FGC in mental health care – Belgrade conference
Door: Jolijn
Blijf op de hoogte en volg Jolijn
03 November 2013 | Servië, Belgrado
It is now Sunday 3 November 2013, I have arrived home after a very inspiring trip to Belgrade, where I participated in the European Network-meeting on Family Group Conferencing http://www.fgcnetwork.eu , together with about 30 other participants from 12 different countries across Europe.
At Thursday 31 October in the afternoon I had my workshop on Family Group Conferencing (FGC) in mental health care. I was very honoured to have about 10 people joining my 1-hour workshop on Family Group Conferencing in mental health care. It was mainly a dialogue where I tried to answer all the questions.
First I explained once again what my relation with Family Group Conferencing is; As an expert with lived experience of forced psychiatric treatments (http://www.mindrights.nl ), I was consulted in the law reform on forced psychiatric treatments by the Ministry of Justice in the Netherlands. I reviewed the law proposal and I fully disagreed with it. In my opinion a law on mental health care should be about providing care, so the scope should not be “when to apply force” but rather “how to offer support to a person in a crisis”, which is a completely different question. I analysed all aspects of the law proposal and defined my own positions. Then I found that Family Group Conferencing seemed to fit as a model for supported decision-making, to avoid state interventions. I wrote a paper about it, and then I was contacted by the Dutch organization for FGC, and we started a pilot-project in 3 regions in the Netherlands, to avoid forced psychiatric treatments by Family Group Conferencing. In this pilot-project, the mental health hospitals in these 3 regions will each refer 20 cases to Family Group Conferencing, instead of proceeding to forced measures, and VUMC University is researching the effects of this pilot. The first results of FGC in mental health crisis situations are promising.
We talked about perceptions around danger and safety. Forced interventions do not increase safety, but lead to more trauma, panic, struggle and therefor create more problems and risks of escalation. The focus of mental health care should be on supporting the person or family going through a crisis. However, the medical model of psychiatry is narrowing the scope of interventions to chemical reactions, leaving out the social dynamics. But mental health is a social issue, and real care is about restoring wellbeing. For supporting mental health, a social approach is needed, which can be found in Family Group Conferencing. It is very important not to focus solely on the ‘problematic part’, but to focus on chances, opportunities, recovery and supporting wellbeing. Family Group Conferencing does have that positive scope.
Forced treatments are often said to be the last resort, but generally there are no first resorts, due to various barriers (financial, bureaucratic, personal). This leads to a situation of neglect of psychosocial suffering, and then a horrible forced intervention follows. Prevention of crisis in the earliest stage possible is very important, and FGC allows for such a preventive approach.
In mental health crisis situations, there are often dynamics of social exclusion, due to the limits of the coping capacity of the social community. FGC offers an opportunity to deal with the powerlessness of the family/community, to prevent powerlessness and burn-out, and to prevent exclusion as a consequence. Family Group Conferencing can enable inclusion.
The stigma and misperceptions around mental, psychosocial, psychiatric problems is huge. Often persons suffering are considered as “too sick to express their views”. It is important to avoid any of such presumptions on incapacity, but the focus should be on offering support in expressing personal views, somehow comparable to the principles of enabling a child’s perspectives to be included in decision making. Every person is able to communicate in any form, and aspects such as understanding body-language are very important. Every person can smile or cry, which is a very clear expression of their personal will. Outsiders may not always understand a person’s behaviour or perceptions, and label it as confused or “mad” or psychosis. However, family and close persons can relate to a much higher extend, and often have a very good understanding of the real roots and discourse of the problems.
We also talked about fear and trust. It can be hard to discuss personal problems, and quite some persons resort to self-isolation in mental health crisis situations. But often, despite the fact that the person is trying to hide it, the network already knows there is something wrong. It is “the elephant in the room”. Some people find their turning point when they are facing the bottom of their existence, and take the chance for changing the situation by coming out and sharing their problems, taking the barrier they have been trying to run away from. This can be healing on itself, which is another potential strength of Family Group Conferencing.
Taking the chance of sharing real feelings also depends on trust, and the level of feeling safe. In a family network, the personal gestures and identity are known, and it’s easier for a person to express his/her real feelings and open up. The informal network has a good understanding of who you are, and often understand the personal signs and origins of anger or a joke. In your own circle of family and friends, there is no need to uphold any theatre, opposite to when professional carers are judging on forced interventions.
By Family Group Conferencing the person is empowered to exercise control over their own life, opposite to losing control. Friends and family in the family circle actually care about the main person, and want to offer support, that is why they join the circle. They are generally trying to find the best solutions, who are harmless and helpful, unlike horrific standardized forced psychiatric interventions, such as seclusion or restraints (which should be called abuse).
Family Group Conferencing is not a threat to personal freedom, but rather a chance to deal with the very real issues of mental health. It is therefore completely different than the currently standardized practices of mental health crisis-intervention.
The issue of fear is very relevant in mental health issues. Mental health care on itself is stigmatized. Psychiatry has a very bad image and most people have a gut feeling that this is not a nice place, not helpful but harmful. For many people it is their worst nightmare to be in a mental health institution. On the one hand due to the horrific practices that are publically known but often still taboo, and on the other hand due to the painful awareness of human vulnerability, and personal suffering, which is something that people sometimes tend to deny that it exists. Generally every person is scared to “loose the mind”, as we all want to remain in control over ourselves. But there is no such thing as “losing the mind”. It is psychosocial suffering, powerlessness at various sides, panic and misunderstanding that are co-existing and form the mental health crisis-situation.
It is completely understandable that most people are scared of psychiatry and mental health care, and fear asking for mental health support. But it is actually very weird that care is perceived as ultimately frightening: it should be warm, helpful and supportive. When care is perceived as a threat, something is awfully wrong with the care-system. The fear of mental health is complicated and relevant. However, Family Group Conferencing can provide a safe space for people to enable real support according to their own views.
Opening up on the real personal struggles and challenges a person is dealing with, and sharing these with the family circle, is often healing and supporting recovery. This effect is also recognized in the model of Open Dialogue Finland which focusses on the social meaning of psychosis. (for an explanatory video-interview on the Finnish Open Dialogue, see http://www.youtube.com/watch?v=ywtPedxhC3U ).
However, Family Group Conferencing is not a therapy, but it is a way of decision making. The focus of FGC is on supporting decision-making, which can replace substitute decision-making done by authorities. In an ideal world: The person and family circle can make their own care-plan, which can include both formal and informal care. In practice however, there is often a kind of dominance of professionals , who might make parallel plans within their own assumptions of “best interest”. Professional opinions are not automatically questioned.
The acceptance of FGC-plans by other (bureaucratic) organizations is often a challenge, despite the fact that personal plans made by the family circle have many big advantages for professionals, such as the fact that families are motivated to realize their own plans. Also in so-called “multi-problem situations”, often the problems are all connected, and Family Group Conferencing has the potential to enable integral solutions, which are highly effective and to the point.
I could see that all participants in my workshop were in deep thoughts taking it all in, and they were obviously inspired and enthusiast about the idea of using Family Group Conferencing in the context of mental health care. And I was very happy to find a huge level of understanding at the European Network of FGC, who all seemed to understand the social dynamics surrounding mental health issues. I really felt like we were on the same page of understanding, and that made me also very enthusiast to keep on being part of this network. I felt really inspired as well. So it was a great workshop, and I feel there is a huge potential to keep on realizing “the quiet revolution”, where all citizens have the right to make their own plan first.
So this was the detailed report of my workshop on Thursday afternoon, after which we had a nice “Belgrade evening”, with a cultural dinner, live music and folk dancing.
On Friday, 1 November 2013, we had the last sessions of the European FGC-Network-meeting. In the morning I joined a workshop on advocacy, which was about individual support persons for vulnerable participants in Family Group Conferencing. An advocate is helping the person to express one’s own views, and to ensure this is heard. In the UK advocates are trained specifically to participate in Family Group Conferencing. There is a short training for family members as advocates, and a more extended training for independent other advocates.
In this session we also discussed the role of peer support in mental health, and the value of sharing lived experience on mental health, psychosocial problems, diverse care and treatment experiences and recovery. Because of the huge stigma surrounding mental health issues, which can even exist on a family level, it is probably very useful to include information from (ex) users survivors as experts with lived experience in the information-sharing part of the conference, complementary to the views of the professional care-system. Everyone agreed that external independent advocates and peers who are not naturally in the family circle, can only participate in the information sharing part, and not in the private family time, because that is totally private for the family only (a core aspect of FGC). The idea of having the advocate or peer support person waiting in the hallway, available for consultation and a maximum of 10 minute participation in the private family time (as is the rule in the UK) was also supported by everyone.
Family members who are taking the role as advocate or support person may face dynamics and consequences afterwards, and sometimes it is easier to have an independent support person. An example was given about a father who was convicted for severe crimes, and the son wanted his father to move back home, but the dominating opinion of the family circle was that this was no option. However, the support person has to stick to the views of the person concerned, and in this case: repeat the wish of the son even if it clashes with the own perceptions or causes resistance and anger towards the person who promotes the opposite view.
This was also a very fruitful and illuminating session. I really enjoyed the ongoing dialogue, and the fact that it was an Open Space, where discussions can be formed at the moment, and topics that come up can be explored together. The flexible agenda enabled us to maximize the energy of the moment. That was really nice.
At the end of the morning the evaluation and closing session took place. We voted on a few designs for a new European FGC logo, and talked about the website www.fgcnetwork.eu and how it serves as a European portal of knowledge and practice. We also voted on the next European FGC-Network meeting to be held in Italy in 2014. Everyone expressed thanks to the organizers of this conference, who absolutely did a fabulous job. We all had a great experience, and everything, really everything was fine, and we had already grown into a really warm group. It was a wonderful inspiring experience.
Then all of us went on a City tour in a bus with an open roof and a guide. The City tour was a very nice gift from Mr. Nenad Matic, the City Secretary of the department of Social Welfare of the government of Belgrade, who had welcomed us in the City Hall of Belgrade after the first day of our meeting. We even got a goodie bag with information and a souvenir, which expressed his gratitude to our participation in the Serbian context. It was a wonderful and amazing experience. We really enjoyed the nice views and the very rich and interesting history of Belgrade, such as Nicola Tesla, and the many very ancient buildings.
After that we had a great lunch at our hotel. Since it was already around 3 pm we were all really hungry and it was really nice. There were a lot of students working in the hotel, so we had the real VIP-treatment: they did everything for us, even opening the lift doors, but it wasn’t too classy and formal. We really had a nice time.
Then later in the afternoon/evening we were all tourists. I decided to join going to the old bohemian centre, with a very old street with many old taverns. And later in the evening we had dinner in one of these restaurants that was recommended to us (Ima Dana). The 6 of us had another delicious Serbian meal, with live music and an actress who came to entertain us. It was a great atmosphere.
I had already decided that I wanted to use my time in Belgrade fully, and I was interested in going out to see the night life of Belgrade. Nataljia, one of the organizers, then arranged for us to be on the guest list of a party where one of her friends was the DJ. It was an underground party at the KST, which is in the hall under the Technical University of Belgrade (and as an Engineer I totally loved that of course). The music was ranging from rock to ska to metal to dance. Everybody danced, it was a true party. I totally enjoyed it. We were back at the hotel just before 3 in the night, and at 5.30 the taxi to the airport would arrive, so I decided to stay awake, and just prepare my leave in a relaxed way.
I am home now and I have warm memories of the trip to Belgrade. The meeting was inspiring and very positive and fruitful, and the people I met were all so nice. I really liked the many deep conversations we had on the practical implementation of “giving a voice to vulnerable people”. I felt really connected and part of a movement.
I was also moved by the unspoken deep wounds in the population, which aren’t healed yet. And the warmth, hospitality, respect and positivity, which is showing their strength in getting along. Absolutely impressive. It touched me, very real, and very deep. Unspoken awareness in the colourful city of Belgrade. A very special and impressive experience.
So it was a very nice and inspiring trip. I enjoyed everything of it!
At Thursday 31 October in the afternoon I had my workshop on Family Group Conferencing (FGC) in mental health care. I was very honoured to have about 10 people joining my 1-hour workshop on Family Group Conferencing in mental health care. It was mainly a dialogue where I tried to answer all the questions.
First I explained once again what my relation with Family Group Conferencing is; As an expert with lived experience of forced psychiatric treatments (http://www.mindrights.nl ), I was consulted in the law reform on forced psychiatric treatments by the Ministry of Justice in the Netherlands. I reviewed the law proposal and I fully disagreed with it. In my opinion a law on mental health care should be about providing care, so the scope should not be “when to apply force” but rather “how to offer support to a person in a crisis”, which is a completely different question. I analysed all aspects of the law proposal and defined my own positions. Then I found that Family Group Conferencing seemed to fit as a model for supported decision-making, to avoid state interventions. I wrote a paper about it, and then I was contacted by the Dutch organization for FGC, and we started a pilot-project in 3 regions in the Netherlands, to avoid forced psychiatric treatments by Family Group Conferencing. In this pilot-project, the mental health hospitals in these 3 regions will each refer 20 cases to Family Group Conferencing, instead of proceeding to forced measures, and VUMC University is researching the effects of this pilot. The first results of FGC in mental health crisis situations are promising.
We talked about perceptions around danger and safety. Forced interventions do not increase safety, but lead to more trauma, panic, struggle and therefor create more problems and risks of escalation. The focus of mental health care should be on supporting the person or family going through a crisis. However, the medical model of psychiatry is narrowing the scope of interventions to chemical reactions, leaving out the social dynamics. But mental health is a social issue, and real care is about restoring wellbeing. For supporting mental health, a social approach is needed, which can be found in Family Group Conferencing. It is very important not to focus solely on the ‘problematic part’, but to focus on chances, opportunities, recovery and supporting wellbeing. Family Group Conferencing does have that positive scope.
Forced treatments are often said to be the last resort, but generally there are no first resorts, due to various barriers (financial, bureaucratic, personal). This leads to a situation of neglect of psychosocial suffering, and then a horrible forced intervention follows. Prevention of crisis in the earliest stage possible is very important, and FGC allows for such a preventive approach.
In mental health crisis situations, there are often dynamics of social exclusion, due to the limits of the coping capacity of the social community. FGC offers an opportunity to deal with the powerlessness of the family/community, to prevent powerlessness and burn-out, and to prevent exclusion as a consequence. Family Group Conferencing can enable inclusion.
The stigma and misperceptions around mental, psychosocial, psychiatric problems is huge. Often persons suffering are considered as “too sick to express their views”. It is important to avoid any of such presumptions on incapacity, but the focus should be on offering support in expressing personal views, somehow comparable to the principles of enabling a child’s perspectives to be included in decision making. Every person is able to communicate in any form, and aspects such as understanding body-language are very important. Every person can smile or cry, which is a very clear expression of their personal will. Outsiders may not always understand a person’s behaviour or perceptions, and label it as confused or “mad” or psychosis. However, family and close persons can relate to a much higher extend, and often have a very good understanding of the real roots and discourse of the problems.
We also talked about fear and trust. It can be hard to discuss personal problems, and quite some persons resort to self-isolation in mental health crisis situations. But often, despite the fact that the person is trying to hide it, the network already knows there is something wrong. It is “the elephant in the room”. Some people find their turning point when they are facing the bottom of their existence, and take the chance for changing the situation by coming out and sharing their problems, taking the barrier they have been trying to run away from. This can be healing on itself, which is another potential strength of Family Group Conferencing.
Taking the chance of sharing real feelings also depends on trust, and the level of feeling safe. In a family network, the personal gestures and identity are known, and it’s easier for a person to express his/her real feelings and open up. The informal network has a good understanding of who you are, and often understand the personal signs and origins of anger or a joke. In your own circle of family and friends, there is no need to uphold any theatre, opposite to when professional carers are judging on forced interventions.
By Family Group Conferencing the person is empowered to exercise control over their own life, opposite to losing control. Friends and family in the family circle actually care about the main person, and want to offer support, that is why they join the circle. They are generally trying to find the best solutions, who are harmless and helpful, unlike horrific standardized forced psychiatric interventions, such as seclusion or restraints (which should be called abuse).
Family Group Conferencing is not a threat to personal freedom, but rather a chance to deal with the very real issues of mental health. It is therefore completely different than the currently standardized practices of mental health crisis-intervention.
The issue of fear is very relevant in mental health issues. Mental health care on itself is stigmatized. Psychiatry has a very bad image and most people have a gut feeling that this is not a nice place, not helpful but harmful. For many people it is their worst nightmare to be in a mental health institution. On the one hand due to the horrific practices that are publically known but often still taboo, and on the other hand due to the painful awareness of human vulnerability, and personal suffering, which is something that people sometimes tend to deny that it exists. Generally every person is scared to “loose the mind”, as we all want to remain in control over ourselves. But there is no such thing as “losing the mind”. It is psychosocial suffering, powerlessness at various sides, panic and misunderstanding that are co-existing and form the mental health crisis-situation.
It is completely understandable that most people are scared of psychiatry and mental health care, and fear asking for mental health support. But it is actually very weird that care is perceived as ultimately frightening: it should be warm, helpful and supportive. When care is perceived as a threat, something is awfully wrong with the care-system. The fear of mental health is complicated and relevant. However, Family Group Conferencing can provide a safe space for people to enable real support according to their own views.
Opening up on the real personal struggles and challenges a person is dealing with, and sharing these with the family circle, is often healing and supporting recovery. This effect is also recognized in the model of Open Dialogue Finland which focusses on the social meaning of psychosis. (for an explanatory video-interview on the Finnish Open Dialogue, see http://www.youtube.com/watch?v=ywtPedxhC3U ).
However, Family Group Conferencing is not a therapy, but it is a way of decision making. The focus of FGC is on supporting decision-making, which can replace substitute decision-making done by authorities. In an ideal world: The person and family circle can make their own care-plan, which can include both formal and informal care. In practice however, there is often a kind of dominance of professionals , who might make parallel plans within their own assumptions of “best interest”. Professional opinions are not automatically questioned.
The acceptance of FGC-plans by other (bureaucratic) organizations is often a challenge, despite the fact that personal plans made by the family circle have many big advantages for professionals, such as the fact that families are motivated to realize their own plans. Also in so-called “multi-problem situations”, often the problems are all connected, and Family Group Conferencing has the potential to enable integral solutions, which are highly effective and to the point.
I could see that all participants in my workshop were in deep thoughts taking it all in, and they were obviously inspired and enthusiast about the idea of using Family Group Conferencing in the context of mental health care. And I was very happy to find a huge level of understanding at the European Network of FGC, who all seemed to understand the social dynamics surrounding mental health issues. I really felt like we were on the same page of understanding, and that made me also very enthusiast to keep on being part of this network. I felt really inspired as well. So it was a great workshop, and I feel there is a huge potential to keep on realizing “the quiet revolution”, where all citizens have the right to make their own plan first.
So this was the detailed report of my workshop on Thursday afternoon, after which we had a nice “Belgrade evening”, with a cultural dinner, live music and folk dancing.
On Friday, 1 November 2013, we had the last sessions of the European FGC-Network-meeting. In the morning I joined a workshop on advocacy, which was about individual support persons for vulnerable participants in Family Group Conferencing. An advocate is helping the person to express one’s own views, and to ensure this is heard. In the UK advocates are trained specifically to participate in Family Group Conferencing. There is a short training for family members as advocates, and a more extended training for independent other advocates.
In this session we also discussed the role of peer support in mental health, and the value of sharing lived experience on mental health, psychosocial problems, diverse care and treatment experiences and recovery. Because of the huge stigma surrounding mental health issues, which can even exist on a family level, it is probably very useful to include information from (ex) users survivors as experts with lived experience in the information-sharing part of the conference, complementary to the views of the professional care-system. Everyone agreed that external independent advocates and peers who are not naturally in the family circle, can only participate in the information sharing part, and not in the private family time, because that is totally private for the family only (a core aspect of FGC). The idea of having the advocate or peer support person waiting in the hallway, available for consultation and a maximum of 10 minute participation in the private family time (as is the rule in the UK) was also supported by everyone.
Family members who are taking the role as advocate or support person may face dynamics and consequences afterwards, and sometimes it is easier to have an independent support person. An example was given about a father who was convicted for severe crimes, and the son wanted his father to move back home, but the dominating opinion of the family circle was that this was no option. However, the support person has to stick to the views of the person concerned, and in this case: repeat the wish of the son even if it clashes with the own perceptions or causes resistance and anger towards the person who promotes the opposite view.
This was also a very fruitful and illuminating session. I really enjoyed the ongoing dialogue, and the fact that it was an Open Space, where discussions can be formed at the moment, and topics that come up can be explored together. The flexible agenda enabled us to maximize the energy of the moment. That was really nice.
At the end of the morning the evaluation and closing session took place. We voted on a few designs for a new European FGC logo, and talked about the website www.fgcnetwork.eu and how it serves as a European portal of knowledge and practice. We also voted on the next European FGC-Network meeting to be held in Italy in 2014. Everyone expressed thanks to the organizers of this conference, who absolutely did a fabulous job. We all had a great experience, and everything, really everything was fine, and we had already grown into a really warm group. It was a wonderful inspiring experience.
Then all of us went on a City tour in a bus with an open roof and a guide. The City tour was a very nice gift from Mr. Nenad Matic, the City Secretary of the department of Social Welfare of the government of Belgrade, who had welcomed us in the City Hall of Belgrade after the first day of our meeting. We even got a goodie bag with information and a souvenir, which expressed his gratitude to our participation in the Serbian context. It was a wonderful and amazing experience. We really enjoyed the nice views and the very rich and interesting history of Belgrade, such as Nicola Tesla, and the many very ancient buildings.
After that we had a great lunch at our hotel. Since it was already around 3 pm we were all really hungry and it was really nice. There were a lot of students working in the hotel, so we had the real VIP-treatment: they did everything for us, even opening the lift doors, but it wasn’t too classy and formal. We really had a nice time.
Then later in the afternoon/evening we were all tourists. I decided to join going to the old bohemian centre, with a very old street with many old taverns. And later in the evening we had dinner in one of these restaurants that was recommended to us (Ima Dana). The 6 of us had another delicious Serbian meal, with live music and an actress who came to entertain us. It was a great atmosphere.
I had already decided that I wanted to use my time in Belgrade fully, and I was interested in going out to see the night life of Belgrade. Nataljia, one of the organizers, then arranged for us to be on the guest list of a party where one of her friends was the DJ. It was an underground party at the KST, which is in the hall under the Technical University of Belgrade (and as an Engineer I totally loved that of course). The music was ranging from rock to ska to metal to dance. Everybody danced, it was a true party. I totally enjoyed it. We were back at the hotel just before 3 in the night, and at 5.30 the taxi to the airport would arrive, so I decided to stay awake, and just prepare my leave in a relaxed way.
I am home now and I have warm memories of the trip to Belgrade. The meeting was inspiring and very positive and fruitful, and the people I met were all so nice. I really liked the many deep conversations we had on the practical implementation of “giving a voice to vulnerable people”. I felt really connected and part of a movement.
I was also moved by the unspoken deep wounds in the population, which aren’t healed yet. And the warmth, hospitality, respect and positivity, which is showing their strength in getting along. Absolutely impressive. It touched me, very real, and very deep. Unspoken awareness in the colourful city of Belgrade. A very special and impressive experience.
So it was a very nice and inspiring trip. I enjoyed everything of it!
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Je kunt nu ook Smileys gebruiken. Via de toolbar, toetsenbord of door eerst : te typen en dan een woord bijvoorbeeld :smiley
