The Royal College of Psychiatrists is the main professional organisation of psychiatrists in the United Kingdom, and is responsible for representing psychiatrists, for psychiatric research and for providing public information about mental health problems. The college provides advice to those responsible for training and certifying psychiatrists in the UK.
In addition to publishing many books and producing several journals, the college produces, for the public, information about mental health problems. Its offices are located at 21 Prescot Street in London, near Aldgate. The college’s previous address was Belgrave Square.
Brief History
The college has existed in various forms since 1841, having started as the Association of Medical Officers of Asylums and Hospitals for the Insane. In 1865 it became the Medico-Psychological Association. In 1926, the association received its royal charter, becoming the Royal Medico-Psychological Association. In 1971, a supplemental charter gave the association the name of the Royal College of Psychiatrists.
Eleanora Fleury, became the first female member of the Medico Psychological Association in 1894, when she was elected by 23 votes to 7. She remained a member until 1924. This made her the first woman psychiatrist in Ireland or Great Britain.
Coat of Arms
The coat of arms incorporates the traditional serpent-entwined Rod of Asclepius symbolic of medicine, and butterflies associated with Psyche. Previous to the grant of these arms, the Medico-Psychological Association had used a device showing the seated Psyche with butterfly’s wings. The arms were originally granted to the Royal Medico-Psychological Association in 1926, and were confirmed to the college on its formation in 1971 by the College of Arms. They were also registered in Scotland by the Court of the Lord Lyon.
Policy and Campaigns
The college runs campaigns, including Choose Psychiatry, which has helped increase the fill rate of posts from 78% in 2018 to 100% in 2020, as well as calling for parity in the funding of mental health services.
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The World Network of Users and Survivors of Psychiatry (WNUSP) is an international organisation representing, and led by what it terms “survivors of psychiatry”. As of 2003, over 70 national organisations were members of WNUSP, based in 30 countries. The network seeks to protect and develop the human rights, disability rights, dignity and self-determination of those labelled ‘mentally ill’.
Activities
WNUSP has special consultative status with the United Nations. It contributed to the development of the UN’s Convention on the Rights of Persons with Disabilities. WNUSP has produced a manual to help people use it entitled “Implementation Manual for the United Nations Convention on the Rights of Persons with Disabilities”, edited by Myra Kovary.
WNUSP joined with other organisations to create the International Disability Caucus, which jointly represented organisations of people with disabilities and allies during the CRPD negotiations. WNUSP was part of the steering committee of the IDC, which maintained a principle of respecting the leadership of diverse constituencies on issues affecting them, and also maintained that the convention should be of equal value to all persons with disabilities irrespective of the type of disability or geographical location. Tina Minkowitz, WNUSP’s representative on the IDC steering committee, coordinated the IDC’s work on key articles of the CRPD, including those on legal capacity, liberty, torture and ill-treatment and integrity of the person. Since the adoption and entry into force of the CRPD, WNUSP has worked with other organisations in the International Disability Alliance and its CRPD Forum to guide the interpretation and application of the CRPD on these issues.
In 2007 at a Conference held in Dresden on “Coercive Treatment in Psychiatry: A Comprehensive Review”, the president and other leaders of the World Psychiatric Association met, following a formal request from the World Health Organisation, with several representatives from the user/survivor movement, including Judi Chamberlin (Co-chair of WNUSP), Mary Nettle and Peter Lehmann (Ex-chairs of the European Network of [Ex-] Users and Survivors of Psychiatry), Dorothea Buck (Honorary Chair of the German Federal Organisation of Users and Survivors of Psychiatry, and David Oaks (Director of MindFreedom International).
Salam Gómez and Jolijn Santegoeds are the current Co-Chairpersons of WNUSP.
Current International Representative and former co-chair of WNUSP is Tina Minkowitz, an international advocate and lawyer. She represented WNUSP in the Working Group convened by the UN to produce a draft text of the Convention on the Rights of Persons with Disabilities and contributed to a UN seminar on torture and persons with disabilities that resulted in an important report on the issue by Special Rapporteur on Torture Manfred Nowak in 2008.
Brief History
Since the 1970s, the psychiatric survivors movement has grown from a few scattered self-help groups to a worldwide network engaged in protecting civil rights and facilitation of efforts to provide housing, employment, public education, research, socialisation and advocacy programmes. The term ‘psychiatric survivor’ is used by individuals who identify themselves as having experienced human rights violations in the mental health system. WNUSP was established to further promote this movement and to respond on an international level to the oppression survivors continue to experience.
After initially meeting, in 1991, as the World Federation of Psychiatric Users at the biennial World Federation for Mental Health conference in Mexico, the network’s name was changed to WNUSP in 1997. In 2000, the WNUSP Secretariat was established in Odense, Denmark. In 2001, the network held its First General Assembly in Vancouver, British Columbia, with 34 groups from twelve countries represented, and adopted its governing statutes.
In 2004, the network held its Second General Assembly in Vejle, Denmark with 150 participants from 50 countries attending.
In 2007 WNUSP received ECOSOC special consultative status at the United Nations.
In 2009, WNUSP held its third General Assembly in Kampala, Uganda. It adopted the Kampala Declaration stating its positions on the CRPD, which was later expanded into a longer version adopted by consensus of the board and the participants in the Kampala GA.
ENUSP
The European Network of (Ex-) Users and Survivors of Psychiatry is the most important European NGO of (ex-) users and survivors. Forty-two representatives from 16 European countries met at a conference to found it in the Netherlands in October 1991. Every 2 years, delegates from the ENUSP members in more than 40 European countries meet at a conference where the policies for the coming period are set out. All delegates are (ex-)users and survivors of psychiatry. ENUSP is officially involved in consultations on mental health plans and policies of the European Union, World Health Organisation and other important bodies. Initial funding came from the Dutch government and from the European Commission but has since proved more difficult to secure. ENUSP is involved in commenting and debating declarations, position papers, policy guidelines of the EU, UN, WHO and other important bodies.
The Critical Psychiatry Network (CPN) is a psychiatric organisation based in the United Kingdom. It was created by a group of British psychiatrists who met in Bradford, England in January 1999 in response to proposals by the British government to amend the Mental Health Act 1983. They expressed concern about the implications of the proposed changes for human rights and the civil liberties of people with mental health illness. Most people associated with the group are practicing consultant psychiatrists in the United Kingdom’s National Health Service (NHS), among them Dr Joanna Moncrieff. A number of non-consultant grade and trainee psychiatrists are also involved in the network.
Participants in the Critical Psychiatry Network share concerns about psychiatric practice where and when it is heavily dependent upon diagnostic classification and the use of psychopharmacology. These concerns reflect their recognition of poor construct validity amongst psychiatric diagnoses and scepticism about the efficacy of anti-depressants, mood stabilisers and anti-psychotic agents. According to them, these concerns have ramifications in the area of the use of psychiatric diagnosis to justify civil detention and the role of scientific knowledge in psychiatry, and an interest in promoting the study of interpersonal phenomena such as relationship, meaning and narrative in pursuit of better understanding and improved treatment.
CPN has similarities and contrasts with earlier criticisms of conventional psychiatric practice, for example those associated with David Cooper, R.D. Laing and Thomas Szasz. Features of CPN are pragmatism and full acknowledgment of the suffering commonly associated with mental health difficulties. As a result, it functions primarily as a forum within which practitioners can share experiences of practice, and provide support and encouragement in developing improvements in mainstream NHS practice where most participants are employed.
CPN maintains close links with service user or survivor led organisations such as the Hearing Voices Network, Intervoice and the Soteria Network, and with like-minded psychiatrists in other countries. It maintains its own website. The network is open to any sympathetic psychiatrist, and members meet in person, in the UK, twice a year. It is primarily intended for psychiatrists and psychiatric trainees and full participation is not available to other groups.
Coercion and Social Control
The other involved the introduction of community treatment orders (CTOs) to make it possible to treat people against their wishes in the community. CPN submitted evidence to the Scoping Group set up by the government under Professor Genevra Richardson. This set out ethical and practical objections to CTOs, and ethical and human rights objections to the idea of reviewable detention. It was also critical of the concept of personality disorder as a diagnosis in psychiatry. In addition, CPN’s evidence called for the use of advance statements, crisis cards and a statutory right to independent advocacy as ways of helping to sustain autonomy at times of crisis. CPN also responded to government consultation on the proposed amendment, and the white paper.
The concern about these proposals caused a number of organisations to come together under the umbrella of the Mental Health Alliance to campaign in support of the protection of patients’ and carers’ rights, and to minimise coercion. CPN joined the Alliance’s campaign, but resigned in 2005 when it became clear that the Alliance would accept those aspects of the House of Commons Scrutiny Committee’s report that would result in the introduction of CTOs. Psychiatrists not identified with CPN shared the Network’s concern about the more coercive aspects of the government’s proposals, so CPN carried out a questionnaire survey of over two and a half thousand (2,500) consultant psychiatrists working in England seeking their views of the proposed changes. The responses (a response rate of 46%) indicated widespread concern in the profession about reviewable detention and CTOs.
The CPN was paid attention by Thomas Szasz who wrote: “Members of the CPN, like their American counterparts, criticise the proliferation of psychiatric diagnoses and ‘excessive’ use of psychotropic drugs, but embrace psychiatric coercions.”
The Role of Scientific Knowledge in Psychiatry
There is a strong view by CPN that contemporary psychiatry relies too much on the medical model, and attaches too much importance to a narrow biomedical view of diagnosis. This can, in part, be understood as the response of an earlier generation of psychiatrists to the challenge of what has been called ‘anti-psychiatry’. Psychiatrists such as David Cooper, R.D. Laing and Thomas Szasz (although the latter two rejected the term) were identified as part of a movement against psychiatry in the 1960s and 1970s. Stung by these attacks, as well as accusations that in any case psychiatrists could not even agree who was and who was not mentally ill, academic psychiatrists responded by stressing the biological and scientific basis of psychiatry through strenuous efforts to improve the reliability of psychiatric diagnosis based in a return to the traditions of one of the founding fathers of the profession, Emil Kraepelin.
The use of standardised diagnostic criteria and checklists may have improved the reliability of psychiatric diagnosis, but the problem of its validity remains. The investment of huge sums of money in Britain, America and Europe over the last half-century has failed to reveal a single, replicable difference between a person with a diagnosis of schizophrenia and someone who does not have the diagnosis. The case for the biological basis of common psychiatric disorders such as depression has also been greatly over-stated. This has a number of consequences:
First, the aggrandisement of biological research creates a false impression both inside and outside the profession of the credibility of the evidence used to justify drug treatments for disorders such as depression and schizophrenia. Reading clinical practice guidelines for the treatment of depression, for example, such as that produced for the UK National Health Service by the National Institute for Health and Clinical Excellence (NICE), one might be fooled into believing that the evidence for the efficacy of selective serotonin reuptake inhibitors (SSRIs) is established beyond question. In reality this is not the case, as re-examinations of drug trial data in meta-analyses, especially where unpublished data are included (publication bias means that researchers and drug companies do not publish negative findings for obvious commercial reasons), have revealed that most of the benefits seen in active treatment groups are also seen in the placebo groups.
As far as schizophrenia is concerned, neuroleptic drugs may have some short-term effects, but it is not the case that these drugs possess specific ‘anti-psychotic’ properties, and it is impossible to assess whether or not they confer advantages in long-term management of psychoses because of the severe disturbances that occur when people on long-term active treatment are withdrawn to placebos. These disturbances are traditionally interpreted as a ‘relapse’ of schizophrenia when in fact there are several possible interpretations for the phenomenon.
Another consequence of the domination of psychiatry by biological science is that the importance of contexts in understanding distress and madness is played down. This has a number of consequences. First, it obscures the true nature of what in fact are extremely complex problems. For example, if we consider depression to be a biological disorder remediable through the use of antidepressant tablets, then we may be excused from having to delve into the tragic circumstances that so often lie at the heart the experience. This is so in adults and children.
Meaning and Experience in Psychiatry
There is a common theme, here, with the work of David Ingleby whose chapter in Critical Psychiatry: The Politics of Mental Health sets out a detailed critique of positivism (the view that epistemology, or knowledge about the world is best served by empiricism and the scientific method rather than metaphysics). A common theme running through Laingian antipsychiatry, Ingleby’s critical psychiatry, contemporary critical psychiatry and postpsychiatry is the view that social, political and cultural realities play a vital role in helping us to understand the suffering and experience of madness. Like Laing, Ingleby stressed the importance of hermeneutics and interpretation in inquiries about the meaning of experience in psychiatry, and (like Laing) he drew on psychoanalysis as an interpretative aid, but his work was also heavily influenced by the critical theory of the Frankfurt School.
The most forceful critic of this view was R.D. Laing, who famously attacked the approach enshrined by Jaspers’ and Kraepelin’s work in chapter two of The Divided Self, proposing instead an existential-phenomenological basis for understanding psychosis. Laing always insisted that schizophrenia is more understandable than is commonly supposed. Mainstream psychiatry has never accepted Laing’s ideas, but many in CPN regard The Divided Self as central to twentieth century psychiatry. Laing’s influence continued in America through the work of the late Loren Mosher, who worked at the Tavistock Clinic in the mid-1960s, when he also spent time in Kingsley Hall witnessing Laing’s work. Shortly after his return to the US, Loren Mosher was appointed Director of Schizophrenia Research at the National Institute of Mental Health, and also the founding editor of the journal Schizophrenia Bulletin.
One of his most notable contributions to this area was setting up and evaluating the first Soteria House, an environment modelled on Kingsley Hall in which people experiencing acute psychoses could be helped with minimal drug use and a form of interpersonal phenomenology influenced by Heidegger. He also conducted evaluation studies of the effectiveness of Soteria. A recent systematic review of the Soteria model found that it achieved as good, and in some areas, better, clinical outcomes with much lower levels of medication (Soteria House was not anti-medication) than conventional approaches to drug treatment.
Efficacy
One comparison study showed 34% of patients of a ‘medical model’ team were still being treated after two years, compared with only 9% of patients of a team using a ‘non-diagnostic’ approach (less medication, little diagnosis, individual treatment plans tailored to the person’s unique needs). However the study comments that cases may have left the system in the ‘non-diagnostic’ approach, not because treatment had worked, but because (1) multi-agency involvement meant long-term work may have been continued by a different agency, (2) the starting question of ‘Do we think our service can make a positive difference to this young person’s life?’ rather than ‘What is wrong with this young person?’ may have led to treatment not being continued, and (3) the attitude of viewing a case as problematic when no improvement has occurred after five sessions may have led to treatment not being continued (rather than the case ‘drifting’ on in the system).
Critical Psychiatry and Postpsychiatry
Peter Campbell first used the term ‘postpsychiatry’ in the anthology Speaking Our Minds, which imagines what would happen in a world after psychiatry. Independently, Patrick Bracken and Philip Thomas coined the word later and used it as the title of a series of articles written for Openmind. This was followed by a key paper in the British Medical Journal and a book of the same name. This culminated with the publication by Bradley Lewis, a psychiatrist based in New York, of Moving Beyond Prozac, DSM, and the New Psychiatry: The Birth of Postpsychiatry.
According to Bracken, progress in the field of mental health is presented in terms of ‘breakthrough drugs’, ‘wonders of neuroscience’, ‘the Decade of the Brain’ and ‘molecular genetics’. These developments suited the interests of a relatively small number of academic psychiatrists, many of whom have interests in the pharmaceutical industry, although so far the promised insights into psychosis and madness were yet to be realized. Some psychiatrists have turned to another form of technology, Cognitive Behavioural Therapy, although this does draw attention to the person’s relationship with their experiences (such as voices or unusual beliefs), and focuses on helping them to find different ways of coping, it however, it is based on a particular set of assumptions about the nature of the self, the nature of thought, and how reality is constructed. The pros and cons of this have been explored in some detail in a recent publication.
Framing mental health problems as ‘technical’ in nature involves prioritising technology and expertise over values, relationships and meanings, the very things that emerge as important for service users, both in their narratives, and in service user-led research. For many service users these issues are of primary importance. Recent meta-analyses into the effectiveness of antidepressants and cognitive therapy in depression confirm that non-specific, non-technical factors (such as the quality of the therapeutic relationship as seen by the patient, and the placebo effect in medication) are more important than the specific factors.
Postpsychiatry tries to move beyond the view that we can only help people through technologies and expertise. Instead, it prioritises values, meanings and relationships and sees progress in terms of engaging creatively with the service user movement, and communities. This is especially important given the considerable evidence that in Britain, Black and Minority Ethnic (BME) communities are particularly poorly served by mental health services. For this reason an important practical aspect of postpsychiatry is the use of community development in order to engage with these communities. The community development project Sharing Voices Bradford is an excellent example of such an approach.
There are many commonalities between critical psychiatry and postpsychiatry, but it is probably fair to say that whereas postpsychiatry would broadly endorse most aspects of the work of critical psychiatry, the obverse does not necessarily hold. In identifying the modernist privileging of technical responses to madness and distress as a primary problem, postpsychiatry has looked to postmodernist thought for insights. Its conceptual critique of traditional psychiatry draws on ideas from philosophers such as Heidegger, Merleau-Ponty, Foucault and Wittgenstein.
Anti-Psychiatry and Critical Psychiatry
The word anti-psychiatry is associated with the South African psychiatrist David Cooper, who used it to refer to the ending of the ‘game’ the psychiatrist plays with his or her victim (patient). It has been widely used to refer to the writings and activities of a small group of psychiatrists, most notably R.D. Laing, Aaron Esterson, Cooper, and Thomas Szasz (although he rejects the use of the label in relation to his own work, as did Laing and Esterson), and sociologists (Thomas Scheff). Szasz discards even more what he calls the quackery of ‘antipsychiatry’ than the quackery of psychiatry.
Anti-psychiatry can best be understood against the counter-cultural context in which it arose. The decade of the 1960s was a potent mix of student rebellion, anti-establishment sentiment and anti-war (Vietnam) demonstrations. It saw the rise to prominence of feminism and the American civil rights movement and the Northern Ireland civil rights movement. Across the world, formerly colonised peoples were throwing off the shackles of colonialism. Some of these themes emerged in the Dialectics of Liberation, a conference organised by Laing and others in the Round House in London in 1968.
Critical Psychiatry Network – Activities
CPN is involved in four main areas of work, writing and the publication of academic and other papers, organising and participating in conferences, activism and support. A glance at the members’ publication page on the CPN website reveals in excess of a hundred papers, books and other articles published by people associated with the network over the last twelve years or so. These cover a wide range of topics, from child psychiatry, psychotherapy, the role of diagnosis in psychiatry, critical psychiatry, philosophy and postpsychiatry, to globalisation and psychiatry. CPN has also organised a number of conferences in the past, and continues to do so in collaboration with other groups and bodies. It has run workshops for psychiatrists and offers peer supervision face to face and via videolink. It also supports service user and survivor activists who campaign against the role of the pharmaceutical industry in psychiatry, and the campaign for the abolition of the schizophrenia label. The CPN has published a statement in support.
This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Critical_Psychiatry_Network >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.
A non-governmental organisation (NGO) is an organisation that generally is formed independent from government.
They are typically non-profit entities, and many of them are active in humanitarianism or the social sciences; they can also include clubs and associations that provide services to their members and others. Surveys indicate that NGOs have a high degree of public trust, which can make them a useful proxy for the concerns of society and stakeholders. However, NGOs can also be lobby groups for corporations, such as the World Economic Forum. NGOs are distinguished from international and intergovernmental organisations (IOs) in that the latter are more directly involved with sovereign states and their governments.
The term as it is used today was first introduced in Article 71 of the newly-formed United Nations’ Charter in 1945. While there is no fixed or formal definition for what NGOs are, they are generally defined as non-profit entities that are independent of governmental influence—although they may receive government funding. According to the UN Department of Global Communications, an NGO is “a not-for profit, voluntary citizen’s group that is organized on a local, national or international level to address issues in support of the public good”. The term NGO is used inconsistently, and is sometimes used synonymously with civil society organisation (CSO), which is any association founded by citizens. In some countries, NGOs are known as non-profit organisations, and political parties and trade unions are sometimes considered NGOs as well.
NGOs are classified by (1) orientation—the type of activities an NGO undertakes, such as activities involving human rights, consumer protection, environmentalism, health, or development; and (2) level of operation, which indicates the scale at which an organisation works: local, regional, national, or international.
Russia had about 277,000 NGOs in 2008. India is estimated to have had about 2 million NGOs in 2009 (approximately one per 600 Indians), many more than the number of the country’s primary schools and health centres. The United States, by comparison, has approximately 1.5 million NGOs.
Brief History
International NGOs date back to at least the late 18th century, and there were an estimated 1,083 NGOs by 1914. International NGOs were important to the anti-slavery and women’s suffrage movements, and peaked at the time of the 1932–1934 World Disarmament Conference.
The term became popular with the 1945 founding of the United Nations in 1945; Article 71 in Chapter X of its charter stipulated consultative status for organisations which are neither governments nor member states. An international NGO was first defined in resolution 288 (X) of the United Nations Economic and Social Council (ECOSOC) on 27 February 1950, as “any international organization that is not founded by an international treaty”. The role of NGOs and other “major groups” in sustainable development was recognized in Chapter 27 of Agenda 21. The rise and fall of international NGOs matches contemporary events, waxing in periods of growth and waning in times of crisis. The United Nations gave NGOs observer status at its assemblies and some meetings. According to the UN, an NGO is a private, not-for-profit organisation which is independent of government control and is not merely an opposition political party.
The rapid development of the non-governmental sector occurred in Western countries as a result of the restructuring of the welfare state. Globalisation of that process occurred after the fall of the communist system, and was an important part of the Washington Consensus.
Twentieth-century globalisation increased the importance of NGOs. International treaties and organizations, such as the World Trade Organisation, focused on capitalist interests. To counterbalance this trend, NGOs emphasize humanitarian issues, development aid, and sustainable development. An example is the World Social Forum, a rival convention of the World Economic Forum held each January in Davos, Switzerland. The fifth World Social Forum, in Porto Alegre, Brazil in January 2005, was attended by representatives of over 1,000 NGOs. The 1992 Earth Summit in Rio de Janeiro, attended by about 2,400 representatives, was the first to demonstrate the power of international NGOs in environmental issues and sustainable development. Transnational NGO networking has become extensive.
Other Terms/Acronyms
Similar terms include third-sector organisation (TSO), non-profit organization (NPO), voluntary organisation (VO), civil society organisation (CSO), grassroots organisation (GO), social movement organisation (SMO), private voluntary organisation (PVO), self-help organisation (SHO), and non-state actors (NSAs).
Numerous variations exist for the NGO acronym, either due to language, region, or specificity.
Some Romance languages use the synonymous abbreviation ONG; for example:
French: organisation non gouvernementale
Italian: organizzazione non governativa
Portuguese: organização não governmental
Spanish: organización no gubernamental
Romanian: organizație neguvernamentală
Other acronyms that are typically used to describe non-governmental organisations include:
BINGO: Business-friendly international NGO or Big international NGO
CSO: Civil society organisation
ENGO: Environmental NGO — organisations that advocate for the environment, such as Greenpeace and the WWF.
DONGO: Donor-organised NGO
GONGO: Government-organised non-governmental organisation — often used derogatorily, these are government-backed NGOs that are set up to advocate on behalf of a repressive regime on the international stage.
GSO: Grassroots Support Organisation
INGO: International NGO
MANGO: Market advocacy NGO
NGDO: Non-governmental development organisation
NNGO: Northern (UK) NGO
PANGO: Party NGO — addressing political matters
PVDO: Private voluntary development organisation — the United States Agency for International Development (USAID) refers to NGOs as “private voluntary organisations”.
Quango: Quasi-autonomous NGO — often used derogatorily, these organisations rely on public funding. They are prevalent in the UK (where there are more than 1,200), Ireland, and the Commonwealth.
SBO: Social benefit organisation — a goal-oriented designation
SCO: Social change organisation
SNGO: Southern (UK) NGO
TANGO: Technical assistance NGO
TNGO: Transnational NGO — coined during the 1970s due to the increase of environmental and economic issues in the global community. TNGOs exist in two (or more) countries.
YOUNGO: Youth NGOs – advocating for youth rights.
Legal Status
Although NGOs are subject to national laws and practices, four main groups may be found worldwide:
Unincorporated and voluntary association
Trusts, charities, and foundations
Not-for-profit companies and co-operatives
Entities formed (or registered) under special NGO or non-profit laws
The Council of Europe drafted the European Convention on the Recognition of the Legal Personality of International Non-Governmental Organisations in Strasbourg in 1986, creating a common legal basis for European NGOs. Article 11 of the European Convention on Human Rights protects the right to associate, which is fundamental for NGOs.
Types
NGOs further the social goals of their members (or founders): improving the natural environment, encouraging the observance of human rights, improving the welfare of the disadvantaged, or representing a corporate agenda. Their goals cover a wide range of issues. They may fund local NGOs, institutions and projects, and implement projects.
NGOs are classified by their:
Orientation, i.e. the type of activities an NGO undertakes, such as activities involving human rights, consumer protection, environmentalism, health, or development.
Level of operation, which indicates the scale at which an organisation works: local, regional, national, or international.
Orientation
Charity: Often a top-down effort, with little participation or input from beneficiaries. They include NGOs directed at meeting the needs of disadvantaged people and groups.
Service: Includes NGOs that provide healthcare (including family planning) and education.
Participatory: Self-help projects with local involvement in the form of money, tools, land, materials, or labour.
Empowerment: Aim to help poor people to understand the social, political, and economic factors affecting their lives, and to increase awareness of their power to control their lives. With maximum involvement by the beneficiaries, the NGOs are facilitators.
Level of Operation
Community-based organisations (CBOs): Popular initiatives which can raise the consciousness of the urban poor, helping them understand their right to services, and providing such services.
City-wide organisations: Include chambers of commerce and industry, coalitions of business, ethnic or educational groups, and community organisations.
State NGOs: Include state-level organisations, associations, and groups. Some state NGOs are guided by national and international NGOs.
National NGOs: An NGO that exists in only one country; they are rare. These include national organisations such as YMCAs and YWCAs, professional associations, and similar groups. Some have state or city branches, and assist local NGOs.
International NGOs (INGOs): Range from secular agencies, such as Save the Children, to religious groups. They may fund local NGOs, institutions and projects, and implement projects.
Activities
NGOs play a vital role in improving the lives of people who have been affected by natural disasters or are facing other challenges. NGOs can act as implementers, catalysts, and partners to provide essential goods and services to those in need. They work to mobilise resources, both financial and human, to ensure that aid is delivered in a timely and effective manner.
NGOs also play a critical role in driving change by advocating for policies and practices that benefit disadvantaged communities. They often work in partnership with other organisations, including government agencies, to address complex challenges that require a collaborative approach.
One of the key strengths of NGOs is their ability to work at the grassroots level and to connect with communities directly. This allows them to gain a deep understanding of the issues facing people and to tailor their services to meet the specific needs of each community.
NGOs vary by method; some are primarily advocacy groups, and others conduct programs and activities. Oxfam, concerned with poverty alleviation, may provide needy people with the equipment and skills to obtain food and drinking water; the Forum for Fact-finding Documentation and Advocacy (FFDA) helps provide legal assistance to victims of human-rights abuses. The Afghanistan Information Management Services provide specialised technical products and services to support development activities implemented on the ground by other organizations. Management techniques are crucial to project success.
The World Bank classifies NGO activity into two general categories:
Operational NGOs, whose primary function is the design and implementation of development-related projects
Advocacy NGOs, whose primary function is to defend or promote a particular cause and who seek to influence the policies and practices of International governmental organisations (IGOs).
NGOs may also conduct both activities: operational NGOs will use campaigning techniques if they face issues in the field, which could be remedied by policy change, and campaigning NGOs (e.g. human-rights organisations) often have programmes which assist individual victims for whom they are trying to advocate.
Operational
Operational NGOs seek to “achieve small-scale change directly through projects”, mobilising financial resources, materials, and volunteers to create local programmes. They hold large-scale fundraising events and may apply to governments and organizations for grants or contracts to raise money for projects. Operational NGOs often have a hierarchical structure; their headquarters are staffed by professionals who plan projects, create budgets, keep accounts, and report to and communicate with operational fieldworkers on projects. They are most often associated with the delivery of services or environmental issues, emergency relief, and public welfare. Operational NGOs may be subdivided into relief or development organisations, service-delivery or participatory, religious or secular, and public or private. Although operational NGOs may be community-based, many are national or international. The defining activity of an operational NGO is the implementation of projects.
Advocacy
Advocacy NGOs or campaigning NGOs seek to “achieve large-scale change promoted indirectly through the influence of the political system”. They require an active, efficient group of professional members who can keep supporters informed and motivated. Campaigning NGOs must plan and host demonstrations and events which will attract media, their defining activity.
Campaigning NGOs often deal with issues related to human rights, women’s rights, and children’s rights, and their primary purpose is to defend (or promote) a specific cause.
Public Relations
Non-governmental organisations need healthy public relations in order to meet their goals, and use sophisticated public-relations campaigns to raise funds and deal with governments. Interest groups may be politically important, influencing social and political outcomes. A code of ethics was established in 2002 by the World Association of Non-Governmental Organisations.
Structure
Staffing
Some NGOs rely on paid staff; others are based on volunteers. Although many NGOs use international staff in developing countries, others rely on local employees or volunteers. Foreign staff may satisfy a donor who wants to see the supported project managed by a person from an industrialised country. The expertise of these employees (or volunteers) may be counterbalanced by several factors: the cost of foreigners is typically higher, they have no grassroots connections in the country, and local expertise may be undervalued. By the end of 1995, Concern Worldwide (an international anti-poverty NGO) employed 174 foreigners and just over 5,000 local staff in Haiti and ten developing countries in Africa and Asia.
On average, employees in NGOs earn 11-12% less compared to employees of for-profit organisations and government workers with the same number of qualifications. However, in many cases NGOs employees receive more fringe benefits.
Funding
NGOs are usually funded by donations, but some avoid formal funding and are run by volunteers. NGOs may have charitable status, or may be tax-exempt in recognition of their social purposes. Others may be fronts for political, religious, or other interests. Since the end of World War II, NGOs have had an increased role in international development, particularly in the fields of humanitarian assistance and poverty alleviation.
Funding sources include membership dues, the sale of goods and services, grants from international institutions or national governments, CSR Funds and private donations. Although the term non-governmental organisation implies independence from governments, many NGOs depend on government funding; one-fourth of Oxfam’s US$162 million 1998 income was donated by the British government and the EU, and World Vision United States collected $55 million worth of goods in 1998 from the American government. Several EU grants provide funds accessible to NGOs.
Government funding of NGOs is controversial, since:
“the whole point of humanitarian intervention was precise that NGOs and civil society had both a right and an obligation to respond with acts of aid and solidarity to people in need or being subjected to repression or want by the forces that controlled them, whatever the governments concerned might think about the matter.”
Some NGOs, such as Greenpeace, do not accept funding from governments or intergovernmental organisations. The 1999 budget of the American Association of Retired Persons (AARP) was over $540 million.
Overhead
Overhead is the amount of money spent on running an NGO, rather than on projects. It includes office expenses, salaries, and banking and bookkeeping costs. An NGO’s percentage of its overall budget spent on overhead is often used to judge it; less than 4% is considered good. According to the World Association of Non-Governmental Organisations, more than 86% should be spent on programmes (less than 20%). The Global Fund to Fight AIDS, Tuberculosis and Malaria has guidelines of 5-7% overhead to receive funding; the World Bank typically allows 37%. A high percentage of overhead relative to total expenditures can make it more difficult to generate funds. High overhead costs may generate public criticism.
A sole focus on overhead, however, can be counterproductive. Research published by the Urban Institute and Stanford University’s Centre for Social Innovation have shown that rating agencies create incentives for NGOs to lower (and hide) overhead costs, which may reduce organisational effectiveness by starving organisations of infrastructure to deliver services. An alternative rating system would provide, in addition to financial data, a qualitative evaluation of an organisation’s transparency and governance:
An assessment of program effectiveness
Evaluation of feedback mechanisms for donors and beneficiaries
Allowing a rated organisation to respond to an evaluation by a rating agency
Monitoring and Control
In a March 2000 report on United Nations reform priorities, former UN Secretary-General Kofi Annan favoured international humanitarian intervention as the responsibility to protect citizens from ethnic cleansing, genocide, and crimes against humanity. After that report, the Canadian government launched its Responsibility to Protect (R2P) project outlining the issue of humanitarian intervention. The R2P project has wide applications, and among its more controversial has been the Canadian government’s use of R2P to justify its intervention in the coup in Haiti.
Large corporations have increased their corporate social responsibility departments to pre-empt NGO campaigns against corporate practices. Collaboration between corporations and NGOs risks co-option of the weaker partner, typically the NGO.
In December 2007, Assistant Secretary of Defence for Health Affairs S. Ward Casscells established an International Health Division of Force Health Protection & Readiness. Part of International Health’s mission is to communicate with NGOs about areas of mutual interest. Department of Defence Directive 3000.05, in 2005, required the US Defence Department to regard stability-enhancing activities as equally important as combat. In compliance with international law, the department has developed a capacity to improve essential services in areas of conflict (such as Iraq) where customary lead agencies like the State Department and USAID have difficulty operating. International Health cultivates collaborative, arm’s-length relationships with NGOs, recognising their independence, expertise, and honest-broker status.
Economic Theory
The question whether a public project should be owned by an NGO or by the government has been studied in economics using the tools of the incomplete contracting theory. According to this theory, not every detail of a relationship between decision makers can be contractually specified. Hence, in the future the parties will bargain with each other to adapt their relationship to changing circumstances. Ownership matters because it determines the parties’ willingness to make non-contractible investments. In the context of private firms, Hart (1995) has shown that the party with the more important investment task should be owner. Yet, Besley and Ghatak (2001) have argued that in the context of public projects the investment technology does not matter. Specifically, even when the government is the key investor, ownership by an NGO is optimal if and only if the NGO has a larger valuation of the project than the government. However, the general validity of this argument has been questioned by follow-up research. In particular, ownership by the party with the larger valuation need not be optimal when the public good is partially excludable (Francesconi and Muthoo, 2011), when both NGO and government may be indispensable (Halonen-Akatwijuka, 2012), or when the NGO and the government have different bargaining powers (Schmitz, 2013). Moreover, the investment technology can matter for the optimal ownership structure when there are bargaining frictions (Schmitz, 2015), when the parties interact repeatedly (Halonen-Akatwijuka and Pafilis, 2020), or when the parties are asymmetrically informed (Schmitz, 2021).
Influence on World Affairs
Service-delivery NGOs provide public goods and services which governments of developing countries are unable to provide due to a lack of resources. They may be contractors or collaborate with government agencies to reduce the cost of public goods. Capacity-building NGOs affect “culture, structure, projects and daily operations”. Advocacy and public-education NGOs aim to modify behaviour and ideas through communication, crafting messages to promote social, political, or environmental changes (and as news organisations have cut foreign bureaux, many NGOs have begun to expand into news reporting). Movement NGOs mobilise the public and coordinate large-scale collective activities to advance an activist agenda.
Since the end of the Cold War, more NGOs in developed countries have pursued international outreach; involved in local and national social resistance, they have influenced domestic policy change in the developing world. Specialised NGOs have forged partnerships, built networks, and found policy niches.
Diplomacy
In the context of NGOs, diplomacy refers to the practice of building and maintaining partnerships with other organizations, stakeholders, and governments to achieve common objectives related to social or environmental issues.
NGOs often work in complex environments, where multiple stakeholders have different interests and goals. Diplomacy allows NGOs to navigate these complex environments and engage in constructive dialogue with different actors to promote understanding, build consensus, and facilitate cooperation.
Effective NGO diplomacy involves building trust, fostering dialogue, and promoting transparency and accountability. NGOs may engage in diplomacy through various means, including advocacy, lobbying, partnerships, and negotiations. By working collaboratively with other organisations and stakeholders, NGOs can achieve greater impact and reach their goals more effectively.
Track II Diplomacy
Track II diplomacy (or dialogue) is transnational coordination by non-official members of the government, including epistemic communities and former policymakers or analysts. It aims to help policymakers and policy analysts reach a common solution through unofficial discussions. Unlike official diplomacy, conducted by government officials, diplomats, and elected leaders, Track II diplomacy involves experts, scientists, professors and other figures who are not part of government affairs.
World NGO Day
World NGO Day, observed annually on 27 February, was recognised on 17 April 2010 by 12 countries of the IX Baltic Sea NGO Forum at the eighth Summit of the Baltic Sea States in Vilnius, Lithuania. It was internationally recognised on 28 February 2014 in Helsinki, Finland by United Nations Development Programme administrator and former Prime Minister of New Zealand Helen Clark.
Criticism
Tanzanian author and academic Issa G. Shivji has criticised NGOs in two essays: “Silences in NGO discourse: The role and future of NGOs in Africa” and “Reflections on NGOs in Tanzania: What we are, what we are not and what we ought to be”. Shivji writes that despite the good intentions of NGO leaders and activists, he is critical of the “objective effects of actions, regardless of their intentions”. According to Shivji, the rise of NGOs is part of a neoliberal paradigm and not motivated purely by altruism; NGOs want to change the world without understanding it, continuing an imperial relationship.
In his study of NGO involvement in Mozambique, James Pfeiffer addresses their negative effects on the country’s health. According to Pfeiffer, NGOs in Mozambique have “fragmented the local health system, undermined local control of health programs, and contributed to growing local social inequality”. They can be uncoordinated, creating parallel projects which divert health-service workers from their normal duties to instead serve the NGOs. This undermines local primary-healthcare efforts, and removes the government’s ability to maintain agency over its health sector. Pfeiffer suggested a collaborative model of the NGO and the DPS (the Mozambique Provincial Health Directorate); the NGO should be “formally held to standard and adherence within the host country”, reduce “showcase” projects and unsustainable parallel programmes.
In her 1997 Foreign Affairs article, Jessica Mathews wrote: “For all their strengths, NGOs are special interests. The best of them … often suffer from tunnel vision, judging every public act by how it affects their particular interest”. NGOs are unencumbered by policy trade-offs.
According to Vijay Prashad, since the 1970s “the World Bank, under Robert McNamara, championed the NGO as an alternative to the state, leaving intact global and regional relations of power and production.” NGOs have been accused of preserving imperialism (sometimes operating in a racialised manner in Third World countries), with a function similar to that of the clergy during the colonial era. Political philosopher Peter Hallward has called them an aristocratic form of politics, noting that ActionAid and Christian Aid “effectively condoned the [2004 US-backed] coup” against an elected government in Haiti and are the “humanitarian face of imperialism”. Movements in the Global South (such as South Africa’s Western Cape Anti-Eviction Campaign) have refused to work with NGOs, concerned that doing so would compromise their autonomy. NGOs have been accused of weakening people by allowing their funders to prioritise stability over social justice.
They have been accused of being designed by, and used as extensions of, the foreign-policy instruments of some Western countries and groups of countries. Russian president Vladimir Putin made that accusation at the 43rd Munich Security Conference in 2007, saying that NGOs “are formally independent but they are purposefully financed and therefore under control”. According to Michael Bond, “Most large NGOs, such as Oxfam, the Red Cross, Cafod and ActionAid, are striving to make their aid provision more sustainable. But some, mostly in the US, are still exporting the ideologies of their backers.”
NGOs have been accused of using misinformation in their campaigns out of self-interest. According to Doug Parr of Greenpeace, there had been “a tendency among our critics to say that science is the only decision-making tool … but political and commercial interests are using science as a cover for getting their way.” Former policy-maker for the German branch of Friends of the Earth Jens Katjek said, “If NGOs want the best for the environment, they have to learn to compromise.”
They have been questioned as “too much of a good thing”. Eric Werker and Faisal Ahmed made three critiques of NGOs in developing nations. Too many NGOs in a nation (particularly one ruled by a warlord) reduces an NGO’s influence, since it can easily be replaced by another NGO. Resource allocation and outsourcing to local organisations in international-development projects incurs expenses for an NGO, lessening the resources and money available to the intended beneficiaries. NGO missions tend to be paternalistic, as well as expensive.
Legitimacy, an important asset of an NGO, is its perception as an “independent voice”. Neera Chandhoke wrote in a Journal of World-Systems Research article, “To put the point starkly: are the citizens of countries of the South and their needs represented in global civil society, or are citizens as well as their needs constructed by practices of representation? And when we realize that INGOs hardly ever come face to face with the people whose interests and problems they represent, or that they are not accountable to the people they represent, matters become even more troublesome.”
An NGO’s funding affects its legitimacy, and they have become increasingly dependent on a limited number of donors. Competition for funds has increased, in addition to the expectations of donors who may add conditions threatening an NGO’s independence. Dependence on official aid may dilute “the willingness of NGOs to speak out on issues which are unpopular with governments”, and changes in NGO funding sources have altered their function.
NGOs have been challenged as not representing the needs of the developing world, diminishing the “Southern voice” and preserving the North–South divide. The equality of relationships between northern and southern parts of an NGO, and between southern and northern NGOs working in partnership, has been questioned; the north may lead in advocacy and resource mobilisation, and the south delivers services in the developing world. The needs of the developing world may not be addressed appropriately, as northern NGOs do not consult (or participate in) partnerships or assign unrepresentative priorities. NGOs have been accused of damaging the public sector in target countries, such as mismanagement resulting in the breakdown of public healthcare systems.
The scale and variety of activities in which NGOs participate have grown rapidly since 1980, and particularly since 1990. NGOs need to balance centralisation and decentralisation. Centralising NGOs, particularly at the international level, can assign a common theme or set of goals. It may also be advantageous to decentralise an NGO, increasing its chances of responding flexibly and effectively to local issues by implementing projects which are modest in scale, easily monitored, produce immediate benefits, and where all involved know that corruption would be punished.
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Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing.
Despite the different approaches, many of the psychosocial processes in the groups are the same. Self-help groups have had varying relationships with mental health professionals. Due to the nature of these groups, self-help groups can help defray the costs of mental health treatment and implementation into the existing mental health system could help provide treatment to a greater number of the mentally ill population.
Types
Mutual Support and Self-Help
Mutual support or peer support is a process by which people voluntarily come together to help each other address common problems. Mutual support is social, emotional or instrumental support that is mutually offered or provided by persons with similar mental health conditions where there is some mutual agreement on what is helpful.
Mutual support may include many other mental health consumer non-profits and social groups. Such groups are further distinguished as either Individual Therapy (inner-focused) or Social Reform (outer-focused) groups. The former is where members seek to improve themselves, where as the latter set encompasses advocacy organisations such as the National Alliance on Mental Illness and Psychiatric Rehabilitation Association.
Self-help groups are subsets of mutual support and peer support groups, and have a specific purpose for mutual aid in satisfying a common need, overcoming a shared handicap or life-disrupting problem. Self-help groups are less bureaucratic and work on a more grassroots level. Self-help organisations are national affiliates of local self-help groups or mental health consumer groups that finance research, maintain public relations or lobby for legislation in favour of those affected.
Behaviour Control or Stress Coping Groups
Of individual therapy groups, researchers distinguish between Behaviour Control groups (such as Alcoholics Anonymous and TOPS) and Stress Coping groups (such as mental health support groups, cancer patient support groups, and groups of single parents). German researchers refer to Stress Coping groups as Conversation Circles.
Significant differences exist between Behavioural Control groups and Stress Coping groups. Meetings of Behaviour Control groups tend to be significantly larger than Stress Coping counterparts (by more than a factor of two). Behaviour Control group members have a longer average group tenure than members of Stress Coping groups (45 months compared to 11 months) and are less likely to consider their membership as temporary. While very few members of either set saw professionals concurrently while being active in their group, Stress Coping members were more likely to have previously seen professionals than Behaviour Control group members. Similarly, Stress Coping groups worked closer with mental health professionals.
Member vs Professional Leadership
Member leadership. In Germany, a specific subset of Conversation Circles are categorized as Talking Groups (Gesprächsselbsthilfegruppen). In Talking Groups all members of the group have the same rights, each member is responsible only for themselves (group members do not make decisions for other group members), each group is autonomous, everyone attends the group on account of their own problems, whatever is discussed in the group remains confidential, and participation is free of charge.
Professionally Led Group Psychotherapy
Self-help groups are not intended to provide “deep” psychotherapy. Nevertheless, their emphasis on psychosocial processes and the understanding shared by those with the same or similar mental illnesses does achieve constructive treatment goals.
Interpersonal learning, which is done through processes such as feedback and confrontation, is generally deemphasized in self-help groups. This is largely because it can be threatening, and requires training and understanding of small group processes. Similarly, reality testing is also deemphasized. Reality testing relies on consensual validation, offering feedback, seeking feedback and confrontation. These processes seldom occur in self-help groups, though they frequently occur in professionally directed groups.
Professional Affiliation and Group Lifespan
If self-help groups are not affiliated with a national organisation, professional involvement increases their life expectancy. Conversely, if particular groups are affiliated with a national organisation professional involvement decreases their life expectancy. Rules enforcing self-regulation in Talking Groups are essential for the group’s effectiveness.
Typology of Self-Help Groups
In 1991 researchers Marsha A. Schubert and Thomasina Borkman created five conceptual categorisations for self-help groups.
Unaffiliated Groups
Unaffiliated groups are defined as self-help groups that function independently from any control at state or national levels, and from any other group or professionals. These groups accept all potential members, and everyone has an equal opportunity to volunteer or be elected. Leaders serve to help the groups function by collecting donations not through controlling the members. Experiential knowledge is mostly found, and there is a high emphasis on sharing. An example of an unaffiliated group includes Wildflowers’ Movement in Los Angeles.
Federated Groups
Federated groups have superordinate levels of their own self-help organisation at state or national levels which makes publicity and literature available. The local unit of the federated self-help group retains full control of its decisions. These groups tend to rely on experiential knowledge, and professionals rarely directly interact. The leaders of these groups would be any members comfortable with the format and willing to accept responsibilities. Leaders do not need to have formal training to gain their title. Examples of a federated self-help group would be Depression and Bipolar Support Alliance (DBSA) and Recovery International.
Affiliated Groups
Affiliated groups are subordinate to another group, a regional or national level of their own organisation. Local groups conform to the guidelines of the regional/national groups. Leaders are self-helpers not professional caregivers, and meetings included educational activities and sharing, supplemented by research and professionals. Examples of an affiliated self-help group would be the National Alliance on Mental Illness (NAMI).
Managed Groups
Managed groups are based on a combination of self-help and professional techniques. These groups are populated generally through referrals and group activities are led by group members. Managed groups do not meet all the criteria for self-help groups, and so should be designated professionally controlled support groups. Examples of managed groups are common with support groups in hospitals, such as those with breast cancer survivors and patients that may be managed by a nurse or therapist in some professional fashion.
Hybrid Groups
The hybrid group has characteristics of the affiliated and managed groups. Like affiliated groups, hybrid groups are organised by another level of their own organisation. To participate in specialised roles, training is developed by a higher level and enforced through trained leaders or facilitators. Like a managed group, a hybrid group cooperates and interacts with professionals, and that knowledge is highly valued alongside experiential knowledge.
Group Processes
No two self-help group are exactly alike, the make-up and attitudes are influenced by the group ideology and environment. In most cases, the group becomes a miniature society that can function like a buffer between the members and the rest of the world. The most essential processes are those that meet personal and social needs in an environment of safety and simplicity. Elegant theoretical formulations, systematic behavioural techniques, and complicated cognitive-restructuring methods are not necessary.
Despite the differences, researchers have identified many psychosocial processes occurring in self-help groups related to their effectiveness. This list includes, but is not limited to: acceptance, behavioural rehearsal, changing member’s perspectives of themselves, changing member’s perspectives of the world, catharsis, extinction, role modelling, learning new coping strategies, mutual affirmation, personal goal setting, instilling hope, justification, normalisation, positive reinforcement, reducing social isolation, reducing stigma, self-disclosure, sharing (or “opening up”), and showing empathy.
Five theoretical frameworks have been used in attempts to explain the effectiveness of self-help groups.
Social support: Having a community of people to give physical and emotional comfort, people who love and care, is a moderating factor in the development of psychological and physical disease.
Experiential knowledge: Members obtain specialised information and perspectives that other members have obtained through living with severe mental illness. Validation of their approaches to problems increases their confidence.
Social learning theory: Members with experience become credible role models.
Social comparison theory: Individuals with similar mental illness are attracted to each other in order to establish a sense of normalcy for themselves. Comparing one another to each other is considered to provide other peers with an incentive to change for the better either through upward comparison (looking up to someone as a role model) or downward comparison (seeing an example of how debilitating mental illness can be).
Helper theory: Those helping each other feel greater interpersonal competence from changing other’s lives for the better. The helpers feel they have gained as much as they have given to others. The helpers receive “personalised learning” from working with helpees. The helpers’ self-esteem improves with the social approval received from those they have helped, putting them in a more advantageous position to help others.
A framework derived from common themes in empirical data describes recovery as a contextual nonlinear process, a trend of general improvement with unavoidable paroxysms while negotiating environmental, socioeconomic and internal forces, motivated by a drive to move forward in one’s life. The framework identified several negotiation strategies, some designed to accommodate illnesses and others designed to change thinking and behaviour. The former category includes strategies such as acceptance and balancing activities. The latter includes positive thinking, increasing one’s own personal agency/control and activism within the mental health system.
Relationship with Mental Health Professionals
A 1978 survey of mental health professionals in the United States found they had a relatively favourable opinion of self-help groups and there was a hospitable climate for integration and cooperation with self-help groups in the mental health delivery system. The role of self-help groups in instilling hope, facilitating coping, and improving the quality of life of their members is now widely accepted in many areas both inside and outside of the general medical community.
The 1987 Surgeon’s General Workshop marked a publicized call for egalitarian relationships with self-help groups. Surgeon General C. Everett Koop presented at this workshop, advocating for relationships that are not superordinate-subordinate, but rather emphasizing respectful, equal relations.
A survey of psychotherapists in Germany found that 50% of the respondents reported a high or very high acceptance of self-help groups and 43.2% rated their acceptance of self-help groups as moderate. Only 6.8% of respondents rated their acceptance of self-help groups as low or very low.
Surveys of self-help groups have shown very little evidence of antagonism towards mental health professionals. The maxim of self-help groups in the United States is “Doctors know better than we do how sickness can be treated. We know better than doctors how sick people can be treated as humans.”
Referrals
A large majority of self-help users use professional services as a gateway to self-help services, or concurrently with professional service or the aftercare following professional service. Professional referrals to self-help groups thus can be a cost-effective method of continuing mental health services and the two can co-exist within their own fields. While twelve-step groups, such as Alcoholics Anonymous, make an indispensable contribution to the mental and/or substance use (M/SU) professional services system, a vast number of non-twelve-step groups remain underutilised within that system.
Professional referrals to self-help groups for mental health are less effective than arranging for prospective self-help members to meet with veterans of the self-help group. This is true even when compared to referrals from professionals familiar with the self-help group when referring clients to it. Referrals mostly come from informal sources (e.g. family, friends, word of mouth, self). Those attending groups as a result of professional referrals account for only one fifth to one-third of the population. One survey found 54% of members learned about their self-help group from the media, 40% learned about their group from friends and relatives, and relatively few learned about them from professional referrals.
Effectiveness
Self-help groups are effective for helping people cope with, and recover from, a wide variety of problems. German Talking Groups have been shown to be as effective as psychoanalytically oriented group therapy. Participation in self-help groups for mental health is correlated with reductions in psychiatric hospitalisations, and shorter hospitalisations if they occur. Members demonstrate improved coping skills, greater acceptance of their illness, improved medication adherence, decreased levels of worry, higher satisfaction with their health, improved daily functioning and improved illness management. Participation in self-help groups for mental health encourages more appropriate use of professional services, making the time spent in care more efficient. The amount of time spent in the programs, and how proactive the members are in them, has also been correlated with increased benefits. Decreased hospitalisation and shorter durations of hospitalisation indicate that self-help groups result in financial savings for the health care system, as hospitalisation is one of the most expensive mental health services. Similarly, reduced utilisation of other mental health services may translate into additional savings for the system.
While self-help groups for mental health increase self-esteem, reduce stigma, accelerate rehabilitation, improve decision-making, decrease tendency to decompensate under stress, and improve social functioning, they are not always shown to reduce psychiatric symptomatology. The therapeutic effects are attributed to the increased social support, sense of community, education and personal empowerment.
Members of self-help groups for mental health rated their perception of the group’s effectiveness on average at 4.3 on a 5-point Likert scale.
Social support, in general, can lead to added benefits in managing stress, a factor that can exacerbate mental illness.
Emotions Anonymous (EA) is a derivative programme of Neurotics Anonymous and open to anyone who wants to achieve emotional well-being. Following the Twelve Traditions, EA groups cannot accept outside contributions.
GROW was founded in Sydney, Australia, in 1957 by a Roman Catholic priest, Father Cornelius Keogh, and people who had sought help with their mental illness at Alcoholics Anonymous (AA) meetings. After its inception, GROW members learned of Recovery, Inc. (the organisation now known as Recovery International) and integrated its processes into their programme. GROW’s original literature includes the Twelve Stages of Decline, which state that emotional illness begins with self-centeredness, and the Twelve Steps of Recovery and Personal Growth, a blend of AA’s Twelve Steps and will-training methods from Recovery International. GROW groups are open to anyone who would like to join, though they specifically recruit people who have been in psychiatric hospitals or are socioeconomically disadvantaged. GROW does not operate with funding restrictions and have received state and outside funding in the past.
Neurotics Anonymous is a twelve-step programme open to anyone with a desire to become emotionally well. According to the Twelve Traditions followed in the programme, Neurotics Anonymous is unable to accept outside contributions. The term “neurotics” or “neuroses” has since fallen out of favour with mental health professionals, with the movement away from the psychoanalytic principles of a DSM-II. Branches of Neurotics Anonymous have since changed their name to Emotions Anonymous, which is currently the name in favor with the Minnesota Groups. Groups in Mexico, however, called Neuróticos Anónimos still are referred to by the same name, due to the term “neuroticos” having a less pejorative connotation in Spanish. This branch continues to flourish in Mexico City as well as largely Spanish-speaking cities in the United States, such as Los Angeles.
Recovery, Inc. was founded in Chicago, Illinois, in 1937 by psychiatrist Abraham Low using principles in contrast to those popularised by psychoanalysis. During the organisation’s annual meeting in June 2007 it was announced that Recovery, Inc. would thereafter be known as Recovery International. Recovery International is open to anyone identifying as “nervous” (a compromise between the loaded term neurotic and the colloquial phrase “nervous breakdown”); strictly encourages members to follow their physician’s, social worker’s, psychologist’s or psychiatrist’s orders; and does not operate with funding restrictions.
Fundamentally, Low believes “Adult life is not driven by instincts but guided by Will,” using a definition of will opposite of Arthur Schopenhauer’s. Low’s programme is based on increasing determination to act, self-control, and self-confidence. Edward Sagarin compared it to a modern, reasonable, and rational implementation of Émile Coué’s psychotherapy. Recovery International is “twelve-step friendly.” Members of any twelve-step group are encouraged to attend Recovery International meetings in addition to their twelve-step group participation.
Criticism
There are several limitations of self-help groups for mental health, including but not limited to their inability to keep detailed records, lack of formal procedures to follow up with members, absence of formal screening procedures for new members, lack formal leadership training, and likely inability of members to recognise a “newcomer” presenting with a serious illness requiring immediate treatment. Additionally, there is a lack of professional or legal regulatory constraints determining how such groups can operate, there is a danger that members may disregard the advice of mental health professionals, and there can be an anti-therapeutic suppression of ambivalence and hostility. Researchers have also elaborated specific criticisms regarding self-help groups’ formulaic approach, attrition rates, over-generalisation, and “panacea complex”.
Formulaic Approach
Researchers have questioned whether formulaic approaches to self-help group therapy, like the Twelve Steps, could stifle creativity or if adherence to them may prevent the group from making useful or necessary changes. Similarly others have criticised self-help group structure as being too rigid.
High Attrition Rates
There is not a universal appeal of self-help groups; as few as 17% of people invited to attend a self-help group will do so. Of those, only one third will stay for longer than four months. Those who continue are people who value the meetings and the self-help group experience.
Overgeneralisation
Since these groups are not specifically diagnosis-related, but rather for anyone seeking mental and emotional health, they may not provide the necessary sense of community to evoke feelings of oneness required for recovery in self-help groups. Referent power is only one factor contributing to group effectiveness. A study of Schizophrenics Anonymous found expert power to be more influential in measurements of perceived group helpfulness.
Panacea Complex
There is a risk that self-help group members may come to believe that group participation is a panacea—that the group’s processes can remedy any problem.
Sexual Predation and Opportunism
Often membership of non-associated self-help groups is run by volunteers. Monitoring of relationships and standards of conduct are seldom formalised within a group and are done on a self-regulating basis. This can mean undesirable and unethical initiation of sexual and intimate encounters are facilitated in these settings. Predatory and opportunistic behaviour in these environments which by association involve divulging volatile mental states, medication changes and life circumstances mean opportunities by those willing to leverage information that is often normally guarded and deeply personal, is a risk more-so than in other social meetup settings or professionally governed bodies.
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The Institute of Psychiatry, Psychology and Neuroscience (IoPPN) is a research institution dedicated to discovering what causes mental illness and diseases of the brain. In addition, its aim is to help identify new treatments for them and ways to prevent them in the first place. The IoPPN is a faculty of King’s College London, England, previously known as the Institute of Psychiatry (IoP).
The institute works closely with South London and Maudsley NHS Foundation Trust. Many senior academic staff also work as honorary consultants for the trust in clinical services such as the National Psychosis Unit at Bethlem Royal Hospital.
The impact of the institute’s work was judged to be 100% ‘world-leading’ or ‘internationally-excellent’ in the Research Excellence Framework (REF 2014). The research environment of the institute was also rated 100% ‘world-leading’. King’s College London was rated the second for research in Psychology, Psychiatry and Neuroscience in REF 2014. According to the 2021 US News Ranking, King’s College London was ranked second in the world in Psychiatry and Psychology.
The IoPPN shares a great deal of its history with the Maudsley Hospital, with which it shares the location of its main building. It was part of the original plans of Frederick Mott and Henry Maudsley – inspired by the Munich institute of Emil Kraepelin – that the hospital would include facilities for teaching and research in 1896. In 1914, London County Council agreed to establish a hospital in Denmark Hill and Mott’s plan began to take shape. The Maudsley Hospital was opened in 1923 as a result of a donation by Henry Maudsley.
Originally established as the “Maudsley Hospital Medical School” in 1924, it changed its name to the Institute of Psychiatry in 1948, with Aubrey Lewis appointed to the inaugural Chair of Psychiatry (which he held until his retirement in 1966). The main Institute building was opened in 1967 and contains lecture theatres, administrative offices, library and canteen.
In 1959 a group of genetic researchers led by Eliot Slater were given Medical Research Council funding to establish themselves as the ‘MRC Psychiatric Genetics Unit’. Although this closed down in 1969, psychiatric genetics continued, eventually as the MRC Social, Genetic and Developmental Psychiatry Centre (SGDP Centre) which moved into new purpose-built building in 2002.
In 1997, the institute had split from the Maudsley and become instead a school of King’s College London. The Henry Wellcome building was opened in 2001 and houses most of the IoPPN’s psychology department. In 2004, a new Centre for Neuroimaging Sciences (CNS) was opened which provides offices, lab space, and access to two MRI scanners for neuroimaging research. In 2014 the institute was renamed to the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), as the remit of the institute was broadened to include all brain and behavioural sciences.
Departments
Addictions
The Addictions Department specialises in research into tobacco, alcohol and opiate addiction policy and treatment. In March 2010 the addiction research unit and the sections of alcohol research, tobacco research and behavioural pharmacology were brought together to form the current The Addictions Department, also known as the National Addiction Centre (NAC).
Biostatistics
This department provides advice in the interpretation and use of statistical techniques in psychological research. They work closely with members of the Neuroimaging section in their work using brain scanners.
The Biostatistics department opened in 1964, then as the Biometrics Unit. The department holds particular expertise in multivariate statistical methods for measurement, life-course epidemiology and the analysis of experimental, genetic and neuropsychiatric data.
The department provides both introductory and advanced training in applied statistical methodology, collaborate on studies of mental health based here and internationally, and undertake research in relevant applied methodology.
The department also hosts the UKCRN accredited King’s Clinical Trials Unit which provides randomisation, data management, analysis and trial management – all of which are available to researchers across King’s Health Partners. The CTU provides support to both medicinal and non-medicinal clinical trials assisting researchers in the conduct of carrying out clinical trials.
Child and Adolescent Psychiatry
The department is dedicated to the study of developmental disorders such as ADHD, clinical depression, autism and learning difficulties. The department has close links with the Michael Rutter Centre for Children and Young People at the Maudsley Hospital which has a number of specialist services for children and adolescents.
Forensic Mental Health Science
Forensic Mental Health Science is the study of antisocial, violent, and criminal behaviours among people with mental disorders. The department’s research focuses on antisocial behaviour as it appears in people with either major mental disorders or personality disorders. The department is closely allied to the Forensic Psychiatry Teaching Unit.
Neuroscience
Researchers in this department carry out a range of studies into diseases such as Alzheimer’s disease and motor neuron disease. The Institute of Psychiatry now houses the Medical Research Council Centre for Neurodegeneration Research, where pioneering research is conducted investigating disease of the CNS. The Department of Clinical Neuroscience in Windsor Walk also contains the MRC London Neurodegenerative Disease Brain Bank.
Department of Neuroimaging and Centre for Neuroimaging Sciences
The Centre for Neuroimaging Sciences (CNS) is a joint venture of the King’s College London Institute of Psychiatry and the South London and Maudsley NHS Trust (SLAM). Completed in early 2004, the centre provides an interdisciplinary research environment.
The Clinical Neuroimaging Department, situated at the Maudsley Hospital, provides a full range of neuroradiographic imaging services, including Magnetic Resonance Imaging (MRI). Within the CNS, the academic Department of Neuroimaging’s Major Research Facility (MRF) manages a range of MRI facilities for research studies. The Department of Neuroimaging also runs an EEG laboratory, re-launched in 2010.
Psychology
The IoPPN Psychology department was founded in 1950. The department conducts research in neuropsychology, forensic psychology, and cognitive behavioural therapy. Hans Eysenck set up the UK’s first qualification in clinical psychology in the department, which has now evolved into a three-year doctoral ‘DClinPsych’ qualification.
Clinically, members of the department offer expert services to the Maudsley Hospital, Bethlem Royal Hospital, King’s College Hospital, Guy’s Hospital and community mental health teams in the South London area. Members of the department also teach psychology to undergraduate medical students from the United Medical and Dental Schools of Guy’s and St Thomas’ Hospitals. Psychiatric geneticist Peter McGuffin was awarded a fellowship at the institute.
Psychological Medicine
The Department of Psychological Medicine, chaired by Professor Ulrike Schmidt, addresses many of the commonest mental disorders which affect adults including depression, anxiety, post traumatic stress disorder, eating disorders, somatoform disorders, and medically unexplained symptoms and syndromes. Its research spans basic science, experimental medicine, epidemiology and public policy. It includes the King’s Centre for Military Health Research, led by the department’s former chair, Professor Simon Wessely, and is responsible for studying the psychological impacts of the 2003 Iraq War. The department also contains a programme of work on liaison psychiatry and studies the many complex interactions between mental and physical illness.
Social, Genetic and Developmental Psychiatry
The SGDP centre is a multi-disciplinary research centre devoted to the study of the interplay between “nature” (genetics) and “nurture” (environment) as they interact in the development of complex human behaviour. Research at the SGDP acknowledges that there is no simple solution to the “nature versus nurture” debate; instead, expertise is combined across fields such as social epidemiology, child and adult psychiatry, developmental psychopathology, development in the family, personality traits, cognitive abilities, statistical genetics, and molecular genetics. In this way it is hoped that a greater understanding can be achieved in risk factors that might predispose an individual to depression, ADHD, or autism.
Brief History
The MRC Social, Genetic and Developmental Psychiatry (SGDP) Centre was founded in 1994 by the Medical Research Council, in partnership with the Institute of Psychiatry (now a school of King’s College London).
The research in social, genetic and developmental psychiatry have already existed at the Institute of Psychiatry since its establishment in 1948. However, the streams of research were not integrated and there have even been times when genetic researchers and social psychiatrists were in a state of hostility. The intellectual warfare between nature and nurture reached its peak in the 1960s and 1970s.
Aubrey Lewis, who was the first Professor of Psychiatry at the institute and the director of the MRC Social Psychiatry Research Unit (first MRC unit at the institute), noticed that social psychiatry was a broad field that included both biological substrate of disorders and social causes. Eliot Slater, the ‘founding father’ of psychiatric genetics in the United Kingdom, was encouraged by Lewis to study genetics in 1930s. In 1959, Slater established another MRC unit at the institute (MRC Psychiatric Genetics Unit), but the unit was closed in 1969 on Slater’s retirement. In 1984, MRC Child Psychiatry Unit was established at the Institute of Psychiatry by Michael Rutter, a member in the MRC Social Psychiatry Research Unit led by Lewis. The unit brought together experts in many overlapping fields, and the mix proved highly successful as the unit had a major impact on child psychiatric research throughout the world.
The MRC Social Psychiatry Research Unit was closed in 1993. The MRC and the institute found that there was a need for refocusing and reintegration with other strands of research including psychiatric genetics and disorders of adult life. Rutter and David Goldberg discussed with the MRC about the establishment of an interdisciplinary research centre that could comprehensively study the interplay of nature and nurture in the development of psychiatric disorders. In 1994, MRC SGDP Centre was established in Denmark Hill, and Rutter was appointed as the first director of the centre. The SGDP Centre has moved into its new purpose-built building in 2002.
Psychosis Studies
The department is the most highly cited group of scientists working on schizophrenia and related disorders. Work focuses on integrating cognitive measures and multimodal neuroimaging techniques, with perinatal, genetic and developmental data. The central aim is to characterise the core pathophysiological dimensions of schizophrenia and bipolar disorder. The section has initiated or participated a number of such treatment studies of new atypical antipsychotics and potential mood stabilising medication and is also developing computerised and web-based applications for disease self-management.
Maurice Wohl Clinical Neuroscience Institute
The Maurice Wohl Clinical Neuroscience Institute is a centre for neuroscience research opened by The Princess Royal in 2015. It is one of the leading neuroscience institutes in the world. The centre is named after British philanthropist Maurice Wohl, who supported many medical projects and had a long association with King’s College London, and was funded by several philanthropic donors, organisations and King’s Health Partners.
The Maurice Wohl Clinical Neuroscience Institute focuses on the development of new treatments to patients affected by neurodegenerative diseases (such as Alzheimer’s disease, Parkinson’s disease and motor neurone disease), mental disorders (depression, schizophrenia) and neurological diseases (including epilepsy and stroke), and the understanding of disease mechanisms. The research institute has 250 clinicians and research scientists from neuroimaging, neurology, psychiatry, genetics, molecular and cellular biology and drug discovery.
The current three major goals of the institute is to determine the underlying genetic and environmental risk factors for disease, to identify tests for early diagnosis and biomarkers that measure disease progression, and to develop informative cellular and animal disease models of disease to accelerate drug discovery.
Funding
Approximately 70% of the IoPPN’s income comes from the research it conducts. Approximately 20% is from clinical work performed for the South London and Maudsley NHS Foundation Trust. Approximately 10% of gross income is from taught courses offered to postgraduate students.
Sources include the government’s National Institute for Health Research and Higher Education Funding Council for England, grant-giving bodies such as the Medical Research Council (UK) and the Wellcome Trust, as well as other governmental, charitable and private-sector organisations. Individual research teams secure around £130 million of funds for their projects each year. Many projects are carried out in partnership with other university and health services, charities and private companies.
The IoPPN and the pharmaceutical company Lundbeck are led one of the largest ever academic-industry collaborations in research, known as NEWMEDS – Novel Methods leading to New Medications in Depression and Schizophrenia. The project is part of the Innovative Medicines Initiative developed by the European Federation of Pharmaceutical Industries and Associations and the European Commission. NEWMEDS aims to facilitate the development of new psychiatric medications by bringing top scientists and academics together in partnership with nearly every major global drug company.
Another key project is the KCL and Janssen led pre competitive public private consortium RADAR-CNS (Remote Measurement of Disease and Relapse in Central Nervous System Disorders), which uses smartphones and wearable devices to track clinical outcomes in disorders like depression, multiple sclerosis and epilepsy.
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The United Kingdom Council for Psychotherapy (UKCP) is a professional association of psychotherapy organisations and practitioners in the United Kingdom. It is restricted to registered clinical psychotherapists and psychotherapeutic counsellors (similar, but with shorter training).
The UKCP exists to “promote and maintain the profession of psychotherapy and the highest standards in the practice of psychotherapy throughout the United Kingdom, for the benefit of the public.” Only psychotherapists or psycho-therapeutic counsellors who meet UKCP’s training requirements and abide by its ethical guidelines are included in its online “Register of Psychotherapists”.
The UKCP was initially founded in the 1980s as the United Kingdom Standing Conference for Psychotherapy following the Foster Report (1971) and the Sieghart Report (1978), which recommended regulation of the psychotherapy field. It was formally inaugurated as a council in 1993.
The UKCP has since evolved into a national umbrella organisation for most major psychotherapeutic modalities. As of 2012, there are more than 70 member organisations representing all the main traditions in the practice of psychotherapy.
The council is run by a board of trustees which is elected by the council’s members. A number of subcommittees, including the ethics committee, report directly to the board of trustees.
UKCP also represents the United Kingdom in the European Association for Psychotherapy (EAP) – a Vienna-based umbrella organisation which sets standards for equivalence of training and practice throughout Europe – and is part of the National Awarding Organisation (NAO) overseeing the European Certificate of Psychotherapy (ECP) award in the UK.
Objectives
To promote the art and science of psychotherapy and psychotherapeutic counselling for the public benefit.
To promote research in psychotherapy and psychotherapeutic counselling, and to disseminate the results of any such research.
To promote high standards of education, training and practice in psychotherapy and psychotherapeutic counselling.
To promote the wider provision of psychotherapy and psychotherapeutic counselling for all sections of the public.
Campaigns
The UKCP’s campaign work has included collaboration with NICE and the Health Professions Council. Campaigns have included:
NICE under scrutiny.
NICE consultations.
Reparative therapy.
Services under threat.
Skills for Health.
Regulatory Role
The UKCP regards the regulation of psychotherapists and the public accountability of their practice as important means to safeguard the interests of patients, clients, and the reputation of registered practitioners. The present Register is voluntary – it is not required by any Act of Parliament – but the UKCP is campaigning with other related organisations for the statutory regulation of the “talking therapy” professions.
The UKCP delegates the accreditation and re-accreditation of members to UKCP organisational members. Organisational members may be designated as “training”, “accrediting” or both. Individual psychotherapists can join the UKCP register only following accreditation by one of these organisations. At present there is no way of registering directly with UKCP.
The UKCP does not run courses leading to UKCP accreditation; courses are provided by its organisational members. Some training organisations also accredit and will award Accreditation of Prior Learning (APL) or give credit for previous training experience.
Candidates for registration who trained on a course that does not lead directly to membership need to seek accreditation by an accrediting organisation member.
Despite the UKCP stating that “We exist to promote and maintain high standards of practice of psychotherapy and psychotherapeutic counselling for the benefit of the public throughout the United Kingdom”, there have been numerous complaints and instances of UKCP registered therapists violating the rights of their clients, harming them psychologically, emotionally and sexually. Some of these instances have resulted in therapists escaping any concrete punishments for their actions and being allowed to continue practicing. One case involved the sexual abuse of a mentally ill client by a therapist registered with the Guild of Analytical Psychologists, a member organisation of the UKCP, with the therapist receiving a suspension only. A report carried out by unsafespaces.com found that one in four therapists continue to practice despite being struck off by member institutions.
Structure
Board of Trustees.
UKCP colleges.
UKCP committees.
Faculties and groups.
Members’ Forum.
Special interest groups.
UKCP Colleges
There are 11 UKCP colleges:
Cognitive Psychotherapies College (CPC).
College of Child and Adolescent Psychotherapies (C-CAP).
College for Family, Couple and Systemic Therapy (CFCST).
College of Hypno-psychotherapists (CH-P).
College of Medical Psychotherapists (CMP).
College for Sexual and Relationship Psychotherapy (CSRP).
Constructivist and Existential College (CEC).
Council for Psychoanalysis and Jungian Analysis College (CPJAC).
Humanistic and Integrative Psychotherapy College (HIPC).
Psychotherapeutic Counselling and Intersubjective Psychotherapy College (PCIPC).
Universities Training College (UTC).
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Centre for Freudian Analysis and Research (CFAR) is a psychoanalysis research, training and low-cost treatment centre located in London, United Kingdom.
The centre was founded in 1985 by Bice Benvenuto, Professor Bernard Burgoyne, Richard Klein and Darian Leader. It was established as a charity with the purpose of advancing education for the benefit of the public in particular by the provision of training and seminars in psychoanalysis.
Courses
CFAR offers introductory and advanced courses in psychoanalysis, and trains psychoanalysts within the context of its clinical training programme. Seminars are given by visiting Lacanian analysts from France, Belgium, Spain and Australia.
Publications
The Centre publishes a Journal JCFAR which contains articles on psychoanalytic themes from a Freudian and Lacanian perspective. In association with Karnac Books CFAR has published The Centre for Freudian Analysis and Research Library which aims to make classic Lacanian texts available in English for the first time, as well as publishing original research in the Lacanian field:
Sexual Ambiguities by Geneviève Morel.
The Trainings of the Psychoanalyst by Annie Tardits.
Freud and the Desire of the Psychoanalyst by Serge Cottet.
Lacan and Levi-Strauss or The Return to Freud (1951-1957) by Markos Zafiropoulos.
Challenge to Health Professions Council
In February 2007 the UK Government published a white paper (‘Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century’) which stated that “The government is planning to introduce statutory regulation for…psychotherapists and counsellors…” and that “…psychotherapists and counsellors will be regulated by the Health Professions Council, following that Council’s rigorous process of assessing their regulatory needs and ensuring that its system is capable of accommodating them”.
As a response to this proposed regulation by the Health Professions Council (HPC), CFAR was one of the organisations that contributed to the Maresfield report which opposed the suitability of the HPC as a regulating body for the professions of counselling and psychotherapy in the UK.
Following on from this report, CFAR was one of six organisations that called for a judicial review of whether or not the HPC had, in fact, fully assessed the regulatory needs of the professions or properly determined if it was the most appropriate body to provide such regulation. On Friday 10 December 2010, a Judicial Review Permission Hearing under The Hon. Mr Justice Burton at the Royal Courts of Justice found against the Health Professions Council and granted permission to proceed towards a Judicial Review of the proposals for regulation under the HPC. On 16 February 2011 the UK government – in its command paper ‘Enabling Excellence’ – halted the project to regulate counselling, psychotherapy and other talking treatments via the HPC.
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The group is one of the first “cyber” support groups to be recognised by the medical providers and receive professional referrals.
Outline
BPDFamily.com provides articles and message boards for family members to learn and share their experiences. The articles explain borderline personality disorder in understandable terms, and the discussion groups help to normalise the experiences of family members. The site appeals to family members who care about someone with BPD, but are frustrated with the relationship demands and conflict.
The site educates its members on concepts developed by Shari Manning PhD, Margalis Fjelstad PhD, Robert O. Friedel MD, and the NEA-BPD Family Connections Programme and reached out to academia for collaborations. The site has an interactive web program that teaches the basic principles of cognitive behavioural therapy (CBT).
The website and support group are certified as a reputable health information resource by the Health On the Net Foundation.
Funding has come from benefactors and member donations.
Use by Healthcare Professionals
BPDFamily.com is a listed reference site of the National Health Service (England), the National Alliance on Mental Illness, the National Education Alliance for Borderline Personality Disorder, and the Personality Disorders Awareness Network.
The group’s services and programmes are recommended in Primer on Borderline Personality Disorder, Abnormal and Clinical Psychology: An Introductory Textbook, Resources to Improve Emotional Health and Strengthen Relationships, I Hate You–Don’t Leave Me: Understanding the Borderline Personality, The Essential Family Guide to Borderline Personality Disorder, Stop Walking on Eggshells, and Discovering Your Inner Child: Transforming Toxic Patterns and Finding Your Joy. The site has been recommended by about.com expert Kristalyn Salters-Pedneault, PhD, Salon advice columnist Cary Tennis, PsychCentral columnist Kate Thieda, and by Randi Kreger at BPDCentral.
The organisation has been involved and referenced in clinical research studies conducted by: Columbia University, University of Wollongong (Australia), California State University, Sacramento, University of Toronto (Canada), University of Nevada, Bowling Green State University, Wright Institute (California), Colorado School of Professional Psychology, Long Island University, Alliant International University (California), Macquarie University (Australia), Middle Tennessee State University, Simon Fraser University (Canada) and Walden University. The organisation also supports industry research studies conducted by the Treatment and Research Advancements Association for Personality Disorder (TARA-APD).
In a January 2013 column, Kristalyn Salters-Pedneault at Boston University School of Medicine says that although she highly recommends this group for family members, readers with borderline personality disorder should keep in mind that some people have been hurt by their family member with BPD and are speaking from this perspective
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The TeenScreen National Centre for Mental Health Checkups at Columbia University was a national mental health and suicide risk screening initiative for middle- and high-school age adolescents.
On 15 November 2012, according to its website, the programme was terminated. The organisation operated as a centre in the Division of Child and Adolescent Psychiatry Department at Columbia University, in New York City.
The programme was developed at Columbia University in 1999, and launched nationally in 2003. Screening was voluntary and offered through doctors’ offices, schools, clinics, juvenile justice facilities, and other youth-serving organisations and settings. As of August 2011, the programme had more than 2,000 active screening sites across 46 states in the United States, and in other countries including Australia, Brazil, India and New Zealand.
Screening Programme
Organisation
The programme was developed by a team of researchers at Columbia University, led by David Shaffer. The goal was to make researched and validated screening questionnaires available for voluntary identification of possible mental disorders and suicide risk in middle and high school students. The questionnaire they developed is known as the Columbia Suicide Screen, which entered into use in 1999, an early version of what is now the Columbia Health Screen. In 2003, the New Freedom Commission on Mental Health, created under the administration of George W. Bush, identified the TeenScreen program as a “model” programme and recommended adolescent mental health screening become common practice.
The organisation launched an initiative to provide voluntary mental health screening to all US teens in 2003. The following year, TeenScreen was included in the national Suicide Prevention Resource Centre’s (SPRC) list of evidence-based suicide prevention programmes. In 2007, it was included as an evidence-based programme in the US Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Registry of Evidence-based Programmes and Practices. In 2009, the organisation launched the TeenScreen Primary Care initiative to increase mental health screening by paediatricians and other primary care providers, the same year the US Preventive Services Task Force recommended annual adolescent mental health screening as part of routine primary care, and the Institute of Medicine recommended expansion of prevention and early identification programmes.
As of 2011, the programme was led by executive director Laurie Flynn, deputy executive director Leslie McGuire and scientific advisor Mark Olfson, M.D., alongside a National Advisory Council of healthcare professionals, educators and advocates.
As of 15 November 2012, TeenScreen has been terminated, will no longer train or register new programmes, and will cease all operations by the end of the year.
Mission and Locations
The mission of the TeenScreen National Centre was to expand and improve the early identification of mental health problems in youth. In particular, TeenScreen aimed to find young people at risk of suicide or developing mental health disorders so they could be referred for a comprehensive mental health evaluation by a health professional. The programme focuses on providing screening to young people in the 11-18 age range. From 2003 until 2012, the programme was offered nationally in schools, clinics, doctors’ offices and in youth service environments such as shelters and juvenile justice settings. As of August 2011, more than 2,000 primary care providers, schools and community-based sites in 46 states offered adolescent mental health screening through the TeenScreen National Centre. In addition, the screening was also being provided in other countries including Australia, Brazil, India, New Zealand and Scotland.
Screening Process
TeenScreen provided materials, training and technical help through its TeenScreen Primary Care and Schools and Communities programmes for primary care providers, schools and youth-serving organisations that provided mental health screening to adolescents. A toolkit was provided, including researched and validated questionnaires, instructions for administering, scoring and interpreting the screening responses. Primary care programme materials included information on primary care referrals for clinical evaluation. In the school and community setting, the screening process was voluntary and required active parental consent and participant assent prior to screening sessions.
The validated questionnaires included items about depression, thoughts of suicide and attempts, anxiety, and substance use. The screening questionnaires typically took up to ten minutes for an adolescent to complete. Once the responses to the questionnaire had been reviewed, any adolescent identified as being at possible risk for suicide or other mental health concerns would then assessed by a health or mental health professional. The result of this assessment determined whether the adolescent could be referred for mental health services. If this was the case, parents were involved and provided with help locating the appropriate mental health services.
Research, Endorsements and Responses
Recommendations and Research
Mental health screening has been endorsed by the former US Surgeon General David Satcher, who launched a “Call to Action” in 1999 encouraging the development and implementation of safe, effective school-based programmes offering intervention, help and support to young people with mental health issues. TeenScreen is included as an evidence-based programme in the US Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Registry of Evidence-based Programs and Practices as a scientifically tested and reviewed intervention. In addition, the US Preventive Services Task Force recommended in 2009 that mental health screening for teenagers be integrated into routine primary care appointments.
Studies have been conducted on the effectiveness and impact of mental health screening for young people. In a 2004 systematic evidence review, the US Preventive Services Task Force found that there were no studies that addressed whether screening as part of primary care reduced morbidity and mortality, nor any information of the potential risks of screening. In a later review, published in 2009, the task force found that there was evidence supporting the efficacy of screening tools in identifying teenagers at risk of suicide or mental health disorders.
A team of researchers from Columbia University and the New York State Psychiatric Institute completed a randomised controlled clinical trial on the impact of suicide screening on high school students in New York State from 2002-2004. The study found that students who were given a questionnaire about suicide were no more likely to report suicidal thoughts after the survey than students in the control group who had not been questioned. Neither was there any greater risk for “high risk” students. A subsequent study by the researchers, in 2009, found that screening appeared to increase the likelihood that adolescents would receive treatment if they were at risk for mental health disorders or suicide.
A study published in 2011, involving 2,500 high school students, examined the value of routine mental health screening in school to identify adolescents at-risk for mental illness, and to connect those adolescents with recommended follow-up care. The research, conducted between 2005 and 2009 at six public high schools in suburban Wisconsin, found that nearly three out of four high school students identified as being at-risk for having a mental health problem were not in treatment at the time of screening. Of those students identified as at-risk, a significant majority (76.3%) completed at least one visit with a mental health provider within 90 days of screening. More than half (56.3%) received minimally adequate treatment, defined as having three or more visits with a provider, or any number of visits if termination was agreed to by the provider.
A separate study published in 2011, found that mental health screening was effective at connecting African-American middle school students from a predominantly low-income area with school-based mental health services. Researchers have also found evidence to support the addition of mental health screenings for adolescents while undergoing routine physical examinations.
Acceptance and Critical Responses
Recommendations endorsing adolescent mental health screening have been issued by the Institute of Medicine (IOM) and the US Preventative Services Task Force (USPSTF). The American Academy of Paediatrics recommends assessment of mental health at primary care visits and suggests the use of validating screening instruments. These add to statements and recommendations to screen adolescents for mental illness from the American Medical Association (AMA), the Society for Adolescent Health and Medicine, the American Academy of Family Physicians and the National Association of Paediatric Nurse Practitioners. TeenScreen has been endorsed by a number of organizations, including the National Alliance for the Mentally Ill, and federal and state commissions such as the New Freedom Commission.
There is opposition to mental health screening programmes in general and TeenScreen in particular, from civil liberties, parental rights, and politically conservative groups. Much of the opposition is led by groups who claim that the organization is funded by the pharmaceutical industry; however, in 2011, an inquiry launched by Senator Charles E. Grassley into the funding of health advocacy groups by pharmaceutical, medical-device, and insurance companies demonstrated to Senator Grassley’s satisfaction that TeenScreen does not receive funding from the pharmaceutical industry. Senator Grassley sent a letter to TeenScreen and 33 other organisations like the American Cancer Society asking about their financial ties to the pharmaceutical industry. TeenScreen replied saying they did not accept money from medical companies.
In 2005, TeenScreen was criticised following media coverage of a suit filed a local screening programme in Indiana by the parents of a teenager who had taken part in screening. The suit alleged that the screening had taken place without parents’ permissions. The complaint led to a change in how parental consent was handled by TeenScreen sites. In 2006, the programme’s policy was amended so that active rather than passive consent was required from parents before screening adolescents in a school setting.
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