5. Advocating

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The training programme underlines the importance of advocacy, i.e. knowing how to bring out and defend the point of view of people who may not have the skills or the social power necessary to defend themselves or, in the policy arena, working for positive change in the social or health care system environment.

 

What this criterion means for care professionals

 

Building mental health promotion programmes, many social groups have difficulty defending their interests or expressing their different points of view, typically concerning what constitutes well-being or how to go about implementing the programme. Social groups such as immigrants, sex workers, gay and lesbian people, ethnic groups, babies, prisoners, isolated elderly people, people with disabilities, people in hospital often may not have the freedom of speech or the skills or conditions necessary to defend their interests.

 

In other situations, although care professionals aim to care for the needs of the client, for example in mental health services, they often have legal obligations to take into account the need of the community to be protected from undue risk. This can create role conflict for the professionals involved. Teach students and professionals to work with independent user organisations, not only with patients in care. Independent user organisations and user representatives can speak freely and they have the legitimacy to represent other users who may not be able to express themselves easily.

 

The European Psychiatry Association Guidance Paper on mental health promotion highlights the fact that getting non-profit organizations and advocacy groups involved as stakeholders in these efforts can help bridge the gap between health professionals and the community (Kalra et al., 2011).

 

What this criterion means for initial training

 

Students have to learn how to include advocacy as a strategy in setting up mental health promotion projects, especially when the activities target groups or individuals whose voice might traditionally be considered in the society as less important or less relevant (e.g. migrants, ethnic minorities, children, women, old people). As mental health promotion aims to develop the social, economic, environmental and cultural well-being of communities with a particular focus on marginalized members, advocacy plays a major role in many promotion strategies.

 

Ideas for training modules/exercises

• Ask each student in the course to present a paper on a different social group; compare the advocacy strategies of these different groups.

• Study the specific roles of care professionals in defending the health interests of patients who are unable to express themselves easily or who come from different cultures. Understand when it is necessary to bring in an outside advocate

• During initial training, students have to learn about human rights as the basis for understanding equal opportunities in access to health for individuals and groups in society. For example, training in the area of migrants or ethnicity should provide participants with knowledge and skills for active advocacy for human rights, to include activities to help defend people’s rights and to raise awareness about the rights of marginalized groups.

• Include a training module on the history of the mental health service user movement (internationally, nationally and locally); the module should be designed and implemented with participation of the user associations themselves.

• Include modules presenting practical cases where support has been given to groups / associations in order to pressure institutions to change local health/social policies.

• Study advocacy reports which identify public health problems, analyse potential policy solutions and determine which advocacy strategies to apply to encourage policy makers to implement the recommended public health policy solution.

 

Illustrate how this criterion could be respected for continuous training

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Continuous training should help professionals improve their attitudes and skills with regard to advocacy. Sometimes participants will need to face their own prejudices and overcome the constraints of their professional role. One of the main problems regarding this indicator in many countries can be the lack of real collaboration between official policy-making bodies and actors from specific mental health related fields. Sometimes professionals have come to feel powerless with regard to defending certain social groups. Training in advocacy should assist care professionals in dealing with care and control conflicts and ambiguities they face in daily practice. Continuous training should provide the opportunity to assess practice in this area.

 

Ideas for training modules/exercises

• Ask participants to give examples from their own experience in which clients’ values concerning health and well-being were unexpected or created value conflict within the team. Examine how bringing in an outside advocate might facilitate decision-making.

• Explore advocacy roles and strategies for promoting the mental health of employees in the institutions where participants are employed. Identify advocacy needs and methods from management through to frontline staff.

• Workshop a social housing project to see how residents might influence determinants of good mental health in their building. Organise a public discussion with users of the building. Assist different groups in defending their point of view.

• Pay particular attention to ethno-psychiatry and immigrant population suffering from adaptation problems to their new environment. Devise a programme to protect and promote the rights of these people to positive mental health.

 

Consult the following Resource Kit for further information, relevant legal and policy texts, and examples of posters, slides and training programmes that respect this criterion:

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