Q The reprot is about The Role of Social Support in Mental Illness Recovery gives us a sense of identity and belonging. Home, - The Role of Social Support in Mental Illness Recovery The Role of Social Support in Mental Illness Recovery INTRODUCTION It is a common saying that no man is an island. Social support is often identified as a key component that binds us together to sustain our wellbeing. It gives us a sense of identity and belonging. Social support is like the branches of a tree that brings together all the parts of the tree to make it a single entity. When isolated, no fruit nor leaf can survive, be sustained nor receive enough supply for growth or recovery when it is injured in one way or the other. Essentially, social support involves having a network of family and friends that you can turn to in times of need. Whether one is facing a personal crisis and need immediate assistance or just want to spend time with people who care about you. These relationships play a critical role in how we function in our day to day life and how we respond to physical and mental challenges.(Cohen, 2004) It is social support that builds people up during times of stress and often gives them the strength to carry on and even thrive in times of challenges. But social support is certainly not a one-way street. In addition to relying on others, one also serve as a form of support for many people in our lives. The social networks a patient is involved in has been found to have direct positive impact on the rate a patient recovers from mental illnesses.(Breier and Strauss, 1984). Social support also play a pivotal role in the process of recovery of patients from mental illnesses. It could both facilitate recovery or make the patients mental health deteriorate depending on various factors.(Harandi, Taghinasab and Nayeri, 2017). (Hooly and Jill 2007). Sources of social supports which is intended to help in times of mental illnesses may turn out to have deteriorating impact on an individual. This is possible when friends and family members are over emotional about an individual’s condition. Recovery from mental illness has been defined as the “personal experience of the individual as he or she moves out of illness into health and wholeness”.(White, Boyle and Loveland, 2004). It is a dynamic process characterized by movement toward conditions of hope, purpose, and wellness. Participation in meaningful social life is a major goal for many persons in recovery. (Mezzina et al., 2006). Recovery may involve a journey both of personal change and of social (re)engagement which highlights the importance of creating accepting and enabling social environments within which recovery may be supported.( Tew et al., 2012). American Psychiatric Association defines mental illness as conditions involving changes in emotion, thinking or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities. The World Health Organization defines mental health as a state of well-being, that in which the individual knows their capabilities and uses them effectively and productively that will be useful for their respective communities.( Harandi, Taghinasab and Nayeri, 2017). As mental health is determined by a complex interplay of physical, psychosocial, cultural and spiritual factors, so also does each of these factors play key roles in influencing recovery during mental illnesses. Social support is a transactional communicative process, including verbal and/or nonverbal communication, that aims to improve an individual’s feelings of coping, competence, belonging, and/or esteem.(Junker, Shutterstock, 2011) In defining social support one also must think about actual versus perceived social support. Actual support is the support that an individual receives in terms of what is said, what is given, and what is done for that individual. However, much more significant than actual support is an individual’s perception of the support. Perceived support refers to an individual’s belief that social support is available, is generally considered positive or negative, and provides what is considered needed by that individual.(Norris and Kaniasty, 1996) Classification of social support and possible roles in recovery Social support reduces the adverse effects of mental stress in 5 ways: emotional attention, helping, information, assessment of others’ feedback about the quality of performance, and sociability.(A., Hamid and A., 2005). Social support could therefore be categorized into: • Emotional support • Esteem support • Network support • Information support • Tangible support. (Schaefer, Coyne and Lazarus, 1981) Emotional support, tries to meet an individual’s emotional or affective needs. These are expressions of care and concern, such as telling someone, “It is such a pity” or “I just want you to know how much you mean to me.” This type of support is what readily comes to mind when we hear the term social support. Expressions of emotional support do not try to directly solve a problem but serve to elevate an individual’s mood. To give them a sense of being loved and missed. This is one type of social support that can have a two way influence over mental health recovery depending on how an individual perceives it. Expressions meant to show care and concern could be perceived as over emotional or critical. When friends and family members including those within the social network are showing empathy to patients with mental illness, caution must be taken so as not to tilt the patient into deterioration as against the intended emotional support. Comments such as “What kind of illness is this?” or being over emotional in the presence of the patient. The second category is the Esteem support. This category aims at boosting the self-esteem of the patient. This is done by exposing the patient to things associated with his / her past achievements, reminding the person of his / her capabilities and areas of strength. No matter how terrible a person is, there is usually something in the past that gives an individual a good self- esteem. A teacher being visited by his /her students could give him / her a sense of relevance and high self-esteem. This could help a patients who is having a feeling of worthlessness. It must be noted that this also has the tendency of making the mental illness worse if par-adventure, these students were the precipitating factor in the first place. How? A teacher who had lost a child in the past suddenly has this new student who bears the same name as her lost child and this same student has come with other students to visit her. The third category focuses on making the patient understand that he / she has a Network of social support that can help during this period of mental illness. This could come inform of a friend and employee who is willing to help in supervising and running his/ her business effectively while receiving treatment. Recovery from mental illnesses could linger if the individual is so burdened with the worries of how his/ her business would thrive in his/her absence. A mother of three children would have less to worry about her children’s school if she knows her husband will always be there to take them to school. And also if she has a sister who is willing to take good care of her children when back from school. All these will hasting recovery when there is less stressful thought.(Cobbs, 1976) Information support aims at providing the patient with sufficient information about his /her mental illness. This will include the predisposing, precipitating and perpetuating factors including the prevalence of the illness, treatment availability, prognosis and possibly how to prevent a relapse. This helps to give the patient insight about the illness. When a patient is well informed about their mental illnesses, that is if they are in a state of mind that is capable of receiving and interpreting this information appropriately, it helps to give hope and alleviate some levels of fears and worries. A patient with less fears and worries about his / her mental illness is more likely to recover faster than a patient who is worried and fearful with little or no knowledge about what he / she is passing through. Tangible social support renders direct help to the individual. It could range from minor activities such as helping to cut nails and hair dressings to helping patients keep up with doctor’s appointment and even driving them down to the hospital. This will help to reduce physical stress and gives a confirmation that they have people they can rely on during their illness.(Grav et al., 2012a). Most impactful social support Considering the types of social support and how they can possibly influence recovery from mental illnesses either by hastening or lingering recovery, one may want to ask, which of these categories would be most impactful? This is explained by the Theory of optimal matching. (Cutrona and Russell, 1990). It suggest that a specific social support intended to have a particular influence over an individual may not be perceived as such. It may not even be identified at all by the recipient. Recovery and social support is best described as what the recipient says it is although this could be difficult to assess in a patient without insight. Social support is most impactful when it meets the recipient’s most pressing needs. This must be identified for any of the categories of social support to be impactful. A woman who is pre-occupied with the thoughts of who will take care of her children while she is on hospital admission may never identify any form of social supports until she is assured of her children’s wellbeing. Interestingly, each category could even interplay to play the role of the other. In the course of rendering a tangible support to meet a patient’s physical needs, it could also supply emotional and esteem supports. Phases and processes of recovery from mental illness Mental illnesses affect a person’s total being which includes physical, psychological, social, spiritual and cultural zones. Recovery from mental illnesses also occur across these various zones of a person’s being at varying speed. Also, recovery, stimulation or boosting of one of these zones could stimulate recovery across other zones. Currently a more robust approach (the Biopsycho Social Model) is employed in the management of patients with mental illness. Recovery involves a reconstruction of personal identity, a reformulation of the relationship between self and illness, and a reconstruction of one’s relationship with the world. (White, Boyle and Loveland, 2004). Positively perceived social support during times of mental illness could help to reconstruct personal identity and one’s relationship with the world and indirectly stimulate reformation between self and mental illness. Identity of self is key to recovery. (Spaniol et al., 2002). It is important to separate recovery from treatment. Recovery is the process of healing the effects of a) one’s illness and its consequences, b) the social stigma attached to the illness, and c) the iatrogenic effects of treatment interventions. (Spaniol et al., 2002). Treatment encompasses the way professionals intervene to stabilize or alter the course of an illness; recovery is the personal experience of the individual as he or she moves out of illness into health and wholeness. (White, Boyle and Loveland, 2004). There are five interlinking Recovery Processes: 1. Empowerment and reclaiming control over one’s life; 2. Rebuilding positive personal and social identities (including dealing with the impact of stigma and discrimination); 3. Connectedness (including both personal and family relationships, and wider aspects of social inclusion); 4. Hope and optimism about the future; 5. Finding meaning and purpose in life. (Tew et al., 2012). These processes are not independent of the other and neither do they occur sequentially. Recovery is a journey of hills and valleys. A robust social support has been found to be associated with accelerated processes of recovery compared with patients with lower levels of social support. (Hendryx, Green and Perrin, 2009). Is social support replaceable? Some studies have stated that in the absence or in instances of dwindling social support, factors like participation in difference activities can suffice. (Hendryx, Green and Perrin, 2009). Occupational therapy has also been found to enhance recovery as it helps the individual to develop a sense of usefulness both to self and the community. These alternatives still on the long run turn around to form a network of social support for the individual. A positively perceived social support does not only help during recovery, it has been found to reduce the chances of an individual coming down with mental illness in the first place and could also prevent a relapse. (Grav et al., 2012b) Conclusion The role of social support in mental illness recovery is pivotal. It could accelerate recovery and could also make recovery deteriorate depending on various factors, most importantly how the recipient perceives what is being rendered. Recommendation In rendering social support to individuals with mental illness, it’s of utmost importance to identify what the recipient’s social need is and how best to meet this need. Early identification of the patient’s social need will make whatever social support that is being rendered relevant to the recipient.