Trieste International Meeting WHO Collaborating Centre A community without Seclusion Trieste, 15‐18 December 2015
The Mental Health Europe’s “Beyond the Bio‐ Medical Paradigm Task Force” Classifications of mental health problems Pino Pini Mental Health Europe
Mental Health Europe (MHE)
A European non-governmental organisation committed to: -
the promotion of positive mental health and well-being
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the prevention of mental distress
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the improvement of care
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advocacy for social inclusion
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protection of human rights for people with mental health problems, their families and carers
About Mental Health Europe • Established in 1985 as the European branch of the World Federation for Mental Health (WFMH) and is an organisation in its own right since 1994 • Representing mental health in its broader sense: No Health Without Mental Health! • Official relations with WHO Regional Office for Europe • Participatory status with the Council of Europe • Liaison function for mental health promotion with the European Commission
MHE’s members More than 85 member organisations in 34 European countries •
Mental health promotion NGOs
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NGOs representing users of mental health services
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NGOs representing users’ families
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Other European NGOs in the mental health field
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Research and educational institutions
+ 60 individual members
MHE’s areas of work Mental Health and Social Policy Mental Health and Human Rights MHE Thematic Committees European Projects
MHE beyond the biomedical paradigm MHE ‐ along with others both within and outside mainstream psychiatry ‐ has noted with concern: •Increasing dominance of a wholly biological approach to mental health problems. •Downgrading of psychological and social interventions which support personal and social recovery. •Psychological and social interventions are more and more dependent on the biological model and less and less close to the needs and aspirations of people at a personal level and in their local context. •The fifth edition of the Diagnostic and Statistical Manual for Mental Health Disorders (DSM‐5) by the American Psychiatric Association (APA) continues to offer worldwide very narrow and questionable solutions to mental health problems
The MHE Beyond the Biomedical Paradigm Task Force (BBPTF) Established in 2012 to investigate, debate and report on the development of DSM‐5, its likely impact and on alternatives to wholly medical/biological psychiatry which are effective and which improve the lives and life chances of people with poor mental health. Currently the main actions of the BBPTF are: •DSM‐5 and ICD‐11 •Sunshine laws •Collecting and disseminating new approaches to mental health problems beyond the bio‐medical model. The action strategy of the BBPTF is summarized in the Bucharest Manifesto http://www.mhe‐sme.org/policy‐work/bbp‐task‐ force/bucharest‐manifesto/
DSM 5 and ICD 11 • Permanent monitoring of the bio‐medical approach in terms of reliability and scientific validity • Ensure that the forthcoming revision of International Classification of Diseases (ICD 10) takes fully into account the worldwide critique of DSM‐5 and involves people with lived experience of mental distress as equal partners in its construction • Develop an independent voice by making links with other independent people and organizations and establish contacts also with WHO
Sunshine laws • The European Union, national and local governments to pass “sunshine” legislation which makes public all payments made by pharmaceutical companies to practising clinicians, other providers of medical treatments and services and to consumer and relative organisations. • Pharmaceutical companies and research groups to register all trials on open access databases and make all their trial data freely available for re‐analysis.
Collecting and disseminating new approaches to mental health problems beyond the bio‐medical model. Supporting the growth of non‐medical approaches and users' knowledge (Peer support , Recovery models, Hearing voices groups, Personal ombudsman, Joint Experiences and Local mental health Systems, Individual Placement Support, Open dialog, Soteria project, Harm Reduction Approach, Trialog models, etc.) • Safeguarding the autonomy of the different approaches and their reciprocal interactions, avoiding the medical approach making non‐medical approaches subsidiary and dependent on the medical model • Balance between biomedical approaches and other approaches •
The MHE Position Paper on the WHO ICD‐10 revision process Recently the BBPTF ‐ ‐http://www.mhe‐sme.org/policy‐work/bbp‐ task‐force/ ‐‐ has produced a position paper on the ICD‐10 revision. We are concerned that ICD‐11, although intended as a general aid to clinicians and researchers, could become an instrument of social control rather than an instrument to better understand individual needs. Classifications oriented too much towards the biomedical model and on statistics cannot respond by themselves to individual needs. We do not reject the insights and treatments arising from biomedical science and international classifications but we do believe that in the end recovery depends on understanding and relating to the individual within the context of their lives, relationships and the communities in which they live.
The MHE Position Paper on the WHO ICD‐10 revision process We think it is useful to make people aware of the risks of over‐dependence on the bio‐medical model especially when it is combined with control, forced treatments and seclusion. People in such situations can become dependent on this approach and therefore risk escaping the benefit of any other kind of help. We are therefore, among other things, strongly urging WHO to include these aspects of the management of mental ill health in a guidance which would accompany the manual as well as greater user and carer participation in the ICD‐10 Revision process.
The MHE Beyond the biomedical paradigm Task Force MHE has identified the following flaws in the current ICD‐10 revision process: • • • • •
Little to no meaningful involvement of users, carers or civil society A lack of transparency The prioritization of health systems over the individual Reinforcement of the biomedical model Prioritizing global knowledge over local knowledge
What MHE will do MHE has decades of experience in supporting the growth of our member organizations and seeking their views, including in particular independent user organizations. We will continue to try to reach out to partners and offer our support in order to ensure that the views of users, as well as carers and enlightened professionals are sought in both a meaningful and constructive way.
Calls for action: Going forward MHE calls on the WHO to: Make the revision process truly participatory by involving users, carers and civil society in a meaningful and constructive way. • Develop, in partnership with representative organisations, more user and carer friendly language. • Ensure transparency at all levels of the revision process as well as ensuring that the identities and allegiances of health professionals who take part in the Global Clinical Practice Network are verified to prevent any conflict of interest. • Ensure that guidance on the use of the ICD is clear and honest, positioning the use of diagnostics as an important tool in an equal relationship of dialogue between the user and the clinician and emphasising the need to recognise the value and validity of local understandings, practices and cultural norms. •
The MHE Beyond the biomedical paradigm Task Force We are therefore, among other things, strongly urging WHO to including these aspects of the management of mental ill health in guidance on using the manual The links to read our position paper on the ICD‐10 revision are http://www.mhe‐ sme.org/fileadmin/Position_papers/MHE_Position_Paper_on_ICD‐ 10_Revision.pdf for the more detailed version and the calls for action regarding the ICD 10 Revision for the shorter version http://www.mhe‐ sme.org/fileadmin/Position_papers/MHE_Call_for_Action_ICD_10.pdf
The MHE Beyond the biomedical paradigm Task Force Survey to seek views on ICD‐10 revision process We are circulating a questionnaire to seek the views of the mental health community on this matter including mental health professionals, organizations active in the field of mental health, users of mental health and their families and carers. If you would like to help contribute, please answer to the questionnaire at the following link: https://www.surveymonkey.com/s/ZYMP9NJ Deadline for answers second week in January 2016
Members of the MHE Beyond the biomedical paradigm Task Force • Full Members: Bob Grove ‐UK‐; Stijn Jannes ‐B‐; Vicente Ibáñez‐Rojo ‐E‐; Colette Versporten ‐B‐; Pino Pini ‐I‐ • Correspondent members: Josée Van Remoortel ‐B‐; Elisabeth Muschik ‐A‐; Nigel Henderson ‐UK‐; Mary Nettle ‐UK‐; Stephanie Wooley ‐F‐; kristijan Grdan ‐HR‐; Birgitte Gorres ‐DE‐; Christa Widmaier‐Berthold ‐DE‐; Donatella Miccinesi ‐I‐ Jan Berndsen ‐NL‐ Barbara Davis –IRE‐ • Staff: Maria Nyman ‐B‐; Alva Finn ‐IRE‐
Thanks for attention The MHE Beyond the biomedical paradigm Task Force MENTAL HEALTH EUROPE – SANTE MENTALE EUROPE aisbl Boulevard Clovis 7, B‐1000 Brussels Tel +32 2 280 04 68 ‐ Fax +32 2 280 16 04 E‐Mail: info@mhe‐sme.org www.mhe‐sme.org
The MHE Beyond the biomedical paradigm Task Force
