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The action project "Harassment and discrimination faced by people with psycho-social disability in health services" is organised in the framework of the Community Action Programme to combat discrimination 2001-2006, and is funded by the European Commission -Employment and Social Affairs. The overall aim is to raise awareness about the discrimination faced by people with mental health problems in health care services and to promote strategies to combat it.
The recommendations are based on the opinions of the national partners and the European Network of (ex-)users and survivors of psychiatry (1) and are inspired by the results of the focus groups that were held during the first year with (ex-) users and survivors of psychiatry and health professionals.
Every day, people affected by mental health problems, as well as carers and relatives, face harassment and discrimination in diverse areas of their lives. This reduces the possibility of recovery and integration in society.
Before summarising possible measures, emphasis should be put on the importance of the participation of (ex-)users and survivors of psychiatry in the formulation and implementation of these measures. The starting point for tackling harassment and discrimination that people with mental health problems or that are called mentally ill and their relatives experience, is their participation in the fight against this discrimination at various levels. The knowledge and expertise with which they can contribute is unique and of an enormous value. This is why measures that address discrimination and harassment must be elaborated by those who suffer from this situation as well as by experts and professionals. The motto "nothing about us without us" of the 2003 European Year of People with disabilities must become practice.
We suggest the development of strategies to change attitudes and the behaviour of the general public and particularly of (mental) health workers. To reduce or eliminate discrimination and harassment an explicit formulation of 'good practices' or care standards and laws on the equality of treatment should be developed and linked with the installation of boards of appeal.
Adequate funding, organisational involvement and support of policy makers are a pre-requisite for the realisation of these recommendations.
1. IMAGE BUILDING
There is a need for the development of programmes to improve public perception of people with mental health problems in the general population. As future aims, programmes should also be developed for journalists and for schools to change the general behaviour and attitudes in the EU accession countries.
It is important that those programmes should be organised by groups of health professionals, (ex-)users and survivors of psychiatry and carers and be focused on the theme "harassment and discrimination - what can be done?"
2. PROMOTION OF THE MOVEMENT OF (EX-)USERS AND SURVIVORS OF PSYCHIATRY
The (ex-)users and survivors of psychiatry movement should be promoted. They should support and reinforce campaigning and decision-making at all the levels, in particular at the level of professionals' organisations and political organisms. Effective participation of trained (ex-)users and survivors of psychiatry is essential for the implementation and development of quality standards and research projects.
Funding and support should be invested in:
3. SENSITISATION AND TRAINING OF SOCIAL AND HEALTH PROFESSIONALS
Discrimination and harassment experienced in the health field is especially important not only because social and health professionals are directly involved in the recovery of the people with a mental health problem and their carers, but also because in many cases this discrimination passes unnoticed or unchallenged.
4. QUALITY STANDARDS OF CARE
Beyond the relationship between the caregiver and the (ex-)user or survivor of psychiatry, there is the higher level in the organisation of care that is crucial in combating discrimination and harassment.
5. LEGISLATION ON DISCRIMINATION AND BOARDS OF APPEAL
Laws on equality of treatment should be adopted and funds provided so that these laws can be put into practice.
6. INVOLVEMENT OF POLICY MAKERS
The health rates of the citizens of a country are a criterion of well-being and mental health is a key point in this respect.
There is a need for a concerted effort on the part of the general public and professionals of mental health care and of health care to change attitudes towards people with mental health problems. Greater efforts must be made not only to increase awareness of the discrimination and harassment routinely faced by people with mental health problems and their families, but also towards the allocation of resources that ensure an improvement in the quality of the treatment. Financial resources, structural and organisational changes, which enforce the movement of (ex-)users and survivors of psychiatry, the explicit formulation of quality standards of care, the adaptations of laws and the involvement of politicians should help to make this possible.
(1) The term "user of psychiatry" refers to people who have mainly experienced psychiatric treatment as helpful. The term "survivor of psychiatry" in turn refers to those who have mainly experienced psychiatric treatment as being a danger to their health. These definitions are often misunderstood: to "survive psychiatry" does not mean that psychiatrists are being accused of trying to intentionally kill people. But it does mean that diagnoses such as "schizophrenia" or "psychosis" very often have a depressing and stigmatising effect, leading to resignation and chronic hospitalisation. And it means that drug-effects such as neuroleptic malignant syndrome or tardive dyskinesia or dystonic or epileptic attacks can be a danger to health and life, which have to be survived. (back to the footnote-call)