Secure Recovery by Drennan Gerard;Alred Deborah;Shuker Richard;

Author:Drennan, Gerard;Alred, Deborah;Shuker, Richard;
Language: eng
Format: epub
Publisher: Willan Publishing

7 Recovering personhood

Using recovery principles

on a long-stay medium secure ward

Jay Smith and Veronica Garcia

Introduction

In late 2003 we opened a 15-bedded ward in the Forensic Directorate of the East London NHS Foundation Trust. Our long-term rehabilitation ward was established for the treatment of male service users who had spent many years in secure psychiatric settings. In psychiatric language, they demonstrated a combination of ongoing psychotic symptoms, behavioural problems, personality disorder and risk. As people, our service users shared a common background of neglectful, abusive or chaotic parenting, which greatly compromised their ability to trust themselves, other people or their environment. These adverse life experiences contributed to an inability to receive help and work collaboratively with others, which at least partly explained how they had found themselves spending a large part of their adult lives in institutions.

In this chapter we seek to describe how the application of recovery principles within the ward setting helped our users to take the first step on the road to recovery: namely, the rediscovery of their personhood. As Anthony (2004) states, ‘people want to self-determine their own goals, be involved in their own lives, believe in their capacity to grow and have hope’. Although this statement is simple and self-evident, as with so many simple principles difficulties arise when translating it into practice. Without careful attention, secure psychiatric hospitals readily become dehumanizing environments, riven by fear, persecutory anxiety and ruthless struggles over power and control. Such environments often iterate the service user’s difficulties (Cordess, 2006) by, for example, emphasizing power at the expense of relatedness or by dismissing the importance of attachments. All who have worked in secure psychiatric institutions will have experienced the shockingly abrupt transfers of staff and patients or witnessed the almost ‘knee-jerk’ repressive response to an infraction of one of the many rules. As Hyatt-Williams (1998 ; p. 217) rightly points out, such environments can promote stasis, but not change.

In designing the ward, we thus had to meet a number of potentially conflicting aims. We had to maintain safety and adhere to the structures of the institution while offering our users a different experience, one that would allow them to rediscover their personhood. For some of our users, we were offering long term care or a ‘home’ as some patients have come to describe it – but we had to make room for the possibility that things might change in a way that would allow some individuals to leave the ward to start a new life elsewhere. We had to have hope for our users, but also acknowledge that such hopes may not be fulfilled.

(Frey-Wehrlin et al., 1989)

This chapter describes aspects of the recovery approach used in our particular community. We describe the structures and approaches we use, all of which has been informed by what our service users have taught us about being a person with mental illness. Several of our service users have contributed aspects of their stories, for which we thank them. We have removed any identifying information to preserve their privacy.

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