Everyday Solutions for Everyday Problems: How Mental Health Systems Can Support Recovery

According to one author, “Social inclusion must come down to somewhere to live, something to do, someone to love. It's as simple—and as complicated—as that” (12). How can clinicians support people to meet housing, employment, and relationship goals?

In many cases, mental health or substance abuse treatment is a precondition for obtaining housing. Yet emerging evidence suggests the everyday solution (housing-first, no precondition, model) leads to greater consumer satisfaction than the specialist solution (supported-housing model) (13). The assumption that being a good tenant should be a requirement for obtaining tenancy has proved unhelpful; for example, the impact of sobriety at program entry on outcome is minimal (14).

For employment, the empirical data are clear—the everyday solution of supporting people to obtain and maintain community-based competitive employment through individual placement and support schemes is more effective than providing noncompetitive employment at sheltered workshops (15). The idea of being clinically cured, an idea sometimes expressed as “work readiness,” has proved to be unhelpful.

In the areas of housing and work, everyday solutions—with appropriate compensatory supports—for everyday problems has proved optimal. Does this principle extend to intimate relationships? Quite possibly. If the concept of readiness has proved unhelpful in relation to housing and employment, perhaps providing social skills training to someone who wants a relationship is equally unhelpful. The alternative, everyday solution is to support people's access to a pool of potential partners with whom they can learn relationship-building skills. Examples include accompanying individuals as they join a community-based social or sports club, work as a volunteer, use an Internet dating service, or attend a speed dating event.

These proactive approaches stretch the individual and the clinician in different ways. The individual may need support to take on these challenges, and it may be more helpful to frame them as learning opportunities rather than to expect initial success. Ongoing involvement and debriefing by clinicians or peers may well be required as the person learns to cope with the ups and downs of these experiences. Similarly, the clinician may need support through supervision to move beyond constraining clinical beliefs, such as the presumption that an individual must “get better” before doing normal things like dating.

If the principle of everyday solutions for everyday problems is accepted, other existing clinical approaches also become open for debate. For example, the search for meaning in life is perhaps universal. Mental illness can profoundly change perceptions of oneself, the world, and others. The experience of illness, whether a disorder of mental or of general medical health, involves identity challenge. Yet people with a mental illness are just as likely as any other citizen to seek meaning in their lives. If everyday solutions are to be the instinctive orientation of mental health workers, explanatory models of mental disorder need to be used judiciously. These models should explain the experience of mental illness but avoid imposing a specialist solution by creating a unidimensional, engulfing identity, such as “schizophrenic patient.” Allowing space for diverse explanations across different dimensions, including clinical, functional, physical, social, and—most challenging of all—existential, becomes important (16).

Whether because of a legacy of Freudian views of religion as regressive and pathological or because clinicians are statistically more likely than the general population to hold atypical spiritual views, discussing spirituality is challenging for mental health workers (17). In fact, belief in a personal God is much less common among clinical or counseling psychologists (24%) than among the U.S. population (90%) (18). Providing opportunities to access spiritual experiences, for example, by reading Scripture, praying, attending places of worship, and using online religious resources; uplifting secular experiences, for example, through exposure to art, literature, poetry, dance, music, science, or nature; and everyday spiritual methods for coping with adversity, such as efforts to establish personal boundaries, spiritual purification, and spiritual reframing are all potential areas of future clinical effort.