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Personal-recovery and agency-enhancing client work in the field of mental health and social rehabilitation: Perspectives of persons with lived experience and specialists
Our team at The CARe Network would like to congratulate Dagmar Narusson on her PhD defence held on 21st October 2019.
Dagmar Narusson has defended for the degree of Doctor of Philosophy in Sociology. Her Supervisors namely, Dagmar Kutsar, PhD, Associate Professor. Institute of Social Studies University of Tartu.
Jean Pierre Wilken, Professor University of Applied Sciences, Utrecht, the Netherlands
Opponent: Alie Weerman, Professor University of Applied Sciences, Windesheim, the Netherlands
The result of this research is: interviewees’ reflections indicated that people with mental illness experience lack the skills to develop connections with the community because they were not taught to think in this manner, and earlier traumatizing and victimizing events are so powerful that they take over memory. Two cultural peculiarities related to the notion of “hope” in the recovery concept revealed that people in Estonia, compared with people in other countries, generally have little trust in other people and that living in a language context which does not make a grammatical distinction between the present and future influences how hopeful perspectives are created.
STUDY I: Narusson, D. (2013). The Disabled persons and rehabilitation specialists dialogue within the rehabilitation assessment and planning process: Analysis based on assessment case reports. Journal of Social Policy and Social Work in Transition, 2, 10–30, DOI:10.1921/5304030202.
STUDY II: Narusson, D. & Wilken, J.P. (2019). Recovery-oriented support work: the perspective of people with lived experience. Journal of Mental Health Training, Education and Practice.
STUDY III: Narusson, D. & Wilken, J.P. (2018). Recovery in the Community: Relational and Cultural Sensitivity. Journal of Recovery in Mental Health, 2 (1): Recovery in the Community, 68–81. https://jps.library.utoronto.ca/index.php/rmh/article/view/31915.
One of the conclusion: "Currently, the terms personal recovery and community do not have unified and common meaning in Estonian society, and for this reason persons with mental health difficulties do not use them consistently. Socio-cultural context peculiarity arises when persons with disability answer questions about hope and being hopeful. Hopefulness seemed important, but persons do not have awareness as to keep hopeful. What also emerged was that hope and feeling hopeful are related to trust in other people and other people’s support in the personal recovery process."
URL to PhD dissertation:
https://dspace.ut.ee/bitstream/handle/10062/65258/narusson_dagmar.pdf
Updated: Oct 21, 2019
The new CARe Interview Series: Social Entrepreneurship, today's interview is conducted with Dilanka on her journey, from being a lawyer to be a social entrepreneur. Her #socialenterprise is LOOMRO
LOOMRO empowers differently abled heroes in Estonia. We create a platform for differently abled people to showcase their artworks through our products and we create job opportunities for them. We encourage and appreciate their creativity.
LOOMRO uses organic cotton and linen materials for the garment and long lasting hand printing method for printing designs to give quality products for our customers. ‘’LOOMRO Differently Abled Hero’’ leaflet comes with our every product.
This interview is with cofounder Kulamini Dilanka Mendis, LL.B (Hons), Legal Adviser, MA (Social Entrepreneurship), Notary Public.
LOOMRO is cofounded with Udara S. Suwanda Arachchi , LL.B (Hons), Legal Counsel, MA (Social Entrepreneurship), Lecturer in Law.
#socent #loomro #thecarenetwork #socialentrepreneurship #tlusema #sustainability #tshirtdesign #mentalhealthcare #inclusion #ecofriendly #handprinted #zerocarbonfootprint
Interview Transcript - Loomro, Dilanka
From a lawyer in Sri Lanka, why the switch to become a social entrepreneur?
So actually after I completed my higher education I worked
as a legal consultant especially in the corporate sector, so gradually I wanted
to change my path and start my own business because I thought that starting
and running a business would be more challenging and exciting and also since
I am most concerned about social problems, I realized that becoming a
social entrepreneur would help me to balance my concerns, interest and life as
well. So that's how I choose to become a social entrepreneur.
What is Loomro’s Business Plan?
Loomro is a tiny concept with a huge positive impact, so I use the word 'tiny'
because our core idea is really a simple one. Basically we sell hand printed cotton
T-shirt as you know so many entrepreneurs doing the same thing but
our specialty is we use artworks of disabled people on our product and we
help them to generate regular income so sixty percent of our profit directly
goes to our disabled artist and not only this financial benefit but also it
helped them to build and increase their self-esteem as well so our brand
is all about ethical fashion I would say. We not only focused
on the sustainability of the fashion products but also the production,
procedure, materials and the design and the printing method. We
started this last April and at the moment one artist is working with us. And we
selected him from Tallinn Mental Health Centre Lasnamae.
The Process - Design Artwork
Okay, once we had a chance to visit Tallinn Mental Health Centre in Lasnamae
and also we got to know about their art sessions which they organize to their
mentally disabled clients. And after that on the second day, we also went to the
art sessions and we spent a whole day with them. After that, we decided to
select some artists from this session. This actually, we were planning to do
this project with the disabled children not really the elder disabled people but
after this visit, we realized the actual difficulty of being disabled and jobless.
So we thought that it would be more impactful if we give chances to this
disabled elderly people. So then now as I mentioned to you earlier, we are currently
working with one artist who is suffering from color blindness and also he has
some health issues related to his mental health and especially I want to mention
that this Tallinn Mental Health Centre in Estonia, they helped us a lot to maintain
our relationship with this artist.
Why should people buy your product and not from others?
We are in the middle of a huge competition, but when it comes to the impact, we are unique. Because if you buy LOOMRO's products you will directly help differently abled people and it creates regular income for them and also you can buy best quality
product from LOOMRO in terms of material quality. We thoroughly believe that
people must use long lasting garment with excellent material
quality because it's good for your health and also it protects the
environment. So we are using organic cotton which is
100% eco-friendly and we buy those garments from certified traditional
manufacturers in Bangladesh and also we use eco-friendly hand printing method to
print the design on the T-shirt. I can say that LOOMRO's products are suitable
for any skin type and even three years old child to 100 years old elderly can use this
product. So LOOMRO is for kind-hearted people who love simple but quality
products and also people who believe in Zero Carbon footprint.
How do you plan to reach this group of people? Currently we are trying to do
marketing through our Facebook Page and webpage.
Still, we're planning more strategies to do our marketing
We try to reach out to them and then I think they can help us to find our customers.
And actual customers.
What is the most rewarding learning of this journey from ideation to the fulfilment of this product, to the hands of your customers?
So at the starting point of our business, we are worried that we are not experienced
enough and we are not good enough to succeed but after we started, selling from
our very first sale, we learned that we would never be a hundred percent ready
to start a business because the best way to learn
something is to throw yourself right into action, so I would say the best
thing we learned from our journey is: there are different types of customers so
we have to face them and they have different types of requirements and also
to win a business or doing a social enterprise is not an easy task and there
is no comfort zone and risk is always there, so no matter what we have to work
on our idea continuously.
There are so many obstacles so we have to change our strategies and try out new
things somehow we have to continue. We are still, we are changing our
strategies and try to find out the most suitable (I mean) best fit strategy for
our business and still, we are very young company, not company, very young project
and still like six months, so still we are trying to find out new things but we
learnt that no there are some people who really love to help people and they
really love the simple but quality clothes.
Social responsibility is an ethical framework and suggest that an entity, be it an
organization or individual has an obligation to act for the benefit of society at large. How do you think it resonates with LOOMRO's work?
LOOMRO is not a single social enterprise. I like to define it as a chain of social enterprises
because we help traditional Bangladeshi organic cotton manufacturers and on the other
hand we help disabled people and we are working with the Tallinn
Mental Health Centre, so we are trying to be socially responsible in many ways.
Our customers also directly or indirectly become socially responsible
by using our product and also we try to balance, the
ecosystem and the economy and ultimately I would like to mention that by
supporting and promoting small and medium enterprises, we can uphold our
commitment to the socially responsible modern economy. I'd like to Thank you
for inviting me for this interview and I would like to invite all the members of
this network, please visit our web page and FB page. Please comment and please
follow us and if you like our products, please buy your next (LOOMRO) T-shirt from
our web store, Thank you!
Thank you so much, Dilanka.
Webstore: https://www.loomro.com
Facebook Page: Loomro - Social Enterprise for Differently Abled People https://www.facebook.com/aSocialEnterprise
CARe Methodology: from the eighties into the new century.
In the seventies mental health in Holland was dominated by ‘the medical view on psychiatric illnesses’. People with psychiatric diseases where mainly seen as people with a medical illness and where treated in large groups in large institution. The illness itself was seen as a kind of defect, and recovery could not happen in most of the situations. Although in Holland we never had the big hospitals like in the USA, our hospitals met with the criteria of Goffman’s total institutions. People lived, worked and recreated together in large groups. Although we did not have much research data yet, the medical view was considered as the most important way of looking at and explaining psychiatric illnesses. An important counter movement in this period of time was the so called anti psychiatry (Laing Pearls).
And also a growing movement developed: consisting of care professionals who where not satisfied by the dominance of the medical model and its implications. The ‘new movement’ tried to see the clients as a whole human being and not as ‘an illness’ or ‘an addiction’. This resulted in a lot of new ‘alternative’ housing facilities for clients.
In the mid eighties the rehabilitation approaches came to Holland. One important approach was the Individual Rehabilitation Approach from Boston. It showed us that there are many possibilities to live with psychiatric diseases: if there is sufficient support. So we started to work systematically with individual clients.
From the English approach (Bennet and Shepherd) we learned that the environment is an important part of this support. So we started to work with the natural environments in which clients spend time, but also in wards in the hospital with the most disabled clients.
In this respect the rehabilitation movement was also a counter movement: not only was it important to giving good ‘recovery oriented’ support to clients, it also worked as a force for change.
When these rehabilitation ideas came to Holland, we were very enthusiastic about it.
The rehabilitation movement in Holland was picked up by critical professionals who also worked in the hospitals and institutions for mentally disabled people.
So the rehabilitation approaches played an important role in the ‘change movement’: the people who tried to change the mental health care into a system in which each individual client has an individual face and an indicial voice.
In the eighties: although the English and American approaches also became very popular, a Dutch approach on rehabilitation developed. This development was carried by people who worked with the most vulnerable clients. Our main concern was the all these nice views and methods would only reach a smaller part of the clients: the clients who are already able and willing to set life goals and to work together with the professional to reach these goals (in ‘Boston terms: the clients who already showed ‘readiness’).
The change movement had strong roots in the hospitals and sheltered living facilities where over the years clients came with problems of increased complexity: a complex of vulnerabilities like double trouble (addiction and psychiatric problems) , or even triple: also clients with mental disabilities.
So there was a need of translating the rehabilitation principles into two ‘new’ directions:
How to work with clients with extensive and complex vulnerabilities
How to improve the quality of the environments of the clients
Main stream rehabilitation is mainly about one entrance: how to support individual clients. The Dutch approach added two entrances (called ‘steering principles’): vulnerability and environment. Combining these steering principled gave the CARe approach her name: the Comprehensive Approach on Rehabilitation.
In Holland the Individual Approach (Boston) and the CARe approach ‘lived together’ for many years, initially more in competition, gradually in peaceful co-existence, recently working up to cooperation. There will always be a need of more flavours than one, and no approach gives us the “One And Only Answer”.
The CARe approach was adopted in Holland and implemented in all parts of Holland and all kinds of facilities: from working with homeless to working in closed wards in the hospitals. More and more tools where created to meet the needs of the different groups of clients and the different settings: clients with autism, with psychiatric problems, with mental disabilities, with forensic psychiatric problems, the elderly, the young clients, the homeless, the addicted and many combinations.
So rehabilitation became ‘normal’: we have rehabilitation departments, rehabilitation professionals, rehabilitation wards and rehabilitation signs on many doors.
And the CARe approach was exported.
GGZ Nederland (the organization of all mental hospitals and addiction services in Holland) gave money for training in several; (mainly eastern European countries). So CARe is now used in: Estonia, Lithuania, Czech Republic, Slovenian Republic, Hungary, Bulgaria, Georgia, Romania, Albania, Kyrgyzstan, Belgium, Curacao and Denmark.
Evaluation 20 years of developing and working with CARe
After 20 years of slow and gradually developments it was time to evaluate, in 2008 and 2009. Two conclusions where drawn:
1. The building of CARe with its extensive toolkit makes it not easy to focus on the deeper core.
2. Rehabilitations has changed from a counter movement to and institutionalised concept and has become a ‘normal service’. But in the process of doing so, it lost a bit of the ‘critical counter movement idea’.
So we looked for ways to get back to the real core and found inspiration in 2 directions:
The so called Presentie –approach (Andries Baart, Holland)
Recent Developments in CARe methodology
Together these core principles (strengths based and presence) form the heart of the CARe approach. So we changed methodology (a bit): now we always start with only 2 tools: a Personal Profile (which is a Strengths assessment) and a Personal Plan.
This generates the energy to work together and really supports recovery processes of the client. And we use the metaphor of the cupboard to describe the CARe toolkit now: it uses a cupboard with several drawers. In the top drawer we find the two tools we always use.
In the second drawer we find some tools that are often useful. And in the third and fourth drawers we find tools for several specific situations. And there are tools for the client (self assessment tools) and tools for the professional. Most tools can be used by both working together.
The experiences so far are great. When you start with a good conception of the core (what is really important) and only a few (powerful) tools, working becomes pleasant for clients and for professionals. In a way we have encountered in Holland ‘a second wave of enthusiasm’: the first wave was when we started in the 80-ties. We were full with both ideas and energy. And we now found that the focusing on the core aspects generates the same energy, with both clients and professionals. Also some financiers showed interest because the focus on strengths generates recovery. And we systematically monitor successes by sharing experiences of success in every meeting.
This more ‘simple approach’ proved to be really successful with psychiatric clients and homeless clients and clients with addictions and clients with mentally impairments. And we are generating experiences with other target groups like clients with autism.
Another nice experience:
Basic trainings in the CARe approach, focusing on the core principles, can be relatively short and the used methodology can initially be kept simple. So the main assessment we teach participants, is the strengths assessment.
Next to this, there still is an elaborate way of CARe assessment on five areas as we teach the TEPLA trainings where Tepla CARe Trainers can use CARe methodology on an expert level, as trainers should. But in their trainings, they also can focus on the core elements and use the elaborate CARe assessment and the CARe cupboard in case they are needed.
And on the Isle of Curacao, the CARe approach is developed as a mixture of the Strengths based direction and the more elaborate direction
Latest developments:
From rehabilitation to recovery
In this century a shift of paradigm took place. Recovery became the new paradigm and the CARe approached was developed in this direction.
Nowadays the CARe methodology is an effective method to support recovery processes. Research proves that participants in CARe trainings effectively support clients in recovery.
Another recent development addresses the positioning of the CARe approach. We don’t believe in the situation that there is only one road and one methodology that works. The CARe approach is proven to be effective but more important is that she is developed to blend with other programs and approaches. So nowadays the CARe approach is used together and in harmony with other approaches and organisations make their own recovery menu and CARe is one of the ingredients.
And:
The Douglas Bennett Award was granted to Jean Pierre Wilken and Dirk den Hollander as an oeuvre prize for all the developments with CARe approach. And Dirk den Hollander was honoured by becoming an officer in the Order of Oranje Nassau by the Dutch King.
Dirk den Hollander
CARe and Strengths
