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Strengths-Based Approach for Mental Health Recovery

Authors:

Abstract

Many health systems have traditionally adopted a view of mental disorders based on pathologies and the risk individuals have towards mental disorders. However, with this approach, mental disorders continue to cost billions a year for the healthcare system. This paper aimed to introduce and explore what the strengths-based approach is in the psychiatric arena. Strengths-based approach moves the focus away from deficits of people with mental illnesses (consumers) and focuses on the strengths and resources of the consumers. The paper also aligned the relevance of strength-based approach to mental health nursing and its contribution to mental health recovery. Declaration of interest: None.
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Review Article
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www.ijpbs.mazums.ac.ir Iran J Psychiatry Behav Sci, Volume 7, Number 2, Autumn / Winter 2013
5
Strengths-Based Approach for Mental Health Recovery
Huiting Xie
*
(Received: 28 Mar 2013; Revised: 20 May 2013; Accepted: 18 Sep 2013)
Many health systems have traditionally adopted a view of mental disorders based on pathologies and the risk
individuals have towards mental disorders. However, with this approach, mental disorders continue to cost
billions a year for the healthcare system. This paper aimed to introduce and explore what the strengths-based
approach is in the psychiatric arena. Strengths-based approach moves the focus away from deficits of people
with mental illnesses (consumers) and focuses on the strengths and resources of the consumers. The paper also
aligned the relevance of strength-based approach to mental health nursing and its contribution to mental health
recovery.
Declaration of interest: None.
Citation: Xie H. Strengths-based approach for mental health recovery. Iran J Psychiatry Behav Sci 2013;
7(2): 5-10.
Key words: Community Mental Health Mental Health Recovery Mental Illnesses
Strengths-Based Approach
••
Introduction
ental health problems have
become one of the major
priorities for legislators and
policy makers. Mental disorders cost the
United States’ healthcare system billions of
dollars per year. The cost of lost employment
or decreased productivity and social welfare
programs have been estimated at USD 273
billion a year of which about USD 70 billion
is the estimated cost of untreated mental
illnesses
(1)
. According to a study by the
World Health Organization (WHO) in 2001,
mental illnesses rank first in terms of causing
disability as compared to other diseases
(2)
.
Many health systems have traditionally
adopted a medical view of mental disorders
based on diagnostic categories such as
‘schizophrenia’, ‘bipolar disorder’ and
‘personality disorders’. The emphasis has
been on looking for pathologies or symptoms
Authors’ affiliation: * Senior Staff Nurse, Nursing Training,
Institute of Mental Health, Buangkok View, Singapore.
Corresponding author: Huiting Xie, Senior Staff Nurse, Nursing
Training, Institute of Mental health, Buangkok View, Singapore.
Address: Institute of Mental health (IMH), Singapore, Punggol
Arcadia, Blk 289C Punggol Place #09-861, Singapore 823289.
Tel: +65 8125- 5821
Fax:+
65 63892207
Email: huitingxie.kerlyn@gmail.com
in people with mental illnesses based on the
diagnostic criteria for mental disorders.
In 1979, the term “salutogenesis” was
coined by Aaron Antonovsky, a professor of
medical sociology, to go beyond looking at
disease to focus on factors that support human
health and well-being
(3)
. The strengths-based
approach does so by focusing the attention on
individuals’ attributes that promote health,
instead of focusing on symptoms and
pathologies that induce sickness.
This paper started with a review of the
social and economic challenges in the mental
health arena to introduce the context for
strengths-based approach. This paper also
drew some beginning parallels of the
strength-based approach to mental health
recovery and present supporting evidence
from the literature. A process for practitioners
to engage in strengths-based approach was
also presented. People with mental illnesses
were addressed as consumers in this paper.
Why the strengths-based approach?
Traditionally, the mental health arena is
highly influenced by the medical model
where severe mental illnesses, are considered
chronic with irreversible neuropathological
M
Strengths Approach for Recovery
Iran J Psychiatry Behav Sci, Volume 7, Number 2, Autumn / Winter 2013 www.ijpbs.mazums.ac.ir
6
brain changes and information-processing
deficits
(4)
. Mental health recovery seems like
an impossible dream.
As healthcare providers paint a gloomy
picture of people with mental illnesses
(consumers), consumers also view themselves
in a negative light. They often realize that
they are different from others. They may
isolate themselves, which per se affect their
self-esteem. Researchers found that 24% of
the people with schizophrenia scored low on
self-esteem on the Rosenberg self-esteem
scale (RSES)
(5)
. In consumers with low self-
esteem, compromised quality of life (QoL)
and poor psychosocial functioning are often
observed
(6, 7)
. Consumers with such negative
self-appraisals perform badly in the
community, and are more likely to relapse
(8)
,
thus impeding their recovery.
Instead of employing the traditional
medical model which emphasizes on
pathology, focusing on problems and failures
in people with mental illnesses; the strength-
based approach allows practitioners to
acknowledge that every individual has a
unique set of strengths and abilities so that
he/she can rely on to overcome problems
(9)
.
Helping consumers’ recovery has become
the fundamental goal for mental health
practitioners
(10)
. Mental health recovery is a
personal journey of gaining increasing
meaningful life despite the presence of mental
illnesses
(11)
. To recover, consumers have to
be confident that they have the ability to
recover from mental health conditions. The
strengths-based approach aligns itself with the
notion of mental health recovery by focusing
on person’s ability, helping them developing
the confidence to embark on the journey of
recovery and aiding them to progress towards
mental health recovery. Attention is placed on
people’s abilities rather than their
shortcomings, symptoms or difficulties.
Mental health issues are seen as a normal part
of human life
(12)
. Consumers’ positive
attributes including assets, aspirations, hopes
and interests are elicited and cultivated.
According to Gable and Haidt
(13)
, an
understanding of strengths can help to prevent
or lessen the damage of disease, stress and
disorder.
Literature review on effectiveness of
strengths-based approach
It has been suggested that people have
strengths within themselves that can contribute
to recovery. Personal factors could aid the
recovery process
(14)
. A study on 55
consumers found that the presence of
personality asset significantly predicted long
term trend of improvement in disability over a
follow-up period of 16 years
(15)
. Additionally,
in a large scale web-based retrospective study
where 1008 participants considered themselves
to have experienced serious psychological
problems or emotional difficulties, the findings
revealed that recovery from psychological
disorders was associated with greater character
strengths
(16)
.
Strengths have been linked to prediction of
positive outcomes. In a study, providing the
multi-disciplinary team with strength-based
data resulted in better academic, social and
overall outcomes for students with emotional
and behavioral disorders as compared to
traditional socio-emotive report that focused
on the problems that students were facing
(17)
.
This suggests the possible usefulness of
strength-based assessment. Indeed, in another
study on children and adolescents living in
residential homes, the level of strengths
significantly predicted success in the
reduction of risk behaviors
(18)
. Even in the
community, studies have shown the
importance of focusing on strengths rather
than deficits. Strengths assessments were
associated with good behavioral functioning
and greater competencies
(19, 20)
.
Strengths-based approach also impacted
life satisfaction. In a study by Rust et al.
(21)
,
131 undergraduates were randomly assigned
into the control group with no treatment or in
one of the two treatment groups. One
treatment group involved participants
working on two strengths while participants
in the other treatment group worked on a
weakness and a strength point for a period of
12 weeks. The results showed no statistically
significant differences in life satisfaction
between the two treatment groups but the
treatment groups had significantly higher life
satisfaction scores than the control group.
Xie H
www.ijpbs.mazums.ac.ir Iran J Psychiatry Behav Sci, Volume 7, Number 2, Autumn / Winter 2013
7
Findings from the literature have shown
that individuals’ strengths are related to
mental health improvement. These strengths
can bring about positive outcomes in various
aspects of life as satisfaction, functional status
or health status, and have the potential to aid
mental health recovery.
Strengths-based approach in mental health
practice
Mental health care approaches in the
community setting have moved in the
direction towards encouraging people to
cultivate their interests, identify and build
their own strengths to pursue their goals
(22)
.
Policies, practice methods, and strategies have
been created that identify and draw upon the
strengths of individuals. Practitioners believe
that the consumers have strengths that can be
utilized for their recovery and work with
consumers to facilitate the use of these
strengths.
Challenges
It is often challenging for mental health
practices to move from a pathology-based
model to an individualized, strengths-based
approach. Practitioners have been socialized
to derive at a diagnosis by means of their
education and training. The common
perception is that an accurate diagnosis helps
practitioners to institute the appropriate
medical treatment to the consumers.
Practitioners are often comfortable and
confident in their role as expert. Strengths-
based approach requires that practitioners
acknowledge that they may not be all
significant in the life of consumers. However,
practitioners can use their knowledge to help
consumers to utilize their strengths and
integrate these into the recovery process.
In addition, many consumers may not seek
services voluntarily and are often viewed as
resistant or non-compliant. All these add up to
interfere with the establishment of a process
for the consumers and practitioners to identify
and work on consumers’ strengths. In
addition, consumers who are from the lower
socio-economic group or who are
experiencing stigma may not access mental
health service at an optimal level.
Furthermore, a lack of mental health
resources coupled with large case-loads poses
a major challenge to creating individualized
strengths-based service plans.
Strategies
The principles of strength-based approach
were highlighted by Saleebey
(23)
. Firstly,
everyone possesses strengths that can be
utilized to improve the quality of their life.
Secondly, the consumer’s motivation to have
better life stems from the focus on their
strengths. And, finally, all environments
contain resources that help consumers
develop their strengths.
Consumers’ families and communities may
be part of the resources consumers rely on to
develop their strengths
(23)
. Mental health
practices may partner with local community
organizations. These local organizations can
help to identify and develop informal support
system for the consumers or to provide
facilities for the consumers to hold meetings
or activities. Mental health practices can
develop a formalized structure that requires
participation from consumers as well as input
from their families and communities. People
with mental health conditions can use
activities that they perceive as meaningful to
aid their recovery
(14)
. Meetings, educational
sessions and social interventional gatherings
between consumers, their family members
and practitioners can be part of the formalized
structure. Opportunities can be created for
consumers to lead and share success stories
with one another as well as practitioners and
other partners involved. With a formalized
structure, practitioners are better able to
prioritize meetings between consumers,
family and community among competing
demands on their time.
Therapeutic relationships may also be
developed between the practitioners and
consumers. The focus of therapeutic
relationships does not lie in people’s diseases
but rather in relationships that people have
(24)
.
The focus on strengths moves the practitioner
away from the tendency to blame consumers,
but towards discovering how people have
strived despite adverse circumstance such as
Strengths Approach for Recovery
Iran J Psychiatry Behav Sci, Volume 7, Number 2, Autumn / Winter 2013 www.ijpbs.mazums.ac.ir
8
relapse of mental illnesses. The focus is upon
the person’s strengths, desires, interests,
aspirations, abilities, knowledge, and not on
their deficits, weaknesses, problems or needs as
seen by others. It does not disregard the real
pain and struggles of people with mental
illnesses but challenges the inadequacy of the
sole focus of pathology
(25).
In such therapeutic relationships,
practitioners and consumers are equal
partners. The consumers’ autonomy is
recognized. Consumers are the ones
possessing the strengths and they will also be
the ones using their strengths for their
recovery. Consumers take the driver seat and
their preferences are incorporated into the
therapeutic relationships. The practitioner
serves as a partner who has the professional
and technical knowledge to facilitate
consumers’ identification and utilization of
their strengths to progress towards recovery.
As in all partnerships, every party has a
vested interest to help the other succeed.
Consumers depend upon the practitioners for
technical advice while the opinions of the
consumers’ help practitioners understand
them better. The recovery of the consumer re-
affirms the efforts of the practitioners. The
entire family and community may also be
involved in the partnership. They could be
potential resources to support the recovery of
the consumers.
Practitioners can begin the development of
therapeutic relationships using the strengths-
based approach through an assessment of
consumer’s strengths. The strengths of each
consumer are unique to the consumer. It can
be almost anything dependent on
circumstance; however, some capacities,
resources, and assets commonly appear on a
roster of strengths. These include: personal
qualities, virtues and traits; what the person
has learnt about themselves, others and the
world; what people know about the world
around them from education or life
experience; the talents people have; cultural
and personal stories, informal networks,
institutions or professional entities
(26, 27)
.
Saleebey
(23)
suggested that strengths can be
found by looking around for evidence of the
person’s interests, talents and competencies
and by listening to their stories. Epstein et al.
(28)
suggested chatting informally with
consumers to help elicit their strengths. If the
consumers have difficulties identifying their
strengths, practitioners might chat with the
consumers asking general questions about
their hobbies or activities so that they enjoy
doing, or how they have gotten through the
acute phase of their illnesses in the past. The
consumers may also be asked to think about
their achievements at work, school or
personal life. From the identified strengths,
practitioners work with consumers to identify
strengths that can be utilized to help them
deal with their issues at the moment. After
which a plan may be developed to utilize the
strengths with the consumer setting the goals
of the plan and deriving at the planned details.
This may mean a significant shift for
practitioner, focusing on issues that the
consumers identify as important, rather than
what the practitioners perceive to be important.
The consumers are asked about the challenges
they are facing and what issues need to be
resolved first. The plan can then be
implemented; for example, by asking the
consumers to use one or more of their
identified strength/s every day for one week.
Consumers can follow-up with the
practitioners a week later to talk about the
approach and this can be an opportunity for the
practitioners to evaluate consumers’ progress.
Conclusion
The practice of mental health has been
shaped largely by the medical model where the
focus has been on solving problems and
controlling the symptoms of mental illnesses.
The strength based approach focuses on the
positive aspect on consumers. Identification and
utilization of the strengths consumers have
could put them on the road to recovery and
nursing with its emphasis of caring and
individual centered approach are in the position
to endorse strength-based approach. Creation of
partnership among consumers, clinicians and
other community agencies as well as
implementing certain policies and practices may
minimize or overcome potential challenges
associated with strengths-based approach
.
Xie H
www.ijpbs.mazums.ac.ir Iran J Psychiatry Behav Sci, Volume 7, Number 2, Autumn / Winter 2013
9
Acknowledgments
The author thanks Dr Jaclene
Zauszniewski, Director of PhD program, Case
Western Reserve University; Ms Samantha
Chong, Director of Nursing, Ms Poh Chee
Lien, Assistant Director of Nursing and all
other staff at the Institute of Mental Health
(IMH) and Joanna Briggs Institute (JBI-IMH)
Centre for Evidence-Based Practice in mental
health care for their support.
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... Social stigma regarding schizophrenia, psychosis, and voice hearing can lead to attitudes which focus on pathology rather than client progress and recovery (Deacon, 2013;Happell & Scholz, 2018;Huiting, 2013). Despite increases in public literacy about mental health over time, attitudes toward people with mental health diagnoses (i.e., mental illness) remain stagnant, and have even deteriorated toward those with schizophrenia (Schomerus et al., 2012). ...
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This chapter contributes to the body of knowledge about the value of stress-relieving practices such as positive psychology, journaling, meditation, and nature therapy for medical residents and practicing physicians as a part of their regular routine. Given the physical, cognitive, and emotional demands on physicians, adopting these creative and mindful applications may mitigate feelings of burnout, anxiety, and overwhelm, as well as promote a happier and healthier mental state in physicians’ personal and professional lives.
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Over the past two decades, the field of positive psychology has grown substantially and has shown great promise as a new approach to mental health care (Pawelski J Posit Psychol 11:357–65, 2016). Positive psychiatry is closely allied with positive psychology and shares many overlapping constructs and aims (Jeste et al. J Clin Psychiatry 76:675, 2015). New approaches are greatly needed, as we are facing many crises in mental health that a traditional pathology-focused approach has not been able to sufficiently address (Seligman, Handb Posit Psychol 2:3–12, 2002; Seligman, Character strengths and virtues: a handbook and classification. Oxford University Press, New York, 2004). This has particular relevance for people of color in the United States, for whom there are significant disparities in mental health care that traditional models of care have been ineffective in addressing (Ruiz and Primm, Disparities in psychiatric care: clinical and cross-cultural perspectives. Lippincott Williams & Wilkins, 2010; Primm et al. Prev. Chronic Dis 7(1), 2010. http://www.cdc.gov/pcd/ issues/2010/jan/09_0125.htm. Accessed 18 December 2018).
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