Dr Anja Esther Baumann

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The Fourth International Stigma Conference
2009Together Against Stigma 21st 23rd January
2009, London, UK

User Empowerment in Mental Health The new
WHO-EC Partnership Project
Dr Anja Esther Baumann WHO Regional Office for
Europe
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Stigma and empowerment
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Action against stigma and discrimination

• Policies and legislation to address stigma and
  discrimination
• Public information about the nature and
  treatment options for mental health problems
• Target-group specific programmes to tackle
  prejudices individuals with mental health
  problems have to face

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Empowerment enhances integration andsocial
inclusion

• Focussing on abilities and potentials, not on
  disabilities
• Ensure partnership with service users and carers
• Place individuals receiving mental health
  services at the heart of planning, development
  and implementation of policies and services

Thornicroft et al. 2008 Parker 2007
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WHO - EC Partnership Project on User Empowerment
in Mental Health

• Support Member States to improve their strategies
  and actions for user and carer empowerment
• Co-funded by WHO and the European Commission
• Duration 1 April 2008 March 2011
• Partners Users and carers associations, experts
  from policy, human rights, social inclusion,
  mental health services, NGOs

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Empowerment in the Helsinki Declaration

• Ministers of Health committed themselves to
• enforce mental health policy and legislation
  that sets standards for mental health
  activities and upholds human rights
• eliminate stigma and discrimination and
  empowering people at risk
• offer people with mental health problems choice
  and involvement in their own care

WHO, Helsinki 2005
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Empowerment in the European Pact for Mental
Health and Well-being

• Promoting good mental health and well-being in
  the population, strengthening preventive action
• Combating stigma and social exclusion
• Provide support to people who experience mental
  health problems and their families

European Commission, Brussels 2008
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Why empower people with mental health problems?
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Policies and practices for mental health in
Europe - meeting the challenges
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Programmes implemented to tackle stigma and
discrimination
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Programmes to tackle stigma

• Wide range of anti-stigma activities
• High availability of school programmes, but few
  activities address specifically vulnerable groups
• Striking lack of evaluation

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Systematic government funding for user and family
associations
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Representation of service users on committees and
groups responsible for mental health services
Planning
Yes
Implementing
No
INA
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Representation of carers on committees and groups
responsible for mental health services
Yes
No
INA
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Representation of service users and carers on
review bodies for external inspections of human
rights protection
Yes
No
INA
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Framework for action
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What do we mean by empowerment?

• Power Involvement - Participation
• Participation seems to be the basis, but is
  not sufficient
• The key to empowerment is the removal of
  barriers and the transformation of power
  relations

Hansson and Björkman 2005 Wallerstein 2006
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Power is central to the idea of empowerment

• Empowerment strategies mean
• challenging control and social injustice,
  through political, social and psychological
  processes that uncover the mechanisms of control,
  the institutional or structural barriers, the
  cultural norms and social biases, and therefore
  enable people to challenge internalized
  oppression and to develop new representations of
  reality.
• Wallerstein N Health Evidence Network Report. W
  HO Regional Office for Europe, 2006.

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Key attributes of empowerment

• Understanding that a person has rights
• Having access to information and resources
• Having decision-making power
• Increasing ones positive self-image and
  overcoming stigma
• Organizational capacity
• Accountability of services

Rogers, Chamberlain et al. 1997 World Bank 2006
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WHO - EC Partnership Project on User Empowerment
in Mental Health
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Project components

• Identification of indicators and success/
  failure factors
• Identification of good practice
• Supporting governments and local actors
• Promoting the mainstreaming of good practice

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Identification of indicators and good practice
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Key areas for the identification of indicators
and good practice examples

• Protecting human rights and fighting stigma and
  discrimination
• Ensuring high-quality care and accountability
  of services
• Access to information and resources
• Inclusion in decision-making processes
• Organizational capacity

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Protecting human rights and fighting stigma and
discrimination

• Legal protection from discrimination is in place
• Review bodies that assess human rights
  protection of users
• Policies and programmes to tackle stigma
  addressing various target groups implemented
  by governments

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Ensuring high-quality care and accountability of
services

• Community-based specialist mental health
  treatment and care are available
• User-led and user-run services are implemented
• Regular assessments of consumer satisfaction
  with services are run

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Access to information and resources

• Adequate information on services and treatments
  is given to users and their advocates
• Government supports service users and carers
  associations by providing funding and
  infrastructure

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Inclusion in decision-making

• Shared decision-making in mental health
  services is the routine
• Measures are implemented to enable people with
  mental health problems to take part in treatment
  and service evaluation research
• Partnership is ensured with service users and
  carers in all types of planning and running of
  programmes to fight stigma and discrimination

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Organizational capacity

• Self-help groups and other social networks for
  users and for carers are in place
• Policies and programmes to support user and
  carer empowerment are implemented
• Government funding is available for establishing
  and operating national and local organizations
  of service users and carers

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Timetable
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Timetable
Deliverable 1 Establishing the Advisory
Group Milestone 1 October 2008 Deliverable 2
First meeting of the Advisory Group Launch of
project, establishing working groups Milestone
2 9 December 2008 Deliverable 5 Joint
WHO/EC/German Alliance for Mental Health
Conference on Mental Health and Well-being at
the Workplace Protection and Inclusion in
Challenging Times Milestone 5 17/18 March 2009
in Berlin Deliverable 3 Development of
indicators Milestone 3 May 2009 Deliverable 7
Collection of information on success and failure
factors Milestone 7 May 2009 Deliverable 8
Second meeting of Advisory Group Milestone 8
June 2009 Deliverable 4 Identification of good
practice examples Milestone 4 January 2010
Deliverable 6 Organize a leadership
workshop Milestone 6 May 2010 Deliverable 9
WHO-EC Report on User Empowerment in Mental
Health Milestone 9 March 2011