THEMHS CONFERENCE 2020
Balancing the System
TheMHS Perth Virtual Conference
9 – 12 February 2021
Balancing the System
TheMHS Perth Virtual Conference
9 – 12 February 2021
Emeritus Professor of EIP and Psychosis in the School of Allied Health and Community, University of Worcester, Worcester, UK
Joint National Clinical Advisor for the EIP Audit, National Clinical Audit of Psychosis for England and Wales
Topic: Harnessing Social Movement – Learning To Shift the Balance in Mental Health Care Systems
Mental Health services in Australia and the UK face similar challenges of escalating costs and shrinking budgets when responding to the increasing and wide ranging needs of the population they are designed to serve. Good clinical care is essential but not enough for the complex issues people with mental health problems face. We need to move upstream away from crisis oriented acute treatment interventions to invest in much earlier intervention to prevent mental ill health and community supports to foster and maintain mental wellbeing.
Throughout history, many dramatic social changes have been driven by groups of people who have come together as a ‘movement’ to fight for rights, solve problems, shift how people think, support each other and demand change in response to need. Social movements have sought out alternative approaches and ways of living which have challenged or rejected the status quo including dehumanised services, marginalisation, inequality, inequity, and the rigidity of entrenched institutions. They have put pressure on systems to accelerate transformation, respond directly to the needs of people and communities and have the potential to impact widely across populations through interpersonal connections and informal networks. Social movements have been gaining increased attention as an effective’ bottom-up’ approach to achieve social, cultural and political change in health care systems through activities that include promoting healthy lifestyles, creating dialogue around stigmatised health issues and experimenting with new approaches to knowledge creation, service innovation, and policymaking (Del Castillo et al 2016). A health social movement can promote or resist change in the experience of health and health systems. Over time, a social movement can move from early adoption into mainstream routine health care delivery when the change, which may be in the form of a service model, a solution, a belief, a pattern of behaviour or a norm, becomes successfully embedded into an organisation, system or society. That said, the transformative and innovative potential of social movements to achieve their aims does depend, in part, on the ability of an organisation or system to listen and effectively respond to a movement and a shared commitment to engage and dialogue to create better ways of doing things.
In striving to re-balance the mental health system, harnessing social movement learning may offer a potential opportunity to think differently about how to better support mental health and wellbeing by combining the energy and dynamism of a social movement with the desire for radical change in current mental health care practice. This presentation will explore the role and potential value of social movement to drive transformation and achieve mental health system change. The presentation will draw on examples from personal experience harnessing social movement principles to effect changes in mental health care for young people with psychosis through the development of early intervention in psychosis services (Shiers and Smith 2014) and to mobilise suicide prevention interventions in higher education institutions, in the context of growing concerns about increasing rates of student suicide. The examples illustrated in this presentation may give a flavour of the nature and scale of change that social movements are capable of achieving. The presentation is designed to foster debate and stimulate discussion around the potential for harnessing social movement learning to help shift the current balance in mental health care systems.
Del Castillo J., Khan H., Nicholas L. and Finnis A. (2016) Health as a Social Movement The Power of People in Movements, Nesta: London
Shiers D. and Smith J. (2014) Early Intervention and the Power of Social Movements: UK Development of Early Intervention in Psychosis as a Social Movement and its Implications for Leadership. In Byrne P and Rosen A (eds) Early Intervention in Psychiatry: EI of Nearly Everything for Better Mental Health, Wiley-Blackwell
Jo Smith is an Emeritus Professor of Early Intervention and Psychosis at University of Worcester in the UK. She was a Chartered Clinical Psychologist working predominantly in adult mental health services during a 34 years NHS career in the UK delivering, teaching and supervising a wide range of CBT based approaches including family, sibling and IPS employment support interventions. For 16 years, she was the Early Intervention in Psychosis (EIP) Lead for Worcestershire Health and Care NHS Trust and a Joint National EIP Programme Lead for England from 2004-2010. She has been an invited EIP expert on several national expert reference task groups and has been involved in the development and roll out of several key national policies and guidance relating to both EIP and IPS. She is co-chair of the International First Episode Vocational Recovery Group (iFEVR) and was an author of the ‘Newcastle Declaration’ (2002), ‘Early Psychosis Declaration'(2004) and ‘Meaningful Lives’(2008) EIP International Consensus Statements. She has co-authored a number of research articles in relation to first episode psychosis and has been involved in several national multi-site EIP research trials. Her clinical and research work has largely focused on the development, evaluation and delivery of psychosocial interventions to individuals with psychosis and their families. Jo is currently National Clinical Audit of Psychosis (NCAP) Joint Clinical Advisor to the EIP Audit in England and Wales.
For the last 6 years, Jo was project lead for ‘Suicide Safer’ a multiagency student suicide prevention initiative at University of Worcester, which was a finalist for a Times HE 2018 ‘Outstanding Support for Students’ Award. She is a member of the international ‘Zero Suicide’ initiative and was a co-author of an ‘International Declaration on Zero Suicide in Healthcare’ published in 2015. She has been a member of several national working groups which produced UUK (2017) ‘#Stepchange: Mental health in Higher Education’, UUK (2018) ‘Minding Our Future’ and UUK and PAPYRUS (2018) ‘Suicide Safer Universities’ Toolkit . Jo has supervised two PhD research studentships exploring aspects of student suicide in UK HEIs. One has explored student suicide prevention and postvention policy and practice in UK HEIs while another has explored postvention support needs and roles for HEI staff following a student suicide. Jo is currently co-editing a book with Dr. Sharon Mallon from the Open University on ‘Student Suicide in FE and HE: what do we know, what can we do?’ which is due to be published by Jessica Kingsley in late November 2020.
Chief Operating Officer of the National Empowerment Center (NEC) USA
Topic: How the International User/Survivor Movement is Creating Balance in Mental Health and Beyond
This keynote will take a critical look at how the international user/survivor movement has worked to create balance in the mental health system, and at times fell short. We will explore the movement’s history to see what can be learned and to help inform decisions moving forward. Real examples from across the world will be highlighted to illustrate how the movement has lessened reliance on traditional systems of care and instead have created more community resilience. Specifically, Oryx will discuss the following:
1) He will describe the impact that media can have, including the film he co-produced entitled Healing Voices. We are currently bombarded with images and messages in the media, many that are grossly inaccurate in terms of mental health. These inaccuracies serve as a major barrier to creating the balance we need in the system. By countering these messages and images through creating our own media, we can help to restore balance.
2) Oryx will present on the ReAwaken community model of organizing and healing, which began in South Australia in 2019. The ReAwaken model asserts that our society is a asleep in many ways, and we need to reawaken to our potential to connect with and heal each other.
3) Oryx will discuss how the National Empowerment Center’s core training, Emotional CPR, is being used around the world to create balance in the mental health system and beyond. Emotional CPR (eCPR) consists of the e for emotion, C for Connect, P for emPower, and R for Revitalize. eCPR now has over 100 trainers worldwide, and has trained tens of thousands of people in over 15 countries and 8 languages.
Lastly, the keynote will explore how the user/survivor movement is needed not only in the mental health system, but in the broader society as well.
Oryx Cohen, M.P.A., is a leader in the international mental health consumer/survivor/ex-patient (c/s/x) or mad pride movement. Currently Oryx is the Chief Operating Officer of the National Empowerment Center (NEC). In addition to organizing the national Alternatives Conference every three years and other responsibilities, he assists states that have an underdeveloped consumer/survivor voice to find that voice and then work toward transforming the mental health systems in those states to become peer-driven and recovery-oriented. Prior to joining NEC, Oryx was Co-Director of the Western Massachusetts Recovery Learning Community. He helped to spearhead an innovative peer-run approach focusing on recovery, healing, and community. Oryx is also the co-founder of Freedom Center, the Pioneer Valley’s only independent peer-run support/activist organization. Freedom Center’s purpose is to empower and support people with psychiatric labels while challenging oppressive mental health policies and practices.
Oryx is the Co-Producer and is a subject in an award-winning documentary called HEALING VOICES, which was released in 2016 and has been screened in over 500 communities in over 15 different countries. Oryx serves and has served on several boards and committees internationally, nationally and regionally, including some time with the Hearing Voices Network USA. He speaks and conducts trainings nationally and internationally on such topics as Hearing Voices, Trauma, and Recovery. Oryx is a lead trainer for Emotional CPR, and has conducted over 50 Emotional CPR trainings around the world. Oryx volunteered for several years with MindFreedom International, directing its Oral History Project. This project involved collecting and documenting c/s/x stories of abuse, empowerment, and healing in the mental health system. Oryx is also adjunct faculty in the Westfield State College Psychology Department.
Florian Daniel Zepf
Chair and Clinical Director at the Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Friedrich-Schiller University, Jena, Germany
Topic: Mental Health and Nutrition: A Blind Spot in Clinical Service Delivery?
Nutrition is part of everyday life, but in comparison to the frequency with which people consume foods rather little is known about the impact of nutrition on mental health. For example, in clinical files the medication chart is critically reviewed by the treating team, whereas (apart from patients with eating disorders) dietary aspects are often neglected or not always monitored in sufficient detail. Balancing the awareness of diet and nutrition in a service and clinical context is an important clinical task, and critical awareness of foods consumed by patients (for example the number of calories, nutritional value of foods consumed, etc.) should be an important part of everyday clinical life. From a service perspective, nutritional awareness in mental health has strong clinical implications, in particular in clinical settings in which patients are provided with foods and beverages by the respective mental health services. In addition, clinicians working in outpatient settings should be aware of their patients’ nutritional intake, and this refers to both quality and quantity of the foods consumed.
Overall, balancing aspects of nutrition and lifestyle with direct as well as indirect effects of nutrition and diet on mental health related symptoms has received more attention in recent years. However, in comparison to the number of pharmacological trials, research studies with a focus on nutrition and diet in mental health patients are still a minority. Amino acids in particular are an important nutritional component, and they can also directly impact the physiological availability of neurotransmitters relevant for depressed mood, cognitive function, and aggressive as well as impulsive behaviours. These particular clinical factors outlined here can directly impact clinical symptoms in patients, and they can also impact clinical risk and management plans. Following this train of thought, the dietary intake of amino acids has a direct clinical impact on patients with various mental health diagnoses (for example patients with depressive disorders or patients with ADHD).
Apart from an individual clinical perspective, physical and social needs and which can include nutrition and dietary interventions require a balanced approach, including individually tailored nutrition plans based on an individual dietary analysis. This includes increased awareness and educational strategies about nutritional factors in psychiatry and mental health. So far, in mental health only few services include aspects of diet and nutrition into their intervention plans and diagnostic process, and this marks a blind spot in clinical service delivery. When planning clinical service delivery, dietary aspects and nutrition should be carefully considered on a needs and case by case basis in order to provide targeted diagnostic processes and interventions.
This presentation aims to give an overview of nutritional aspects in psychiatry and mental health. Clinical research examples showing a direct impact of nutrition and dietary factors on mental health symptoms will be presented, and service related implications will be discussed.
Prof. Dr. Florian Daniel Zepf (MD, FRANZCP) is the Chair and Clinical Director at the Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy at the University Hospital of the Friedrich-Schiller-University in Jena, Germany. From November 2014 to November 2018, he was the Chair of Child and Adolescent Psychiatry at the University of Western Australia (UWA) in Perth, and the Clinical Director of the Specialised Child and Adolescent Mental Health Services in Western Australia. His research interests include aspects of nutrition and diet in the context of mental health, ADHD, neurophysiological and neurochemical aspects of psychiatric disorders, developmental psychopathology and gender dysphoria. He is the recipient of many prestigious awards, including the “Young Minds in Psychiatry Award” (American Psychiatric Association, APA) and the “Donald J. Cohen Fellowship Award (International Association of Child and Adolescent Psychiatry and Allied Professions, IACAPAP).
Pat Anderson AO
Chair, Remote Area Health Corporation and Lowitja Institute
Topic: Making the Unconscious Conscious: How the Uluru Statement from the Heart Could Heal the Nation.
‘Until you make the unconscious conscious, it will direct your life and you will call it fate.’ – Carl Jung
Twenty years into this century, Australia finds itself in a difficult place. Many non-Aboriginal people haven’t come to terms with the continent’s First Nations peoples and the history we embody. The relationship of mainstream Australia with the living systems that sustain life is fraught: this time last year great areas of our fragile land were on fire. As a nation, we seem to be ‘stuck’, unable to have a proper conversation or move forward on many of the challenges we face.
The 2017 Uluru Statement from the Heart provides a map for healing, a way forward on some of the pressing issues facing us all. It calls for a constitutionally enshrined First Nations Voice directly to the Federal Parliament; and for the establishment of a Makarrata Commission to supervise the making of Treaties together with a process of Truth-telling which could form the basis for genuine reconciliation.
These three things – Voice – Treaty – Truth – provide a structure within which Australia can bring to light the hidden histories and assumptions that continue to hold us back, and to embark on a journey of healing for people and Country.
Ms Pat Anderson is an Alyawarre woman known nationally and internationally as a powerful advocate for the health of Australia’s First Peoples. She has extensive experience in Aboriginal health, including community development, policy formation and research ethics.
Ms Anderson has spoken before the United Nations Working Group on Indigenous People, has been the CEO of Danila Dilba Health Service in Darwin, Chair of the National Aboriginal Community Controlled Health Organisation, Chair of the Aboriginal Medical Services Alliance Northern Territory, and was the Chair of the CRC for Aboriginal Health from 2003 to 2009. She has served as co-chair of the Prime Minister’s Referendum Council, is the current Chairperson of the Remote Area Health Corporation, and the Chairperson of the Lowitja Institute. Ms Anderson is the inaugural Patron of WoSSCA, the Women’s Safety Services of Central Australia.
Ms Anderson has published many essays, papers and articles, including co-authoring with Rex Wild QC of Little Children Are Sacred, a report on the abuse of Aboriginal children in the Northern Territory.
In 2007, Ms Anderson was awarded the Public Health Association of Australia’s Sidney Sax Public Health Medal in recognition of her achievements. She was awarded the Human Rights Community Individual Award (Tony Fitzgerald Memorial Award) in 2012 and the Human Rights Medal in 2016 by the Australian Human Rights Commission. In 2019, Ms Anderson was named a Menzies School of Health Companion in recognition of her exceptional contribution and support to the continued development and success of the Menzies School of Health Research.
Ms Anderson won the public policy category Australian Financial Review and Westpac 100 Women of Influence Awards in 2015, and in 2018, the National NAIDOC Committee recognised her life-long contribution with the Lifetime Achievement Award.
In 2013, Ms Anderson received an honorary doctorate from Flinders University. Edith Cowan University conferred on Ms Anderson a Doctor of Medical Science honoris causa in 2017. The University of New South Wales awarded Ms Anderson an honorary Doctor of Laws in recognition of her advocacy of social justice and lasting change for Australia’s First Peoples. In December 2019, the University of Melbourne admitted Ms Anderson to the degree of Doctor of Laws honoris causa in recognition of her exemplary, inclusive leadership, her forthright advocacy for the advancement and recognition of Indigenous communities and voices, and her highly distinguished contributions to health research that benefit not just Aboriginal and Torres Strait Islander peoples but the nation at large.
Ms Anderson was appointed Officer of the Order of Australia (AO) in 2014 for distinguished service to the Indigenous community as a social justice advocate, particularly through promoting improved health, and educational and protection outcomes for children.