Quick Links:  page 2    page 3    page 4    page 5    page 6    page 7     Third Quarter 2002


Preston Garrison to Lead WFMH

Pirkko LahtiMessage from the WFMH President

My dear readers,

World Mental Health Day, founded by WFMH, was celebrated on 10 October in many countries. The theme was “The Effects of Trauma and Violence on Children and Adolescents.”

Children are exposed to violence through having to live amidst armed conflicts; they see violent behavior and end up victims themselves. In some countries, children are used in wars as soldiers. Natural catastrophes affect the lives of numerous children and families. Very often children are victims of domestic violence and family abuse, unable to avoid witnessing what goes on around them. The media is saturated with violence. All these things undermine children's basic security and affect how they experience the world. The issue is now receiving wider international attention.

On 3 October the World Health Organization (WHO) published the World Report on Violence and Health, the central message of which is that violence is a major factor affecting health. Those faced with violence not only need health services, but also services provided by the social, labor and legal administrations, as well as the police. Repercussions of violence are felt far into the future.

The WHO Report divides violence into three categories: self-directed violence (suicidal behaviour or self-abuse), interpersonal violence (family and intimate partner violence and community violence) and collective violence, which can be political, economic or social. By nature, violence is physical, sexual, psychological or involves deprivation or neglect.

The Report provides a comprehensive knowledge base of the violence prevalent in today’s world. The fact that a total of 4,450 people lose their lives to violence every day is shocking.

The WHO Report also aims to prevent violence, which is a goal as well of the World Mental Health Day arranged by the World Federation for Mental Health. But how to make this a reality?

Firstly, countries need ways to measure the occurrence and types of violence. How are the indicators of violence defined? How much protection does legislation provide? What are the costs of violence and how is it embedded in mental health questions? Secondly, we need better information systems to assess the situation. And finally, we need more research, which is clearly preventive, redresses the grievances, is action-oriented and provides practical information on how to prevent violence.

It is crucial that professionals in the mental health sector are able to recognise the occurrence of violence and its impact. They need more training and education.

Violence has secretly become an intrinsic part of our everyday life and culture. It affects everyday life without even being questioned. Therefore, the major campaigns launched by the World Federation for Mental Health and WHO have an important role. We need sensitivity in order to understand what is happening and how. We need to be explicit: violence cannot be tolerated.

Pirkko Lahti
President

*To download the pdf version of the WHO Report or a summary, or to order the book, go to www.who.int/violence_injury_prevention

Preston Garrison, Secretary General of the World Federation for Mental Health

Preston J. Garrison has been named as Secretary General and Chief Executive Officer of the World Federation for Mental Health (WFMH). His appointment was confirmed by the Federation’s Board of Directors at a meeting held in September at the Royal College of Psychiatry in London.

In announcing the appointment, WFMH President Pirkko Lahti commented “I am excited about this new step in the history of the World Federation for Mental Health. Mr. Garrison’s knowledge, experience, and understanding of both organization management and the mental health advocacy field will help strengthen our organization, and will challenge us to move forward in our work.”

Ms. Lahti, who is the Executive Director of the Finnish Association for Mental Health, was the interim chief executive officer of WFMH from July 2001 until the London meeting.

In a long career leading voluntary organizations in the mental health and social justice sectors in the United States, Mr. Garrison served as the chief executive officer of the National Mental Health Association (USA) from 1984 through 1991. Prior to that appointment, he was the chief staff officer for local and state NMHA affiliates in Georgia, Tennessee and Florida. His concerns at those posts included advocacy for improved community-based mental health services, enhanced consumer involvement in planning for mental health services, membership development, fund-raising, and special attention to children’s issues and to rural mental health.

He has served as president of the national staff organization, the American Society of Mental Health Association Professionals. He has also been a consultant to a range of local, regional and national non-profit social service organizations, providing advice on management, fund-raising, strategic positioning, and organization renewal.

A WFMH member for 25 years
“It is a distinct honor to have been selected by the WFMH Board of Directors as its Secretary General and Chief Executive Officer,” Mr. Garrison said. “WFMH has a long history of leadership in building an international voice on behalf of the millions of children, adolescents, and adults who need acceptable treatment and rehabilitation services to help them overcome serious mental, emotional, and behavioral disorders. All too often, such services remain unavailable, and public opinion often does not view these disorders in a positive and supportive light. The Federation’s member organizations and individuals are doing important work in over 80 countries to bring mental and emotional health treatment, prevention, and promotion into the 21st century. After having been an individual member of WFMH for 25 years, I am pleased now to have the chance to lend my efforts to this important global effort as its chief professional staff officer.”

Former position
Mr. Garrison has relinquished his role as founding executive director of the National Practitioners Network for Fathers and Families, Inc. in Washington, D.C., a post he held since November 1998. He guided the establishment of this new association, building its membership, programs, and foundation support. NPNFF now has a nationwide network of over 600 individual practitioners and programs that serve disadvantaged communities, designed to increase the involvement of fathers in the lives of their children. This work fits well with WFMH’s goals concerning the mental health of children, the promotion of mental health, and the prevention of mental and behavioral disorders.

Garrison’s interests outside of his professional work include tennis and photography. For many years, he has been a freelance wildlife, adventure, and travel photographer and writer, and has traveled extensively to complete assignments and projects focusing on preserving endangered species, valuable ecosystems, and promoting eco-tourism in developing nations. He is a resident of Woodbridge, Virginia. His wife, Susan, is an elementary school principal in the Fairfax County Public School System in northern Virginia. They have one son, Lance, who is a marine scientist, and a three-year-old granddaughter.

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September Board Meeting in London

On 8 September the Executive Committee of the Federation’s Board of Directors met at Imperial College, London. Other committee meetings also took place. Following these preparatory sessions, a meeting of the Board was held at the Royal College of Psychiatry on 9-10 September, chaired by WFMH President Pirkko Lahti. The major item on the agenda was the appointment of Preston J. Garrison as Secretary General and Chief Executive Officer. A session of the Membership Assembly was convened after the Board meeting.

The Board reviewed current expenditures, the budget for next year, and other financial matters. A number of Bylaw changes were approved for submission to the Assembly, including one to establish a review process for those voting member organizations not having paid annual dues, which will lead to cancellation of voting status. Changes to the Manual of Policy and Procedures included the adoption of revised procedures governing the submission of resolutions at the Assembly.

After a discussion of the current World Mental Health Day campaign, the Board decided to adopt a theme involving children’s mental health again in 2003. This will be the second time a two-year theme has been used.

A report from the organizers of the next World Congress in Melbourne, Australia, was presented, and the Board also reviewed plans for future Congresses after the February 2003 event.

The Federation’s Main Representative to United Nations Headquarters in New York, Nancy Wallace, gave a presentation on recent activities there, including the meeting of the ad hoc committee on a proposed UN convention on disability (28 July-9 August). She attended the meeting on behalf of the Federation with Board member Sylvia Caras, who also provided comments. The Board passed a resolution expressing support for the development of the convention, with the intention of soliciting the active interest of the Federation’s membership. Earlier, on the afternoon of 8 September at Imperial College, Ms. Wallace had given a general briefing to Board members on the Federation’s advocacy work at the United Nations.

Seven applications for the renewal of Collaborating Center status had been received. The following were approved:
Women’s Health Program, University of Toronto, Canada
Office for Gender and Health, University of Melbourne, Australia
Department of Psychiatry and Mental Health, University of Cape Town, South Africa
Harvard Program in Refugee Trauma, Harvard University, USA
Service for the Treatment and Rehabilitation of Torture Survivors (STARTTS), Caramar, New South Wales, Australia
Institute for Human Ageing, University of Liverpool, UK
CCPMH/IPSER, University of Maastricht, The Netherlands.

A voting member application from the Suicide Prevention Advocacy Network, USA, was accepted.

The Board passed a resolution supporting the investigative efforts being undertaken by the World Psychiatric Association with regard to alleged misuses of psychiatry in China to suppress the practices of the Falun Gong.

Edith Morgan, Former WFMH President
Edith Morgan

Former President Edith Morgan (1985-87) attended the meeting and chaired the session of the Membership Assembly. Leo deGraaf, president of Mental Health Europe, a WFMH Regional Council, also attended the Board meeting as an observer.

- Elena L. Berger


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Promotion and Prevention Gain New Support

The Second World Conference on the Promotion of Mental Health and Prevention of Mental and Behavioral Disorders, London, September 11-13, 2002

Recognition of the importance of promotion and prevention in mental health continues to grow. The London conference attracted an audience enthusiastic about the field, and speakers gave an impressive overview of the latest developments. It is clear that a vigorous momentum is developing, and this is especially noticeable since the December 2000 inaugural conference at the Carter Center in Atlanta.

Rosalynn Carter, Jacqui Smith, Ma'an Barry
Rosalynn Carter (left), with UK Minister of State for Health Jacqui Smith
and WFMH Regional Vice President for the Eastern Mediteranean Ma'an Barry

In deference to the events of September 11 last year, the meeting began with information about Britain’s national minute of silence at 1.46 pm local time. Later in the day conference participants joined this observance, which was followed by a plenary session about prevention in relation to violence and trauma. Mrs. Rosalynn Carter, wife of former US President Jimmy Carter, spoke about posttraumatic stress disorder as a consequence of natural and man-made disasters. Beverly Raphael, Director of the New South Wales Department of Health, Australia, discussed the many sources of violence in society and its results for individuals, especially children. She said that some interventions, but not all, could be helpful after incidences of mass violence. Prof. Dusica Lecic-Tosevski of the University of Belgrade, Yugoslavia, noted the importance of including disaster preparation in prevention programs.

The overall program was designed to highlight five core tasks in prevention and mental health promotion. The first was developing insight into the onset of mental health problems and the development of positive mental health. The others were influencing national policies to improve mental health and reduce the incidence of disorders; developing stakeholder partnerships; moving from research to effective programs; and developing a competent workforce for prevention and promotion. Speakers who described current scientific research and the implementation of programs came from government agencies and departments, academic institutions, NGOs and mental health associations.

Beverly Long and Clemens Hosman
Beverly Long, chair of the Biennial Conference Committee, and Clemens Hosman.
chair of the Programme Committee for the London Conference.

The World Health Organization was represented by Benedetto Saraceno, M.D., Director of the Department of Mental Health and Substance Dependence, and by Shekhar Saxena, M.D., Coordinator for Mental Health Evidence and Research. A session in the program was devoted to WHO’s current work in prevention and promotion. To coincide with the conference it released a new publication, Prevention and Promotion in Mental Health (see below for information about obtaining a copy). This will be followed by other reports, now in preparation, on prevention (2003, under the direction of Clemens Hosman) and promotion (2004, under the direction of Helen Herrman). Professors Hosman and Herrman gave overviews of their work on these projects.

The British authorities paid significant attention to the conference: improving mental health services is one of the government’s top three health priorities. The Minister for Health and Social Services for Wales, Jane Hutt, gave a presentation at the welcome reception on 10 September. On the following day England’s Minister of State for Health, Jacqui Smith, opened the conference. That evening she hosted a government reception for participants at the Foreign and Commonwealth Office.

From Research to Implementation
Prevention and promotion programs operate at many levels and selectively target age groups throughout the lifespan. A large number focus on prenatal health, effective parenting, and school-based initiatives. Others target women’s mental health, workplace conditions, and issues affecting older people. Moving from research to demonstration programs, and then to broad-based government policy initiatives, is a time-consuming process. Transferring the knowledge gained from one culture to another is even more difficult.

Vikram Patel
Vikram Patel, London School of Hygiene and
Tropical Medicine / Sangath Society, India

Many speakers gave a Western perspective, and so the views of those who represented developing countries were particularly welcome. Vikram Patel discussed the limited provision for general health care in India, and how difficult it is to implement services for prevention and promotion in mental health when basic programs are lacking. A WFMH Board member from South Africa, Shona Sturgeon, spoke feelingly about the wide gap between rich and poor countries and how poor countries react when help is offered without a realistic appreciation of their circumstances. The Federation’s Regional Vice President for Africa, Elizabeth Matare of Zimbabwe, gave a witty and energetic address about ways to campaign at grassroots level to urge governments to improve mental health services and meet their commitments under UN conventions.

In the closing session WFMH Board Member Janet Meagher spoke about the need to close the gap between scientific research and those who receive services, which she saw as an essential requirement for the general implementation of demonstration projects. She urged the organizers to consider broad approaches, such as involving self-help groups in promotion and prevention.

Michael Murray
Michael Murray, Chief Executive, The Clifford Beers Foundation

Michael Murray of The Clifford Beers Foundation was chair of the organizing committee, and Prof. Clemens Hosman of the universities of Njimegen and Maastricht in The Netherlands chaired the scientific program committee. The members of the Biennial Conference Committee in overall charge of the conference were Beverly Long (chair), Clemens Hosman, Michael Murray, Sheppard Kellam, Gregory Fricchione, Thomas Bornemann, Patricia Mrazek (until 1 June 2002) and Patt Franciosi (after 1 June 2002).

The conference was an integral component of the World Federation for Mental Health global program for the promotion of mental health and the prevention of mental and behavioral disorders. It was organized by WFMH and The Clifford Beers Foundation of the United Kingdom in collaboration with The Carter Center, and co-sponsored by the World Health Organization.

A Demonstration Project from Scotland

Many participants were already implementing demonstration programs, and described them in symposia throughout the conference. An example was a presentation from the leadership team of the “Starting Well Health Demonstration Program” in Glasgow, Scotland. Glasgow has one of the poorest health records in Europe, and this three-year program is designed to promote positive parenting and improve the outlook for children in disadvantaged families. It is based on an existing health visitor program which provides home visits in the prenatal period.

The demonstration project broadened the service offered to provide other levels of support for family members. The role of the health visitors continued, but was supplemented by support workers, nursery nurses and community support facilitators. The team provided services directly and also facilitated access to other programs. Local employment was created within the community through special training for the paid support positions, and an effort was made to recruit Asian workers to assist Asian families.

The presenters noted how difficult it was to mesh the new staff involved in the demonstration program with the existing group of health visitors, and how hard it was to move the health visitor program from a medical approach to a wider context emphasizing social and behavioral issues.

The program was successful in targeting an increased amount of assistance for new mothers who experience post-partum depression. It also paid attention to other mental health problems of family members and tried to find ways to help. One member of the Glasgow team observed that the health visitors saw many cases of depression – which individuals simply accept as normal in their lives. Domestic violence proved to be especially difficult to address.

Presentations like this during the conference showed that, while it might be difficult to replicate exactly a program tailored to specific local circumstances, the underlying aims could be adopted in many other places

Two Publications Released at the London Conference

Proceedings of the Atlanta Conference at the Carter Center, December 2000 To obtain a copy of Toward a Strategy for Worldwide Action to Promote Mental Health and Prevent Mental and Behavioral Disorders (for the cost of shipping and handling) contact:

WFMH
P.O.Box 16810
Alexandria, VA 22302-0810
Fax: 703 519 7648
Email: wfmh@erols.com

WHO Report: Prevention and Promotion in Mental Health
Available at no charge. Contact:

Dr. Shekhar Saxena
Coordinator
Mental Health: Evidence and Research
World Health Organization
CH-1211, Geneva, Switzerland
Also, the pdf version of the report can be downloaded from the following URL:
http://www5.who.int/mental_health/main.cfm?s=0006#evidence

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The Second World Conference on the Promotion of Mental Health and Prevention of Mental and Behavioral Disorders, London, September 11-13, 2002

Recognition of the importance of promotion and prevention in mental health continues to grow. The London conference attracted an audience enthusiastic about the field, and speakers gave an impressive overview of the latest developments. It is clear that a vigorous momentum is developing, and this is especially noticeable since the December 2000 inaugural conference at the Carter Center in Atlanta.

Rosalynn Carter, Jacqui Smith, Ma'an Barry
Rosalynn Carter (left), with UK Minister of State for Health Jacqui Smith
and WFMH Regional Vice President for the Eastern Mediteranean Ma'an Barry

In deference to the events of September 11 last year, the meeting began with information about Britain’s national minute of silence at 1.46 pm local time. Later in the day conference participants joined this observance, which was followed by a plenary session about prevention in relation to violence and trauma. Mrs. Rosalynn Carter, wife of former US President Jimmy Carter, spoke about posttraumatic stress disorder as a consequence of natural and man-made disasters. Beverly Raphael, Director of the New South Wales Department of Health, Australia, discussed the many sources of violence in society and its results for individuals, especially children. She said that some interventions, but not all, could be helpful after incidences of mass violence. Prof. Dusica Lecic-Tosevski of the University of Belgrade, Yugoslavia, noted the importance of including disaster preparation in prevention programs.

The overall program was designed to highlight five core tasks in prevention and mental health promotion. The first was developing insight into the onset of mental health problems and the development of positive mental health. The others were influencing national policies to improve mental health and reduce the incidence of disorders; developing stakeholder partnerships; moving from research to effective programs; and developing a competent workforce for prevention and promotion. Speakers who described current scientific research and the implementation of programs came from government agencies and departments, academic institutions, NGOs and mental health associations.

Beverly Long and Clemens Hosman
Beverly Long, chair of the Biennial Conference Committee, and Clemens Hosman.
chair of the Programme Committee for the London Conference.

The World Health Organization was represented by Benedetto Saraceno, M.D., Director of the Department of Mental Health and Substance Dependence, and by Shekhar Saxena, M.D., Coordinator for Mental Health Evidence and Research. A session in the program was devoted to WHO’s current work in prevention and promotion. To coincide with the conference it released a new publication, Prevention and Promotion in Mental Health (see below for information about obtaining a copy). This will be followed by other reports, now in preparation, on prevention (2003, under the direction of Clemens Hosman) and promotion (2004, under the direction of Helen Herrman). Professors Hosman and Herrman gave overviews of their work on these projects.

The British authorities paid significant attention to the conference: improving mental health services is one of the government’s top three health priorities. The Minister for Health and Social Services for Wales, Jane Hutt, gave a presentation at the welcome reception on 10 September. On the following day England’s Minister of State for Health, Jacqui Smith, opened the conference. That evening she hosted a government reception for participants at the Foreign and Commonwealth Office.

From Research to Implementation
Prevention and promotion programs operate at many levels and selectively target age groups throughout the lifespan. A large number focus on prenatal health, effective parenting, and school-based initiatives. Others target women’s mental health, workplace conditions, and issues affecting older people. Moving from research to demonstration programs, and then to broad-based government policy initiatives, is a time-consuming process. Transferring the knowledge gained from one culture to another is even more difficult.

Vikram Patel
Vikram Patel, London School of Hygiene and
Tropical Medicine / Sangath Society, India

Many speakers gave a Western perspective, and so the views of those who represented developing countries were particularly welcome. Vikram Patel discussed the limited provision for general health care in India, and how difficult it is to implement services for prevention and promotion in mental health when basic programs are lacking. A WFMH Board member from South Africa, Shona Sturgeon, spoke feelingly about the wide gap between rich and poor countries and how poor countries react when help is offered without a realistic appreciation of their circumstances. The Federation’s Regional Vice President for Africa, Elizabeth Matare of Zimbabwe, gave a witty and energetic address about ways to campaign at grassroots level to urge governments to improve mental health services and meet their commitments under UN conventions.

In the closing session WFMH Board Member Janet Meagher spoke about the need to close the gap between scientific research and those who receive services, which she saw as an essential requirement for the general implementation of demonstration projects. She urged the organizers to consider broad approaches, such as involving self-help groups in promotion and prevention.

Michael Murray
Michael Murray, Chief Executive, The Clifford Beers Foundation

Michael Murray of The Clifford Beers Foundation was chair of the organizing committee, and Prof. Clemens Hosman of the universities of Njimegen and Maastricht in The Netherlands chaired the scientific program committee. The members of the Biennial Conference Committee in overall charge of the conference were Beverly Long (chair), Clemens Hosman, Michael Murray, Sheppard Kellam, Gregory Fricchione, Thomas Bornemann, Patricia Mrazek (until 1 June 2002) and Patt Franciosi (after 1 June 2002).

The conference was an integral component of the World Federation for Mental Health global program for the promotion of mental health and the prevention of mental and behavioral disorders. It was organized by WFMH and The Clifford Beers Foundation of the United Kingdom in collaboration with The Carter Center, and co-sponsored by the World Health Organization.

A Demonstration Project from Scotland

Many participants were already implementing demonstration programs, and described them in symposia throughout the conference. An example was a presentation from the leadership team of the “Starting Well Health Demonstration Program” in Glasgow, Scotland. Glasgow has one of the poorest health records in Europe, and this three-year program is designed to promote positive parenting and improve the outlook for children in disadvantaged families. It is based on an existing health visitor program which provides home visits in the prenatal period.

The demonstration project broadened the service offered to provide other levels of support for family members. The role of the health visitors continued, but was supplemented by support workers, nursery nurses and community support facilitators. The team provided services directly and also facilitated access to other programs. Local employment was created within the community through special training for the paid support positions, and an effort was made to recruit Asian workers to assist Asian families.

The presenters noted how difficult it was to mesh the new staff involved in the demonstration program with the existing group of health visitors, and how hard it was to move the health visitor program from a medical approach to a wider context emphasizing social and behavioral issues.

The program was successful in targeting an increased amount of assistance for new mothers who experience post-partum depression. It also paid attention to other mental health problems of family members and tried to find ways to help. One member of the Glasgow team observed that the health visitors saw many cases of depression – which individuals simply accept as normal in their lives. Domestic violence proved to be especially difficult to address.

Presentations like this during the conference showed that, while it might be difficult to replicate exactly a program tailored to specific local circumstances, the underlying aims could be adopted in many other places

Two Publications Released at the London Conference

Proceedings of the Atlanta Conference at the Carter Center, December 2000 To obtain a copy of Toward a Strategy for Worldwide Action to Promote Mental Health and Prevent Mental and Behavioral Disorders (for the cost of shipping and handling) contact:

WFMH
P.O.Box 16810
Alexandria, VA 22302-0810
Fax: 703 519 7648
Email: wfmh@erols.com

WHO Report: Prevention and Promotion in Mental Health
Available at no charge. Contact:

Dr. Shekhar Saxena
Coordinator
Mental Health: Evidence and Research
World Health Organization
CH-1211, Geneva, Switzerland
Also, the pdf version of the report can be downloaded from the following URL:
http://www5.who.int/mental_health/main.cfm?s=0006#evidence


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Visit to Kissy Mental Hospital, Sierra Leone

Florence Baingana
By Florence Baingana
Senior Health Specialist, The World Bank

We got off the plane, went through customs and then there seemed to be a mad rush for the very narrow gate in a prison-like metal partition. On the one side, we were trying to get out, and on the other were about twenty to thirty men, all in yellow shirts, the uniform denoting the porters for the airport, trying to get at our luggage. All the gentle manners that we had shown each other on the plane and in all the airports we had been through were suddenly thrown off, and it was push and shove as best you could.

I immediately began worrying about my luggage. What if someone grabbed and made off with it? Luckily, a hand-made sign appeared above the heads, tossing and turning with the flow of human traffic. I heaved a sigh of relief. The person who was to help me through the airport procedures and onto the helicopter had received the message and was waiting.

He got me onto the helicopter, which was another mad rush. Although I was first to set off for boarding, I was actually last to get in. The luggage was loaded in the center, and along the two walls were benches on which as many people as the helicopter could take were loaded. A gentleman was asked to carry the child of a mother who had two children. It seems there was no weight limit. When the helicopter took about twenty minutes, with groaning and wheezing, before it got off the ground, I began to worry again about whether I should have taken the almost two-hour journey by road instead of the seven-minute helicopter ride. We flew low across the water, from Lungi Airport to Freetown, the capital city of Sierra Leone.

Freetown to Kissy This was nothing compared to the ride from Freetown to Kissy Mental Hospital. Freetown is a crowded city with pavement sellers on every street, selling everything, from potatoes to lettuce and cucumber to shoes and clothes, gum and sweets to buns loaded with baked beans. The streets were crowded with people going to and fro, others begging, and money changers offering the best price every time the car slowed down.

The journey out of the city was slow, the streets were narrow, the traffic heavy and the “seven-day rain” not letting up. We gradually made it out of the city limits and began to climb a very pot-holed road. When I thought it just could not get any steeper, we suddenly came to an almost vertical incline with a pile of gravel in the middle of the road. The road itself seemed to be made of huge boulders and the gravel was an attempt to fill in the gaps between them. I presumed the job was begun and never finished.

I suggested to the driver that I walk the rest of the way but he decided to give it one shot. The car slithered and slid up the incline, threatening to stall and slide back every minute. We finally made it to the top without any major mishap. I looked around and saw a dilapidated sign saying Kissy Mental Hospital propped against an ancient building made of stone blocks. The hospital was built in the mid 1800s and for the most part, has not been renovated since then.

I had a note that allowed me entrance and a tour. The staff member in charge happily agreed to take me round. He informed me that he was a nursing aide. There is only one psychiatrist and one psychiatric nurse in the whole country of 5 million people. Non-specialist staff like medical officers and general nurses are not willing to work at Kissy Mental Hospital.

At the Hospital As we walked to the very first ward, which he called the acute male admission ward, he suddenly said “watch out where you step.” I was about to step into what looked like human excrement. In the first ward, there was not a single bed or mattress. The patients were all chained to rings in the floor. Most patients were naked. The ward had no door or windows. It was in a very dismal state.

We made a tour of the whole hospital. The wards progressively got better but most patients were still chained to the beds. The reason given was the lack of adequate staff, no isolation rooms and inadequate medications. An attempt was made to provide some art materials as recreation but the drawing was carried out while the patients sat on the beds to which they were chained. The occupational therapy room was overgrown with weeds, and so was the mortuary.

Kissy Mental Hospital is the only psychiatric facility in Sierra Leone. There are no psychiatric services of any kind in any of the other hospitals. The only outpatient mental health service in the whole country is the private clinic of the only psychiatrist. Following ten years of civil conflict, some NGOs have attempted to introduce mental health and psychosocial services. These include Medicins Sans Frontieres, Cooperazione Internazionale, Handicap International, the Centre for Victims of Torture’s community based mental health program, and the International Refugee Committee’s gender-based violence program. These programs are few and far between.

Mental health has been included as one of the priorities in the country’s revised health policy, and the World Health Organization has made a commitment to provide a consultant to carry out an epidemiological survey and provide support to the development of a mental health policy. The time is ripe for facilitation of the formation of a consumer and carer organization to compliment the initiatives of the Government and NGO sectors.


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Human Rights Abuses in Kosovo

“While conditions at all inpatient facilities we observed are poor – and raise serious human rights concerns – conditions at Shtime are the worst. In part, this is because detention in Shtime usually means segregation from society and detention in the institution for life…. People spend their days in inactivity, without any semblance of privacy, living in filth….There are no clocks to orient people as to the time of day. Many people spend their days sitting on benches, wandering the grounds, or sleeping on bare concrete floors.”

Mental Disability Rights International has released a strong report about deplorable conditions in three institutions for people with psychiatric and mental disabilities in Kosovo - the Shtime institution, the Elderly Home (which housed people of all ages at the time of MDRI’s investigation) and the psychiatric ward of Prishtina University Hospital. The report examines serious abuses, including unhygienic conditions, inadequate staffing levels for general and medical care, and inappropriate placements.

Of special concern were reports from patients and local and foreign staff about cases of sexual harassment, rape and other types of violence at the three institutions. “Kosovo’s social care facilities and psychiatric wards are not safe places. In addition to violating the rights of patients, the lack of protections against violence or sexual exploitation undermines the function of psychiatric wards to assist people in need of acute mental health care.” There was no system to conduct independent investigations of alleged incidents, considerable fear of making such reports, and little effort to protect patients from violence.

The report contains a careful review of the difficulties of post-conflict international intervention, and problems caused by short-term foreign aid and its gradual withdrawal. It is highly critical of policies adopted by the United Nations Mission in Kosovo (UNMIK) which failed to address reforms and permitted abuses to continue. It points out that UNMIK’s programs in Kosovo do not conform to the UN’s own disability rights standards.

A list of recommendations is offered for urgently needed funding and policy changes to provide major improvements in care. About the Shtime institution, where the report says “many residents live in filth, surrounded by the smell of urine or feces,” the recommendation is that the place “is so dangerous and destructive to the mental and physical health of its residents that the UN should plan for its closure at the soonest possible date – as soon as alternatives can be created in the community.”

The report “Not on the Agenda: Human Rights of People with Disabilities” was released in August after six site visits to Kosovo by MDRI teams. It was written by MDRI Executive Director Eric Rosenthal, and Eva Szeli, MDRI Director for European Programs. The text is available online at www.mdri.org.

Contact:

Mental Disability Rights International
1156 15th Street NW, Suite 1001
Washington, DC 20005, USA
Tel: 202 296 6550
Fax: 202 728 3053
Email: mdri@mdri.org



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South America’s Serious Problems

Paulo Alterwain

Paulo Alterwain, WFMH Regional Vice President, writes about the effects of the economic crisis in South America

All of South America is experiencing important difficulties. Numerous new problems have been added to the existing problems and underdevelopment. Progress that has been made in the care of mentally ill patients is jeopardized where economic and financial difficulties have compelled reductions in public budgets, including health expenditures. Argentina, Brazil and Uruguay, having made strides in mental health, are confronting serious setbacks.

There is a preoccupation with worsening conditions and the increased fragility of populations living in uncertainty or hopelessness. Alerts have been posted about the increase of patients registered in psychiatric hospitals. The “new poverty” is generating suffering, pathologies and diseases beyond depression. Suicides, homicides and violence have increased, and deaths related to hypertension, stroke and heart attack. The needs are growing for care of stress and post-traumatic personality disorders.

Efforts to improve community-based delivery care systems and de-institutionalization from psychiatric hospitals are continuing. Consumer organizations are maintaining their efforts, but community-based services are at serious risk of deterioration.

Additional planning for media attention is recommended to highlight the new poverty and social troubles in such countries as Argentina, Brazil, Paraguay and Uruguay.

We wish to point out that even under these conditions, our Argentine and Chilean affiliates are developing important new activities. A regional (Argentina, Paraguay and Uruguay) meeting on “Mental Health and Work During Periods of Crisis” was held on September 6 and 7 in Cordoba, Argentina. Also in September, a course for physicians and professionals on primary mental health care was organized by the Chilean Society of Mental Health (Sociedad Chilena de Salud Mental) in Valdivia, Chile.

South America needs international cooperation and government initiatives to deal with the socio-economic deterioration and the psychosocial reactions and other psychiatric problems linked to it.

Strength and union. We continue working.

 

 

 

SUD AMERICA Y SUS GRAVES PROBLEMAS DE HOY

Sud América está atravesando dificultades importantes en toda su extensión. A los problemas ya conocidos y a su necesidad general de desarrollo, se han agregado hoy numerosos problemas y crisis prácticamente en toda su extensión.

Corren peligro los progresos realizados en la Atención de los Enfermos Mentales en aquellos países donde las dificultades económicas y financieras han obligado a reducir los presupuestos, incluso los de Salud. Argentina, Brasil y Uruguay, países con desarrollos importantes en Salud y Salud Mental, están enfrentando problemas en este sentido. Existe gran preocupación por fenómenos que han agravado y aumentado la fragilidad de la población, que vive en incertidumbre continua. Surgen permanentemente alertas por el aumento de los ingresos en los hospitales públicos.

La "nueva probreza" está generando sufrimiento y patologías que superan la depresión. Se está apreciando un incremento de los suicidio, los homicidios y actos violentos e incluso muertes súbitas por crisis hipertensivas, ataques cardíacos y accidentes cerebro vasculares. Comienzan a aparecer muchas necesidades respecto a la atención del estrés y los Trastornos de Personalidad Post Traumáticos.

Sud América requiere de la cooperación internacional y una más activa incidencia sobre los gobiernos, que seguramente están alarmados por los problemas socio-económicos y deben tomar medidas en lo referente a las reacciones psico-sociales y otros problemas psiquiátricos ligados con ellas.

Los esfuerzos para mejorar los Sistemas de Atención de Base Comunitaria y la descentralización desde el Hospital Psiquiátrico continúan. Las organizaciones de usuarios prosiguen con su esfuerzo, pero se advierte el riesgo de enlentecimiento y deterioro de los Servicios Comunitarios.

Es altamente recomendable que aparezcan más y más planteos a través de los medios masivos de comunicación y se enfatice que la nueva pobreza y el deterioro social ya están en países como Argentina, Brasil, Paraguay y Uruguay, generando crisis, depresión e intentos de suicidio que día a día aumentan las demandas de atención y los ingresos hospitalarios.

Queremos destacar que aún en estas condiciones, nuestras afiliadas de Argentina y Chile desarrollan importantes actividades. Los días 6 y 7 de setiembre se realizó en la ciudad de Córdoba, Argentina, una reunión subregional (Argentina, Paraguay y Uruguay) sobre "Salud Mental y Trabajo en período de crisis".

Y también en la ciudad de Valdivia, Chile, un Curso de Psiquiatría para médicos y profesionales sobre Atención Primaria en Salud organizado por la Sociedad Chilena de Salud Mental.

FUERZA Y SALUD. CONTINUAMOS TRABAJANDO.

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The WFMH Newsletter is published by the Secretary General of the World Federation for Mental Health for its members four times a year.
Editor: Elena L. Berger, D. Phil.
Consultant: Prof. Eugene B. Brody, M.D.
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