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International Psychiatric Hospital in Transition Alliance


International Psychiatric Hospital in Transition Alliance Questionnaire

This questionnaire has been drawn up with the aim of gathering the views and experiences of Hospital Directors, mental health managers, professionals, health directors and others who have worked in various ways and in different capacities to improve the quality of life of service users in psychiatric and social hospitals and community services around the world. We therefore are asking you to answer the questions as completely as possible, focusing on those aspects, which form part of your direct working experience. Therefore, when possible, use concrete examples from your own experience or that you know of indirectly. At the end of the questionnaire, please add any notes or comments regarding any relevant aspects, which you were unable to include in your responses to the questions given. The material gathered will be used to form the basis of the Alliance Partners wealth of experiences and will be shared as a learning opportunity for all of us.

Go to the Questionnaire here


Whole Person,Whole Life and Recovery into Practice Approach

A Twinning Collaboration Convention - A Common and Shared Purpose

Introducing a new IMHCN Network: International Psychiatric Hospital in Transition Alliance

The IMHCN with partners in India, Brazil, Malaysia, Serbia, Hungary, Palestine,  Azerbaijan, The Gambia, Canada, Italy and the UK have developed the International Psychiatric Hospital in Transition Alliance, this was founded at the 2015 Franco and Franca Basaglia International School held in Trieste.

This Alliance builds on the declaration made in Trieste in 2011 at the Franco and Franca Basaglia International School "Beyond the Walls" entitled  "The process of phasing out of psychiatric hospitals as places of social exclusion and the shift to community services" 

The Declaration proposes the following:

"1. Support and guidance in various countries for deinstitutionalisation and development of integrated/comprehensive Community Mental Health services by:

  • drafting of policies at the local and national level
  • strengthening leadership and management (e.g through the exchange of operators, on-site and off-site training, courses and stages)
  • supporting implementation and development of local services network
  • supporting workforce development (multidisciplinary teams)

2. Collaboration, partnership and networking with some countries/areas which demonstrate the willingness and capacity to deliver community based service development
3. Diffusion of Whole Systems & Recovery approaches: 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)"

In many countries the development of a comprehensive community mental health system to replace the psychiatric hospital has and will be a patchy and slow process. This is due to many factors, economic, political, environmental, social, educational and ideological.

However, there are excellent examples around the world of community services and recovery practices that have proved to be more beneficial in meeting the needs of people with mental health issues.

There are thousands of people in psychiatric hospitals in low to middle income countries as well as many in richer countries. They need more opportunities to improve their human rights, mental health and wellbeing whilst they are in these hospitals.

The main purpose of this International Alliance is to improve their quality of life, their human rights, to meet their individual needs, to improve their choice of treatments and therapies and to protect them from abuse and discrimination.

The World Health Organisation (WHO) has recently launched the "The QualityRights Programme" which aims to improve the quality and human rights conditions in inpatient and outpatient mental health and social care facilities and empower organizations to advocate for the rights of people with mental and psychosocial disabilities. The WHO states

"The care available in mental health facilities around the world is not only of poor quality but in many instances actually hinders recovery. It is common for people to be locked away in small, prison-like cells with no human contact or to be chained to their beds, unable to move. Violations are not restricted to inpatient and residential facilities however; many people seeking care from outpatient and community care services are disempowered and also experience extensive restrictions to their basic human rights."

The mission of the Alliance Partners will be to address these challenges by changing the culture in in-patient settings from one of maintenance and no hope to a Whole Person, Whole Life and Recovery Approach.

We will do this by:

  • Identifying and sharing best practice in improving the users experience in hospitals
  • Campaigning for their human rights
  • Identifying and sharing good examples of community developments
  • Examples of Whole Person, Recovery Practice
  • Creating a web page for each Alliance Partner on our website
  • Developing an Alliance newsletter
  • Identifying bad practices
  • Introducing a Learning Set on the process of Deinstitutionalisation
  • Providing training in deinsitutionalisation and community development
  • Offering to Partners a Learning Set on Whole Person, Whole Life-Whole System, Recovery into Practice
  • Acting as advocates for culture change
  • Introducing to Partners new ways of working with users and family members
  • Organising events in Alliance Partners Hospitals and community services

You can read the full proposal below.

 


 

Introduction

International Psychiatric Hospitals In Transtion Alliance

Twinning Collaboration Convention

Membership and Development of the International Psychiatric Hospital In Transtion Alliance

Membership Commitments

Becoming an Alliance Partner


Introduction

Over 200 years ago societies decided to treat people with mental health problems in a very different way to other people with health or social problems. No doubt motivated by a misguided sense of philanthropy and prevailing civic wisdom, coupled with societal changes towards industrialization in western countries. Thus creating an approach of ‘ Out of sight, Out of mind’ in isolated psychiatric institutions.

This system of institutionalisation developed both in scale and geographical spread to almost every country in the world. This set the standard and practice of mental health care that still exists in the majority of countries today. As a direct result of this, the public perception of mental health, often driven by fear, ignorance and an unhelpful popularist media, is invariably stigmatising, negative, misunderstood and biased. Progress in developing more humanistic community services and therefore a different attitude towards mental health by the public has been slow and patchy.

There is little doubt that much progress has been made over the past thirty years both through the introduction of more effective clinical interventions, e.g. atypical neuroleptics, psychological therapies and the development of new community service models, including, more recently, what has come to be known as. ‘functional’ community teams. However, whilst these developments have been steps in the right direction they have not produced the sorts of outcomes or quality of life that service users would desire. It may also be said that users remain in a relationship that assumes that others ‘know best’ about the nature and course of the assistance that may be offered or available. Choice of treatments and therapies remains illusive and there is still much that focuses upon ‘treating the symptoms’ of mental ill health rather than enabling people to seek their self determination and self management .They should be given the best opportunity to have mental good health but also to retain or indeed gain the sorts of social experience that we all desire and enjoy.

The IMHCN Whole Person,Whole Life-Whole Systems Approach sets out a clearer framework of what needs to be developed to meet the whole life needs of service users. Development of mental health services that truly embrace the full implications of this in its entirety will require people to embrace local solutions that go beyond simple reconfiguration of existing staff, services or resources. It will also require organisations to put at the centre of their activity a real understanding of the needs of individual service users and focus their purpose and resources on meeting those needs by drawing upon the resources and supports available in people’s local networks and communities.

People with mental health problems still face discrimination, isolation, stigma, misunderstanding and abuse of basic human rights and needs. Attitudes and practices and service systems still need to overcome archaic institutional thought and ways of working with users. New forms of community facilities that were developed at the time of closing institutions are in some cases still institutions themselves. These foster and have perpetuated social exclusion and in some cases reproduced social isolation and re-enforced the community’s belief in that people with mental health problems are still very different and need expert care separate from other services in society.

Experience across the world has demonstrated that effective and efficient services and practices can improve users functioning and enhance their opportunities in a local community but also have a direct impact on reducing the myths, stereotypical attitudes and also improve the understanding of local people of the needs of users and consequentially reducing stigma. There is a strong correlation between good service systems and communities’ willingness to become involved in finding new solutions that can improve people’s mental health and well being.

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International Psychiatric Hospital In Transition Alliance

In many countries the development of a comprehensive community mental health system to replace the psychiatric hospital is not likely at present. This is due to many factors, economic ,political, environmental, social,educational and ideological.

There are thousands of people in these psychiatric hospitals in low to middle income countries as well as many in richer countries. They need more opportunities to improve their human rights, mental health and wellbeing whilst they are in these hospitals.

The main purpose of this Alliance is to improve their quality of life,their human rights, to meet their individual needs, to improve their choice of treatments and therapies and to protect them from abuse and discrimination.

The mission of the Alliance Partners should be to change the culture in in-patient settings from one of maintenance and no hope to a Whole Person,Whole Life and Recovery Approach.

A person with a mental health issue has the same basic human needs as all of us. Recognising the whole person is the way to develop and lead a life that is full of purpose, interest, recognition, contribution, value and reward. People with a mental health problem are seeking a whole life comprising of these needs and aspirations. Enabling people to have a whole life opportunity and assisting them in their recovery and wellbeing requires full access to health, educational opportunities, vocational training schemes, work, volunteering, social networks, sport and leisure, art and culture and faith and religion.

In many places, hospitals, community organisations and individual mental health workers, users, family members have developed services, projects,programs, new practices and research in hospitals and the community that have been of benefit to users and family members.

An important purpose of developing this Alliance is to share and learn from these good practice examples from across the world.

In some countries where the psychiatric hospitals have closed there is still a need to develop a culture of Whole Person Whole Life and Recovery into practice in community services.

The IMHCN is working with these and this work can be shared through this Alliance.

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Twinning Collaboration Convention

A well established method of working together for a common and shared purpose is the Whole Person,Whole Life-Whole Systems Twinning Collaboration Conventions that IMHCN has developed.

The Whole Person,Whole Life-Whole Systems Twinning Collaboration Convention brings together people and organisations that wish to learn from each other in a reciprocal way that addresses the following:

  • identifying areas of good practice based on our philosophy, values and practice
  • agreeing areas of common interest in service development and practices that promote the Whole Person, their Whole Life and opportunities for Recovery
  • overcoming the barriers of thinking, practice and organisations that prevent progress in achieving a whole life for people.

The Twinning Collaboration Convention has been developed and supported by IMHCN members over the last eight years and has proven to be an effective way of introducing new ways of thinking and working.

The Twinning involves two, three or four organisations who have identified a common agenda and wish to apply this to change and develop their services and practices.

The organisations develop a programme for study visits where workers, service users and family members spend time examining the day to day operation of each other services and practices.

Lessons learnt by the study groups about the visited services are then discussed and shared with a wider group of colleagues and managers within their respective organisations.

Consideration is then given by participating  organisations to the application of the learnt thinking and practice within their local services.

A  partnership and networking MOU agreement is then established and overseen by a joint steering group from members of participating organisations.

An implementation plan is agreed between the participating organisations that sets out the process of change that is needed to bring about the new ways of thinking and practice.

The plan should include as a foundation to our understanding of each others circumstances in the following areas;

  • Clarity of service provision in each Service Provider Organisation
  • Situational analysis of the needs, characteristics and numbers of people currently using the service.
  • Population needs assessment across different localities
  • The range of treatments and therapies available to service users
  • To gather information on evidence based practice in hospitals and local partners
  • To build relationships and partnerships with local community resources
  • Methods used to reduce the stigma and discrimination by people and the public
  • Improvements made to improve the hospital environment
  • What has been done to introduce the Whole Person, Whole Life and Recovery Approach in In-Patient settings

We also need to improve our knowledge of hospital and community mental health nationally and internationally by;

  • Gathering information and research on evidence based practices in the literature but also through unpublished material through our Networks.
  • Examining philosophies and belief systems that have changed the thinking of professionals, service organisations and the public.
  • Recognising the values and guiding principles that have gained and sustained new ways of working with people with mental health problems over long periods of time.
  • Gathering user and carer stories of experiences and positive things that have helped them to recover

An important aspect of improving the lives of people in the psychiatric hospitals is to provide opportunities for them in a wide range of meaningful occupation including:

  • Full time – part time work in open employment
  • Self-employment as advocates, trainers, etc.
  • Casual work as a means of gaining confidence.
  • Volunteering in community work.
  • Social firms – social enterprises developments.

Research conducted over the last 30 years has demonstrated that employment opportunities are of considerable value to people with mental health needs in assisting in their recovery, including those with long term and severe problems. Work and meaningful occupation is a central part of everybody’s purpose in life and society itself. Through this meaningful purpose in life we also meet our needs for achievement, meaningful relationships, self-esteem, our identity and how we contribute to our communities. This is more true for people with mental health problems.

The Member organisations in these Twinning Convention Collaborations should hold progress meetings, workshops and host joint conferences in the development of this Alliance and its work programs focussing on the following:

  • Identifying and sharing best practice in improving the users experience in hospitals
  • Campaigning for their human rights
  • Identifying and sharing good examples of community developments
  • Examples of Whole Person, Recovery Practice
  • Creating a web page for each Alliance Partner on our website
  • Developing an Alliance newsletter
  • Identifying bad practices
  • Introducing a Learning Set on the process of Deinstitutionalisation
  • Providing training in deinsitutionalisation and community development
  • Offering to Partners a Learning Set on Whole Person, Whole Life-Whole System, Recovery into Practice
  • Acting as advocates for culture change
  • Introducing to Partners new ways of working with users and family members
  • Organising events in Alliance Partners Hospitals and community services

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Membership and Development of the International Psychiatric Hospital In Transition Alliance

The approach, purpose and values of the Alliance is concurrent with many local, national and international policies and strategies.

Psychiatric Hospitals in low to middle income countries around the world will be invited to apply for membership of the Alliance. They will need to sign up to the commitments and agreement listed below.

We will also invite mental health service providers in other counties whose contributions will be valuable to the success of our work. This will include learning from the processes of deinstitutionalisation where psychiatric hospitals have been succcessfully transformed into community mental health services.

The Alliance and Twinning Collaborations should be regarded as core business of each partner organisation on changing and developing mental health services. As this is a significant way of introducing new thinking practice and systems; the capacity to bring about improvements for users and the services should be fully recognised and adopted by the hospitals and organisations.

The IMHCN will help to coordinate and facilitate the Alliance and its programs. This will bring coherence and a strategic direction through the partnership working with all organisations that will need to collaborate and deliver their particular contributions

In order to make this a reality within each partner organisation and their wider communities there is a need to establish small effective local project groups to oversee and manage the development of the work of the Alliance and Twinning Collaborations.

The project groups will consist of senior managers and clinicians, users,family members, mental health workers and NGO’s.

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Membership Commitments

Members should agree to:

Sign up to the IMHCN Charter of Purpose and Action (see www.imhcn.org)

Share information about the implementation of the Whole Person,Whole Life – Whole Systems developments within each organisation and their community partners with their Networks

Participate actively in this Twinning Collaboration Convention Program

To be prepared to host an occasional International School on specific topics of interest to the membership of the Alliance

To be prepared to contribute and participate in IMHCN conferences, symposiums and workshops

To identify individuals who would be prepared to provide expertise and contribute to the IMHCN international developmental work

To spread knowledge of the work of IMHCN through seeking potential new partners and members in their region and country

To provide information, materials, articles, research for the IMHCN website

To participate in IMHCN social media and website forums

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Alliance Partners

The Founder partners are:

India

Brazil

Malaysia

Serbia

Hungary

Palestine

Azerbaijan

The Gambia

Canada

Italy

UK

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