Osaka
- 22-23 November 2017
#WhatWENeed
Peer
support as community development, not "mental health care"
Excerpts from "TCI Asia Action in Japan"[1] [2]
One of the objectives of TCI AP's Japan
exchange were:
- To bring a small group of peer support practitioners from TCI Asia
membership, and to have focussed discussion on the importance of peer
support in Asia.
- It was also hoped that there will be lively
exchange with the Japanese government, and other key policy stakeholders,
on the importance of peer support in Japan. Being a high income
economy, TCI Asia Pacific also learnt a lot about the highly
institutionalized setting of mental health care.
Peer support movement in the way
practised in the West, has been there for at least 2 decades, as far as we
know, in Asia (e.g. Hong Kong, Japan). Some leading
user/survivor figures at the time, for e.g. Mary O'Hagan, supported the
trainings and mentorship of DPOs in the countries[3]. Open Dialogue was
also quite popular here. Such community development methods were growing
at a fast pace, with lead taken by organizations and by persons with
psychosocial disabilities, particularly the Japan Group of Mentally Disabled
People (JGMDP, Osaka).
In Osaka[4], we
learnt that peer support for 'Recovery' (within the mental health system) and
peer support for 'Inclusion' (as a part of community development) were two
different pathways of actions. The former is done within the medical
paradigm; the latter is within the disability / social inclusion
paradigm.
The Japan Health Department presented
their study on the experiences of peer workers within their highly
institutionalized mental health system. A high percentage of mental
institutions in Japan are private, and they have the typical warehousing design
of colonial hospitals, with very high conduct of involuntary admissions.
Hospital stay is very high in Japan, 275 days per person on an average. The
Government is concerned, but hasn't known how to work in communities. So they
provided for special cadres of "peer supporters" who work in such
highly institutionalized medical settings. Around 2000 peer supporters exist
within the system.
While the stated objective of Peer
Support, in this framework, was "living independently in
communities", the program did not have the desired
effect. Community care is not making good progress, in the view of
the health department - readmission, revolving door phenomena, all continue to
exist in Japan. The Ministry of Health did a survey on peer support utilization
from 64 local municipalities. Participants had high experience as peer
supporters with a 10.6 years average.
The definition of 'peer supporter' is
not very uniform or even clear. Peer supporter activities - awareness and
psycho-education, escort services for activities outside of hospital, running
support groups, home visits assistance very much underpaid, with between 2.5 -
30 hours a week. Peer staff support medical consultations especially on
medicine compliance. They provide decision making support within the
medical system. They expected that their co workers will understand their
disability, respect them as human beings, be recognized for their special
skills, appreciate their professionalism and enjoy equal treatment. They also
expected that their peer support work will be recognized. However, peer support
work was not recognized and was undervalued within the system.
The way peer support is being used in
countries like Japan, Hong Kong, raises the question, is the expected outcome
strengthening mental health treatment, or is it to strengthen the supports in
the community. Peer supporters- are they to work more like personal assistants
to the person with the disability, or more like a psychiatric nurse?
Within high income Asian countries, the
role of the peer supporters are largely within the medical, often institution
based, system. In Thailand, peer supporters can be exhorted to share
confidential information by psychiatrists. There was sharing of
experiences about widespread 'co-optation' when peer supporters work within the
system. There was a strong opinion that a peer supporter should give news about
side effects of medication to the person with disability, whether they want to
hear it or not.
Low and middle income country
experience of peer support is more from the location of Disability Inclusive
Development (Indonesia, Pakistan, India, Sri Lanka), within communities,
informal support and going beyond medical role, towards access to a variety of
support systems for enabling living in communities. There is more DPO led
actions in these countries. In India, however, the situation is fast changing,
with psychiatrists leading peer support efforts. It raises the question whether
it is peer support at all.
In nearly all countries, using arts and
performances, turning to nature / agriculture and running, football and
sporting were included as part of self care and recovery; and as community
development activities. Some countries enjoyed funding support from social
welfare for some of these activities. In Japan, the use of rhythm and drumming
to explore possibilities of dialogic communication was useful, and it was
considered as the 'Asian' way by JNGMDP.
The question of 'who pays' for peer
support services has a variety of responses in Asia. Peer supporters
staff are paid in places, but not peer supporters. Its a part time
or full job for some people. Others are working closer with community families,
etc. where it may also be voluntary, stipend based, informal work, etc.
Peer support is a felt training need
for all over the region. Different small and big groups of persons with
psychosocial disabilities are practising it. However, locally adapted,
culturally appropriate peer support models, in compliance with the CRPD need to
be developed, for sustaining the movement and expanding it through the
region. There is a crying need for a regional training program, and
having peer partnerships throughout Asia.
Japan
National Group of Mentally Disabled Group (JNGMDG) is a Japan
based organisation led by users survivors of psychiatry fighting against
Japanese Ministry of Health and Welfare, mental hospitals, psychiatrists and
discrimination against persons with psychosocial disabilities.
To contact them reach out to:
scp_kirihara@yahoo.co.jp
[1] JNGMDP
& TCI Asia (2017). "TCI Asia Action in Japan: Peer
Support". Report of a Country Mission Visit to Japan, Ibaraki, Osaka,
November 22-23, 2017. Japan National Group of
Mentally Disabled People (JNGMDP) in collaboration with TCI Asia, Research
Center of Ars Vivendi of Ritsumeikan University, and NPO Corporation Aru.
Report by TCI Asia, 2017.
[2] Thanks
to, the team of JNGMDP, for visioning, planning, mobilizing resources,
leadership, cordial and generous hospitality; Core team of JNGMDP for the
gracious partnership; Ito, Kasumi, JNGMDP for tireless admin, translation,
organizing and local support work; Shivani Gupta, for overall
co-ordination and backend support.
[3] Anthony
C. Stratford, Matt Halpin, Keely Phillips, Frances Skerritt, Anne Beales,
Vincent Cheng, Magdel Hammond, Mary O’Hagan, Catherine Loreto, Kim Tiengtom,
Benon Kobe, Steve Harrington, Dan Fisher & Larry Davidson (2017): "The
growth of peer support: an international charter". Journal of Mental
Health. To link to this article: http://dx.doi.org/10.1080/09638237.2017.1340593
[4] TCI
members and international participants who travelled to the meeting were,
Indonesia (3); SriLanka (1); Pakistan (1); South Korea
(1); Thailand (2); Taiwan (3); HongKong (2); China (2);
India (1); Japan (9 key members from different
provinces). In all, 66 people participated in the peer
exchange. Importantly, there was provincial representation from Japan in the
meetings. JNGMDP organized simultaneous translation services for the 23rd
meeting. For the meeting on the 23rd, around 89 persons participated from all
allied sectors. The Workshop attracted around 50 participants.
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