Around the world there are vastly different ways people with mental health issues receive treatment. At worst, they’re removed from their families and institutionalized in psychiatric hospitals, given sub-par treatment and alienated from society. But the World Association for Psychosocial Rehabilitation (WAPR), an international non-governmental agency, is working diligently to educate countries and practitioners around the globe about a more integrative, humane approach.
Psychosocial rehabilitation is a process that facilitates the opportunity for those with long-term mental health issues reach their highest level of functioning within the community. In other words, it’s personalized treatment focusing on helping individuals develop skills and access the resources needed to live meaningful lives. Recently, ABILITY spoke via SKYPE with WAPR’s president, Ricardo Guinea, MD, who is based in Spain, about the organization’s mission, successes and challenges.
Chet Cooper: Can you give us some background on WAPR, when it started and its mission?
Dr. Ricardo Guinea: Yes. It’s a professional organization that was created in the last decade of the last century by a group of psychiatrists, psychologists and other mental health professionals. We are interested in improving the psychosocial rehabilitation of people who are disabled due to a mental illness. The approach is very community-based. I realize the term “mental illness” can be controversial for some groups, but this is, I think, the clearest way to state it.
We’ve been working for the last 30 years trying to improve treatment options. We have a declaration that states what we define as proper attention and care. It is in our founding document, which is on our website, and states that it should be a good treatment with all kinds of social support for the person that includes family and the wider community. To accomplish this in various countries, it requires a lot of intervention in terms of politics, improving facilities and training professionals. Of course, we are advocating a community-based approach as opposed to an institutional approach. We think people should receive the best support possible in an environment with his or her family, and that offers all kinds of social support, access to work, and so on.
We need to change the philosophy of how help is provided for people affected by mental illnesses. When we started, institutionalized treatment was the most common approach. In many parts of the world, it is still the norm—someone receiving treatment will likely be put inside a hospital and might receive good or maybe not-so-good treatment. So the philosophy we try to spread is, “OK, colleagues, we have to change this perspective. We have to provide patients with the best possible treatment in their homes, and we have to think beyond just providing treatment, but helping patients access work and so forth.”
Cooper: How do you promote this approach internationally?
Guinea: We don’t receive a lot of support. We are not a wealthy organization, so our main tool is to offer training wherever needed. Sometimes it involves participating in mental health conferences for professionals. Sometimes we collaborate with organizations to provide training in both developed and developing countries. We try to provide training everywhere. In developed countries our main tool, for instance, is our World Congress. We have a World Congress every three years, but between congresses we have a lot of small, local and regional conferences, where we can explain our philosophy. Slowly, I think, this philosophy is being accepted more and more everywhere.
Cooper: So when you talk about training, do you have best practices? Do you have examples of the differences between the conventional, old-school methods compared to what WAPR advocates?
Guinea: Yes. We have all kinds of things we consider good practices, but what can be considered good practice varies a lot depending upon the country. In a developed country, for instance, good practices a couple of years ago could be, “OK, we should try to reduce the number of long-term beds in psychiatric hospitals. We don’t like psychiatric hospitals. We want to offer different types of treatment.” But in middle-developing countries where mental health is receiving very, very little attention from the states’ health and social ministries, we try to push by saying, “OK, your government needs to offer a network of services for the people.” For example, one big success over the last few years is Peru.
Four years ago we toured Latin America, and in Peru we succeeded in connecting with some key professionals at the right time. They began to push for full psychiatric reform. When we first went there, there were only old-fashioned psychiatric hospitals in the middle of big cities. This was the normal situation in many, many countries in the world. But then, they understood this philosophy, and they said, “OK, you are right. We will begin with psychiatric reform.” They opened a lot of community centers in many different places around the country, not only in the big cities, but also in accessible areas where people could go frequently to receive support, advice and medication when necessary. This is an example of what we do.
Cooper: So the idea is to replace hospitals with community centers that allow people to receive treatment but live on their own or with their families?
Guinea: Yes, but in Peru, for instance, the success involved a very complex strategy. They have trained hundreds of professionals in this new approach. By professionals, I mean psychiatrists, psychologists, social workers, occupational therapists and even teachers. And instead of people going to these old-fashioned mental hospitals in the middle of the cities for treatment, they go to a community center in their neighborhood. Individuals and their families should go there to receive advice about treatment and support. This should be a good practice, for instance.