[D66] Berlin Manifesto for a Humane Psychiatry

[A.OUT]

Berlin Manifesto for a Humane Psychiatry

When examining the situation of psychiatry in Germany today, the picture
is alarming: More and more psychotropic drugs, more use of electroshock,
many avoidable coercive measures, the expansion of hospital, residential
and forensic beds, and often inaccessible and inadequate outpatient
services. In addition, there is an overabundance of bureaucratic and
economic requirements in all areas of psychiatric care. These are some
of the deficiencies that prevent care for people in psychological crises
to — always — respect human dignity.

The consequences are serious and damaging. The long-term recovery rates
of people with psychosocial disabilities have not improved over the last
20 years. The mortality rate of people who are given psychiatric
diagnoses and who receive conventional treatments remains very high.
Psychotropic drugs are prescribed far too often, for far too long, and
in far too high dosages. This has a negative effect on all involved:
persons with mental health problems, their family members, and those
working in psychiatric services. From a human rights perspective, the
reform of mental healthcare and support services is progressing far too
slowly! This contradicts the UN Convention on the Rights of Persons with
Disabilities (UN-CRPD), which provides a legal framework for all forms
of support for individuals in mental distress. The convention has been
ratified by Germany in 2009.

A growing number of people do not want to accept this intolerable
situation anymore. This manifesto has been drafted by individuals with
lived experience of mental distress, family members, and psychiatric
professionals as well as formal caregivers from Berlin. We have drawn up
the following demands as guiding principles for a reform of the entire
mental health and psychosocial support system in Germany. To bring these
ideas to life is not only the responsibility of mental health
professionals, of family members and users/consumers/survivors of
psychiatric services; it’s everybody’s business and a task for the whole
of society.

Guiding Principles for a Humane Psychiatry

People in their pursuit of happiness and well-being are the measure of
our actions. The human rights principles established in international
conventions such as the UN-CRPD must feed into all mental healthcare and
support structures. A broad public debate including all stakeholders in
the mental healthcare and psychosocial support system is necessary. The
debate should avoid and counteract the stigmatization of people with
psychological impairments.

Our demands are as follows:

1. Autonomy and self-determination

A humane psychiatry in accordance with the UN-CRPD guarantees the right
of users/consumers/survivors to decide for themselves which type of
psychiatric and psychosocial support services they want to use and how
to do so. In crisis situations, if and when it is more difficult to
determine the person’s own preferences, intensive individual support
must be offered. Supported decision-making also helps to avoid coercive
measures. Any support provided to better coordinate the use of services
must remain “help for self-help.”

2. Economic security

Care should not address the individual alone, but must also take into
account the social and economic situation of users and their respective
environment. Income security and adequate housing are a prerequisite for
any therapeutic success. It is a common experience that individuals who
have limited working capability or who receive
reduced-earning-capacity-pensions due to their impairments frequently
fall into precarious economic situations. By contrast, measures to
guarantee economic security must always be adjusted to the person’s needs.

3. Taking into account individual social networks

Mental or emotional crises as well as long-term impairments always arise
and exist within a social arrangement and have an impact on it.
Therefore, the inclusion of the person’s social network is necessary and
must be guaranteed throughout the whole process of care and support.
This requires the improvement and extension, as well as a greater
variety, of crisis support services (e.g., crisis rooms, crisis
pensions) that are low-threshold, accessible, and outside psychiatric
hospitals. Outpatient and community care must take precedence over
in-patient treatment. This requires, among other things, a bed reduction
in acute psychiatric services, especially in large, overcrowded, and
confusing mental health wards. These steps are necessary to open all
mental healthcare and support structures to the whole society.

4. Transparency of mental health support systems

Users/consumers/survivors need comprehensive information about their
rights as well as about available support services. This applies in
particular when a variety of mental health care and support services are
available locally. Being able to choose how and when care and support
are provided complies with the human right of individuals that their
will and preferences are respected while at the same time taking into
account the realities of their lives. Transparency and diversity of
services must be guaranteed for all phases of the recovery process.
Psychiatric and psychosocial support systems should be financially
transparent and their organization should be clear. Compliance with
human rights principles in the whole mental healthcare and support
system should be monitored regularly. Violations must be sanctioned
effectively.

5. Participation

We need more participation at all levels. This requires a paradigm shift
from a medical treatment model towards a support model. Mental health
professionals cannot produce recovery; they can only accompany and
facilitate it. In accordance with the principle of helping individuals
to help themselves, users/consumers’ autonomy must be strengthened.
Professionals should be experts in raising awareness and building
capacity to take self-responsibility. Participation, however, is more!
Ultimately, psychiatric and psychosocial support systems cannot be
planned without experts with lived experience, as stated in the slogan
“Nothing about us without us.”

Many of these demands have been discussed among experts for years. They
are part of successful models and are included in the recommendations of
the council of experts of the Federal Ministry of Health (in Germany).
It is astonishing that they do not yet constitute the foundation of our
mental healthcare and support systems.

To achieve this, we need commitment at all levels of society.
Fundamental issues concerning public services as well as social and
health policies are at stake. The “Psychiatrie-Enquête,” the German
expert commission’s Report on the State of Psychiatry, initiated
significant improvements in psychiatric care since 1975. However,
against the background of a bureaucratization and marketization in
mental health services, these reform approaches have been worn down and
lost in many aspects.

It is time to change this!

We invite you to support our efforts to achieve a more humane psychiatry
in Germany. In signing the Berlin Manifesto you can call for the
inviolability of human dignity in all areas of psychiatry!

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Sign the Berlin Manifesto for a Humane Psychiatry at
www.change.org/berliner-manifest

Further information can be found at www.berliner-manifest.de

https://www.madinamerica.com/2019/10/berlin-manifesto-humane-psychiatry-released/