Mental health and Citizenship: Breaking down barriers in Brazil and Canada

April 14, 2015
Hartley Butler George

IDRC-funded research calls for a new approach to mental health care

Around the world, people suffering from mental health issues struggle to exercise full citizenship in health care systems that leave little room for their independence. Could a more democratic approach — one that fully involves clients in their own treatment — lead to healthier citizens and happier outcomes?

With funding from IDRC and Canada’s Social Sciences and Humanities Research Council, researchers in Brazil and Canada have spent the past five years trying to answer that question. Their findings are challenging long-held beliefs about the most supportive responses to mental health issues and inspiring policy change in both countries.

Partnering for change

From 2009 to 2014, researchers, clients of mental health services, public and community-based organizations, and more than 70 graduate students from Brazil and Québec joined forces in an ambitious international collaboration.

Lead researchers Rosana Onocko Campos of Brazil’s State University of Campinas and Lourdes Rodriguez del Barrio of Université de Montréal worked with citizen user committees from both countries on a range of activities. These included participatory research involving both providers and users of mental health services.

They believed that Canada and Brazil shared the same fundamental challenge: a need for a more welcoming attitude and culture of rights in mental health services.

“In both countries, there is a ‘them and us’ attitude that prevents users of mental health services from achieving full citizenship,” Rodriguez del Barrio says. And in both countries, Onocko Campos says, society’s concept of mental health care needs to expand beyond the walls of the clinic.

Nevertheless, they found grounds for optimism. “We have a lot of evidence that it is possible to change services from working inside of them, but we must work with our heads and our hearts,” Onocko Campos notes.

Shifting power 

Team projects were rooted in a revolutionary approach – “Gaining Autonomy & Medication Management,” known as GAM – which allows clients to take their medication in a more active and informed manner

The researchers had come to believe that social problems and emotional distress were increasingly classified as medical issues requiring drug intervention. They witnessed a pervasive attitude on the part of practitioners that clients suffering from serious mental health issues were not capable of making informed decisions about their own well-being.

For example, “people can be on psychiatric drugs that render them unable to read, unable to study,” Onocko Campos says. “But we can look at this from a different angle: how can we change their medication to allow them to do well at something like school? And then to provide them with the other supports they need, such as working with their teachers.”

With a small shift in power and an increased sense of control, researchers saw lives transform under the program. Rodriguez del Barrio cites one example of a participant living a solitary and isolated existence whose days are now filled with work in the community and artistic endeavours

Changing practice

Research from the international collaboration is now informing practice. The Mental Health Commission of Canada has adopted the central principle that users of mental health services should help shape the system. In Quebec, the Health and Welfare Commissioner considers GAM an evidence-based practice in mental health, and users and providers have consolidated the approach by producing a GAM tool kit.  

In Brazil, GAM has been adopted by the health department in the southern state of Rio Grande do Sul and included in mental-health policies.

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Hartley Butler George is an Ottawa-based writer.