At the end of the project, from November 18th to November 20th, a 3 days International Meeting was held in Trieste (Italy), hosted by the Permanent Conference for Mental Health in the World. This workshop provided an opportunity for dialogue among different stakeholders not only about the multi-country project implementation but also about wider themes such as mental health, de-institutionalization and rights. The objectives of the meeting, mainly linked to the dissemination of the project, were the following: Sharing different implementation experiences and lessons learnt throughout the multi-country project implementation and by the presentation of the Final Transnational Comparative Report. Showcasing the Italian experience of deinstitutionalization of mental health services. Promoting a dialogue with international and Italian stakeholders about the theme of shifting from a hospital based model to a community mental health system. Promoting the efforts done in terms of achievements and network development both at national and international level. The meeting hosted 22 participants including 3 representatives of the project in Mongolia and 2 for the Indonesia, 3 for Brazil and 1 for Liberia (the former Project Manager, as it was not possible to involve people from Liberia due to the Ebola outbreak); 1 representative for the Permanent Conference for Mental Health in the World; the President of Friuli Venezia Giulia Health Regional Commission; 1 representative of the AIFO project on Mental Health in China financed by the EU; the researcher having developed the project final publication; 6 representatives from AIFO, among which the President; 1 DPI’s representative; the Director of Mental Health Centre of Brindisi; the KIP School President and OCSE/DAC group against poverty Vice-President; the Coordinator Human Rights and Mental Health within the Human Rights Secretariat in Brazil. Attached, the schedule of the meeting and participants’ names.
November 2014, the final Meeting of the project “Multi-country small pilot initiatives of community mental health in low and middle income countries”
Mental Health; Promoting Rights, Fighting Stigma- Clara Di Dio/EU Multi Country Mental Health Project Manager
AIFO started the implementation on community mental health over two years ago, through the contribution of the European Union and the technical sup-port of a high number of partners ranging from the World Health Organization to Disabled People International. The work done in Liberia on Community Based Rehabilitation (CBR) and mental health is part of this programme, which also targets Indonesia, Mongolia and Brasil, countries where AIFO’s presence is well rooted through either CBR or health programmes.The two main trajectories of the project are human rights and community mental health. The work on human rights is crosscutting to all AIFO activities, since AIFO’s mandate as health NGO is to apply a human rights based approach to health. Human rights based approach to healthcare implies that people with mental health conditions are seen in first places as subjects of rights: right to quality accessible healthcare; right to live their lives in a safe and favorable environment. Mental health is the most neglected area of healthcare and mental illness is everywhere associated to a very resilient type of stigma that has to with dangerousness, and aggressiveness.
In the Liberian context, stigma attached to mental illness takes a particular form and is often associated to witchcraft and possession. Mental illness is therefore sometimes perceived as a condition that has to do with the world of spirits, the result of a possession or of an open channel (open mole) where bad thoughts and spiritual entities can enter, causing confusion and delusions; accordingly, if the mentally ill is possessed by bad spirits, then mental illness is an evil condition. It must be said that every culture of the world develops different explanatory models when it comes to mental illness and most of them resort to the world of spirits; in all the target countries of AIFO programme, traditional beliefs and superstitions creates false images about the mentally ill; the construction of myths in turns results in stigma and discrimination; in many cases, the direct result of these constructions are human rights violation ranging from unnecessary physical restrain (the use of chains for instance) to sexual violence or even killing. Sadly, communities are not the only inhospitable places for the mentally ill since everywhere in the world many human rights violations take place within the same health services that should provide treatment and support: lack of access to quality services and medications; forced admissions; physical restrain are among the most common violations.
AIFO supports the view, already embraced by many governments including the Government of Liberia, that mental health services should be provided as close as possible to the person to ensure that his/her ties with the communities and families are not broken because of the illness and to allow the full enjoyment of their social rights. Accordingly, AIFO is therefore promoting community mental health systems rather than hospital based models. In Liberia , our work on human rights and community mental health consists of a wide range of activities implemented in Margibi, Bong, Nimba, River Gee and Mary land: training of field workers and health professionals to build their capacity to recognize and prevent human rights violations both in the communities and within the health system; a protocol of intervention that links the CBR field workers deployed in the communities with the local mental health services to ensure that the first identification and assessment is done at the community level and that a follow up and a human rights monitoring system is in place in the community for those clients who are under treatment or have been hospitalized and then discharged. The community mental health interventions are complemented by awareness raising activities, such as community talks on the theme of mental illness to make Liberian communities hospitable places also for those who are facing mental illness.
In Mongolia, the programme focuses on the establishment of self-help groups of people with mental health conditions; training of family doctors on mental health skills to pro-mote the integration of mental health into primary health care, workshops on human rights and community mental health for mental health and primary health care professionals. In Brasil, the activities consist of training users, families and professionals on human rights and mental health services quality standards; the project has there-fore established a platform of users, families, civil society and professionals who engage on a participative assessment of quality and human rights standards in two mental health hospitals in Salavador de Bahia. In Indonesia, activities focus on training healthcare and CBR professionals on mental health skills. One of the key messages has to do with abandoning a very widespread practice in Indonesia: the so called pasung, namely the physical restraint of the mentally ill in the community through chains and locks. Different settings, different activities but one goal: promoting the rights and improving the lives of people living with mental illness.
The Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda has been issued on May 30th 2013, with the title“A NEW GLOBAL PARTNERSHIP: ERADICATE POVERTY AND TRANSFORM ECONOMIES THROUGH SUSTAINABLE DEVELOPMENT”.
The Report will be used by the UN Secretary General Ban Ki Moon at the MDG Review Summit scheduled to take place for September 2013. As the guiding principle was “Leave no one behind”, the number of references to persons with disabilities is high. This is the result of the great efforts of national DPOs worldwide and their international networks. The International Disability Alliance has commented that the document call for disability disaggregated data to ensure that no one is left behind and targets should only be considered ‘achieved’ if they are met for all relevant income and social groups. Disability is also represented in the goals 1 (poverty) and 3 (providing quality education and lifelong learning). While many vulnerable groups are mentioned, persons with disabilities are always highlighted.
References to Disability in the “A New Global Partnership: Eradicate Poverty and Transform Economies through Sustainable Development” (05/30/13) Report by the High Level Panel on the Post-2015 Development Agenda
1. “After2015 we should move from reducing to ending extreme poverty, in all its forms. We should ensure that no person – regardless of ethnicity, gender, geography, disability, race or other status – is denied universal human rights and basic economic opportunities.” (Executive Summary, 1. Leave no one behind)
2. “A new partnership should be based on a common understanding of our shared humanity, underpinning mutual respect and mutual benefit in a shrinking world. This partnership should involve governments but also include others: people living in poverty, those with disabilities, women, civil society and indigenous and local communities, traditionally marginalised groups, multilateral institutions, local and national government, the business community, academia and private philanthropy.” (Executive Summary, 5. Forge a new global partnership)
3. “To gather these perspectives, Panel members spoke to farmers, indigenous and local communities, workers in the informal sector, migrants, people with disabilities, small business owners, traders, young people and children, women’s groups, older people, faith-based groups, trade unions and many others.”(p. 2, Chapter 1: A Vision and Framework for the post-2015 Development Agenda)
4. “People with disabilities also asked for an end to discrimination and for equal opportunity. They are looking for guarantees of minimum basic living standards.” (p. 2, Chapter 1: A Vision and Framework for the post-2015 Development Agenda)
5. “All these groups asked that when the post-2015 agenda is put into place, it includes a plan for measuring progress that compares how people with different income levels, gender, disability and age, and those living in different localities, are faring – and that this information be easily available to all.” (p. 2, Chapter 1: A Vision and Framework for the post-2015 Development Agenda)
6. “Such a spirit could inspire us to address global challenges through a new global partnership, bringing together the many groups in the world concerned with economic, social and environmental progress: people living in poverty, women, young people, people with disabilities, indigenous and local communities, marginalised groups, multilateral institutions, local and national governments, businesses, civil society and private philanthropists, scientists and other academics.” (p. 3, Chapter 1: A Vision and Framework for the post-2015 Development Agenda)
7. “The next development agenda must ensure that in the future neither income nor gender, nor ethnicity, nor disability, nor geography, will determine whether people live or die, whether a mother can give birth safely, or whether her child has a fair chance in life.” (p. 7, Chapter 2: From Vision to Action—Priority Transformations for a post-2015 Agenda)
8. “Civil society organisations can play a vital role in giving a voice to people living in poverty, who include disproportionate numbers of women, children, people with disabilities, indigenous and local communities and members of other marginalised groups.” (p. 11, Chapter 2: From Vision to Action—Priority Transformations for a post-2015 Agenda)
9. “Likewise, our illustrative framework tackles inequality of opportunity head on, across all goals. When everyone, irrespective of household income, gender, location, ethnicity, age, or disability, has access to health, nutrition, education, and other vital services, many of the worst effects of inequality will be over.” (p. 16, Chapter 3: Illustrative Goals and Global Impact)
10. “Data must also enable us to reach the neediest, and find out whether they are receiving essential services. This means that data gathered will need to be disaggregated by gender, geography, income, disability, and other categories, to make sure that no group is being left behind.” (p. 23, Chapter 4: Implementation, Accountability and Building Consensus)
11.”Leave No One Behind. We must ensure that no person – regardless of ethnicity, gender, geography, disability, race or other status – is denied basic economic opportunities and human rights.” (p. 29)
12.”To ensure equality of opportunity, relevant indicators should be disaggregatedwith respect to income (especially for the bottom 20%), gender, location, age, people living with disabilities, and relevant social group. Targets will only be considered ‘achieved’ if they are met for all relevant income and social groups.” (p. 29)
13.”For more than a billion people, $1.25 a day is all there is to feed and clothe, to heal and educate, to build a future. We can be the first generation to eradicatethis extreme poverty. This is a global minimum standard and must apply to everyone, regardless of gender, location, disability or social group.” (p. 32)
14.”Some countries have made significant gains in the last decade in reducing disparities based on disability, ethnicity, language, being a religious minority and being displaced.” (p. 37)
15.”Metrics should be put in place to track progress on equal access and opportunity across age, gender, ethnicity, disability, geography, and income.” (p. 60)
16.”A focus on the post-conflict context and vulnerable groups – including women and girls, disabled youth, LGBT youth, and youth in war-affected areas – is necessary.” (p. 62)
17.”Other Vulnerable Groups: i. Disability and Ageing” (p. 63)
18.”Disaggregation of data by disability, age group and gender should be part of all targets.” (p. 63)
19. “Disability and ageing must be mainstreamed across policies of the government, and laws that prevent discrimination against the disabled and aged must be put in place” (p. 63)
Addressing the Issue of Fractional Justice for Prisoners and Pre-trial Detainees: A Collaboration between Mental Health Care, Community Based Rehabilitation and Probation Services
A coordinated system of care and referral pathway: The Ministry of Justice with support from the Carter Center Mental Health Program, GIZ and AIFO conducted a one-day intensive working session for Probation Officers, Mental Health Clinicians and Community Based Rehabilitation Workers from across the country. The ultimate goal was to establish and promote strong partnership and collaboration between the probation, mental health and rehabilitation sectors. The workshop took place on May 27, 2013 at the GIZ central office, Mamba Point. Participants came from 5 counties,: Bong, Margibi, Lofa, Nimba, and Montserrado.
A glimpse of the condition of many pre-trial detainees: Jay-girl goes to jail for half a year for stealing 3 monkey apples. Young Mohammed spends at least 24 months in prison as a punishment by a top official. Tutu-boy experiences so much anger and pain for been in prison for 9 months based on an allegation of stealing a pair of shoes. All three young people are incarcerated in the same room with hard-core convicted criminals whose crimes include armed robbery, murder and rape. Jay-girl, Mohammed and Tutu-boy have no idea when they will be freed or see a judge or learn a skill or have psychosocial care; everything is just uncertain and indefinite. This is the case of many imprisoned persons across the country. 80-90 % in prison are pre-trail detainees without court hearing not convicted criminals. The prisons offer little or no room to learn new skills, improve mental health care or be rehabilitated. Often times instead of positive change in behavior, these detainees after so much exposure and interactions with hardened criminals, tend to learn new, but negative skills that they then take back to their communities. Sometimes the experience is so bad that it causes major mental health problems for which they receive little or no care during incarceration.
Benefits of the new collaboration: Linking probation, mental health and community-based rehabilitation can improve the conditions of imprisoned persons and probationers. Detainees would be exposed to regular mental health care and treatment before, during and after probation as well as an opportunity to acquire new knowledge and skills before returning to and/or while in their communities.
Probation services only became operational in Liberia in 2010. Persons who qualify for probation must have no previous criminal history and be willing to meet certain conditions including restitution and community services. The workshop officially set the pace for Probation Officers, Mental health Clinicians and Community Based Rehabilitation workers to consolidate efforts in advocating and supporting the protection of the rights of persons with disabilities, improvement of mental health care for detainees and probationers, establishment of effective network and referral system, and reduction of stigma and discrimination that the persons with disabilities suffer in Liberia.
“Is it possible that the psychiatric profession has a strong desire to label things that are essential human behaviour as a disorder?”
Have a look at this article on The Guardian about the DSM (the Diagnostic and Statistical Manual of Mental Disorders published by the American). DSM basically provides a list of mental health disorders and has a major impact on the way the debate over mental health is frame. In its latest version, even shyness in children can be classified as mental illness. One might ask: why psychiatry is so often obsessed with the compulsive desire to objectify persons and to label them? What about the role of vested interests in diagnosis?
Read the full article at: http://www.guardian.co.uk/society/2013/may/12/medicine-dsm5-row-does-mental-illness-exist#ixzz2UghQ9IKJ
…and same topic, same newspaper
Human Rights Watch Documentary about abuses in psychiatric institutions, spiritual healing centers and community in Ghana