Social Inclusion and the Transformation of Mental Health Services: Transatlantic Perspectives
June 12-14, 2008
University of Pittsburgh
Sponsored by
University of Pittsburgh:
European Union Center of Excellence
School of Medicine
Western Psychiatric Institute and Clinic,
&
Allegheny County of Pennsylvania
Annie E. Casey Foundation
Anonymous Donor
Center for Mental Health Services SAMHSA/US Dept of HHS
Staunton Farm Foundation,
Transforming Mental Health Services:
Building on the findings of the President´s New Freedom Commission on Mental Health, the United States is engaged in an extensive effort to transform mental health services. Its goals are to reshape and improve psychiatric care in order to promote recovery and enable people with psychiatric disorders to find a “life in the community”. While the country overall has making strides in this direction- treatment options and available social supports have improved and stakeholders, especially consumers, have gained a voice in the direction of care- there is still much to be done. In particular, many of the doors to the resources and opportunities found in the general community remain firmly closed to persons with psychiatric disorders- they are “socially excluded”. It is clear that it is not enough to work to equip people with the personal and material resources they need to live in the community. There must be places and opportunities (niches) where they can live a life in recovery, where they are socially included. How can these niches be created?
Promotion and Protection of Mental Health:
Just as individuals can be socially excluded, the same is true on a broader scale for whole communities of people. They can be set aside by a variety of socioeconomic processes. It has long been known that such extruded populations are at risk for and carry the burden of psychiatric distress and co-occurring physical disease and social dysfunction. This is especially true if the circumstances appear to offer no prospects for rescue. In these circumstances limited target-oriented services are of little avail. It is not enough to save a few people when the entire community is drowning. There must be initiatives to help all find higher ground, to discover sources of resilience and creativity. How can we promote and protect the mental health of communities pushed to the margins of society?
The European Union´s Experience with Social Exclusion/Inclusion and Mental Health:
Building on the findings of the President´s New Freedom Commission on Mental Health, the United States is engaged in an extensive effort to transform mental health services. Its goals are to reshape and improve psychiatric care in order to promote recovery and enable people with psychiatric disorders to find a "life in the community". While the country overall has making strides in this direction- treatment options and available social supports have improved and stakeholders, especially consumers, have gained a voice in the direction of care- there is still much to be done. In particular, many of the doors to the resources and opportunities found in the general community remain firmly closed to persons with psychiatric disorders- they are "socially excluded". It is clear that it is not enough to work to equip people with the personal and material resources they need to live in the community. There must be places and opportunities (where they can live a life in recovery, where they are socially included. Where will they be found?
Promotion and Protection of Mental Health
Just as individuals can be socially excluded, the same is true on a broader scale for whole communities/populations of people. They can be set aside by a variety of socioeconomic processes. It has long been known that such extruded people are individually and collectively at risk for and carry the burden of psychiatric distress and co-occurring physical disease and social dysfunction. This is especially true if the circumstances appear to offer no prospects for rescue. In these circumstances limited individually oriented services are of little avail. It is not enough to save a few people when the entire community is drowning. There must be initiatives to help all find higher ground, to discover sources of resilience and creativity and opportunity. How can we promote and protect the mental health of peoples pushed to the margins of society?
The European Union´s Experience with Social Exclusion-Inclusion and Mental Health
The term "les exclus" originated in France over 30 years ago as a way to describe people living on the margins of society, untouched by the social protections of French society. As time progressed, national efforts to address social exclusion grew in France and the UK, and then, following the Lisbon Summit and Nice Council in 2000, throughout the European Union and its member states. They agreed to focus domestic policy on combating "social exclusion" and fostering "social inclusion" as a way to achieve its statutory obligation to promote social cohesion. These terms have been adapted in recognition of the fact that, on their own, other terms such as "poverty", "racism" "sexism" and stigma, while capturing key elements of societal dysfunction, do not describe the multi-dimensional ways in which people and communities are excluded from participating in society, and sharing in its resources.
From the website of the European Commission (link)
“Social inclusion- Solidarity is a hallmark of the European Union. It is an intrinsic goal of European models of society and welfare that people should not be prevented from benefiting from and contributing to economic and social progress. Building a more inclusive Europe is vital to achieve the European Union's goals of sustained economic growth, more and better jobs and greater social cohesion.
In 2000, EU leaders established the Social Inclusion Process to make a decisive impact on eradicating poverty by 2010. Since then, the European Union has provided a framework for national strategy development as well as for policy coordination between the Member States on issues relating to poverty and social exclusion. Participation by actors such as NGOs, social partners and local and regional authorities has become an important part of this process.
In the field of social inclusion, EU action has finally created a clear consensus about the following key challenges:
Within this policy framework, the EU has further determined that the pursuit of social inclusion should underlie activities addressing mental health and illness.
From the recent Member Nation Consultation on the EU Green Paper on mental health in Europe: (link)
“Social exclusion is a major public health risk that affects the mental health of a very large number of people across the EU. People with mental ill health or disability meet fear and prejudice from others, often based on misconceptions about mental ill health. Stigma increases personal suffering and can prevent help seeking. Social exclusion and discrimination can impede access to services and resources such as housing and employment. Article 13 of the EC Treaty sets out a legal basis for community level action to combat discrimination based on disability. Social exclusion can be considered in terms of the loss or reduction of rights and participation in society. Social exclusion takes many forms: subtle stigmatisation and social distancing; self- stigmatisation; territorial exclusion; and discrimination. It is important to address all aspects, through actions at different levels.
The relationship between mental health and social exclusion is bi-directional and multidimensional. This raises challenges about how to prevent negative events or protect against their consequences. Social exclusion has both economic and social consequences, leading to increased, sustained costs to public services, negative social and personal effects in terms of quality of life, and lost capacity in the labour market.
Promoting social inclusion can help the EC promote economic growth and flourishing societies, as set out in the Lisbon agenda.”
Recently, work in the EU has focused on developing methods to improve social inclusion of people with mental illness or at risk of mental illness. Numbers of examples exist and will be discussed at the conference. (see link)
As a basis for conversation, the conference will examine in detail the circumstances of Pittsburgh and Glasgow, Scotland, both former industrial cities that have suffered social and economic dislocation and have developed active programs to transform mental health services. The examples of these cities will link the local and the international, and promote the translation of ideas for both practice and policy. The activities of the International Initiative for Mental Health Leadership have pointed the way in this regard and will serve as a background to the work of the conference. (see http://www.iimhl.com/)
Purpose of the Conference:
This conference will examine the concept of social inclusion and its role in recovery and in mental health promotion. It will address the following questions:
- In the EU, how do public policies based on the concept of social inclusion:
- Foster recovery and promote the opening of opportunities in the community for people with psychiatric disorders?
- Promote mental health and resiliency in distressed communities at risk for high rates of mental illness?
- How might such a policies be translated into the U.S. context, implemented and evaluated?
- How can we best learn from each other across international boundaries?
It is the intent of this conference to
- Expose Americans to the EU experience addressing social inclusion/exclusion in mental health and consider its meaning for the public and philanthropic policy in the U.S.
- Foster an environment of mutual exchange and learning to facilitate the creation of an ongoing learning network.
- Elaborate means for the successful translation of health and public policy across international boundaries
Why Pittsburgh?
Over the past seven years, the University of Pittsburgh has sponsored three conferences on health and social policy to generate Transatlantic exchange. The European experience in community development, in approaches to health equity, and in understanding the relationship between social inequality and health have been the topics of discussion. This conference builds on these efforts- indeed the organizers and some of the proposed participants were instrumental in them.
2008 is also an auspicious time for the conference. The city of Pittsburgh is celebrating its 250th anniversary and its history and future are in the spotlight. In addition, Pittsburgh´s sole remaining State Hospital is being closed this year. The time is right to begin an international conversation with local implications.
Participants
The conference will include approximately fifty participants: twenty from Europe and thirty from the U.S. with the possible inclusion of participants from Canada and New Zealand to add an additional perspective. European participants have been identified as active participants in addressing social inclusion in mental health. U.S. participants will include representatives of the Federal Government, other mental health policy makers and philanthropists.
Preconference Activities>
A website for the posting of information will be created and participants will be encouraged to engage ideas and experiences before the conference. If possible, conference facilitators will visit in Europe with as many European participants as can be managed to go over the conference goals and establish personal relationships. The day before the conference starts there will be an informal reception and dinner for participants.
Conference Activities
The conference will last two and a half days, beginning on Thursday evening and ending with a dinner on Saturday. Thursday evening will feature a Keynote address and welcome reception. Following a light breakfast and introductions, the first day will include an extended presentation about the circumstances and current activities in Pittsburgh and Glasgow followed by two EU panels addressing social inclusion initiatives in mental health services and in promoting and protecting mental health. Friday evening will feature a social event for conference participants.
The second day will be structured to allow open facilitated conversations on key themes underlying the concept and practice of social inclusion in mental health. Following an end of day address by Kathryn Power, Director of the Center for Mental Health Services, the conference will end with a reception followed by a closing dinner.
The last day will focus on wrapping up the work of the day before, identifying and writing up what has been learned with a discussion of what further actions the group will take to further the agenda of social inclusion and to ensure future shared learning.
Post Conference Activities
Participants in the conference will be encouraged to stay active in the conference website/email list. They will be solicited to respond to an open ended questionnaire about their further thoughts on what they had learned, how they learned it and what they were going to do with their knowledge. Conference proceedings will be written up and posted. Any action plans developed to promote social inclusion policies will be pursued.
Conference Sponsors
European Union Center of Excellence, University of Pittsburgh
School of Medicine
Department of Psychiatry, WPIC, University of Pittsburgh
Allegheny County, PA
Annie E. Casey Foundation
Anonymous Donor
National Social Inclusion Program, England
Center for Mental Health Services SAMHSA/US Dept of HHS
Staunton Farm Foundation
Web Resources
Key Documents
Mental Health and Social Inclusion (Ireland)
— Executive Summary
EU Task Force Report: Child Poverty and Well-Being in the EU: Current Status and Way Forward (European Union)
President´s New Freedom Commission on Mental Health (United States)
Mental Health: A Report of the Surgeon General (United States)
Is the U.S. a Good Model for Reducing Social Exclusion in Europe? (United States)
Green Paper, Improving the mental health of the population (European Union)
With Inclusion in Mind (Scotland)
Let Glasgow Flourish (Scotland)
The Aftershock of Decentralisation (Scotland)
International Organizations
International Initiative for Mental Health LeadershipEuropean Government
The City of Glasgow
Scottish Urban Regeneration Forum
Glasgow 2020
Glasgow Centre for Population Health
National Resource Centre for Ethnic Minority Health, Scotland
Scottish Development Center for Mental Health
The Scottish Government's National Programme for Improving Mental Health and Wellbeing Center for Mental Health Services
The Scottish Government Mental Health DivisionEuropean institutions
Mental Health Europe
University of Central Lancaster, England
Glasgow Centre for Population HealthU.S. Government
Pennsylvania Office of Mental Health and Substance Services
SAMHSA, U.S. Department of Health and Human Services
Allegheny County Department of Human ServicesU.S. Institutions
Mental Health America
National Alliance on Mental Illness
The Center for Social Inclusion
The Center for Economic and Policy Research
The Adler School of Professional Psychology Institute on Social ExclusionPennsylvanian Foundations
Staunton Farm Foundation
McCune FoundationUniversity of Pittsburgh
Graduate School of Public Health
School of Social Work
School of Medicine
Contact Infomation
| About Pittsburgh |
www.imaginepittsburgh.com |
| Kenneth S. Thompson, MD Associate Director for Medical Affairs, Center for Mental Health Services Substance Abuse and Mental Health Services US Department of Health and Human Services Associate Professor of Psychiatry and Public Health University of Pittsburgh |
Ken.Thompson@SAMHSA.hhs.gov Tel: (240) 427-7911 |
| Timothy S. Thompson Associate Director European Union Center of Excellence, European Studies Center University Center for International Studies University of Pittsburgh |
tst@ucis.pitt.edu Tel: (412) 624 3503 |
| Brandon M. Boylan Conference Research Assistant Doctoral Student Graduate School of Public and International Affairs University of Pittsburgh |
bmb55@pitt.edu |
European Union Center of Excellence
4200 Posvar Hall, University of Pittsburgh
e-mail: euce at pitt.edu
Phone: (412) 648-7405 | Fax: (412) 648-2199