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Charter

Introduction

Charter of Purpose and Action

The IMHCN Values and Principles


Individual Service Users

  1. Citizenship
  2. Recovery
  3. Whole Person, Whole Life and Wellbeing
  4. Cultural Diversity and Values
  5. Respect and Dignity
  6. Individualisation, Identity and Personal Responsibility

Community Mental Health Services

  1. Person Centredness
  2. Accessibility
  3. Comprehensiveness
  4. Effectiveness
  5. Equity
  6. Evidence based practice and values
  7. Family involvement
  8. Efficient use of resources
  9. Relationships
  10. Advocacy

IMHCN Charter Articles:


Introduction
This Charter sets out the basis upon which organisations and individuals who wish to be members of the IMHCN will be encouraged and assisted to improve their mental health policy, service development and practices based on a Whole Life-Whole Systems approach.

Members are required to formally adopt the vision, philosophy, values and principles and to apply these to service development and practice.

This commitment will need members to embrace the centrality of the individual and their right to full citizenship.

Achieving the vision and reality of a Whole Life-Whole Systems approach will require members to work with all stakeholders to endorse a community common purpose of learning, collaborating and networking. Working together to explore, reconcile and operationalise by action, the shared values and principles that underpin social inclusion and recovery processes.

Over the last thirty years, governments around the world have increasingly developed policies and strategies to introduce community mental health systems to replace the institutional system. However, good quality, comprehensive, effective and socially inclusive services have only been developed in a relatively small number of places.

In every country challenges and, concerns remain. Many large institutions still exist, but even where they have been phased out, institutional thought and practice are still evident. Comprehensive community mental health services have not been fully implemented, and are not integrated with other community resources, such as education, housing, leisure and work opportunities. Unhelpful boundaries and obstacles, which segregate and exclude remain in place across many communities. This poverty of ‘ordinary life’ in current supporting services makes long term care and support a barrier for many people with enduring problems. It similarly presents very real problems for people with more ‘common’ and/or brief mental health problems. Even where community mental health services have been better implemented, the experience and expertise of service users has not been well used and thus their importance minimized. A real consequence is the stigma and discrimination are still everywhere in many communities.

The IMHCN through its members, can provide solutions to overcome these difficulties and challenges to enhance community mental health that can provide service users with the opportunities for recovery and social inclusion.

Mental Health Organisations, Services Groups and individuals that uphold the values and principles and practices outlined in the Charter can apply to become members of the IMHCN. We wish to capture good practice from our membership to demonstrate the potential of introducing the Charters Values and Actions within the culture and routine day to day work of all organisations.

We strongly believe that recovery for individuals can be achieved if there is the necessary commitment from mental health services to implement a Whole Life-Whole Systems methodology. By joining with the IMHCN, our Programmes, Learning Sets, Education, Training, Exchanges and Online resources will be made available to you.

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Charter of Purpose and Action
The IMHCN Charter sets out the purpose of what we believe is necessary to achieve a Whole Lifefor people with mental health issues. Our mission is to:

- enable people with mental health issues to obtain full citizenship free from stigma
- fight for social inclusion in all life domains
- campaign and advocate for human rights and social justice around the world
- promote and support community based mental health services through the closure of institutions
- better meet the needs of the communities we serve through community participation and partnership
- promote a Whole Life System development approach involving as partners Governments, policy makers, community organizations, service providers, professionals, managers, service users and families.

The charter has seven core Articles that set out our purpose and how these can be achieved by member organisations and individuals. The charter has at its core a fundamental belief in the values and principles that should be applied to any mental health service and professional practice.

Founder members of the IMHCN have experience in applying the values and principles below in designing and developing in effective and comprehensive community mental health services and practice.

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Individual Service User IMHCN Values and Principles

Individual Service Users
1. Citizenship
The concept of citizenship incorporates the belief in equal rights for every individual regardless of their circumstances to access civil, political, social and economic opportunities. It is particularly important for people with mental health problems to enjoy the same rights and social justice as all citizens and to be protected from laws; social exclusion; institutional service and treatment practices that segregate or discriminate in any form or kind.

2. Recovery
The concept of the recovery approach for service users is founded in human values and their application by the service user, professionals and the service itself. Its objective is to achieve health and wellbeing regardless of the degree of disability or distress of the individual.

It requires a paradigm shift in thinking from pathology and illness to self determination, life stories, human strengths, hopes and dreams, peer support and control by the user with support from professionals as partners, mentors and advocates.

It should be rooted in cultural, social, religious and ethnic diversity that gives meaning to the persons identity, belief and circumstance.

To promote the recovery approach staff should reevaluate their role in the treatment process to one of negotiation, partnership and trial and error.

Service organisations need to allow and support staff in practicing in this way by adopting a culture of creativity, innovation, openness, encouragement for diversity and recognition for good practice.

3. Whole Person, Whole Life and Wellbeing
A person with a mental health problem 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 s 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.

The IMHCN Whole Life approach promotes this by applying a Whole Systems methodology in the design, planning and implementation of a comprehensive integrated mental health system. The Whole system has to have an agreed common purpose and objectives negotiated and owned by all community stakeholders. In this way the components of the System are interdependent with each other and have themselves a well defined contribution to the Whole System. The Whole is the most important objective and not each component on their own.

4. Cultural Diversity and Values
In many countries in the world people from diverse ethnic backgrounds have struggled with being treated as different to the rest of the community. This has a significant impact on peoples wellbing and mental health. In Western countries people from black and minority communities are over respresentative in services and it is acknowledged by policy makers and providers as an issue of concern.

Specifically, more people from diverse ethnic backgrounds are diagnosed as having a mental health disorder for emotional and mental distress, furthermore they are being diagnosed with serious mental illnesses more than the rest of the population. In some countries, particularly the UK, people from these backgrounds are being compulsory treated and to stay longer in hospital than the rest of the population.

Instead of people from diverse ethnic backgrounds being stigmatised and treated differently they should be valued for the diversity and richness they bring to society. All people having an impact on an individual’s wellbeing should be aware of their own perceptions, assumptions and prejudices particularly when making judgements and assessments of an individual’s mental health status.

There is much to be learned in the world from cultures, ways of life and the ways people are included of people in every aspect of a community life. For example there are many countires in the developing world with greater recovery rates from serious mental health conditions in comparison with European and Western countries. The evidence from international longitudinal studies need to be taken into account by service users, family members, policy makers and providers.

5. Respect and Dignity
Every person has the right to be treated with respect and dignity and it is essential that this is common practice by professionals, organisations and the public. Being treated with respect and dignity enhances people’s feeling that they are worthwhile and are valued, useful and important as fellow human beings. This will lead to the person gaining confidence in their self worth, self respect, ability and contribution to society.

6. Individualisation, Identity and Personal Responsibility
People want to be regarded as individuals and not to be identified or labelled by their diagnosis or pathology. People want to be in control of their recovery journeys and assisted by services in a equitable and empowering way. All to often people have been slotted into an illness paradigm that disempowers and maintains people within mental health services. Professionals and services need to recognise and harness the capabilities and assets of people with mental health problems. People with mental health problems need to take personal responsibility for their own recovery journey. In this way an individual can take the power to ensure that their unique goals, strengths and needs are harnessed, are fully recognised and acted upon

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Community Mental Health Services

1. Person Centredness
Knowing the person is fundamental to establishing and maintaining a trusting relationship and only by working alongside a person in this way can practices and treatments be fully effective.

2. Accessibility

Services should be organised and provided in a way that enables easy access through a single point of entry with a pathway that is well understood by users, carers and other providers. Whenever possible services should be provided close to where people live.

3. Comprehensiveness
It is well understood that a comprehensive, well integrated service system that meets the needs of people in a way that is holistic and provides continuity of care is much more likely to provide better recovery opportunities and outcomes for service users. Each component of the service should be seen and interwoven as part of the Whole System.

4. Effectiveness
To ensure the best outcomes for people, services should be; evidence based, subject to good governance, meet quality standards and performance indicators that promote and measure their effectiveness.

Mental Health Services and resources should be organised and provided at an equitable level and standard to every geographical area in a given region or country. This will ensure that the whole population is being served.

6. Evidence based practice and values
It is acknowledged that there are many treatments and therapies that are effective for many mental illnesses. These should be commonplace and where necessary introduced into the daily practice of professionals to maximise the best outcomes for service users. Service users should be given choice and be able to determine and access the most appropriate treatment and therapy to meet their need.

7. Family involvement
Families and friends should be valued and involved as partners in the recovery process of the service user, alongside professionals and the service as a whole. The involvement, education and understanding of mental health and the needs of their family member by families and other supporters is an essential part of a participative, effective, positive therapeutic alliance and experience.

8. Efficient use of resources
Mental health human and financial resources are not always sufficient to provide the best service possible in most countries. This is particularly the case in low to middle income countries. It is fundamental that the resources that are available are used in the most efficient and effective manner. Resources should not be wasted on administrative and bureaucratic structures and large psychiatric hospitals. Instead they should be focussed on developing frontline services that directly support service users. The priority should be to develop and support effective community based services.

9. Relationships
The evidence base demonstrates that the most important factor in developing an effective therapeutic alliance is founded the trust forged between the people working in services and the people using the services. These relationships must be mutual, reciprocal and founded on good rapport and shared responsibility.

10. Advocacy
Advocacy in all its forms seeks to ensure that people, particularly those who are most vulnerable in society, are able to have their voices heard. People with mental health issues often have difficulty in having their voices heard on issues that are important to them. In defending and safeguard their rights and have their views and ensuring their wishes are genuinely considered when decisions are being made about their lives is the repsonsibility of us all.


Professionals, family and friends have a role in advocating for the person. It is essential that people with mental health issues must have access to a range of advocacy services that professionals are aware of and support the person to access they include;

  • Citizen Advocacy
  • Independent (Issue-based) Advocacy
  • Group Advocacy
  • Peer Advocacy
  • Legal advocacy

Advocacy services should be independent of service providers and not be controlled by the organisations that are providing the mental health services. This is because advocacy has to be truly independent to be effective. The goal of advocacy in all its forms should be to enable and support the person to develop the confidence and skills to be able to speak and advocate for themselves.

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IMHCN Charter Articles

Article 1: Promoting and advocating for human rights for people with mental health issues

All over the world there is still widespread stigma about mental health and towards people with mental health problems

This can take various forms;

  • complete isolation from the community
  • laws that discriminate and exclude people
  • suppression and denial by families
  • institutional services and practices
  • violation of basic human right
  • physical and psychological abuse

This stigma and belief system has its origins in how society chose, 200 years ago, to deal with people that they thought were very different from the “rest’ of society. Consequently, this has dictated the nature of the legal response, service provision, clinical practice, this in turn has perpetuated stigma and the social exclusion of people with mental health problems.

Whilst there has been some worthy exceptions to this, they are few in number, compared to the general situation throughout the world.

The IMHCN is committed to work with others to continue to fight all forms stigma and to promote actions and solutions to overcome them.

Some of the actions that can be taken to reduce the misunderstanding and misconceptions of society are:

  • No restrictions in life for people with mental health problems in society through laws that discriminate
  • Developing educational programs in schools, colleges and universities and vocational learning
  • Promoting positive messages and stories of good mental health and recovery to all forms of media (including journalists, TV and Radio producers, online platforms etc)
  • Organising effective, consistent and regular anti discrimination and positive identity campaigns within local communities
  • Developing publications and other media (e.g videos and audio) to educate the public empowering and enabling carers and users to share their own stories
  • Advocating and campaigning for legislation to protect the rights of users.Educating professionals on how to interpret correctly the implementation of mental health laws to the maximum benefit of people with mental health problems.
  • Mental health service providers also need to play their part in challenging practices and services that perpetuate stigma and discrimination.

Some essential targets for action include:

  • Reducing and ending locked facilities in acute in-patient settings
  • No physical or chemical restraint
  • Reducing compulsory admissions and treatments
  • Reducing the need and use of specialised forensic services
  • Reducing the lengths of stay in acute in-patient and other settings

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Article 2: Campaigning for social inclusion for service users and their families<

Issue
We need to Develop the responsibility and commitment of the wider community for mental health through harnessing community resources and seeking the active support and partnerships of local and national community organisations and groups.

The key causal and aggravating factors to good mental health and the opportunities for recovery is improving social determinates in the community. These are factors such as poverty, unemployment, poor housing, lack of education, social isolation etc.

It is also important to move away from the ever increasing preoccupation and misunderstanding that society has about security and risks posed by people with mental health issues. This has led to unjustified anxieties and myths resulting in social exclusion and restricting the potential and real ability for people with mental health issues to play their full part in society.

ActionWe need common purpose and understanding for improving mental health and wellbeing of the population by harnessing community resilience. This will be achieved by the the development by communities of a Whole life Whole Systems Strategy for Mental Health.

The process of developing a strategy will be through engaging with forming partnerships with all relevant community stake holders that have real or potential capacity to improve opportunities and access in all life domains (housing, employment, volunteering, art and culture, sport and leisure and education).


Article 3: Protecting and Respecting Culture and religion
Good mental health is recognised as an integral part of a person’s wellbeing, embedded in all aspects of a whole life, their beliefs, faith, culture, environment, spirituality, work, housing, education, family and community respect.

There is much to be learnt in western countries from the holistic approach practiced in some developing countries.

When assisting developing countries and black and minority ethnic populations within western counties, care must be taken not to promote or impose western ideas and models, as these only perpetuate outdated ideas of a western medical model.

Further, it is important to apply culturally sensitive approaches and competencies in attitudes, understanding and practice towards people all over the world.

To achieve this, recognition and respect for peoples backgrounds, traditions, beliefs, customs and local and natural helping networks must be fully acknowledged.


Article 4: Developing innovative community based services and supporting deinstitutionalisatio<
The design and development of a community mental health service system should be based on the creation of community mental health services which are integrated, non-stigmatizing, transparent and coherent. The main focus is to enable the development of community strategies that address the wider mental health and well being of people in a given community.
To achieve the development of community health service the fundamental starting-point remains a deinstitutionalisation of all services, this aims to supersede the psychiatric hospitals, but also the danger of retaining an essentially reductionist medical model, which finds expression in current psychiatric practice of only “treating and curing illness”.

The fragmentation of separate responses for specific needs of individuals should be avoided. The primacy of bureaucratic categories and ideologies of exclusion only reproduce separation and depersonalization. Further, notions of ‘primary and secondary’, ‘enduring and common’, ‘serious and mild’ create barriers that prevent the adoption of citizenship and community models of care.

The following basic presuppositions are at the heart of the Network’s drive for modern practice intended to produce positive outcomes for communities and people with mental health problems:

  • Breaking the domination of the medical paradigm, and reconstructing and endowing individual life-stories with value in a culturally and community appropriate way.
  • We must acknowledge that illness or distress can be an expression of suffering within persons life domains. Therefore the adoption of a therapeutic approach should take the ‘whole life’ of the individual into full account and recognises his or her uniqueness as a citizen of a given community. People do not wish to be excluded because of a mental health problem as everyone has the potential to have a whole life with or without the presence of mental health symptoms or problems.
  • We affirm the need to protect human rights as the fundamental element in the care of any individual by supporting a person to good health, whilst protecting and enhancing their status as a citizen.
  • A community mental health and social care service system should be comprehensive and integrated with primary and secondary health services. It must be part of a Whole System of social/welfare services, education, housing and employment agencies, meaningful work opportunities, using community resources and operated as a whole community system.
  • Wherever people are receiving services it is important to ensure trusting relationships, consistency of approach and continuity of care between services, therapies and treatment.
  • All services should be planned and implemented based on IMHCN shared practice, values and principles.
  • The lessons learnt from the ongoing deinstitionalisation programmes around the world for the last thirty years need to be captured for policy makers, service providers, campaigners and community leaders wishing to undertake the closure of psychiatric institutions and the development of community wide services.

Article 5: Acting on and developing new thinking in practice, treatments and care
Issue
There have been many advances in our understanding of how to promote mental health wellbeing,
resilience and recovery. The evidence for this comes from various sources and methodologies, including individuals, communities, health and social care services from many different cultures. These includes individual testimony of service users and families and research findings.

Action
Research and best practice indicates that there are key innovations that we need to further develop and implement to provide effective support, care and treatment for people with mental health issues.

  • New community mental health practice and systems should be based on these foundations:
  • All practices should be provided in non-coercive ways and without the use of force or restraint
  • Care, support and treatment should be provided to people in their own local communities,in their homes, wherever possible based on the choices made by the person
  • Mental health services should be integrated into primary health care systems
  • Services must be accessible and available when and where the person requires them, on a 24 hour / 7 day a week basis
  • All people regardless of their status must have equal opportunity and culturally appropriate access and experience of relevant service provision
  • Identifying mental health issues at an early stage and providing effective support should be provided as quickly as possible
  • Care, support and treatment must be person centred and based on individual need and choice
  • Practices should incorporate the means to evaluate service user experiences in their use of treatments and supports
  • Improved access to effective modern methods including talking therapies
  • Mental Health systems should adopt the latest service user led research evidence for delivering effective support and practice
  • Mental Health systems should encourage and support the development of user run services as an essential learning in the development of all services
  • Effective recovery care practice should be coordinated through Multi-disciplinary Team Work that promotes access to a range of effective services
  • Greater promotion of self-management and peer support techniques and skills by service users and family members
  • Increasing access to individual talking or psychological therapies
  • Developing support to families
  • Promoting in everyday practice, opportunities for employment through vocational training, social enterprises and engagement with local businesses
  • Promoting the proper and effective use of medication
  • It is essential to ensure service users have access to, and the necessary provision of physical health care

Examples of Good Practice can found on our website www.imhcn.org


Article 6: Encouraging action research in new ways of working
Issue
It is necessary that innovative practices are further researched to demonstrate their effectiveness.

Further, qualitative and participatory research needs to be given equal status to quantitative methodologies. Importantly equal care needs to be taken in determining the validity and applicability of current “scientific methodologies”.

Action
Research must be based on peoples experiences and narratives. It should be co-produced and encompass a diversity of view points and positions and relevant to the priorities identified by people, their lives and needs.
New research centres and networks need to be established and further developed, for example the IMHCN Research Network and the Hearing Voices Movement Research Centres.


Article 7: Person Centredness
People have a responsibility for determining for themselves the lives they lead and their own wellbeing. This is particularly relevant when they are concerns about the persons mental health and well being. The services should encourage and support the important principle of self determination by providing services and practices that support and underpin this.
1. Choice: Service users should be able to determine their own recovery plan in collaboration with their workers, families and significant others. Service providers should accept that recovery is a process requiring every service user to be regarded as a unique individual. Their wishes, needs and hopes should be at the centre of service provision.2. Relationships: The service user should be able to determine the person they want to work with based on the importance of a trusting relationship.
3. Ownership: Service providers should accept that the service users are experts in their own life experience and this should be the foundation of a therapeutic alliance with the expert by profession.
4. Opportunities. The service user should have available the same life opportunities as a person without a mental health problem.

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