Butabika Recovery College - Peer Nation

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Butabika Recovery College

Recovery Manual

BREC:

RECOVERY MANUAL

Butabika Recovery College

‘Recovery is an ongoing journey rather than a destination.’

Recovery

Thank you to those who were involved in the original Recovery Listening Events: the Sharing Stories Group (names) and the original participants (Names). Thanks you to the Recovery Trainers, who took the material and developed the lessons (names, Peer trainers and staff). Thank to all the people who attended the College, both people with lived experience or carers or staff, who contributed their expertise to these discussions and allowed us to capture a better understanding of what Recovery means in Uganda. And thanks to Jenny Lang, who listened carefully to the stories and experience of Recovery to allow us to share this more widely.

This manual was created with input from a huge number of different individuals and groups, some of whom are named here, as well as many individuals whose contribution is not recognised. We would like to thank all those involved.

This manual started with 3 Recovery Listening Events held in 2015, facilitated by the Sharing Stories Group, as part of the Brain Gain 2 project. It was them developed into Recovery Education sessions by Recovery Trainers at the Butabika Recovery College. The descriptions and examples in the manual were rescued by Dr Jennifer Lang from discussions between Recovery Trainers and students at the Butabika Recovery College.

Thanks to the Tropical Health Education Trust (THET) for providing funding for the Brain Gain projects and for the development and ratification of this manual.

Thank you

Dr. Hafsa LukwataMinistry of Health

Acknowledgements

BREC: Recovery - Introduction |

Recovery

Use and Distribution Rights

This work is the copyright of Brain Gain (a collaboration between Butabika Recovery College (BREC), Butabika East London Link and Ugandan Ministry of Health). We retain the right to be identified as the author for all uses. This material can be copied, reproduced or adapted to local need; any or all parts of this manual, provided the parts reproduced are distributed free or at cost- not for profit. Commercial copying, hiring or lending is prohibited.

Email: Available to download at

Project Team Uganda

Butabika Recovery College, Butabika Hospital and Ministry of HealthProject Co-ordinators: Eddie Nkurunungi, Ruth Nakachwa, Richard Mpango, Mauricia Kamuhiirwa, Benon KabaleRecovery Trainers: Ministry of Health: Dr Hafsa Lukwata

Project Team London

Butabika-East London LinkProject Leads: Dr Dave Baillie, Cerdic HallUK Volunteers: Jennifer Lang, Helena Tucker, Carter Newman

Sharing Stories Team

Facilitators: Will Curvis, Jenny Davies, Keith Holt, Benon Kabale, Rosco Kasujja, Lynda Esther Nakalawa, Edward Nkurunungi, JJ Paul Nyeko, Samuel Ouma, Rob Parker, Bethan Roberts, and Helen Walls.

Acknowledgements


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Recovery

Recovery is a concept that has increasingly been used as a way of thinking about mental health problems. For 200 years, people with mental health problems have been observed, studied and evaluated by mental health workers. This has lead to some important advances in mental health care, with the development of evidence based medicines and psychological therapies, but it has also meant that that people have come to believe that the solutions for mental health problems lie only with the professionals. It also assumes that there is a clear cut off between those who have mental health problems (“the mentally ill”) and those who do not. The expertise of people with lived experience of mental health problems has not been recognised and the language and terminology of the professionals has been seen as more important. This is disempowering for people with mental health problems, as it suggests that people with they cannot help themselves but must rely on professional expertise. It also reinforces the idea that the professionals description, diagnosis and narrative about mental health problems is the correct one and does not recognise the importance of people own understanding of their mental health problems or their own resilience of goals.Recovery is a concept that recognises that mental health problems lie on a continuum, that all of us will have mental health problems of one kind or another. It values the importance of peoples own lived experience of mental health problems: it assumes that we gain learning from mental health problems and wisdom that can help ourselves and others. It asserts that it should be up to an individual to decide how they want to live and how they assess what is important in their recovery, rather than this being decided by mental health professionals. Common themes around recovery have been identified by asking people with mental health problems what they think is important in their recovery, rather than asking mental; health professionals what they think is important for peoples recovery. The common themes that have emerged have been the importance of relationships; of hope and optimism that things will get better; of having a strong sense of identity, not simply being someone who has a mental health problem; of being able to make sense of mental health problems, finding meaning in mental health problems; and of being able to make decisions for ourselves.

What is Recovery?

BREC: Recovery - Introduction | 6

Recovery

Studies have been done in high income settings, such as UK and Europe, US, Australia and New Zealand, to find out what people understand by Recovery in these countries. However, there has not been much research down on what people in low income settings would see as important or their Recovery. In 2015, several Recovery Listening Events were held in Uganda (in Kampala and in Jinja) which aimed to find out what people, both service users (people with lived experience) and staff (people with training expertise), thought about Recovery. Participants were simply asked 3 questions:• What is recovery?

• What helps achieve and maintain recovery?

• What hinders recovery?Following a number of group and individual listening sessions, what people said was looked at by all praticipants and a definition of Recovery was described and Recovery themes were identified. Recovery was described as a journey rather than a destination: Recovery was described as a process, about freedom, about social wellness, about being to contribute and be useful, about being economically stable and making sue of available resources, about acceptance and forgiveness, and about triumph

Ugandan Recovery ThemesThirteen Recovery themes were identified. Some of these were very similar to what had been identified, such as the importance of Support and Relationships, Hope and Acceptance, Empowerment, Expression of self and being understood and Feeling useful and having a purpose. Having a healthy Lifestyle and Access to holistic quality services was important. But in Uganda, there were some themes identified were different from those that had been identified in high income settings: Having access to finances was seen as central to people’s ability to look after themselves, to contribute to their community and to feel valued. And some themes refklected Recovery in a more collectivistic setting, where people’s Recovery was important for the individual themselves, but also it was important to use their Recovery for the benefit from their community, particularly for others experiencing mental health problems, so themes included the importance of Influencing policy, Raising awareness at all levels, and Challenging stigma. Spirituality was also seen as central to peoples Recovery.

Recovery in Uganda


Recovery

These themes went onto provide the framework for Recovery sessions that are held at the Butabika Recovery College, Kamapla. These sessions were developed by and are delivered by a recovery trainer, with lived experience of mental health problems, and a mental health professional through the model of co-production. These sessions are open to all people with an interest in recovery; including users of mental health services, both people in the hospital and the community, mental health professionals and carers. Each session focuses on a different theme of recovery. The sessions are interactive and generate ideas of how people may progress along their journey of recovery. They are a safe space to share stories and experiences and inspire one another.

The Recovery Manual

This manual has been created from using ideas, stories and experiences of mental health service users, peer support workers, carers and professionals in Uganda. Each chapter covers a different theme. It discusses what the theme is and why it is important in recovery. It gives quotes from people with lived experience of mental health problems about how this theme has impacted their recovery. The content and quotes in this manual are taken from recovery sessions, the original listening event document and videos of interviews with peer support workers.

Who is this manual for and how do you use it?

This manual is for anyone with an interest in recovery. You might be a user of mental health services, a carer or a mental health professional. We realised that some people would like to have information about recovery but are not able to attend the recovery sessions. This manual has been created using the ideas and stories of people with lived experience of mental health problems. We hope that these ideas and stories may guide and inspire others.How you use the manual is up to you. It could be used to teach about Recovery, either in educational sessions or ina discussion group. Or you could read this by yourself, and use it a workbook. You may want to read it from beginning to end like a book or chose chapters that you find particularly interesting.

Recovery in Uganda


Recovery

Each chapter contains:• Questions about the theme of recovery • Ideas and information about the theme• Quotes from people with lived experience of mental health problems• Exercises to allow you to think about what that theme means to youYou might like to discuss theme themes with your friends or family or a mental health professional.It is important to remember that everybody's journey of recovery is different.

AcknowledgementsThank you to those who were involved in the original Recovery Listening Events: the Sharing Stories Group (names) and the original participants (?Names). Thanks you to the Recovery Trainers, who took the material and developed the lessons (names, Peer trainers and staff). Thank to all the people who attended the College, both people with lived experience or carers or staff, who contributed their expertise to these discussions and allowed us to capture a better understanding of what Recovery means in Uganda. And thanks to Jenny Lang, who listened carefully to the stories and experience of Recovery to allow us to share this more widely.

This manual was created with input from a huge number of different individuals and groups, some of whom are named here, as well as many individuals whose contribution is not recognised. We would like to thank all those involved.

This manual started with 3 Recovery Listening Events held in 2015, facilitated by the Sharing Stories Group, as part of the Brain Gain 2 project. It was them developed into Recovery Education sessions by Recovery Trainers at the Butabika Recovery College. The descriptions and examples in the manual were rescued by Dr Jennifer Lang from discussions between Recovery Trainers and students at the Butabika Recovery College.

Thanks to the Tropical Health Education Trust (THET) for providing funding for the Brain Gain projects and for the development and ratification of this manual.

Recovery in Uganda



Recovery

‘Recovery is an ongoing journey rather than a destination.’

What is Recovery?

Recovery is a word used to describe a process which people experiencing mental health difficulties go through.

Recovery means different things to different people. Here are some examples of what some people describe as recovery:

• Recovery is returning to a ‘normal’ state.

'It is when the water in my heart stops boiling.' It means resuming normal functioning after being disturbed by mental illness. People describe regaining spiritual fulfillment, energy, cognition, intelligence and memory as things that come with recovery. People also talk about appetite, sleep and hygiene patterns returning to normal.

• Recovery is a process.

'Recovery is an ongoing journey rather than a final destination.' People talk about being able to manage symptoms and live with their illness. This means being able to manage stress and daily challenges.

• Recovery is about freedom.

It is about 'not being in a green uniform'. The green uniform is what people wear at Butabika, the main mental health referral hospital in Uganda. Some people associate recovery with not being in hospital. People talk about recovery meaning they are free to move where they want and have choice in what they do.


Recovery

• Recovery means social wellness.People describe feeling able to be around others and communicate with them. They describe being able to join in with family life and activities again like going to church, singing, dancing, working. On another level social wellness means being able to marry and have children.

• Recovery means being able to contribute and be useful. “I’m giving back to my family and the community.” People talk about being able to support others and feel equal to them.

• Recovery is economic stability.Being able to be independent, support yourself and meet your responsibilities is important. This is important on many levels, such as having a good standing in the community and being able to access ongoing medical treatment.

• Recovery is about acceptance.People talk about understanding and accepting themselves and their condition. Recovery also means being accepted by the community for who they are and also “being acceptable to the community by modeling yourself to their standards”Recovery is about forgiveness.People talk about forgiving others for the things they did and also forgiving themselves.

• Recovery is a process for carers too.“When he recovered, I recovered too.” Caretakers talk about how they and their families join the process of recovery.

• Recovery is making use of resources.“Having a good relationship with my doctor” “Participating in my treatment”

• Recovery is about triumph.“I’m soaring above the problem like an eagle.” Recovery is doing things you didn’t previously think were possible. It is about experiencing positive change.

•


Recovery

• This manual is a guide to different aspects of recovery, called themes.

• The manual is divided into thirteen different themes:

o Acceptanceo Access to holistic quality serviceso Empowerment o Expression of self and being understood o Feeling useful and having a purpose o Having access to financeso Healthy lifestyleo Hopeo Influencing policyo Raising awareness at all levelso Spirituality o Stigmao Support and Relationships

• Each chapter covers a different theme. It discusses what the theme is and why it is important in recovery. It gives quotes from people with lived experience of mental health problems about how this theme has impacted their recovery.

What is this is manual?

How was this manual made?

This manual has been created from using ideas, stories and experiences of mental health service users, peer support workers, carers and professionals in Uganda.

In 2015 a listening event was held in Kampala and Jinja aimed at enabling mental health service users and staff members to think about recovery.

Participants were asked to think about:

• What is recovery?• What helps achieve and maintain recovery?• What hinders recovery?

Recovery


Following a number of group and individual listening sessions the thirteen themes above were identified.

These themes went onto provide the framework for recovery sessions that are held at the Butabika Recovery College, Kamapla. These sessions are delivered by a recovery trainer, with lived experience of mental health problems, and a mental health professional through the model of co-production.

These sessions are open to all people with an interest in recovery; including users of mental health services, both people in the hospital and the community, mental health professionals and carers.

Each session focuses on a different theme of recovery. The sessions are interactive and generate ideas of how people may progress along their journey of recovery. They are a safe space to share stories and experiences and inspire one another.

The content and quotes in this manual are taken from recovery sessions, the original listenting event document and videos of interviews with peer support workers.

Recovery


Who is this manual for and how do you use it?

This manual is for anyone with an interest in recovery. You might be a user of mental health services, a carer or a mental health professional.

We realised some that people would like to have information about recovery but are not able to attend the recovery sessions.

This manual has been created using the ideas and stories of people with lived experience of mental health problems. We hope that these ideas and stories may guide and inspire others.

How you use the manual is up to you. You may want to read it from beginning to end like a book or chose chapters that you find particularly interesting.

Each chapter contains:

• Questions about the theme of recovery

• Ideas and information about the theme

• Quotes from people with lived experience of mental health problems

• Exercises to allow you to think about what that theme means to you

• You might like to discuss theme themes with your friends or family or a mental health professional.

• It is important to remember that everybody's journey of recovery is different.

BREC: Acceptance | 1

Acceptance

‘For me, acceptance is making peace with yourself and everything about you.’

What does it mean to accept yourself?

This theme is about the importance of accepting yourself and of being accepted by others in the process of recovery.To many, accepting yourself is about understanding that you have a mental health problem. Accepting this allows people to start the process of recovery.

Accepting yourself can also include accepting other things, such as where you come from and the family you come from.

‘Acceptance is step one to recovery, the moment you accept you have started recovery.’

‘Acceptance of yourself is when you understand your illness and you find ways to cope, such as medication and exercise.’

‘If you accept you have a condition, that is the first step to finding the treatment or solution to a problem.’


Acceptance

• People feel able to seek and accept treatment• Gives people hope that there is help and they can recover• Helps people to learn more about their diagnosis and

understand themselves• Helps people find ways of coping and learn their triggers for

relapse• People feel able to love and forgive themselves and it can

improve their self esteem• Allows people to accept help from professionals and their

family and friends• Allows people to explain themselves to others and for others to

accept them• Can improve your relationship with family and friends• Can help people cope with and tackle stigma• Can help to reduce mob justice and abuse if a person and their

community are able to accept• Can help to reduce stress, anger and frustration

How do people find it helpful to accept themselves and their mental health problem?

‘If you accept that you are sick it is easy for you to recover because it is easier for you to take your medications, keep your appointments and allow yourself to rest when you need to.’

‘Accepting you have a problem, that you are sick, means you can understand how people are trying to help you. If you don’t accept then you might continue arguing with your family.’

‘If you don’t accept yourself, who do you expect to accept you?’

‘I accepted myself and I stopped hating myself. I had hope. It improved my self-esteem. I believed in myself and started to know I could be healed.’

Acceptance


Some people explain that before they accepted themselves they didn’t engage in treatment; they were angry with themselves and others and would argue with their families. They did not want to accept help. Some people say this has an impact on their self-esteem and relationship with others. They feel that they did not have hope and had not started their journey of recovery.

‘The first thing you do is accept the situation, you learn the triggers and it can prevent relapse.’

Some people find that by accepting their condition they are more able to cope with and tackle stigma.

‘When someone calls me mad, I say, that’s normal for me. It doesn’t upset me like it used to. I now talk to them about mental health and try to educate them.’

‘Acceptance helps to tackle stigma, if you accept it becomes normal for you, then normal for your family, then normal for your community.’

What can happen if you do not accept yourself?

Acceptance and stigma!

Exercise: How does acceptance help you in your recovery?

Acceptance

For many people acceptance from others including their family, community and colleagues is key to their recovery.This acceptance allows them to feel understood and supported. It enables them to play a role in their community. Acceptance can also make people feel safer in their communities because people know their problems and can help. Some people explain that acceptance by their community reduces mob justice.

Such acceptance by the wider community is not always straightforward and is closely linked to the themes of challenging stigma and raising awareness at all levels.

How is acceptance by others important to recovery?

‘My community accepted who I was. I was given the defence position in my village, they have hope in me.’

‘I am accepted by my family and my workmates. I enjoy my recovery.’

‘Being accepted is very important, if you feel the people you are with are not accepting you then you will not you will not open up, you will not show your talent, you many never show the positive things about yourself.’

‘If people are accepted in their communities they learn that with this chronic condition, they can function, they can contribute to society, they can earn a living, they can have a family, they can contribute to taxes, they can develop, they can leave a legacy and can be meaningful.’


Exercise: Do you feel that you are accepted by the people around you?

How does that make you feel?

BREC: Access to holistic, quality services | 1

Access to holistic, quality services

‘For services to be quality they should have enough medicines, the staff should be caring and knowledgeable and they should share their knowledge.’

• To know where to go to get such services• For services to be easy to get to• Facilities should be clean and well equipped• Having facilities that provide both physical and mental

health care• Care should consider all aspects of recovery including physical,

psychological, social, economic and religious needs• Having talking therapies and counselling available• Having occupational therapy and social work• Having support for drug and alcohol problems• Having the ability to choose from available services; choosing

what works best for you• Staff being knowledgeable and well trained• Staff having caring attitudes, not discriminating• Staff providing information and engaging people in their

treatment• Service users collaborating with professionals to provide care• Staff keeping updated and sharing good practice• Having service user support groups & peer support

What do we mean by access to holistic quality services?

Access: To be able to get something.

Holistic: Including everything you need, covering all areas.

Quality services: Services that are very good, providing excellent care.

What things do people say they would like in order to access such holistic and quality services?


‘Facilities should be furnished, and be able to tackle mental and physical health problems, everyone should have their own bed and even maybe their own room. Meals and water should be provided.’

‘You should be able to access services which are useful in solving the problem. You should be able to experience different services and try different options, and see what works well for you. Then pick out what best fits your situation at that time for a quicker recovery.’

‘They should share knowledge and you give information, involving you and your carers in your treatment, they should respect your right to information.’

‘For services to be quality they should have enough medicines, the staff should be caring and knowledgeable and they should share their knowledge.’

‘Services should be fully fledged and standardised. They should be easy to reach and close by. They should offer complex services including medical treatment, rehab treatment, psychological treatment, all the services to get back to a better living.’


Exercise: What does holistic, quality services mean to you?

What things would you like from a mental health service?



• Health centres• Hospitals (District, Referral, Butabika)• Village health teams• Community outreaches• Churches• Traditional healers

Where else can we get information about mental health services?• Schools• Books• Internet• Recovery college

Where do we access mental health services?

Exercise: Do you access mental health services?Where do you access them?


People find that accessing such services can help in a number of ways, these can include:• Enabling recovery• Allowing you to recover more quickly• Reducing stress• Bringing hope• Allowing you to return to normal life• Allowing you to return to your community• Improving self-esteem and confidence• Allowing you to accept yourself and recognise that you are not

alone in this situation• Allowing you to explain to others about mental illness and raise

awareness• Allowing you to return to work• Allowing you to return to your family• Allowing you to support others with mental illness• Reducing stigma

Why is access to holistic, quality services important in recovery?

‘When you get good services, you get back your respect and self-esteem. It gives you hope and power.’

‘It is also psychologically healing to know that the services are there. It brings confidence in someone – ‘I can access and I can recover.’ It relives the worries.’

‘Getting good care and support shortens the journey of recovery.’

‘When I learn more about my illness it helps me to explain to those who care for me. We need to raise awareness that we are not the only ones. By having user groups, we will learn more about our illnesses.’

‘When I get the services, I can then continue with my normal life.’


BREC: Having access to finances | 1

Having access to finances

‘Financial well-being is really important.’

This theme is about having money and the different ways to get money.Having money to spend and having ways to make money are a very important part of recovery for many people.

How is having access to finances helpful in recovery?• Allows you to buy what you need, such as food and pay

for rent• Allows you to pay for medication• Allows you to pay for transport; to meet friends, to visit family,

to see the doctor• To pay for school fees and support your family• Reduces stress• Allows you to gain self-confidence and feel worthy• Allows you to buy clothes and look smart• Allows you to save for the future in case you get sick• Allows you to develop yourself and your skills• Allows you to help others

What is having access to finances?

‘You can’t recover on an empty stomach.’

‘Finances are really very very important in recovery because before you can do anything it is helpful to buy food, to buy medication, to enable transport, like if I’m going to meet a doctor. Even if I am going to have friends around me, I will need to have some finances to feel I am someone worthy in society.’



‘It’s all about resources. How can I recover when I am unsure about my tomorrow?’

‘Even things like clothing are important, people with mental illness want to look nice like everyone else.’

‘Financial well-being is so important that without money some people can relapse.’

‘Finances are really important, if I can’t take care of my basic needs, or do something that I want to do that really puts you down, if you can’t take care of yourself.’

‘Access to finances is one way that can help us be able to attain our goals, having your goal fulfilled contributes greatly to your recovery.’

‘I have a child in boarding school. If I can’t provide for my child, I can easily breakdown into depression. So, I try to work and earn money to avoid relapsing and getting admitted to hospital.’

Exercise: How is access to finance important in your recovery?


Many people have different ways of getting access to finances. People often talk about wanting to have a regular source of income.These are some of the ideas of how to get access to finances that have been suggested in recovery sessions:

• Farming• Rearing animals• Selling chapattis/pancakes• Making bricks• Building• Opening a shop• Through family businesses• Repairing & making clothes• Cleaning• Starting a business• Making jewellery• Fetching water for others• Teaching

How can we get access to finances?

‘I make necklaces and other items from beading which helps in my recover and also to earn money.’

‘I wanted to do something that gave me a regular income, so I could feel secure and not worry about money so much.’


Exercise: How do you access finances? Do you have any ideas that might improve your access to finances?

BREC: Challenging Stigma | 1

Challenging Stigma

‘Stigma is when they segregate you and they don’t like you everywhere you go.’

What is stigma?

Stigma is about negative attitudes and bad feelings towards people. Here we are talking about stigma towards people because of their mental health problems. These attitudes can lead to negative actions and discrimination.‘Public stigma reflects the negative attitudes that the public has towards people with mental health problems.’There are different ways in which stigma towards people is shown.

‘Stigma is the bad and unfair feeling that people have about people with mental illness.’

‘You try and talk at a family meeting and they do not listen to you because you have been mentally sick.’

‘The picture people have about mental illness, they see naked people, people who have not bathed or who are smelling, unkempt hair, that’s what they think.’

‘Just because a doctor said I have bipolar that’s not my end, that’s not what defines me.’

‘You know what? Lives are depending on me. So, when people see that, they say ‘But look here, you mean someone actually married that woman or she’s actually still married?’’


Challenging Stigma

• Being called abusive names• Being labelled as a diagnosis, e.g. ‘bipolar’ instead of ‘a person

with bipolar disorder’• Being ignored, not listened to, being undermined• Being denied jobs or losing a job• Being paid less for the same work• Being isolated• Being beaten• Being exploited or not being given responsibilities• Having property and possessions stolen• Being laughed at and pointed at

What forms of stigma are there?

Here people talk about two main types of stigma; self-stigma and stigma from others.Self-stigma is the negative attitude someone might have about themselves and their mental health problems.‘You feel that you are not worthy and you stigmatise yourself’Stigma from others is the negative attitude people have towards others because they have a mental health problem.

It can occur in many ways and from different groups of society including family, community, friends, colleagues & institutions.

Staff who work with people with mental health problems sometimes experience stigma also.

Forms of stigma include:

‘I used to have a big shop, one day a woman who worked for me saw me taking my medicines and she told everyone around that I was mad. My business declined, I felt stigmatised and out of place.’

‘Even mention the word Butabika in a taxi and it elicits the reaction that tells it all. It’s like you’re cast. It’s like you’re not part of the community. People make you feel like you belong to a village labeled ‘the mentally sick zone’.’

Challenging Stigma

Exercise: Have you experienced stigma? What have your experiences been like? What has it made you feel like?

• Beliefs around mental illnesso This includes beliefs that mental illness is caused by

spirits or because someone has done something wrong or that mental illness is contagious

• Lack of knowledge about mental illness• Lack of government policies to protect people• Poverty and homelessness• Denial of mental health problems• Lack of access to mental health services• Breakdown of relationships• Poor hygiene• Shouting and violence

‘If you say you are schizophrenic, that alone, somebody imagines a lunatic moving around with a panga to do horrendous things, without even looking at you. That is what goes along, it removes your human values, your human identity, to be labelled with something that is not accurate.’

What causes stigma?

There are many things that people feel cause stigma.

‘Ignorance is the greatest cause of stigma. Those stigmatising others are ignorant. That’s why you find them sometimes manhandling a mentally sick patient in a rough way, not in a merciful way. Literally not knowing that one day also it might be them being like this person, mentally sick. It could be their own biological child going through this.’‘Some people believe that you are mentally ill because you must have done something wrong or your parents might have done something wrong and this is the result of what you have done but that is not true. Some people think you have been bewitched.’


Challenging Stigma

People describe a number of effects of stigma. These include:• Social isolation• Loosing hope• Stress• Relapse• Self-neglect• Dropping out of education• Mistreatment• Anger• Violence• Fear• Losing your job• Losing your home• Breakdown of relationships, e.g. marriages, friendships• Loss of dignity and low self esteem• Minimises your potential• Suicidal ideation

What are the effects of stigma?

‘Stigma in society is the most disabling part of the mental illness, most of the people can do a lot of useful work for this country and some of them even have high qualifications but they are not being given the chance to work.’

‘Brains are just like any other part of the body. For some people, it’s their eyes that get problems. For others, it’s their ears that get problems. For others their teeth are extracted. For others, it’s their hearts or other parts. So, the brain is just like any other part of the body and when treated, a person can recover and get well.’

Exercise: What do you think the causes of stigma are?What causes of stigma have you seen?


Challenging Stigma

There are many ways in which people fight stigma, this is closely linked to theme about raising awareness at all levels.Ways in which people fight stigma include:• Sensitisation: Educating others and raising awareness about

mental health issues. This includes:

– Through the media– Through drama– At markets and other open places– Through churches, schools and universities– Educating leaders

• Sharing stories– Telling stories of your recovery– Being open about mental health problems and recovery– Giving helpful advice to others

• Forming support groups• Believing in yourself• Working hard and being productive, being an example of

recovery• Taking care of yourself:– Having a good network of support– Keeping good hygiene– Taking medication– Getting enough rest

• Having groups to fight for the rights of people withmental health problem

How can we fight stigma?

‘We want to sensitise the world that people who have mental illness, they can recover, they can be healed, they can become well and they can be part of society.’


Challenging Stigma

These are ideas that other people have had:

‘One of the biggest ways of challenging stigma about mental health problems is making people who are experts through lived experience clearly visible. Let their voices be heard. There is stigma attached and the media is displaying misconceptions, and misinformation. Let us not only display the sorry state when we are on chains, when we are suffering, but also display the recovered state of the people, so that those who are in that sorry state can be supported. We would like to be displayed when we are doing powerful things.’

‘When you begin making mental health an issue on everybody’s lips, attitudes will change.’

‘At home in the village, when I am sick, instead of helping me, they beat me. I think there should be posters in the villages, explaining mental health problems.’

‘In my village people used to ignore me, or if I tried to hug them they would run away. But over time they have seen me recover and now they come to see me for advice and help if one of their family is sick.’

Exercise: In what ways do you think we can fight stigma? Write down some ideas of things that you could do to challenge stigma.


BREC: Empowerment | 1

Empowerment

‘I think empowerment is being able to contribute to the decision making of any given organisation or set up. But first of all, before you can think of contributing to the decision making of a society or organisation, you must be able to make your own decisions for yourself without somebody deciding for you.’

‘If someone is controlling your life you are a pet; like a dog or a cat. You are not who you are, your head on-top of your shoulders feels as if it doesn’t work, so someone has to do the work for you, this makes you very vulnerable.’

‘It is like being promoted to a better status.’

‘I stand in front of people and talk and they listen to me. I am heard and I am understood – this makes me feel empowered.’

‘I used to think that if you were admitted at Butabika you were a gone case. I was disempowered at that time. But now I know about recovery – there is life after Butabika. There are jobs and relationships. You canrecover and even do better than before you were sick.’

‘It’s being given the strength, authority and confidence to do things.’

People describe empowerment as being given strength to do things, particularly to:• Make decisions• Have a voice and be listened to• Be more independent and care for yourself• Access education and learn new skills

Some people describe feeling disempowered when they are unwell. This may be because decisions are for made for them without involving them, they are not listened to or they are not able to provide or care for themselves. People describe becoming empowered as something key to their recovery.

What does empowerment mean?

Empowerment

Exercise: What does empowerment mean to you?

• By the encouragement of friends• Through the help of caretakers• By avoiding bad peer groups• Through advocacy• By having freedom to make choices and being involved in

decision making• By having your choices and opinions listened to• By being given ownership of decisions• By being given responsibilities• By having independence and being able to provide for yourself• By having hope that you will recover and be healed• By having a job• By being given authority to do something freely• Through education and training• By being given skills that enable a more independent life

How can someone be empowered?

‘As you get more responsibility on the ward and at home, this allows you to be empowered.’

‘Whenever I go back home I do my business and I feel empowered. I do not need to beg. I thought I would not be like others again, but I can be. I managed to start a business.’

‘You can also be empowered through hope.’


Empowerment

For many people, one of the key steps of empowerment is being involved in decision making about their treatment and their care.

‘When you are brought to hospital, you’re told that you certainly have to take whatever medication they have given you and the only thing that you can do is to take the medication. But some of us with side effects have been discussing with our psychiatrists, ‘I’m not comfortable with this medicine can you give me some better medicine for me?’ Until we find the medicine that really works for us. For me, I get my monthly Haldol injection and it gives me very little side effects, I just have some few tremors. But it would be useless to give me medication to become well if the medicine is disabling me and I’m like a zombie and I can’t do anything. Then you are giving me medication for what? I’m supposed to be well, move around and do some work. So, if the medication is locking me in one place and in a funny shape then it’s useless.’

Being involved in decision making

Exercise: What has empowered you? How would you like to be empowered in the future?


!

Empowerment

• Hospitals and health centres

• At churches and mosques

• Support groups and the recovery college

• By meeting with friends and family

• At schools and universities

• Through the media; such as on TV and radio

• Through social media; such as facebook

• At sport centres

• At arts centres, through art, music and drama

• At work

What are the barriers to empowerment?

People explain that the barriers to empowerment include; being unwell, being stressed, not taking treatment, being unemployed, poverty, stigma, isolation, lack of information, taking alcohol and drugs, lack of family support, lack of community awareness, lack of hope and lack of education.

How can we overcome these barriers to empowerment?

People also describe that such barriers can be overcome through things such as acceptance of self, raising awareness, challenging stigma, taking treatment, by gaining access to finance, by joining support groups, by having good relationships with family and friends and through sharing stories.

Where can we find empowerment centres?

People explain that there are some places they go can help them to become empowered. These include:


BREC: Expression of self and being understood | 1

‘Explaining to others what you are, where you come from, what you do.’

• Through speaking to people• By telling their stories• By talking to others about how they are feeling• Through music and drama• Through art and poetry• Through actions, such as through work• Through the way they dress• Through body language and facial expression

Many people find it helpful to share their stories and experiences, particularly with peers who have had similar experiences.

This can help people to feel better understood.

What is expression of self and being understood?

Many people find that expressing themselves and being understood by others is helpful in recovery.Expressing yourself means ‘showing yourself to others’ and being listened to and understood means that ‘people get you’. People talk about showing the ‘inside you’, not the ‘outside you’.

‘Expression means to be exposed.’

‘I think expressing yourself is showing your real opinions and feelings. Showing what is inside, not the false on the surface.’

In what ways do people express themselves?

Expression of self & being understood



‘I express myself by telling my story.’

‘I write poems about my experiences, it helps me to tell stories about what has happened.’

‘By sharing stories in a group, we are all helped in recovery. By talking and listening we know we are not alone and gain hope.’

Exercise: How do you like to express yourself?

People explain that there can be some barriers to expressing yourself. These include isolation, stigma, poverty, language barriers, lack of self-acceptance, low self-esteem, lack of awareness and problems in relationships.

Ways in which people tackle such barriers include speaking to peers with similar experiences, acceptance of self, seeking support and advice from friends and family and professionals, raising awareness and challenging stigma.

What are the barriers to expressing yourself?


People feel there are many benefits to being able to express yourself and feeling that you are understood. These include:• Helps your family, friends and community to understand you• Helps you to be better supported and accepted• Relives stress and makes you feel free• Can improve confidence and self esteem• Sharing stories with others can bring hope and acceptance• Helps staff to understand you and provide the right treatment• Can help to raise awareness and reduce stigma

How does expression of self and being understood help in recovery?

‘Telling others about the voices I hear enabled me to get help in understanding them and tackling them. They don’t bother me much anymore.’

‘It allows your family members to understand you and allows them to see if maybe you become unwell again.’

‘It makes you feel free and gives you peace.’

‘The medical staff get to know you and how to help you.’


Exercise: How does expressing yourself and being understood help in your recovery? How do you feel when you express yourself?

BREC: Feeling useful and having a purpose | 1

‘If you feel important and useful it will mean you will look after yourself.’

This theme is about having something to do and making a contribution. For many people this is key to recovery. People talk about doing something for yourself and doing something for others. People describe it giving them a reason to get up in the morning and giving them goals for the future.

People find many different ways to be useful and have a purpose. Examples include:• By doing housework• By caring for your family• By having a job• By doing charity work and volunteering• By meeting people and being friendly• By being of service to others• By supporting others• By being creative• By learning and gaining knowledge• By being kind• By digging and farming• By rearing animals• By having a business• By employing others• By praying and keeping faith• By engaging in community activities• By doing sports

What do we mean by feeling useful and having a purpose?

In what ways can you be useful and have a purpose?

Feeling useful & having a purpose


‘Think, what is your purpose for the day? What will you achieve? Then there is a reason for you to wake up. Something you are working towards, a goal, a plan. Something from your heart that you want to do.’

‘When you wake up every day, do something. You will start to feel better.’

‘You can be useful to yourself and then extend to the community.’

‘Being with a mental problem does not mean that you are useless, you can be useful to the community, for example in my church where I pray from, I am the treasurer, I am useful to my community.’

Feeling useful and having a purpose

Exercise: What things do you like to do to feel useful and have a purpose?

Are there other things you would like to do in the future?


Many people feel that this is a key part of their recovery. Ways in which it can help recovery include:• To improve confidence and self esteem• To be respected by others• To earn money• To reduce stress and have peace of mind• To develop skills and talents• To know yourself• To keep healthy• To keep an active mind• To improve relationships with others• To provide motivation to look after yourself• To learn to love yourself• To prevent relapse• To prevent isolation, to meet other people and socialise• To prevent laziness and idleness• To give hope• To feel a useful member of your community and of society• To provide focus and goals• To contribute to the wellbeing of others• To feel appreciated and valued

How is being useful and having a purpose helpful in recovery?

‘If you are occupied, even if you are sick, it means you don’t think about the sickness.’

‘It is important to feel useful, I had lost hope but I learnt a few skills and began to sell what I had made. I knew I had a purpose.’

‘If you feel important and useful it will mean you will look after yourself.’

‘I go and give words of teaching in the community, which makes me so happy and I see myself as useful to the community.’

‘When you feel useful you can interact with other people. By interacting with others you will get ideas to push you ahead and it will help you to be a better person and you can learn skills.’



‘My mum has always trusted me with her ATM card to withdraw money but once my sister felt I would easily loose the card. It was a bad statement but my mother continues to give me her ATM card to withdraw money. It makes me feel useful at home.’

‘Two years ago, I was a very different person, there was a time I felt completely useless, when I wanted to commit suicide, my parents told me I would never be anything. I was so down, I lost hope, I was in denial. But I started to meet people who were having the same problems. I started to learn to make beads and jewelery. I learned to sell my work, so every morning I wake up and I have a purpose and a drive. I now have hope and even bigger dreams.’

‘I find that I can perform just like any other person and actually find that the people I deal with appreciate what I do.’

‘It is important as a way to meet people, is a way of stepping out, getting you out. Stops you hiding.’

‘I help with work at home, there I’m taken as someone sick but when I help I feel useful. My mother feels I am of importance to her because I do something for her, I am not dormant. You feel of importance to your parents if you can help them.’


Exercise: How does feeling useful help you in your recovery?

How does it make you feel to have a purpose?

BREC: Healthy Lifestyle | 1

Healthy lifestyle

‘Eating a balanced diet, getting enough rest and relating with others keeps my recovery going.’

This theme is about the things you can do to can keep your body and mind well. It is important to look after yourself and know yourself to keep a healthy body and mind.

When people talk about being healthy they describe being physically well but also having healthy mind, socialising and living in a healthy environment.

What things do people do to keep a healthy body and mind?

There are many different things that people do keep a healthy body and mind. These things include:• Eating a balanced diet• Eating regularly• Taking medication• Taking enough rest and getting enough sleep• Having time to relax and spending time in calm environments• Taking exercise, for example walking, football or yoga• Keeping good hygiene:

– This includes keeping yourself clean, your clothes cleanand the place you live clean

• Engaging in leisure activities like singing, watching filmsand reading books

• Expressing yourself creatively, for example through crafts,drawing or dance

• Having good family planning• Going for regular health checks

What does a healthy lifestyle mean?

Healthy Lifestyle

Exercise: How do you keep yourself healthy?

• Gives you peace of mind• Reduces stress• Can reduce the risk of relapse• Improves self confidence• People may give you more respect• Can help you adopt a new lifestyle and new ways of thinking• Can help you meet new people, for example through sports• Allows you to relate to others better, for example if you have

good hygiene• Helps you to get employment and organise a routine• Helps you to be responsible

How can a healthy lifestyle help with recovery?

‘If I am eating well, sleeping well and avoiding drugs and alcohol I remember easier, I can set a routine and keep to it, it allows me time and energy to socialise and do my work.’

‘Environment is key, if I am in a clean place I have a clean mind.’

‘Eating a balanced diet, getting enough rest and relating with others keeps my recovery going. This is my healthy lifestyle.’


Healthy Lifestyle

‘Playing sports heals me.’

‘To see somebody clean, to brush their teeth, to put on their shoes, is a very very important part of recovery, in fact, it is a sign that somebody has even recovered.’

‘I will also tell them; ‘Look at me from an outward appearance, do I look like I am mad? I am smartly dressed as you can see me. Have I come to hurt you?’ Then they say, ‘Today I think you are well and your brain is coordinated.’

Exercise: How does having a healthy lifestyle help you in your recovery?


BREC: Hope | 1

Hope

‘When you say hope I see a light at the end of the tunnel. As you’re struggling through that tunnel, you struggle towards that light, it is a constant fight but if there is that light then you will somehow reach it at some point, if you take one step at a time.’

‘To me, hope is thinking positively about my future life. Knowing things will get better’

Hope is very important to many people. Hope is about positive thinking and looking forward. For many it is about believing in yourself, setting goals and having courage. Hope is a key element in recovery. Many go on to inspire hope in others on their journey of recovery.

What is hope?

Exercise: What does hope mean to you?

BREC: Hope | 2

Hope

• Gives you focus• Helps you to plan and work hard• Gives you motivation and helps you achieve your

goals• Helps you to take treatment• Reduces stress for you and your family• Helps you to accept what has happened in the past• Helps improve your self esteem• Allows you to embrace opportunities• Helps to reduce stigma• Helps to prevent relapse• Helps you emotionally

How can hope be helpful in recovery?

‘Hope is a very important aspect in one’s life, never giving up. Always hoping for the best. Even if everything may look hard, even if I relapse now it is not the end. Hope is a very useful thing.’

‘If I am hoping, I feel less stressed, you look forward, you think I am going to be fine and eventually you get fine.’

‘It is just like when you are applying for a job. The first thing you need is hope that you’re going to get this job, if you are hopeless you will not even apply. The same is true in recovery.’

‘When people don’t have hope, even when opportunity is around, they will not embrace it. It is just like; you need something and it is brought to you and you refuse to pick it. So hope can help us to face life, it is one of the biggest pillars in recovery.’

‘The fact that I am still living, it drives me to hope for a better tomorrow. That even if, whatever I might be going through now might not be so so good, but I believe somewhere at the end of the corner where it looks to be dark, I will see some light.’

Hope

Exercise: How does hope help in your recovery?What things are you hoping for?

As people progress along their journey of recovery many want to help inspire hope in others. Ways in which people do this includes:• Being an example, showing your recovery through your life

and your work• Through sharing your story with others• Encouraging others• Through teaching• Returning for review through recovery

How can we plant the seed of hope in others?

‘Hope is to me reciprocal. So by giving hope to others they give me hope back, by appreciating my role in their lives.’

‘The dream is now achievable. We are no longer at that stage where we think oh no, my world is stopped. Though other members in our group may not have hope, we are there to show our example and help them come out and then they help others and the generations to come.’

‘Though I was mentally sick, I still had hope. I started doing small work, fetching people water, they gave me some money, then I bought a bicycle and utensils. I still had hope; I thought ‘I can still work; I am still somebody’. People would laugh at me, but despite the stigma I had hope that I would make my business. Now they see me and see that I am doing well. I always tell others they should keep hope.’

BREC: Hope | 3

BREC: Influencing policy | 1

Influencing policy

This theme is about how people feel national policy could better represent and serve people with mental health problems.

Policies are principles, rules and guidelines that organisations, such as governments, have.An example of a policy in Uganda is that all children have the right to free primary education.

Key areas of policy that are important to people with mental health problems include:

• Being represented in government

• Their rights being included in policy and enforced in law

• Being able to live in a safe environment free from abuse

• Workplaces and communities making accommodation forpeople with mental illnesses

Being represented in government • Many people with mental health problems would like to be

better represented at government level. This includes having a member of parliament to represent people with mental health problems.

• Many people also raise the issue that when applying to work in public service you are asked if you have any history of mental health problems. They explain that those who answer yes are normally excluded straight away.

What is policy?


Influencing policy

‘So, I don’t want other people to represent our issues. I don’t want other people to ride on our backs to make their pockets fat. I want our issues to be represented by us, that’s what I believe in. Because we have a voice, we can speak, and most importantly we’ve gone through it. Because when you go through something, you give it a human face, people stop looking at you as a statistic, people stop looking at you as what the doctor diagnosed. They actually say ‘Ey, you mean these people are actually human beings? They actually feel and think the way I do?’ You see? People begin to think and realise, you know what, what we have been doing has not been right. Mindsets begin to change.’

‘In Uganda, you’ll find a member of parliament for the physically disabled persons but there’s no member of parliament representing the mentally disabled persons. Does it mean that once you’ve had a mental health challenge you aren’t able to hold meaningful discussions? Why should somebody else think for me? Mentally challenged persons should now be considered and our issues taken care of so that we are represented in parliament.’

‘I believe the law is something that should be started with if we are to improve on mental health. You find that the law itself, constitutionally, impinges people with mental illness, as persons who are discriminated they are unique in the community, and the law doesn’t favour them in one way or another, not at all. You find that even if you go to courts of law to access justice there is no justice to someone who has suffered from mental illness.’

! Rights and Law

• Many people feel that is very important for the rights of people with mental health problems to be defined in law. These rights include how people with mental health problems should be treated both in the community and when in hospital.

• It is also important for people with mental health problems to have access to the justice system and for those who abuse people with mental health problems to be prosecuted.

• Many also talk of the need to improve the Mental Health Treatment Act which was written in 1964, to better help and protect mental health patients.

Influencing policy


• It is very important to all people who have experienced mentalhealth problems to feel safe in their environment, whether thisis in the community or in hospital.

• This includes receiving the care needed and being protectedfrom abuse.

• A key area raised by many is being protected from sexualharassment and abuse.

• Many people talk of how workplaces and communities shouldmake reasonable accommodation for people with mental healthproblems.

• This may include:

- Giving people time to attend appointments

- Helping people return to work after a period of illness

- Paying people the same as other employees

• People with mental health problems can be productivemembers of society if given the support needed.

Living in a safe environment

Workplaces and communities

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‘At the time at which the 1964 mental health act was written, it was not written with favour towards the patients. It was written as if the patients are a bother to everybody to the extent of writing in the law ‘idiots’ and ‘imbeciles’. You could see that those people writing it were more interested in protecting the rest of society from the mentally ill and not to help the mentally ill themselves.’

‘Sometimes some of us are isolated, sometimes they don’t feed you, don’t bathe you, sometimes they sexually harass you. The government should come up and fight this stigma.’

Influencing policy

‘Some people discriminate or underpay us because we have a mental problem. We are working longer and are being paid less. A mental health patient should be paid equally for the work they have done.’

‘A mental patient employed somewhere needs to be given sick leave and annual leave like any other person. Let them allow you to come for review. But now they say the job is over, they didn’t know you were mentally sick.’


Exercise: What areas of policy would you like to see improve to help people with mental health problems?

People try to influence policy in different ways including:• Raising awareness

• Speaking to leaders

• Lobbying government

• Through their vote

• Through organisations

How can we try to influence policy?

‘That is why the awareness at all levels is important and paramount so that the policy makers are also educated and then they can change the policies and make better policies to accommodate all people.’

BREC: Raising awareness at all levels | 1

Raising awareness at all levels

This theme talks about improving understanding of mental health issues.

Many people feel that everyone should understand more about:• What mental health problems are

• How mental health problems are caused

• How mental health problems are treated

What should we raise awareness about?

‘In the setting where we live there are a lot of misconceptions and speculations, maybe they say a person has been bewitched, which is not the case. There is a lot to be covered as far as raising awareness about mental health issues.’

‘In the past people would be tied in ropes, people took their lives because they couldn’t share, families would never discuss mental illness. Now as we raise awareness more people are coming up and are willing to talk about this.’

‘People need to know that we can recover, function and lead normal lives.’



Exercise: What do you think we should raise awareness about?

What things about mental health should people know about?

Many people want to improve understanding of mental health problems in all groups of society. Such groups include:• People with mental health problems• Families• Friends• Communities• In schools• The general public• The police, army, prisons• Government and politicians

In which groups should we raise awareness?

‘From person zero to the president, everyone should understand more about mental health problems.’

‘Sometimes when things are never talked about, people may never understand or they may never discover anything about themselves or others. It’s until someone says something, then they wake up.’



Exercise: In which groups do you think we should be raising awareness?

What are the benefits of raising awareness at all levels?

To you:Many feel it is good to understand your own diagnosis and treatment and to be aware of your triggers for relapse.

‘If I understand my own problems I can better care for myself.’Understanding your own condition can also help you to explain your condition to others. By doing this you continue to raise awareness.

‘Raising awareness helps us to accept our mental illness which aids our recovery.’‘It helps to give us freedom, independence and respect.’To your family and friends:For many, explaining mental health problems to their family helps them understand and means that their family can help them.

‘If my family know my problem they can bring me to hospital, remind me of my medicines and my appointments. It helps them take better care of me.’Some also feel that by explaining their problems to their families and friends they have a better relationship with them.

‘I lost some friends because I did not share with them my problem. With those I told, they could understand and stayed with me. It keeps our relations alive.’



What are the benefits of raising awareness at all levels?

To your community:By raising awareness in communities this can reduce stigma and discrimination against people with mental health problems.

‘If we share in our communities we can allow integration and all live together peacefully.’Many also talk of how raising awareness in communities allows people to get the help they need.

‘All these people get to know the signs of mental illness and then if it happens in their community they can help and do something about it.’‘When you get a problem, if people already know they can rush to help before it is out of control. For me they recognised I was unwell, I got help and I didn’t need to go to hospital.’To society:Many feel that by raising awareness in wider society, including the general public, the police and the government and politicians, helps to protect the rights of people with mental health problems and allows them to be more valued members of society.

‘Sometimes the police handle people badly when they don’t understand mental health.’Raising awareness in society may also promote the development of services and support for people with mental health problems.

‘Awareness at all levels is important so that the policy makers are also educated and then they can change the policies and make better policies to accommodate all people.’



There are many ways in which people can raise awareness and this can take place in many different places. It can be as an individual or in groups or organisations. Examples of ways to raise awareness include:• Telling your story• Talking to family and caretakers• Discussing with friends• Through churches• Through schools• Through hospitals• Through the media: Radio, TV, newspapers, Facebook, Youtube• Through training• Through drama and art• At markets• Talking to politicians and leaders

How can we raise awareness?

‘I raise awareness slowly, slowly.’

‘When people don’t know much about what you went through and they just hear from others misconceptions and misinformation then the stigma will increase. One way is for me to come out, whenever I have a platform or opportunity, I tell my story.’

‘We found sometimes the police were handling people badly, we organised some workshops so they could understand more about mental health problems.’

‘One time I was travelling in a taxi and the man sitting next to me saw that I was carrying a medical form from Butabika. He turned to me and said ‘Are you mad?’. I said ‘Yes I am sick, what is wrong with that?’. We started talking and we became friends.’

‘Sometimes we need to raise awareness, not from the billboards but it starts with us. People have seen me in the community before and they are seeing me know. Yes, I fell down, it was me, now I am up, it is still me.’

‘When I see people on Facebook saying bad things about mental health, they don’t get it, they make jokes, so I try to talk to them. I discuss with them and explain what it is about.’



Exercise: How would you like to raise awareness?

‘We should be teaching in our families also. We as patients at home should be the primary teachers, we should be the ones raising awareness.’

BREC: Spirituality | 1

Spirituality

‘Spirituality is your inner belief system.’

What is Spirituality?

When people talk about spirituality they are talking about their inner belief system. Many people talk about their ‘heart’ and their ‘soul’.Spirituality is connected to religion but is not the same. People may be Christian, Muslim, Buddhist, or another religion or may not believe in God and have their own form of spirituality.

Exercise: What does spirituality mean to you?Is spirituality something that is important in your life?

Spirituality

Many people feel that their spirituality helps in their recovery. Different people find that it can help in different ways. These include:

• Giving you hope and peace• Helping you look for meaning in life and giving you a

sense of direction• Allowing you to accept yourself• Giving strength and courage• Through prayer• Believing there is a higher power guiding you• Support from communities such as the church or mosque• Giving moral guidance and help in decision making• Allowing you to give service to others• Allowing you to meet new people and make friends

How can spirituality help recovery?

‘My beliefs allow me to accept myself and give me courage and strength in the face of hardship.’

‘To me spirituality helps shorten my recovery journey, it gives me hope, inspiration and allows me to tackle stigma.’

‘It helps me that God knew me before I was born and has a plan for me, this gives me hope.’

‘When I am unwell I often ask: ‘Why me?’ ‘What is happening?’ I envy people. I even envy a bird, it is free, it can fly, it can even build its own home. My faith helps me know that there is a plan for me for the future and not to lose hope.’

‘Having faith in something you believe means you don’t lose hope, you believe there is something better, you have faith. During that time, it helps you, the medication is working, the therapy is working and your relationship with God increases and it is a win win. Spirituality is really important.’


Spirituality

For some people the relationship between spirituality and mental health can be complex, some people believe that their problem is spiritual, that it might be the result of witchcraft or something related to the ancestors.

This can influence where they seek care. People are more likely to seek help from traditional healers if they believe the illness is cultural. Traditional healers are often more accessible and affordable.

Some people find that religious groups may advise different ways of tackling mental health problems. In some cases they advise stopping taking medication which can cause problems for people, such as relapse.

Many people who are in recovery from mental illnesses feel that members of the religious community and medical community should work together to improve the care of people with mental health problems.

Interactions between spirituality and mental health

Exercise: How does spirituality help in your recovery? Can you think of any times that your beliefs have helped you in your journey of recovery?


!

Spirituality


‘I remember one time that I relapsed, they prayed and they prayed but things did not work. Then one pastor because he had had an encounter with a psychiatrist, who was also born again, said if you have prayed for somebody and cursed out the devils, you have done everything you think is possible and the person still has not recovered then that person needs treatment from the hospital.’

‘I believe god works through people, he can work through medical people as well as the priests and these people should work hand in hand at improving mental illness.’

BREC: Support & relationships | 1

‘Support and relationships are important parts of our life, whether you have a mental illness or not you need all the support you can get, from your family, community, friends, colleagues, it’s all about team work.’

Support means getting help. Having people to support you and having good relationships is a key part of recovery for many people. How do support and relationships help in recovery?People find that supportive relationships can help in many ways. These ways include:

We can receive support from different people including:

What is support?

Who can provide support?

Support & relationships

• Providing care• Feeling listened to• Feeling loved• Having a calm home

environment

• Family• Friends• Community• Colleagues

• Reducing stress• Feeling worth something• Having hope• To receive sympathy• To be more than your diagnosis

• Peer support• Support groups/organisations• Church/Religious groups• Doctors and Nurses



!

!

Family support

For many having a good relationship with their family is key. Both being loved and cared for but also being able to love and care for others is helpful for many in their recovery.

‘My family has always been there, even when we didn’t understand what was going on they tried to ind out and ind out how they could help me.’

‘My children keep me on the right track, if I feel suicidal I talk to them, I discuss, we laugh and I come out of it.’

‘My family help me to know that I can be someone, even having this disease.’

Other support and relationships

Support from friends can also be very important in recovery. Spending time with friends can be a time to share problems and reduce stress.

People also find that having good relationships with other carers and service providers helps them.

Many feel that having a good network of support increases their chances of recovery.

‘My friends tell me they will be praying for me. They say, ‘I am always with you’ and so I never feel alone.’

‘My grandmother, my brother, my sister, my pastor, my community, my friends, my nurses, they all contributed to my wellbeing and recovery.’

‘Greeting and talking with people pushes the dark thoughts from my mind.’

‘My friends keep me well by giving me advice and listening to me. When I am depressed they take me out for a soda and we reminisce about times in the past.’



Exercise: Who do you get support from?

Exercise: How do support and relationships help your recovery?



Peer support

Support from peers who have been through similar problems can be very helpful. Getting peer support from someone who understands can provide companionship, hope and help you greatly through your recovery.

‘I get support from other people I meet who also have had problems and take medication. I see that I am not the only one, there are many of us. I see that we can make it. It gives me hope.’

Providing support to others in similar situations to you can also be helpful in recovery and in maintaining your own wellness.

‘Supporting others allows me to continue on my journey of recovery. By sharing my story, I can show people that there is a future ahead.’

!

Exercise: Have you received support from a peer? If you have, how did getting support from someone who has been in a similar situation make you feel?



Exercise: Have you given support to a fellow peer? If you have, how did supporting someone make you feel?

Sometimes people face challenges in their relationships with family and friends. Things that can cause problems include:

Ways in which people face these challenges in their relationships include:

Challenges in relationships

• Arguments and misunderstanding

• Lack of work and money• Different opinions

• Being patient• Listening to one another• Having peace talks• Engaging service

providers• Engaging the wider

family and community

• Drugs and alcohol• Violence

• Cooperating with oneanother

• Doing activities to getmoney and saving

• Doing activities like sports• Stopping taking alcohol

and drugs

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Exercise: Have you faced challenges in your relationships?

How did you overcome the challenges?

Sometimes families might find it challenging caring for someone with a mental health problem. Often carers need support too, this can be from other family members or friends, other carers in similar situations or service providers.

Maintaining good and supportive relationships is a key part of many people’s recovery, with family, friends and the wider community. For some a key stage in their recovery is feeling supported and able to start their own family.

‘I was young when I became sick, I worried that I would never have a family. Now I am happily married with two children; I even have grandchildren! Many of my peers are also the same, having families of their own.’

Support for carers

Relationships of recovery

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Exercise: Do you have relationships that you feel represent your recovery?

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Butabika Recovery College - Peer Nation

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