Ad hoc list to expand goal statement for the WFMH July Board meetings in Vancouver, BC
II.3 WFMH Goals
1 To heighten public awareness about the importance of mental health, and to gain
understanding and improve attitudes about mental disorders.
2 To promote mental health and optimal functioning.
3 To prevent mental, neurological and psychological disorders.
4 (Sylvia) To improve the care and treatment of
those with mental, neurological and psychosocial disorders.
I was only asked to expand on item 4, but they seem seamless to me and the People Who
have things to say about all of them.
1. health is seamless - stop carving out mental health from
coordinate with WPHA
language matters: discrimination, prejudice,
stereotype (not "stigma") www.peoplewho.org/documents/wordsmatter.htm
all information and communication material most
reflect the position that recovery happens
use information technology
always include primary beneficiaries when presentations are
speaking about us
without us sends the message that we can't speak for ourselves
2. context matters: abuse, poverty, housing, employment
public health model: community not individual
3. address abuse and violence and trauma, including the trauma of
understand how many people have a co-occuring post-traumatic stress disorder, including
from events that happen within
the system of
acknowledge the wound, the anger, that many
continue to carry
4. treatment without full and informed consent is justified when,
and only when, a patient is not conscious, is a child, is legally
- "Human rights must not be sacrificed to achieve public health goals."
APHA International Human Rights
one of the Principles approved September 00
forced medication, forced electroshock, forced magnetic therapies, ... destroy any
possibility of therapeutic alliance
involve consumers and survivors in
meaningful and significant ways in all aspects of what affects them, from public
education, policy planning, and prevention to their own emergence as self-determining
involve carers when they represent
consumers who can not represent themselves
socializing newly diagnosed patients into" the mentally ill" affects
self-esteem, recovery, sense of personal control,
internalized shame and self-hatred. This includes the confessional requirement
of admitting to one's diagnosis.
people without jobs need employment before treatment
people without housing need homes before treatment
anecdote and experience is evidence.
evidence-based interventions cannot select only one kind of evidence to validate
themselves as "scientific" while not valuing less commercial interventions..
use the established user committee for advice
honor resolutions adopted at the General
maintain at least two At Large board seats for
consumers and survivors
include in the Congress contracts that
consumers and survivors receive, at a minimum, Congress registration scholarships
NZ and AU have done well in being inclusive and
respectful; get guidance from them
Example: Wellness Guide www.wellnessguide.org
Context (part of a longer document I wrote):
In the twentieth century, as advanced societies moved from manufacturing to service,
the self help movement and the human rights movement parented the mental patient movement.
This new movement inherited the self help principles of volunteering, mutuality, valuing
the experiential, and deflating professional privilege, along with the civil rights focus
of other disability rights, gay rights, and women's movement groups (Reissman, Chamberlin)
and was nurtured by the politics of empowerment in an increasingly self-help oriented
society (Katz, Zinman). From the beginning there was a drive to unite in hope of change,
or at least raise awareness, and to release some of the feelings of anger and betrayal.
In the 60's, the mental patient movement challenged psychiatry's hold on explaining
behavior and remained separatist. Madness Network News published survivor accounts and
views. By the 80's, diagnosed people were changing the mental health system from within
(Church). Some groups maintained a strong anti-psychiatry ideology (Emerick); society was
urged to increase social acceptance of human diversity (Breggin). Some groups developed
institutional collaborations or at least interactions (Emerick).
Beginning in 1985, the U S federally sponsored Alternatives conferences gathered
consumers, survivors, and ex-patients who shared views as divergent as what they chose to
be called. The World Federation of Psychiatric Users, later renamed The World Federation
of Psychiatric Survivors and Users, was established in 1991 (del Vecchio). By the end of
the 90's the U S government and three fifths of the states had consumer affairs specialist
offices (Center For Mental Health Services 98-012). The 90's emphasized jobs and
consumer-operated business (Church). Nearly every country and U S state has a statewide
organization (Center For Mental Health Services 98-013).
How to reshape the rhetoric to affect reality is a central question (Everett). One
researcher sees four themes: language, labeling, stereotyping and stigma; the medical
model and how it has been accepted as the primary model for understanding mental illness;
the power base of psychiatry and the criticisms of it by those in the mental health rights
movement; professionalism and how this is understood by students and carers (Porter). The
base of shared values remains constant: self-determination and empowerment, independence,
egalitarianism, voluntariness, confidentiality, responsibility, choice, respect and
dignity, peer support, hope and recovery, social action (del Vecchio). Personal competence
is connected with a desire for and a willingness to take public action (Zimmerman and
Rappaport). And social action and social change remain a core movement activity (Van
The characteristics of feminist activities match movement values. Writing about the
women's movement, Linton notes that the people involved are the active central focus, that
activities are cooperative, that there is a recognized urge for liberation from the
oppression of the status quo, that issues are identified and strategies developed, that
the process is open and inclusive, that those involved are respected and valued, including
their diverse experiences even when in conflict (Linton).
Still, the problem for movement advocates lies in shaping a common social identity among
the diverse population of people with psychiatric disabilities (Kaufmann). For instance,
the reduction in government-sponsored housing programs became uncomfortably visible when
some expressed their discontent with services by choosing the streets. The twenty-first
century will still pose the challenge of rights as the family movement campaigns to lessen
the legal protections and increase coercive medical interventions and institutionalization
Managed care and access to information have helped invert the health care pyramid. Instead
of first consulting a health expert in person, today health needs are first met by data
gathering (Ferguson). Those who use the Internet have an important tool for all health,
including mental health. At the end of 1998, Alta Vista Internet searches found 19 million
hits for health, 292 thousand for mental health and 57 thousand for mental illness.
Almost all current mutual support and advocacy of people who experience moods swings,
fear, voices, and visions are supported by local and national mental health systems and
associations, drug manufacturers, and grants. Some believe that this kind of funding dulls
the philosophic edge of the grass roots user movement and supports biomedicine instead of
healing and autonomy (Caras, 1994). On the other hand, increasing intensity of competition
among consumer organizations is anticipated as groups struggle to secure a niche in the
social movement industry (Kaufmann).
Citations are at: http://www.peoplewho.org/sylvia/om/bibliography.htm
Basis of mental illness
From a site at: http://www.PAB2000.org
Full citations there
The U.S. Congress, Office of Technology Assessment of the United States Congress (1992)
published a report titled The Biology of Mental Disorders. The report concludes:
"Research has yet to identify specific biological causes for any of these
disorders" (p. 14).
In a psychopathology textbook used for second-year medical students, the authors state,
"psychiatry is the only medical specialty that...treats disorders without clearly
known causes" (Maxmen & Ward, 1995, p. 57).
Colin Ross, discussing the chemical imbalance model for schizophrenia, claims that the
"dopamine theory of schizophrenia is a political strategy" with the goal of
obtaining additional research grants (Ross, 1995, p.108).
Peter Breggin, M.D. (1997), author of Brain Disabling Treatments In Psychiatry,
declares that "there are no known biochemical imbalances in the brain of typical
psychiatric patients" (p. 5b).
In a recent consensus conference sponsored by the National Institutes of Health (NIH)
in November of 1998, the panel of experts concluded, "there are no data to indicate
that ADHD is due to a brain malfunction" (p.2). In their report they went on to state
that the same can be said for "most psychiatric disorders, including disabling
diseases such as schizophrenia" (p.2).
Dr. William Wirshing (1999), a researcher and professor of psychiatry at UCLA, stated
to a room full of psychiatrists that we have been lying to everyone for years concerning
the chemical imbalance model. No one in the audience challenged him.
In an article approved for continuing education by the American Psychiatric
Association, the author states, We dont know how psychotropic medications really
work (Khan, 1999).
"Child sexual abuse is associated with a substantial increased risk of
psychopathology, whether or not it occurs as part of a larger syndrome of childhood
adversities. The results of this study suggest the need for publich health
prevention programs both to reduce the prevalence of child sexual abuse and to develop
efficacious treatments. Public health practitioners should note, however, that
it is not only high-risk families with a constellation of adversities that should be
targeted. We have shown that child sexual abuse that occures in relatively health families
can also be damaging. Thus primary prevention approaches targeting all children and
families as being potentially at risk should be continued and rigorously evaluated.
These programs should go beyohnd grou-based personal safety instruction to include
perpetator prevention stragegies and parenting workships. Additionally, evaluation
should ensure that primary prevention efforts are not doing harm. ... From an
epidemiolgoic perspective the results of this study suggest that the prevention of child
sexual abuse may also be an important strategy for reducing psychopathology."
Molnar et al, Child Sexual Abuse and Subsequent Psychopathology, American Journal of
Public Health, May 2001, 915, p 758
We've already selected violence as the theme for World Mental Health Day in 2002.
Educating about child sexual abuse is a strategy that fits neatly.
RELATIONAL WORLDVIEW AS AN ORGANIZING MODEL
The relational worldview, sometimes called the cyclical worldview, finds its roots in
tribal cultures. It
is intuitive, non-time oriented and fluid. Balance and harmony in relationships is the
driving principle of this
thought system, along with the interplay of spiritual forces. The relational worldview
sees life in terms of
harmonious relationships; health or wellness is achieved by maintaining balance among
the many interrelating
factors in ones circle of life. Every event relates to all other events
regardless of time, space or physical
existence. Health exists only when all elements are in balance or harmony.
In the relational worldview, helpers and healers are taught to understand problems
balances and imbalances in the persons relational world. We are taught to see and
(sometimes illogical) interrelationships that can be influenced by entering the world
of the client and
manipulating the balance contextually, cognitively, emotionally, physically and/or
Interventions need not be logically targeted to a particular symptom or cause, but
should be focused
on bringing the person back into balance. Nothing in a persons existence can
change without all other
things being changed as well. Hence, an effective helper is one who gains understanding
of the complex
interdependent nature of life and learns how to use physical, psychological, contextual
and spiritual forces to
Volume I: Cultural Strengths and Challenges in Implementing a System of Care Model in
model describes mental health as a balance among context, mind, body, and spirit.
For decades now the disability rights movement has tried to
shift the focus from the disabled body to social
discrimination. Rather than simply "fix" the individual
body according to a "medical model," disability advocates
argue that the discriminatory attitudes and structures need