resilience, self-care and why they matter to mental health

 

Self care is the single most important element in mental health services, as outlined in the  World Health Organization's Optimal mix of mental health services, above. The pyramid shows that the highest need is for self care and informal supports, and the lowest need is for acute hospital care, although this is what we often focus our spending on. Of course, hospital services are the most expensive, and self care is the least expensive, but sometimes hard to achieve.  

This is an excerpt from a social work blog I wrote recently on resilience and self-care.

‘Making sense (of difficult experiences) is a source of strength and resilience’
Dan Siegel (2010). Mindsight, Melbourne: Scribe.

If you have lived long enough, you will have experienced adverse life events. I come from a relatively privileged, educated, middle class background: as a result, I have been able to ‘make sense’ of these adverse life events, and I now see myself as a fairly person. As a younger practitioner, however, I often felt quite vulnerable and insecure about my ability, and found working as a therapist very stressful at times.

By learning more skills, and understanding theories that helped me make sense of the challenges my clients were experiencing, I have gained in confidence and self-belief. I have also gained a great deal from working with many fantastic colleagues, students and clients  over the years, who have taught me many skills, but also helped me appreciate my own abilities. Studying social work has not really changed this, although it has given me a broader framework in which to understand human behaviour, and has consolidated previous learning.

I have always been inspired by people who were social activists and who fought for human rights, from a position of disadvantage and adversity: Nelson Mandela has always been one of my heroes.

Resilience as an overarching concept is the ability to 'Keep on keeping on' or to 'bounce back' in the face of adversity or difficult circumstances. Practice wisdom and social work theories suggest that resilience is a personal quality that clients, and, indeed, all of us, need to have or develop, in order to thrive rather than just survive. As we all know, life is challenging, and we all need a certain amount of determination to be able to face these life challenges, rather than avoid them.

However, I think that resilience can be misunderstood, particularly in the general population, where phrases such as 'suck it up'/'man up'/'get over it' and 'move on' are frequently used, when people are unhappy or not coping. Thus resilience can be seen as a need to 'toughen up', or even used as a subtle form of 'blaming the victim'. It is hard, for example, to find resilience in places where people do not have many opportunities for self-determination. Detention centres for asylum seekers come to mind. Finding resilience in such places would be the exception, not the rule.

What I have learnt about resilience is that it is not developed by simply making a decision to 'move on' in spite of what has happened. The concept of 'moving on' is quite abstract and alien to me. To me 'moving on' implies that we should ignore what our emotions are telling us and try to forget about what happened. So how do we develop resilience, if we don't already have it?

According to Siegel (2010), resilience is developed through secure attachment relationships. If we don't have these nurturing relationships when we are infants, there is still the possibility of developing resilience later in life, as the brain is still able to change and grow. A therapeutic relationship can provide the unconditional positive regard that the individual needs to 'make sense' of experience. This is developing resilience from the inside out.

I also believe that taking action according to what is important to us, will help to make us more resilient, which could be seen as from the outside in. The behaviour that helps me to build resilience is the practice of 'self-care'. This is the foundation of resilience, and we can learn to do this even if we had adverse life experiences when younger. This applies to all of us, not just social workers or clients, but people in general.

For me, self-care includes behaviours that keep me physically healthy, and those that increase my ability to emotionally self-regulate. After working in this field, particularly with trauma survivors, for several decades, I have developed a range of self-care practices. This includes going to the gym, eating well, practising yoga, cycling, meditation, gardening, cooking, reading lots, and also my art practice. It also involves having good supportive relationships, especially with my partner, family, friends and colleagues.

When I feel stressed or anxious, it becomes harder to do these things, but this is when they are most important.

more later