It's easy to assume that when it comes to psychosocial recovery, more support is going to lead to better outcomes. This is an easy pitfall to slip into when you have struggled to get support for a long time and finally receive a package through the NDIS.
When we are struggling with psychosocial disability it can feel like such a complex issue. Psychosocial disability is not as tangible as others. We can’t easily measure it, and sometimes it's not easy to pinpoint exactly what causes it and what will help. For many, this leads to an assumption that we’re going to need “all the help we can get”.
At Mind-Life we believe that psychosocial disability is a symptom of chronically unmet needs and lost opportunities. We do not see it as a deficit within the person, rather it’s the systems of support and wellbeing in their life.
“Psychosocial disability is not a symptom of mental illness; it is a negative side effect of lost opportunities”
“Psychosocial disability is not a symptom of mental illness but a symptom of unmet need.”
What happens when a person who has deficits within their systems of support engages more of the same kind of support in the hope that things will get better?
Sometimes the person experiences atrophy in their mind-life skills which leads to a worsening of their “symptoms”. Often the person and their supporters think that this deterioration is due to the person’s disability getting worse. So, what do they do? Load up with more services! And so, the cycle continues.
In this situation the person doesn’t need more services, they need something completely different. When a person seems to be getting worse (or no better) no matter how much support they have, it can feel scary. This can trigger values and beliefs within themselves and their supporters. These beliefs often come from a caring value base, but are actually false:
Mental illness is a degenerative condition and it's inevitable that the person will need more supports as time goes on.
This person is “sicker” that those other people who recover. The best we can hope for is Maintenance.
My role (supporter) is to give this person quality of life as best I can, keep them safe and protected from stress.
If the person pushes themself too hard, they might get unwell and relapse.
Relapse is always a bad thing
These beliefs are pitfalls, and they only get perpetuated when we take on more and more, inappropriate support.
A great analogy for what happens in this case is the muscles in a limb that has been in a cast for a very long time. The muscles are our mind-life muscles; our self-righting; self-determination; human rights; confidence; self-esteem; belief etc. When we get wrapped up in lots of services because they assume we are broken, the services wrapping around us act as a cast.
However, in the case of a broken arm or leg, the doctor only keeps the cast on for as little time as necessary. The doctor has no intention of leaving the cast on for the rest of the person’s life. The doctor knows that the cast is useful for a short time to allow the person’s self-righting to do its initial work (mend the bone), but if the cast stays on too long the muscles will be too weak and cause a whole raft of other problems. Additionally, the doctor knows that when that cast comes off, the person will need a different kind of help to practice using those muscles again. It will be hard, tiring and maybe even a bit painful. But it's an essential part of the healing journey so they prepare to support the person through that.
When the cast of “wrap around psychosocial supports” is left on for too long, our mind-life muscles atrophy too. We cannot flex those muscles and build them up with a full cast on, but when that cast comes off, we will initially feel vulnerable and weak. Of course, the doctor treating the broken limb doesn’t just abandon the person to their rehabilitation journey, there is targeted, temporary support offered to that unique phase of the self-righting process. There is still support (e.g., physio) but it's different, with a different intention and positioning.
What tends to happen in many situations is that a person’s psychosocial cast is never taken off, or it’s taken off without the understanding of the different needs of this phase of the self-righting journey. The support is removed without any training in how to build up that muscle again. The person is vulnerable and falls down and the cast is quickly re-applied and sometimes the person is blamed for it.
There are two distinct phases of intervention in the broken bone analogy.
The initial phase is the rest and protect phase. In this stage of healing, the injury is protected from moving too much or undergoing stress. A cast is used to keep the limb protected so that the person’s internal healing efforts can be focused on mending the bone. It's important to note that cast doesn’t do the healing - the person does. The cast simply creates an environment that is conducive to self-healing.
The Second phase: is the strengthen and build phase. In this stage of the healing journey the focus is no longer of reducing stress and movement. It's about targeting the atrophied muscles and building them up gradually. The person is expected to make a full recovery and will need to develop full strength in order to function in their normal life. It is seen as normal and natural to experience some pain, difficulty, and frustration. They may even experience setbacks. The person is expected to do work- exercises etc. They are supported to do this by highly skilled and trained people with a deep understanding of what this takes. This is all seen as a natural and necessary part of the self-righting process. The intention of support is to help the person to carefully stretch and build their functioning beyond what feels comfortable, without going so far as to create further injury.
When we experience wrap around psychosocial supports that aim to keep us safe, happy and “maintained” - especially those who expect to remain in our lives forever, we are ultimately signing up to keeping our cast on permanently. While this might feel safe, it may be killing us with kindness.
If you have been experiencing psychosocial disability for a long time, maybe you need to assess what stage of the self-righting journey you are in. If it's time to take the cast off, what specific, targeted, and temporary, supports do you need to help you flex those mind-life muscles and build your strength - without causing further problems? This is not about removing support; it's about accessing something different.
How much discomfort are you willing to tolerate?
What small risks or challenges are you willing to take to build up those muscles?
How will you know when it's time to rest so that you don’t end up back in the cast?
What special skills and experience do you need your supporters to have for these tasks?
These are some important questions to ask yourself and could create a brilliant conversation with your supporters.
For people providing support:
Are you a cast or a strengthen and build service?
If you are a flex and build service, how are you helping the person to stretch and grow?
How are you creating an environment of challenge, supported risk taking and growing independence?
How do you help the person to manage their need for rest and become able to self-manage that?
If you are not doing these things with the people you are supporting, then perhaps you are simply a cast. But you can change that.
There are lots of resources on the Mind-Life website that can help individuals and supporters to move out of the cast stage and into strengthening, building, and flexing their self-righting mind-life muscles.
Join the conversation by signing up at www.mind-life.org.au.