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Guidance on Community Mental Health Services Guidance on community mental health services Promoting person-centred and rights-based approaches i Guidance on community mental health services Promoting person-centred and rights-based approaches Guidance on community mental health services: promoting person-centred and rights-based approaches (Guidance and technical packages on community mental health services: promoting person-centred and rights-based approaches) ISBN 978-92-4-002570-7 (electronic version) ISBN 978-92-4-002571-4 (print version) © World Health Organization 2021 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. 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Geneva: World Health Organization; 2021 (Guidance and technical packages on community mental health services: promoting person-centred and rights-based approaches). Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CiP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Design and layout by Genève Design. Photo credits: Cover photos: Friendship Bench, Home again/Kapil Ganesh, Hand in Hand – Ami Vitale. Page 16: Ask Alice Photography/Andrea Alexis. Page 21: Missing Link Housing. Page 26: Open Dialogue/Mia Kurtti. Page 31: Wise Management Services Ltd. Page 71: Hearing Voices - Helena Lopes. Page 76: USP Kenya. Page 81: PSSEO/ Beverley Johnston. Page 87: Atmiyata Gujarat. Page 92: Friendship Bench. Page 102: Naya Daur - Jayati Saha, Iswar Sankalpa. Page 113: Hand in Hand - Ami Vitale. Page 118: Home again/ Kapil Ganesh. Page 123: Keyring/Sean Kelly. Page 154: Campinas mental health service network. Page 160: East Lille/Nathalie Paulis. Page 165: Trieste/Massimo Silvano. Page 171: Centro de Salud Mental Comunitario El Buen Vivir de Condorcanqui-Amazonas. Page 173: Bosnia and Herzegovina mental health service network. Page 175 & 177: WHO Lebanon/R. Ziade. The accompanying guidance document and technical packages are available here. Contents Illustrations . vii Foreword . viii Acknowledgements . ix Executive summary . xvii What is the WHO QualityRights initiative? . xxiii About the WHO Guidance and technical packages on community mental health services . xxiv 1. Overview: person-centred, recovery and rights-based approaches in mental health ..... 1 1.1 The global context . .2 1.2 Key international human rights standards and the recovery approach . .4 1.3 Critical areas for mental health services and the rights of people with psychosocial disabilities . 6 1.4 Conclusion . 12 2. Good practice services that promote rights and recovery ..................................... 13 2.1 Mental health crisis services . 15 2.1.1 Afiya House - Massachusetts, United States of America 16 2.1.2 Link House - Bristol, United Kingdom of Great Britain and Northern Ireland . 21 2.1.3 Open Dialogue Crisis Service - Lapland, Finland . 26 2.1.4 Tupu Ake - South Auckland, New Zealand . 31 iii Guidance on community mental health services 2.2 Hospital-Based Mental Health Services . 37 2.2.1 BET Unit, Blakstad Hospital, Vestre Viken Hospital Trust - Viken, Norway . 38 2.2.2 Kliniken Landkreis Heidenheim gGmbH - Heidenheim, Germany . 43 2.2.3 Soteria - Berne, Switzerland . 49 2.3 Community mental health centres . 54 2.3.1 Aung Clinic - Yangon, Myanmar. 55 2.3.2 Centros de Atenção Psicossocial (CAPS) III - Brasilândia, São Paulo, Brazil . 60 2.3.3 Phoenix Clubhouse - Hong Kong Special Administrative Region (SAR), China . 65 2.4 Peer support mental health services . 70 2.4.1 Hearing Voices support groups . 71 2.4.2 Nairobi Mind Empowerment Peer Support Group - USP Kenya . 76 2.4.3 Peer Support South East Ontario - Ontario, Canada. 81 2.5 Community outreach mental health services . 86 2.5.1 Atmiyata - Gujarat, India . 87 2.5.2 Friendship Bench - Zimbabwe . 92 2.5.3 Home Focus - West Cork, Ireland . 97 2.5.4 Naya Daur - West Bengal, India. 102 2.5.5 Personal Ombudsman - Sweden . 107 2.6 Supported living services for mental health . 112 2.6.1 Hand in Hand supported living - Georgia . 113 2.6.2 Home Again - Chennai, India . 118 2.6.3 KeyRing Living Support Networks . 123 2.6.4 Shared Lives - South East Wales, United Kingdom of Great Britain and Northern Ireland . 128 2.7 Conclusion . 134 iv 3. Towards holistic service provision: housing, education, employment and social protection ....................................... 136 3.1 Housing. 138 3.2 Education and training . 141 3.3 Employment and income generation . 144 3.4 Social protection . 147 3.5 Conclusion . 150 4. Comprehensive mental health service networks ....................................... 151 4.1 Well-established mental health networks . 153 4.1.1 Brazil Community Mental Health Service Network - A Focus on Campinas . 154 4.1.2 East Lille community mental health service network - France . 160 4.1.3 Trieste community mental health service network - Italy . 165 4.2 Mental health networks in transition. 170 4.3 Conclusion . 179 v Guidance on community mental health services 5. Guidance and action steps ........................ 180 5.1 Policy and strategy for mental Health . 182 5.2 Law reform . 185 5.3 Service model and the delivery of community-based mental health services . 188 5.4 Financing . 192 5.5 Workforce development and training . 197 5.6 Psychosocial interventions, psychological interventions and psychotropic drugs . 201 5.7 Information systems and data . 205 5.8 Civil society, people and the community . 209 5.9 Research . 215 References . 218 Annex . 262 vi Boxes Box 1. Peru – a mental health network in transition . 171 Box 2. Bosnia and Herzegovina – a mental health network in transition. 173 Box 3. Lebanon – a mental health network in transition . 175 Box 4. Lebanon, Peru and Bosnia and Herzegovina – strengthening civil society and meaningful participation . 177 Box 5. Key directions for policy, strategy and systems . 183 Box 6. Landmark legal reforms . 186 Box 7. WHO QualityRights assessment tool kit . 189 Box 8. Financing as a lever for reform in Belgium, Brazil, Peru and countries of West Africa . 194 Box 9. WHO QualityRights Training Materials on mental health, disability, human rights and recovery . 197 Box 10. WHO QualityRights e-training on mental health and disability : eliminating stigma and promoting human rights . 199 Box 11. The recovery approach in mental health– WHO resources and tools . 202 Box 12. WHO resources for psychological interventions . 203 Box 13. Tools for data collection on mental health and psychosocial disability . 206 Box 14. Challenging mental health stigma and discrimination . 210 Box 15. Civil society organizations of people with psychosocial disabilities . 212 Box 16. Call for action by the Parliamentary Assembly of the Council of Europe . 216 vii Guidance on community mental health services Foreword Around the world, mental health services are striving to provide quality care and support for people with mental health conditions or psychosocial disabilities. But in many countries, people still lack access to quality services that respond to their needs and respect their rights and dignity. Even today, people are subject to wide-ranging violations and discrimination in mental health care settings, including the use of coercive practices, poor and inhuman living conditions, neglect, and in some cases, abuse.
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