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Mental Health Europe Conference 2012 From individual to collective responsibility The social determinants of mental health
Book of Abstracts
Title: Book of abstracts MHE 2012 conference „From individual to collective responsibility: The social determinants of mental health“ and Satellite symposium „Post-traumatic stress disorders and their impact on 2nd and 3rd generations“ Editor: Sto koluri Split & Mental Health Europe (MHE) Editorial Coordination Maja Soco, Silvana Enculescu Proofreading Tanja Boškovic, Silvana Enculescu Translation from Croatian into English: Pavao Akrap Graphic design Silvana Enculescu Printing DES Split Published in June 2012 ISBN:978-953-95459-8-5
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Contents Introduction................................................................................................8 Programme Satellite Symposium...................................................10 Abstracts from Speakers - Satellite Symposium...................13 Changes in the Balkan and Central Eastern European countries. A historical approach - Goran Cerkez Trauma and the Political and Social Context for Community Healing and Empowerment - Malgorzata Kmita Inter-professional and interagency collaboration: the challenges and obstacles - Jo Lucas
Abstracts - Parallel workshops........................................................17 Social support and PTDS symptoms in war-traumatized people Social support and PTSD symptoms among war traumatised women - Miro Klaric Secondary trauma of wives of war veterans who suffer PTSP - Aleksandra Stevanovic, Gordana Kuterovac Jagodic, Tanja Franciškovic Posttraumatic stress disorder: Myths and Reality - Miro Jakovljevic War and Post-war Psychotraumatology - Prof. Em. Stijn Jannes Psychosocial consequences of traumatic experiences Care for people with PTSD and mental disabilities in post-war countries - Goran Dodic Hidden pathways of totalitarian irrationality in transitional societies - Robert Oravecz
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www.mheconference2012.com Psychosocial consequences of sexual abuse in early childhood - Milena Srpak Consequences of sexual abuse - Leonida Zalokar Contextualising childhood sexual abuse – work of ‘Wildwasser ‘Berlin Martina Hävernick Parents with post-war trauma and the consequences on the mental health and development of their children Parental involvement in the war in Croatia 1991-1995 and psychopathology in Croatian adolescents - Is there any connection? - Tomislav Franic Are there missing variables in child abuse and parenting research in Croatia? - Eva Andjela Delale Trauma in childhood – risks for the child’s development - Katharina Purtscher Intercultural understanding and cooperation Introduction - Hans Gullestrup Community psychiatry development in Slovenia - Vesna Švab Intercultural aspects of mental health - Rita Donabauer/Erwin Kargl/Michaela Kéita-Kornfehl
Programme MHE Conference 2012..................................................32 Abstracts from Speakers - June 15....................................................38 Mental health : in the mainstream - Matt Muijen, Antoinette Kaic-Rak Implementing the European Pact for Mental Health and Well-being in Challenging Times - Jürgen Scheftlein Social determinants of mental health in Europe - José Miguel Caldas de Almeida
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www.mheconference2012.com The situation regarding mental health in the Republic of Croatia - Prof. Goran Dodig Social concept of psychosocial disability - Kristijan Grdan Meeting the basic needs of children and youth as an investment in the future Tomislav Franic Managing mental health at work – why bother? - Tanya Kennedy A framework for the establishment of strong and supportive networks - Thor Rogan The role of volunteering in the establishment of strong and supportive networks in rural and remote areas - Svetlana Varjun
Abstracts - Parallel sessions..............................................................47 Parallel session 1 - Meeting the basic needs of children and youth as an investment in the future Mental health care in SOS Village for children - Gordana Daniel, Matic Višnja Technique is not enough- Fabian Davis, Lynn McDonald and Nick Axford OmSorg- Dealing With Bereavement- Working with Training Groups for Bereaved Children - Jes Dige and Per Bøge Parallel session 2 - Changing the attitude of employers towards people with mental health problems Changing attitudes to mental health in a business environment Paul Litchfield, Chief Medical Officer British Telecom Group plc, UK Overcoming stigma and discrimination at work – what does the evidence tell us? Bob Grove
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www.mheconference2012.com Parallel session 3 - Framework for the establishment of strong and supportive networks From state hospital to outpatient regional treatment: The process of deinstitutionalisation in Germany - Thomas Pirsig Putting The Community back into Community Mental Health; promoting inclusion through co-produced services in an age of austerity - Prof David Morris, Beyond the statutory services, Associations, Services and Municipalities-The Joint Experiences and Local Mental Health Systems Project - Niccolò Cortopassi, Donatella Miccinesi and Pino Pini Parallel session 4 - The role of volunteering in the establishment of strong and supportive networks in rural and remote areas The role of volunteering in the establishment of strong and supportive networksBettina Arbesleitner How local and European young volunteers may contribute to make community based mental health services accessible to severe users in rural areas - Pablo Gómez The installation of a Volunteer Network for health issues in the rural region of Fokida, Central Greece - Benefits and actions - Ioanna Kallia
Abstracts from Speakers - June 16................................................60 The human rights aspects of the access to community-based mental health services - Josée Van Remoortel Deinstitutionalisation and the UN Convention on the Rights of Persons with Disabilities - Jan Pfeiffer The role of the media in changing the attitude of people towards mental health issues - Jane Gabriel Round Table debate: Solidarity between generations in the mental health field Elisabeth Muschik 6
From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com Abstracts - Paralell Sessions....................................................................65 Parallel session 5 - The human rights aspects of the access to communitybased mental health services The human right aspects of the access to quality community-based services Erwin Kargl Choice and control – the right to live independently and to be included in the community - Nevena Peneva Kober The role of international and national monitoring bodies in protecting the rights of persons with mental disabilities - Marija Definis-Gojanovic, Goran Mijaljica and Mario Malicki Parallel session 6 - Deinstitutionalisation and the UN Convention on the Rights of Persons with Disabilities Deinstitutionalisation and the UN Convention on the Rights of Persons with Disabilities - Rita Donabauer Community Psychiatry Development in Slovenia - Vesna Švab, Marijana Janet, Evgen Janet Recovery in Scottish mental health services - Bridey Monger, Robin lon, Nigel Henderson, Dr Scott Hardie, Jane Cumming Parallel session 7 - Role of the media in changing the attitude of people towards mental health issues Telling the real story: The UK media and mental health - Alison Kerry Mental Health - ‘Something We All Have’ - Krzysztof Bierski The role of the media in changing the attitude of people towards mental health issues – Branka Meic
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Introduction MHE has decided to dedicate its 2012 Conference to engaging with the social determinants of mental health, in a bid to emphasize the role society plays in both reinforcing and addressing inequalities. The conference, co-organised by MHE and Sto Koluri Split, brings together experts from all across Europe to present different methods for improving the social environment in schools and workplaces, encouraging inclusion within the community and developing strong and supportive networks that can have a positive impact on mental health. It is a great pleasure for us to introduce you to this book of abstracts, which includes a large number of important contributions in relation to the theme of the conference: “From individual to collective responsibility – The social determinants of mental health”. Unfair and avoidable – the terms used by the World Health Organization (WHO) to describe the social determinants of health are both grim and hopeful. They underline the need to act on the conditions that so deeply impact the length and quality of people’s lives, but they also offer hope that inequalities can indeed be tackled. A special satellite symposium for participants from Balkan and Eastern European countries is also held in Split, right before the conference, on the theme “Post-traumatic stress disorders and their impact on 2nd and 3rd generations.” The presentations from this symposium are also summarized and included in this publication. Recognizing the lack of services and support for people with mental health problems in Eastern Europe, Mental Health Europe chose Croatia as the place of its conference, hoping this will increase media coverage of disability issues in the area, and encourage policy development. In particular, MHE and Sto Koluri Split wish to dedicate specific attention to de-institutionalization throughout this conference, as “institutional care” is still among the most important barriers for persons who experience mental health problems to (re)integrate in society. Being able to live in and contribute to society is a basic fundamental right, and the basis for every persons’ wellbeing. Therefore, Europe needs to gradually but definitely go through a transition process, where institutional establishments for users of mental
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health services, and all other persons are being closed down and replaced by community-based alternatives. Civil Society plays an instrumental role for shaping and delivering the necessary services, where users themselves have the power to take informed decisions about what support they need, when, where and from whom. Therefore, a strong and transparent partnership between the governments and representative organizations working in the field of mental health must be established across the European Union (EU), at local, regional, National and EU level. Governments have the responsibility to empower and support relevant organizations to undertake this role, in order to allow for real and effective involvement of civil society in the decisionmaking processes, which is a pillar for a well-functioning democracy. In 2012, we are in facing a unique opportunity to shape the future: the EU will adopt crucial regulations, which can push governments to use EU funds to develop community-based services. Of course, living in the community is not only a question of money: European countries’ legislation and policies are still full of measures that hinder real independent living from becoming a reality. The institution of guardianship is still in place in most of Europe, and without legal capacity people with mental health problems cannot exercise their right to live where they want. Since the ratification of the United Nations Convention on the Rights of Persons with Disabilities, civil society has a newly-acquired tool and chance to reshape the whole legislative frame that forms our life nowadays: to abolish guardianship and develop supported decision making practices, to close down psychiatric institutions and establish well-designed community based services instead, and to ban all forms of involuntary treatment. We hope that you will enjoy reading through this booklet and we trust that you – whatever function you may have and wherever you come from – will be further inspired to make your contribution in ensuring an inclusive society where all persons’ needs are equally respected. If we join forces, we will be able to create the society we all want to live in, and where the best conditions for a positive mental health are guaranteed. Nace Kovac President, Mental Health Europe
Maja Soco, Director, Sto Koluri Split
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Satellite Symposium for delegates for the Balkans and Eastern European countries Post-traumatic stress disorders and their impact on second and third generations Programme (as per June 5, 2012) 9:15 – 9:45
Welcome by Predrag Matic, Minister of Veterans, Croatia Nace Kovac, President of Mental Health Europe
9:45 – 10:15 “Trauma and the political and social context for community healing and empowerment” – Malgorzata Kmita, MHE Board member, UK/ Poland 10:15 – 10:30 Koluri Split
Information about the workshops – Maja Soco, director Sto
10:30 – 12:00 Parallel workshops (presentations and discussion) 12:00 – 12:30 Break 12:30 – 13:30 Parallel workshops continued (discussion and preparation of report) 13:30 – 14:30 Lunch 14:30 – 15:00 Feedback from the parallel workshops 15:00 – 15:30 Changes in the Balkan and Central Eastern European countries. A historical approach - Goran Cerkez, Assistant Minister for International Cooperation and Coordination of Strategy Development, Bosnia and Hercegovina 15:30 – 17:00 Workshop: Inter-professional and interagency collaboration. The challenges and obstacles – led by Jo Lucas, UK 17:00 – 17:30 Conclusions and recommendations by Jo Lucas
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From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com Parallel workshops Social support and PTDS symptoms in war-traumatized people
Introduction - Prof. Miro Klaric, Psychiatric Clinic, School of Medicine, Mostar University, Bosnia and Herzegovina Workshop contributors: Secundary trauma of wives of war veterans who suffer from PTSD Aleksandra Stevanovic, Assistant professor at Department of psychiatry and psychological medicine, School of Medicine, University of Rijeka, psychologist in Referral Center for psychotrauma, Croatia Posttraumatic stress disorder: Myths and Reality - Prof. Miro Jakovljevic, MD, PhD, Department of Psychiatry, University Hospital Center Zagreb War and post-war psychotraumatology - Prof. Em. Stijn Jannes, Professor of Psychiatry Gent University Belgium, MHE Senior Policy Adviser
Psychosocial consequences of traumatic experiences Introduction by Prof. Goran Dodig, psychiatrist, Head of Psychiatry Department, Split University Hospital, Croatia Workshop contributors: Hidden pathways of totalitarian irrationality in transitional societies = Robert Oravecz, Psychiatrist, PhD in psychology, director of the Institute on Social Psychiatry and Psychotraumatology, Slovenia Psychosocial consequences of sexual abuse in early childhood - Milena Srpak,, Clinical psychologist, Psychotherapist at Psychiatric Hospital Ormoz, Slovenia Consequences of sexual abuse - Leonida Zalokar, psychotherapist, Ljubljana, Slovenia
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www.mheconference2012.com Contextualising childhood sexual abuse – work of ‘Wildwasser ‘Berlin Martina Hävernick, Wildwasser Selbsthilfe & Beratung, Berlin, Germany
Parents with post-war trauma and the consequences on the mental health and development of their children Workshop contributors: Parental involvement in the war in Croatia 1991-1995 and psychopathology in Croatian adolescents is there any connection? Tomislav Franic, Researcher, Department of Psychiatry, University of Split School of Medicine Are there missing variables in child abuse and parenting research in Croatia? - Eva Andjela Delale, Psychologist, University of Zagreb, Faculty of law, Department of social work
Intercultural understanding and cooperation Introduction by Prof. Hans Gullestrup, Professor Emeritus in Social and Economic Planning, Aalborg University, Denmark Workshop contributors: Cultural differences in perceiving stigma because of the diagnosis schizophrenia - Vesna Svab, Psychiatrist, Professor at Ljubljana University, Slovenia Intercultural aspects of mental health – Rita Donabauer and Erwin Kargl, Pro Mente Upper Austria
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Abstracts Speakers
Changes in the Balkan and Central Eastern European countries. A historical approach - Goran Cerkez, Assistant Minister for International Cooperation and Coordination of Strategy Development, Bosnia and Hercegovina Bearing in mind that 450 million people in the world experience mental health problems, data indicate that by 2020 depression will be the second leading cause of disability. Therefore, the countries of Southeast Europe, through a joint initiative formed in 1999 in Dubrovnik, decided to act through regional projects in the five areas with the aim of improving the health of the population. One of the areas of the joint action is the mental health project in southeastern Europe, with its central office in BiH. The project has significantly improved the situation in this area, primarily due to the establishment of mental health policy, the strengthening of community service and the education of professionals in the field of mental health. These activities in Southeast Europe can serve as a positive example for other European countries. It is important to emphasize that they did not stop with the initiative, but continued through joint cooperation. The aim is to strengthen uses’ initiative, but also to promote the fight against the stigma often experienced by persons with mental problems.
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www.mheconference2012.com Trauma and the Political and Social Context for Community Healing and Empowerment Malgorzata Kmita, MHE Board member, UK/Poland War and conflict has characterised the human condition from the dawn of time. In the 21st century they continue to blight the experience of millions throughout the world, many of whom are civilians, who face, for example, the fear of annihilation, witnessing the deaths of close members of their family, rape, torture and abuse together with associated poverty, destitution, malnutrition and starvation. Such experiences are often exacerbated by deep-rooted ethnic, religious, political, economic and territorial differences and disputes. The traumatic consequences and effects of war and conflict at the social and personal levels create a profound sense of violation at the very core of individuals and their communities which is expressed in loss of hope, lack of trust and a sense of disempowerment. In order to respond to, and begin to heal, such a sense of violation clear and unambiguous long term policies and strategies are required to address the mental health needs and well being of those whose lives have been impacted by war and conflict. My presentation draws upon my experiences of working with Eastern European World War II survivors with whom I worked in the UK particularly in the 1980’s and 1990’s. These people were often classified as mentally ill and they carried this stigmatising label without receiving appropriate support at the individual, community and socio-economic levels. There was a significant degree of shame and guilt attached to their experience and often their local ethnic community was not supportive. I will refer to my statement which I made in Prague in 2009: “We have to expand our vision and our mindsets in order to understand the concept of mental health and well being in the socio-economic context and go beyond diagnosis, symptoms and labels, in order to empower European Citizens and instil HOPE for the future” This perspective is particularly reevant to communities who witnessed and experienced war and conflict and its associated wide-ranging traumas and losses. There is a deep need for traumatised people to receive holistic, meaningful and effective therapeutic support on an individual basis through talking
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From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com treatments as well as, for example, art, music and body movement therapies where healing through dialogue and interactions with others in a context of trust and respect is nurtured. However, such therapeutic interventions may be of limited value if they are not complemented by appropriate changes at socio-political, community, economic and educational levels which aim to dismantle oppressive structures, discrimination and inequality in order to minimise the likelihood of conflict. It is important to work at many levels, adopting a multi-faceted approach, in order to (re)build civil society in which NGOs can play a significant role in addressing issues of discrimination, gender, ethnic and faith conflicts which often underline the origin of conflict. I will conclude my presentation with reference to the UN Convention Against Torture, Cruelty and Degrading Treatment which can only be put into practice when the intrinsic value of human life regardless of race, faith, ethnicity, life style or economic status is actively recognised and affirmed. Article 3 of the Lisbon Treaty states “the objective of the EU shall be to promote peace, it’s values and well being of its people” This objective has wideranging and significant implications for survivors of war and conflict as they require concerted action in order to re-establish trust and facilitate healing. Amnesty International has stated; “Governments must show legitimate leadership and reject injustice by protecting the powerless and restraining the powerful” Here lies the nature of successful empowerment of citizens which ultimately must include compassion, kindness and creative ways of overcoming oppression and abuse. There can be no meaningful social cohesion and associated peace without the development of the positive mental health and well being of all citizens who have an intrinsic right to be free of oppression in its many and varied forms. War and conflict can be regarded as being symptomatic of wider political, economic, cultural and moral issues and it is imperative, therefore, that therapy, ‘making whole’ and ‘healing’ in its widest sense is reflected in empowerment at the individual, social, economic and political levels. Governments, therefore, must demonstrate legitimate and accountable leadership which affirms human rights and mental health and well-being for all.
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www.mheconference2012.com Inter-professional and interagency collaboration: the challenges and obstacles Jo Lucas - Fibonacci Associates “We could learn a lot from crayons: Some are sharp, some are pretty, some are dull, while others are bright, some have weird names, but we have to learn how to live in the same box.” – Author Unknown I will be looking at collaboration on the different levels of personal/professional, across disciplinary boundaries, between agencies, across agency boundaries and across national boundaries. I suggest that one of the major issues is trust and professional self confidence. It is relatively easy to work with someone who you know and trust, across all these boundaries. A secondary factor is that of professional self confidence. If you are clear about the boundaries of your professional competence, the strengths of your profession and what you can offer the people you work with, it will be easier to work with people from other professions. This is the best way of ensuring the people you serve get a good service and that resources and information are shared. I will look at some of the obstacles that I have experienced to collaboration that might be specific to central and eastern Europe and the former Soviet block and offer some thoughts about how these might be overcome. Then I will look at some of the interpersonal obstacles to collaboration and think about what they reflect in the professional and individuals and if there are ways of moving on from them. “Coming together is a beginning, staying together is progress, and working together is success.” - Henry Ford
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Abstracts - Parallel workshops Social support and PTDS symptoms in war-traumatized people Social support and PTSD symptoms among war traumatised women Miro Klaric, Psychiatric Clinic, Mostar University School of Medicine, Mostar, Bosnia and Herzegovina Causal pathways of health are complex, whereas socially structural and psychosocial factors have their impact on health determinants that operate on complexed way in intertwined relationships with other factors arised from the social context of people’s lives. These determinants represent posttraumatic predictors, risk factors for manifestation and maintenance of posttraumatic and other mental symptoms respectively. Since PTSD introduction in Diagnostic and statistical manual of mental disorders (APA, 1980), it was clear that, althoug necessary, exposure to trauma may not be sufficient for the development of posttraumatic stress disorder. Various sources confirmed that social support is one of the greatest resources to cope with the trauma, and has a major role in the healing process. Correlation between social support and levels of PTSD symptoms was higher in people who were exposed to war rather than civilian trauma. Many data from the literature indicate that the emotional sources of social support,especially family, although important for both sexes, are more important for women’s health,while social and professional status are more important for men. However, in the situation of individual and social polytraumatization such as war, the importance of certain sources of social support depends on the context in which traumatized person is in that moment. Considering that social support is based on mutual trust and connection with others, with the weakening of social network, also is weakening its help to vulnerable members. Additionally, psychological and behavioral consequences of individual trauma are reflected onfamily structure and its functionality. Such families are often a source of new stressful experiences than a source of security and trust to their traumatized member. As a result, in the post war societies, where with social disintegration we also have high individual trauma, the sources of social support can change the usual patterns of significance, especially when it comes to women, where family social support is more important for mental health than social and professional status. From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com Secondary trauma of wives of war veterans who suffer PTSP Aleksandra Stevanovic1, Gordana Kuterovac Jagodic2, Tanja Franciškovic1 Results of researches done so far point to the fact that wives of war veterans have a whole sequence of psychical and physical symptoms, including the symptoms of secondary trauma stress. Taking a number of veterans of the Croatian Independence War who suffer of PTSP, the emerging question is the health of their wives. The aim of this research was to find out the level of symptoms of secondary trauma stress (STS), current psychological symptoms and perception regarding quality of life as well as comparing groups of women whose husbands suffer from PTSP (KS1, N=50), women whose husbands have no PTSP (KS2, N=50) and women whose husbands did not participate in Croatian Independence War (US, N=50). Also, the aim was to find out the connection between STS symptoms, psychological symptoms and perception about quality of life. The research was conducted in the Center for psychotrauma Rijeka where structured interviews were held with all participants, and these interview provided the socio-demographic data. All participants filled in short questionnaires - a brief inventory of symptoms and a MANSA questionnaire for estimating quality of life. A modified questionnaaire for indirect trauma was filled only by wives of war veterans. Results showed that 36% of the wives of war veterans who suffer of PTSP fulfill criteria for secondary trauma stress disorder. Participants from KS1 group showed a significant lyhigh level of STS symptoms of all symptoms of emotional functioning that were researched and a significantly lower perception of life quality related to other participants from groups KS1 and US. The results of connection researches showed that wives of veterans that have higher levels of STS symptoms also have higher levels of all psychological symptoms and a lower perception regarding quality of life. Clinics who deal with psychotrauma should have in mind that living with traumatized war veterans can lead to secondary stress reactions in their wives. Systematic psyho-terapy approach in work with veterans of Croatian Independence War could not only prevent symptoms of secondary trauma stress, but improve functioning of first-trauma victim and functioning in partnership. 1 Cathedra for psychiatry and psychological medicine, Medical University in Rijeka 2 Psychology department, University of philosophy in Zagreb
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www.mheconference2012.com Posttraumatic stress disorder: Myths and Reality Miro Jakovljevic, University Department of Psychiatry, University Hospital Centre Zagreb, Croatia PTSD has probably been with us for thousands of years, but it was not until several decades ago described as the nosological entity (DSM-III, APA 1980). After the wars in former Yugoslavia, PTSD from the Cinderella diagnosis became the most popular and beneficial diagnosis in Croatia raising a lot of important questions. The fact that PTSD is included in DSM-IV-TR and ICD-10 with clearly defined diagnostic criteria may lull us easily into false perception that everything is clear with PTSD as a specific psychopathological and diagnostic entity. PTSD is recognized as normal reaction to abnormal situation, reactive transient mental disorder, adjustment mental disorder, resilience disorder, stress (life-events) induced mental disorder, traumatic stress induced mental disorder, Big Gate into various psychiatric disorders, secondary gain related mental disorder and factitious disorder. According to fervent critics, PTSD is not a true medical diagnosis rather it is best seen as a medicolegal, benefit-linked criterion as well as a political diagnosis. For some authors it is a bureaucratic hurdle for a claimant to surmount, not a medical diagnosis with implications for treatment and cure. Its use does more harm than good and there are no useful treatment implications. It is liable to lead to needless chronicity and worry. Psychotrauma is one of the key concepts in the psychopathology and etiology of mental disorders in general and it is not related only to the etiology of PTSD which is by definition a consequence of traumatic stressful life events. The current construct of PTSD is reviewed from the standpoint of the next seven questions: 1. Is there any specific neurobiological aberration in patients with PTSD? 2. Is there any specific theoretic model explaining PTSD not applicable for any other diagnostic entity in psychiatry? 3. Is there any drug treatment to be specific for patients with PTSD? 4. Does PTSD exist without comorbidity? 5. Is there any of the so called functional mental disorders without significant role of psychotrauma in cumulative lifetime history? 6. May dissociation, hyperarousal, avoidance behaviour and trauma experience repetition have defense and adaptive meaning? 7. Is „two“ or “multiple hits model“ universal model in psychiatry and not exclusively reserved for schizophrenia? Reading the literature we are confronted with three issues, one explicit, about the „facts“, and the other implicit, about the „false facts“ and the third epistemological about the „metafacts“ of PTSD. Biopsychosocial, transgenerational, cultural, and political processes should be in mind to understand essential aspects of the overall construct of PTSD.
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www.mheconference2012.com War and Post-war Psychotraumatology Prof. Em. Stijn Jannes, Professor of Psychiatry Gent University Belgium, MHE Senior Policy Adviser In war people are confronted with a terrible amount of psychotrauma. Sudden death of people we love. Loss of the integrity of the body, of possessions we cherish, of traditions and historicity. We face occupation and persecution, often with torture, mutilation and rape. There is betrayal, deception, discord, hatred and suspicion even in the own community, family, friends. Also the offenders (soldiers) are confronted with severe traumas. They kill and torture so-called ‘enemies’, innocent people in so called collateral damage and sometimes even on ‘befehl’, and against their own principles and values. They lose comrades (killed or severely wounded). They are wounded and invalidated themselves. The psychological changes are always impressive and sometimes definitive. Anxiety and fear, anger, suspicion, disillusionment, dissociation,. normal reactions in order to survive but problematic when they disturb good functioning, relations, trust, love…More overt are irritability and overacting, sleep disorders, disorders in sexuality, Burnout, Hyper Esthetic Emotional Syndrome, mood changes, character changes (disinhibition, become dull, recklesness, bigotry, introversion and withdrawal, theatricality, etc.), drug abuse (medication, soft drugs, hard drugs). Severe disorders can occur, Post-traumatic stress disorder, Acute traumatic stress disorder, Severe depression, Psychosis, Amnesia. Care and cure are of great importance and necessary. It must be done with respect, humane concern, availability, accessibility and appropriate and specific therapy. There is a special need of an attitude that is warm, open, without any condemnation or even judgment. To be attentive to reactivation or prickling of psychotraumatic memories and circumstances is important and active listening and cautious coaching is required. The personality and sometimes the gender of the therapist is of crucial importance, not his therapeutic school .Re-enacting is not always evidence based, it can be harmful, the patient will indicate his/her needs. Focusing alone on the traumatic events is not good, we must also approach the despair, the disillusion, anger, revenge feelings, loss of interest and belief. Let the patient lead you in the topics he/she wants to speak about. Be always aware of the broader context so you can bring this into the therapy, when the alliance is strong and the urge to bring their history and feelings not prevailing any more. There must be also a strong coaching of family and environment. Learn them to see, understand and accept these changes, problems and disorders. Help actively in reintegration. Learn them to avoid all forms of stigmatisation, condemnation, expulsion. In case of rape: combat judgment, dispise, hidden and overt discrimination and expulsion. Society and politicians must be urged to make a top priority of better understanding, combating stigmatisation, setting up reintegration programs, creating specific and sufficiently equipped services or teams to deal with these problems. They must target on the most vulnerable: women and children, because they are mostly the most exposed to torture, rape, mutilation in the war itself, and of stigmatisation, repulsion and disintegration by their own societies afterword. 20
From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com Psychosocial consequences of traumatic experiences Care for people with PTSD and mental disabilities in post-war countries Goran Dodic To talk about care for people with PTSD and mental disabilities in the post-war countries is not entirely justified because every country has its own organizational, worldview and even professional specificities when we talk about this issue so we cannot take just one country to be an example of other countries. But the issue can be seen from several main aspects: 1. Specificity of the country where we look at this issue 2. Globalization civilization trends when we look at this issue 3. Specificity of the PTSD and preparedness of the Croatian health system on this issue Ad 1. When we look at this issue, we must bear in mind the fact on which population are we talking about, whether on members of regular military units – trained individuals and organizational structures that can cope with the war operations and even the war traumas or are we talking about self-organizing individuals who have found themselves in the war. Furthermore, are we talking about civil victims of war traumas or people with disabilities with resolved or unsolved social professional status. To adapt complete civil system to that issue is not simple or easy task. When we also add to that issue the financial problem of the specific countries with dealing with this issue than we can see all the problems regarding the latter. Ad 2. With all the problems of medical organization which are not small, question of globalization value systems that are affecting the mentioned issues is being asked. All post-war countries, including Croatia, are becoming every day more and more the part of that value system where, unfortunately, health is being placed on the market category. Ad 3. Even theoretically known, psychiatry entity PTSP has surprised the Croatian health system in two ways – therapeutically and with its mass. With enthusiasm of the health workers and self organized patients we cope with the issues pretty well, but evidently we are in situation where numerous and almost permanent re-traumatisations are making issue more complicated. Therefore, it is necessary to do a re-conceptualization of the treatment and care of disorders created by the war traumas.
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www.mheconference2012.com Hidden pathways of totalitarian irrationality in transitional societies Robert Oravecz MD, PHD The fall of the Nazi regime at the end of the W.W.II was also the end of the wellknown “rebellion against civilization�, the totalitarian and irrational political ideology of fascism. In an attempt, to conceptualize the developmental process of extreme political irrationality, many psychological theories were developed. A critical insight would be made on the relevance of those theoretical concepts, regarding the contemporary appearance of political irrationality, totalitarism and exclusionism. As it becomes even clearer, that irrational ideologies could appear everywhere, at any time, almost unpredictably. Irrational and exclusive ideologies are very often observable as overwhelming social principles, not just at the level of global society, but even in the settings of large groups. Shame, humiliation and the consequent negative self-narratives play important role in understanding the development of totalitarian irrationality. The contemporary transitional processes in Central - Europe generate some kind of uncertainty (incoherence) of meanings, regarding social discourse. And the uncertainty of situation - determined meanings is strongly connected to the fragmentation of narratively built individual or collective identity. The author intends to present a political event, which happened a few years ago in a supposedly well consolidated transitional society, as it appeared in the media. According to the media transferred narratives, it seems possible to track the most important elements of rising political irrationality.
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From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com Psychosocial consequences of sexual abuse in early childhood Milena Srpak, Psy.D., Specialist Clinical Psychologist, Psychotherapist I am going to present a case of a patient who was hospitalized many times from the age of twenty-three until the beginning of her psychotherapeutic treatment for different diagnoses, ranging from anxious depression and depressive neurosis to paranoid schizophrenia, post-schizophrenic depression, etc. Before that she had gone through the periods of wandering with distorted perceptions of reality, with visual and auditory hallucinations and several suicide attempts. Before she started analytic psychotherapy session with me once a week to release individual development she had changed her psychiatrist and switched from classical to atypical anti-psychotics. From the beginning of her condition and the first hospitalization she left school, found a job far below her abilities, lost her friends, and had many inappropriate sexual relationships. She was in psychotherapy for five years and went through different phases, starting from an utter inability to trust and to bond with other people due to separation issue. Her defense mechanisms were weak (projection and projective identification), and after a period of strong psychological ambivalence she was slowly capable of starting to build a relationship which has helped her to confront her childhood trauma. That was a starting point for her to start growing up.
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www.mheconference2012.com Consequences of sexual abuse Leonida Zalokar, psychotherapist, Ljubljana, Slovenia We are presenting the children and adolescents with many different disorders, treated in the Residential Institutional Treatment Planina (Slovenia). This summary demonstrates the purposes and admission criteria for accepting the children and adolescents in this institution, focusing on the sexually abused. The Residential Treatment Institution provides social services in the field of education and upbringing for minors and youth with behavioural and emotional disorders, mild mental development issues, combined disorders, pre-psychotic conditions, initial stages of mental illnesses, addictions, consequences of different kinds of abuse, self-harm behaviour, suicidal behaviour, psychosomatic disorders and organic disorders. The basic legal grounds for children and youth’s admission, are either a legally binding decision issued by a Social Work Centre, or a legally binding corrective measure issued by a court of law. When researching files of the admitted children and adolescents, we found many indicators of sexual abuse. This was the reason for a more profound study of the consequences that affect sexually abused children. The definition of ‘’child sexual abuse’’ includes and describes various and extensive acts of sexual abuse. In general sexual abuse can be defined as any involuntary sexual contact. Apart from that, the term ‘’child sexual abuse’’ also includes all kinds of noncontact abuse such as solicitations, exhibitions, harassments over world wide web etc. We have observed that our children have different perceptions of sexual abuse. Theory confirms, that the age and gender of the abused child, the gender of the sexual abuser and the relationship he/she had with the child, the duration of sexual abuse, the presence of violence and/or threats, and the fact if the child told someone about the abuse, determine the severity of child’s perception of the consequences. We conducted a study in our institution, regarding the children with suspected history of sexual abuse. In most cases the perpetrators were found to be family members. These children were exposed to watching pornographic material, witnessing sexual intercourse and/or striptease performances, or were themselves victims of incest, sexual intercourse with the perpetrator and rape. In some cases the victims that were sexually abused as children, have become perpetrators themselves. They also showed signs of self-harm behaviour, aggression, depression etc. It is quite concerning that only 3 out of 14 such cases ended up in court. In only 5 out of 14 cases a sexual abuse was mentioned in the documents that we received prior to acception of the child in our residential institution. Therefore, it is very difficult to determine if the source of the difficulties, disabilities and disorders lies only in the sexual abuse and/or in other factors. 24
From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com Contextualising childhood sexual abuse – work of ‘Wildwasser ‘Berlin Martina Hävernick, Wildwasser Selbsthilfe & Beratung, Berlin, Germany Back in 1982 two women who experienced sexual abuse in their childhood have founded the first German self-help group concerned with this topic. The NGO Wildwasser which today comprises 39 projects in 30 German cities evolved from that group. Eight of those projects operate in Berlin, where Wildwasser has started. Most of them are targeted at young girls and include both sheltered accommodation and counseling places. This presentation will outline the basic values and principles of the only project of Wildwasser Berlin, which works with adult women who have experienced sexual abuse in childhood. In the course of the last 30 years this project has developed and established a unique approach, known as ‘betroffenenkontrollierter Ansatz’ (bkA) which translates as survivor-controlled approach. This approach is characterized by three fundamental principles: - The experience of violence is never perceived as an individual problem only. Wildwasser addresses the psychosocial, economic and political circumstances in advancing its concept and the daily work. This means always bringing all the different aspects of child sexual abuse in relation to the wider society. Otherwise it is not possible to influence the political and social development. - All counselors have experienced sexual abuse in their own childhood. They have reflected this experience and its consequences in many different ways. The knowledge they gained from that process is an additional value and a vital qualification, which they bring into the counseling work. - Gaining back self-determination and control over one’s own life are the most important goals when working with experiences of violence and in particularly with sexual abuse in childhood. Central to this process is the creation of a safe environment, in which every woman is able to find her own definition of what was done to her, understand the consequences and also find out her strengths and capabilities. Wildwasser doesn’t focus on pathology and doesn’t find the psychiatric diagnoses or any other classification system helpful. The client determines and controls the counseling process and decides what and how much she wants to share as well as what kind of support she needs. Yearly about 500 women are seeking support from Wildwasser Berlin. Some of them later join the project as volunteers or workers. From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com Parents with post-war trauma and the consequences on the mental health and development of their children Parental involvement in the war in Croatia 1991-1995 and psychopathology in Croatian adolescents - Is there any connection? Tomislav Franic1
Aim - To investigate the association between parental war involvement and different indicators of psychosocial distress in a community sample of early adolescents ten years after the war in Croatia 1991-1995.
Methods - A total of 695adolescents were screened with a self-report questionnaire assessing parental war involvement, sociodemographic characteristics, and alcohol and drug consumption. Personality traits were assessed with the Junior Eysenck Personality Questionnaire; depressive symptoms with the Children’s Depression Inventory (CDI); and unintentional injuries, physical fighting, and bullying with questions from the World Health Organization survey Health Behavior in School-aged Children. Suicidal ideation was assessed with three dichotomous items. Suicidal attempts were assessed with one dichotomous item. Results - Out of 348 boys and 347 girls who were included in the analysis, 57.7% had at least one veteran parent. Male children of war participants had higher rates of unintentional injuries and more frequent affirmative responses across the full suicidal spectrum). In boys, thoughts about suicide and unintentional injuries were associated with parental war involvement even after logistic regression. However, girls were less likely to be affected by parental war involvement, and only exhibited signs of psychopathology on the CDI total score. Conclusion Parental war involvement was associated with negative psychosocial sequels for male children. This relationship is possibly mediated by some kind of identification or secondary traumatization. Suicidality and unintentional injuries are nonspecific markers for a broad range of psychosocial distresses; which is why the suggested target group for preventive intervention are veteran parents as vectors of this distress. 1 University of Split School of Medicine, University Hospital Split, Department of Psychiatry, Split, Croatia 26
From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com Are there missing variables in child abuse and parenting research in Croatia? Eva Andjela Delale, University of Zagreb, Faculty of law, Department of social work The general consensus now is that parental behavior is shaped by multiple influences, including the parents’ individual characteristics and resources, the characteristics of the child and contextual sources of both stress and support. Having in mind reciprocal relationships of parents and children and that they are shaping each other, one could assume parent’s war experiences are embodied into their children’s life in many ways. There is a large body of research in Croatia related to different aspects of parenting recently. In the narrow sense they are related to parenting practices and different aspects of parenting from early childhood to adolescence, focusing also on the use of violence and corporal punishment against children. Huge epidemiological study aiming at mapping child abuse and neglect in the general population of 11 to16 year old children in the Balkan countries was conducted recently. In broader sense, some researches were focused on societal changes, aiming at parental attitudes toward changes within Croatian educational process and on the role of parental involvement in schools in post-conflict communities. An article in 2011 aiming to determine the risks for child physical abuse of their children resulted with conclusion that parents with mixed anxiety and depressive disorder and posttraumatic stress disorder (PTSD) due to war trauma, exhibit high risk of child abuse. Authors emphasized that although international research demonstrated that psychiatric disorders were an important risk factor for child maltreatment, no research focusing on this topic has been carried out in Croatia so far. Even though Croatia and its citizens went through war experiences in 1990’s and in spite of large body of research on post-war social reconstruction process, it looks like PTSD is rarely included in research as a predictor of risk factor for parental practices or child abuse. Lack of variables related to parental PTSD or family exposure to war trauma in researches relating to parenting and mental health and development of their children in Croatia will be discussed. From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com Trauma in childhood – risks for the child’s development Katharina Purtscher MD, Landesnervenklinik Sigmund Freud, Dept. Child and Adolescent Psychiatry, Graz, Austria Studies of early childhood traumatic experiences have clearly established a causal relationship between the experience of childhood psychic trauma and long-term effects on cognitive emotional und social development. Children exposed to chronic trauma can have difficulty regulating their emotions as well as difficulty knowing and describing their feelings. Symptom formation and psychopathology up to long-term effects on personality development result in high numbers of emotional disorders like depression, anxiety and phobic disorders and co-morbid conditions like alcohol and drug abuse and antisocial behaviour. More intermediate-term consequences of childhood trauma are likely to reside in higher rates of risk for the development of conduct disorders, higher rates of teenage pregnancy, school droop out, and involvement with the juvenile court jurisdiction because of law violations. Multiple researchers showed that the diagnosis of PTSD is not able to sufficiently meet the symptoms of children and adolescents who are victims of chronic trauma. Especially when the caregivers are traumatised and adults and children are no longer able to life in safe environments multiple symptoms and disorders can occur. Because of no other diagnostic options at the moment children and adolescents are diagnosed with a variety of co-morbidities such as ADHD, contact disorder, anxiety disorder, attachment disorder and separation anxiety. Children with complex trauma-related symptoms frequently receive different diagnosis and different therapeutic interventions. Exposure to chronic traumatic stress frequently can lead to developmental disorders. Early psychosocial interventions and trauma specific therapy along the developmental needs of children and adolescents and the opportunity for appropriate interventions to the specific needs of traumatised children in school and everyday life are necessary at any point in time. Psycho-social interventions have first to meet the basic needs of children and their families such as being able to sleep, meeting other children and peers, attending school, enjoying leisure time and support the future age-appropriate development. Children with severe disturbances, psychopathology and disorders need therapeutic interventions like psycho-social support and specific trauma focused therapy for their further development. To meet a child’s psycho-social needs in daily life after traumatic experiences different times of support and therapy are needed. These involve parents, teachers, social workers and therapists as well. Clearly structured cooperation and collaboration between care-givers and mental health professionals are needed. Mental health professionals should be advisors for educators and all people concerned with the well being of children. 28
From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com Intercultural understanding and cooperation Introduction Hans Gullestrup, Professor Emeritus in Social and Economic Planning, Aalborg University, Denmark People have always met other people, and in more recent times most of us are probably meeting more new people than was the case in former times. We meet them as individuals, or in major or minor groups. We meet them at various places of work, and in connection with different spare-time activities, and we meet them when travelling to other countries, and when people from other countries travel to our country. Some of these people are easy “to understand” and easy to “associate with”, while others are more difficult “to associate with”. The former are often so because they basically “resemble ourselves”, and the latter are usually so because they think and act in “a peculiar way”. At any rate, “peculiar” compared to what we expect and are used to, and different compared to what we believe is the normal manner of thinking and behaving. And yet both parties believe that they think and act quite naturally because is this not how all ordinary and decent people think and act? What can be ascertained is that, at different points in time, and in different contexts, small or big units of people will perceive reality and act in their surroundings with a large degree of uniformity - both when they are with their own kind of people and with people from other units - than they will with people who belongs to other units at a given point in time and in a given context. The behavior and feeling of all human beings is - therefore - basically the result of the cultural foundation of the individual in question as well as of his or here experienced environment. As the perceiving and experiencing of the “reality” - of “the real world” -is allways based on each own culture, the capability of understanding others as well as ones own culture and cultural foundation become very important. In this talk there will be focused on a way of understanding culture more generally as well as on ways of improving our capacity in intercultural understanding with focus on the Mental health and well-
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www.mheconference2012.com being. There will be precented a theoretical/abstract model for cultural understanding, illustrated with examples from the “real world”. Both the theoretical/ abstract model as well as a more emperical model for the analyses of intercultural understanding and co-action is more deeply precented and discussed in the book: Hans Gullestrup: “Cultural Analysis - towards crosscultural understanding”, Aalborg University Press and Copenhagen Business School Press, Aalborg and Copenhagen 2006. Community psychiatry development in Slovenia Vesna Švab, Marijana Janet, Evgen Janet, University of Ljubljana Slovenian psychiatry is predominantly hospital based. The wide network of outpatient psychiatric clinics was at least partially dissolved with privatization taking place from the 1990s and partially resolved with ambulatory care with little psychiatry network planning. At the same time non-govermental rehabilitation services were developed in all parts of Slovenia. Only in 2012 the Minister of Heath approved finances for development of community psychiatric teams in several, most deprived regions regarding service provision and with low mental health indicators. 15 community psychiatric teams are to be placed all over Slovenia until 2015. This plan is described in a National Community Mental Health Action Plan which will be presented and justified in this presentation. Mental Health Needs research and evaluation of this process are to be discussed. I Intercultural aspects of mental health Rita Donabauer/Erwin Kargl/Michaela Kéita-Kornfehl, Pro mente Upper Austria The arrangement of living together in an ethnically, culturally and religiously more and more differentiated society requires new kinds and ways of access to counselling and care services. In future, the potential users of mental health care will more and more become people with other cultural backgrounds, different lifestyles, religions and philosophical convictions. Therefore, the intercultural opening of mental health services and the acquiring of intercultural competence of the staff is an important and necessary 30
From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com step in the integration process of migrants and a social challenge. Intercultural opening – the response to a growing need Migrants are usually regarded as vulnerable population groups exposed to particular stresses and characterized by poorer health care. Due to their migration experiences they have acquired also a variety of resources and skills. There are burdens that can be attributed to the fact of migration: loss of family relationships and loss of social status, isolation, stress, adaptation and identity problems. Refugees and asylum seekers are often traumatized by war, torture, persecution and their escape. Then there are stresses caused by the conditions of life in a society, that excludes and discriminates migrants: Stressful working conditions and poor housing conditions, no recognition of professional qualifications and diplomas and therefore de-skilling, furthermore discrimination and racism. Barriers to mental health care There are many barriers which restrain migrants from using mental health services: language, lack of information and knowledge, different concepts of mental health, experience of being discriminated, prejudices... Often, mental disorders, which were caused or influenced by the migration process, are confused with culture-specific behaviors. Usually there are socioeconomic factors that make people sick, not “culture”. Knowledge of the cultures of our foreign fellow citizens is helpful, but there are no “onesize-fits-all recipe”. Migrants are a heterogeneous group with diverse cultural, class-specific and migration-related backgrounds. It is not so much a new model resp. it has not been developed a special service for the mental health care of people with migrant backgrounds, but intercultural competence is to be understood as part of general social competence. We need to “engage oneself” in the world of experience of the others, flexibility and creativity, not being afraid of strangers but showing interest, appreciation and respect. Intercultural competence is not created by itself, it requires a structured analysis of your own approaches, images and ideas, your prejudices, stereotypes and cliches. From individual to collective responsibility - The social determinants of mental health. Abstracts.
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Mental Health Europe Conference 2012 From individual to collective responsibility The social determinants of mental health Co-organised by Mental Health Europe and Sto Koluri Split
Programme (as per June 5, 2012) Thursday, 14 June 2012 – Diocletian’s Palace, Split 19:00
Official opening of conference Welcome by Nace Kovac, President Mental Health Europe Maja Soco, Director of Sto Koluri Zoran Milanovic, Prime Minister Republic of Croatia, tbc Ante Sanader, Split County Council 20:00
Drink and snacks
Friday 15 June 2012 – Radisson Blue Hotel, Split 09:00
Welcome address by Mental Health Europe and Sto Koluri
Mrs. Milanka Opacic, Deputy Prime Minister and Minister of Social Welfare Policy and Youth, Croatia (tbc) Video message by EU Commissioner Laszlo Andor, Employment, Social Affairs and Equal Opportunities 09:15 Address by Dr. Antoinette Kaic-Rak, Head of WHO country Office in Croatia Address by Jürgen Scheftlein, representing EU Commissioner Dalli, Health and Consumer Protection
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From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com 10:30 Keynote speech “Social determinants of mental health in Europe” Prof. José Miguel Caldas de Almeida, Prof. of Psychiatry, Universidade Nova de Lisboa, Portugal 11:15 Discussion 11:30 Break – refreshments 12:00 State of play of the mental health field in Croatia - from the professional viewpoint: Goran Dodig, Psychiatrist, Head of Psychiatry Department at Split University Hospital - from the mental health service users’ viewpoint: Kristijan Grdjan, The Shine, Zagreb 13:00 Discussion 13:30 Lunch 14:30 Introduction to the first 4 parallel sessions 1. Meeting the basic needs of children and youth as an investment in the future – Tomislav Franic, child and adolescent psychiatrist, Clinical Hospital Split, Croatia 2. Changing the attitude of employers towards people with mental health problems - Tanya Kennedy, Workplace Director “Business in the Community”, Belfast, UK 3. Framework for the establishment of strong and supportive networks – Thor Rogan, Deputy Director General Ministry of Health and Care Services, Norway 4. The role of volunteering in the establishment of strong and supportive networks in rural and remote areas – Svetlana Varjun, Director Estonian Society for Mental Health, Tallinn 15:30
Break/refreshments
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www.mheconference2012.com 16:00
Parallel sessions
Parallel session 1 - Meeting the basic needs of children and youth as an investment in the future 1. Mental health care in SOS Village for children- Gordana Daniel, Matic Višnja, SOS village for children, Croatia 2. Technique is not enough- Fabian Davis, Lynn McDonald and Nick Axford, British Psychological Society, UK 3. OmSorg- Dealing With Bereavement- Working with Training Groups for Bereaved Children- Jes Dige and Per Bøge, Danish Cancer Society, Denmark
Parallel session 2 - Changing the attitude of employers towards people with mental health problems 1. Changing attitudes to mental health in a business environment - Paul Litchfield, Chief Medical Officer British Telecom Group plc, UK 2. Overcoming stigma and discrimination at work – what does the evidence tell us? - Bob Grove, former CEO Sainsbury Centre London, UK, MHE Senior Policy Adviser
Parallel session 3 - Framework for the establishment of strong and supportive networks 1. From state hospital to outpatient regional treatment: The process of deinstitutionalisation in Germany - Thomas Pirsig, Dachverband Gemeindepsyhiatrie 2. Putting the Community back into Community Mental health; promoting inclusion through co-produced services in an age of austerityDavid Morris, Inclusion Institute, University of Central Lancashire, UK 3. Beyond the statutory services, Associations, Services and Municipalities- The Joint Experiences and Local Mental Health Systems Project- Niccolò Cortopassi, Donatella Miccinesi and Pino Pini, Italian Association for Mental Health, Italy
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From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com Parallel session 4 - The role of volunteering in the establishment of strong and supportive networks in rural and remote areas 1. The role of volunteering in the establishment of strong and supportive networks- Bettina Arbesleitner, Pro Mente Wien, Austria 2. How local and European young volunteers may contribute to make community based mental health services accessible to severe users in rural areas - Pablo Gómez, Fundación Intras, Spain 3. The installation of a Volunteer Network for health issues in the rural region of Fokida, Central Greece - Benefits and actions- Ioanna Kallia, Society of Social Psychiatry and Mental Health, Greece 17:30 End of parallel sessions and of conference day 1 20:00 Conference dinner Saturday, 16 June 2012 – Radisson Blue Hotel, Split 09:30 Introduction to parallel workshops 1. The human rights aspects of the access to community-based mental health services – Josée Van Remoortel, MHE Senior Policy Adviser 2. Deinstitutionalisation and the UN Convention on the Rights of Persons with Disabilities – Jan Pfeiffer, Psychiatrist, member of the Council of Europe Centre for the Prevention of Torture 3. The role of the media in changing the attitude of people towards mental health issues – Jane Gabriel, Editor openDemocracy 50.50, UK 4. Round Table debate: Solidarity between generations in the mental health field – Elisabeth Muschik, MHE Senior Policy Adviser 10:15 Start of parallel sessions and Round Table debate
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www.mheconference2012.com Parallel session 5 - The human rights aspects of the access to community-based mental health services 1. The human right aspects of the access to quality community-based services- Erwin Kargl, Pro mente Upper Austria, Austria 2. Choice and control – the right to live independently and to be included in the community - Nevena Peneva Kober, European Union Agency for Fundamental Rights, Austria 3. The role of international and national monitoring bodies in protecting the rights of persons with mental disabilities- Marija Definis-Gojanovic, Goran Mijaljica and Mario Malicki, University of Split, School of medicine, Croatia
Parallel session 6 - Deinstitutionalisation and the UN Convention on the Rights of Persons with Disabilities 1. Deinstitutionalisation and the UN Convention on the Rights of Persons with Disabilities- Rita Donabauer, Pro mente Upper Austria, Austria 2. Community Psychiatry Development in Slovenia- Vesna Švab, University Ljubljana, Slovenia 3. Recovery in Scottish mental health services- Bridey Monger, Penumbra & University of Abertay, Dundee
Parallel session 7 - Role of the media in changing the attitude of people towards mental health issues 1. Telling the real story: The UK media and mental health- Alison Kerry, Mind, UK 2. Mental Health - ‘Something We All Have’- Krzysztof Bierski, Goldsmiths, University of London, UK 3. Role of the media in changing the attitude of people towards mental health issues – a perspective of the Disability Ombudsman Office, Croatia Branka Meic, public relations adviser to the Disability Ombudswoman, Croatia
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From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com 8. Round Table debate “Solidarity between the generations in the mental health field Moderator: Elisabeth Muschik Petra Cadova, Policy Officer, European Commission, DG Sanco Mario Percin, user representative, Croatia Representative of the Social Platform Marita Ruohonen, Mental Health Europe Board member; Chair of the MHE Task Force on “active ageing” 11:45 End of parallel sessions and break/refreshments 12:15 Presentation of the discussions in the parallel sessions 12:45 Draft Recommendations from the conference and from the satellite symposium 13:15 Thanks session and end of conference 13:30 Lunch 15:30-18:00
General Assembly of Mental Health Europe members
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Abstracts
Speakers - June 15 Mental health : in the mainstream Matt Muijen, Antoinette Kaic-Rak, WHO EURO, WHO CO in Croatia WHO European Regional Office is in the process of drafting a new Mental Health Action Plan. This is in response to new challenges since the Helsinki Declaration was endorsed in 2005. Since then Europe is facing challenges such as an economic crisis, but also changed expectations by service users and their families and a growing awareness of the interaction between physical and mental health. This has a range of implications for mental health interventions. The new European Action Plan firstly addresses the need to optimise the wellbeing of the population throughout the lifespan, starting at childbirth and continuing into old age. Secondly, user empowerment is at the heart of this Action Plan. It proposes that users have the right to determine their aspirations, and that services should provide treatment and support sensitive to needs, wishes and culture of users and their families. Thirdly, we need to continue deinstitutionalization, and replace large hospitals with services that are accessible, available and affordable, comprising primary care, outreach and small hospital units in general hospitals. Such units can also look after the physical needs of mental health patients and offer mental health assessments of patients with physical illnesses. Fourthly, and essentially, the treatment experience is central. Unless effective treatment and care are offered in sensitive and person centred ways, stigma of mental health and acceptability of mental health services will not improve, wherever care is provided. WHO has formed a working group to agree the Acton Plan, involving users, carers, clinicians and country representatives. A first draft has been produced, and it will be submitted to the European Regional Committee of the WHO in September 2013.
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From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com Implementing the European Pact for Mental Health and Well-being in Challenging Times Jürgen Scheftlein, representing EU Commissioner Dalli, Health and Consumer Protection In 2008 the Commission supported the launch of the European Pact for Mental Health and Well-being. The Pact brought together policymakers and stakeholders from a broad range of backgrounds. It symbolised their will to work together on mental health challenges and opportunities and to build commitment for mental health as a responsibility of society as a whole. A series of five thematic conferences was organised between 2009 and 2011, and these confirmed the high relevance which promoting mental health, preventing mental disorders and supporting people experiencing mental disorders has for the realisation of several of the EU’s policy objectives in the fields of active and healthy ageing, economic development and social inclusion. Council Conclusions under the Hungarian Presidency of June 2011 undertook a positive evaluation of the Pact implementation. Member States made important commitments, such as to make mental health and well-being priorities of their health policies, to include the prevention of mental disorders and mental health promotion into their strategies and/or action plans, and to promote, where possible and relevant, community-based, socially-inclusive treatment and care models. The Council invited the Commission and Member States to set up a Joint Action on Mental Health and Well-being under the EU-Health Programme, and the Commission to continue addressing mental health and well-being in partnership with EU health policy and other policy areas. The economic crisis which currently hits most Member States further increases the risks for mental health and well-being, and the need to protect the population, in particular vulnerable socio-economic groups, from harm. The rise in suicide rates in several Member States is a key concern. EU-projects such as “Optimizing suicide prevention programs and their implementation in Europe (OSPI)” play a key a role in informing Governmental responses.
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www.mheconference2012.com The Commission’s future priorities will be, firstly, to continue the work with Member States, in particular by successfully setting up the Joint Action on Mental Health and Well-being. Its objective will be to develop an endorsed common framework for action on mental health in the participating Member States. Secondly, the Commission will continue its work with other EU-policy areas. Joint seminars with the Directorates-General for Education and Culture and with DG Research and Innovation are under preparation. Thirdly, the Commission will continue to closely work together with international organisations, in particular the WHO and the OECD. Finally, the work on mental health and well-being will be integrated into emerging work at EU-level on chronic disorders.
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From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com Social determinants of mental health in Europe JosÊ Miguel Caldas de Almeida, Prof. of Psychiatry, Universidade Nova de Lisboa, Portugal All available literature suggests that social determinants have an important impact in individuals’ mental health. The majority of the available evidence shows that those with lower income, unemployed, underemployed, pertaining to the most disadvantaged categories, those with lower levels of education, lower SES, social class, or lower standard of living have higher prevalence of mental disorders. The current socio-economic crisis in Europe will inevitably have a significant impact on mental health of the populations in consequence of cuts in health services budgets, cuts in social services and programmes, cuts in pensions, unemployment, and social instability. In this context some important challenges have to be faced: how to include mental health among the priorities in health/social policies, prevent fragmentation and weakening of mental health system and maintain mental health care of good quality, respond to new mental health problems, and take advantage of opportunities offered by the crisis. In this presentation we will discuss the main results from the mental health surveys in European countries that can help to understand the effect of social factors, especially inequalities, on mental health of the populations. We will also discuss the challenges that will have to be faced in Europe in the near future, as well as the strategies that can be used to tackle these challenges.
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www.mheconference2012.com The situation regarding mental health in the Republic of Croatia Prof. Goran Dodig, Psychiatrist, Head of Psychiatry Department at Split University Hospital In this presentation an author expresses proper stands and understandings of the problem of mental health in Republic of Croatia completely aware of all lacks and limits of such qn approach. On the other hand, being involved in health-care system for many years now, and especially in a field of mental health and welfare for people with mental disorders and having insight to global trends related to this topic justifies this approach – an approach that does not serve to those excluding and often problematic statistic data. Institutions find mental health care problems interesting mostly and only as global problems while, when we are talking about clinics, the problem is lowered to individual levels. In this context the problem of mental health with all its stratifications in Croatia is actually following general trends related to “a man” and his Earth-fate. It is an interesting fact that we never had more talks about rights, freedoms and care for people, and on the other hand, the main goal in life of individual, society, nation and state is to promote economic progress, profits and material goods. The general trend´s characteristics in the world are unfortunately becoming fact in Croatia too. For this reason it is interesting to ask what grounds are used for prognoses of world health organization about the huge increase of depressive conditions in centuries to come, prognoses about the number of suicides and increasing number of diseases and addictions. So, it would be wrong from both – professional or ethnic point of view, to discuss the current conditions regarding mental health in Republic of Croatia without taking in consideration trends that already strongly determine and define this problem even at this moment. Social concept of psychosocial disability Kristijan Grdan, The Shine – Association for Social Affirmation of People with Psychosocial Disabilities People with psychosocial disabilities represent one of the most disadvantaged populations in Croatian society. There are more than 4.500 people with psychosocial disabilities in Croatia removed from the eyes of society by long-term institutionalization in remote residential social care homes. They represent more than 50% of people with disabilities institutionalized at all. Further, people with psychosocial disabilities usually face violations of their 42
From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com findamental human rights that are usually done by implementing „measures of protection“. Result of such protection can be statistically measured as more than 15.000 persons in Croatia are currently fully deprived of their legal capacity. The medical concept of psychosocial disabilities in Croatia has significant role when determining scope of rights of this social groups. In 2008 the Republic of Croatia ratified United Nations Convention on the Rights of Persons with Disabilities. The author shows what are necessary steps that have to be done in order to harmonize Croatian legislation and practice with the conventional standards, therefore enabling understanding the new paradigm of social conceptualization of psychosocial disability. Meeting the basic needs of children and youth as an investment in the future Tomislav Franic, child and adolescent psychiatrist, Clinical Hospital Split, Croatia There are growing neediness in the field of child and adolescent mental health. Unfortunately it seems that very often childhood it is not period of happiness and security. The reason for this might be fact that some classical psychiatric disorders are more prevalent, some are more likely to be diagnosed, some are the “products” of pharmaceuticals companies, some are product of modern society with its changes in different and broad ways. Sometimes it is escape from responsibility. But we cannot escape from it, the children are our “product” and reflection of the environment in which they are growing. The whole MHE conference is about responsibility, and child and adolescent mental health is the most important field to be responsible. This symposium will bring little light on some aspects of child mental health which are not as recognizable as bereavement or loss of adequate parenting care. Also we will see that parenting is skill which might be learned. So there is no place for irresponsibility.
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www.mheconference2012.com Managing mental health at work – why bother? Tanya Kennedy, Workplace Director “Business in the Community”, Belfast, UK The fear and reality of negative attitudes towards mental health issues at work has spiralled into a crisis currently costing UK employers £26 billion, or £1,035 per employee every year. In fact, at any one time, 1 in 6 employees is experiencing depression, anxiety or stress, and yet, mental health at work remains the elephant in the room. Pressures within workplaces are increasing and, as a result of the recession, 10% of workers saw their GP for stress and anxiety whilst 1 in 7 have started taking antidepressants. This trend appears to be continuing with people reporting that work is the most stressful thing in their lives, above money worries, marriage and relationships, or health issues and employees’ fears that stress would put them first in line for redundancy are real with 1 in 5 of those who have disclosed a mental health problem at work having been sacked or forced out of their job. It’s become a chicken and egg situation. So where does an employer even begin to make a difference? Where employers have a genuine desire to enhance performance through improved employee wellbeing and are prepared to take a long hard look at the factors that have greatest impact on people and the business, the rewards are rich. It all boils down to a water tight business case. Tanya Kennedy, Workplace Director from Business in the Community will share her experience of having worked with over 150 leading business in the UK supporting them in strengthening the business case for investment in health and wellbeing at work and delivering effective wellness strategies and interventions – with positive impact. As well as providing advice on simple steps to take to support staff improve and maintain their mental health, Business in the Community has developed strategic tools to support organisations to make clear links between employee wellbeing and business health. During this session she will share her journey with you and will discuss what works as well as outlining the reasons why so many workplace wellness schemes fail to deliver positive outcomes in the real world. 44
From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com A framework for the establishment of strong and supportive networks Thor Rogan, Deputy Director General Ministry of Health and Care Services, Norway Putting the right questions is the first step to get the right answers – and the answers should be given by the users and carers themselves. The answers are as individual as people are different. - What are my resources and possibilities? What are my wishes in life? What do I need to utilize my potentials? - What are basic needs in life – What can I cope with by myself - and what are supported needs in daily life? What are needs? (a home, a social life, participation in society, being able to pay bills, something meaningful to do, safety, someone to call upon when needed, knowing that there always is someone there, motivation, to be picked up when you are down, assistance at home, transport, etc?). Who can and should be part of a network? - Some public authority must have a clear commitment to initiate and coordinate services and support! – other public authorities may or should take part (GP, local nurse, labor market authorities, priest, mental health centre, etc) - Family, friends, NGOs, trained or not trained ex-users – (no limitations!) - a starting point may be: “Who do you want to be part of your network?” A good network should: - Be stable over time and based on agreements with all taking part – all having a common understanding on roles and approaches - Be proactive and easy accessed – not taking over, but being there when needed - Be coordinated by someone the user can count on Good services should: - Give opportunities to have wishes, preferences, information and options on treatment and actions, facilitate the user to take informed decisions in collaboration with staff – offer individual life planning From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com - Give people hope for the future, motivation and belief in own potentials - Recognize user experiences as valuable and necessary as professional knowledge – both necessary for good services, for better lives – facilitate people to (re)gain controle over life - Support user and carers/family to cope with daily life, building network - Prevent admissions to hospitals through good follow up and crisis planning - Cooperate with and support NGOs Concepts as empowerment, recovery, patient centeredness and shared decision making as well as a few examples on how users can take better control over daily life will be briefly discussed. References to WHO and EU will be made. The role of volunteering in the establishment of strong and supportive networks in rural and remote areas Svetlana Varjun, Director Estonian Society for Mental Health, Tallinn There are 2 key questions to answer for creating strong and supportive networks through volunteering: -Do people care enough to volunteer and create networks? Volunteering is not something standing apart of general mentality and development of civil society. What are the core values this society is based on? Do people believe that they can make a difference? Do they identify themselves as one local community (is there „us“ or only „me“?) Do they care enought to take any action together?! If not, you can still start the change but prepare yourself to spend lots of time, energy and funds. -Do people have resources needed to volunteer and create networks? Information as basic resource. How people get information on volunteering in local community? Limits set to networking by publik transportation, internet connections, etc. Can people get together? Is there any existing networks you can rely on? – social workers, local initiatives, key-persons. Funding of activities through EU programmes. How to bring people together in rural and remote areas and encourage them to volunteer?: campaigns, start-ups, training the leaders „to spread the spark“. Success-stories and examples. 46
From individual to collective responsibility - The social determinants of mental health. Abstracts.
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Abstracts - Parallel sessions Parallel session 1 - Meeting the basic needs of children and youth as an investment in the future Mental health care in SOS Village for children Gordana Daniel, Matic Viťnja, SOS village for children, Croatia Quality of childhood experience is of utmost importance in determining whether in later life this experience would be of help or an obstacle. Even though we know about importance of childhood, children are still being neglected, maltreated and abandoned. For SOS Children`s Village Croatia, as part of international non-governmental organization SOS Kinderdorf International, the main goal is to provide systematic and thorough aid to children which have suffered various forms of traumatic experiences in their families, also to children which have been abandoned by their parents, or whose parents were not able to take care of them. Since its establishment in Croatia, SOS Children`s Village has taken care of several hundred children through a special SOS family child care model. Our work with children is based on attachment theory framework, which states that at least one emotionally benevolent relation is needed for developing self confident and self conscious child’s identity, namely that every child needs a relationship with at least one adult who would provide psychological support and help. This theory has been endorsed by contemporary researches in neuroscience which show that our brain is not an inalterable matter, but rather our most formative organ, whose transformations are being set off by interpersonal interactions. In that way our mind can transform and develop throughout our life under the influence of emotionally involved relationship, through which a person fulfils its basic need of security and affiliation. This paper will show some cases of children who have entered SOS family child care system multiply traumatized, and who have shown borderline results on self-assessment and problem assessment scales. Today, they are young adults, more or less autonomous and responsible, who have told their perception of social and other support(s) which they were being provided during their stay in SOS Children`s Village. We can From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com conclude that in addition to family child care model, other planned and focused interventions have reduced the influence of stressful and traumatic events in their lives and have contributed to their mental heath.
Technique is not enough- Fabian Davis, Lynn McDonald and Nick Axford, British Psychological Society, UK Evidence-based parenting programmes improve child and family well-being. They are effective in RCTs. They can also fail to reach socially disadvantaged groups. We have surveyed the UNODC’s 2011 list of twenty-three programmes and collected examples of socially inclusive practice from ten respondents. This paper identifies four socially inclusive principles which if followed should make parenting programmes more socially inclusive. Parenting programmes have weaknesses. There are misunderstandings and myths about them. They should be welcomed but they form less than 5% of children’s services. Their market penetration is low. Much can be done to improve this situation. One aspect is ensuring they are socially inclusive i.e. they must reach the largest possible proportion of their target population and retain parent interest throughout and be effective in diverse cultures so they become part of the local community and integrate into “services as usual”. We highlight socially inclusive practices to address these issues. The fundamental challenge is engaging and retaining families. Too often we consider some families ‘hard to reach’. The real problem is services are ‘hard to access’. The good thing however about this kind of work is that it is exactly what practitioners tell policy makers they want to do so there is hope for progress. Our examples show how working on parenting programmes is relational, radical and creative because it involves face-to-face work with families, because it can help even the most marginalized families access service entitlements, and creative because it demands innovation and culturally sensitive community outreach. Model fidelity with appropriate cultural adaptation is also a challenge. Programmes’ effective ingredients must be properly delivered and be culturally adapted to ensure buy-in from practitioners, maximise parent uptake and learning and create long-term social support for positive parenting in local communities. Adaptations, planned and undertaken by local parents 48
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www.mheconference2012.com in co-production teams, in consultation with programme developers, can ensure programme/community “fit”. This provides scope for creativity and embedding positive parenting in local social networks through developing social capital. Finally if programmes are to reach the largest possible proportion of their target population they must be scaled-up. Much can be learned from system reforms and programmes that have been taken to scale (e.g. Sure Start). We also address ways of making programmes ‘system ready’, i.e. adapting content and how they are introduced so they can be readily implemented in service systems as “services as usual” and thus be sustained long-term. OmSorg- Dealing With Bereavement- Working with Training Groups for Bereaved Children Jes Dige and Per Bøge, Danish Cancer Society, Denmark The Bare Facts Every year more than 2,500 Danish children under the age of 18 experience the loss of a parent by death. Another 42,000 children experience that their mum or dad is acute hospitalized with a severe illness. The Effort For more than 18 years the project OmSorg (Dealing with Bereavement) has been a nationwide practical founded school and kindergarten based intervention towards children (age: 0 - 18) in loss and grief. The aim is to secure responsible adult help to grieving children – no matter the course of the grief. The main effort has been to inspire and support teachers and kindergarten staff in attending these difficult matters. This is done by offering educational materials, giving lectures, consultation and courses, establishing training groups for bereaved children, working with the media and by political lobbyism. Action Plans One of the basic conditions in working with children in loss and grief is that the teachers share a common approach on what their basic responsibilities are. Therefore one of the main tasks has been (and still is) to encourage the teachers in establishing Action Plans for their meeting with children in loss and grief. From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com During the 14 years Action Plan intervention so far, we are happy to learn that the schools have realised the necessity and benefit from establishing these plans. And further more that the kindergartens now follow the same positive trend. An annual randomised survey among all Danish Public Schools (since 1997) and Kindergartens (since 2003) shows the development on the following issue: “Do you have a written down Action Plan on how to comply with children in loss and grief?” Schools Kindergartens 1997: 4% 2003: 23% 2012: 96% 2012: 82% “Speech is Golden” In our opinion, the basic condition when working with children in loss and grief is that the responsible adult person involved in the child’s unbearable situation makes space for the child to be heard, seen and understood. The key to this work is to denounce the part of our upbringing that taught us that silence is golden. Grief is not an illness, but on the contrary a very tough condition of life. If we realise that SPEECH is golden, we can help the child continue life in spite of the wounds in the soul that a big grief causes.
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From individual to collective responsibility - The social determinants of mental health. Abstracts.
www.mheconference2012.com Parallel session 2 - Changing the attitude of employers towards people with mental health problems Changing attitudes to mental health in a business environment Paul Litchfield, Chief Medical Officer British Telecom Group plc, UK Mental illness has been associated with social stigma since ancient times. Attitudes have changed with the development of modern psychiatry but there is a widespread residual fear of illnesses that cannot be seen and which remain poorly understood by most. Employers are ordinary people who share the attitudes and the prejudices of the society in which they live. Managing risk is a core element of business and many employers fear that people with mental health problems will “cause trouble�. The relapsing and remitting nature of many conditions, the unpredictability of the effects together with the impact that behaviours can have on colleagues and customersall contribute to a reluctance by many employers to take on people with mental illness. Changing attitudes in the workplace is a journey for which the starting point varies. Changes in disability discrimination law to encompass mental health can provide a helpful backdrop but legislation, of itself, rarely changes attitudes even if behaviours are modified. Work can be beneficial for mental health but it can also cause harm in some circumstances and employers need to control workplace risks. The high prevalence of mental health problems in society, with at least 1 in 4 people being affected, brings the issue onto the business agenda in its own right. Employers therefore need also toconsider how best to deal with people who develop mental health problems with no occupational cause; failure to do so is business negligence. Enlightened companies see that controlling the costs of illness is only part of the story. Promoting wellbeingin the workplace improves engagement of the workforce and stimulates productivity. Education is the key to delivering change once the business case has been made. Managers and colleagues need to be better informed about what constitutes a mental health problem, why it might develop and what can be done in the workplace to avoid or mitigate harm. The standard public health approach of primary prevention, early intervention and effective rehabilitation provides a good model for company mental health programmes. Normalising mental health and removing the fear associated with it changes the work environment and leads to more civilised behaviours that benefit not just people experiencing mental illness but all around them. From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com Overcoming stigma and discrimination at work – what does the evidence tell us? Bob Grove, former CEO Sainsbury Centre London, UK, MHE Senior Policy Adviser Although there are signs of improvement in the UK, stigma and discrimination against people with mental health problems in the workplace is still rife and very many who would like to work remain unemployed. Surveys of mental health service users show that many have experienced high levels of discrimination in trying to get work or seek promotion and that many more have avoided putting themselves forward because of anticipated discrimination. When in work many do not disclose their mental health history for fear of negative consequences, but in doing so deny themselves the opportunity of getting support or workplace adjustments. There are no quick or easy solutions to these problems but in recent years evidence has been accumulating about how to bring about change in attitudes and behaviour - at national level, at organisational level and in day to day interactions between employees, their managers and their colleagues. Anti-discrimination campaigns involving people who are prepared to talk about their own illnesses do work. Many big employers have begun to see the business advantages and cost savings that can accrue from relatively simple measures to promote mental health and manage mental distress. Training line managers to talk to people in distress really helps. Systemic changes to the ways GPs work and are trained can bring about better and more work-focused mental healthcare. Individual Placement and Support Schemes are much the most successful way of enabling people with severe mental health problems to get and keep paid employment. The challenge of the next decade is to continue to do the right, evidence-based things when distracted by extreme economic difficulties.
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www.mheconference2012.com Parallel session 3 - Framework for the establishment of strong and supportive networks From state hospital to outpatient regional treatment: The process of deinstitutionalisation in Germany Thomas Pirsig, Dachverband Gemeindepsyhiatrie New outpatient treatment models for people with mental health problems. Integrated Healthcare Department of the Association of Community Psychiatry Since the psychiatry Enquete of 1975 all of the large psychiatric hospitals were closed but a similarly large number of regional clinics and inpatient facilities was established, for example homes. In the past 3 decades, many outpatient offerings were established. There are possibilities of reintegration and they only take effect if the person is “significantly disabled�. Possibilities for out-patient treatment for people with mental health problems are still very few in Germany. Every psychiatrist has to treat 800 to 1,000 people. The time for the patient is too little. When people are discharged from hospital after treatment, they often fall into nothing - there are no offers. For more than three years now new models are being tested in Germany: especially integrated care, which is a network model funded by the health insurance. The motives of the health insurance companies are: 1. permanent increase in mental illness and 2. frequent hospitalizations = revolving door patients = chronic = increasing costs. - In 2008 the Association of community psychiatry (Dachverband Gemeindepsychiatrie) started to develop reference contracts with health insurance. Since 2009 these agreements are implemented by 25 member organizations in nine regions. - Basis of the offer is a 24 hour availability on 365 days a year. It is primarily an outpatient aid. Patients are visited in their usual environment. The methods are evidence based. The instruments are: Home Treatment, need adapted treatment, social therapy and outpatient psychiatric care. The teams are multi-professional and therapeutic. Psychiatry experienced persons are part of the team. The initial results are positive: the hospitals visits are less often, the people are satisfied and the inclusion works better. In the future this form of treatment can be established in other European countries. The methods are of European origin: From Finland, UK and many others. It’s time to give back. From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com Putting The Community back into Community Mental Health; promoting inclusion through co-produced services in an age of austerity. Prof David Morris, Inclusion Institute, University of Central Lancashire, London, UK Recent UK policy on inclusion for people with mental health problems identified community participation and strong social networks as being key to challenging the everyday exclusion faced by people with mental health problems at community level. UK policy on localism such as that known as ‘Big Society’ aims to encourage the empowerment of communities and the better promotion and deployment of local community capital. At the same time, despite the advent in mental health services of a range of new community teams, there has been little engagement by the staff of those services with communities themselves as potential partners in service design and delivery. With responsibility for implementing the actions set out in the report of the report of the cross-government Social Exclusion Unit, the National Social Inclusion Programme (2005-9) worked with a range of organizations to link the aims of inclusion policy with those of community engagement in order to establish effective community level practice for inclusion in which communities themselves are involved; work that is continuing at the Inclusion Institute. The presentation will look at the implications of this work for models of community mental health services based on co-production. It will discuss this work with reference to the Institute’s current joint programme with the Royal Society of Arts: ‘Connected Communities’, which is looking in seven sites, over five years at social network interventions that promote inclusion and reduced demand for public services. An age of austerity in which State services are under significant threat creates an additional urgency for service approaches that help to create and draw on effective social networks. Transforming services to embed these approaches is a challenge that will be met only by rethinking the way professional staff engage with communities and by developing the local leadership of health and social care agencies to enable it to become embedded in the day to day work of these services. This presentation will discuss the challenge and drawing on extensive UK experience, offer a practical perspective on how this challenge can be met in a European context.
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www.mheconference2012.com Beyond the statutory services, Associations, Services and MunicipalitiesThe Joint Experiences and Local Mental Health Systems Project Niccolò Cortopassi, Donatella Miccinesi and Pino Pini, Italian Association for Mental Health, Italy With the development of community based mental health services in several parts of Europe over the last 20 years, considerable work has taken place to develop good partnership working between services, local governments and associations. This joint working has been accompanied by changes in structure and processes at all levels, with the aim of improving both the care available for people with mental health problems and the attitudes of general public. To date, less importance has been given to joint working with the intermediary organizations, primarily users and carers associations, that also work with service users to provide support and facilitate social inclusion. The term ‘intermediate area’ refers to the realm of mental health and wellbeing activities outside the statutory mental health services. It is the interface between the service and the local community, where most of the joint experiences or interactions between different service providers and community agencies are located. The development of joint working between the statutory agencies is no longer enough: the whole system requires re-engineering and re-adaptation from the perspective of service users and carers. It is therefore important to identify the elements of the intermediate area in order that the mental health system as a whole will become more effective and more responsive to the needs of the local service users, their families and the community at large. The evolution of the project Joint Experiences and Local Mental Health Systems along of a period of more than twenty years will be presented. Some recent suggestions, raising from the current edition of the project linking three site internationally, will be stressed. The main suggestion is that the Intermediate Area of the Joint Experiences needs to be really independent both from services and from the local governments. It will be useful to establish formally the intermediate area as a new organisation defining in the same time the relationships with the local governments on one side and with the services on the other side. This can allow better interactions within the whole local mental health system and better development of all the subjects involved. We think that the Joint Experiences and Local Mental Health Systems project is developing like a new model with significant differences with the psychosocial model where services, having too many responsibilities for all mental health issues, risk to be too dominant and to create dependency and passivity. From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com Parallel session 4 - The role of volunteering in the establishment of strong and supportive networks in rural and remote areas The role of volunteering in the establishment of strong and supportive networks Bettina Arbesleitner, Pro Mente Wien, Austria, Leader of „Social companionship“ „Social companionship“ ist one of the main services of pro mente Vienna which was founded in 1965 by Raoul Schindler – it was the first service offered and there is still a high need for this special support. Today pro mente Vienna has a staff of about 60 people, has several departments and cares on the whole for 1688 people with mental health problems. This social association consults, accompanies and helps people with psychiatric diseases, psychological and social problems to find their autonomy and quality of life again. Before, during and after a stay at the psychiatry mental health service users are helped with integration to social life. „Social companionship“ means that people suffering from mental deseases are accompanied by social companions who carry out their work exclusively on a voluntary basis. Companionship means personal contact once or twice a week for a period of between one and three hours each time. The length of companionship varies but should last approximately one year, on average it keeps up from 4 to 5 years. The main aim is to establish a relationship which includes participation in social life and organizing their daily structure. During the contact periods, the companion joins in with leisure activities as well as helping with the everyday life of the accompanied people but the time spent is always tailored to the requirements of the individual. To promote a viable relationship based on confidence reliable and periodic meetings are necessary. Accompaning these people to shops, public authorities, physicians, organisations, special group offers or events facilitates the dealing with social phobia, anxieties or other forms of mental deseases. Companions also help organizing the daily structure based on the interests of the person accompanied. Sometimes social companions can also mediate between the person with mental health problems and „lost“ friends or family members because of the isolated way of life.
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www.mheconference2012.com The aim is the improvement in the quality of the accompanied people‘s lifes by improving and increasing the social networks as well as the improvement of self-efficacy. To work as a volunteer in the „social companionship“ it is obligatory to attend an introductory course in „basics of socio-psychiatric work“ and to take part in supervisory and team work during their companionship time. Social companions have a point of contact at pro mente Vienna to receive professional support whenever it is needed. The aim is to provide high-quality voluntary social companionship to the mental health service users. This service doesn’t replace professional services but is a unique additional supply because there is no dependence within the relationship between the person accompanied and the social companion – this enables greater openness and confidence! How local and European young volunteers may contribute to make community based mental health services accessible to severe users in rural areas Pablo Gómez, Fundación Intras, Spain High rural character European regions, face nowadays a double difficulty when providing community services. Current economic crisis reduces resources availability to overcome traditionally higher costs due to low population density, great travel distances, progressive ageing and depopulation. Community based mental health services at Castile and León, largest region in Europe, are deploying innovative concepts of support, making use of the innovation and technology, activating existing human resources as well as discovering new ones. In this presentation strengths and difficulties of a model of Rural Support Team (RST) is presented as an example of a successful initiative targeting the population with severe mental health issues and their families in rural and remote areas. With the objective to keep this service cost-effective, accessible to greater number of people and arise service added value, the involvement of volunteers has played a key role. From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com A culture of self-reliance that exists in many rural and remote communities does not promote help-seeking behaviours for social and emotional problems. Some people may be reluctant to seek support because of stigma about mental health issues and concerns about confidentiality in small communities RST main goal is to minimize patient/client risk of exclusion from the mental health regional recovery services and processes, allowing early intervention, building of positive patient-clinician relationship, and the continuity and effectiveness of treatment. RST includes local but also European volunteers, thanks to the European Volunteer Service, Youth in Action programme. They play a key role with the clients, their families and communities, in order to cooperate on tasks fostering greater autonomy of the persons and their independent life within the community. RST Volunteers have become and indispensable source of IDEAS, TIME to listen and establish personal relations, CONTACT, EXPERIENCES, ACTIVITIES very relevant for recovery engagement and RAISING AWARENESS. Volunteer easily becomes an agent for raising awareness, contributing to reduce social stigma in the local community, above all if the community is very small and facilitates personal contacts. Volunteering activity has shown notable effects on the community. Thus, this experience sums up an european scope programme thanks to European Volunteer Service to tackle an increasing demand for community based attention in rural areas. It has also been very relevant at national level as it has procured unseen coordination between social and health different commissioners. It is being considered as a pilot to mainstream and it has been awarded by National Spanish Health Ministry in 2011.
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www.mheconference2012.com The installation of a Volunteer Network for health issues in the rural region of Fokida, Central Greece - Benefits and actions Ioanna Kallia, Society of Social Psychiatry and Mental Health, Greece Volunteering is a versatile dynamic system where personal fulfillment is met with the collective welfare. Social work offer is based on principles of solidarity, social justice and social participation without material price. In recent years in Fokida, a prefecture of central Greece covered with mountains, inaccessible villages and rural development, people have made efforts to develop volunteering in various sectors such as environmentaldevelopment and blood donations. In January 2011 and after the Society of Social Psychiatry and Mental Health in Fokida, NGO that has been working with the local population since 1981, took the initiative to organize a Volunteer Network for Health issues. This effort is implemented in collaboration with the two municipalities of the region, Delphi and Dorida, local health agencies, associations and community services. It is also a member in the broader Akeso health care network that has been established in the same region since 2010. Goal of the network is to inform and raise public awareness about the concept of volunteer work in health issues, as well as locals mobilization, so that each person be able to offer help to people in need according to his knowledge, interests and time. Another goal of our initiative is to provide volunteers experience working in health institutions. Moreover, the network eliminates prejudice and social exclusion by promoting the development of social support culture. Our ultimate goal is to have at least one volunteer in each village of Fokida. The role of volunteers in mental health is important as they may be useful partners in the work of a health institution. The framing of such a voluntary contribution must be guided by a particular philosophy and principles. We also need to act based on the appropriate methodology, taking into account the human resource management and assessment methods. Volunteers act as external observers, having an attitude of unconditional offer in professionally organized networks of health care. According to the above, we present you the operation of volunteer network for health issues and its benefits to a provincial prefecture of central Greece. At the end we will inform you about future ideas and actions related to it.
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www.mheconference2012.com Speakers - June 16 The human rights aspects of the access to community-based mental health services Josée Van Remoortel, MHE Senior Policy Adviser Human Rights and the development of Community mental health services are two important action fields of Mental Health Europe and of this Conference. The rights of people with mental health problems are regulated by different legal instruments: -the UN Convention on the Rights of people with disabilities -the European Convention on Human Rights (Council of Europe) -the EU charter on Fundamental Rights The Un Convention is far most the largest and most important legislation, It is a binding instrument for the governments who ratified it and persons with mental health problems are mentioned in the purpose of the Convention. It focuses on the interaction of persons with impairments and the barriers which prevent their full participation in the community.. In the context of the Conference this parallel session will deal with the “Access of persons with mental health problems to Community Based Mental Health services”. It is important we make clear what we understand by “community based mental health services” in order to agree on a number of “minimum standards” that need to be put in place and to make clear what is not acceptable; What are the key problems to solve? What is absolutely necessary to make the shift from institutional care to community bases care? How can we develop good practices and alternatives? How can we put governments before their responsibilities? How can taboo and stigma in the community be tackled? How can we change the “culture “ of the population to take part in this changing process? How can we use the “economic crisis” to our advantage? In this parallel session interesting experiences will be presented from Austria, Croatia Spain and the EC Fundamental Rights Agency.The discussion will certainly lead us to develop a consensus on how new alternatives in community based mental health can be realised. 60
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www.mheconference2012.com Deinstitutionalisation and the UN Convention on the Rights of Persons with Disabilities Jan Pfeiffer, Psychiatrist, member of the Council of Europe Centre for the Prevention of Torture Although to keep people with disabilities in any segregating setting is against the UN Convention on The Rights of Persons with Disabilities and then we can say is “ illegal,” and there is lot of evidence of human rights abuse in mental health institutions, there are still hundreds of thousand people with mental health problems in large, segregating psychiatric institutions. Such arrangement of care can be find in most countries in Europe, but on a bigger scale and higher number in the countries of middle and eastern Europe. In these countries we can find at least experimentation in deinstitutionalization of services for children or people with intellectual disabilities, but the issue of people with mental health problems is often neglected. The history of the totalitarian regimes that lasted up to the end of the 20th century is still present in the mindsets of people and influences that stereotype of paternalistic thinking,, the resistance of professionals of psychiatric services afraid of loosing their historical power position and the prejudices of broader society is a strong obstacle to any change. From the last 50-60 years of experience of de institutionalization there is lot of knowledge about the necessary conditions and processes fro successful reform. There is also a lot of knowledge about“ risky scenario”. Very often, as a first reaction to criticism of the conditions in mental health hospital, money, ,including Structural Funds, is invested in the “humanization” of mental health institutions. Such investments did not bring any real change to the quality of life of clients. They only prolonged the segregation and postponed the real transformation of the services . But if Structural Funds are used properlym they can be a strong vehicle for systemic reform of institutional to community based care. The European DI Expert Group in the last three years did a lot on influencing the European Council to understand the issue of Structural Funds and deinstitutionalization, Alsom due to this activity, the framework of use of EU Structural Funds for the period 2014-2020 will be much more open for using this resource for reform processes in social and health care, including mental health care. It is crucial that all those pro-reform at EU as well as at country levels unify and use this opportunity to the maximum. In the lecture, the processes of deinstitutionalization will be discussed in detail, as well the needed steps to assure reform processes will starte also in those countries where institutions are still a main part of mental health care. From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com The role of the media in changing the attitude of people towards mental health issues Jane Gabriel, Editor openDemocracy 50.50, UK Twenty years ago we had de-institutionalisation and ‘care in the community’ when the life stories of people diagnosed as being mentally ill were widely accepted as causal factors in mental illness. Today we have a biological model in which chemical imbalances in the brain are widely accepted as causing mental illness, with a different mental illness for every day of the year - and a drug to treat it. What has remained constant are the many voices of people who have been diagnosed as being mentally ill, and who have said, in numerous ways, and at different times, that they believe that their behaviour is a sane response in an insane world. So what’s been going on? Diagnostic categories, just like individuals, have their own histories. The balance of power between mental health professionals changes constantly. The question of what qualifies as madness remains contested. The boundaries between normal and abnormal are often unclear... The media has the capacity to reveal the underlying, less visible world of the mental health sector by addressing key questions: who are the arbiters of what is normal and what is abnormal ? how is the consensus constructed and maintained, and by whom? how has the balance of power shifted between mental health professionals? what are the interests involved? what counts as evidence and what evidence counts? The media has the power to present the larger picture and to frame mental health issues in ways that everyone can relate to - some argue that a human and civil rights framework is the one to use today in order to change attitudes. There are tools to be used, and arguments to be put forward. This is the role that the media should be playing Telling the stories of the mentally ill, together with the stories of the diagnoses of mental illness, informs people, but in my experience of making documentaries about mental illness and mental health practice in Greece and Britain in the 1990’s, it is when people’s emotions are engaged as well that there is an increased chance of changing attitudes. Sixty years on from the first DSM, it’s time to bring into view the whole picture. The media - whether old or new - with complementary multiple platforms, has the ability to do this. 62
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www.mheconference2012.com Round Table debate: Solidarity between generations in the mental health field Elisabeth Muschik, MHE Senior Policy Adviser Solidarity – a value in danger of getting lost… Solidarity – not only in words but in practice… Solidarity – an alliance of individuals in society - a two-way-action for the socially weakest in society After the 2nd World War –from 1945 to 1975 –a “top down social redistribution” was started in western democracies . It brought employment, income, wealth and peace for many years; social inequality in western societies was severely reduced thanks to state support in the social field. In that frame also the first psychiatric reforms and the first steps towards de-institutionalization were undertaken in many countries from Italy to Germany and Austria and all the other western countries. Until the political turn in 1989 the western social market-economy brought a constant level of wealth and security for almost all citizens. Today we experience more and more social breaches in the society in a painful contrast to the social “adjustment” we had in the past. Social groups are splitting up, political engagements become loose. Trade Unions have big troubles to mobilize workers when defending their interests. Social-democratic political parties lose members and voters. This is the consequence of the “over-expanding neo-liberal market-economy” we had, without political adjustment and with uncontrolled supporting social differentiation and individualization, now hampering solidly united actions. We see increasing numbers of people losing their jobs – and as a consequence losing income, home, societal structures and positions, respect, acceptance and security, self-worth and self-confidence. It is no longer possible to close our eyes for the rapidly increasing number of people becoming poor, developing mental health problems and disturbances like burn-out and depression, sometimes resulting in suicide. Health in general, and mental health in particular, is directly connected to social stability and wellbeing in society. It seems that “the European Social Model” is becoming history – do we really want that? In comparison to the world around us it has once been “the Capital” of the EU, bringing us social stability, satisfaction and peace for From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com decades. People have put their trust in democracy as the political system they wanted to live in. Today “Social Justice” is again a critical request on democracy – even in the USA, where people up to now have followed the slogan: “everyone is the architect of his/her own fortune”. But as soon as more and more middle-class-families can no longer afford to pay for their house, the education of their children and the provisions for one’s old age - while money and properties are cumulated in the hands of few – the former proudly presented slogan becomes unrealizable. The meaning of democracy is that people can believe and trust in getting fair chances and a perspective for their personal life as well as having the opportunity to contribute to development and progress of society at all. “Social Inequality” jeopardizes democracy and peace! When the European Year 2012 “Active Ageing and Solidarity between Generations” was launched at the conference “Stay active – what does it take?” in January 2012 in Copenhagen, no attention was paid to mental health problems neither were any ideas launched about how to bring forward intergenerational solidarity. Member States are encouraged to consider active and healthy ageing measures in their operational Programs for the period 2014 – 2020 that can help deliver the objectives of the Structural Funds programs. But people suffering from or developing mental health problems because of getting older/becoming old and weak and sick and also the problems of old ‘psychiatric’ patients seem to be forgotten. Therefore Mental Health Europe has set up a task force on “Mental Health and Active Ageing” which will discuss the big challenges linked with lobbying for the mental health of older people at the European level. The second core area of the European Year 2012 - “intergenerational solidarity” is only mentioned in the headlines of the different documents from European Union institutions; unfortunately no ideas or proposals are launched on how to work on the development and sustainability of this social dimension which is indispensable for the future quality of life of every single person and the society as a whole. Therefore Mental Health Europe wants to focus during this debate on solidarity between the generations in the mental health field. 64
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www.mheconference2012.com Parallel session 5 - The human rights aspects of the access to community-based mental health services The human right aspects of the access to quality community-based services Erwin Kargl, Pro mente Upper Austria, Austria The UN-Convention on the Rights of Persons with Disabilities confirms rights on different levels – from individual positions over service-acces-rights through organizational and governmental duties. Access to rights means participation, barrier-free entries (and exits) and the legal manifestation of the rule “nothing for us without us”. The accessibility of community-based services is a question of structure and “point of view”: Persons with disabilities must be assisted in their normal life at home (nobody lives not “at home”) and in their daily needs by supportive, empowerment- and recovery-oriented personal assistance. The UN-Convention on the Rights of Persons with Disabilities describes the community-based services in several articles (Art. 19, 25 and 26). The keyarticle 19 confirms the right of free choice which kind of support every person chooses on the basis of community-based service to avoid exclusion and isolation. Individual positions and needs as well as service access rights can only be achieved by organizational and governmental duties. As long as supportive services do not reach the “homes” of persons with disabilities – human rights stand still and do not enter the targets that they consider. And as long as these different duties are not transferred into the daily life of persons with disabilities, human rights can not be considered as achievable or/and accessible. If we think and talk about human rights and the access to community-based services, first we must create the structures to make them possible. After having reached this frontier, we can discuss about the “quality” within these services. It’s not the question “if”, it’s only the question “how” for “what”. 1. What are the needs of persons with disabilities in their daily life from a community-based point of view? 2. How can we ensure the access-rights within the UN-Convention on the Rights of Persons with Disabilities? 3. How can we create and develop organizations to ensure the Convertion of the UN-Convention on the Rights of Persons with Disabilities? 4. And finally (or first) – how can we all make sure that the government/ state respects human rights – not only by friendly declarations of intent but by measures that persons with disabilities see and feel in their daily life? pro mente OÖ has developed different measures and steps to make sure that these 4 questions find answers. In the workshop we`ll present our answers. From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com Choice and control – the right to live independently and to be included in the community Nevena Peneva Kober, European Union Agency for Fundamental Rights, Austria The UN Convention on the Rights of Persons with Disability (CRPD) has brought about a paradigm shift to disability policy and practice. The social model of disability moves away from a medical conception of disability as an individual problem, towards rights driven and equality-based approach that positions the cause for inability in the barriers set by society. Societal and environmental barriers and prejudices, however, continue to hinder the effective inclusion of people with disabilities in the community and the practical realisation of their right to live independently. Article 19 of the CRPD enshrines the right of persons with disabilities to live independently and to participate in the community on equal basis with others. Article 19 does not, however, conceive of the right to live independently as living ‘alone’ without support, but rather it reinforces the right of persons with disabilities to receive support and have access to services tailored to their individual needs. In 2011, in the context of its project on the ‘Fundamental rights of persons with intellectual disabilities and persons with mental health problems’ the European Union Agency for Fundamental Rights (FRA) carried out field research in nine EU Member States. Interviews and focus groups were conducted with people with personal experience of intellectual disability or mental health problems, their families and carers as well as with service providers and health, disability and legal professionals. The research focused on experiences of institutional care and treatment, options and challenges for independent living and access to justice for people with intellectual disabilities or mental health problems. Many people who were interviewed reported having limited choice and control over where and with whom they lived, and over their everyday activities, impeding their right to live and participate in the community on an equal basis with others. Lack of housing and community-based support, scarcity of tailored daily support services as well as low income and recently introduced austerity measures led to restricted choice and reduced autonomy for persons with disabilities. Participants in FRA’s research shared as well 66
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www.mheconference2012.com positive experiences. Those included further growth of user-led organisations and self-help groups across Europe, as well as continued efforts for deinstitutionalisation, though progress materialises with different pace in the EU Member States. The significant differentials in the provision and availability of support services for daily living reflect the range of welfare policy regimes across EU Member States. However, FRA’s research identified common challenges which could be addressed by employing new approaches to community-based services introduced in some countries, such as personalised support in the form of direct payments and personal budgets, and support from personal assistants and personal ombudsmen. These services, among others, enable persons with disabilities to lead a life of self-determination and exercise choice and control over the right to live independently and to be included in the community. This presentation will illustrate FRA’s findings on the issues of the right to live independently and to participate in the community, which will first be released on the 8th of June 2012. The role of international and national monitoring bodies in protecting the rights of persons with mental disabilities Marija Definis-Gojanovic, Goran Mijaljica and Mario Malicki, University of Split, School of medicine, Croatia Persons with mental disabilities often suffer a wide range of human rights violations and social stigma, especially those deprived of liberty. In protection of their rights the preventive approach which seeks to expose the causes of violations and to find solutions to prevent further abuses from taking place is important. Monitoring bodies, such as the UN Subcommittee on Prevention of Torture (SPT), the European Committee for the Prevention of Torture (CPT) and domestic bodies like National Preventive Mechanisms (NPMs), with their specific mandate, play significant role in that proactive strategy. This paper presents how mentioned bodies could help to prevent torture and other forms of ill-treatment and what should be done to develop a comprehensive, integrated and cooperative preventive approach of all relevant stakeholders for effective promotion and protection of human rights of people with mental disabilities detained in different institutions. From individual to collective responsibility - The social determinants of mental health. Abstracts.
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www.mheconference2012.com Parallel session 6 - Deinstitutionalisation and the UN Convention on the Rights of Persons with Disabilities Deinstitutionalisation and the UN Convention on the Rights of Persons with Disabilities Rita Donabauer, Pro mente Upper Austria, Austria Since the early start of psychiatric reforms in the 1960s, the term „deinstitutionalization” has become a symbol for tearing down the walls of institutions – institutions which often worsened patients’ conditions instead of supporting them. Over the last decades, times have changed and so did our terminology, and even the meaning of the remaining terms. However, in many cases de-institutionalization has also led to a special type of institutionalization within community-based services - special forms of housing, living, working and leisure time facilities. With the UN Convention on the Rights of Persons with Disabilities, a new period has begun which can be described as the “social model” or “the model of inclusion”. The “social model” means that disability occurs in the interaction between people with disabilities and the society, where attitudes and environment-related barriers hinder them from participation. The human rights approach also means that the slogan “not anymore of the same” applies to a wide range of services and support systems – they all have to go through a profound transformation. How can de-institutionalization become meaningful, how can it enable people to make their own choices in a society where ‘disability’ and ‘ability’ have new meanings? The most important focal point in this process is the whole system we live in, including support services, but it is also a matter of legislation that set up the rules of participation in the society. There is still a long way to go to achieve a more inclusive society, where deinstitutionalization is just one step of many. Good practices are already on the way – in the workshop we want to present examples from Pro Mente Upper Austria.
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www.mheconference2012.com Community Psychiatry Development in Slovenia Vesna Ĺ vab, Marijana Janet, Evgen Janet, University Ljubljana, Slovenia Slovenian psychiatry is predominantly hospital based. The wide network of outpatient psychiatric clinics was at least partially dissolved with privatization taking place from the 1990s and partially resolved with ambulatory care with little psychiatry network planning. At the same time non-govermental rehabilitation services were developed in all parts of Slovenia. Only in 2012 the Minister of Heath approved finances for development of community psychiatric teams in several, most deprived regions regarding service provision and with low mental health indicators. 15 community psychiatric teams are to be placed all over Slovenia until 2015. This plan is described in a National Community Mental Health Action Plan which will be presented and justified in this presentation. Mental Health Needs research and evaluation of this process are to be discussed. Recovery in Scottish mental health services Bridey Monger, Penumbra & University of Abertay, Dundee, Robin lon, Nigel Henderson, Dr Scott Hardie, Jane Cumming Rising from the ashes of institutionalisation and the therapeutic nihilism of the asylum era, recovery has become one of the most important and influential concepts in mental health. ln contrast to reductionist biological cure based approaches, recovery focuses on the universal need of service users to lead a well-rounded, fulfilling life with or without symptoms of mental illness. Recovery now appears in the policy documents of many governments, and is apparent in the position statements and practice of many voluntary and statutory organisations. This movement is slowly changing the culture of mental health services in Europe. Where embraced, recovery has shown the potential to change more than the lives of people with a mental health problem and the services that support them. A focus on recovery has demonstrated the potential to improve attitudes and reduce stigma within the media, the workplace and the community.
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www.mheconference2012.com ln this session, we will outline the Scottish move to recovery by describing the progress one Scottish mental health organisation, Penumbra, has made in achieving a recovery focussed culture throughout its work. We will describe the organisational and cultural changes Penumbra has made in order to ensure that its strategy, philosophy, values and practice reflect a recovery focus. ln addition we will describe the development of a tool designed to address the challenge of measuring the recovery journey, the lndividual Recovery Outcomes Counter (|-ROC). We will describe the development process and the on-going validation. We will explore how |-ROC can be used in order to facilitate a personalised, recovery focussed service and how this tool is beginning to have an influence in shaping mental health services in Scotland.
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www.mheconference2012.com Parallel session 7 - Role of the media in changing the attitude of people towards mental health issues Telling the real story: The UK media and mental health Alison Kerry, Mind, UK Half of UK newspaper reports about mental health problems are stigmatizing, with headlines often focusing on dangerous behavior and homicides. Sensationalist journalism promotes fear and mistrust and widens the gap of public understanding about mental health issues. Perhaps even more concerning is that the proportion of stigmatizing articles has increased by seven per cent over the last year. There seems to be a hardening of attitudes, with UK media reporting of mental health issues getting worse rather than better. Mind works to promote positive and accurate representations of mental health in the media and actively challenges discrimination. This presentation will focus on the many innovative ways that the charity is engaging with the media to create a shift in their handling of mental health issues. Every year Mind speaks to hundreds of journalists, documentary makers and scriptwriters and advises them on all aspects of mental health reporting. It encourages them to include the voices of people with mental health problems and reflect their achievements. Presenting the real picture can help to increase public understanding as well as being incredibly empowering for those individuals involved. Through the annual Mind Media Awards the charity recognizes excellence in media reporting and encourages best practice. The awards have been shown to inspire media professionals to create more authentic, well-crafted depictions and reports about people with mental health problems. Last year Mind decided to tackle the problem of an increase in media stories that vilify disability benefit claimants. Since the UK Government began its reform of the welfare system there has been an increase in the number of articles that focus on disability benefit fraud . The tabloid media frequently refer to claimants in dderogatory terms such as ‘scroungers’ or ‘spongers’ and this is impacting public perceptions of all disability benefit claimants but
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www.mheconference2012.com particularly those with ‘hidden’ conditions such as mental health problems. A study by the University of Glasgow found that people with ‘depression’ and ‘stress’ were often portrayed in the media as ‘undeserving’ of benefits. In response, Mind produced its own alternative newspaper the Daily Stigma. The spoof paper challenges misleading media reports about fraud and highlights the unfair way that disability benefit claimants are portrayed. So far over 2,000 copies have been distributed and over 21,000 people have read the paper online. Time to Change, England’s biggest mental health anti stigma campaign led by Mind and Rethink Mental Illness, has also come up with some creative ways to challenge people’s assumptions. It developed the short film “Schizo” which opens like a trailer for a horror movie but then shocks viewers by unveiling a scene of domestic bliss. This provocative film was designed to attract members of the public who don’t realize they are causing stigma and discrimination. Mental Health - ‘Something We All Have’ Krzysztof Bierski, Goldsmiths, University of London, UK In the United Kingdom, mental health activists work towards intelligible aims of building social awareness, eradication of stigma and prejudice and improvement of lives of people facing mental health problems. Among the myriad of campaigns and projects, both at local and national level, activists have come to operate with a concept of universal mental health. Through the promotion of mental health as ‘something we all have’ they highlight the necessity for individual and social responsibility for one’s and others’ health and offer a radically new model of society united by shared responsibility. As such, contemporary mental health activism in the UK can be seen as diametrically different from social movements of the past as it does not entail demands for acceptance or tolerance for difference but, instead, it calls for recognition of health as an indicator of sameness. Ideas and postulates which activists operate with, as well as their strategies, such as compromise on illness specificity, stand as evidence of their adaptation to the changing political and economic situation conditioned by the global
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www.mheconference2012.com financial crisis and austerity measures. This adaptation is also manifested in activists’ innovative employment of a wide range of media. Production of broadcast media, invariably taking the lived experience of mental illness and/or recovery as its subject, is fuelled by an unprecedented use of Internet-based social networks for discussions of mainstream and activistmade representations, evaluation of campaigns, sharing of experiences and narratives as well as mutual support. In this paper I explore the development of the concept of universal mental health and associated practices and responsibility by discussing a range of mental health media. These include Facebook Fan Page of Time to Change, a nation-wide anti-stigma campaign and films made in collaboration with Richmond Borough Mind, a mental health charity in South-West London, on their project addressing senses of locality and community. Furthermore, I look into the question of individual and social responsibility for mental health in more detail by discussing the emergence of a new model of organisation of mental health services in the London Borough of Richmond. Based on data collected during ethnographic research conducted between 2009 and 2011, this paper addresses the complexity of recently emerging ideas and practices around mental health and corresponding responsibility in the United Kingdom. With reference to practical examples it considers advantages of applied social research at grassroots level and outlines possibilities for effective cooperation between different social actors including activists, the voluntary sector and the state. The role of the media in changing the attitude of people towards mental health issues – a perspective of the Disability Ombudsman Office, Croatia Branka Meic, public relations adviser to the Disability Ombudswoman, Croatia The mandate of the Disability Ombudsman Office along with protecting and monitoring the rights of persons with disabilities (hereinafter PwDs) also includes promoting their rights through participation in public activities aimed at improving the situation of PwDs and fighting prejudice and stigma surrounding them.
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www.mheconference2012.com The key international document in the area of protection of rights of PwDs, the UN Convention on the rights of PwD (herienafter UN CRPD) recognised the importance of media in changing negative, stigmatising and prejudicial attitudes of the public towards PwD which very often amounts to barriers to their inclusion into society on an equal basis with others. Persons with mental health issues or mental disability as referred to by the CRPD are particularly adversely affected by stigma associated with their condition which poses one of the main obstacles to realising their remaining potential as active members of the society and in turn leads to their isolation and even segregation from the community. Furthermore, the experience of the Office shows that the notion of persons with mental health issues as persons with disabilities is still new not only in general public but also among professionals. All these factors make the change from medical to social and human rights model of disability that was introduced by the CRPD even more challenging for persons with mental disabilities compared to other disability groups. Since the Disability Ombudsman Office has a special mandate covering all disability groups, its activities related to raising awareness of the social and human rights model of disability among representatives of the media involve also special focus on specific issues of persons with mental health issues, that is persons with mental disabilities. Several workshops that were organised for representatives of the media where in the first place focussed on promoting the CRPD and social/human rights model of disability and mental health issues as a part of these questions. These workshops indicated the need for initiating further scientific research in the area which would provide representatives of the media with guidelines on how to report about persons with mental disabilities especially in situations of suicide and violence. The work of the Office in this area has therefore primarily focussed on educational and awareness raising bactivities. As the next step, the office plans to react to media coverage on persons with mental disabilities that heavily rely on prejudice and reinforce stigma by supplying facts that most persons with mental disabilities are indeed not violent.
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This publication is supported by the European Community Programme for Employment and Social Solidarity (2007-2013). This programme was established to financially support the implementation of the objectives of the European Union in the employment and social affairs area, as set out in the Social Agenda, and thereby contribute to the achievement of the Lisbon Strategy goals in these fields. The seven-year Programme targets all stakeholders who can help shape the development of appropriate and effective employment and social legislation and policies, across the EU-27, EFTA and EU candidate and pre-candidate countries. To that effect, PROGRESS purports at: • providing analysis and policy advice on employment, social solidarity and gender equality policy areas; • monitoring and reporting on the implementation of EU legislation and policies in employment, social solidarity and gender equality policy areas; • promoting policy transfer, learning and support among Member States on EU objectives and priorities; and • relaying the views of the stakeholders and society at large. For more information see: http://ec.europa.eu/employment_social/progress/index_ en.html The information contained in this publication does not necessarily reflect the position or opinion of the European Commission
STO KOLURI
Croatian Association for Psychosocial Wellbeing Šibenska 27, HR-21000 Split, Croatia Tel/fax: +385 21 772 935 E-Mail: direktorica@stokoluri.org
MENTAL HEALTH EUROPE AISBL Boulevard Clovis 7, B-1000 Bruxelles Tel: +32 2 280 04 68 Fax: +32 2 280 16 04 Email: info@mhe-sme.org Website: www.mhe-sme.org