Service users，families，psychiatrists and other providers need to work together towards a common understanding

Helen HERRMAB

Service users，families，psychiatrists and other providers need to work together towards a common understanding

Helen HERRMAB

In the Forum presented in the previous issue［1,2］,Derson Young and Bin x ie present important view points on the need for compulsory hospitalization and,more im portantly,on the need for open conversations about the appropriate regulation of com pulsory hospitalization.Professor x ie emphasized that there is no fundamental conflict in the interests of mentally ill patients,psychiatrists and psychiatric hospitals.

I agree with this position and would go further to state that it is vital for all stakeholders in the mental health enterprise—patients,family members,mental health providers,hospitals,other social welfare institutions,and others—to work together to reach an understanding about their common interests.Combining their efforts will help create the convincing arguments needed to persuade government leaders and community members to invest societal resources in mental health care and in the educational and research efforts essential to the promotion of mental health.Professor xie describes a repetitive cycle in the history of psychiatry that has resulted in dramatic fluctuations in the proportions of patients treated in institutional versus community-based mental health services.This cycle develops in large part because of a failure to em ploy evidence-based practices in the care of mentally ill people.The resulting lack of coordination between the institutions that participate in the management of mentally ill people（including health,housing, welfare,justice and others）makes it im possible to develop a balanced system of hospital-and community-based care［3］.Behind these failures lie inadequate attention and resources for the care of persons living with mental illness.In most countries, and especially in low-income countries,there are too few resources for the training and em ployment of a capable workforce,poor translation of research to policy and practice,persistent discrimination against mentally ill peop le,and,most importantly, neglect of the problem s of persons struggling with mental illnesses.

A taskforce established by the World Psychiatric Association（WPA）has recently highlighted the importance of developing a unified approach to advocacy for mental health at country and international levels［4,5］.Adequate support for mental health care in any country requires a united voice.But in many countries there is no effective partnership between the many stakeholders concerned about mental health so they will need help to achieve a collective voice.Patients and their family members are crucial members of the coalition that is needed to instigate changes in the provision of services to the mentally ill but they typically lack the power to interact equally with mental health professionals and government decision makers,so helping them to develop this power is important for promoting mental health.

Those who use mental health services still experience stigma and discrimination in the community,have poor access to care for mental and physical health problem s,and receive treatment under conditions that rob them of respect and dignity［4］. The WPA is reinforcing previous calls from psychiatrists and advocacy groups for the inclusion of service users and care providers in all decisions directly and indirectly related to the treatment and rehabilitation of the mentally ill,including the development and management of services,related scientific research,the creation and imp lementation of relevant policies,and the resolution of related societal problem s such as the social exclusion of the mentally ill［6,7］.Ten recommendations about the changes required to achieve these goals are posted on the WPA website（www.w panet.org ）and will soon be published［5］.Professor Young’s discussion called for open conversations about the criticalmatters of regulation of compulsory treatment,diagnostic and medical errors,and other issues；in any country these conversations will be more likely to occur successfully w hen there is the full involvement of service users and their families.In recent years,service users and caregivers have been involved positively in a range of activities including advocacy for the support of mental health research,provision of mental health care,promotion of the social inclusion of mentally ill individuals,and development of self-help projects［8-11］.The experience of the‘trialogue’［12］between consumers,caregivers and professionals pioneered in German-speaking countries and undertaken successfully during a workshop at the International Congress of Psychiatry in Beijing in 2010,is an exam ple of the power of such dialogue to creatively resolve the misunderstandings and tensions between the different stakeholders that need to work together to promote mental health.

1. Young D.Compulsory treatment and diagnostic errors.Shanghai Arch Psychiatry,2011,23（1）:46-47.

2. x ie B.Balancing patientsˊrights and public safety:rethinking‘deinstitutionalization’and‘reinstitutionalization’.Shanghai Arch Psychiatry,2011,23（1）:48-50.

3. Maj M.M istakes to avoid in the implementation of community mental health care.World Psychiatry,2010,9（2）:65-66.

4. Herrman H.WPA project on partnerships for best practices in w orking with service users and carers.W orld Psychiatry,2010, 9（2）:127-128.

5. W allcraft J,Amering M,Freidin J,Davar B,Froggatt D,Jafri H, et al.In Press.Partnerships for better mental health w orldw ide: WPA recommendations on best practices in working with service users and family carers.World Psychiatry.（Accepted 10.1. 2011）

6. Sartorius B.Fighting for mental health.Cambridge:Cambridge University Press,2002:1-256.

7. Amering M,Schmolke M.Recovery in mental health.Reshaping scientific and clinical responsibilities.Chichester:W iley, 2009:1-266.

8. W allcraft J,Schrank B,Amering M.Handbook of service user involvement in mental health research.Chichester:W iley, 2009:1-256.

9. Katontoka S.Users’networks for Africans with mental disorders.Lancet,2007,370（9591）:919-920.

10. Froggatt D,Fadden G,Johnson DL,Leggatt M,Shankar R. Fam ilies as partners in mental health care:a guidebook for imp lementing family w ork.Toronto:W orld Fellow ship for Schizophrenia and Allied D isorders,2007:1-168.

11. W orld Health O rganization.Advocacy for mental health.Geneva:W orld Health O rganization,2003:1-54.

12. Amering M.Trialog-an exercise in communication between consumers,carers and professional mental health w orkers beyond role stereotypes.Int J Integr Care,2010,10（Suppl.）: e014.

（Helen Herrman,M.D.,Professor of Psychiatry,Centre for Youth Mental Health,University of Melbourne,Australia；Secretary for Publications,W orld Psychiatric Association.E-mail：h.herrman@unimelb.edu.au）

10.3969/j.issn.1002-0829.2011.02.009