Nurses need confidence to write for publication
A recent blog by one of my writing colleagues, Amy Martin, talked about the having the confidence to write for publication. Although Amy...
The following is an article published in the Care Programme Approach Association journal, The Approach in 2014. It is reproduced here, with kind permission from the CPAA, in a slightly shorter form.
The Place of Animals in Recovery
Half of UK households own a pet (Reynolds, 2006), therefore many people experiencing mental health problems will have companion animals and their relationships with these are often significant and important. Owners will each have a different level of attachment to their animals and where several are owned it is likely that the individual will have a different connection with each one (Peacock, Chur-Hanson and Winefield, 2012). However, mental health services very rarely consider the significance of animals in people’s lives, their role in recovery or how they impact on risks. Understanding an individual’s relationship and attachment to animals could be a significant element in recovery that is being missed. Whilst animal assisted therapy for mental health, as well as other health problems, has been fairly well researched, examination of the significance of actual animal ownership and effect on mental health has had little consideration (Walsh, 2009; Peacock, Chur-Hanson and Winefield, 2012).
Owning a companion animal can allow us to have an important relationship, one that is safe, trusting and uncomplicated. It brings responsibility and a role, as well as an opportunity to focus on another living being. Animals provide unconditional love and affection which, for those who are isolated and stigmatised due to mental health problems, can be highly important and affirming and can also provide physical contact and reassurance. For many, companion animals are considered to be a member of the family, may be included in celebrations and given presents (Walsh, 2009).
Mental health workers are required to collate a great deal of information about service users, starting at the first assessment, but individuals’ relationships with their animals are rarely asked about, or considered to be important, therefore they are unlikely to feature in care plans or reviews. If workers do not understand, or even acknowledge a service user’s animals in assessments, in conversations and in care plans there can be a significant gap in holistic care. Peacock, Chur-Hanson and Winefield (2012) identified that any psychological assessment should include information about attachment and relationships with animals. At the very least talking about a person’s animals is a good method of building rapport and engagement, often helping someone to start to talk about them self.
Recovery based care is an important and recognised approach but when services do not consider a person’s animals and their significance, care cannot be truly individualised and recovery focused. Animals can be helpful in building resilience to mental illness and can provide a routine that supports important coping strategies. If we are to use a truly holistic approach which considers every aspect of peoples’ lives, their animals should feature. For many, both those who are experiencing mental health problems, and for those who are not, animals can give meaning to their lives. Therefore care plans need to take in to account the part played by any animals in service users’ lives.
For many, animals can reduce risks, as they can be protective factors for those who self harm or are suicidal. The thought of leaving their animal behind has been shown to prevent individuals from harming themselves, can give them a focus (Walsh, 2009) and animals can be a comfort which provide solace and affection. In these situations a companion animal can offer hope and help a service user develop a belief that they can cope with life and Walsh (2009) identified that animals can support individuals through difficult events and transitions.
For many, animals provide a purpose and a structure to the day by giving them a sense of worth and control over part of their life (Slatter, Lloyd and Kind, 2012). Those with poor motivation may find that they will get up and out for their animals when they would not do so for themselves. Routines based around animals can support the development of coping strategies for difficult times.
Where animals provide livelihoods there will be different attachments to them by their owners but these are no less important than those with companion animals. Farmed animals are often given names (Brown, 2006) and the impact on mental wellbeing for farmers and others when they lose their stock can be profound as demonstrated in the last foot and mouth epidemic, the ongoing tuberculosis infections of cattle and the recent losses of stock in the severe weather of spring 2013.
For some individuals the owning of animals can increase risk. As circumstances change, due to factors such as illness and reduced finances, owners can become overwhelmed with the care that their animals require. Physical risks in the form of trips and falls can be a problem with those who are physically infirm; however owners with dogs and who walk them have been shown to be physically fitter (Smith, 2012). Owning an animal can expose previously unidentified issues. When they first own an animal the nurturing that it requires can be overwhelming for some individuals due to their own experiences of poor nurturing or neglect by their families.
For some, the thought of being separated from their animals will lead them to delay treatment (Peacock, Chur-Hanson and Winefield, 2012) or prevent them from moving to appropriate accommodation (Morley and Fook, 2005). This has been the case for older people needing a care setting and also for homeless individuals who will not take up accommodation if their animal is unable to go with them (Slatter, Lloyd and King, 2012). Concern about one’s home, including pets, has been identified as a factor in absconding from hospital (City University, 2003).
For many owners the loss or death of a companion animal will cause a grief reaction that is often experienced similarly to the death of a loved person (Brown, 2006; Walsh, 2009). The level of grief experienced will be related to the level of attachment to the animal (Donohue, 2005). This is normal especially as companion animals are generally considered to be family by owners. What often causes problems are the responses from others, including health workers, who give trite reassurances such as pointing out that it was only an animal or that another can be obtained. Responses such as these further compound the individual’s grief and sense of loneliness (Brown, 2006). Sometimes the death of an animal has a wider significance when it is a last link to a human that they have lost.
Women in abusive relationships have delayed or not left the situation due to either, not being able to take their animals or their children’s animals with them, or due to threats of harm to the animals from the abuser (Krienert ,et al 2012; Allen, Gallagher and Jones, 2006). The abuse of animals has been identified as a possible indicator for domestic and child abuse (Blewett, 2008) with agencies in some USA states routinely sharing information where animal abuse has been identified (Patronek and HARC, 2001).
The responsibility, time and cost of caring for a companion animal will increase risks for some individuals but will reduce them for others. Caring for an animal can become overwhelming and can be costly which may result in a service user ‘going without’ to provide for their animal. For some individuals caring for animals runs out of control, in worst cases producing animal hoarding situations (Williams, B. 2014). Here numbers of animals are kept in conditions that not only do not meet their needs, but significant cruelty, suffering and death are caused. The impact on humans in animals hoarding situations is also enormous as children and vulnerable adults can be living in the household. Animal hoarding situations are often driven by changes in circumstances including physical illness, but it is very likely that there will be comorbid mental health problems (Patronek, Loar and Nathanson, 2006). Animal hoarding is more common than many think but is often ignored by agencies as it is seen as a ‘lifestyle choice’ (Reinisch, 2008).
It is important to consider if there is an impact on carers when those they support have animals. Carers can experience an increased burden by having to take responsibility for animals when a service user is unable to do so. For some this may be something that they are willing and able to do, but services should not just assume that a carer is able to meet the welfare needs of someone else’s animals, including the financial implications. The role of the care coordinator and good care planning is essential to identify what is the best for a service user, carers and the animals should there be a crisis or if circumstances change.
In the current times of economic austerity some may feel that taking the time to understand and support service users’ relationships with their animals is inappropriate, but if we are to work in a truly recovery based way we need to understand what is important to service users. Those with mental health problems are stigmatised enough without services ignoring or dismissing an element of their lives, which may be immensely important and helpful to them.
Workers, services and others may believe that those they work with do not have the ability or resources to care for a pet. As long as the animals’ welfare needs are sufficiently met as required by law (Animal Welfare Act, 2006, see box 1), there is a positive impact for the service user and the responsibility is manageable for them, why would there be a problem? We can work with service users to ensure they chose appropriate animals for them and their circumstances. We can care plan with crisis and contingency plans including details of how their animals can help or increase symptoms and risk when they are becoming unwell. We can also support the drawing up of clear plans for where animals should go should the service user become unwell.
An animal’s needs shall be taken to include;
(a) its need for a suitable environment,
(b) its need for a suitable diet,
(c) its need to be able to exhibit normal behaviour patterns,
(d) any need it has to be housed with, or apart from, other animals, and
(e) its need to be protected from pain, suffering, injury and disease.
(The Animal Welfare Act, 2006, section 9)
Mental health workers are already pressured for time and may consider discussing a service user’s animals as a waste of time or unnecessary, however this then misses an opportunity for aiding engagement, for understanding what is really important for the individual and their life. It also can mean that certain risks and protective factors are missed. Many mental health workers own animals that are hugely important to them, so why should our service users be treated any differently? For many their relationships to animals are important, life affirming and profound. Recovery approaches cannot be authentic if workers and services chose to ignore this significant aspect of service users’ lives.
In summary, there is a significant part of people’s lives that is often missed by services and if we are to really deliver supportive, meaningful and individualised care we need to consider the role of animals in peoples’ lives.
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