현재 주류인 정신의학 중심의 정신건강서비스에 대한 인권기반의 모델에 대하여 Tina Minkowitz가 각국에서 이미 실천되고 있는 대안적인 모델을 소개해 주었습니다. 누가 한국말로 잘 번역해서 공유해 주실 수 있으신지? Here are some of the models I think are useful, that people are working on: Soteria - house where a very small number of people can go through crisis/madness/psychosis with lots of support “Beyond Soteria” - Soteria is classically for people experiencing first time psychosis who have not had long history of being drugged and locked up and abused in psychiatry. Cindi Fisher, a colleague in Washington State, is working on a project to expand Soteria concept for people who have been in the system a long time. Part of the concept is to have a second house as a base for a neighborhood peacemaking team that could can de-escalate situations of aggression or violence. (See Annex in the RMHL/MOMS/CHRUSP and others shadow report for review of US under CERD, on CHRUSP website). Family Group Conferencing - this is Jolijn’s project and she can explain it best. Bringing people together who the person wants, the person remains in control, but people can come together to offer ideas and advice, think together about what can be done. I think this is a better approach than Open Dialogue which remains under the control of mental health professionals, and nobody I know in OD has been willing to say that will not use force or coercion. Intentional Peer Support - an approach to relationships that turns on its head the ways that the mh relates to people. Chris Hansen if she’s on this list can explain better. Principles of IPS are: Learning vs helping; Relationship vs individual (we aren’t going to focus on fixing anybody but on creating a satisfying relationship) and Hope vs fear. Tasks are: Connection, Worldview (being aware of our own worldview in relation to others and how our worldviews shape what we know and what we do), Mutuality, and Moving towards. Mutuality is important I think because it says each person has some responsibility in the relationship; we have to be aware of how our actions affect others and of what we can contribute, not only think about what we need, and vice versa; if we habitually deny ourselves we have to be aware of our own needs and assert them as well as contributing to the other person’s goals. WRAP - Wellness Recovery Action Plan - Mary Ellen Copeland created this, a self-help and peer support tool now in many languages and many variations, allows people to think about what they need to stay well and to resolve a crisis - my best understanding, someone on this list probably has better understanding PO - personal ombud - Maths Jesperson co-created this approach to reaching out to people who were isolated and might need support, who might also be living in their own reality most of the time. Key features are the careful work to establish communication and build relationship and the total confidentiality and accountability to the person receiving support; the PO can only act based on what the person asks him/her to do, doesn’t keep records etc. I think of this as the element of “support to seek support” - a way to respectfully reach out to people who are not asking for support, without thinking that you have to force or coerce the person. Independent living - the independent living movement has a lot to offer us, I think, but often people with psychosocial disabilities are excluded out of prejudice or fear of the unknown (in my opinion). People with psychosocial disabilities might need practical support that can make a difference in daily life - a service animal, a housekeeper, a companion to go shopping or go on transportation, etc. We shouldn’t think that everything is about mental health or subordinate to receiving specific mental health services (medical model or otherwise). Support to exercise capacity as a type of paralegal assistance: Michael Njenga in Kenya is working on this, I think it’s a very interesting idea and approach to support in exercising legal capacity. Focusing on the “legal” aspect e.g. I would imagine help with understanding contracts, legal proceedings or even any kind of decision with implications of being bound for the future. (Michael if you are on this list can you explain?) Related to this - Lawyers and judges can develop good skills in communicating with people, understanding unusual communication styles and expressing themselves in plain language. I’m not saying all lawyers and judges - clearly a lot are pedantic and poor communicators, but a lawyer who works with people with disabilities and cares about meaningfully representing the client can be a good resource for developing support practices for the exercise of legal capacity, especially on article 13 access to justice issues. In Moldova the legal capacity reform is proceeding not through legislation but as a result of judges rejecting guardianship applications and insisting instead on a provision of the Civil Code that provides for a type of support relationship. Community-based support that is not medical model - i.e. support that is really about community relationships, not “mental health services located in the community - Alberto Vasquez is working on this in Peru. We included some reference to this in our last submission on the Article 12 general comment, and Alberto can surely say more. Spiritual and cultural practices that are meaningful - for many many of us psychosis or what is labeled as such is a spiritual crisis or spiritual awakening; or a call to creativity. Bhargavi has written a lot about this in Indian context; Annie mentioned that Ubuntu was making connections with the sangomas, the traditional healers in South Africa - madness is seen as a call to become a sangoma. Reshma Valliappan also in India has a project called The Red Door that brings many young people together and it is essentially about creativity and mutual support. Look for The Red Door on Facebook, fun and enlightening discussions. So - what else is going on? What do you think? Do we need to develop some policy with a “menu” of services and supports? Or just continue to create good practices based on the specific resources of a country or community? It would be interesting to ask the people who developed these things, how they came to do it - how they conceived of the idea that this is what was needed. A process like that as well as a list of good practices or models that can be adopted is relevant. Tina Minkowitz
Posted on: Sat, 26 Jul 2014 15:13:18 +0000
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