Recently, another “scandal” emerged from the asylum’s labyrinth of Mental Hospital of Dromocaiteion in Athens: Violation of human rights of mentally ill persons, limitation of their contractual power as workers in a small social firm, decrease of the quality of care and treatment for socially excluded people suffering from mental disorders. We are witnessing an “as if” situation where the gap between the declarations and practices of human rights is once again widening. Yet, it is not just another local “as if” situation. It is remarkably notable that 53% of the psychiatric admissions in Greek mental health hospitals are involuntary and therefore this leads one to admit the existence of a permanent national scandal for our country.
During the actual economic crisis in Greece, new phenomena appear challenging the limits of the public and psychiatric system of care: a constantly growing population, a “no man’s land” people in the centre of the metropolitan area of Athens living in extremely precarious conditions as well as a dramatic increase in psychiatric admissions in mental health hospitals for homeless people with no present mental disorder.
In the early 70s, under the influence of radical ideologies, psychiatry was defined through its scientific object as “the knowledge and practice dealing with the singularity of the others, without violating the recognition and respect of the dignity of the suffering person” (B. Doray, Ethique et Psychiatrie, MIRE Paris, 1985).
The key strategy of a progressive mental health movement of this period was the suppression of the old asylums and their transformation in a comprehensive, accessible and effective community – based mental health system, covering the needs of the population.
The questions actually raised, in the era of globalization and domination of neo – liberal market – oriented culture, are the following:
• How should the wider field of mental health including psychiatric practice and PSR services change, in order to respond better and more accurately to the mental health needs and new complexity of urban suffering, social exclusion, poverty, social discrimination, lack of dignity and hope?
• Why do we raise the matter of ethical principles of psychiatric practice when the basic civil and political rights are violated and denounced? Why is there no integrated part of today’s struggle and process to improve mental health care, combining advocacy issues with good practices and evidence promoting recovery and full citizenship? It seems that the answer of both questions ought to be the same: The core of the psychiatric scientific community denies these new realities or underestimates the huge impact of social determinants on mental health (Patel, Saraceno, Kleinman 2006).
Despite the general statements of most psychiatrists in favor of a “bio-psycho-social model” of understanding and treating mental illness, there is a huge mental health gap between official statements and strategies to promote social inclusion and defend human rights of people with mental health problems and the real today’s practice.
According to the World Health Organisation (2005) “Advocacy is an important means of raising
awareness on mental health issues and ensuring that mental health is on the national agenda of governments. Advocacy can lead to improvements in policy, legislation and service development.” Promoting advocacy, empowerment and social inclusion requires a radical change of the existing psychiatric culture of bio-medical model and a shift to a new paradigm of understanding and promoting mental health under a global perspective.
This change should include, among other issues, an in-depth transformation of medical and
psychiatric curricula, an active participation of mental health professionals, users, families and other stakeholders to a process of an inclusive, involving and accountable governance, new political and social alliances in order to promote communication and active interaction of health, mental health and social services in education and training, in employment opportunities, in housing rights, in transport, in leisure and cultural activities and the active protection of civil and human rights. Involuntary admissions are a major and thorny issue in the protection of human and civil rights. The way the psychiatric services operate, results in the reproduction of stigma and social discrimination for people who constantly reside in the chambers of a mental health hospitals through a “revolving door” phenomenon. The legal mechanisms of defense of the human and civil rights should also be empowered through good practices such as the Observatory for Human Rights or the Ombudsman.
Consequently, if we are set to implement its full meaning it has to be integrated as an attitude in today’s practice with person-centred services, recovery oriented services, with active involvement of users and families. As professionals, we should invent feasible ways to
increase government budget for mental health which is significantly low to non-existent in most of the countries worldwide (Mental Health Atlas, 2005). Additionally, the poor existing budget for mental health should be wisely spent in the direction of Psychiatric Reform. We should promote deinstitutionalization and enhance the use of local resources to serve the needs of the local population with the existing means for this. Mass media should be on our side. The matter of publicity is an important one and our advocation towards it, should be aware of the local and national trends.
Last but not least, nothing is ever good if there is no monitoring and evaluation. WHO refers to evidence and ethical based practices which are not partial but part of a whole life-whole system approach. Thus, monitoring and evaluating the process of change is absolutely vital to ensure the success of our work. WAPR’s challenge is to advocate towards a change of the political agenda of International Organisations emphasizing on a better mental health care and respect of human dignity.
S. Stylianidis
VP of WAPR, Greek Counterpart for mental health in WHO,
Ass. Prof. of Soc. Psychiatry, Panteion University
During the actual economic crisis in Greece, new phenomena appear challenging the limits of the public and psychiatric system of care: a constantly growing population, a “no man’s land” people in the centre of the metropolitan area of Athens living in extremely precarious conditions as well as a dramatic increase in psychiatric admissions in mental health hospitals for homeless people with no present mental disorder.
In the early 70s, under the influence of radical ideologies, psychiatry was defined through its scientific object as “the knowledge and practice dealing with the singularity of the others, without violating the recognition and respect of the dignity of the suffering person” (B. Doray, Ethique et Psychiatrie, MIRE Paris, 1985).
The key strategy of a progressive mental health movement of this period was the suppression of the old asylums and their transformation in a comprehensive, accessible and effective community – based mental health system, covering the needs of the population.
The questions actually raised, in the era of globalization and domination of neo – liberal market – oriented culture, are the following:
• How should the wider field of mental health including psychiatric practice and PSR services change, in order to respond better and more accurately to the mental health needs and new complexity of urban suffering, social exclusion, poverty, social discrimination, lack of dignity and hope?
• Why do we raise the matter of ethical principles of psychiatric practice when the basic civil and political rights are violated and denounced? Why is there no integrated part of today’s struggle and process to improve mental health care, combining advocacy issues with good practices and evidence promoting recovery and full citizenship? It seems that the answer of both questions ought to be the same: The core of the psychiatric scientific community denies these new realities or underestimates the huge impact of social determinants on mental health (Patel, Saraceno, Kleinman 2006).
Despite the general statements of most psychiatrists in favor of a “bio-psycho-social model” of understanding and treating mental illness, there is a huge mental health gap between official statements and strategies to promote social inclusion and defend human rights of people with mental health problems and the real today’s practice.
According to the World Health Organisation (2005) “Advocacy is an important means of raising
awareness on mental health issues and ensuring that mental health is on the national agenda of governments. Advocacy can lead to improvements in policy, legislation and service development.” Promoting advocacy, empowerment and social inclusion requires a radical change of the existing psychiatric culture of bio-medical model and a shift to a new paradigm of understanding and promoting mental health under a global perspective.
This change should include, among other issues, an in-depth transformation of medical and
psychiatric curricula, an active participation of mental health professionals, users, families and other stakeholders to a process of an inclusive, involving and accountable governance, new political and social alliances in order to promote communication and active interaction of health, mental health and social services in education and training, in employment opportunities, in housing rights, in transport, in leisure and cultural activities and the active protection of civil and human rights. Involuntary admissions are a major and thorny issue in the protection of human and civil rights. The way the psychiatric services operate, results in the reproduction of stigma and social discrimination for people who constantly reside in the chambers of a mental health hospitals through a “revolving door” phenomenon. The legal mechanisms of defense of the human and civil rights should also be empowered through good practices such as the Observatory for Human Rights or the Ombudsman.
Consequently, if we are set to implement its full meaning it has to be integrated as an attitude in today’s practice with person-centred services, recovery oriented services, with active involvement of users and families. As professionals, we should invent feasible ways to
increase government budget for mental health which is significantly low to non-existent in most of the countries worldwide (Mental Health Atlas, 2005). Additionally, the poor existing budget for mental health should be wisely spent in the direction of Psychiatric Reform. We should promote deinstitutionalization and enhance the use of local resources to serve the needs of the local population with the existing means for this. Mass media should be on our side. The matter of publicity is an important one and our advocation towards it, should be aware of the local and national trends.
Last but not least, nothing is ever good if there is no monitoring and evaluation. WHO refers to evidence and ethical based practices which are not partial but part of a whole life-whole system approach. Thus, monitoring and evaluating the process of change is absolutely vital to ensure the success of our work. WAPR’s challenge is to advocate towards a change of the political agenda of International Organisations emphasizing on a better mental health care and respect of human dignity.
S. Stylianidis
VP of WAPR, Greek Counterpart for mental health in WHO,
Ass. Prof. of Soc. Psychiatry, Panteion University
*Editorial, WAPR (World Association for Psychosocial Rehabilitation) Bulletin, December 2010
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