Mental health Archives - Commonwealth Foundation

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Accountability in health policy and service provision: a blog journey

Posted on 15/05/201919/07/2019 by Susan Fock-Tave

Blog entry one: the week ahead…

I am Susan from Seychelles. Over the next two weeks I will be in Geneva participating in a number of health governance meetings. On May 13-15 I will be participating in the Commonwealth Foundation’s Health Learning Exchange workshop in my capacity as Chairman of the National Mental Health Advisory Committee. The National Mental Health Advisory Committee was set up to advocate for and conduct the review of the current mental health law in Seychelles and to steer the proposed reforms. I’ll be sharing our experience in Seychelles where we decided to repeal and replace the outdated mental health Act, through the administrative and legislative channels.

I am really looking forward to this learning exchange because it is an opportunity for sharing and exchanging ideas and good practices. Learning from the successes (and failures) of others is always useful. I really want to hear how others engage with a range of stakeholders and involve them in big policy decisions. In my line of work, I am constantly involved in developing new policies and pieces of legislation. To stay true to the ‘Health in all, Health for all and Health by all’ policy, reaching out to non-health stakeholders and civil society organisations is an imperative.

On a day to day basis, I am usually bogged down by the sheer amount of what has to be done. I do not always have a chance to take a step back and look at the how it should be done and who I should be engaging with. The three-day workshop will provide me with an opportunity to do just that – to take stock of the wonderful things I have contributed to, to engage with people who have similar issues, but have worked out ways to better engage with those we perceive to be ‘outsiders’.

Following the learning exchange, I’ll be attending the Commonwealth Civil Society Policy Forum (May 18), the Commonwealth Health Minister’s meeting (19 May) and ending with the World Health Assembly (20 -28 May). Although each meeting will be a very different ‘space’ I expect that there will be many common threads running through. My aim is to leave Geneva not only with new ideas, but most importantly with new friends who I can reach out to for guidance and advice in the future.

I look forward to sharing my experiences along the way.

Blog entry two: thoughts during the exchange:

Blog entry three: concluding thoughts

As I mentioned in my first post, I was in Geneva last month to participate in a learning exchange organised by the Commonwealth. The theme of the learning exchange is relevant to Seychelles context, where the Government, as well as the opposition and the whole of society, is calling for accountability. Very often, the call for accountability is directed at others. We point fingers at others and rarely look inwards to our personal accountability.

I enjoyed the learning exchange and the subsequent civil society policy forum. It was interesting to sit in a room with passionate and very vocal members of civil society organisations, and listen to them talk about their work, their successes, and their frustrations, often directed at governments who fail to be accountable to their citizens.

I am especially pleased that my presentation on the review of Mental Health Legislation in the Seychelles was so well received. It made participants realise that very often while talking about gender and equity issues, mental health is left out of the conversation. Saoyo Tabitha Griffith, from KELIN, realised that she may have missed out on providing valuable input in the revision process for Kenya’s Mental Health Law. I salute her enthusiasm and passion in tracking the bill through the system and recall her relief that she could still make a difference.

I particularly liked Anil Patil’s project. Anil is the Founder and Executive Director of Carers Worldwide. His project was centred on giving a voice to unpaid family caregivers in India. In Seychelles, a member of the family can benefit under a home carer scheme financed by the Agency for Social Protection for taking care of a loved one if the beneficiary meets certain criteria. Families may also opt to have somebody other than a family member take care of their loved one. There is currently a discussion aimed at formally employing the care givers, so they may benefit from all the advantages of full-time employment. I believe we can learn from Anil’s experience with caregivers in India. Carers Worldwide can also learn from our experiences in implementing a home-carer scheme. I am also planning to link several patient support groups (Cancer Concern Association, Alzheimer Foundation and the Stroke Foundation to name a few) with Carers Worldwide, so they can explore possible areas of partnership or cooperation.

After the civil society policy forum, I had the privilege of attending the Commonwealth Health Ministers Meeting and the World Health Assembly. The focus of both meetings was universal health coverage which is clearly relevant to the work we are doing in Seychelles. While it is generally recognised that we have achieved universal health coverage, we do have groups of hard to reach populations, or rather—as was highlighted in the civil society policy forum—groups we have not done enough to reach. Forty years after Alma Ata, the Seychelles is holding a national conference in July this year to revisit its primary health care successes and challenges, and to come up with a concept that will ensure Seychelles meets the goals of SDG 3.8. My experiences in Geneva will certainly influence my participation and contributions to this important event.

Coming into the learning exchange, I did not fully know what to expect. I must say, however, that it was an energising and reinvigorating experience.

Susan Fock-Tave is a consultant ear, nose, and throat Surgeon at the Ministry of Health, Seychelles.

Mental health policy reform: time to decolonise our minds

Posted on 20/11/201705/10/2018 by Vijay Krishnarayan

Mental health legislation in 20 per cent of Commonwealth countries was passed before 1960.

The term “idiot” remains on the statutes of 10 Commonwealth countries. The law in many Commonwealth countries is in conflict with contemporary international human rights obligations towards people with mental illness. The roots of mental health legislation can often be traced to a bygone era. It’s time we de-colonised our minds.

‘The roots of mental health legislation can often be traced to a bygone era.’

The Commonwealth Foundation is not a mental health focussed organisation but we are committed to strengthening civic voice in policy reform. We funded a review of mental health laws across the Commonwealth five years ago. The final report – produced by the Commonwealth Health Professions Alliance (CHPA) and written by Dr Soumitra Pathare and Dr Jaya Sagade of the Indian Centre for Mental Health Law and Policy highlighted the dichotomy between existing laws and human rights. The CMNF identified two countries where policy reform was being considered. They applied to the Commonwealth Foundation for a grant to help make change happen and were successful.

One of the project’s countries is Seychelles and I was privileged to see for myself the way they are going about the process of reform. Seychelles was identified because of the willingness of lawmakers, and civil society (mental health and allied professionals and people with mental illness) to work together to address the policy challenge. The inclusion of people with mental illness in the process speaks to the Foundation’s core purpose of strengthening less heard voices.

Civil society has provided the impetus for reform but it has drawn strength from the support of the Minister for Health who impressed upon me the need for civic-state dialogue to make health services responsive to contemporary demands. The need for change is evident. The existing law is the Mental Health Act of 2006. Although relatively recent the legislation was passed before Seychelles signed the UN Convention on the Rights of Persons with Disabilities. I heard from mental health professionals that the law emphasises retaining people with mental illness in institutions rather than the treatment and rehabilitation of patients. As one mental health professional critiqued it’s about protecting “us” from “them.”

‘the law can help to either re-inforce or deconstruct social attitudes.’

A Mental Health Advisory Committee was established to steer the project in-country. It is chaired by the Chief Medical Officer and it brings together health professionals, policy specialists and service consumers. The Committee is supported by the CMNF and Dr Pathare and during my stay I sat in on their discussions. I heard how hard it is for people with mental illness to enjoy rights that we take for granted – to gain employment or to get insurance. I also heard how easy it is for people with mental illness to be incarcerated or restrained. The particular challenge of the stigma associated with mental illness in a small state was never far from the surface and it was recognised that the law can help to either re-inforce or deconstruct social attitudes.

Essential to the process of reform was the engagement of the Attorney-General’s office. I had the chance to meet with the newly appointed Attorney General and I was struck by his recognition of the importance of bringing his office nearer to people. His representative sat with the Committee as they pored over the new draft Act, line by line. The draft Act was then presented at an open meeting at the Seychelles Hospital. About forty people from all walks of life gathered: patients, politicians, police and practitioners. They attested to the need for change, called for more and targeted dialogue with particularly affected parts of society like young people. They want to see the Act passed and fully implemented. They want to see the new law make a difference and all were optimistic about the chances of the Act going before Parliament by next April.

Our colleagues on the Advisory Committee – public officials and civil society alike are committed to change. They agreed that there was no point in trying to change elements of the existing 2006 Act and are developing a national policy that will provide a framework for the new Act. They recognised that the spirit of the existing law was a ghost from a time long past. This was a time when administrators wrote laws to suit themselves and when it was presumed that people with mental illness were objects of charity rather than agents of their own destiny.

Colonial institutions are not just fine buildings that are well preserved but they are laws and practices that have also endured. While I’ve been here, discussions with Ministers, senior officials and civil society have all touched on the continuing relevance of the Commonwealth. In Seychelles they’ve taken a problem left behind by empire and addressed it using the empathy and solidarity that are the hallmark of the People’s Commonwealth.

Image credit: Flickr CC darkday