I paint, I sing, I dance; I also have a mental illness: The importance of personally meaningful leisure activities in recovery from severe mental illness

Individuals with severe mental illness (SMI) often have sedentary and secluded life. It leads to compounded psychological and physical effects in the form of feeling isolated, having an increased propensity for lifestyle-related illnesses, and the like.[1] It affects the perception of others also, which often manifests as a narrow and negative approach to the patient and their problems. This approach creates an impression that the patient and their issues are inseparable and that their life revolves around those problems. It leads to neglect and underestimation of the patient’s abilities, hobbies, and likings. For example, a patient with schizophrenia may be perceived as someone with eccentricities (e.g., talks to self) who does not adequately involve in daily living activities and remains secluded. Unfortunately, a patient may imbibe these perceptions leading to self-stigma, which, in turn, can affect their overall functioning.[2] It is, therefore, imperative that intervention for mental illness has a strength-based approach that focuses on the person’s abilities apart from the target to improve the symptoms. Motivating patients to engage in personally meaningful activities they enjoy can be a step in this direction. It does not only defocus the attention of the patient and the caregivers from a “symptom only” approach but also help make the patient active, participative, and involved in what interests them. Given this, therapeutic recreation is being advocated as one of the ways to promote health and wellness in individuals with mental illness.[3] Therapeutic recreation promotes positive behaviour, such as social connectedness and cooperation, by involving people in therapeutic residential camping, leisure activities, and the like. Involving people in such leisure and recreational activities can be an effective way of reinvigorating those self-soothing and enjoyable activities that get subdued in the inactive life of mental illness.

Furthermore, patients can be involved in such goal-driven recreational activities that reduce the illness effects. For example, specially designed cognitively stimulating recreational activities can effectively reduce the cognitive impairments commonly observed in people with severe mental illness. Likewise, group activities can help enhance social skills, decrease apathy (and other negative symptoms), and improve interpersonal skills.

THE RESEARCH EVIDENCE

Of late, there has been a surge of interest in understanding the effectiveness of leisure activities in promoting the psychological and social well-being of people with mental illness. Research indicates that involvement in personally meaningful leisure activities can boost recovery and aid toward active living for people with mental illness.[4,5] For example, enjoyable leisure activities and perceived active living consistently correlate with a sense of well-being and recovery.[5-7] Therapeutic recovery camps, aiming to involve participants in physically and mentally challenging activities, have been found to lead to a sense of determination to overcome the challenges caused by mental illness.[3] Activities that involve adventure and fun (such as rock climbing, picnic, and skating) can be physically stimulating, weight reducing (a common requirement in mental illness due to metabolic abnormalities), and a boost to self-esteem.[8] Also, leisure activities can act as a protector from mental illness. For example, a sense of meaningful use of time through leisure activities is associated with lower depressive symptoms.[9,10]

NOT “ONE FIT FOR ALL”

Since recreational and leisure activities can significantly boost the psychological and social well-being of people with mental illness, these activities must be part of the overall intervention plan. While doing this, a few things need to be kept in mind. For example:

1. The activities chosen must be personally meaningful for the individual. The contribution of leisure activities in recovery and active living largely depends on what meanings the patients gain from those activities.[4,5] Perception of an activity to be personally meaningful motivates the individual to engage and continue it. For example, realizing that doing yoga with friends brings a positive mood, helps companionship, and revitalizes spirituality can be a driving force for engaging in it regularly.[4] Iwasaki and colleagues suggest that leisure activities can be meaningful for an individual if they promote a sense of belongingness, autonomy, competence, and other factors.[5]

2. Active living does not limit to some physical exercises; it also involves activities that augment body-mind-spirit harmony and promote emotional health, social connectedness, creativity, and so on.[11]

3. Recreational and leisure activities should be planned in a manner that it incorporates the patient’s needs. For example, a patient with cognitive deficits can be involved in such activities that are cognitively stimulating. Involving patients to work in groups to create Rangolis (an art in which an array of colors is precisely used to create designs on the floor) can be an enjoyable activity with the potential to improve attention.

INDIAN SCENARIO

Unfortunately, there is a paucity of research from India about the effectiveness of therapeutic recreational activities for people with SMI. It has significant implications; for example, even if some centers involve patients in recreational activities, they are not guaranteed to be effective. At NIMHANS, we have started a structured recreational program that involves patients in various leisure activities according to their choice. A preliminary study shows that the patients perceive the benefits of these activities in terms of the experience of positive emotions, opportunities for social interactions, and the like.[12] We need more research exploring the utility of various approaches to actively include patients and their caregivers in focused recreational and leisure activities, such as recreational camping for a longer duration. We must remember that symptom amelioration is not the sole target of working with people with mental illness. Recovery is a broader concept with a strength-based perspective to enable an individual to lead a meaningful life and utilize their potential to the fullest. Recreational activities can serve as an important medium to attain this goal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.