An electronic publication for mental health in developing

countries - promoting fresh ideas to reduce suffering worldwide.

AChangeofHeartDignityinmentalhealthcare

Edition 4

In this edition of Developing Mental Health - themed 'Dignity in Mental Health Care' in line with the 2015 World Mental Health Day - it is worth considering that dignity afforded to self and others seems to be health-giving across all determinants and definitions of health.

A common approach when trying to transform care systems with dignity in mind is to create a set of rules and that can promote dignity. These may manifest themselves as policies, training or legal frameworks.

Certainly there is a role for this in challenging and transforming ingrained patterns of working, organisational and societal norms and protecting those made more vulnerable by the actions of others. There is, though, a deeper work to do.

TheOxfordEnglishDic:onarydefinesdignityas:Thestateorqualityofbeingworthyofhonourorrespect

andAsenseofprideinoneself;self-respect

Developing Mental Health

Apleafordignityandtherighttobe

Moral guidance about extending value and worth beyond 'our own' has existed for centuries in all the major 'wisdom teachings’.

So why does lack of dignity so often remain an issue in our health and social care systems?

Power, inequality and fear play a role, so perhaps one of the reasons is that true change happens only when attitudes are transformed. Such change considers self and others as worthy of honour or respect and this requires a change at a deeper level, at belief, at heart level. 

Change comes from an open-hearted and open-minded way, rather than a rule-bound way, and from that flows authentic transformation that transcends labouring from the rule book and dignifies both those receiving and offering care.

So whilst acknowledging the place of the policies, training and legal frameworks that support a rights-based approach to dignity in mental health care, let us also reconnect with that older deeper wisdom. A wisdom that pre-dates these 'enlightened times' – examine ourselves and dare to have a change of heart.

In the realm of health and social care 'dignity restored' is probably most required in mental health. and that requires a change of heart. There is much for us to do, but if we do this, there will be much in others and ourselves that will be renewed and restored.

“Derogatory words are used to describe us, such as mentally disturbed, having unsound mind, idiots, lunatics, imbeciles, mad people, demoniacs and many other hurtful labels. These words and the beliefs from which they derive devalue us and form the basis of discrimination and the loss of our inherent dignity.

“… we are people first, we have potential, abilities, talents, gifts, skills and each of us can make a great contribution to the world. We in the past, the present and in the future have, do and will make great contributions if barriers are removed, we are all different, unique … we need all people to embrace this diversity and allow us the liberty to be ourselves.

Mrs Robinah Alambuya’s presentation at the launch of WHO QualityRights Toolkit can been seen and listened to in full at http://bit.ly/1KcGUKO (12mins)

Mrs Robinah Alambuya Nakanwagi, President, Pan African Network of People with Psychosocial

Disabilities, Uganda Giving.

Transformationthatdignifies-astoryofchangeinSriLanka

“Being a mental patient is no reason to be ostracised. You can get the medication you need these days and you can even become financially independent. We are normal now and can do anything you can do.”

Vivienne Perry, a journalist working for The Guardian interviews Sumina, a Sri Lankan diagnosed with schizophrenia, Dr Michelle Funk the WHO mHGP programme coordinator, and Ananda Galappatti a mental health practitioner in Sri Lanka.

The interview can be listened to at http://bit.ly/1XGNF1p or the transcript read at http://bit.ly/1VtCaZl

The transformation in services described involved imagining and developing services that were overwhelmed by the effects of natural disaster of tsunami in 2004. Aid money and resources arrived, and responding well and in a way that left a legacy has been important.

Whilst the interview is not specifically about dignity, the themes of discrimination and mental health and dignity are never far away in the conversations. Bringing together a patient and family perspective alongside a global health view and the description of a transforming mental health service is an illustration of the importance of combining good education, and the human rights based approach to support system-wide transformation that transforms lives of those needing care.

Learningaboutdignityindementia

Let us consider dignifying the moment for those suffering from the effects of dementia.

“People will forget what you said. People will forget what you did. But people will never forget how you made them feel.” Maya Angelou

Watch Naomi Feil, founder of Validation Therapy, shares a breakthrough moment of communication with Gladys Wilson a woman who was diagnosed with Alzheimer's in 2000 and is virtually non-verbal (both pictured above).

www.youtube.com/watch*(Wait until Gladys sings!)

Transformed attitudes towards those suffering from the effects of dementia can dignify the moments and for those with dementia, the moment might be for them everything. What can we personally to those interactions as carers, friends and family to those moments of those who may not remember?

“Just because I'll forget it some tomorrow doesn't mean that I didn't live every second of it today. I will forget today, but that doesn't mean that today didn't matter.” Still Alice by Lisa Genova

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WHOQualityRightsToolkit

This is useful resource when approaching service development with a human rights underpinning. The WHO QualityRights Toolkit Assessing and improving quality and human rights in mental health and social care facilities was published in 2012 and can be downloaded at http://bit.ly/1FBiBow. This is useful resource when approaching service development with a human rights underpinning. (A brief 4 page flyer outlining the toolkit can be found at http://bit.ly/1ES1ioD).

This Toolkit takes a human rights and quality improvement approach to provide a framework for improving mental health and social care facilities and is written in a way that can support this in low, middle and higher income settings and as such acknowledges the needs for improvement in all these contexts.

The toolkit covers five human rights themes:

1. The right to an adequate standard of living and social protection2. The right to enjoyment of the highest attainable standard of physical and mental health3. The right to exercise legal capacity and to personal liberty and the security of person4. Freedom from torture or cruel, inhumane or degrading treatment or punishment and from

exploitation, violence and abuse5. The right to live independently and be included in the community.

WHO QualityRights Act, unite and empower for mental health

dmh@prime-international.org developing-mental-health DevMentalHealth developingmentalhealth developingmentalhealth

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