E1142Mental Health6 Recovery oriented services and relationships6.1 Recovery-oriented practice6.1.1 Recovering from asylums: the history of mentalhealthWhereas the concept of mental health/illness is a relatively recent one, there is evidence thatpeople have lived with mental health conditions since ancient times. Ancient cultures in Egypt,Greece and Rome viewed mental illness as an expression of ‘spiritual powers at work on aperson’ so they dealt with it in a religious context. Another theory was that mental illness wascaused by an imbalance of body fluids which affected the brain, the ‘organ of the mind’. In theMiddle Ages, mental illness was often seen as a sign of ‘the Devil at work’ and people were,unfortunately, treated accordingly. Historic evidence shows that some people burnt at the stakeas ‘witches’ or ‘heretics’ were simply people living with a mental illness.Source: Salve Matar Asylum,Wesley Brown, 2016.The first institution’ or ‘home for people with mental illness was established in the 15th centuryin Spain and this trend of confining unwell people together in one place, continued for the next fewcenturies across Europe and later in the New World. These early institutions later became knownas asylums and they remained as the primary approach to dealing with mental illness until the 20thcentury. This meant that people with mental illness were removed from their communities andlocked away in institutions where they were subjected to treatment methods that can only becalled dubious at best and in some instances, cruel.Water treatments, electric shocks and insulin-induced coma are examples of treatment methodsthat were used in this period; there is little evidence of people recovering as a result of thesetreatments.In the late 19th/ early 20th century, there was a significant change in the approach to mental illnesswhen Sigmund Freud and his disciples started introducing a very different way of working withpatients. ‘The talking cure’ as it was called, offered an alternative model of care and treatment,| Topic – 2 / 8© Open Colleges Pty Ltd, 2020.however, it was not well-received by the medical community, ironically perhaps because it wasseen as ‘too easy’.Around the same time, the American psychiatrist, Walter Freeman, introduced another treatmentfor people deemed as suffering from ‘incurable mental illness’. The prefrontal lobotomy was aprocedure where nerves in the brain were severed to achieve calmer behavior in patients. Thisprocedure was performed thousands of times in the 1940s and 1950s, mainly in the US, also inother countries such as Australia. Germany and Japan outlawed this operation, effectivelyremoving it from the scope of treatments for people with mental illness.The history of mental health treatmentsWatch this video about the history of mental health treatments to gain better insight of howpeople with mental illness were treated in the past.[https://youtube.com/watch?v=1Izmyru5T_w]Note: This video contains some disturbing images and information. Some students may find it confronting andupsetting. Please be aware of this before watching.Institutions as the preferred model of care continued into the second half of the 20th centurywhich meant that people with mental illness continued to be excluded from wider society.| Topic – 3 / 8© Open Colleges Pty Ltd, 2020.Welfare authorities argued that this was for the good of:the public who needed to be protected from people with a mental illnesspeople with a mental illness who needed to be protected from themselves.This further strengthened the idea that people with a mental illness were different and eitherdangerous or frightening.Living in an institution limited the opportunities for people with a mental illness to learn life, socialand work skills. One of the problems with this approach is that if people do not learn the relevantskills, they may behave inappropriately in social situations. For example, they might be withdrawnas they lack the confidence or social skills to interact with people or, at the other end of thespectrum, they might be overly affectionate. Most people typically react negatively toinappropriate behaviour, which can reinforce an individual’s already low sense of self-worth,making it even harder for that person to recover optimal good health. The occurance ofinappropriate behavior was often attributed to the person’s mental illness, rather than theirexperiences in institutional care and strengthened the perception that the person was ill-equipedto live in society.While there are still specialised mental illness facilities today, these are usually located alongsideor in other healthcare services, and people are admitted to these facilities for a specified lengthof time. This sends the clear message that people with mental illness are no different and no lessworthy than people with other conditions or disabilities. Inpatient mental health facilities areusually for stabilising people experiencing an acute episode before they are discharged back intothe community.In the 1970s a psychologist, David Rosehan, carried out a study of different psychiatric hospitals.Eleven volunteers rang up different hospitals, claiming to have heard voices. Each of thesevolunteers was admitted, despite the fact that none of these volunteers had a mental illness andhad simply volunteered forDavid Rosehan’s experimentThe process of deinstitutionalisation – moving the care of people with mental illness fromspecialised settings back to the community – commenced in the 1970s and 1980s. The main drivers of this process werean increased understanding of humanrights concerns for consumers as wellas advances in medication to treatconditions that were previously seen asuntreatable. Chlorpromazine was“| Topic – 4 / 8© Open Colleges Pty Ltd, 2020.[https://en.wikipedia.org/wiki/Rosenhan_experiment]. After admission, none of the volunteers displayed behaviours to indicate they were experiencinga mental health illness.All institutions showed the following aspects of care; some to a greater or lesser degree thanothers:there was no privacy for patientstoileting and other personal activities were conducted in the view of staffall staff were able to access the patient’s personal information.The volunteers noted that corporal punishment was used on clients/patients and that staff weredisrespectful to those in their care. The interactions between staff and patients were distressing.Patients who became angry or distressed by their treatment were not given the chance to speakout, and there were no structures in place to handle complaints. Any attempts at makingcomplaints were seen as symptoms of illness, rather than as being a reasonable response to anunreasonable environment. This experiment highlighted the dehumanising conditions ininstitutions and contributed in part to the closure of institutions.In Australia, in the early 1980s both the public and people working in the mental health sectorwere becoming aware that there were better, more effective and more humane ways to treatpeople with mental illnesses. The ‘The Richmond Report[http://nswmentalhealthcommission.com.au/node/1521]‘ (1983), was about redressing the imbalance between institutionalised hospital care andcommunity care in mental health services while advocating strongly for a more decentralised andintegrated model of care and support.Ten years later in 1993, the “Burdekin Report”, strongly supported deinstitutionalisation. Thisreport was a result of a national inquiry into the human rights of people with mental illness. Thisinquiry was carried out in the early 1990s and included extensive research as well as publichearings with consumers and their families. The establishement of a mental health crisis team andcommunity mental health facilities were some of the results of this report which opened thedoors for people with mental illness to integrate back into the wider community.intended for the use on patients duringsurgery, it quickly attracted theinterest of the psychiatric profession asa treatment for people withschizophrenia (Healy, 1997). Thesuccessful use of medication led tofurther research and a continuingincrease of psychiatric medication,superseeding other treatment formssuch as brain surgery or the applicationof electro-convulsive therapy (ECT). Theappearance of psychiatric medicationalso started a shift in perception, aspeople who were previously seen asuntreatable were now seen as beingable to live without the framework of| Topic – 5 / 8© Open Colleges Pty Ltd, 2020. Reading 42512The Burdekin ReportFind out more about theimportant report[https://www.humanrights.gov.au/news/speeches/burdekin-national-inquiry]that changed the landscape of mental health care in Australia. You will learn more aboutthe context of the recovery framework.ACTIVITY 42512 TYPE ReadingSCENARIO The Burdekin Report an institutional environment.| Topic – 6 / 8© Open Colleges Pty Ltd, 2020. Reading 42513The Not for Service report[https://mhaustralia.org/sites/default/files/imported/component/rsfiles/publications/Not_For_Service__Full_Report.pdf]Read thisNot for Service report[https://mhaustralia.org/sites/default/files/imported/component/rsfiles/publications/Not_For_Service__Full_Report.pdf]that describes the complex relationship between mental health and human rights.HintsThis report was published over 10 years after the Burdekin report. Many issues have stillremained the same.ACTIVITY 42513 TYPE Reading| Topic – 7 / 8© Open Colleges Pty Ltd, 2020.SCENARIO The Not for Service report Deinstitutionalisation is one of the major social changes that has taken place; placing people in arestricted facility is now considered only as a last resort. However, some people with profoundmental health issues do require intensive care. In the past, this care could only be provided infacilities or hospitals. Late last century, new processes and systems were introduced to helpcater for people with high-level mental health needs without forcing them into an institution.In most Australian states, these processes and systems are known as Community TreatmentOrders (CTO) or Community Counselling Orders (CCO), they are a legal order made by either amagistrate or the Mental Health Review Tribunal. They provide details about when, how often andthe type of care and treatment a person who has previously refused care, must receive. If theperson fails to comply with their CTO, they can be involuntarily admitted to a psychiatric hospital.Another key change has been in the use of language to describe people accessing services.Previously, people were called ‘patients’, which indicates someone who follows instructions. Nowthey are known as ‘clients’ or ‘consumers’, which implies that the person has the right to demandthe type of care they receive. This change aligns with the person-centred and recovery-orientedmodel of mental health care. A worker using this model of mental health care will focus on theperson’s strengths, as well as their needs and preferences.The use of consumer workers is another feature of contemporary mental health care. Aconsumer worker is someone who has experience as a consumer of mental health services.Consumer workers have insights into the needs and experience of people with a mental illnessand are often well-placed to advocate for other consumers. In addition, consumer workers canhelp providers improve the quality of the service they provide.Deinstitutionalisation and the movement towards a more rights-based approached required for anew framework of service delivery to consumers, one where people with mental illness were notonly seen through the lens of their deficits and subjected to treatment, often without theirconsent. The recovery-oriented model was born.| Topic – 8 / 8© Open Colleges Pty Ltd, 2020.
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