Assessment

For the person experiencing mental illness, integration of the experience of mental illness into their overall identity is an important step on the journey of recovery.

It cannot be done to the person, so assessment involves working with the person to help them develop their own explanation.

Many people will start their recovery by trying to make sense of what has been, and is, happening.

This may start with an answer from the mental health professional. Part of the assessment therefore will involve  collecting enough information to be able to offer a professional perspective.

A diagnosis is a description not an explanation

As a mental health professional you should certainly think about sharing your professional view, but be careful how it is then used in the assessment process.  It is a resource to offer to the service user, not ‘the’ answer.

A diagnosis can be helpful, for example in showing that others have experienced similar things. However, it can also be unhelpful if either the worker or the service user think that now the professional knows what’s going on, they can cure them.

No Quick Fix

For a lot of people with mental illness, there is no quick fix, despite what they may hope for. The reality is that recovery involves lots and lots of small acts.

Communicating your professional perspective therefore needs to be genuine, not a therapeutic manoeuvre to soften the blow of diagnostic reality.

The individual’s decision on the meaning of their experiences may or may not be consistent with a professional perspective, but it doesn’t matter!

Identity

Assessment can help someone identify their strengths and therefore construct a positive self identity.

Up close, nobody is normal. Asking only about negative parts of someone’s personality will give a biased picture of the individual, as not having very many strengths and personal or social resources. Assessment should amplify strengths as well as identify difficulties. 

One approach is to develop a structured dialogue, to identify a person’s strengths, values, coping strategies, dreams, goals and aspirations.

Responsibility

The goal of assessment is to create a partnership relationship with the importance placed on the individual’s efforts towards recovery, not the professional’s role in their recovery.

The challenge is to get ‘out of the way’ of the person’s recovery, by avoiding dependency-creating relationships, deficit-focused assessments, doing-to treatments, and drip-feeding responsibility back to the person.

One example is in goal-setting activity. Many people experience difficulty in developing purposive activity.

Staff can support this by using person-centred questioning like this

• When have you most felt alive? 
• When did you last have fun?
• What would make a difference in your life?
• What are your dreams?
• What do you want in life?
• What would make your life better?
• What would give your life more meaning?
• What would make your life more enjoyable?

These can then be used do determine goals. The challenge is then not to get in the way by assuming responsibility, for example through helping the client to decide whether the goal is realistic, or identifying for the person the steps towards their goal.

The antidote to any professional tendency to assume responsibility is to use coaching skills for supporting partnership relationships:

• What would it take to meet this goal?

• What would happen if you challenge the rule that says you’re not allowed to do that?

Hope

Change at the level of identity is a frightening prospect, and hope that recovery is possible may be vital.

How can this hope for the future be realistically supported, when we cannot know what the future holds for an individual?

It is possible to identify values, attitudes and behaviours in staff which promote hope in the people they work with.

Action Points