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Human rights and citizenship in community mental health

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Human rights and citizenship in community mental health

  1. 1. Human Rights & Citizenship in Community Mental Health Indigo Daya Policy & Communications Manager, VMIAC Honorary Research Fellow, Faculty of Law, UoM @vmiac @indigodaya TheMHS Summer Forum 2019 Speaker notes
  2. 2. Crisis support? Or dangerous double binds? Personal experience: How the system put me at greater risk Last year I had a powerful and very personal reminder of how poorly we support people in the community during crisis. I had a return of suicidal thinking,, and I knew that I needed to reach out for some help. The problem was, I knew if I was honest about what I was feeling, I was at risk of being forcibly medicated or hospitalised. These responses are not helpful for me, in fact they’re traumatising and would have increased my risk of suicide. The existence of compulsory treatment put me at serious risk of not being able to get help in a crisis. When we say that compulsory treatment, and breaching rights, is necessary to protect people’s safety—is that really true? Not for people like me.
  3. 3. 1. Assume there is no safety or quality without human rights. Human rights limits & breaches in community mental health Compulsory Treatment Orders (CTOs) Discriminatory barriers to NDIS (because there isn’t) Human rights is not a separate subject to quality and safety. From consumer perspective, a service is not safe if we lose our rights. A service is not good quality if we lose our rights. Conversations about quality and safety in mental health are meaningless if they are not underpinned by human rights. Limiting, or breaching, human rights is not a benign act. Too often in mental health settings, people think that ignoring human rights is benign. It’s not benign: for many people, a loss of rights is a loss of dignity— and this can be emotionally harmful. In community settings, CTOs and NDIS barriers are the big ‘negative’ rights issues.
  4. 4. 2. Evolve our thinking. Mental Illness & symptoms Health & human services system Professionals lead, consumers participate Mental, emotional, social, spiritual Meaningful reactions, social determinants, trauma & diversity Citizen control, peer & community-run alternatives Consumer leaders, ‘professional’ allies Before we can improve rights, we have to change our conceptual thinking. People in the consumer/survivor movement have long conceptualised issues and opportunities differently to those working inside the mental health system. These different concepts are fundamental to improving rights. If you only see my distress as a meaningless symptom of illness, you may feel more justified in breaching my rights. If you see my experience as a meaningful reaction to terrible things that happened to me—then my rights become central. We need to get over past practices that always place clinicians in leader roles, and consumers as minority participants. Consumers can, and should, lead conversations about our own lives.
  5. 5. 3. Only fund services that support personal recovery hope making sense Fund for the outcomes that matter to us. Too many mental health services are funded to do things that are contrary to personal recovery. Recovery is still not even well understood in the mental health sector—I’ve certainly never even seen a clinical service that was genuinely recovery-oriented. We need services that make a meaningful difference in the important parts of our lives and mental health experiences.
  6. 6. Any customer can have a car painted any colour that he wants so long as it is black. - Henry Ford This is a well known quote by Henry Ford. And it seems to me that this same kind of thinking prevails in mental health systems…
  7. 7. You can get treatment in any form you like, as long as it’s medical. Quite simply, we have to do much better than this.
  8. 8. Bio-psycho-social choices in mental health People have talked about biopsychosocial mental health services for years now. We’ve even evolved to sometimes talk about bio- psycho-social-spiritual- ecological. But if we look into the cupboard of mental health services, the reality doesn’t stack up to the rhetoric.
  9. 9. Genuine bio-psycho-social options & choice BIO Medical treatments: ―Voluntary ―Fully informed Physical health care PSYCHO Counselling & Therapy Group programs Trauma specialist services Hearing voices approach SOCIAL Places of belonging Peer communities, drop-ins Equal access to a home, work, standard of living Open dialogue approach, Safe Haven cafes What genuine bio-psycho-social services might offer These are just some of the kinds of services that the sector should be providing, if we are serious about providing services that respect rights, and that make a real difference in people’s lives.
  10. 10. Consumer-led services Peer-run services (drop-ins, respites, specialist, groups) Independent peer workers ‘…people who accessed consumer- operated services experienced improved levels of empowerment, social inclusion, well-being, housing, employment, hope and program satisfaction, than those who accessed only traditional services. Grey, F., and O’Hagan, M. (2015). Evidence Check: The effectiveness of services led or run by consumers in mental health. Mental Health Commission of New South Wales, Sax Institute. Governments need to start funding consumer-run services as well. It’s great that we’ve had such growth in peer work in Australia, but it’s only the first step of many. Countries around the world are fast outstripping Australia with peer-run services. These places are fundamentally different to what’s currently on offer. They are rights based, often creative, and they make a difference.
  11. 11. Cheat sheet on innovative, rights-based approaches • The Open Dialogue approach (Western Lapland, UK) • Intentional Peer Support (US, Australia) • Peer zone (New Zealand) • Peer-run services, including respite services • Piri Pono (New Zealand, consumer run residential service) • Afiya Peer run respite (USA, consumer run peer respite service) • The Leeds Survivor-Led Crisis Service (UK) • Safe Haven support cafes (UK) and other types of community hubs for both crisis and non-crisis • The Power Threat Meaning Framework (British Psychological Society, UK) • Hearing Voices Approach (Intervoice, UK; Voices Vic, Victoria, Maastricht, NDR) • Alternatives to Suicide (Western Mass, US) • Alternatives to Coercion in Mental Health Settings (Melb Social Equity Institute, UoM) Learn about the possibilities If you are a leader in mental health, you should be well- informed about the services and approaches listed on this page. Please use the links on this page and learn about the many innovative options we could, and should, be developing in Australia. If you’re in a position of power, start finding ways to fund these services.
  12. 12. 4. Support us to achieve equality Negative rights • Victims of violence • Discrimination Positive rights • Employment • Standards of living • Health & life expectancy Our rights in the community are central to our mental health. If you work in community mental health, it’s critical that your work contributes to addressing inequalities. Not just within services—but across our experience in the wider community. Negative rights Understand the high prevalence, and mental health impacts, of being a victim of violence in the community, and of being discriminated against in many common settings. Positive rights As mental health consumers, we are one of the most disadvantaged groups in society. We need support and pathways to jobs, a home, a decent standard of living. We need urgent action to stem the shocking reductions in our life expectancy.
  13. 13. Human rights & citizenship in community mental health 1. Assume there is no safety or quality without human rights 2. Evolve our thinking 3. Only fund services that support personal recovery • Genuine bio-psycho-social options & choices • Consumer-run services 4. Support us to achieve equality
  14. 14. www.vmiac.org.au

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