10 th Congress of World Association for Psychosocial

10 th Congress of World Association for Psychosocial Rehabilitation 12 th – 15 th November 2009, Bangalore, India Role of Consumers in Mental Health Care Chintha Munasinghe Consumer Action Forum Sri Lanka

SRI LANKA: Another side of a Paradise WHO observations [2008] revealed: More than three decades of conflict and the effects of the Tsunami are having a strong impact on the mental well-being of the Sri Lankan population, very especially, on its most deprived sectors. Mental health data from Sri Lanka shows an increase in severe and common mental disorders, in times of armed conflict. This country was famous for its high suicide rates in the world. It is estimated that 3% of the Sri Lankan population suffer from some kind of mental disease. .

Distribution of Mental Health Care Services BEFORE 2000 AFTER 2000 Compared to the year 2000, Sri Lanka has developed tremendously in the provision of mental health services at community level through a network of about 36 psychiatrists and more than 100 medical officers – mental health, covering ¾ of the island.

SRI LANKA: Legislation and Implementation Presently, the country has a comprehensive National Mental Health Policy and the Legislation, which prioritized the need for incorporating mental health services into the stream of public health system that is supported by Community Mental Health programmes such as: World Bank Health Sector Development Project [2005 -2010], complemented by the community based interventions of local and international NGOs operating in the country. Big Lottery funded Southern Province Partnership programme of Basic. Needs on Mental Health Care through Community Partnership WHO assistance programmes World Vision assisted Community Mental Health programme in Hambantota district

Despite all these efforts, there still exists the treatment gap and the key issues observed are: reluctance of approaching mental health services by the consumers due to unawareness, stigma and discrimination, and non-availability of community support structures that provide community care and advocate for the rights of mentally ill people and support the mental health professionals in the effective delivery of their services in the localities.

THE NEED: MULTI-STAKEHOLDER ACTION Area Identification of Mentally ill Treatment Rehabilitation Social Integration Introduction to income sources PSYC MOMH PSW /OT PHW SSO MH NGO Other NGOs PSYC – Psychiatrists; MOMH – Medical Officers Mental Health (trained); PSW/ OT – Psychiatric Social Workers/ Occupational Therapists; PHW – Primary Health care Workers; SSO – Social Service Officers; MH NGO – Mental Health NGO

THE EVOLUTION OF CONSUMER ACTION FORUM [NIDAHAS CHINTHANA SANSADAYA] 3) LEADERSHIP DEVT. (Consumer Action Forum) 2) ANIMATION (Self-Help Groups/Group activities) 1) CONSULTATION & AWARENESS CREATION (Mentally ill people In the Community) All the members of Consumer Action Forum are the participants of Df. ID funded Basic. Needs Sri Lanka Programme (2003 -2007) collaboratively implemented with Southern Provincial Directorate of Health Services, Embilipitiya Divisional Secretariat and the two NGOs – Navajeevana and GIDES.

A PICTORIAL PRESENTATION OF THE EVOLUTION OF CONSUMER ACTION FORUM Through Basic. Needs Programme

Dr. Neil Fernando 3/15/2018 9

Like a Guerrilla leader organising the community for an action, she – a consumer advocate, in disguise of the Country Programme Manager of Basic. Needs Sri Lanka slowly brainwashed us to take the responsibility on behalf of ourselves. The result was the CONSUMER ACTION FORUM. Sriyani Dhammika, Secretary in her book “Guerrillas amidst the Gorillas”

Nidahas Chinthana Sansadaya CONSUMER ACTION FORUM An NGO of 154 stabilised consumers, their carers, and community volunteers who assisted them to control their illnesses supported by Mental Health professionals and Development Practitioners from government and nongovernment sector. All 154 consumers are the participants of Df. ID funded Basic. Needs Sri Lanka Programme (2003 -2007) collaboratively implemented with Southern Provincial Directorate of Health Services, Embilipitiya Divisional Secretariat and the two NGOs – Navajeevana and GIDES.

OUR ROLE? Stabilized Consumers of Mental Health In Action

educate community on effects and issues related to mental ill health for reducing stigma and discrimination build the confidence of community development workers to involve mentally ill people and their families in development programmes encourage mental health professionals to develop partnership with development organisations advocate and provide

Role of Consumer Action Forum Area Action Outcome Community Mobilization and reduction of stigma • Theatre of Oppressed – forum theatre based on consumers’ life stories performed at village level • Sharing life stories and conduct at participatory consultation workshops • Organising exploration visits for health and development practitioners • More mentally ill people registered for mental health services • Community attitudes changed Assistance in mental health service delivery • Organising outreach clinics at village level • Referrals • Communicate issues that service providers are challenged with to the decision makers • Decrease in treatment gap • Effective and efficient mental health services at localities of mentally ill people Capacity building – consumers and carers • Self-help group mobilisation • Follow-up visits by CAF members • Mental health educational programmes • Livelihood development programmes • Increase of membership • Continuity of medication • Inclusion of stabilised consumers in livelihood programmes User – led research & Information • Self-monitoring and observations by other members • Life story analysis • Insight about oneself • Learning shared • Policy influenced Advocacy • Participating and organising advocacy forums • Institutional policies & practices changed

A PICTORIAL PRESENTATION OF THE ACHIEVEMENTS OF CONSUMER ACTION FORUM Since 2007

Members’ Meeting of the Consumer Action Forum

Theatre of Oppressed Performed in the community

Mental Health Promotion National Event organised with Ministry of Health and Nutrition [2008]

The drama based on a member’s life story

The audience reacting

OPENING CEREMONY OF THE CAF OFFICE DONATED BY THE GOVERNMENT

Planning our work

APPRECIATING OUR HARD WORK. . . On 12 th November 2009, Consumer Action Forum was awarded the THIRD PLACE of HAMBANTOTA DISTRICT PRODUCTIVITY AWARD-2008 By the District Secretary of Hambantota

NOW WE ARE READY TO. . . Conduct community consultation workshops with mentally ill people, carers and communities Forum Theatre performance to reduce stigma and discrimination Work with service providers in designing interventions in community mental health and development Building partnerships with them

My Sincere Thanks to. . . Chintha Munasinghe Founder Consumer Action Forum Everyone of you who have patiently watched this presentation, despite my absence WAPR organisers who gave us the opportunity to share our views • Basic. Needs, its partners and community volunteers for their invaluable support and guidance • Dr. Neil Fernando, Dr. Ranjani Senevirathne and all the psychiatrists, MOs. MH and therapists at Ministry of Health who are with us throughout this effort • Southern Provincial Directorate of Health for their collaborative support • District Secretary, Hambantota and his team for trusting us and included us in their work • All the members of our forum who are volunteered to share their personal experience