Charter

The IMHCN Charter sets out the purposes of what we believe is necessary to achieve a Whole Life for people with mental health problems, for them to obtain full citizenship free from stigma and to fight for social inclusion for themselves. It is a campaigning and advocacy agenda for human rights and to fulfill our mission in promoting community mental health services that better satisfy the needs of those who are service users.

It also calls for action from Governments, policy makers and service providers, professionals, managers, users and carers.

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.

The charter has 7 core Articles that set out the purpose and some actions of what is required by organizations to achieve these.

Members of the IMHCN have experience in applying these articles in community mental health service design and development.

The IMHCN Values and Principles for:

Individual Service Users

  1. Citizenship

    The idea of citizenship incorporates the belief of equal rights for every individual regardless of their circumstances to access civil, political, social and economic opportunities. It is also important, particularly for people with mental health problems the right of every individual to protection from laws, social, 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 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 Life and Wellbeing

    A person with a mental health problem has the same basic human needs as anybody. This is how to develop and lead a life that is full of purpose, interest, recognition, contribution, value and reward. A whole life comprising of these needs and aspirations is what most people with a mental health problem are seeking for themselves. Access to health, education opportunities, vocational training schemes, work, volunteering, social networks, sport and leisure and art and culture activities are all important in enabling people to have a whole life opportunity to assist them in their recovery and wellbeing.

    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 and not each component on their own.

  4. Cultural diversity and values

    In European countries people from diverse ethnic backgrounds have struggled with the perception and reality of being treated as different to the rest of the community.

    This has resulted in more people experiencing common mental disorders and serious mental illnesses with higher numbers of people being compulsory treated and institutionalised.

    The perceived and real difference instead of being stigmatised should be valued and celebrated for their richness, importance and opportunity for users to recover.

    In many other countries in the world there is much to be learned from their cultures, way of life and inclusion of people in every aspect of a community and its functioning.

    This has demonstrated in many cases a greater recovery rate for some mental health conditions.

  5. Respect and Dignity

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

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Community Mental Health Services

  1. Accessibility

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

  2. Comprehensiveness

    It is well understood that a comprehensive well integrated service system that meets the needs of people in a holistic and continuity of care way 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.

  3. Effectiveness

    Services should be evidence based and subjected to governance quality standards and performance indicators to ensure that they are effective to provide the best outcomes for service users.

  4. Equity

    Mental Health Services and resources should be organised and provided to the same level and standard to every geographical area in a given region or country to reach all the population being served.

  5. Evidence based practice and values

    It is acknowledged that there are many treatments and therapies that are proofed effective for most mental illnesses. These should be introduced as routines in the daily practice of professionals to maximise the best outcomes for service users. Users should be given a choice and be able to access the most appropriate treatment and therapy to meet their need.

  6. Family involvement

    Family education and involvement in understanding mental illness and the needs of the user is an essential part of the therapeutic experience.

    The family should be valued as partners in the recovery process of the user by professionals.

  7. Efficient use of resources

    Mental health human and financial resources are always not sufficient to provide the best service possible in most countries. This particularly true in low to middle income countries. It is fundamental that the ones available are used in the most efficient and effective manner. Resources should not be wasted on administrative and bureaucratic structures and large psychiatric hospitals.

    The priority for their use should be on front line user services in the community.

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    IMHCN Charter Articles

    Article 1: Promoting and advocating for human rights for users

    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 rights and in cases 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.

    Ever since this has dictated the legal response, service provision, clinical practice and in turn perpetuated stigma and the social exclusion of users.

    For sure there has been some worthy exceptions to this but they are very few, compared to the general rule in the world.

    The IMHCN is committed to work with others to continue to fight this 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 in society through law
    • Tackling education programs in schools
    • Giving positive messages and stories to the media including TV and Radio producers.
    • Organising regular anti stigma campaigns in local communities
    • Users and cares publishing their own stories in publications
    • Advocating for legislation to protect the rights of users.
    • Educating professionals on how to interpret correctly the implementation of the law to maximize the benefit to users

    On the other hand mental health service providers need to play their part in the way that they provide services. Some targets for their action are:

    • No locked facilities in inpatient settings
    • No physical or chemical restraint
    • Reduction in compulsory admissions and treatment
    • Reduced forensic services and admissions

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    Article 2: Campaigning for social inclusion for service users and their families : Community responsibility and community resources

    This is to develop a wider community responsibility and commitment through partnerships with local and national community organisations.

    It is important to move away with the ever increasing preoccupation with security and risk to ways to improve the social determinants that are key causal and aggravating factors to a persons’ mental health and the opportunities for their recovery.

    A common purpose of understanding and action for improved mental health and wellbeing of the population needs to be developed in communities.

    This should use a Whole Systems developmental approach by engaging with all community organisations that have real or potential capacity to provide housing, employment, volunteering, art and culture, sport and leisure and education.

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    Article 3: Protecting and respecting culture and religion

    It is important to apply a culturally sensitive approach and competency in attitude, understanding and practice towards people through their own backgrounds, traditions, beliefs, customs, local and natural helping networks, etc.

    Mental health in non-western countries is an integral part of a person’s wellbeing which sees it embedded in all aspects of a whole life belief, faith, culture, environment, spirituality, work, housing, education, family and community respect.

    There is much to be learnt in western countries from this holistic approach and care must be taken in assisting developing countries not to promote or impose western ideas and models of separate mental health that are still often dominated by outdated ideas of a western medical model.

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    Article 4: 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 first goal, the fundamental starting-point remains a deinstitutionalisation of all services; this aims to supersede not only 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 and individuals should be avoided; this only reproduces separation and depersonalization based on the primacy of bureaucratic categories and ideologies of exclusion. Notions of ‘primary and secondary’, ‘enduring and common’, ‘serious and mild’ 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.
    • Acknowledging the possibility of illness or distress as an expression of suffering within the various areas of a person’s life, and the adoption of a therapeutic approach which takes the ‘whole life’ of the individual into full account; and which recognises his or her uniqueness as a citizen of a given community who does not wish to be excluded because of a mental health problem and who has the potential to be content with or without the presence of mental health symptoms or problems.
    • Affirming the protection of rights as the fundamental element in the care of any individual. Helping a person to good health, at the same time of 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, and be a part of social/welfare services, education, housing, employment agencies, work opportunities and community resources and organised and operated as a whole community system.

    It is important to ensure continuity of care between services and standard therapeutic approaches wherever the user is, based on trusting relationships.

    The components of the service should be planned and implemented based on evidence based practice and evidence based values and principles.

    A community mental health service should consist of the best practice experiences available in the world that have been developed and showed to be effective in delivering the best outcomes for service users. The relevance in replicating them will depend on the cultural, environmental and economic situation of a place and country.

    Members of the IMHCN have many examples of good practice that can used by others in developing their services.

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    Article 5: Advocating for new thinking in practice, treatments and care

    There has been a revolution over the last two decades in our understanding of what promotes recovery from mental illness. This evidence comes from various sources, from many different cultures, involves both health and social care perspectives and is based on various methodologies. This includes the individual testimony of service users and families, practice based evidence as well as the results of more scientific randomized controlled trials. Research and clinical best practice points to several key areas underpinning contemporary ways of providing effective care & treatment. These include:

    • Care and treatment should be provided closer to the individual’s home in normal settings chosen by the person themselves;
    • Services must be accessible and available when and where the person needs it, that is on a 24 hour / 7 day a week basis;
    • Detection and intervention must happen at an earlier stage in the development of the illness;
    • Care and treatment must be person centered and based on individual need and choice;
    • Increased access to individual talking or psychological therapies, such as CBT;
    • Access to family interventions and support, such as Psycho-educational and behavioral approaches to family support;
    • Effective recovery oriented Care Coordination in the context of Multi-disciplinary Team Work, which promotes access to effective services, continuity and coordination;
    • Greater promotion of client self-management and peer support approaches;
    • Integration of effective vocational interventions into everyday practice to support greater employment opportunities;
    • Improved access to effective modern medications.

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    Article 6: Encouraging action research in new ways of working

    It is possible to produce evidences to validate innovative practices using traditional methods like psychiatric epidemiology and epidemiology of services, RCTs or pragmatic trials. It is anyway necessary to develop new methodologies of research for mental health in a view of complexity beyond positivistic ‘scientific method’ for natural sciences, e.g. qualitative participatory research, based on narratives and experiences, or any form that encompasses different viewpoints of stakeholders. A new set of health indicators for outcome measures must be taken into account for policies rather than performance and economic measures.

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    Article 7: Self determination, wellbeing and recovery for users

    Service providers will ensure that the user is at the centre of the process working with the client to achieve their (the users) outcomes. The core beliefs in a recovery-orientated service are:

    • Choice. Clients are able to choose their interventions in discussion with their workers, families and significant others.
    • Ownership. Service providers accept that the client owns their own experience and that they (the clients) are experts of this experience.
    • Interventions. Service providers accept that recovery is a process not a model and that every client will have a service developed around their expressed wishes, needs and hopes.
    • People. The client should be able to choose the people they want to deliver their agreed interventions.
    • Opportunities. The client should have available the same life opportunities as a person without a mental health problem.

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    Recovery Practice

    Recovery practice requires service providers to have access to a recovery toolbox. The network will enable providers, consumers and significant others to have access to such a toolbox. This will be done through access to workbooks, training days, master-classes and online support. Within the network there are a number of workbooks to enable people to work through issues such as voices, self-harm and planning recovery.

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

    It requires a formal commitment from IMHCN members to adopt this Charter’s vision, philosophy, values and principles and to apply these to service development and practice.

    This commitment will need to embrace the centrality of the individual and the right to full citizenship. It is our belief that only through a Whole Life-Whole Systems approach will the stigma and social exclusion associated with mental health be successfully challenged and changed.

    Achieving the vision and reality of a Whole Life-Whole Systems approach will require all stakeholders to endorse a community common purpose of learning, collaborating, networking and 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’, supporting services makes long term care and support problematic 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. Stigma and discrimination are still everywhere in many communities.

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

    John Jenkins
    Roberto Mezzina
    Nicholas Daumerie
    Paul O’Halloran
    Ron Coleman

    June 2010

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