Interaction Values Statement

Interaction believes respect is the corner stone of better mental health and promotes respect for users and their families as a primary objective of any activity. We will try to demonstrate respect in all our communication and interactions. Interaction aims to be a challenging organisation that provides critical thinking and analysis to the international mental health community and the various agencies involved. However, we will never personalise these activities nor single out individuals. Rather we will focus on systemic and institutional issues, behaviours and patterns and the power relations that underpin them.

Human dignity must be recognised and upheld in all aspects of life. Institutions (of all forms) are particular prone to ignoring the dignity of individuals and must be scrutinised and challenged at all times to ensure dignity is preserved.

All stakeholders have the need and right to meaningful choice in their lives. Interaction promotes choice by ensuring people are aware of all relevant information and the options that exist. We will support people to reflect on choices and learn from the good and bad outcomes of the particular choices they make in the real world.

We promote equal partnerships with other organisation both in the UK and overseas. This includes the shared development of projects and initiatives and the open agreement of budgets and financial arrangements. Interaction will never act as a front or a project facilitator for overseas organisations simply trying to obtain UK funding.

Interaction promotes openness and transparency in all its work and in its inter-organisational relationships. We will use the website and online forum to provide information and details on our activities and programmes and invite participation and communication from external sources. All our materials, research findings and tools are openly available. Whilst we assert our intellectual property and copyright of our work we invite all other parties to freely use it in their work as long as they recognise the source and respect the rights of Interaction. The only things we keep confidential are private information belonging to a specific individual or group that we do not have permission to share and research data before it has been anonymized.

As an organisation we try to be constantly reflective, reflexive and self-critical. We believe this is the best way to demonstrate and promote learning. We never claim expertise and all our statements and activities are articulated in an open awareness of our own particular set of values and vision for the world. We believe that this is essential to establishing meaningful dialogue with others and enables us to challenge and work in a creative fashion.

Interaction Manifesto for Change and Development

Interaction promotes a particular manifesto for change and development in all its activities. The ideas and thinking for the manifesto come out of the work of the Centre for Reflection on Mental Health Policy and the MIRROR think tank, as well as research and consultation. The manifesto is part of a wider process of reflection within the organisation and is subject to constant change, revision and development as the organisation grows and learns. It is closely associated with the Interaction vision and mission and informs the organisation's activities and external relationships with other organisations and stakeholders. Anyone with an interest (either supportive or critical) of the issues raised and the development and testing of the manifesto in real world scenarios are welcome to contribute to its development via the online Interaction forum.

As of 24th March 2005 the manifesto states:

People with the experience of using mental health services (either currently or in the past) should be central to all issues related to mental health including the development, implementation, management and evaluation of policies, projects and services. To ensure that the inherent power dynamics that exist within the mental health environment, Interaction recommends that users should make up at least 33% of all activities.

Participation of the grassroots in local, national and international policy processes must be meaningful and rigorous. Tools such as Participatory Action Learning (PAL) and public action must be embedded in to all activities to ensure vulnerable and excluded groups have a strong voice in policy.

Local communities should be supported and empowered to take control of their own mental health needs. At the same time, community development should not be prescribed from outside as a blueprint development solution. Rather mental health and development agencies should listen to the needs, aspirations and wants of local communities and their stakeholder groups and work as equal partners to achieve change.

The role and position of women and the associated gender issues must be consciously recognised by all those involved in mental health. Women must be supported to articulate their practical and strategic needs and enabled to work together with other stakeholders to realise them. The imbalance of over representation of men in positions of power and seniority in political and medical systems must be scrutinised and challenged and structures put in place to enable women to have greater power, voice and influence in mental health policy.

The old order of mental health systems and the psychiatric model need critical reappraisal and a re-evaluation of its ability to contribute to long-term development goals. Assumptions and norms need to be questioned.

Those in positions of power within the mental health system need to recognise and articulate their power in open and transparent ways and look for ways to share and transfer power to vulnerable and excluded groups.

Corruption is manifest in the mental health systems and wider political systems for many countries in all parts of the world. Openness and transparency from the grassroots upwards must be promoted in all aspects of mental health and public life.

The real costs of all mental health services, activities and organisations should be made openly available in an accessible and understand form to enable stakeholders to come to informed conclusions regarding the allocation of scarce resources and the efficiency of organisations and activities.

The World Health Organisation (WHO/OMS) as the primary body for the global governance of mental health should be transparent, accountable and open to critical examination in the interests of promoting better mental health for local communities. Users and local communities should be supported to ask questions and evaluate the work of the WHO. A radical open and progressive WHO has the potential to be one of the most powerful tools in development and change and an ally of grassroots development. However, if it reinforces power dynamics, maintaining elite professional groups and a limited medical model, it also has the potential to be a major barrier to good governance.

Some consistently defined needs and wishes of people with mental health problems around world are:

• To have a voice
• Access to information
• An end to stigma and discrimination
• Attainment of rights
• To live in the community and to have a life defined by more than health status
• Income to overcome poverty that includes employment and meaningful work
• Self help and mutual support
• Decent housing.

Users should have the opportunity and space to continually articulate and promote their interests. The mental health policy-making process should recognise these as forming the core objectives of policy. Policy initiatives should be judged on the basis of how they have delivered these outcomes. Users and beneficiaries should be central to evaluating, auditing and learning from initiatives.

The Case for Change

Research from the World Health Organisation (WHO) shows that, regardless of country, one in four people will experience mental health problems at some point in their life. People with long-term mental health problems in many parts of the world remain socially excluded, marginalised and disenfranchised. Not only is this socially undesirable, it fails to make use of the wisdom and expertise of the users of mental health services.

In the countries of Central and Eastern Europe, the Caucuses and Central Asia, those with long-term mental health problems remain, for the most part, in large institutions. There is much documentary evidence that where people are incarcerated they suffer isolation, human rights abuses and physical deprivations with little chance of reintegration into society.

This is also the case in many countries throughout the world, such as Russia and Japan. In China it is unclear what is happening, although there is increasing evidence of the political abuse of psychiatry as there was in the former Soviet Union. In the developing countries (for example, in Africa and South Asia) the picture is even more vague as many problems are obscured by other issues such as poverty, corruption, tribalism, ethnicity, conflict, and, more recently, other pressing health issues such as HIV/AIDS.

In many of these countries, the response to mental health problems (where it happens at all) in policy terms, has been to adopt a ‘top-down’, prescriptive view. This assumes that governments and inter-governmental agencies, together with other powerful actors such as the medical profession and the pharmaceutical industry, can readily apply lessons that have been learned in the West to these new situations without working at a grass-roots level with their own citizens.

There are problems with this approach, not least because it places at the centre of mental health care dominant elite groups at the expense of the individual, and also of locally accountable and democratic processes. The danger is that, in policy terms, we are at risk of reproducing in the developing world the same kinds of structures as exist in the West, together with the drawbacks and disadvantages that mitigate against the user of western mental health services.

The policy model used has become out-dated and ignores the pressing need for real grass-roots engagement in the 21st century.

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