The history of advocacy in mental health

Andres Barkil-Oteo Columbia Public Psychiatry Fellowship March 2012

Presidents new freedom commission on mental health

Mere reform to the existing mental health system are insufficient Transformation represents a bold vision to change the very form and function of the metal health service delivery system It implies profound change not at the margins of a system but at its very core

DHHS 2005

What is advocacy and why is it important?

Mental health advocacy includes a variety of different actions aimed at changing the major structural and attitudinal barriers to achieving positive mental health outcomes in populations.

WHO 2003

Barriers to mental health

Among patients with a disorder, 32.9 % received treatment between 2001 and 2003 20.1% of the population 18 to 54 years of age received treatment for emotional disorders between 2001 and 2003. Only about half those who received treatment had disorders that met diagnostic criteria for a mental disorder.

Kessler 2005 NEJM

Barriers to mental health

Lack of mental health services Unaffordable cost of mental health care Lack of parity between mental health and physical health Poor quality of care in mental hospitals and other psychiatric facilities Absence of alternative services run by consumers Paternalistic services, in which the views of service providers are emphasized and those of consumers are not considered Violations of human rights of persons with mental disorders Lack of housing and employment for persons with mental disorders Stigma associated with mental disorders, resulting in exclusion

WHO 2003

How to combat stigma

Community education on mental disorders Psychoeducation for consumers and families on how to live with persons who have mental disorders Empowerment of consumer and family organizations Improvement of mental health services (Quality, access) Legislation on the rights of persons with mental disorders Development of demonstration areas with community care and social integration for persons with mental disorders

WHO 2003

Philippe Pinel at the Salptrire

Dr.Philippe Pinel at the Salptrire (Releasing Lunatics from Their Chains) by Tony Robert-Fleury, 1795

Traitment Moral/Bictre
The ex-patient Jean-Baptiste Pussin and his wife Margueritte, and the physician Philippe Pinel developed the first form of moral treatment at La Bictre in Paris Pussin first freed patients of their chains and banned physical punishment, although straitjackets could be used instead. Patients were allowed to move freely about the hospital grounds, and eventually dark dungeons were replaced with sunny, well-ventilated rooms. Former patients were hired as staff : In addition to being gentle, honest, and humane, former patients are less likely to abuse or mistreat the inmates and are more likely to respect them as fellow human beings

Davidson 2010

Moral treatment/York retreat

There is much analogy between the judicious treatment of children and that of insane persons. Samuel Tuke Moral=Mental to Moral=Ethical

Dorothea Dix

http://tinyurl.com/7rdplyc

Dorothea Dix
Education/ social justice, free evening school for poor children Mentally ill at East Cambridge jail in England In Massachusetts, investigated poor houses, alms houses and Jails The retreats as a standard of care was accessible only to the wealthy patients The outcome of her lobbying in MA was a bill to expand the state's mental hospital in Worcester, and more Successful efforts in other seven states Bill for the Benefit of the Indigent Insane legislation to set aside Federal land for the benefit of the insane with proceeds from its sale distributed to the states to build and maintain asylums. Dix's land bill passed both houses of Congress, but in 1854 President Franklin Pierce vetoed it, arguing that the federal government should not commit itself to social welfare, which was properly the responsibility of the states.

Dorothea Dix
Dixs legacy The recovery of insane patients frequently depends on their being removed from their connexiones and put under proper care and treatment

Jane Addams

http://tinyurl.com/849uo9m

Jane Addams
Founded Hull house in a poor neighborhood of Chicago The first American woman to be awarded the Nobel Peace Prize People do not always have to be removed from their current life circumstances in order to receive assistance in addressing their difficulties What one person is likely to find helpful are the same kind of things another person will likely find helpful were that person in the same life situation A person should not be viewed as being either a person needing help or a helper, people are most often in both roles at once. It may be easier to accept help from others if one feel that one is giving help as well Helping people sometimes extend beyond individuals and their families to the levels of the community, the city, state, and the country (and beyond)

Clifford W Beers

http://tinyurl.com/6rvdqob

Clifford W Beers

A Mind That Found Itself (1908), an autobiographical account of his hospitalization and the abuses he suffered He also started the Clifford Beers Clinic in New Haven in 1913, the first outpatient mental health clinic in the United States Founded the "National Committee for Mental Hygiene"

Howie the Harp

He was born and raised in New York City. and was hospitalized for more than a year at the age of 14. At the age of 17, he ran off to become a part of the psychiatric survivor movement Howie became involved in formal advocacy through the Insane Liberation Front in Oregon in 1971 Returned to New York to begin the Mental Patients Liberation Project. Founded or helped found Project Release in New York in 1975 and several advocacy groups in California in the 1980's.

Advocacy: Recovery style

The concept of recovery is rooted in the simple yet profound realization that people who have been diagnosed with a mental illness are human beings (Deegan 1993) The recovery movement is first and foremost a civil rights movement by and for people with serious mental illness It is only secondarily a movement which has implications for the way mental health practitioners practice (Davidson 2010)

References
The Roots of the Recovery Movement in Psychiatry: Lessons Learned. By Larry Davidson. Wiley; 1 edition (March 23, 2010)