The Point of Our Work - exploring mental health reform in Australia


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These slides were used as part of a one day workshop with Richmond Fellowship in Western Australia. They begin by exploring the historical background to our work, the meaning of citizenship and key elements of a reformed mental health system.

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The Point of Our Work - exploring mental health reform in Australia

  1. 1. The Point of Our Work Growing Our capacity for Change Dr Simon Duffy ■ The Centre for Welfare Reform ■ 9th October 2013 ■ Perth, WA ■ Richmond Fellowship 1
  2. 2. We need humility and the capacity to work together to find a better way of respecting each other and living together We only have only just begun to learn how to undo the damage done by decades of institutional care 2
  3. 3. At the end of the nineteenth and for most of the twentieth century it was common for people to think that people with intellectual disabilities and mental illness were very different, hardly human, and certainly not equal citizens. 3
  4. 4. The powerful eugenic movement that spread across Europe, America and the British Empire led eventually to the murder of over 250,000 people with disabilities or mental illness in Nazi Germany. 4
  5. 5. 5
  6. 6. 6
  7. 7. The process of de-humanisation that preceded the Holocaust had seven steps: 7
  8. 8. 8
  9. 9. Three factors weakened people’s grasp of their shared humanity: 1. Mass Morality 2. Rootlessness 3. State Power 9
  10. 10. 10
  11. 11. • Utilitarianism - all that matters is happiness • Relativism - moral rules are just habits • Communism - what matters is class • Nazism - what matters is race 11
  12. 12. Francis Galton: Theory of Eugenics - race improvement 12
  13. 13. Powerful ideas which undermine traditional moral codes, including respect for the sanctity of life. Humanity was swept into great movements, with utopian goals. 13
  14. 14. Graves at Hadamar, an institution that became a euthanasia centre 14
  15. 15. 15
  16. 16. Without certain fundamental securities we become weak. We can be led to do evils that we would never believe ourselves capable of. 16
  17. 17. The lack of common interest so characteristic of modern masses is therefore only another sign of their homelessness and rootlessness. But it alone accounts for the curious fact that these modern masses are formed by the atomisation of society, that the massmen who lack all communal relationships nevertheless offer the best possible “material” for movements in which peoples are so closely pressed together that they seem to have become one. Hannah Arendt 17
  18. 18. 18
  19. 19. • Nationalism - centrality of the state • Tax & Welfare - growth in economic power • Control - growth of law and policing • Elitism - growth of the ‘professions’ 19
  20. 20. The modern state is more powerful, more organised, more professional than any previous form of government. It is capable of doing great good or great harm. 20
  21. 21. In the fall of 1941, with the completion of the first major phase of the euthanasia operation, gas chambers at psychiatric institutions in southern and eastern Germany were dismantled and shipped east, where they were reinstalled at Belzec, Majdanek, Auschwitz, Treblinka, and Sobibor. The same doctors and technicians and nurses often followed the equipment. Germany’s psychiatric hospitals forged the most practical link between the destruction of the mentally ill and handicapped and the murder of Germany’s ethnic and social minorities. Robert N Proctor 21
  22. 22. Inspired by the ideas of scholars like Binding, Hoche, and Ploetz, Adolf Hitler came to believe that the future volkish state should aggressively pursue pro-natalist policies based upon selective breeding and the eugenic elimination of the unfit in order to maintain the racial purity of the German state. Suzanne E Evans 22
  23. 23. Existing stereotypes and negative propaganda can be used to prepare groups to be scapegoats - sacrificial victims who can be blamed for problems that nobody knows how to solve. 23
  24. 24. 24
  25. 25. “Life without Hope” 25
  26. 26. 26
  27. 27. Even after the victim has been selected they have to be prepared for destruction. There are 3 steps: 1. Rightlessness 2. Poverty 3. Segregation 27
  28. 28. 7 April 1933 - Law for the Restoration of the Professional Civil Service - dismissal of Jews from government 25 April 1933 - Law against Overcrowding of German Schools - no more than 1.5% of non-Aryans to be admitted to public schools and universities 14 July 1933 - Law on the Revocation of Naturalisation and Annulment of German Citizenship - withdrawal of citizenship from ‘undesirable,’ especially East European Jews 15 September 1935 - Nuremberg Laws: Reich Citizenship Law and Law for the Protection of German Blood and German Honour - the Jew defined and separated legally, socially and politically. 14 November 1935 - First Ordinance on Reich Citizenship Law - Jews denied citizenship 15 October 1936 - Jewish teachers banned from private education of Aryan children 12 June 1937 - Secret directive of Heydrich, head of Security Police that ‘race-violators’ be put in ‘protective custody’ after serving their sentences. 26 April 1938 - Registration of all Jews with assets exceeding 5,000 RM 14 June 1938 - All Jewish business have to be registered and credit refused by public savings bank 15 June 1938 - June Action sends 1,500 Jews to concentration camps 6 July 1938 - Termination of certain Jewish businesses 23 July 1938 - Special identification cards for Jews 25 July 1938 - Jewish doctors can only treat other Jews 27 September 1938 - Jewish lawyers removed from the bar 12 November 1938 - 1 billion RM fine on the Jews following Reichkristallnacht 15 November 1938 - Jewish children excluded from German schools 28 November 1938 - Movements of Jews restricted 14 December 1938 - Decree replaces the Jewish owner or director of a firm with an Aryan general manager 1 January 1939 - All Jews have to carry the middle name of Israel or Sara 30 April 1939 - German landlords can evict Jews and other Jews must accept homeless Jews into their households 1 September 1939 - German attack on Poland, beginning of World War II 28
  29. 29. The Jews had to be stripped of their rights, their resources and their place in society. People with disabilities and mental illness were already rightless, impoverished and incarcerated within the institution 29
  30. 30. 30
  31. 31. Bodies being cremated at Hadamar 31
  32. 32. Lennoxcastle Hospital in the 1920s 32
  33. 33. 33
  34. 34. From “Christmas in Purgatory” (1974) 34
  35. 35. In the UK the peak population for the institutions was in the 1970s. 35
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  37. 37. 37
  38. 38. 38
  39. 39. 39
  40. 40. But the journey away from the institutions has been neither straight nor fast. 40
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  42. 42. This shows spending in one part of England after the institutions were closed: 42
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  45. 45. 45
  46. 46. Often English de-instutitionalisation was institutions without the park 46
  47. 47. Yet people keep breaking through the barriers placed in front of them. Social innovation by people with disabilities, families and their allies has changed the lives of many. 47
  48. 48. 48
  49. 49. There is not just one kind of institution we bring the institution with us 49
  50. 50. The creation of the welfare state and social rights has helped lift people from poverty and increased the capacity for wider citizenship. But today the welfare state and social rights are also under attack. 50
  51. 51. The UK Response to ‘Austerity’ 51
  52. 52. In the UK we have seen a very rapid unravelling of the language of rights and inclusion - back towards the language of shame and stigma. 52
  53. 53. 53
  54. 54. 54
  55. 55. This is in turn leading to new more radical and political expressions of the need for change. 55
  56. 56. Many are questioning the role and competence of the state. 56
  57. 57. Pruitt–Igoe (St Louis) 1955-1972 57
  58. 58. 58
  59. 59. We need a new appreciation of the value of community. 59
  60. 60. But he who is unable to live in society, or who has no need because he is sufficient for himself, must be a beast or a god. He is no part of a state. (Politics 1.2) Aristotle 60
  61. 61. We must also welcome human diversity, and yet treat each other as equals. 61
  62. 62. Aristotle explains that a community is not made out of equals, but on the contrary of people who are different and unequal. The community comes into being through equalising, 'isathenai.' [Nich. Ethics 1133 a 14] Hannah Arendt 62
  63. 63. 63
  64. 64. 64
  65. 65. Q: What’s wrong with Hayley? A: Absolutely nothing. 65
  66. 66. Three reasons to be optimistic. 3 66
  67. 67. Reason for optimism No. 1 The Danes - some people do resist. 67
  68. 68. Reason for optimism No. 2 Families - they just won’t go away 68
  69. 69. 69
  70. 70. Reason for Optimism No. 3 People themselves - the human spirit is hard to exstinguish. 70
  71. 71. Suzie Fothergill 71
  72. 72. I’m a woman who has talent That they can’t take away. They tried with drugs And needles to dope me every day. They shoved me in a hostel As a guest of the Salvation Army, With the company of drunks and punks It was enough to send a poor lass barmy. Institutions stink, They make you want to puke, The doctors think they’re it And they’ll read you like a book. I wonder why it had to be that all my life No one to love me No one to care No one to see No one to listen properly. I was kicked around and used Insulted and abused; So now my second life begun They messed my mind right from the start A new chance to live life through my son; Treated me like a dirty tart. A reason for living I have found And it’s going to be better second time But it was them that did that, round. It was them that scarred my mind, It was them that corrupted my innocence, So now I tell you And left me feeling that no one cared. I’ve got a voice I’ve got a right to make a choice. I’m not a toy for you to abuse I’m a woman of spirit and now I’ll refuse… To take that abuse anymore. 72
  73. 73. Questions 73
  74. 74. Citizenship is the right goal 74
  75. 75. Being a citizen is better than being ‘normal’ it brings us together as equals but also as unique free individuals Equal and different 75
  76. 76. 76
  77. 77. What is wrong with institutions? 1. Devalued lives - the institution defines your place, your role, your purpose. 2. No freedom or control - the institution strips you of freedom and personal authority 3. Impoverishment - economic power is nullified 4. Sheltered, but homeless - a home is more than a roof - it’s vital to control privacy and security 5. ‘Care’ not help - ‘care’ already assumes the passivity and lower value of the person ‘in care’. 6. Disconnected - the institution cuts you off and leaves you within a hierarchical system where abuse can become natural 7. Loveless - relationships have no place in the institution 77
  78. 78. Why citizenship is safer 1. Direction - It’s risky if my life lacks meaning and value 2. Freedom - It’s risky if I cannot direct my life, communicate or be listened to. 3. Money - It’s risky if I lack money or if I cannot control my own money. 4. Home - It’s risky if I cannot control who I live with, my home and my privacy. 5. Help - It’s risky if I’ve no one to help me and if I cannot control who helps me. 6. Life - It’s risky if I am not a valued member of my community. 7. Love - It’s risky to have no friends or family. 78
  79. 79. Citizenship is also very practical. We can use the idea of citizenship to think about how to help someone. 79
  80. 80. Citizenship is possible for everyone it just might take some extra thought 80
  81. 81. 1. Purpose 81
  82. 82. Demanding of man that he assumes his condition and not till his neighbour's field, he [Rebbe Yaakov-Yitzhak, The Seer of Lublin] said: "There are many paths leading to perfection; it is given to each of us to choose our own, and by following it with great dedication, we can make it become our truth, our only truth." Elie Wiesel 82
  83. 83. 83
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  85. 85. 2. Freedom 85
  86. 86. I used to think that freedom was freedom of speech, freedom of the press, freedom of conscience. But freedom needs to include all of the lives of all of the people. Freedom is the right to sow what you want. It's the right to make boots of shoes, it's the right to bake bread from the grain you've sown and to sell it or not to sell it as you choose. The same goes for a locksmith or steelworker or an artist - freedom is the right to live and work as you wish and not as you're ordered to. But these days there's no freedom for anyone - whether you write books, whether you sow grain or whether you make boots. Vassily Grossman 86
  87. 87. 87
  88. 88. 88
  89. 89. 89
  90. 90. 3. Money 90
  91. 91. You could no more make a city out of paupers than out of slaves. Aristotle Self-interest is the most powerful engine for individual and social development, in other words, social progress, in other words social justice. It is when the most disadvantaged in society have the opportunity to improve their lives in their own self-interest that change will take place. Noel Pearson 91
  92. 92. 92
  93. 93. 93
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  95. 95. 4. Home 95
  96. 96. Then the old Vainamoinen put this into words: 'Strange food goes down the wrong way even in good lodging; in his land a man's better at home loftier. If only sweet God would grant the kind creator allow me to come to my own lands the lands where I used to live! Better in your own country even water off your sole than in a foreign country honey from a golden bowl.' The Kalevala 96
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  100. 100. 5. Help 100
  101. 101. There are eight degrees of charity, one higher than the other. The highest degree, exceeded by none, is that of the person who assists a poor Jew by providing him with a gift or loan or by accepting him into a business partnership or by helping him find employment - in a word, by putting him where he can dispense with other people's aid. With reference to such aid, it is said, “You shall strengthen him, be he a stranger or a settler, he shall live with you” (Lev. 25:35), which means strengthen him in such manner that his falling into want is prevented. Maimonides 101
  102. 102. 4. Assist 5. Safeguard Help 1. Discover gifts & interests © Simon Duffy & Wendy Perez 2012. All Rights Reserved. 2. Create opportunity 3. Make connections 102
  103. 103. 103
  104. 104. 104
  105. 105. 6. Life 105
  106. 106. True love leads a man to fulfilment, not by drawing things to himself but by forcing him to transcend himself and to be something greater than himself. True spiritual love takes the isolated individual, exacts from him labour, sacrifice, and the gift of himself. Thomas Merton 106
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  108. 108. 108
  109. 109. 109
  110. 110. INFO Give useful information Connect to another individual or family £ Refer to community organisations Recommend appropriate providers 110
  111. 111. 7. Love 111
  112. 112. Resources multiply in networks created by intentionally building relationships that cross boundaries & serve people's deepest purposes. Seymour Sarason 112
  113. 113. 113
  114. 114. 114
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  116. 116. Citizenship is the full realisation of our interdependence - the value we bring to each other in all our differences. The lame rides a horse the maimed drives the herd the deaf is brave in battle. A man is better blind than buried. A dead man is deft at nothing. From Viking - Havamal 116
  117. 117. Questions 117
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  128. 128. For more information: Web: Twitter: @CforWR and @simonjduffy Blog: Facebook: centreforwelfarereform Campaign: © Simon Duffy. Rights Reserved. Full copyright details at 128