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Developing innovative community based services and supporting deinstitutionalisation
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.
Trieste Community Mental Health Centres Presentation by Roberto Mezzina