06: Socially Enabling Care (Bonding and Nursing care)

 

SOCIALLY ENABLING STRATEGIES FOR CARERS (MENTAL HEALTH NURSES

At the present time, in the U.K., people with Behaviour disorders (Mental Health disorders) are ‘treated’ by the Mental Health services, and cared for by Mental Health Nurses.                     Below, there is an account of an Enabling Social Care provision, which discounts the patients symptoms of’ pathology’, and explains how ‘carers’ engaging groups of sufferers in a social, non judgmental, friendly way can readily allay the anxiety which is at the root of the problems.

 INTRODUCTION

The evolved neuro-chemical Bonding Process in the newborn, establishes Social Needs for approval and acceptance in everyone, for the rest of their lives. When these needs are met they give the individual self-confidence and a sense of worth, along with feelings of pleasure and contentment. These motivate them to be altruistic, cooperative and kind with other people, and this encourages ‘bringing out the best’ in others, rather than competing with them. Interpersonal relationships will form, but it is the interactions between many people, which are the mechanism that builds individuals into successful communities.

People live as members of a variety of groups and communities that form for different purposes. These roughly divide into ‘work’ and ‘leisure’. However, underlying the purpose and activity of all groups is the necessity that every member’s Social Needs are met in some degree, so that they are all in some accord about the purposes and activities, for the group to be successful. It is the total, and the organisation of all the individual interactions that make up the social lives that are unique to humans.

It is evident that some people fail to function fully in the communities in which they live, and the Psycho-social Pathology article gives a brief account of the Behavioural Disorders that result from high levels of anxiety which lead to antisocial symptoms. Whatever strategies are devised to help restore ‘normality’, to be fully effective, they must ensure that people have the opportunity to behave sociably, in order to experience the pleasures of having  their Social Needs met, and become able to find friendship and contentment, and experience approval and self-confidence. 

There are many different patterns of disturbed behavior, but they all have in common, high levels of anxiety and feelings of fright and loneliness. It is likely that when people are in this state and they have to interact with people, they often have negative experiences. This is partly because they worry or frighten people whose help they need, and partly because there is a universal stigma regarding M H Disorders. When Professional help is needed, concentration on managing symptoms, rather than meeting Social Needs, can delay recovery.

The common denominator for all people with M H Disorders, is that their Social Needs are not being met in some degree. The core strategy for carers (M H Nurses) is to ensure the safety and wellbeing of clients, and to generate an environment and situations which provide purposeful activities and fun occupations that facilitate plenty of interaction between everyone. This will enable friendships between them and lead to optimism and contentment.

ESTABLISHING SOCIABILITY CARE

Because of the problem of ‘stigma’, it is important to set up Units in the community that are not identified with any Mental Health Services. and the Enablers are not identified as Mental Health Nurses.

Units may be residential or for day care; size and situation of groups decided; mix of participants by age, type or severity of problems; and pathways to participation decided.

The most useful strategy for Enabling Social Care is to ensure the safety and well being of the distressed people, by allaying their anxiety and engaging their trust. Then, to motivate sociability and ‘normal’ patterns of behaviour.  The most effective way to achieve this is through engaging with others who are distressed, in a variety of social groups. Growing evidence shows that Experiential Group Activities are the most effective way to provide a lived experience of what the give and take feels like and how enjoyable the fun can be. Because the Social Needs are being met everyone is motivated join in with whatever is offered, and maximize their own contributions.

STRATEGIES FOR SOCIAL CARE PROGRAMMES.

For the purpose of this account the sufferers of Behaviour Disorders will be referred to as Needy, and the people who are employed to provide Care, may be Mental Health Nurses, social workers or psychologists, (and volunteers). Their function will be to Enable sociability through engagement in a wide variety of work and leisure activities. What title they might be given is open to negotiation, but the term Helper will be used here.

There are some genetic factors relating to the Maternal Infant Bonding Process that have to be taken into account when planning and implementing care for the Needy. The first is the genetic reflex response of Attention Seeking Behaviour  in  distressed people, whose Social Needs are not being met sufficiently. The second is related, and is defined as the Neurotic Paradox, where the Needy feel deprived of anything good from any others, and so reject anyone offering care,or even kindness, in order to avoid being further hurt by them. The last factor is the genetic Stigma of Mental Illness, and is most difficult to counter.   These negative mechanisms have to be consciously over ridden by Helpers as they engage with the Needy, in order to avoid being patronising.

As things stand at the moment, the Needy are under the care of psychiatrists, but they should be assured that they are not ‘ill’, but are temporarily ‘misfits’, who can now be helped to find friends and fun with other people, and engage with ‘life’ again.

The Philosophy of Sociability Care

Helpers of the Needy recognise the uniqueness and worth of people who because of factors beyond their control have difficulties in socialising with others, but who remain worthy of respect, and entitled to dignity.  They will use their skills and endeavour to ensure a safe and enabling ambiance and provide adequate resources, without fear or favour to anyone.

THE STRATEGIES FOR ENABLING SOCIABILITY

The size and composition of groups for the Needy will depend on referrals in the first instance, but it is to be hoped that there will also be the possibility of self referral for the misfits and the lonely in the community. Whichever it is, decisions have to made as to the total numbers, their age range and the extent of their difficulties, for individual groups. And then there are the questions about attendance; for providing enabling help; for timing the sessions, one hour ‘group therapy’ is not appropriate, so it could be for a morning, an afternoon or all day, and for one to five days a week.                                                                                                                         There may need to be residential, as well as community provision, so that there is safety for seriously disturbed newcomers, or individuals who fail to benefit from the enabling programs, and become withdrawn or troublesome.

With those decisions made, the task is to organize all the work and leisure group activities within which the Needy will be helped to maximise  and share all their skills and abilities, as they experience the fun and friendship that will meet their Social Needs and give them a sense of belonging.

The skills the Helpers need are empathy and patience, imagination and enthusiasm, and enough life experience to be able to contribute and learn by participating in the groups. A good team spirit and sound observation skills will pave the way to success.

It will take skilled negotiation with the NHS and Social Services to sort out suitable funding, accommodation and staffing to fully implement Sociability Caring for all those who need it. However, for starters, where there is a team of skilled enthusiastic Helpers it can be put into practice wherever there is a room to hold at least twenty people who can have room to run around.

Running Experiential Socially Enabling Groups

The reception interview maybe individual or communal, and is an attentive listening exercise, rather than a form filling duty, with a welcome that gives a broad outline of what is on offer, and does not involve too many facts. Preliminary information about safety and consideration of others is essential, as is the importance of turning to Helpers with any difficulties or problems.

There are now books and websites about Experiential Learning which can give examples and ideas for group activities, and are useful to begin with. They mostly refer to Experiential Group ‘Therapy’, which tends to focus on overcoming individual’s ‘problems’, but the group activities they use are excellent, and ‘trust’ exercises which are important can lead to many other ideas.

There is one aspect of ‘modern’ life that should be omitted from Enabling Group activities, and that is ‘competition’. Wherever there is competition, there are always more people who are losers than winners, and therefore more people with knocks to their self esteem. It is difficult to prove, but it is likely that the ‘rewards of winning’ anything, do not meet Social Needs in anyone, but the pleasure ‘buzz’ can become addictive and not useful for a contented society.

Planning for Groups is based on all human life, and should  provide for the engagement of all the physical, intellectual and emotional aspects of behaviour. There can be a whole range of activities that can stimulate ‘sharings’ of all these facets in the groups. Especially helpful is finding  voluntary ‘work’ activities in the local community.

Planning for, and devising strategies for implementing Sociability Caring within the NHS presents great challenges, but in conjunction with Social Services, offers huge benefits, both to individual sufferers and society at large.