Psikiyatrik İyileşmede Yeni Bir Yönelim: İyileşme Odaklı Yaklaşım

Year 2019, Volume: 28 Issue: 2, 83 - 97, 30.06.2019

Süleyman Ümit Şenocak , Hülya Arslantaş , Rüveyda Yüksel

Abstract

İyileşme; bireylerin sağlık ve iyilik hallerini
geliştirmek, kendi kendilerini idare edebilecekleri bir hayat yaşamak ve tam
potansiyellerine ulaşmak için çabaladıkları bir değişim sürecidir. İyileşme kavramı
için yapılan tanımlar; klinik iyileşme
ve kişisel iyileşme üzerine bir
ayırım yapılmasını zorunlu kılmıştır. Klinik
iyileşme; ruh sağlığı çalışanları tarafından tanımı yapılan tıbbi modelin
bir terimidir. Semptomların azalması ya da durması ve sosyal işlevselliğin
düzeltilmesi, hastanın önceki sağlık durumuna geri dönmesi anlamına gelir ve
biyomedikal görüşün bir yansımasıdır. Kişisel
iyileşme ise bireyin gelişim ve değişim sürecini ifade eden bir kavramdır.

"İyileşme" kavramına duyulan ilgi giderek artmaktadır ve gelişmiş ülkeler kendi ruh sağlığı sistemlerini, iyileşme yönelimli uygulamaları ve hizmet yapılarını kapsayacak şekilde yeniden şekillendirmeye başlamışlardır. Bu makalede, biyomedikal görüşün benimsemiş olduğu klinik iyileşme yerine bir gelişim ve değişim sürecini ifade eden kişisel iyileşme kavramı üzerinde durulacaktır. Dünya alan yazın çalışmalarında iyileşme yönelimli yaklaşıma ilişkin sayısız yayın bulunmakla birlikte ülkemizde konu ile ilgili olarak gittikçe artmakta olan az sayıda yayına rastlanılmıştır. Bu makalede iyileşme odaklı yaklaşımın tarihsel sürecinden, iyileşme kavramının tanımından ve iyileşmeye rehberlik eden ilkelerden, iyileşme modellerinden, iyileşme yönelimli yaklaşımı temel alan bazı kılavuz ilkelerden,  iyileşme odaklı yaklaşım ile ilgili dünyadan araştırma örneklerinden ve ülkemizdeki durumdan söz edilecektir. Derlemenin ülkemizde de bu hizmetlerin planlanması ve yürütülmesi açısından yol gösterici olmasına katkı sağlaması umulmaktadır. 

Keywords

Psikiyatrik iyileşme, iyileşme odaklı yaklaşım

A New Direction to Psychiatric Wellness: Recovery Oriented Approach

Abstract

Recovery is a process of change in which individuals struggle to improve their health and wellness, to maintain a life which they lead on their own and to reach their full potential. Definitions on recovery necessitated to make a distinction between the terms clinical recovery and personal recovery. Clinical recovery is a term of medical model which is defined by mental health professionals. It has meanings like symptom reduction or healing, restoring social functionality, turning back to previous health status of the patient and it is a reflection of the biomedical model. However, personal recovery is a concept which points out improvement and change process of individuals. Interest on the "recovery" concept increase gradually and developed countries have started to restructure their mental health systems by including recovery-oriented applications and service structures. In this article more attention will be paid to concept of personal recovery which means a change and improvement process, instead of discussing clinical recovery adopted by biomedical model. Although there are numerous publications related to recovery-oriented approach in the worldwide literature, a limited but increasing number of studies are encountered in our country. Historical process of recovery-oriented approach, definitions of recovery concept, recovery models, some of the guiding principles based on recovery-oriented approach, worldwide researches related to recovery-oriented approach and current situation in our country will be discussed in this article. With this review, it is expected to contribute guiding in terms of planning and performing these services in our country.

Keywords

Psychiatric wellness, recovery oriented approach

References

• 1. Farkas M. The vision of recovery today: what it is and what it means for services. World Psychiatry. 2007;6(2):68–74.
• 2. Department of Health, Mental Health, Drugs and Regions Division, State Government of Victoria. Framework For Recovery-Oriented Practice 2011, Australia. Erişim Tarihi: 02.03.2018. Available from:http://docs2.health.vic.gov.au/docs/doc/0D4B06DF135B90E0CA2578E900256566/$FILE/framework-recovery-oriented-practice.pdf
• 3. Australian Health Ministers’ Advisory Council, Commonwealth of Australia 2013, A national framework for recovery-oriented mental health services: Guide for practitioners and providers. Print ISBN: 978-1-74186-010-8Online ISBN: 978-1-74186-011-5Publications approval number: 10287. www.health.gov.au/mentalhealth All information in this publication is correct as at August 2013. Erişim Tarihi: 02.03.2018. Available from:https://www.health.gov.au/internet/main/publishing.nsf/content/67D17065514CF8E8CA257C1D00017A90/$File/recovgde.pdf
• 4. Murray P. Recovery, Inc., as an adjunct to treatment in an era of managed care. Psychiatric Services. 1996;47(12):1378-81.
• 5. Sowers W. Transforming systems of care: the american association of community psychiatrists guidelines for recovery oriented services. Community Mental Health Journal. 2005;41(6):757-774.
• 6. Piat M, Sabetti J. The development of a recovery-oriented mental health system in Canada: What the experience of commonwealth countries tells us. Can J Commun Ment Health.2009;28(2):17–33.
• 7. Mental Health Commission of Canada (2015). Recovery Guidelines. Guidelines for Recovery-Oriented Practice Hope. Dignity. Inclusion. Ottawa, ON: Author. Erişim Tarihi: 02.03.2018. Available from:https://www.mentalhealthcommission.ca/sites/default/files/MHCC_RecoveryGuidelines_ENG_0.pdf
• 8. Noordsy DL, Torrey WC, Mead S, Brunette M, Potenza D, Copeland ME. Recovery-oriented psychopharmacology: Redefining the goals of antipsychotic treatment. Journal of Clinical Psychiatry. 2000;61(3):22–29.
• 9. Van Tosh L, Ralph R, Campbell J. The rise of consumerism. Psychiatric Rehabilitation Skills. 2000;4(3):383-409.
• 10. Berlim MT, Fleck MP, Shorter E. Notes on antipsychiatry. European Archives of Psychiatry and Clinical Neuroscience. 2003;253(2):61-67.
• 11. Dixon LB, Goldman HH. Forty years of progress in community mental health: the role of evidence-based practices. Australian & New Zealand Journal of Psychiatry. 2003;37(6):668-673.
• 12. Ramon S, Healy B, Renouf N. Recovery from mental illness as an emergent concept and practıce in Australia and the UK. International Journal of Social Psychiatry. 2007;53(2):108–122.
• 13. Field BI, Reed K. The Rise and Fall of the Mental Health Recovery Model.(ROC) The International Journal of Psychosocial Rehabilitation. 2016;20(2):86-95.
• 14. Meehan TJ, King RJ, Beavis PH, Robinson JD. Recovery-based practice: do we know what we mean or mean what we know? Australian and New Zealand Journal of Psychiatry. 2008;42:177-182.
• 15. President's New Freedom Commission on Mental Health (2003). Achieving the promise: Transforming mental health care in America. Executive Summary. DHHS Pub. No. SMA-03-3831. Rockville, MD.
• 16. Caldwell B, Sclafani M, Swarbrick M, Piren K. Psychiatric nursing practice and the recovery model of care. Journal of Psychosocial Nursing and Mental Health Services. 2010;48(7):42-48.
• 17. Anthony WA. Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal. 1993;16(4):11-23.
• 18. Akgün Çıtak E. Ruhsal Hastalıklarda İyileşme ve İyileşme Modelleri. In: Ruh Sağlığı ve Psikiyatri Hemşireliği, 1. Baskı. (Ed Gürhan N): 269-287. Ankara, Nobel Tıp Kitabevleri, 2016.
• 19. Corrigan PW, Slopen N, Gracia G, Phelan S, Keogh CB, Keck L. Some recovery processes in mutual-help groups for persons with mental ıllness; II: Qualitative analysis of participant ınterviews. Community Mental Health Journal. 2005;41(6): 721-735.
• 20. Leamy M, Bird V, Le Boutillier C, Williams J, Slade M. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis The British Journal of Psychiatry. 2011;199(6):445-452.
• 21. Farkas M, Gagne C, Anthony W, Chamberlin J. Implementing Recovery Oriented Evidence Based Programs: Identifying the Critical Dimensions. Community Mental Health Journal. 2005;41(2):141-158.
• 22. Davidson L, Roe D. Recovery from versus recovery in serious mental illness: One strategy for lessening confusion plaguing recovery. Journal of Mental Health. 2007;16(4):459-470.
• 23. Piat M, Sabetti J. The development of a recovery-oriented mental health system in Canada: What the experience of commonwealth countries tells us. Can J Commun Ment Health. 2009;28(2):17–33.
• 24. Caldwell B, Sclafani M, Swarbrick M, Piren K. Psychiatric nursing practice and the recovery model of care. Journal of Psychosocial Nursing and Mental Health Services. 2010;48(7):42-48.
• 25. Substance Abuse and Mental Health Services Administration. Illness Management and Recovery: Practitioner Guides and Handouts. HHS Pub. No. SMA-09-4462, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 2009.
• 26. McCormack, J. (2007) Recovery and strengths based practice. SRN Discussion Paper Series. Report No.6. Glasgow, Scottish Recovery Network.Erişim Tarihi: 02.03.2018. Available from:http://www.ispraisrael.org.il/Items/00410/SRNDiscussionPaper6Strengths.pdf
• 27. Xie H. Strengths-based approach for mental health recovery. Iranian Journal of Psychiatry and Behavioral Sciences. 2013;7(2):5-10.
• 28. Francis A. Strengths-based assessments and recovery in mental health: reflections from practice. International Journal of Social Work and Human Services Practice. 2014;2(6):264-271.
• 29. Tse S, Tsoi WS E, Hamilton B, Mary O’Hagan M, Shepherd G, Slade Mike et al. Uses of strength-based interventions for people with serious mental illness: A critical review. International Journal of Social Psychiatry. 2016;62(3):281-291.
• 30. Shanley E, Jubb-Shanley M. The recovery alliance theory of mental health nursing. Journal of Psychiatric and Mental Health Nursing. 2007;14:734-743.
• 31. Jacobson N, Greenley D. What is recovery? A conceptual model and explication. Psychiatric Services. 2001;52(4):482-485.
• 32. Oades L, Deane F, Crowe T, Lambert WG, Kavanagh D, Lloyd C. Collaborative recovery: An integrative model for working with individuals who experience chronic and recurring mental illness. Australasian Psychiatry. 2005;13(3):279-284.
• 33. Barker P. The Tidal model: Developing an empowering, person-centred approach to recovery within psychiatric and mental health nursing. Journal of Psychiatric and Mental Health Nursing. 2001;8(3):233-240.
• 34. Barker P. The Tidal model: The lived-experience in person-centred mental health nursing care. Nursing Philosophy. 2004;2(3):213-223.
• 35. Buchanan-Barker P, Barker PJ. The Tidal Commitments: extending the value base of mental health recovery. Journal of Psychiatric and Mental Health Nursing. 2008;15(2):93-100.
• 36. Barker P, Buchanan-Barker P. The Tidal model of mental health recovery and reclamation: application in acute care settings. Issues in Mental Health Nursing. 2010;31(3):171-180.
• 37. Knutson MB, Newberry S, Schaper A. Recovery education: A tool for psychiatric nurses.J Psychiatr Ment Health Nurs. 2013;20(10):874-881.
• 38. Cook JA, Copeland ME, Jonikas JA, Hamilton MM, Razzano LA, Grey DD et al. results of a randomized controlled trial of mental ıllness self-management using wellness recovery action planning. Schizophr Bull. 2012;38(4):881-891.
• 39. Solomon P, Decesaris M, Petros R, Linz S, Hanrahan Nancy P. A pilot randomized control trial of autovideography ıntervention to enhance recovery for people with severe mental illness. Best Practice in Mental Health. 2016;12(1):1-13.
• 40. Rabenschlag F, Konrad A, Rueegg S, Jaeger M. A recovery-oriented approach for an acute psychiatric ward: is it feasible and how does ıt affect staff satisfaction?. Psychiatr Q. 2014;85(2):225–239.
• 41. Van Eck RM, Burger TJ, Vellinga A, Schirmbeck F, de Haan L. The relationship between clinical and personal recovery in patients with schizophrenia spectrum disorders: A systematic review and meta-analysis. Schizophrenia Bulletin. 2017 14 doi: 10.1093/schbul/sbx088.
• 42. Rossi A, Amore M, Galderisi S, Rocca P, Bertolino A, Aguglia E et al. The complex relationship between self-reported ‘personal recovery’ andclinical recovery in schizophrenia. Schizophrenia Research. 2018;192:108–112.
• 43. Nowak I, Sabariego C, Świtaj PM. Disability and recovery in schizophrenia: A systematic review of cognitive behavioraltherapy interventions. BMC Psychiatry. 2016;16:228.
• 44. Burgess P, Pirkis J, Coombs T, Rosen A. (2010) Review of Recovery Measures. Erişim Tarihi: 24.07.2017. Available from:https://www.mentalhealth.va.gov/communityproviders/docs/review_recovery_measures.pdf
• 45. Davidson L, Lawless MS, Leary F. İyileşme kavramları: birbiriyle çelişiyor mu yoksa birbirini tamamlayıcı mı? Current Opinion in Psychiatry. 2006;2:6-41.
• 46. Liberman, R.P. (2011). Yetiyitiminden İyileşmeye. Psikiyatrik İyileştirim El Kitabı. American Psychiatric Publishing, Inc. Washington DC, 2008. (Çev. Ed Yıldız M). Türkiye Sosyal Psikiyatri Derneği, Ankara, s. 278-310.
• 47. Çam O, Bilge A. Psikiyatrik rehabilitasyon/iyileştirim ve evde bakım. In: Ruh Sağlığı ve Hastalıkları Hemşireliği Bakım Sanatı. 1. Baskı. (Eds Çam O, Engin E.) 1049-1072. İstanbul, İstanbul Tıp Yayınevi, 2014.
• 48. Çam O, Savaşan A. Ruh sağlığı ve hastalıkları hemşireliğinde bir model: Tidal (Gel-Git) model. In: Ruh Sağlığı ve Hastalıkları Hemşireliği Bakım Sanatı. 1. Baskı. (Eds Çam O, Engin E.) 87-102. İstanbul, İstanbul Tıp Yayınevi, 2014.
• 49. Yıldız M. Recovery as a Process in Severe Mental Illnesses. Noro Psikiyatr Ars. 2015;52(1):1-3.
• 50. Savaşan A, Çam O. The effect of the psychiatric nursing approach based on the tidal model on coping and self-esteem in people with alcohol dependency: a randomized trial. Arch Psychiatr Nurs. 2017;31:274-81.
• 51. Çam O, Aydoğdu Durmuş H. Ruhsal hastalığı olan bireyler ve psikiyatri hemşireleri açısından iyileşme. Ege Üniversitesi Hemşirelik Fakültesi Dergisi. 2016;32(2):97-106.
• 52. Kavak F, Ekinci M. The effect of yoga on functional recovery level in schizophrenic patients. Arch Psychiatr Nurs. 2016;30:761-767.
• 53. Soygür H, Yüksel MM, Eraslan P, Attepe Özden S. Mavi At Kafe’nin 6 yılda öğrettikleri: Şizofreni hastalarının gözünden iyileşmeye katkıda bulunan etmenler-nitel bir analiz. Türk Psikiyatri Dergisi 2017;28(2):75-80.
• 54. Yılmaz E, Okanlı A.Test of mindfulness-based psychosocial skills training to improve ınsight and functional recovery in schizophrenia. Western Journal of Nursing Research. 2017;1:1-17.
• 55. Çam O, Yalçıner N. Ruhsal hastalık ve iyileşme. J Psychiatric Nurs. 2018;9(1):55-60.
• 56. İpçi K, İncedere A, Kiras F, Yıldız M.Şizofreni hastalarında öznel iyileşme ile bilişsel içgörü arasındaki ilişkinin araştırılması. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi.2018;4(1):1-4.
• 57. Yildiz M, Erim R, Soygur H, Tural U, Kiras F, Gules E. Development and validation of the Subjective Recovery Assessment Scale for patients with schizophrenia. Psychiatry and Clinical Psychopharmacology. 2018;28(2):163-169.
• 58. Coşkun E, Şahin Altun Ö. The relationship between the hope levels of patients with schizophrenia and functional recovery. Arch Psychiatr Nurs. 2018;32: 98-102.