Understanding the whole person
The Revolving Doors Agency has just (26 November 2015) published the first in a series of literature reviews on severe and multiple disadvantage.
Entitled: Understanding the whole person, it asks the key question:
What are the common concepts for recovery and desistance across the fields of mental health, substance misuse, and criminology?
Written by Lucy Terry (@LucyACTerry)and Vicki Cardwell (@vickihcardwell), and funded by the Lankelly Chase Foundation, the report examines existing research in several different disciplines and concludes that people facing complex needs and disadvantaged lives will see many common steps across their recovery journeys.
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Commonalities
The authors reviewed 53 studies across the mental health recovery, desistance from crime and substance misuse recovery sectors. They found three common themes:
- Recovery journeys are difficult and relapse or setbacks are common. But many people can and do overcome deeply entrenched problems
- Finding meaningful opportunities and roles helps to build a positive self-image
- Supportive friends and family play a key role in sustaining these journeys, while discriminatory attitudes and labels can hold people back.
These findings are explored in more detail below.
A long and difficult process
The literature is clear across all three domains that recovery from/in mental illness, recovery from substance misuse and desistance from crime are processes that take considerable time and effort. The journeys involve deciding to change (whether gradually or suddenly), and then consistently maintaining that decision in the face of stigma, anxiety and fear, barriers to opportunities and social exclusion. Maintaining a process of change is different from and harder than deciding to change. Lapses and setbacks are part of most journeys, which are non-linear, even if the overall trajectory is upwards.
Maintaining the process of desistance or recovery is dependent on things like personal skills and capabilities, support networks, self-confidence and location. For example, recovery from drug misuse may require building up a new community of supportive friends, and moving away from contacts who encourage using.
The literature across all three domains depicts these processes as highly subjective. It is about the ‘lived realities’ of people’s lives, not a prescribed service intervention or a combination of factors that automatically propel someone forward. Recovery and desistance happen largely outside formal treatment settings and support services. Professional roles are to support and facilitate these journeys, with some researchers arguing that the main responsibility of professionals is simply to not “get in the way” of recovery.
One of the most fundamental aspects of successful journeys of recovery and desistance is a strong, coherent and positive personal identity. People must be able to imagine themselves beyond the identities of addict, offender, or mental health patient. This new identity must also be reaffirmed by others. Without this robust sense of a ‘good’ self, which is meaningful to the individual, it is hard to believe in the possibility of change.
In addiction recovery and desistance in particular, a feeling of shame or dislike around what one has ‘become’ is fairly common, but must be accompanied by a sense of a positive future for oneself.
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Meaning in life
Identity is strongly tied to meaningful roles in life, which validate new positive identities, making people feel part of the ‘mainstream’ and giving self-worth. People’s roles reinforce their identities, defining themselves by their occupation, their role in the community, their relationship to others: mother, friend, carer, expert by experience, counsellor. Longitudinal data shows a strong association between higher life quality and engagement in meaningful activity. But (re)assuming these roles is not always easy; for example it is hard to reassert parental authority following residential care or prison.
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Support
The literature across all three domains shows that developing a meaningful identity cannot be separated from social capital. Social networks provide emotional support, empathy, inspiration, encouragement, opportunities, roles, practical help, a chance to give help as well as receive, and motivation to change. The research finds that supportive social networks are a strong predictor of quality recovery from substance misuse.
Differences
However, there are also some differences in recovery journeys from these different problems (although, it is important to remember that many people face two or all three of these problems – and often homelessness as well).
The mental health recovery model is not primarily about recovery from mental illness symptoms, since many people will need to learn to cope with these symptoms throughout their lives.
In the mental health literature, services and systems are often portrayed as the biggest barriers to recovery, in undermining choice, personhood, hope, and self-control. Some problems are actually caused by doctors and the mental health treatment system and the continuing (if slowly lessening) stigmas and stereotypes which abound in mainstream society.
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Conclusion
The paper is part of an ambitious project aiming to break down academic boundaries and promote collaboration between researchers, leading to greater insight into the experiences of people facing multiple needs.
Vicki Helyar-Cardwell, one of the authors and the Director of Research and Development at Revolving Doors, said:
People facing multiple and complex needs have a steep hill to climb in search of a better life. People need to believe in their own potential, and have the support of others. The review should also encourage us to be optimistic as it shows that change is possible, even if it is hard to get there.
3 Responses
Before I start I just want you guys to know I am not ant-police, I have met some really decent coppers n my time who have done the job the way it is supposed to be done, it was ever personal for me, i was comitting crimes and getting captured case closed. I also know we do need the police because if we did not have anyone to enforce the rules,regulations and laws there would be some really bad people running things and i mean really really bad people who are nothing only bully’s but nasty bully’s that can really hurt other people, hurting other people as ever my thing even when i was a junkie and so i know why we need the police in our world god forbid we should ever have none.
I left my home town moved 25 miles away to another area and went into an hostel, I joined in any groups they had going, and got loads of good support fro the staff and people they introduced me to and i also got an excellent drug worker and doctor to, my life was so good at this point, the best I had ever known it in my 40 years and i was flying high ( no pun intended 😉 i’d been there just over a year when i got my flat, i was ecstatic, you would of thought i was moving into a palace but i knew this time things would be different, it was time for me to start making amends and helping the community you know sort of give something back, i was doing voluntary work with people with mental health problems, and got another voluntary job cooking with vulnerable adults, my life was on track my family had come back into my life 6 months before-hand everything was running like a dream, we’d worked hard on our gardens at our flat we had 3 Gardens, a tiny one at the side and front and huge backyard one which was almost an acre in size and because we were a down stairs flat it was our responsibility and the grass had been 6ft high when we moved in and there had been all sorts of rubbish in this back garden, there was even a pathway were people had been using it to cut through to another street at the back of it, but we got it looking like a bowling green, we built fences and put shrubs and flowers to, my parents spent a couple of thousand making sure our home as nice and comfy insides and besides i wanted the neighbours to think i was as good as any of them, we’d never been respected in our own communities and i was determined it would be different this time and we weren’t known for drugs in this area and we never would be and so we got the respect any person gets and we kept it nice and we mixed well with some of the neighbours, only chatting in the street and at wk ends my partner would go on the front with a couple of the other lads who lived there and they would fix cars, we fitted in really well, I didn’t go into anyone’s home chatting or anything like that, i kept a bit of distance and it worked for us we were really happy there and it seemed i was having so much good luck I thought that it couldn’t last, this never happened to me where I got all this luck and I loved my new life, I am paying all my bills and in no way am i involved in any criminal activity at all, yes life was good, I used to say to my mother that i couldn’t believe how things had turned out and that I kept waiting for the bubble to burst, i could never fully enjoy the feeling and with good reason back then as it turns out. So one morning we are going to get the fortnightly food shop at our local tesco’s, it’s freezing and as been snowing and would be hard work getting there underfoot but money was tight so we walked it to save on taxi fares, we didn’t drive but we didn’t mind, my son had called down that morning and said he would come with us, he was so proud of me my son and i loved him seeing me doing normal “Mum” stuff it felt really good, so were walking down a street and from nowhere a little police car pulls up at the side of myself and my son looked at us up and down and then moved further up the road to my partner who was in front of us, now we all had our scarves and hats, gloves etc it was so cold, next thing they jump out the police car a man and woman and run round the car to where my partner is and start asking him his name, so he goes on the defensive right away because we’ve done nothing and they are not supposed to be able to do this kind of thing if we haven’t done anything wrong and my partner says “why should I tell you my name, am I being arrested for something”? and we hear a noise an old guy who lives in a house where stood in front of as come to his front door and is watching and listening, so the policeman starts getting pissy and tells my partner “Take your hood and hat off i want to see your face now and if you cause problems you won’t like me” to which my partner tells him “I don’t like you anyway and I am not taking my hood down or hat off unless I am being arrested so am I being arrested”? at which point to I want to calm things down and I say “I’ll give you my name and so there on the side of the road with my son who has never been in trouble in his life and is a manager in a local well known restaurant, the local policeman drinks in this place and takes his family and chats regularly with my son and all sorts of other prominent people go in this place my son manages and so they take my details and his, i wanted to cry because I had lead that life all those years and never had my children been questioned by the police or PNC searched and next he ask my son for his details , after me pleading for a minute my partner gives them his details, he was a nasty little sod with a bad attitude the policeman was and the woman didn’t say much except but stood as if she as ready to back him up and the way he had been with us all had rubbed my partner up the wrong way and he was angry although quietly angry as he did not want to give them any excuses to lock him up now he would of found something to lock him up for i am sure but the man was still watching from his front door step and so he let us go, we carried on and an hour or so after had forgotten all about it and enjoyed the rest of our day. Forward to lunchtime the following day I am just getting ready to go out at lunchtime and there’s a knock at my door, I open it to see 2 policemen standing there, one of them says my name and asks if they can “come in Dawn and don’t look so worried you’ve not done anything wrong” and I reply ” I know i have not done anything wrong and yes come in” they come in, I have never seen either of them before in my life and the he drops a bombshell he say’s “You have come up on our computer system as a person of interest and so we are going to be keeping a close eye on you for a while” I was stunned ” I ask “are you joking”? and he’s shaking his head and saying “Someone will call on you each day Dawn only for a minute or 2 why they make sure everything is above board and when they think it’s ok then we’ll be told to stop coming” I ask what reason they are coming he tells me “We don’t know the answer to that Dawn it just comes up on computer and we follow orders ad with that they leave, It didn’t sin n properly that first day but when the second day they rolled up my partner is ready to blow and he tells them you’re not coming in our house and in future you knock at the door and go down the path again and stay there till we answer and so I calm the situation down as best I can because underneath I know it is the sneaky little swine that pulled us going to Tesco’s and he wants my partner in the cells were he can get at him and by the end up really sobbing by the 5th day, I have to tell my family now, and i am scared they won’t believe me when i tell them i have done nothing wrong, i have been crying non stop for 5 days now, my life is not meant to be straight i am thinking and so i cry twice as hard why i am explaining all of this to my parents and my sister luckily my sister is made of stronger stuff and right away she puts wheels in motion and the day after she is speaking the the chief superintendent of my area, who is telling my sister there will be a reason for them coming, she explains how i have moved away and turned everything round, she also brings in my drug worker and my doctor and a day later it turns out they cannot find a reason why this had been started, it was one of the police who came to the house that gave us the right phone number to get in touch with the right people, he knew we’d done nothing wrong and he also said “It isn’t right what’s being done to you” that kick started it all getting sorted out and stopped, luckily i had enough people to fight my corner and the policeman that had pulled us that i said was the little swine who did it, i was right about him, he was reprimanded and punished in someway but how i don’t know, but it really knocked me and took me ages to feel good in my skin again, and so it as the police who came the nearest to knocking me backwards to the dark side of the road again and it made me wonder how many of them have pulled stunts like this because had it been someone that didn’t have family and such to stand up for them they’d of stood no chance, suppose he thought he would end up coming to the house one day on one of the daily calls and would have my partner then……..I actually think that once the police service is being run properly by people who are not out to get certain criminals just because they don’t like them or things they’ve done, that should never be a reason to go after someone because it breeds resentment and causes more strife for everyone…the last thing you need or want in recovery is being punished because of what or who you used to be and the very last people you expect to do that to you is the police, all of us should feel like we are in the safest place in the world when we are with a policeman/woman or in a police station.
People in powerful positions need to be very aware of what stages that addicts or vulnerable people are in when they are in reovery
Thanks for that, it read like a Franz Kafka scenario and it’s appalling that such a thing can happen to people. The power of the police can be abused and this is a prime example of this. Best wishes and I really appreciate you sharing this experience, which reinforces the negative and obtrusiveness power of stigma. I’m really glad that you’ve had some closure to this. Happy gardening.