Consulting to the Mental Health Community in Northern Ireland,
Nov 12-13, 2004 By Daniel Fisher

I had an excellent opportunity to bringing a message of hope and recovery to Northern Ireland on Nov. 12th and 13th. The users (their name for consumers), carers (family members in US), providers and administrators were eager to hear that recovery can and does occur for most people with mental illness. They especially appreciated the message of hope that I carried. Hope is vital in healing from fear and Northern Ireland is slowly emerging from 30 years of the trauma of a frightening civil war. They said that my messages of recovery and hope came at just the right time in the cultural transformation they are carrying out. The passion and enthusiasm of these people crossed all the usual divisions in the mental health world. The strong spirit of these people is palpable and itself inspiring. We in the US can learn a great deal about courage from them.

In early fall I had been contacted by Dr. Mary McLean. She had been searching the Internet for new approaches to mental health. She had been frustrated by how little traditional mental health was doing for her relative. Mary encouraged Dr. David Bamford, Chair of their mental health review to invite me to conduct a conference. In short notice, Judith Lee, the Director of Education for the Northern Ireland Association for Mental Health, organized an all day conference attended by over 100 members of the mental health community at the Wellington Park Hotel, Belfast, Northern Ireland. The title of the conference was, “Recovery is for Everyone.” The two major segments of Dr. Fisher?s presentation were, ” How a Recovery Approach Improves Clinical Practice,” and

“From Maintenance to Recovery: How Consumers are transforming the Mental Health System.” Dr. Bamford felt that the emphasis on recovery was timely because the Northern Ireland Mental Health Review Committee had just released their report to the government. The Review emphasized the importance of users and carers working in partnership with providers, of a shift of more of their care to the community, and of empowerment and humanism playing a more central role in the caring process. The following day, I facilitated a group discussion by 30 user and carer leaders of the issues raised the previous day. The group was readily able to reach common understanding and recommendations. There was general agreement that user-run services should have high priority, that users and carers generally have more insight into the problems people labeled with mental illness face than most professionals, that there is too much emphasis on medications, and that these problems have more to do with the relationships between people and their environment than their biology. The recommendations the group reached were:

  1. Ten percent of the mental health budget should be devoted to user-run and carer-run advocacy and support organizations.
  2. There should be more meetings between users and carers to allow them to form a strong joint voice for advocating that these recommendations be carried out.
  3. Users and carers should play a central role in educating the professionals and the public that there is hope for everyone with mental illness to recover.
  4. Users and carers need to accumulate more evidence that people recover to combat the negativity of professional (though one user independently expressed the same sentiment as consumers in the in the US: “we are the evidence”).
  5. The mental health system should invest in alternatives to hospitalization such as Soteria House.
  6. Users and carers should constitute 51% of all the policy forming bodiesUsers and carers should come up with a definition of recovery since professions do not seem interested or capable of doing so.
  7. There was agreement that the major elements of recovery cited by Dr. Fisher made sense and should be used as the starting point and be used as goals for the system. A person who has recovered:
  1. Makes the primary decisions in their life
  2. Has a network of friends and supports outside the mental health system
  3. Has learned to cope with emotional distress by self-directed, holistic care and peer support without having to rely primarily on professionals [there was also almost a consensus that seeing these problems as relationship issues rather than medical issues was an important component of recovery
  4. Would be considered normal by a neighbor or other untrained professional
  5. Has achieved a major social role and identity (such as worker, parent, or student) greater than user
  6. In addition, the group added, “has achieved the rights and responsibilities of other citizens (or its equivalent for non-citizens”)

In the end most of the group wanted me to return to Northern Ireland to assist in their transformation to a recovery-based society. It feels like a new sun is shining in Northern Ireland and a rainbow is appearing from the years of conflict. Is it too grandiose to think that a small group of dedicated users and carers can not only help individuals with mental illness recover but through the principles of recovery help the community as a whole heal? I look forward to helping with recovery and healing in the community.