Have a template like this in mind.

Skills needed to assess risk must expand to include thoughtful curiosity.

The recovery model (or a similar philosophy) requires the professional to be curious about what drives the service-user,
what is meaningful to him, and why.
Understanding what makes a person tick illuminates risk assessment and management
and makes it more likely that the right boxes on the inevitably necessary forms are ticked.[ Extract Inquiry Moncrieff; Gonzales ]

and.:- "We know that in the months and years before Mr Gonzales committed his crimes he was ill, unhappy, and lonely.
The onset of mental illness may mean the loss of certain hopes and expectations,
but it is does not have to be the end of all hope for the future
and it is possible to have a fulfilling life with mental illness; even with schizophrenia.
An ordinary understanding of human nature suggests that someone is less likely to go down the path of destruction and self-destruction if his life feels good enough. "

Engagements, imposed, expected and directed from outside, founder unless and until they come to be directed from inside. The need for maintaining wellness, has to come from within, for then the internal backing - the foresight in the brain is drawn together by the 'want to do' whatever. In schizophrenia decision and intent from inside, starts with the brain organised. This intent has the backing of associations already together in the mind/brainis; they are held together better, than when an expectation comes from outside when the 'brain/mind' has to go in search, retrieve, and hold onto matching associations. The 'trick' is to find interest and activity which becomes what the 'inside ' wants to do. Find something for sufferer to do which is possible for them, and takes them away from their withdrawal into themselves, something that can be pursued outside the family base, or something that will carry forward what is an already personal interest, or into some personal aim in life: make it a future possible .
In the short term this is is what the professional should have already said.
' From the experience we have of others with the same condition, exercising your neurons is as necessary for restoring and maintaining recovery, as exercising your muscles and joints, whilst recovering from an injury. '

If a laid down process for this is not there in the Needs Assessment stage of the Care Programme Approach,
You, the carer, must ask for a plan to come up in aftercare,
if not in place as an expectation, it is to be recorded as an UNMET Need to go on register as such for the delivery Trust
to find a way of implementing it in after-care provision:
to the funding Primary Care Trust to purchase the resource necessary.

Because it is a medical unmet need, a treatment need to maintain and continue recovery,
it is an obligation on the local Primary Care Trust to purchase it,
and the local secondary specialist delivery Trust to provide it,
as it would be for any other maintaining after-care treatment provision in general health
– to promote and maintain rehabilitation.

How is this activity engagement, a necessary treatment for residual schizophrenia.
It is the way to rebuild and reconnect an internal anticipation with an outside routine,
so that there will be an internal framework of brain networking,
to call upon to match the requirements of an external programme.

Take as a template,a Monday, Wednesday ,Friday programme of, say:
an educational activity, an interest activity, a sheltered work activity, building up to a regular weekly engagement.

After Friday the sufferer is left with a mental and actual diary reminder
that next Monday such and such will be coming up; after Monday such and such ...
Each thing that is there to be taking part in, on those days is an anchor point,
The internal small world network connecting processes can build up whatever is a relevant past to taking part in the particular event
– .... the journey, the people to be met, the things that will be done.

The anchoring routine re-connects - what is, through the illness - a loosened internal association system which has lost any attachment, the calling in of meaningful 'priming' preparation for the outside experience; those associations of beahviour that are to be assembled, to be matched to whatever is needed on the outside.
The anchor points enable this building up to be done.

Without this direction onto external expectations, the regular practicing on the routine, the internal brain work is not helped to co-ordinate inside what is required to get into a 'normalisation' with people and activity.

After this first arrangement for an external routine is secured and well founded, a wider range of gains, can be progressively added, without provoking the level of anxiety that might otherwise occur.

back to index page