Can one-page profiles work in mental health?

Written by Sarah Carr, independent Mental Health and Social Care knowledge Consultant www.sarahcarrassocs.co.uk

Sarah Carr

When I wrote my one-page profile I was thinking specifically about mental health and prevention. I reflected on what helps and hinders me and what makes me feel safe. I think my profile is a very effective tool for self-management – sometimes I lose sight of what can affect me! Because I had complete control over what is in the profile, I represented myself in a way that is true to me – I didn’t have to use a diagnosis, explain my history or fit into a category. I communicated who I am and what I need without having to label myself. In this way profiles can help with overcoming the stigma associated with psychiatric diagnosis and can challenge self-stigma. Like many people with mental health problems, I have a negative view of myself and fairly low self-worth. Here, I was especially challenged by the part where I had to think about what people appreciate and value in me, my gifts and my strengths. Although it was a hard exercise, for me it was a form of therapy. Finding good things about yourself and committing them to writing as part of a profile to be shared so you can be understood fully can be a powerful exercise for someone with low self-worth or internalised stigma. At the moment I’m using my profile to remain aware of what keeps me safe and well (and to remind me of what people value in me!) but if I should experience a crisis again I would use the profile to communicate with mental health practitioners and as a way to aid my recovery – that is recovering my life and self.

As an independent mental health and social care knowledge consultant, my lived experience of mental distress and service-use informs my work. I really wanted to join the conversation about one-page profiles on this blog site because I believe they have the potential to address many of the difficulties that people who experience mental distress or use mental health services often encounter.

One-page profiles in a mental health crisis

If someone is using mental health services a one-page profile can be a powerful way to communicate and maintain their personhood in what can often be a dehumanising, medicalised system. For someone who finds themselves in crisis and is admitted into hospital, a profile can be a very effective way of communicating who they are and what good support looks like at a time when they might not have the capacity or opportunity to do so in any other way. Many people who have been patients in psychiatric hospitals say that they felt reduced to their symptoms or diagnosis and weren’t understood as whole people with interests, strengths, talents and preferences. We now know how detrimental this can be and clinical guidelines are in place to emphasise the person-centred, human elements of mental health support such as empathy, optimism, dignity, respect, support for self-management, emotional support, being known and having appropriate activities. A one-page profile, written by the person when they feel well, with support if needed, can be an effective way to support continuity of understanding about an individual in changing circumstances and fluctuating mental health. They could be used alongside more formal Advance Directives, which are designed so the individual gets a say over treatment and other practical decisions should they become too unwell to make decisions themselves.

In the workplace

Many workers and workplaces struggle with understanding how to recognise and address the stress that can lead to new mental health problems or a relapse of existing ones. Employers may find workplace accessibility and reasonable adjustments difficult to understand for mental health. Stigma continues to be very a difficult issue for people with mental health problems who are job seeking or in employment. But as in mental health services, the solutions are often rooted in simple things like communication and being understood as an individual. Both these aspects are addressed in a one-page profile which could help facilitate a person with a mental health problem to self-manage at work and help their manager or colleagues to be supportive in practical ways. If an individual is having problems with workplace stress or is recovering from an episode of mental distress, the ‘how to support me’ part of the one-page profile can help with implementing reasonable adjustments and ensuring accessibility. Mental health stigma can be reduced and crisis prevention promoted in the workplace if every employee has a one-page profile, designed to communicate individual strengths, preferences and needs to line managers and HR personnel.

To summarise, I think that if used well, in mental health services profiles could significantly improve the experience of users and if applied in the workplace, this simple approach could make it a much safer and more accessible place. In both cases, it’s about being known as a person and being able to communicate what’s important to you, which can help with prevention and self-management as well as getting through a crisis period.

Not just someone lying in bed 2B

An inspirational example of how one-page profiles can help people in hospital connect with others during confusing and difficult times. Kris had no idea of the impact her mum’s one-page profile would have, not just for them, but for the medical staff, other patients and their loved ones.

A photo of Laurine’s one-page profile on the wall in the hospital

Written by Kris, a person-centred thinking trainer

Meet my mother, Laurine Kaiser. She has been married to my father for soon to be 63 years. They have three children, myself (Kris) being the middle child in addition to my older brother Stephen and my younger sister Kimberly. Mom was born in 1927 and will be celebrating her 86^th birthday in November this year. She has always enjoyed an active life as a Mom, wife, travel companion, pharmacist, bridge player, friend and sister to a younger sister and brother who live in Kitchener.

My Mom and Dad moved in to my home in 2010 shortly after my husband passed away. We spent a few months together before my Mom fell ill for the first time in her life. She ended up at St. Joseph’s hospital in Hamilton where she remained a patient for five months. The doctors had quite a challenge for some time trying to figure out exactly what was wrong with her. She eventually ended up in the Intensive Care Unit (ICU) and spent almost two weeks there before she graduated to the Progressive Care Unit.

At that time my Mom was not able to use words and was extremely tired from the long journey she’d been on in the ICU. On several occasions nurses, doctors, therapists etc. would enter the room and ask me questions about my Mom…did she ever work, what line of work, is she married, how many grandchildren etc. That was when I decided to create a one-page profile for my Mom. Looking at this frail yet dignified and elegant woman lying there so peacefully yet so helpless I knew that I needed to do something so that people could connect with my Mom by looking and reading her profile. It was a way to humanize my Mom and value her as a person with a story to tell and not just someone lying in bed 2B.

I was excited to complete this one-page profile for her, knowing that this would make a positive difference in her life. I created the profile in one night with a dollar store bristle board, a black magic marker and a few photos of her along with the joys in her life.

When I returned to the hospital the next day I couldn’t wait to put it up! My Mom was thrilled with it and stared at it for hours. She would smile and point to people making kind gestures. The nurse came in the room that afternoon and read the board and quickly pointed out that my Mom’s favourite TV show was Big Bang Theory which was also hers. She remarked, “I’ll put it on the TV for her tonight at 7:30. Mom gave her the biggest smile.

Word seemed to get around the floor and the hospital about my Mom’s one-page profile and soon other patients’ families and friends on the floor were asking to see it, vowing to create one for their loved one. It just seemed to snowball with positive remarks from all. Close to the end of my Mom’s extended stay at St. Joseph’s the administration team came to have a look at the profile and said that they should introduce this in their hospital. That was a great day!!

Doing the one-page profile for my Mom made such a difference in her mental and physical recovery. Having this tool created a way for others to have a conversation with Mom and it also provided information about her interests and hobbies which often was a source of some great chats with people she met at St. Joe’s.

I’ve always known that the one-page profile works however I didn’t know the impact it would have on so many people and their loved ones.

 

Carrying Sandra’s voice above the noise

A powerful example of how a person living with a mental health condition can be empowered by using a one-page profile to ensure her voice is heard.

Sandra’s one-page profile

Written by: Marianne Selby-Boothroyd

Forty-seven year old Sandra likes going to church, listening to instrumental Jazz music, going to college, meeting new people and spending time with her cat, Molly. She doesn’t like it when she has flashbacks, feels paranoid or when the voices in her head take over and she can’t hear her own.

Born in Lancashire, Sandra moved with her mother, brothers and sister to the Caribbean when she was three. At 13 she returned to the UK and it was whilst living in London and attending secondary school that Sandra began to feel really isolated. As a child she was described as quiet, caring and overly sensitive. She was bullied at school where she felt she was not as clever as the other children. Leaving education at just 16 to escape the bullying, Sandra went to see her GP about her problems for the first time. But instead of getting the support and understanding that she craved, Sandra was prescribed sleeping tablets for anxiety and depression.

Sandra first tried to kill herself at just 20 years old by taking an overdose of sleeping tablets, thinking “If I just go to sleep and never wake, it will all be over”. This began a cycle which lasted throughout her twenties and thirties. Sandra’s life was mapped by frequent suicide attempts and admissions to hospital mainly under section. She experienced periods of mania followed by extreme lows and would also hear voices.

In recent years Sandra was introduced to person-centred thinking tools and was supported to produce a one-page profile. The aim was to regain control over her life, find new ways to manage her mental health (other than medication) and start looking to the future again. Sandra wants to get back into paid employment. She wants to travel. Move to a bigger house. Look into fostering. Spend more time doing the things she enjoys such as writing poetry. Much like anyone else, Sandra’s hopes for the future are all about leading a happy and fulfilled life – something that she now knows is possible by clearly communicating to people how best to support her in the here and now.

Of the profile Sandra said: “It has had a big impact on my life. It is so important to me to help others through my own experience but I find it really hard to speak in public or be in large groups. Doing my profile helped me understand the kind of support I need to prepare to be with others, being able to share this information with others has meant I have gone from strength to strength – last week I spoke at a conference full of medical professionals – I got a standing ovation!”

In 2000, there was a turning point in Sandra’s life. She was allocated a black social worker. For the first time she felt listened to – particularly in relation to her cultural needs. It was her social worker who found Fanon Resource Centre and who stuck with her for the eight months that it took Sandra to build up the courage to go there.

Sandra credits her social worker and Fanon Resource Centre for not judging her on her past, instead focusing on the present and the future. Through Fanon, Sandra started to get involved in groups and even completed college courses. For the last year she has acted as an Ambassador for Southside Partnership – which has involved speaking at public events and supporting others to identify the support they need in their recovery.

Struggling with a mental health condition is incredibly hard. The one-page profile has helped Sandra to communicate who she is, what she likes, what she doesn’t like, and how best to support her. She shares it with the important people in her life, her friends, family, doctors, mental health professionals and new people that need to understand her. With this support in place, Sandra has lots of good days and fewer bad days where she feels down and is hearing voices. She is doing a lot with her life including a three year college course learning British Sign Language with the plan of becoming an interpreter.

Sandra is now at a stage where she feels she is in recovery. She is moving ever closer to fulfilling her dreams. She still hears voices. But having her own voice carried through a one-page profile means that it can never be lost in the noise.