Community Mental Health

28 – 29 March 2015

Summary report

Community mental health is a decentralized pattern of mental health, mental health care, or other services for people with mental illnesses. Community-based care is designed to supplement and decrease the need for more costly inpatient mental health care delivered in hospitals. Community mental health care may be more accessible and responsive to local needs because it is based in a variety of community settings rather than aggregating and isolating patients and patient care in central hospitals.

Twenty-two participants presented the community mental health situation in their respective countries, shared their experiences and exchanged good practices.

The seminar started with a welcome by the Director of the Department of Social Solidarity of the Regional Administration of Central Macedonia, Serres Branch, Mr.Vassilis Vafiadis. He appreciated the initiative by GAMIAN-Europe for organizing seminar on a topic which is still a taboo in many countries and communities. He also expresses his concern about the increasing cases of mental health conditions.

Exchanges among participants

Situation in Greece

The inaugural speech was presented by Thanasis Tsouvalas, Psychiatrist at the Community Mental Health Centre of Serres and Director of the project “Help at home”, in which he welcomed all the guests and presented the Greek situation of community mental health. He discussed about the Greek mental health system, the Greek mental reform and the “Psychargos” program. He highlighted that over the years the Psychargos program became almost synonymous with the deinstitutionalisation of long term psychiatric patients with the development of a wide range of community mental health services, and he identified several positive and noteworthy achievements by the reforms of the Greek mental health system as well as weaknesses. He also presented the community mental health services at local level and the “Help at Home” program.

Spyridon Zorbas from ADHD Hellas

Being a parent or a teacher of a child who suffers from Attention Deficit Hyperactivity Disorder or even an adult with ADHD ιs not an easy task. Often the difficulties you are confronted with appear insurmountable. However, as with every difficulty, there is much to be gained through knowledge and information.

Spyros presented the Pan-Hellenic Association of individuals with Attention Deficit/Hyperkinetic Disorder (ADHD), and its efforts to set up a Network of support and coaching of people with ADHD and their families in Greece, to sensitize the Society and the State, so that the prejudice for ADHD is refuted, to serve as an advocate for appropriate public policies in response to the needs faced by people with ADHD, and to strive for efficient solutions for the multimodal management of the peculiarities that individuals with ADHD present with.

Giorgios Karakitsios and Liana from SOFPSI N.SERRON

Giorgos and Liana presented their experience from participating in empowerment and self-help groups offered by SOFPSI N.SERRON.

Giorgos:

“Hi and welcome to the city of Serres. I’m George and I am a man with a disorder, not a disorder with a man. If I only knew it 20 years ago… I would have not quit my studies, I might have not lost my job, and my wife might probably not have left me.

The weight of the system’s labels is dragging us down as much as the disorder or illness itself is. It is not money or social standing that makes the person. Look at Ms. Nomidou, SOFPSI’s president. She is loved for the work she does in the field of community mental health services. Her sole reward is spiritual, non-monetary.

Yet if you were to put her in “the system,” she would probably be quickly diagnosed with a disorder, such as delusions of grandeur-trying to rid the world of mental illness stigma and discrimination. After all, it’s not “normal” to help others for the sheer joy or inner peace it gives you. Ms. Nomidou is not a disorder, and neither am I.

It took me a long time to get to know that I am entitled to be treated with every amount of rights, respect, and decency. But I did not this alone…how could I ? We all need support to make decisions. And if support is necessary to choose a perfume or a pair of boots, you can imagine how support is being important to regain our confidence and take our lives in our hands.

I have been very fortunate that despite the system huge gaps in our area, there is a ray of hope for people labelled like me. Attending SOFPSI’s daily empowerment program I got empowered, gained access to information and re-gained decision-making power.

I learned to redefine who I am, what I can do and how to redefine my relationships. I am part of a group and I have a positive self-image. I can dream and I have hope. SOFPSI’s empowerment-oriented program is not a good but a best practice”.

Liana:

Hi, I am Liana and I have been diagnosed as a human being, Homo Sapiens. I am a woman who enjoys romance novels, long beach walks, love songs and fashion clothing. I forgot to mention that I also suffer from a mental disorder.

I have been part of or accessing the mental health system for more than 8 years and through that time I have had many feelings and thoughts about who I am. I had actually started to believe that I was dysfunctional and this was all my fault.

And then I came across the organisation SOFPSI and I joined their peer-support group. I got to know other people who have experienced distress like me. It was a big gift to myself, as I found I was not isolated anymore as someone who had experienced mental distress and been hospitalised and accessed services.

I have been able to talk to and be around people who could understand where I have been and what I am still going through. It is so important to be believed and validated as a person, as this kind of support from psychiatric services is simply not there and this was what I needed to deal with my traumas.

Peer support has helped me regain my dignity and my self-pride and their belief in me means that I am going to continue my fight for my full recovery. I have finally re-found my missing link to my full recovery and that is the strength of sharing a true reality with my peers.

This is how I set my mind to my recovery and I started to regain confidence, personality and rebuilt my identity. Now I know I am much more than a patient; much more than my disorder. An this could not happen without the help I got from SOFPSI’s peer-support group.

Situation in Israel

Yoram Cohen from ENOSH

Enosh, the Israeli Mental Health Association, was founded in 1978 by a group of families, volunteers, and professionals. Enosh initiates and develops many multidimensional services for mentally ill persons within communities throughout Israel – Housing, Employment, and Leisure. 55 branches spread, including the Arab Sector, which serves 5,500 patients and 3,000 families. Enosh’s mission is carried out by a volunteering board and implemented 700 employees and 900 volunteers.

Enosh goals are to promote the welfare and rights of people dealing with psychiatric disabilities, to provide professional rehabilitation services to individuals within and beyond the subsidized services, to improve the functioning abilities mental health patients and helping them reach an optimal level of independent functioning in society, self- realization and recovery, to develop innovative rehabilitation services for patients and their families and to rebut stigmas regarding mentally ill persons through information activities, events and media coverage.

Enosh operates: Housing, Occupational Training, Leisure, Family Support and Counselling Services, Raising Awareness and Advocacy with special projects as Drama and Dance groups, Musical Ensembles, Cafes operated by service users, Creative Writing Workshops, Business initiatives, Vacations in Israel and Abroad.

The Social Clubs – Enosh operates 75 Social Clubs which aims to develop social skills, to reduce the sense of loneliness, to teach how to use free time and getting integrated in the community. The clubs are operated in the afternoon and activities include: workshops, lectures, trips, circles, parties etc.

Supportive Housing – housing in the community as an alternative to hospitalization or staying at the parents’ household. It is adjusted to the mentally disabled individuals’ needs and creates a rehabilitative continuity. The supportive housing services operate in several levels: Individual, Group and Hostels.

The occupational training club – protected social framework, in which the patients can experiment in various occupations based on their needs and skills. Its goals are to develop work habits and personal skills, to improve learning skills, to be responsible, to improve solving problems and to expand social network.

Supported Employment – To assist professionally patients to integrate at the regular workforce.

Families Services – assist family members to adjust and deal with mental illness and encourage rehabilitation processes. Enosh operates Family counselling centers which support by: Individual, couples, peers, and support groups, provision of information, seminars and conferences.

Situation in Belgium

Rebecca Muller from UPS&DOWNS

Ups & Downs is a self-care organisation for people suffering from bipolar disorder and chronic depression. We support both patients and their family members in coping with these illnesses. Monthly meetings take place in nine regional groups in Flanders (the Flemish speaking part of Belgium). During these meetings, information on bipolar disorder and depression is given and the participants have the opportunity to share their experiences. The combination of information and personal exchange makes this kind of self-care within the Ups & Downs groups highly unique. Participants feel that they are no longer alone and can share their experiences with other sufferers.

The nine groups are located in various cities of Flanders: Lede (near Alost), Antwerpen (Antwerp), Brugge (Bruges), Gent (Ghent), Roeselare, Hasselt, Leuven (Louvain), Geel and Mechelen (Malines). These groups are run by volunteers who are often themselves patients or family members of patients.

For the moment, the organisation has about 20 – 25 active volunteers working across Flanders in the regional groups as well as in the board of the organisation.

Ups & Downs only receives as a volunteer organisation, but receives no financial support from the Flemish or Belgian government for the core activities and has no funds to employ professional staff members.

Ups & Downs also collaborates well with professionals, inviting them as guest speakers in the regional groups or at seminars. The organisation is becoming well-known for its expertise in professional circles and many doctors see us as a useful addition to complement their own therapies; in many cases they refer patients to our self-care groups. Volunteers from Ups & Downs often give lectures in schools, mental health centres, educational sessions in psychiatric hospitals and at other events where a larger public is reached.

Ups & Downs is also strongly involved in the changing environment of mental health care due to new Belgian legislation entitled “Article 107”. This new approach of the Belgian federal department of health, aims to decrease the hospitalization of people suffering from mental illness. More community self-care is planned And experts by experience are involved in care settings. Ups & Downs is growing fast: they currently have some 380 members (including partners and family).

Situation in Ireland

Jacinta Hastings from BODYWHYS

“A Vision for Change” details a comprehensive model of mental health service provision for Ireland. It describes a framework for building and fostering positive mental health across the entire community and for providing accessible, community-based, specialist services for people with mental illness. This comprehensive model of mental health service provision is:

Person Centred – service user involvement at all levels. Service users should be partners in their own care.

Recovery Oriented – care plans reflecting services users’ needs, goals and potential, addressing community factors which impede recovery.

Holistic – all aspects of mental health: biological (e.g. medication), psychological (e.g. “talking therapies”) and social (e.g. housing, employment, education/training).

Community-based – provide services in communities where people live, reduce hospital admissions, more home-based treatments and outreach services.

Multi-disciplinary – in addition to doctors and nurses, have a range of professionals e.g.psychologists, social workers, occupational therapists on all mental health teams.

Population-based – focus on mental health and well-being of the whole population, from childhood to old age

Presentation available here

Situation in Hungary

Robert Kristof & Istvan Gallai from the AWAKENINGS FOUNDATION

Both presentations are available to download:

Mental Health Care Services in Hungary and their Accessibility by Robert Kristof
Hearing voices groups in Hungary by Istvan Gallai

Situation in Czech Republic

Daniel Cernik from KOLUMBUS

Daniel presented the goal of the patient-driven organization which is to protect rights and interests of people with mental illness and improve their lives. He described how they work to improve laws for mental health users in psychiatric hospitals, how they help people before admission and after release, how they provide emotional support and accompaniment to patients in psychiatric hospitals and in the community (post, banks, home, local authorities, shopping). Daniel summarized that being paid to help patients to have a better social contact and increase their self-confidence and self-esteem, help both the recipient and the provider of help.

Situation in Wales

Tracy Lee & Ruth Wilson from HAFAL

Presentation available to download here: Access to treatment in Wales

Situation in the Netherlands

Bert Aben from VMDB

Bert Aben made an excellent presentation of the mental health service provision in the Netherlands starting from the middle-ages.

Participants also discussed and summarized what they believed to be challenges and opportunities to access to community mental health services. They also participated in an open-floor discussion about a common way forward. The following highlights points raised from this process:

Challenges:

An overwhelming experience of social exclusion, discrimination and negative stereotypes of mental health service users

The high numbers of mental health service users in psychiatric units and the huge stigma and shame which exists around issues of mental health within the community

The language/wording of “Mental Health”. This was felt to be stopping mental health service users engaging in services, and fed into a central topic of the stigma existing within communities

Fear of judgment from and within the community is a source of stress and a cause of mental ill-health. Mental health service users are afraid to say what’s going on in their head.

Opportunities:

Events like this seminar which bring GAMIAN-Europe member organizations together. Listening to each other.

There are currently many organizations delivering help and advice around mental health in the community. There are many networking opportunities in which GAMIAN-Europe member organizations can play a key role.

The way forward:

First point of contact on what to do if concerned about mental health needs to be more obvious/visible and well “sign posted”

GP’s need to have a better understanding of mental health related issues

Working groups – establish needs of local communities

We need to have a clear understanding of the effects that discrimination and social exclusion has had on mental health service users

Need to put supports in place to help individuals to work through these difficulties

Counselling, group work, discussion groups, peer-support groups, personal development courses need to be designed and implemented

It is essential that mental health service users are supported to talk about their experiences and how this makes them feel

Service providers need to develop empathy when working with mental health service users

Awareness raising events need to be developed to sensitize the community

Conclusions and recommendations

Generally, a wide range of community mental health services exists within Europe, with at least some available in every country. However, whilst a few countries lead the way in the successful implementation of community-based mental health services according to an evidence-based “balanced care model” that integrates elements of community and hospital services, in many others access to community-based services is still very limited and may commonly consist of small pilot projects. Although there is a definite trend towards an increase in community-based mental health services and a decrease in institutional care, the pace and scale at which this is occurring, as well as the quality of services, varies widely throughout the countries. Community mental health development faces a long road ahead. Efforts must be put into building capacities and developing improved ways to set priorities in the field of mental health and community mental health. Moreover, the role of the consumer movement needs to be that of a meaningful participant, and close collaboration between all relevant stakeholders, needs to be maintained.

Views and appreciations

Greece – Giannis: I talk, I go to school, I work. I am happy

Ireland – Jacinta: For me the meeting captured the benefit of these events and the richness of contributions.  This was a very beneficial learning experience and one which I value greatly. Serres gave us all – a great location, a warm welcome, an informative programme among friends old and new. It was truly a great Greek experience. I loved every minute of it all. The Greek night will stay with me for a long time – not as a tourist spot – but as a normal tavern where ‘normal’ people go on a Saturday night – to eat, drink and be merry.

Belgium – Rebecca: Many thanks again for being such a lovely and warm hearted hostess. The visit to the Monastery was wonderful and I will never forget that experience.

Hungary – Istvan: I had a great time in Serres. Nice to meet all of you ! Thank You for being part of the conference! –

Hungary – Robert: There are countries with better and worst situations than Hungary. That gives me an impetus to fight more against stigma, prejudice and help people live a better live. Still with the buzuki reverberating in my heart and the sweet lilt of the Greek folk music in my ears, and the fantastic ouzo in my veins.

Greece – Domna: Thanks to SOFPSI N.SERRON we learn what’s happening around Europe about good practices in mental health

Wales – Tracy: Happy with the positive and calm atmosphere here . happy to bring back home experiences of other countries.

Belgium – Rebecca: I appreciate what SOFPSI N.SERRON is doing without financial resources

Greece – Liana: I’ve got so many things from SOFPSI N.SERRON. I became a better person. Try to not give up. Control ourselves to not feel guilty