Active Citizenship and Mental Health: Opportunities and Challenges

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Active Citizenship and Mental HealthOpportunitie
s and Challenges

• Dr Fergus OFerrall
• Director
• The Adelaide Hospital Society

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• Mental health is central to the human, social
  and economic capital of nations and should,
  therefore, be considered as an integral and
  essential part of other public areas such as
  human rights, social care, education and
  employment
• Helsinki Mental Health Declaration and Action
  Plan for Europe Facing the Challenges, Building
  Solutions 14 January 2005

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• Mental health as defined by WHO is a state of
  wellbeing in which the individual realises his or
  her own abilities, can cope with the normal
  stresses of life, can work productively and
  fruitfully, and is able to make a contribution to
  his or her community.
• Mental health strengthening mental health
  promotion WHO Fact Sheet No 220 (Revised,
  November 2001)

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• Report of Task Force on Active Citizenship March,
  2007
• The Developmental Welfare State
• NESC, May 2005
• NESC Strategy 2006 People, Productivity and
  Purpose
• Towards 2016 Ten Year Framework Social
  Partnership Agreement 2006-2015
• Engaging Citizens the Case for Democratic
  Renewal in Ireland
• Democracy Commission, 2005

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• The civic deficit is not a single thing. It
  is the accumulation of the deficits, the
  liabilities over the assets, in our civic
  culture. That civic culture contains in itself a
  number of intertwining sub cultures the civic,
  the intellectual, the democratic, the
  institutional and the moral. We can say that,
  taken together with perhaps some others, these
  constitute our attenuated civic culture.
• What do we mean by culture? It is a shared
  collection of values, principles, conventions and
  priorities that determine decision-making,
  especially collective decision-making.
• see Tom Barrington The Civic Deficit in
  Ireland in People Power Proceedings of the Third
  Annual Daniel OConnell Workshop M.R. OConnell
  (Institute of Public Administration on behalf of
  DOCAL Daniel OConnell Association Ltd, Dublin
  1993) pp1-18 there is a critical analysis of
  Irish political and civic culture in J.J. Lee
  Ireland 1912-1985 Politics and Society (Cambridge
  University Press, Cambridge, 1989) chapter 8
  Perspectives pp511-687

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• A health system that supports and empowers you,
  your family and community to achieve your full
  health potential.
• A health system that is there when you need it,
  that is fair, and that you can trust
• A health system that encourages you to have your
  say, listens to you, and ensures your views are
  taken into account.
• Health Strategy, 2001

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Centralisation and Clientalism erodes Active
Citizenship

• Irish Health Reform illustrates a controlling
  State and a further erosion of citizenship

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The value of greater public participation in
Irish healthcare

• Benefits to the health services
• Restoration of public confidence
• Improved outcomes for individual patients
• More appropriate use of health services
• Potential for greater cost effectiveness
• Contribution to problem resolution
• Sharing with the public responsibilities for
  healthcare

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The value of greater public participation in
Irish healthcare

• Benefits to people
• Better outcomes of treatment and care
• An enhanced sense of self-esteem and capacity to
  control their own lives
• A more satisfying experience of using health
  services
• More accessible, sensitive and responsive health
  services
• Improved health
• A greater sense of ownership of the HSE

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The value of greater public participation in
Irish healthcare

• Benefits to public health
• Reduction in health inequalities
• Improved health
• Greater understanding of the links between health
  and the circumstances in which people live their
  lives
• More healthy environmental, social and economic
  policies

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The value of greater public participation in
Irish healthcare

• Benefits to communities and to society as a whole
• Improved social cohesion
• A healthier democracy reducing the democratic
  deficit
• A health service better able to meet the needs of
  citizens
• More attention to crosscutting policy issues and
  closer co-operation between agencies with a role
  to play in health promotion

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• Mental health policy is commonly established
  within a complex body of health, welfare and
  general social policies. The mental health field
  is affected by many policies, standards and
  ideologies that are not necessarily directly
  related to mental health. In order to maximise
  the positive effects when mental health policy is
  being formulated it is necessary to consider the
  social and physical environment in which people
  live. It is also necessary to ensure
  intersectoral collaboration so that benefit is
  obtained from education programmes, health,
  welfare and employment policies, the maintenance
  of law and order, policies specifically
  addressing the young and the old, and housing,
  city planning and municipal services
• Source WHO Mental Health Policy and Service
  Guidance Package

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The Characteristics of Civic Republican
Citizenship

• Social constitution of human person
• Commitment to the common good
• Freedom as non-domination
• The practice of the civic virtues
• Voluntary action and civil society is key sphere
• An enlarged view of human capacity for living a
  humane life
• The intangible hand

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Implications and Future ChallengesI

• A paradigm shift
• Reimagine a new culture of active citizenship
• A vibrant and healthy civic society
• In short
• From a managerialist centralised State
• towards a new civic participatory Republic

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Implications and Future ChallengesII

• Take seriously the social determinants of health
  outcomes
• new Dept of Population Health
• social inclusion
• community and voluntary social networks are key
• tackle inequalities and promote the common
  good
• develop an enabling State

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Implications and Future ChallengesIII

• The policy implications of The Social Capital
  debate are critical
• Develop trustful relations in Irish society
• The Key to Success in Health Outcomes
• The Active Capacity of People

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CONCLUSION

• ACTIVE CITIZENSHIP
• AND SOCIAL CONNECTEDNESS
• A Powerful Determinant of Health and Wellbeing