Strength-based approaches to community healing
In the fall of 2007, a rather quirky independent film was released that to this day has a small but dedicated following: "Lars and the Real Girl."
The movie is fictional, yet it provides an exquisite example of the power of community inclusion for healing not only of the lead character, Lars Lindstrom, but also for the family, health professional, and community as a whole.
The movie’s premise rests on shy and awkward Lars and his need for a deep loving relationship, which results in the introduction of his new girlfriend Bianca – a life-size "blow-up" doll he purchased from the Internet. The local family doctor, who also has a background in psychology, declares that Lars has a delusion, and the best remedy is for all to accept his delusion as it serves a purpose and will end when Lars resolves the "purpose." The family, community, coworkers, and the church parishioners are challenged to accept not only Lars, but also Bianca.
Many people diagnosed with serious mental illnesses struggle with this very issue of social inclusion, developing and maintaining relationships, and overall social connectedness, which often leads to loneliness and isolation. Symptoms, public judgments, and stigma contribute to the deep isolation and fears of social situations for people with mental illnesses. Recovery or healing from mental illness, therefore, should move beyond a focus on symptom reduction alone and must include social rehabilitation, family education, housing, and employment support. Through the recovery process, feelings of awkwardness, fear, and being judged are reduced by the fundamental things that give meaning and purpose to people’s lives – of which social interaction is a critical component.
Recovery, then, requires a person-centered approach, which simply means moving from symptom reduction alone to giving priority to people’s goals, and what gives meaning and purpose to their lives. As such, people receiving services for mental illness might not articulate that reducing symptoms will give their life meaning and purpose, yet, may identify dating, improving relationships with family, and securing housing or employment as their goals. A focus on goals, which gives people a sense of fulfillment and satisfaction, yields an increase in motivation and engagement, and enhances the quality of the therapeutic alliance and relationship with mental health professionals, thereby increasing the possibility of symptom reduction.
How, though, can a psychiatrist, a social worker, psychologist, or peer provider working alone or in silos, succeed in meeting this complex set of needs for the people they serve, especially when moving from a narrow concentration on symptom reduction to a broader and more holistic focus on helping those with mental illness achieve a sense of meaning and purpose in life?
Community-based solutions
A new development that has been helpful toward the attainment of this goal is that the Substance Abuse and Mental Health Services Administration (SAMHSA) has funded a 5-year initiative called Recovery to Practice (RTP).
RTP was designed to foster the provision of recovery-oriented mental illness and substance use disorder care through the development of curricula customized for a variety of behavioral health professionals. Several disciplines, including psychiatry, psychology, social work, psychiatric nursing, peer support, and drug and alcohol counseling, have created curricula focused on equipping their practitioners with the knowledge and tools to provide recovery-oriented services to people with mental disorders.
The RTP psychiatry curriculum, developed through a partnership of the American Psychiatric Association and the American Association of Community Psychiatrists, has been guided by a group of advisers, many of whom are advocates and mental health professionals with lived experience of mental illness. The curriculum includes modules focused on the importance of creating an engaging and welcoming environment, person-centered care, shared decision making, building living skills and natural supports, and the inclusion of peer support to optimize quality of care.
Actualizing the inclusive mantra, "nothing about us without us," people with lived experience of mental illness and substance use disorders have been integrally involved in the creation of the psychiatry curriculum and will play a primary role as cofacilitators with psychiatrists in delivering the curricula to medical students, psychiatry residents, and practicing psychiatrists in community mental health, inpatient, and emergency settings.
"Lars and the Real Girl," set in small-town, upper Midwest USA, demonstrates the power of community inclusion, and while it does not explore relationships between a person with mental illness and mental health professionals, it demonstrates how the community itself becomes part of the array of mental health care services. For those practicing in rural settings and urban settings where health disparities are glaring, especially in communities of color, or Anywhere USA, where resources and services are in short supply, "Lars and the Real Girl" can be seen as an example of addressing scarce resources, and the need for culturally and linguistically appropriate services. Most importantly, it reminds us to not rely exclusively on mental health professionals for solutions, rather to incorporate in a balanced way contributions from those natural supports that exist right in our own communities.
