The Effect of the Program Which Improves Self-Acceptance in the Person With Mental Illness
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Session presented on Saturday, July 23, 2016 and Sunday, July 24, 2016: Background: In psychiatric rehabilitation, it is important that persons with mental illness understand themselves and rebuild their lives (Deegan1998, Anthony 1993). To achieve this goal, the approach which is focus on recovery model is useful. According to perspective of recovery, person could look at themselves beyond their illness deeply and realize their possibility, therefore they could be release from Illness and Disability, and finally they could get their well-being (Charles & Richard 2014). Deegan (1998) described that Recovery refers to the lived or real life experience of persons as they accept and overcome the challenge of the disability. Indeed, he insisted accepting what people cannot do or be leads to the beginning to discover who they can be and what they can do. His insistence means that the person with mental illness had better to accept their illness as a part of the self. And also, Charles and Richard (2014) described strength model which is based on recovery model. According what Charles and Richard (2014) explained, people should discover their strength and use their strength effectively to develop their new meaning and purpose of their lives. Especially, the most necessary is to discover their strength which related to recovery from mental illness. Because, people who notice their strength could make their goal based on their lives, not based on illness or disability. As a result, this process of discover their strength could help to promote their quality of life. There are some approaches which is focused on recovery model, e.g. strength assessment, care management, team approach (Charles & Richard 2014). But there are a few reports of concrete approach focused on recovery model. Especially there are not reports about nursing approach which is focused on recovery model. Most reports of nursing approach for the person with mental illness are about approaches to promote understanding their illness or symptom, e.g. cognitive behavioral therapy, psychoeducational program. Actually these approaches make the person with mental illness chance to look into themselves about their illness effectively, but these approaches could not make them accept themselves beyond illness. Therefore, we made new approach which includes perspective of recovery. Aim of this new approach was that the people with mental illness can improves Self-Acceptance through thinking various topics about health and notice their strength. And finally they can get sense of the self which have possibility, hope and desire. So, we named this program "Smile program". Aim: The purpose of this sturdy was to clarify how the program which improves Self-Acceptance affects the person with mental illness. Method: Subject: Our study's Subjects were patients with mental illness in a psychiatry hospital. Contents of program: The number of participants in one group is 4-5 people. The program is performed once a week and consisted of 12 sessions. The themes of each session are comprised of "What is your Strength?" "The reason to drink liquor" "The people who support you?" "Think about our health-good appetite, sound sleep and regular motion" "Physical and Psychology connection" "Sleep and health" "Medicine and health" "What is it mean to drink liquor for you?" "The effect of relaxing" "The effect of laughing" "How to enjoy living your town" "Enjoy your new life". Each session is consisted lecture and worksheet. Procedure: First, we recruited subjects that their doctors and nurses decided patient's condition could stand our study, and then we ask to consent with each subject. We investigated Demographic information from medical record (age, sex, diagnosis, chlorpromazine equivalent) in hospitals. Subjects were asked to answer 3 scales at one week ago of the program start and one week later of the program end. Scale: The Recovery Assessment Scale (RAS). Total items of the RAS is 24 items with 5-point Likert response ranging from 1(strongly disagree) to 5 (strongly agree).The RAS consists of 4 factors. Factors of the RAS are Personal Confidence, Willingness to ask for Help, No Domination by Symptoms, Goal and Success Orientation and Hope, and Reliance on Others. Higher total scores are indicative of the further process of recovery (Corrigan et al., 2004). The reliability and validity of 24 items RAS have been confirmed in the US and Japan (Corrigan et al., 2004; Chiba et al., 2010). Psychological well-being Scale. Psychological well-being Scale was based on concept of psychological well-being which Ryff insisted and developed by Nishida (2000). Total items of Psychological well-being Scale Nishida (2000) developed is 43 items. But according other report which used this scale, construct validity of 19 items have been confirmed as a result of factor analysis (Sawada et al., 2004). Therefore, our study use 19 items version with 5-point Likert response ranging from 1 (strongly disagree) to 5 (strongly agree). This scale consists of 4 factors consists of 4 factors. Factors of the scale are Personal Growth, Self-Acceptance, Purpose in Life, Autonomy. Higher total scores are indicative of high standard of Psychological well-being. Insight Scale (IS). The IS was developed by Markova and Berrios (1992, 2003). The IS focus on patients' awareness and expression of subjective experience. The reliability and validity of a Japanese version of the IS have been confirmed (Ohmori&Mori 2011). Total items of the IS are 29 items. Higher total scores indicates patients aware toward their illness. Ethical considerations: Our study obtained organization of the Ethics Committee's proposal. We explained the purpose and method of this study, the participation is free, keeping anonymous in document. Participants signed on Consent form. Result: 19 patients participated in our study (16 Schizophrenia, 1 Bipolar disorder, 1 schizoaffective disorder, 1 Substance-related disorder). Participants were 15 male and 4 female and the average age was 39.78(SD=9.5) years old. Scales of Cronbach's alpha coefficient were 0.86, 0.92, and 0.87 for the RAS, Psychological well-being Scale and The IS. There is not related to age and sex, but the scores of Reliance on Others and Willingness to ask for Help which are factors of the RAS were different between male and female. The scores of Reliance on Others and Willingness to ask for Help female answered were higher than the scores male answered. Therefore, we analyzed the data of male in our study. As a result of Wilcoxon signed-rank test, there is no difference between before program start and after program finished about Psychological well-being Scale. However, Reliance on Others which is a factor of the RAS was significant difference between before and after the program (p=0.045). The score before program start (Me=13.00, IQR=4.00) was higher than the one after program finished (Me=15.00, IQR=3.00). And also, total score of IS was significant difference between before and after the program (p=0.039). Total score of IS before program start (Me=13.00, IQR=11.00) was higher than the one after program finished (Me=15.00, IQR=12.00). Discussion: Our findings suggests that our new approach cloud promote process of recovery in the people with mental illness. Especially, the factor as Reliance on Others will be improved. One of our program is thinking about "The people who support you". In this session, participants might be conscious to their family and friends and awarded themselves as they live as being supported by many important people. Besides that the score of the IS was improved. Deegan (1998) insisted recovery is marked by an ever-deepening acceptance of their limitation. It means that it is important process that people with disability aware themselves deeply and notice "What I cannot do" and "What I can do?" in their recovery. Our result as score of the IS was improved suggests that participants aware toward themselves through the program and it might help to accept the self beyond the limits of disability. But in our study we analyzed only the data of male. So, this is limit to generalize our result. And also, there were difference between male and female about how to answer the RAS. Therefore, next study need to increase the number of the participants.