revolutionaries such as Pinel and Pussin. They must have faced tremendous opposition at the time. Their philosophies of respectful and humane treatment were so inspirational in the face of those early (and sometimes present) notions of institutions as sterile, medical environments where the medical establishment were the experts.
ReplyDeleteJane Addams work was so powerful as a community organizer and the development of community based services. As I consider what I learned from this course, Jane Addams powerful influence – what I appreciate most is that Jane Addams is such an inspiration of how one humble, person can make a difference of a magnificent magnitude. She didn’t elevate herself as a politician. She purchased a humble home in the community and did humble jobs to care for and wash newborn babies, development of development of day care for young mothers, etc. Recovery for individuals with mental illness can occur when there are supports i.e. familial, community based, medical, psychological etc. I always like the Hillary Clinton’s adage: “It takes a village to raise a child.” Hillary must have been inspired by Jane Addams.
In each of our professions, it is up to us to follow best human services practices, to advocate those most vulnerable that we are privileged to serve. To consider each person's individual's needs goals and aspirations provides a solid foundation for client-centered approach. This course has inspired me to become a better advocate for my consumers as well as to make more of an effort to connect with those medical and clinical professionals that work with my clients so as to better provide coordinate services which advocates for best practices for those I serve.
Best wishes everyone !
Sue,
DeleteI am with you. Jane Addams truly is the epitome of one person making a monumental, positive difference. This course has inspired me in many ways as well, and I am thankful for the insight of my classmates.
Lisa,
DeleteI too had Jane Addams as my top pick in the movers and shakers group. it is amazing how much of a difference one person can make if they are committed to a new vision of treatment or new approach to dealing with social change.
Nancy
Thanks for your comments Nancy & Lisa ! This course overall has certainly been enlightening!
DeleteFor me, the story that gave me an "aha" moment, was the story or video of Natasha McKenna, in the blogger "There but by the grace of God go I...". This film by Judge Rotenberg is one of the most horrific, things I have seen in this 6 week course. He was so right to expose them and show how this women died at the hands of all these so called professional people. Who are supposed to be trained to help and care for people. This 48 minute video, seemed even longer as I sat there thinking to myself "Why isn't anyone stepping up to the plate, and saying something, about how long she has been struggling"? I can not believe with all the people in that room, that no one thought of another way to transport her to wherever she was going, either with medication or other professional opinions about how this could be done, because I continued to feel like "this should stop or be stopped". If a crisis plan had been in place, she would have known she was going and a plan of care could have been used, so she may decide how she would like to be transported. This was a senseless death, and I hope they use this long film, in all of their training's, so everyone can learn how to treat another human with dignity and respect. Very sad story!!
ReplyDeleteI think that one of the biggest "aha" moments was the Soteria Project. The Soteria Project was designed as an experiment for young newly diagnosed people with schizophrenia. He found that most individuals were better off with the psychosocial treatment compared to the control group of the medicated individuals. It is a form of recovery that does not need medication. It is evidence-based program that shows time and social aspects can help individuals with schizophrenia. Another aspect that he discussed was how the American Psychological Association has turned into the American Pharmaceutical Association. No treatment or recovery related books includes the Soteria Project and their findings. It seems that the association is run by money and power. It seems that doctors are so quick to diagnose an individual and prescribe them with medications rather than taking the time to listen and understand them. Another aspect is that this project has not been included in a form of treatment for individuals with schizophrenia.
ReplyDeleteI think that the Soteria Project captures what challenges and difficulties that we will find in our counseling profession. The push of medications versus quality time of person-centered therapy. This will continue to be a challenge for all of us.
Hi Taya:
DeleteI really appreciated the Soteria Project information as well. Did you know that there is one in Vermont? http://www.pathwaysvermont.org/what-we-do/our-programs/soteria/
One of my main take-aways from our course materials in this class was from the YouTube clip of the interview with Psychiatrist Daniel Fisher about the concept of hope. Daniel states that one of the worst things to ever happen to someone with a mental illness is if they are told they will never recover because that takes away all hope. Without hope, a person may be more inclined to just give up. Giving up can lead to suicide or just resigning oneself to a life that does not serve them or offer them a chance at fulfillment and love. Hope is a key ingredient in recovery because it provides the necessary frame of mind to push forward and to try to build a life that is meaningful and enjoyable (based on what they choose as important to them and not what others decide as important). Hope brings someone closer to love and a lack of hope will only push them further away. I found it powerful that Daniel shared his own experience with this concept and I thought he was very eloquent at describing the importance of hope. This video stuck with me and reminded me how important it is to instill hope and empower the people that we work with. -Joe Hayes
ReplyDeleteThere were many aha moments to take from this class. I found I really focused on the steps that Mead and Hilton developed when working with someone who is suffering from MI. Those steps are: listening to their story, maintaining non-judgement, maintaining awareness of where the fear and discomfort are, negotiate ways of being with the person to work towards safety/safety of feeling comfortable, make room for development of a new shared story where we’ve both contributed to the story allowing this to develop a deeper trust between the two parties (Crisis and Connection, 2014). The message I found that was the most important throughout this class was how we as professionals are going to build and maintain a relationship with those that we are working with. This class has dispelled the fear that I learn through societal messages, the media continues to portray how dangerous one can be every time there is a school shooting. I want to have awareness, but I want to be a safe person for people to connect with and offer hope towards their future by being present for them. The message was clear to treat someone humanely and not give up, they may cycle but we can’t walk when that happens.
ReplyDeleteThis was one of the best classes in teaching us how to help those who are suffering from MI...we can offer hope through their own recovery.
Cindy
So eloquently stated, Cindy. I agree!
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ReplyDeleteThere were so many great reading and video assignments this semester that it was difficult to choose just one.
ReplyDeletePat Deegan’s work is such a fitting way to both begin and end our journey this semester. Both of her articles (Deegan, 1995; Deegan, 1996) had a great impact upon me personally and professionally. Deegan’s own experience described a world of health and human service professionals that never treated her as someone capable of recovery, but rather a lost cause where one could only hope for compliance. This concept really resonated with me, as it succinctly defined what so many psychiatrists and other mental health workers seem to be striving for in their work, rather than truly helping the patient feel better and become autonomous. Compliance creates a cycle of dependence by the client upon the treatment providers. This approach suggests that it is always the mental health providers that are deciding what is effective and never allows the patient to refuse treatment or be the one who determines what works.
It is self-determination that is the desired outcome (Deegan, 1995), and our role as professionals is to support that through empowerment and creating an environment that encourages recovery. There needs to be a future in mental health care that envisions a life beyond psychiatric hospitals and short-term acute psychiatric centers, and one that provides the space for someone who really embrace their strengths and abilities without being defined by their diagnosis. Where have we gone wrong in the “helping” professions to perpetuate such a rigid and unhelpful message of treatment and assistance?
Thank you for a great semester. I have learned so much from our schoolwork and from all of you.
I too found this class to be one of the better ones in the program. I learned more practical information than in other classes.
ReplyDeleteNancy
My top take away from the course is that I have a lot to learn about working with people with mental illness. While this doesn’t come as a complete surprise, neither did knowing that I already practice the importance of the person coming before the mental illness and knowing how important it is to approach each client as a unique individual and form a collaboration toward recovery. Using a person-centered approach is important for the success of treatment and recovery of mental health patients. So, there are two top takeaways from this course for me personally: 1) I have a lot to learn and 2) I am already doing some things right.
ReplyDeleteKaron’s article, “The Use of Hallucinations in the Treatment of Psychotic Patients,” was enlightening to me because it talked about using hallucinations to help communicate with patients in order to really hear what people are trying to convey through their hallucinations. And teaching patients to pay attention to their hallucinations because “when they can pay careful attention to their perceptions, then they can learn to distinguish between fantasy and reality.” It added another layer to how someone might communicate, or how information could be extracted from a client in another way, through their hallucinations. Communication is fundamental to recovery as well as laying the foundation of a trusting counselor/client relationship, which is another important aspect of successful recovery.
Lisa,
DeleteWhat a fantastic humble take away. Great to hear that you are already exercising some of the things we have discussed in class. I am sure you had quite a bit of aha moments this semester. To caveat with you, I am learning daily as well every day brings forth new ideas. One morning you are working with a client who blames you for everything from here to the sun the next day may bring a client who is thankful for what you share with them and are appreciative of your efforts. I enjoyed reading your take away.
While this may not have been an "a-ha" moment, it was what I think would be my biggest take away, or maybe my favorite thing from this course. I was so inspired watching the West 47th Street video about Fountain House. Being able to watch a documentary that was uplifting and should the successes possible in mental health treatment, as reported by people who lived those experiences, was something we all should remember in our future journeys. Unlike Deegan, whom was inspirational in her own right, these were everyday people. Not people whom had collegiate training and were well versed in the educational side of mental health, in the theoretical approaches, etc., but everyday people whom lived and still live with mental illness, who experienced the negatives and positives of societal treatment of them as a result, be it having experienced homelessness and judgement, to being valued and accepted, and given opportunities to live full lives on their terms. That sort of positive outcome is what we should hope to attain with every client we work with. We listen to them, we value them, we give them opportunities to share their gifts and talents, while helping them to learn to live with their mental illness and still have full, meaningful lives as they see it.
ReplyDeleteEach person at Fountain House is treated as an individual. They are accepted for who they are and where they are in accepting themselves. They are not coddled, either. They are held accountable to do their jobs, etc., just like everyone else. I was inspired by two scenes the most -
Zeinab Wali, a women with schizophrenia whom was shunned by her husband and lost her children, is moved into her own apartment after living on the streets for many years. She tears up, and is so grateful for the opportunity. She comments how difficult living on the streets was and how she almost cannot comprehend now having a safe, comfortable place to stay. Things many of us take for granted.
Tex Gordon, a older man whom has spent 40 years of his life with others in control of him, what he does, where he goes, where he lives, etc., and being subjected to different abuses and exploitation, is now granted control over his own life by the very court system that stripped him of that control 20 years earlier. As he recalls his past and shows us where he lived and how he lived, it is humbling and inspiring.
Some of these people may have had relapses in recovery, but that is to be expected. Recovery is not a destination, but an lifelong experience, with ups and downs, not so unlike the lives of every one of us. Good days and bad, to me its more about how you handle those days, what you aspire to do with your life, and if you have supports to help you along the way. To me mental illness is just another label. I am more interested in getting to know the people, and supporting them as individuals with their own unique gifts, and stories, and dreams. We all should be viewed from this perspective.
A big "Aha" moment for me was learning about the Tukes, Pinel, and traitement moral vs moral treatment. This section of the course stood out to me because I see the impact of the Quaker approach to treatment/management so strongly in the way we currently provide care to mental health patients especially in inpatient treatment. I found it so interesting to see where the roots of these approaches come from and the thinking behind them and how much they shape patient care and how patients are viewed (i.e. as needing to be 'corrected' in order to fit into and be functional in society). Understanding the foundations of the rationale for the treatment helped me to identify it when I see it in current practice (behavioral plans with incentives & consequences, earned privileges, etc.) and it really enabled me to start questioning is that the best system? I don't think I have solid answers to that very important question at this point, but the fact that I am looking at and questioning the status quo now is much more than I was doing before taking this class.
ReplyDeleteThroughout the course in this semester it was fascinating to learn how far back the study and care for the mentally insane and mentally challenged dates back. This has made me wonder if Pussin and Pinel had not brought forth the movement for moral treatment of mental illness when they did, could we have read different names from a different period of time. Pussin and Pinel changed the methods of treatment on how the mentally ill were treated. This resulted in a change of positive behaviors from the mentally insane. The mentally insane were no longer viewed as animals. The big take away is that in 1793 this was a big game changer in the field of mental illness. Today the field of mental health continues to make positive strides. Certainly, with the adoption of the Americans with Disabilities Act of 1973 in which prohibits discrimination against people with disabilities played a big part in inclusion for those who have a disability. New ideas and treatment have been adopted in the past two decades, we can look forward to newer ideas or enhanced methods of what is in place today will continue to be reshaped as we continue our care for those who face their disability and mental illness challenges. I look forward to see how evidence-based practice and shared decision making will continue to make strides in assisting our patients as they learn how to live with their disabilities or mental illness.
ReplyDeleteIt’s so hard for me to pick just one “aha” moment from this class, since I feel like I had at least one each week. I guess I could say the whole concept of recovery from mental illness for me was a big “aha” moment. As a social work major, we talk a lot about mental health as many of the clients we have also have some mental health issues going on. For most of my education on this topic, the idea of “recovery” was never brought up. The conversation was usually centered around how to help people manage, treat, or “deal with” their mental illness. I had never once before heard this framed as “recovery”, which makes so much sense when you actually think about it. Learning how to best manage and treat your mental illness and work towards that IS recovery (duh moment). I’m glad that going forward, I’ll be able to talk about this process and frame it as recovery, because I think this specific wording is also important, both to patients and to professionals. It implies that mental illness is not something that needs to take over and control your whole life, but rather something that can be dealt with and managed and learned to live with in specific ways for each individual.
ReplyDeleteNoelani,
DeleteIt is fantastic to read what recovery means to you and that now you will be able identify with your patients that they may be participating in their form of recovery while meeting with you. One of the things that stuck to me this semester is a statement that Dr. Deegan made in one of her articles in that when a person goes through recovery there may be some gains and times of relapses. As practioners we all hope that a patient will not relapse, however we all know it is inevitable that a patient may relapse and we have to be prepared when our patient needs us to be there for them.
My top take away from this course is continue to be proactive, to ask questions and keep my mind and eyes open to the movement of recovery. The course really laid out the course of mental health and it’s progression to where we are today and it’s always refreshing to get back to the roots and see how treatment and care has evolved for the better of the patient. With that said, I still need to be aware and understanding for patients to ensure they are receiving the care they are entitled to because sadly bad things still happen in the mental health field.
ReplyDeleteThis course enlightened me about prescriptions and the push behind them from pharmaceutical companies and agencies. How agencies are sometimes more concerned with numbers than they are with the proper care. I need to be aware and advocate for myself and clients. As a future provider I hope to be able to instill empowerment and hope into my clients and to provide a safe haven for them to be themselves and receive the best care possible.
I agree Vessa that it's so important to be proactive in advocating for our clients. It was so interesting to see the Mental Health movement from its origins.
DeleteBest wishes !
This class seems to tie together a lot of the information from other classes and offer some tips in terms of client advocacy.
ReplyDelete