Message from the WFMH PresidentPreston Garrison to Lead WFMH
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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.
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
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
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 (left), with UK Minister of State for
Health Jacqui Smith
and WFMH Regional Vice President for the Eastern Mediteranean Ma’an Barry
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, 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, 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, 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: [email protected]
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
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 (left), with UK Minister of State
for Health Jacqui Smith
and WFMH Regional Vice President for the Eastern Mediteranean Ma’an Barry
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, 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, 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, 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: [email protected]
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
Visit to Kissy Mental Hospital, Sierra Leone
By Florence Baingana
Senior Health Specialist, The World Bank
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.
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: [email protected]
South America’s Serious
Problems
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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