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The
Community
Psychologist

Volume 48 Number 4 
Fall 2015

Transformative Change in Community Mental Health Interest Group

Edited by Geoffrey Nelson, Wilfred Laurier University (gnelson@wlu.ca)

The Practice of Transformative Community Mental Health: Challenges and Perspectives for Change

Ornelas.jpgWritten by José Ornelas, Associate Professor at ISPA – University, Lisboa Portugal (jornelas@ispa.pt / www.ispa.pt), Co-founder of the Transformative Change in Community Mental Health Interest Group

The SCRA Interest Group on Transformative Change in Community Mental Health was formed by a transnational group of academic, professional and movement leaders who share a common vision around the need to strengthen and transform mental health communities worldwide. Within Community Psychology, over the past 50 years, a substantive body of research has been published, and countless reports of practical experiences have been produced containing major lessons on ecological approaches to community integration, on empowerment, and on the recognition of the value of mutual help groups, user movements, and consumer-run organizations. More recently, it has become increasingly important to consider the applicability of the capabilities approach to mental health services and supports, providing in-depth reflections on the role of organizations in the promotion of the development of the peoples they were designed to support and the communities where they live (Shinn, 2015).

Since 1987, a community-based organization named AEIPS (Associação para o Estudo e Integração Psicossocial) was designed to contribute towards the development of a transformative community mental health paradigm in Portugal. This organization, founded by professionals, consumers and families, emerged in a sociopolitical context of great expansion of civil society initiatives, including the emergence of private media, a diversity of social initiatives addressing child poverty, youth development, and interventions in neighborhoods, as well as in the field of arts and culture, following Portugal joining in 1986 the EEC (European Economic Community), nowadays the EU (European Union). AEIPS established an innovative practice of partnership with the University (ISPA-University Institute), that provided the opportunity to link research and action, and the constant reflection on the challenges of the overall aim of deinstitutionalizing and operationalizing a mission focused on advocacy for human rights and social justice for those who live with the experience of mental illness, and the vision of communities enriched by human diversity.

Transformational change in this context is conceptualized at multiple levels of analysis and matching intervention strategies with the appropriate level of analysis. AEIPS operates as a mediating structure, promoting transformative change across levels that includes influencing public policies, promoting organizational change and development, and providing individual opportunities and networks for social integration. In the realm of public policies, through almost three decades, AEIPS has been involved in several key-moments of building or changing legislation, such as public financing schemes for community-based organizations in mental health, including community centers, housing, employment, and educational programs and supports; establishing national plans for the reform of mental health services, including the substantial reduction of large-scale psychiatric hospitals; and co-founding a national federation of community-based organizations, that at present represents these organizations at the National Council for Mental Health.

At the organizational level, transformative change emphasizes active consumer participation in planning, governance, evaluation, and research, with real voice and power. The emphasis on empowerment and collaboration is relevant to consumer participation. Mutual collaboration between professionals and consumers has become increasingly relevant in terms of support coordination, resource mobilization, and innovation. Such partnerships involve consumer participation in all decision-making, service delivery, and evaluation procedures in AEIPS (see photo of AEIPS below).

Building.jpgThe individual level of analysis includes the recognition of the importance of the concepts of recovery, empowerment, advocacy, and mutual help controlled by users. Since 2006, consumers have been able to expand their influence by forming the National Network of People with Mental Illness, which organizes a nation-wide meeting once a year, promotes awareness, mobilization and representation both at the local and national levels. The advocacy for community integration has lead to the permanent focus on bridging with regular social resources, organizing support networks to facilitate consumers’ access to independent housing, to enroll and graduate in regular schools or universities, and to have opportunities for mainstream employment in the community.

In the housing stream, the support program provides individualized and flexible services to assist people with mental illness to live independently, including the choices concerning location where participants want to live and with whom they wish to live. The generalization of this model and its influence on the mental health systems is inspired by the Housing First approach (Tsemberis, 2010), which is being implemented in several cities in Portugal. Housing First was introduced in Portugal by AEIPS in Portugal in 2009, and represented the country as an innovative initiative in the European Year against Poverty (2010). Based on the premises of supported employment and education, AEIPS has offered since 1990 individualized support to people who want return to school, to undertake or complete any level or degree of education, or achieve employment in mainstream businesses in the community (Ornelas, Durate, & Monteiro, 2014).

The completion of a cycle of model program streams based on individualized housing, education and employment embodies the transformative community mental health mission that emphasizes human rights and social justice. This endeavor requires professionals and consumer leaders who focus on community integration, health and well-being promotion. These change actors are aware that their interventions are an alternative to the reproduction of traditional in-ward or even community practices associated with occupational or art therapies including painting, work-crafts or other entertaining activities as a replacement for active empowerment, full community participation and leadership.

The movement towards a transformative community mental health model is a possibility in all stages of the life cycle, and deinstitutionalization is still a path to complete, as large scale psychiatric institutions persist. Following the National Plan for the Reform of Mental Health Services, the Portuguese Government decided to close Hospital Miguel Bombarda (1848-2011), the oldest psychiatric hospital in the country (see photo), where Egas Moniz used “patients” for his psychosurgical experiments (e.g., lobotomies).

AEIPS conducted a careful preparation and transition to a community residential facility of the last group of 24 elderly patients, who averaged 71 years of age, and continuous hospitalization for an average of 42 years. This initiative probed to demonstrate that people of all ages and long-term hospitalizations are able to live in and be part of the community if coherent and consistent efforts focus on community integration, empowerment, and recovery.

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The SCRA Interest Group on “Transformative Change in Community Mental Health”, following the spirit of the roundtable held during the XIV Biennial Conference in Lowell, Mass., is a privileged space to discuss and share these experiences in a global perspective, to promote innovation, science and change processes in the field of community mental health.

References

Ornelas, J., Duarte, T., & Monteiro, M.F. (2014) Transformative organizational change in community mental health. In G. Nelson, B. Kloos & J. Ornelas (Eds.) Community psychology and community mental health: Towards transformative change (pp. 253-277). New York: Oxford University Press.

Shinn, B. (2015). Community psychology and the capabilities approach. American Journal of Community Psychology, 55, 243-252.

Tsemberis, S. (2010). Housing First: The pathways model to end homelessness for people with mental illness and addiction. Center City, Minnesota: Hazelden Press.