The document discusses human rights and citizenship in community mental health. It makes four key points: 1) Human rights are not separate from quality and safety in mental health services. Limiting rights is emotionally harmful. 2) Thinking must evolve to view mental health experiences as meaningful reactions rather than just symptoms, and give consumers leadership roles. 3) Only services that support personal recovery through diverse bio-psycho-social options and are led by consumers should be funded. 4) Achieving equality, by addressing violence, discrimination and disadvantages consumers face, is important for mental health and rights.

1. Human Rights &
Citizenship
in
Community
Mental Health Indigo Daya
Policy & Communications
Manager, VMIAC
Honorary Research Fellow,
Faculty of Law, UoM
@vmiac
@indigodaya
TheMHS
Summer Forum
2019
Speaker notes

2. Crisis support? Or dangerous
double binds?
Personal experience: How the
system put me at greater risk
Last year I had a powerful and
very personal reminder of how
poorly we support people in the
community during crisis.
I had a return of suicidal thinking,,
and I knew that I needed to reach
out for some help.
The problem was, I knew if I was
honest about what I was feeling, I
was at risk of being forcibly
medicated or hospitalised. These
responses are not helpful for me,
in fact they’re traumatising and
would have increased my risk of
suicide. The existence of
compulsory treatment put me at
serious risk of not being able to
get help in a crisis.
When we say that compulsory
treatment, and breaching rights,
is necessary to protect people’s
safety—is that really true? Not for
people like me.

3. 1. Assume there is no safety or
quality without human rights.
Human rights
limits & breaches
in community
mental health
Compulsory Treatment
Orders (CTOs)
Discriminatory barriers
to NDIS
(because there isn’t)
Human rights is not a separate
subject to quality and safety.
From consumer perspective, a
service is not safe if we lose our
rights. A service is not good quality
if we lose our rights.
Conversations about quality and
safety in mental health are
meaningless if they are not
underpinned by human rights.
Limiting, or breaching, human
rights is not a benign act.
Too often in mental health settings,
people think that ignoring human
rights is benign.
It’s not benign: for many people, a
loss of rights is a loss of dignity—
and this can be emotionally
harmful.
In community settings, CTOs and
NDIS barriers are the big ‘negative’
rights issues.

4. 2. Evolve our thinking.
Mental
Illness & symptoms
Health & human
services system
Professionals lead,
consumers participate
Mental, emotional,
social, spiritual
Meaningful reactions, social
determinants, trauma &
diversity
Citizen control, peer &
community-run alternatives
Consumer leaders,
‘professional’ allies
Before we can improve rights, we
have to change our conceptual
thinking.
People in the consumer/survivor
movement have long
conceptualised issues and
opportunities differently to those
working inside the mental health
system.
These different concepts are
fundamental to improving rights.
If you only see my distress as a
meaningless symptom of illness,
you may feel more justified in
breaching my rights. If you see my
experience as a meaningful
reaction to terrible things that
happened to me—then my rights
become central.
We need to get over past practices
that always place clinicians in
leader roles, and consumers as
minority participants. Consumers
can, and should, lead
conversations about our own lives.

5. 3. Only fund services that
support personal recovery
hope
making sense
Fund for the outcomes that
matter to us.
Too many mental health
services are funded to do things
that are contrary to personal
recovery.
Recovery is still not even well
understood in the mental health
sector—I’ve certainly never even
seen a clinical service that was
genuinely recovery-oriented.
We need services that make a
meaningful difference in the
important parts of our lives and
mental health experiences.

6. Any customer can
have a car painted
any colour that he
wants so long as it
is black.
- Henry Ford
This is a well known quote by
Henry Ford.
And it seems to me that this
same kind of thinking prevails
in mental health systems…

7. You can get treatment
in any form you like,
as long as it’s
medical. Quite simply, we have to do
much better than this.

8. Bio-psycho-social choices in
mental health
People have talked about
biopsychosocial mental health
services for years now.
We’ve even evolved to
sometimes talk about bio-
psycho-social-spiritual-
ecological.
But if we look into the cupboard
of mental health services, the
reality doesn’t stack up to the
rhetoric.

9. Genuine bio-psycho-social
options & choice
BIO
Medical
treatments:
―Voluntary
―Fully informed
Physical health
care
PSYCHO
Counselling &
Therapy
Group
programs
Trauma
specialist
services
Hearing voices
approach
SOCIAL
Places of
belonging
Peer
communities,
drop-ins
Equal access
to a home,
work, standard
of living
Open dialogue approach, Safe Haven cafes
What genuine bio-psycho-social
services might offer
These are just some of the
kinds of services that the sector
should be providing, if we are
serious about providing services
that respect rights, and that
make a real difference in
people’s lives.

10. Consumer-led services
Peer-run services
(drop-ins, respites,
specialist, groups)
Independent peer
workers
‘…people who accessed consumer-
operated services experienced improved
levels of empowerment, social inclusion,
well-being, housing, employment, hope
and program satisfaction, than those
who accessed only traditional services.
Grey, F., and O’Hagan, M. (2015). Evidence Check: The effectiveness of services
led or run by consumers in mental health. Mental Health Commission of New
South Wales, Sax Institute.
Governments need to start
funding consumer-run services
as well.
It’s great that we’ve had such
growth in peer work in Australia,
but it’s only the first step of
many.
Countries around the world are
fast outstripping Australia with
peer-run services. These places
are fundamentally different to
what’s currently on offer.
They are rights based, often
creative, and they make a
difference.

11. Cheat sheet on innovative,
rights-based approaches
• The Open Dialogue approach (Western Lapland, UK)
• Intentional Peer Support (US, Australia)
• Peer zone (New Zealand)
• Peer-run services, including respite services
• Piri Pono (New Zealand, consumer run residential service)
• Afiya Peer run respite (USA, consumer run peer respite service)
• The Leeds Survivor-Led Crisis Service (UK)
• Safe Haven support cafes (UK) and other types of community hubs for both
crisis and non-crisis
• The Power Threat Meaning Framework (British Psychological Society, UK)
• Hearing Voices Approach (Intervoice, UK; Voices Vic, Victoria, Maastricht,
NDR)
• Alternatives to Suicide (Western Mass, US)
• Alternatives to Coercion in Mental Health Settings (Melb Social Equity
Institute, UoM)
Learn about the possibilities
If you are a leader in mental
health, you should be well-
informed about the services
and approaches listed on this
page.
Please use the links on this
page and learn about the many
innovative options we could,
and should, be developing in
Australia.
If you’re in a position of power,
start finding ways to fund these
services.

12. 4. Support us to achieve equality
Negative rights
• Victims of violence
• Discrimination
Positive rights
• Employment
• Standards of living
• Health & life expectancy
Our rights in the community are
central to our mental health.
If you work in community
mental health, it’s critical that
your work contributes to
addressing inequalities. Not just
within services—but across our
experience in the wider
community.
Negative rights
Understand the high
prevalence, and mental health
impacts, of being a victim of
violence in the community, and
of being discriminated against
in many common settings.
Positive rights
As mental health consumers,
we are one of the most
disadvantaged groups in
society. We need support and
pathways to jobs, a home, a
decent standard of living. We
need urgent action to stem the
shocking reductions in our life
expectancy.

13. Human rights & citizenship in
community mental health
1. Assume there is no safety or quality
without human rights
2. Evolve our thinking
3. Only fund services that support personal
recovery
• Genuine bio-psycho-social options & choices
• Consumer-run services
4. Support us to achieve equality

14. www.vmiac.org.au