DEINSTITUTIONALIZATION PROCESSES IN INTERNATIONAL AND LOCAL CONTEXT Roberto Mezzina, Director MH...
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DEINSTITUTIONALIZATION PROCESSES IN INTERNATIONAL AND LOCAL CONTEXT Roberto Mezzina, Director MH Dept. / WHO CC for Research and Training AAS 1, Trieste
DEINSTITUTIONALIZATION PROCESSES IN INTERNATIONAL AND LOCAL
CONTEXT Roberto Mezzina, Director MH Dept. / WHO CC for Research
and Training AAS 1, Trieste Kotor 24 March 2015
Slide 2
Italy 100.000 inpatients in 1971 in PHs 48.000 inpatients in
1978 All PHs closed in 2000 1978 reform law: -no Phs admission, no
new PHs -community based care -human rights focus / involuntary
treatment duration reduced (1 week +) 2 pych. to mayor -No police /
justice involved just health protection
Slide 3
Mental Health Departments They are rooted in areas of about
300.000 inhabitants and encompasses a number of components: -Small
general hospital acute units (15 beds), 1/10.000 -Community Mental
Health Centers (up to 12hr, sometimes 24hr) 1/80.000 -Group-homes
2/10.000 with a wide range of support up to 24hr (17.000 beds in
Italy, mostly NGOs) -Day Centre (also with NGOs)
Slide 4
Policy documents supporting D.I. EU Union Green paper (2006) on
social inclusion European Pact for MH and Wellbeing, 2008 Combating
stigma and social exclusion Develop mental health services which
are well integrated in the society, put the individual at the
centre and operate in a way which avoids stigmatisation and
exclusion WHO, 2009 Psychiatric hospitals (PHs) have a history of
serious human rights violations, poor clinical outcomes, and
inadequate rehabilitation programmes. They also are costly and
consume a disproportionate proportion of mental health
expenditures. WHO recommends that psychiatric hospitals be closed
and replaced by services in general hospitals, community mental
health services, and services integrated into primary health
care
Slide 5
As shown by a recent survey of WHO, 80% of government spending
on mental health care are absorbed by psychiatric hospitals (Saxena
et a., 2011). The data regarding a number of experiences in Italy
show that savings of up to 50% can derive from such a total
reconversion into a network of community services and related
instruments for social inclusion.
Slide 6
INEFFICIENT USE OF RESOURCES: High concentration of resources
in mental hospitals
Slide 7
INEFFICIENCY: MENTAL HEALTH BUDGET, STAFF WORKING AND USERS
TREATED IN MENTAL HOSPITALS BY INCOME (median rate per 100,000
population)
Slide 8
Overview of the Mental Health Action Plan 2013 -2020 Vision A
world in which mental health is valued, promoted, and protected,
mental disorders are prevented and persons affected by these
disorders are able to exercise the full range of human rights and
to access high-quality, culturally appropriate health and social
care in a timely way to promote recovery, all in order to attain
the highest possible level of health and participate fully in
society and at work free from stigmatization and
discrimination.
Slide 9
Slide 10
WHO QualityRights Improving quality and human rights in
facilities and promoting a civil society movement Assessment of
facilities Development of a change plan Capacity building on human
rights issues
Slide 11
State of mental health in the European Region Mental disorders
affect more than a third of the population every year, the most
common of these being depression and anxiety. Depressive disorder
is twice as common in women as in men. People with severe mental
health problems, such as schizophrenia, bipolar disorder or severe
depression, have a 20- 30 year shortened life expectancy compared
to the general population. 60% of this excess mortality is
accounted for by their poor physical health. Mental disorders
account for as much as 44% of social welfare benefits or disability
pensions in Denmark, 43% in Finland and in Scotland and 37% in
Romania.
Slide 12
Slide 13
Mental Health Programme Distribution of beds per 100 000
population in mental hospitals and in community psychiatric
inpatient units & units in DGHs
Slide 14
Mental Health Programme Home treatment
Slide 15
Policy developments supporting the New European MH Action Plan
(September 2013) The European Commission launched its European Pact
on Mental Health and Wellbeing in 2008, 2008 was marked by the UN
Convention on the Rights of People with Disabilities, now ratified
by the large majority of European Member States and also the
European Unio participation in society, protected from stigma and
discrimination). In 2011, WHO statement on user empowerment was
produced, with indicators of progress towards empowering mental
health service users. In 2008, the WHO launched the Mental Health
Gap Program. Reducing health inequities through action on the
Social Determinants of health (2010).
Slide 16
Forgotten Europeans, forgotten rights (OHCHR) 2011 This report
has emphasized that, under international and European human rights
law, Governments should transfer from a system of institutional
care to alternative community-based services that enable children,
persons with disabilities (including users of mental health
services) and older people to live and participate in the
community. They will also need to ensure compliance with human
rights standards when monitoring the situation of persons receiving
community-based residential services.
Slide 17
Ad Hoc Expert Group on the Transition from Institutional to
Community-based care. In its report the Expert Group recommended
that EU member States should adopt strategies and action plans...
accompanied by a clear timeframe and budget for the development of
services in the community and the closure of long-stay
institutions, with a proper set of indicators to measure the
implementation of these action plans.
Slide 18
The vision of Health 2020: a WHO European region where all
people are enabled and supported in achieving their full health
potential and wellbeing, and in which countries, individually and
jointly, work towards reducing inequalities in health within the
Region and beyond. It puts forward an agenda for action for Europe,
corresponding to the Global Mental Health Action Plan (WHO
Geneva).
Slide 19
Values of European Strategy Empowerment: All people with mental
health problems have the right throughout their lives to be
autonomous, having the opportunity to take responsibility for and
to share in all decisions affecting their lives, mental health and
wellbeing. Fairness: Everyone is enabled to reach the highest
possible level of mental well being, and is offered support
proportional to their needs. Any form of discrimination, prejudice
or neglect that hinder the attainment of the full rights of people
with mental health problems is tackled. Safety and effectiveness:
People can trust that all activities and interventions are safe and
effective, able to show benefits to population mental health or the
wellbeing of people with mental health problems.
Slide 20
Scope Improve the mental wellbeing of the population and reduce
the burden of mental disorders, with a special focus on vulnerable
groups, exposure to determinants and risk behaviours; Respect the
rights, addressing stigma and discrimination, and offer equitable
opportunities to people with mental health problems (including
dementia and substance use disorders) to attain the highest quality
of life; Establish accessible, safe and effective services that
meet people's mental, physical and social needs and the
expectations of people with mental health problems and their
families.
Slide 21
Definitions Mental health a state of well-being in which an
individual realizes his or her own abilities, can cope with the
normal stresses of life, can work productively and is able to make
a contribution to his or her community. Resilience the capacity for
positive adaptation and generally refers to individuals,
organisations, communities or localities that do better than
expected in the face of adversity. Recovery a process of change
through which individuals improve their health and wellbeing, live
a self-directed life, and strive to reach their full potential,
whether or not there are ongoing or recurring symptoms or
problems.
Slide 22
Strategic objectives Four core strategic objectives Everyone
has an equal opportunity to realize mental wellbeing throughout
their lifespan, particularly those who are most vulnerable or at
risk. People with mental health problems are full citizens whose
human rights are valued, protected and promoted. Mental health
services are accessible and affordable, available in the community
according to need. People are entitled to respectful and effective
treatment, and to share in decisions.
Slide 23
3 objectives These are supported by 3 objectives: Health
systems provide good physical and mental health care for all.
Mental health systems work in well coordinated partnerships with
other sectors. Mental health governance and delivery are driven by
good information and knowledge.
Slide 24
Trieste / AAS n.1 The Healthcare Agency is organised as
follows: 4 Healthcare Districts (each responsible for approx.
60,000 inhabitants), operating according to area (primary care and
home care, the elderly, specialised medicine, Rehabilitation,
Children and adolescents, Family counselling, District diabetes
centre) 3 Departments (Mental Health, Dependency, Prevention) 2
Specialised Centres (Cardiovascular and Oncological). 118 Service
for health emergencies 1215 employees. Budget: cash balance
29,327,155.82
Slide 25
The Mission of MHD The MHD shall operate for the elimination of
any form of stigmatisation, discrimination and exclusion concerning
the mentally ill persons. The MHD is engaged to actively improve
full rights of citizenship for the mentally ill persons. The MHD
shall ensure that the community mental health services of the LHC
have a coherent and unique organisation as a whole, through a
strict co-ordination of actions and links with the other services
of LHC, particularly with general health districts and emphasizing
the relationships with the Community and its institutions.
Slide 26
Todays features in Trieste (WHO CC lead for service
development) are: Services: 4 Community Mental Health Centres
(equipped with 6-8 beds each and open around the clock) incl. the
University Clinic 1 small Unit in the General Hospital with 6
emergency beds; Service for Rehabilitation and Residential Support
(12 group-homes with a total of 60 beds, provided by staff at
different levels; 2 Day Centres including training programs and
workshops; 13 accredited Social Co-operatives); Families and users
associations, clubs and recovery homes. Staff: 215 people - 1/1.000
(26 psychiatrists, 9 psychologists, 130 nurses, 10 social workers,
6 psychosocial rehabilitation workers).
Slide 27
PROGRAMMES User training and involvement Information for family
members Prison consultancy service Promotion of social enterprise
activities Creative/play activities Promotion of self-help
activities Intensifying relationships with health districts
Intensifying relationships with hospitals Relationships with the
citys cultural agencies Gender difference and mental health
Prevention of lonely deaths(Amaliaproject) Suicide prevention
Special Telephoneproject)
Slide 28
peppe dell'acqua dsm trieste who collaborating center
[email protected] 28 Where are the beds today? Year 1971: 1200
beds in Psychiatric Hospital Year 2015: 78 beds of different kind
in the community: 26 community crisis beds available 24 hrs. Mental
Health Centres (11 / 100.000 inhabitants) 6 acute beds in General
Hospital (3,5 / 100.000) 45 places in group-homes (20 /
100.000)
Slide 29
The coops: activities cleaning and building maintenance
(diverse agencies) Canteens and catering, incl. Home service for
elderly people Porterage and transport Laundry tailoring Informatic
archives for councils, etc furniture and design cafeteria and
restaurant services Hotel Front-office amd call-center of public
agencies Museumsstaff agricultural production and gardening
handicraft carpentry photo, video and radio production computer
service, publishing trade, CD-Rom serigraphics theatre
administrative services Group-homes (type A) Parking
Slide 30
Overarching criteria / principles of community practice in the
MH Dept. Responsibility (accountability) for the mental health of
the community = single point of entry and reference, public health
perspective Active presence and mobility towards the demand = low
threshold accessibility, proactive and assertive care Therapeutic
continuity = no transitions in care Responding to crisis in the
community = no acute inpatient care in hospital beds
Comprehensiveness = social and clinical care, integrated resources
Team work = multidisciplinarity and creativity in a whole team
approach Whole life approach = recovery and citizenship, person at
the centre
Slide 31
the central practical-theoretical point If the CMHs is
conceived as a simple out patient clinic, that means accepting an
unavoidably subordinate situation in terms of structure and work
similar to the hospital based services DCS and private clinics. If
CMHSs do not control the channels for admission into the old and
new hospitalising institutions, they are placed themselves in a
peripheral position. Hence the concept of controlling the circuit
or the pathways of psychiatric demand
Slide 32
the central practical-theoretical point a new model is
developing a strong CMHS working 24 hours a day, equipped with beds
and having great flexibility as far as facilities, resources,
duties and modes of intervention are concerned. The originally of
the Italian concept of CMHS was for it to be the main or the only
point of reference for all psychiatric requirements of the entire
catchment areas. This allows the CMHS to conduct a continual cycle
check.
Slide 33
peppe dell'acqua dsm trieste who collaborating center
[email protected] 33 Some relevant outcomes In 2011, only 16
persons under involuntary treatments (7 / 100.000 inhabitants), the
lowest in Italy (national ratio: 30 / 100.000); 2 / 3 are done
within the 24 hrs. CMHC; Open doors, no restraint, no ECT in every
place including hospital Unit; No psychiatric users are homeless;
Social cooperatives employ 400 disadvantaged persons, of which 30%
suffered from a psychosis; Every year 240 trainees in Social Coops
and open employment, of which 20-30 became employees; The suicide
prevention programme lowered suicide ratio 40% in the last 15 years
(average measures); No patients in Forensic Hospitals.
Slide 34
34 How much does it cost? 1971: Psychiatric Hospital 5 billions
of Lire (today: 28 million ) 2011: Mental Health Department Network
18,0 millions 79 pro capita 94% of expenditures in community
services, 6% in hospital acute beds
Slide 35
Costs of MHD - 2010 Costs% Staff 11.158.171,0159% Medications
1.077.500,036% General expenses 2.920.853,9516% Social expenses
956.802,885% Personal Health Budgets 2.645.362,8114% Total
18.758.690,68100%
Slide 36
outcome research 75% compliance to antipsichotics (n=587)
related to service provision and SN enhancement. 27 people - high
priority, 5 years f-up: Highly significant reduction of symptoms
severe > 65 p at BPRS from 20% to 4%), increase of social
function (50% score), 9 at work, 12 indep living, unmet needs (CAN)
from 75% to 25%, 70% reduction of night accomodations. Only 1
drop-out. Qualitative research on recovery / social dimension
(IRRG, Am J Psy Rehab 2006) 24 h services (among 13 centres) better
for crisis care and 2-year f-up, trust, continuity, comprehensive
health and social care (2005). Reduction of emergency presentations
in the GH casualty of 70 % in 20 years. 1983-1987, first f-up after
reform law showed better outcomes for Trieste and Arezzo among 20
centres due to better organisation and social integration.
Satisfaction of users is 78% (2008)
Slide 37
The experience in the Region Friuli Venezia Giulia for reform
implementation A clear action for deinstitutionalisation of PH The
development of 24 hrs CMH Centres The develpoment of a network of
services for rehab and social integration, e.g. group homes, day
centres and social cooperatives The creation of strong MH
Departments in order to co-ordinate all services according to
principles of contrasting social exclusion, stigma and
discrimination and promoting social inclusion.
Slide 38
Slide 39
What is a 24hrs CMH Centre? An open door on the street A
multidisciplinary team in a normalised therapeutic environment
(domestic) for day care and respite, socialisation and social
inclusion A multifunctional service: outpatient care, day care,
night care for the guests, social care & work, team base for
home treatment and network interventions, group & family
meetings / therapies, team meetings, mutual support, relatives and
other lay people visits, inputs and burden relief. Social
cooperative home management Leisure and daily life support (self
care; brekfast, lunch and dinner) And many other ordinary and
straordinary things
Slide 40
Hospitalisation / hospitality Institutional rules
Institutionalised Time Institutionalised (ritualised) relations:
among workers / and with users Time of crisis disconnected from
ordinary life Stay inside A stronger patients' role Minimum
networks inputs Agreed / flexible rules Mediated time according to
users needs Relations tend to break rituals Continuity of care
before/during/after the crisis Inside only for shelter /respite
Maximum co-presence of SN
Slide 41
Hospitalisation / hospitality Difficult to avoid: Locked doors
Isolation rooms Restraint Violence Illness /symptoms /body-brain
Open Door System Crisis / life events / experience / problems
Slide 42
CSM DOMIO CSM BARCOLA
Slide 43
Personalised Plan (PP) PP funded by Personalised Healthcare
Budget and organised along 3 axes indispensable for full social
functioning and empowerment : housing, work, socialisation. The PP
accesses other services (mental health services, healthcare
districts, social services) and community resources (volunteers,
social coops, associations, families), and works as much as
possible within the users family, physical and social setting. The
Healthcare Agency must guarantee the quality of the PP.
Slide 44
Slide 45
Slide 46
Trieste demonstration A town without a psychiatric hospital for
30 years. From total institution to a fully community based
service, without barriers, immersed in the community, and a low
threshold of access. Practice with the highest degree of freedom,
following the principle of respecting users power of negotiation.
There are places, like the CMHC, group homes, day centres, socila
clubs, where anybody can live health and ill mental health in their
interface in peoples lives. Mental health issues are recognized in
their intersections with mental ill health and social inclusion
(with welfare systems), with justice, with general health and
health needs. The paradigm of illness is broken in favor of that of
the person. It is possible to open an issue of diverse stakeholders
and collective subjects (users, families, networks, community,
society) and of their power, while the vertiical power of
psychiatric institution has been dismantled.
Slide 47
Deinstitutionalisation as a process The process of the
deinstitutionalisation of PHs necessarily implies a major
involvement on the part of both the general population and
psychiatric operators. In fact, these latter do not necessarily
have a decision-making role in cases involving a purely
administrative deconstruction and the emptying of hospitals, which
can only be activated by policymakers. By deinstitutionalisation we
mean that process which aims at the gradual transformation of
living conditions, treatment and care and the
restoration/construction of patient rights, together with the
progressive substitution of the rules of internment with procedures
based on a full negotiability between patients and operators.
Slide 48
a) staff culture criticism of psychiatrys custodial mandate and
the re-elaboration of the mandate for control; abolishing practices
of violence and restraint as a form of institutional management vs
no restraint at all levels; top-down vs bottom-up lead of change;
contributions of new, diverse actors who are not part of normal
institutional life (e.g. volunteers, citizens, artists,
intellectuals, family members, non-profit organisations). b)
relations with the user changing institutionalised behaviour,
responding to needs, listening and reconstructing life stories,
restoring voices, instigating and sustaining empowerment, creating
participation
Slide 49
c) the organisation of life in the hospital humanisation (e.g.
dignity of habitat; personalising patient living spaces; private
possessions, clothes, keys, wardrobes; managing own money,;
contacts with outside world; first outings; finding life stories)
liberalisation (e.g. opening up wards; mixed m/f wards; therapeutic
community-type meetings; break up totalised life of patients;
giving patients a voice; focus on primary needs such as income and
housing; individual and group outings; parties; invite family
members) deinstitutionalisation (e.g. planning the phasing out and
suppression of the PH through sectoralisation and internal
reorganisation; closing wards and a gradual reconversion moving
towards community services; transfer resources to services and
directly to users, guaranteeing life in the community through
economic resources for subsidies and training; opening the first
group homes and single residences, with appropriate support; create
social enterprises / coops, etc.)
Slide 50
d) interventions and deinstitutionalisation policies involving
and influencing administrations and policies, administrative
management of transformation; involving civil society, creating
public awareness and fighting stigma; contaminating the judicial
and forensic psychiatric system; changing the legal framework for
Mental Health and inclusion; integrating Mental Health into general
healthcare (e.g. at the community level / primary care and not just
hospitalisation for acute cases); integrating Mental Health with
welfare systems (e.g. inter-sectorial link with social services for
housing, work, free time, education and cultural training);
reconverting or restoring psychiatric hospital sites to the
community.
Slide 51
The decisive step in the process of phasing out PHs is
identifying where to accept or admit new psychiatric cases.
Generally, one opts for a mix between the use of specific wards (or
beds) in general hospitals and hospitality in mental health centres
or in other types of non-hospital residential structures, with
preferably a very limited number of beds. The suppression of the PH
should coincide with the creation of networks of totally
alternative services capable of providing care for a given
population (as in sector policies), but which stress the recovery
and reinclusion of patients/inmates (as opposed to the sector
model).
Slide 52
Despite international recommendations, even those of the WHO
(The Optimal Mix of Services for Mental Health, 2011) which stress
that PHs can be reduced or suppressed only if community services
and structures have already been established and thus thanks to new
funds specifically allocated for that purpose we believe that a
contemporaneous process of reconversion which can impact profoundly
not only on the renewal of services but also on the community and
its culture, is not only practicable but desirable. Despite the
significant disparities due to national and local contexts, we
believe that while this process can be instigated by a top-down
impetus and be guided by a responsible institutional leadership, it
can only be fully achieved thanks to a bottom-up process which
mobilises actors and resources.
Slide 53
working directly within total institutions but without
deceiving ourselves that their closure can come from outside or due
to a natural death; creating alternative networks of coherent
services that work in synergy within the community, thereby
avoiding useless and often harmful fragmentation and
specialisations, and thus working not according to preconceived
models but by processes that are verified collectively by users,
families and caregivers, and the community and its institutions;
avoiding priority implementation of hospital services for
crisis/emergencies instead of community structures. assign to the
community services the task of taking responsibility for persons
who come from their territory of competence, who are still interned
in the PH; plan the phasing out of PHs at the local, regional and
state levels, with specific time-frames and the possibility of
applying administrative sanctions in cases of non-compliance.
Slide 54
The deinstitutionalisation process is not only downsizing or
even suppressing psychiatric hospitals, but undertaking a complex
process of removing the ideology and power of the institution by
putting the person over the institution with their subjectivity,
needs, life story, significant relationships, social networks,
social capital. In order to do that, it is necessary to shift the
power in order to empower people with mental health problems, shift
resources from hospitals to a range of community based services
useful for his/her whole life. It opens pathways of care and
programs that integrate social and health responses and actions.
This complex process of change involves users, carers,
professionals and the general citizenry, and extends to the
legislative and political level.
Slide 55
This latter means no longer managing processes for exclusion
through the segregation of persons, but placing the individual at
the centre of the system, with their human and social rights, and
their needs, in a perspective which is based on the persons whole
life and on recovery from the experience of a mental disorder.
Based on what we have described above, the transformation process
takes place at the following multiple levels: movements (civil
society) political legislation service models and practices
networks and organised actors, autonomously or through the
institutions, and community development, as a general raising of
awareness regarding these issues, and the activation of
non-technical resources and initiatives.
Slide 56
Terms of reference TOR 1 - Assist WHO in guiding countries in
deinstitutionalisation and development of integrated and
comprehensive Community Mental Health services. TOR 2 - Contribute
to WHO work on person centred care through applying Whole Systems
& Recovery approaches: innovative practices in community Mental
Health. TOR 3 - Support WHO in strengthening Human Resources for
Mental Health.
Slide 57
To support WHO in promoting mental health reform processes with
focus on deinstitutionalization (1) Technical support in countries
as agreed with WHO, particularly in South/East Europe for
deinstitutionalization and development of integrated and
comprehensive Community Mental Health services. (2) Promoting
intersectoral and integrated approaches and related technologies
for governance in low, medium (Czech Republic) and also for high
income countries (e.g. Australia and New Zealand, Japan, the
Netherlands, the UK), to support social inclusion. In collaboration
with GOs, NGOs, community organisations and welfare and general
health services incl. Primary Care.
Slide 58
Deliverables (1) Guidelines for phasing out psychiatric
hospitals, based on actual experiences in deinstitutionalization.
(2) Guidelines for setting comprehensive community-based services.
(3) Local report of activities for each countries of pilot sites.
(4) Contribute to the collection of Europan good practices on
recovery and to the 10 point recovery message (FRA 17). WHO
deliverable: contribution to implementation of th European and
Global Mental Health Action Plans. Relevant outputs described under
WHO/EURO Key Priority Outcome 7 as per WHO/EURO MNH workplan
2014-15: Member States offer evidence based interventions to
improve mental wellbeing of the population and the quality of life
of people with mental disorders by applying the Global and European
Mental Health Action Plans.
Slide 59
To support the development of reform processes in South America
through Latin American networks The activity is aimed at providing
support to the implementation of Reform Law of 2010 in Argentina,
through WHO, by enhancing a network of good practicies and offer
training in Trieste to young professionals; in Brazil the shift
from institutions to community services will be promoted through
training (twinning conventions with Universities). Other countries
can be involved in agreement with WHO.
Slide 60
Deliverables (1) Organization of the International School in
Brazil. (2) Local reports of activities for each project. (3)
Training material related to deinstitutionalization and
rehabilitation. WHO deliverable: Contribution to implementation of
the Global MH Action Plan: Objective 2: To provide comprehensive,
integrated and responsive mental health and social care services in
community-based settings.
Slide 61
Collaboration with WHO QualityRights Programme (implementation
of WHO programmes and activities at country level) To support human
right issues and developments in institutions together with NGOs
collaboration with WHO QualityRights in identified countries such
as Malaysia and India. Deliverables: (1) A project to implement a
no restraint approach in Johor Bahru (Malaysia) and related report.
(2) A project for implementing WHO QualityRights toolkit in India
(Chennay) and related report WHO deliverable - Contribution to
implementation of the Global Mental Health Action Plan. Programme
Budget outputs 2.2.1 and 2.2.2.
Slide 62
Strengthening Human Resources for mental health through Franca
and Franco Basaglia International School (1) In coordination with
WHO, to offer study visits and training courses in Trieste and
other relevant demonstration sites from countries named in all
other activities or proposed by WHO; and (2) to develop a formal
curriculum (International School / Master Course) on organization
of community based MH Services, together with other International
NGOs and Institutes, as agreed with WHO.The latter is organized in
modules (study visits; training packages; workshops; longer stage
periods). Deliverables: (1) Each year: n. 5 study visits with 2/3
daystraining packages; a 5-7 days workshop; stage periods of 3-6
months. Trainees: from 40 to150 per year ca.; an expected number of
about15 trainee mh professionals will be trained in Trieste for
longer stage periods. (2) Diffusion of documents and other material
focused on innovative practices in community MH (e.g. alternatives
for acute care; comprehensive CMH Centres; rehabilitation,recovery
& social inclusion services; deinstitutionalisation & whole
systems change; early intervention integrated network; social
enterprises & Cooperatives technology, operation &
policies).
Slide 63
Contribute to WHO implementation of mhGAP and related support
to specific countries In countries where the WHOCC already
established contacts with WHO National Counterparts or Programme
Leaders and Officers, mhGAP outcomes are addressed through specific
agreements within WHO mhGAP Programme. Local developments in
Primary and Secondary Care will be supported by mhGAP training and
development of multidisciplinary teams. Deliverables: (1) Local
report of activities. (2) Planning and adaptation of toolkits and
training packages. (3) Related seminars and courses. All
deliverables will be shared and exchanged through mhGAP community.
Participation tomhGAP annual meeting. WHO deliverable: Contribution
to implementation of the Global Mental Health Action Plan.
Programme Budget outputs 2.2.1 and 2.2.2.
Slide 64
Conclusions: a paradigm shift This process must be linked to an
awareness that creating a new paradigm is indispensable: this means
a new way to conceive of the relationship with mental disorder, and
a new way to organise social welfare- healthcare for the population
that is more emancipatory in its content. The focus must be shifted
from illness and custodianship to responding to the needs of
persons.
Slide 65
Toward a value-driven service A citizen with rights Helping a
person and not treating a illness Understand events of life,
overcome crisis Explain and discuss experience Not losing value as
a person (invalidation, neglect, violence) Keep social roles and
maintaining social networks / systems Develop growth potential
(recovery) Have opportunities real empowerment Change (living
conditions, style) Material resources (work, money, practical
help)
Slide 66
Roberto Mezzina, Director WHO CC for Research and Training, MH
Dept. Trieste [email protected]
www.triestesalutementale.it