jueves, 14 de diciembre de 2017

Reforming Mental Health Services in Europe.

Report from the working group "Reforming Mental Health Services in Europe"; Conference “The right and the opportunity to have a whole life”. Trieste, Italy; 15-18 November 2017.
Ricardo Guinea. WAPR President.

Organisers of the conference, leaded by Roberto Mezzina, succeeded in gathering a group of expert professionals from different countries of Europe, and inviting them to present a report on how the different countries are dealing with mental health services, with its transformations and its challenges. The meeting and their reports conformed a varied panel of information, personal opinions and assessments that I will try to summarise.

                  On the one hand, we had reports from countries that are succeeding in implementing reforms in the desired directions (i.e., Belgium, Netherlands and to some extent, Spain). P. Janssen reported about the evolution in Belgium to a more deeply community oriented model; by implementing innovative services, such as mobile teams or telephone hot lines to improve and ease accessibility to care. J. Berdsen (Netherlands) reported the wide dissemination of the recovery model in his country (i.e., recovery colleges in preparation), the interest in the open dialogue model, the creation of users’ networks for peer support and the trend to replace coercive treatments for high intensity of care services. Stakeholders from these countries gave the impression of an ongoing trend of reforms in course that is leading to significant improvements in those countries.

Ricardo Guinea and Roberto Mezzina.
However, as the representative from Spain said, the reform of institutions does not lead necessarily to a real transformation of services. For some reason, some old asylums in Spain that were reformed into a residential model, kept the same old style practices in the new reformed facilities. This statement emphasized that professional practices are harder to reform that just changing the shape of the services. This speaker pointed out his concern on some problems: deinstitutionalisation sometimes lead to re-institutionalization; help is often provided in a dis-coordinated way –tipically: discoordination between the welfare system and mental health system. Some reforms often collide with fears, skepticism of even opposition of some professionals or family careers –i.e., reforms that lead to an in deep incorporation in practices of implications of the Human Rights perspective-. An even in these countries where reforms are experiencing advances, some problems seem still very challenging: stigma, homelessness or how to deal with offenders with mental health condition.

                  The vision of stakeholders from some other countries (Poland, Hungary) seem to point out that the situation in some countries is not evolving in the desired direction or in the required rhythm. Sometimes, plans are drafted by policymakers but never implemented; sometimes there is no public perception that some reforms are needed and old style practices remain in an uncritical way. According to the opinion of presenters from those countries, the current general perception there seem to give priority to social control, and a kind of divorce happens between the available services and the needs of the patients –at least from the perspective of a contemporary community approach-. The problem of how the pharma industry takes a leading role in training new professionals in those countries – which may not be an exceptional situation- was also emphasized.
                  Some interventions, due to some special circumstance, seemed to emphasise a different perspective. It was the case of the report by Milos Jankovick, Deputy Ombudsman from Serbia. He presented a hard statement from the perspective of Human Rights. He stated that it is necessary to consider seriously the existence of practices that can be regarded as torture in psychiatry, and presented a strong plea to take this issue seriously.  He reviewed some hot topic in contemporary psychiatry that represent conflict with the interpretation of Human Rights Declaration and the CRPD: the state of detention under mental health condition, and the conditions under which it is done. He stated that it is necessary to review practices regarding detention under mental condition and reconsider some of its circumstances (isolation, physical restriction, detention in cages). Guarantees when mental capacity is compromised by a mental condition should be carefully monitored: protection of legal capacity according CRPD principles and implications, humanitarian conditions when detention takes place. And finally, that it is necessary steady work to reach a reasonable common standard in all different bodies that intervene in psychiatric attention.
                  In his turn, Theodoros Megaloeconomu and Katerina Nomidou (from Greece), presented a touching report about how the economic crisis in Greece has damaged and often has destroyed past achievements, with a huge trend back for social exclusion, increase of violent and coercive treatments, and transinstitutionalization.
                  Other presenters highlighted other points that may be common at some extent to some European countries: the prevalence of ill treatments that deteriorate rather that ameliorate the life of patients, the diffuse limits of mental health when life, social or economic problem are presented as problems of mental health, or when mental institutions are made responsible for social needs of some vulnerable groups.
                  As final remark, I would say that there was a common view about how the community model should be implemented and developed as the best tool to organise accessible and quality services for the population, and that public policy needs to be involved in implementing systems of attention. There was also a quite common view about what we should consider a quality treatment: should be consensual, humanitarian, respectful of the dignity of the person and available. In that framework, some different approaches emerged in a technical point of view. Last, there was a quite common perception from different about the outstanding need to go on in considering how to go on ameliorating services and practices.

*Participants in the working group: Patrick Janssen, (Belgium), Jan Berdsen (Netherlands), Adam Zawinsky (Poland), Juanjo M. Jambrina (Spain), Judith Harangozó (Hungary), Milos Jankowick (Serbia), Dragan Cabarkapa (Montenegro), Jan Pfeiffer (Chec Republic), Vito Flaker (Lubliana), Theodoros Megaloeconomu, Katerina Nomidou (Greece). Chair, Ricardo Guinea (Spain).

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