The Organization of Self Help Movement in the Context of Mental Health System Reform towards Community-Based Psychiatry

Nellie Levina and Dr. Yevgeny Lubov

Abstract

New Choices is an All-Russia organization of people with psychiatric disabilities and their families that had its beginning in 2001. This article describes its philosophy and directions, with particular attention to activities in psychoeducation, vocational rehabilitation, club work, advocacy, establishing supported housing, and collaboration with partner organizations, professionals, and media towards reduction of stigma and sound public policy. Parallels are drawn to activities of similar organizations in other countries.

Introduction

The total number of people with severe mental illness in Russia is at least 3 million, including more than 1 million persons who are officially registered as having a disability and receive disability benefits. More than 80% of these people are cared for by their family members. In total, considering the number of family caregivers, mental illness directly affects at least 10 million Russians, or one in every fifteen people. However, the mental health service system has an extreme deficit of personnel skilled in psychosocial support and intervention, resulting in little support for families. Traditional services have been paternalistic and, in Russia as other countries, gave little consideration to family concerns in planning and implementation of interventions (Smith & Velleman, 2002).

In the light of current public attention in Russia to human rights and interests of persons with mental illness, as one of the most vulnerable population groups, mental health care is faced with new priorities. We are witnessing the ideological, organizational, and practical shift in mental health system towards interprofessional and intersectoral collaboration and the involvement of patients' family resources (Gurovich, 2007, Gurovich et al., 2004). Considering these paradigmatic changes, the development of self help movement in Russia becomes a legitimate and essential condition for sharing the responsibility for service outcomes between professionals, patients, and their families. There is a trend towards collaboration between these groups in a productive "trialogue."

The All-Russia public organization of people with psychiatric disabilities and their families "New Choices" (NC) was established in 2001 and included 45 regions. Now the organization brings together over 3,000 members in 53 regions across the country. The NC Program defines tactical and strategic goals of the organization. The mission of NC is similar to the mission of many self help groups throughout the world: improving social and legal status of persons with disabilities and their families, and assisting professionals in improving the quality of mental health services. The main directions of activities are as follows: psychoeducation, vocational rehabilitation, club work, advocacy, working towards the establishing of supported housing, and collaboration with partner organizations, professionals, and media.

Group Psychoeducation for Patients and Families

Contemporary guidelines and quality standards include comprehensive education for patients and their families (American Psychiatric Association, 2004; Dixon, 1999), with the emphasis on the accessibility of education and clinically effective, structured and standardized approach. However, in routine practice, consumer education is often neglected. Therefore, in many countries it is self help organizations that often take initiative and implement psychoeducation for families of persons with severe mental illness (Reynolds, 2004; Sin et al., 2003).

In our country, when 250 NC members from 10 regions were surveyed in 2004, only one in every 10 survey participants "had heard" at least something about this approach. The majority of survey participants (up to 90% of family members of persons with chronic mental illness) identified the need not only for direct and substantial information about the nature of the disorder, but also for concrete advice related to effective and safe coping with their loved one's behaviors,. NC members, similarly to other consumers throughout the world (e. g., Wynne, 1991), would like to participate in the processes of planning and implementing of their own treatment. They want to become less dependent on the professionals and to reduce discrimination associated with mental illness.

In the recent years, psychoeducation approaches have been introduced to mental health services across Russia, facilitated by psychiatrists. These sessions are conducted according to a standard module (Gurovich et al., 2004) that includes elements of behavioral therapy. Learning to control symptoms and mastering independent living skills strengthen the attitudes towards recovery.

NC groups have also created their own psychoeducation programs. As a result, according to the survey, the majority of patients (75%) who participate in psychoeducation sessions, as well as their families (85% of whom are mothers of patients, most often of the retirement age) know their diagnosis and can name their medications. This statistic is important because, as the survey demonstrated, family members tend to avoid discussing issues associated with the illness even with their loved ones, and often blame themselves for the illness. They express concerns about the future of their loved ones, once the caregivers are gone. They think that major manifestations of the illness in their loved ones result in their helplessness in everyday life, withdrawal, and absentmindedness. Half of the family member survey participants would like to work, but are unable to do so because of their caregiver responsibilities. Ninety-five percent (95%) of family members do not believe in the possibility of a significant improvement in their loved ones' condition, nor they believe in the possibility of their independent living, without the inevitable future placement in a longterm care facility. One third of the family members express despair.

However, 80% of surveyed caregivers noted that their family members' illness had taught them to be more tolerant, and gave them an opportunity to meet good people (often within the NC). At the same time 40% of those surveyed believe that their family physicians neglect their loved ones' complaints, 45% complained of lack of understanding by their psychiatrists, and 70% wanted their voice to be heard in the process of choosing the treatment, needed more complete information about the illness, the available treatments, and the benefits for the families. The majority of families (85%) had accepted the fact of the illness, and believed that the main benefit they expect to be rendered by treatment would be decreasing the risk of hospitalizations, rather than resolving the essential issues. Eighty-five percent (85%) believed that their children needed healthy recreation and employment, and it was considered most desirable that patients work together with their family members. They also thought that the most helpless patients needed supported housing with builtin independent living skills training programs.

Some family members had received partial information earlier from various sources, most often from occasional communication with each other. Psychoeducation sessions provided patients and their families with clearly defined, modern concept of schizophrenia, which helped them understand the benefits of early intervention and comprehensive combination of pharmacological and psychosocial treatment. After the sessions, they better understood the meaning of the therapeutic alliance between the patient and the doctor based on mutual trust. Psychoeducation sessions that focus on patients' rights and community resources often involved guest speakers, such as lawyers (although only very few of them specialize in mental health issues) and representatives of social services and local administrations.

Psychoeducation strengthens the attitudes of informed optimism in both patients and their families, and these attitudes create essential conditions for recovery. Psychoeducation group leaders use their personal everyday experiences of coping with the illness to teach other members of the New Choices. Although group leaders are not professionals, their groups can become therapeutic due to mutual support between the members and the growing understanding that they are not alone. Group members feel stronger together, which enables them to better advocate for their own rights, recognize the necessity of improving the quality of services. They begin to believe in the possibility of overcoming the stigma associated with mental illness and raise public awareness about the discrimination. Group members exchange information and support each other.

Interregional and international training exchanges help strengthen psychoeducation strategies and empower patients and family members to develop more self help initiatives. Since 2005 NC leaders have initiated a series of interregional Leadership School sessions that were designed for future instructors and leaders of regional psychoeducation groups. To date, 48 patients and their family members from 27 cities have been trained. These sessions provided materials for creating training video films, which were distributed among regions.

The educational and leadership capacity of NC have also benefited from a number of exchange initiatives within Canada-Russia collaboration, with the participation of Schizophrenia Society of Alberta (Calgary Chapter) and the University of Calgary. One of these exchange events, the Consumer Leadership training seminar in Moscow in June 2004, involved 68 participants from 26 regions across Russia and two Canadian couples who have children with schizophrenia. More than 10 Russian family members from NC also visited Canada. These empowering and educational exchanges between patients and their family members from the two countries gave the participants an opportunity to share personal stories, organizational growth experiences, and learn new psychoeducation techniques.

The participants of educational activities believe that peer education approach is the key to understanding one's role as an active agent of recovery, rather than a passive victim of the disease. The educational approach of knowledge transfer "from equal to equal" corresponds with the international experiences. Collaborative efforts between professionals and self help groups are equally important, because they contribute to reducing the frequency of hospital readmissions and increase the levels of social functioning (Chinman M.J., 2001, Edmunson et al., 1982; Klein et al., 1998; Nikkel et al., 1992). Professional/consumer collaboration increases clinical and social effectiveness of mental health services.

Joint participation of patients and their families in education activities contributes to strengthening the patients' social competence and reducing their withdrawal and isolation. Since 2005, the NC has maintained a mutually beneficial on-line forum dialogue between service consumers and providers: to date, this forum at www.nvm.org.ru has been visited by 4,842 people. The NC always includes educational topics in the organization's monthly newsletter and its annual magazine.

By 2008, the organization plans to create a 24-hour information telephone hotline. The hotline will be used by persons with mental illness and their families and give them psychological support through providing accessible information about resources available for recovery. Along with volunteering mental health professionals, the hotline will involve NC members who will have been trained for this work in psychoedication sessions. By providing assistance through the hotline, the organization members will undertake a double role of consumers and providers.

Social Support: Social and Vocational Rehabilitation

Because of a predominantly medical focus of psychiatric services, little attention is paid to supporting patients and their families outside the hospitals. When psychoneurological dispensaries were first organised in Russia approximately 70 years ago, they were actively involved in the "patronage", or community based support of their patients. These activities are not emphasized in the modern mainstream mental health system. As well, Community Social Service Centres discriminate against persons with mental illness and groundglessly decline their requests for community support.

To address these issues regional branches of NC regularly approach local administrative bodies and professional communities and raise the issues of improving community social supports for people with mental illness and their families. In a number of regions across the country, positive changes have been made towards collaboration between mental health and social service sectors.

Volunteers from NC reach out to persons with psychiatric disabilities, create lists of people in need, and provide support and assistance to the families. This support can prevent hospital admissions in those numerous cases where social and family problems become a sole reason for admission. NC volunteers are also gaining experience providing emergency support to people with mental illness in their homes or rehabilitation hostels. Participating in peer support activities, both emotional and instrumental, also improves the psychological wellbeing of the helpers, through the increased feeling of being needed (as indicated in literature, e.g., Gartner & Riessman, 1982).

NC members participate in many inpatient and outpatient rehabilitation programs. For example, the Moscow chapter of NC, since 2003, has facilitated a binding and printing workshop under the leadership of an experienced professional, and with the participation of young persons with schizophrenia. The workshop produces the NC quarterly newsletter and annual magazine. Workshop members also have produced a video film about vocational rehabilitation activities of NC. The film has been translated into English and demonstrated at various international gatherings, such as the European Federation of Associations of Families of People with Mental Illness (EUFAMI) Board of Directors' meeting in Belgium and a gathering of the Self Help Association of Estonia (2007). There are also sheltered employment placements run by other NC branches across Russia.

Many NC members in various regions across Russia work in sheltered workshops. As a rule, such sheltered workshops are in a miserable condition, in debt, work on negative financial balance, and do not provide any material incentives to people with disabilities. A number of regional NC branches run vocational rehabilitation models that have much better perspective, usually producing artistic products that are sold in stores run by charitable organizations.

Collaborative work with general employment centres is very productive in some regions. However, finding a job placement for a person with mental illness is usually a responsibility of his or her parents, who often receive information about vocational options from the local NC branch. NC members usually have access to low qualified jobs, for example, farming and seasonal jobs, courier or delivery positions, and low paid janitorial positions in psychiatric hospitals or dispensaries. For those persons with mental illness who have university education obtaining appropriate work positions is problematic.

In the international literature, the data on benefits of supported employment for persons with severe mental illness are not sufficiently systematic (Davidson, 1999; Solomon & Draine, 2001). The NC experiences have demonstrated that supported employment placements often serve as a point of stagnation for these patients, rather than an effective springboard for their transition towards a stable mainstream employment. Working partnerships between governmental structures, public organizations, and business communities can open new horizons for resolving the difficulties of vocational rehabilitation for persons with disabilities. The development of intersectoral collaboration has a strong potential.

NC representatives were included in the program planning process for the Moscow city employment initiative for people with disabilities (2007). The inclusion of NC in this process was associated with their earlier joining as members, together with the All-Russia Society of the Disabled (ARSD), in the Social Development Committee at the Public Chamber of the State Duma of the Russian Federation.

NC members, with the support of the Moscow Research Institute of Psychiatry (MRIP), are developing a project of an outpatient rehabilitation centre based at the day hospital of one of Moscow dispensaries. Some of the NC members have never had an opportunity to experience independent living or meaningful employment. They cannot acquire such experiences without support. In 2004-2006, NC repeatedly approached the State Duma of the Russian Federation and the Federal Council of Russia with a request to review the benefits available for these people.

Support provided to people with mental illness and their families by churches and religious communities is another important component of the comprehensive biopsychosocial treatment, as it concerns the issues of coping and the indirect alleviation of the family burden (Rammohan et al., 2002; Stanley & Shweta, 2006). NC branches in many regions across Russia collaborate with local churches through joining religious services and sermons.

Supported Housing

In a number of regions, hostels for homeless and isolated people with mental illness are attached to psychiatric hospitals and provide rehabilitation and treatment programs. Some of these hostels use the help of volunteers-- NC participants who serve as informal members on the hostels' polyprofessional teams.

In Moscow, NC members proposed a pilot project of a so called "pensionate": a housing program model designed for young persons with severe mental illness who live in the community and have a high risk of becoming homeless. These people often have a psychiatric disability, and their only care-givers are their aging parents. NC members, with the methodological support of the MRIP conducted the analysis of the estimated need for this housing model, and justified its effectiveness. The Project was approved by the Russian Society of Psychiatrists and submitted to the Public Chamber of the State Duma of the Russian Federation, but still has not been implemented. NC leaders continue to lobby the Heard of the local Department of Health, Duma Deputes, and the Federal Council of Russia. They also search for sponsors among various non-governmental structures.

Club Work

Club work is aimed at organising healthy recreation, and is facilitated at all regional branches of NC. The organization members attend concerts, swimming pools, celebrate holidays together, and perform amateur music concerts and theatre plays. For example, a number of amateur music concerts were held at the Moscow psychiatric hospital #4. The concerts were organized through collaborative participation of NC members, hospital inpatients, medical personnel, and members of other disability organizations. Bringing such performances to other organizations, such as orphanages and general hospitals, has had significant anti-stigma meaning.

NC supports and actively participates in the annual interregional and international expositions of amateur artists. In the six expositions that have been held to date, more than 100 artists from 23 cities across Russia have exhibited 360 art pieces. These artists usually participate in art studios of various mental health treatment facilities; many reports about them have been published by their local media. Poetry collections by NC poets have been published, for example "Poetry Collection" in Ivanovo (2003), "My Soul's Uneven Flames" in Moscow (2004), and "The Garden of my Soul" in Yaroslavl (2005). Newsletters and annual magazines issued by NC are illustrated by the society's members. Their graffiti works decorate hospital gardens, the walls of a local boarding school in Moscow, and the office of the Moscow NC chapter.

Club work includes computer graphics classes and the Internet use training sessions for patients, with the possibility of including their family members in the future. By studying English in language classes, NC members pursue a utilitarian goal: communication with their peers abroad. In addition, club work contributes to including NC members in recreation activities, such as music (karaoke) and sports. For example, the Moscow Family Club submitted a proposal for purchasing equipment for creating a gym. These activities are important because adynamia, or apathy, is considered to be one of the most frequent complaints in people with mental illness. In Russia, according to the survey of NC members, over 80% of the participants presented such complaints, which is also true for their peers abroad (Rosenheck & Lam, 1997).

Anti-Stigma Campaign

All NC activities have an anti-stigma component. For example, in 2005 the Moscow TV channel TVC featured a series of documentary films The Right for Hope about work and recreation activities of Moscow NC members. The documentary was also featured at the WHO European Ministerial Conference (Helsinki, 2005), and was accepted with great interest by the conference participants. In many cities across Russia, media regularly publishes materials about the activities of local NC chapters. Since 2005, NC members have annually organized and performed concerts for the World Mental Health Day.

In 2005 NC joined European Federation of Associations of Families of People with Mental Illness (EUFAMI) in the International Zerostigma Campaign. With the support of this Campaign, all regional branches of NC have issued and distributed educational anti-stigma flyers and booklets for the World Mental Health Day. In some cities, the publication of these color-printed flyers has now become ongoing. As a part of the Anti-stigma Campaign, in 2006 a film festival was organized in Tomsk with a free public access to the demonstration of the best films focused on mental health themes, which pictured the lives of people with mental illness. In Moscow, NC members are developing a psychoeducational program for high school students. The program titled Mental Disorder: Truth and Myths will be piloted at the Moscow school # 380. Psychiatrists and NC members will collaborate in their work with the school students.

Information and Communication Network

Regular regional consumer conventions are held by all regional branches of NC three times per year. Since 2002, annual national NC conventions have been held in Moscow and facilitated experience sharing and interregional coordination of activities (see Table 1).

Table 1:
Annual Inter-regional Meetings (Moscow, 2002 - 2006)

As seen in Table 1, consumers and their families represented the majority of participants in the recent conventions. Psychiatrists, social workers, and clinical psychologists also take part in the conventions, presenting in meetings that have an educational focus, such as lectures or seminars focused on specific topics. In addition, the NC conventions include members of the ARSD, health care administrators and policy makers, and media representatives. It has been suggested that in the future the location of NC national conventions rotate through the various regions.

Moscow Research Institute of Psychiatry is a co-founder of NC and continues to provide the society with the methodological support. NC has also es-tablished working partnerships with regional mental health services, local gov-ernment administrations, and regional branches of the ARSD. In many cities intersectoral collaborations have been established.

The newsletter New Choices is issued quarterly, and the annual magazine based on the materials of NC national conventions is printed with the support of a drug company. These publications are distributed among all regional branches, as well as regional psychiatric and social services and local govern-ments. The society's website www.nvm.org.ru is functioning with the ongoing support from another company. A documentary about the NC Third National Convention filmed by a Tomsk regional NC activist Elena Nazarova was sent to 25 regional branches in Russia and some international partner organizations (Schizophrenia Society in Calgary and Saskatoon).

Since 2002, NC is a regular participant of the Russian National Congress of Psychiatrists and the annual All-Russia Conferences of Psychiatrists and Plenary Sessions of the Russian Society of Psychiatrists. With the support of the psychiatric community, NC has become a consistent advocate for the improvement of the quality of pharmacological treatments and psychosocial services for persons with mental illness, through constantly lobbying governmental power structures, including the President. Articles by NC members are regularly published in Social and Clinical Psychiatry, the leading journal of the Russian Society of Psychiatrists, as well as in the EUFAMI Bulletin. Since 2006, NC is a member of the Public Council at the office of the Head Psychiatrist of the Ministry of Health of the Russian Federation. NC activists with psychiatric experience and their family members have made numerous presentations in professional education seminars across the country and abroad (e.g., in Calgary in 2003 and 2006 and in Vienna in 2005). NC is a member of the International Board of Directors of EUFAMI (since 2004) and the World Fellowship for Schizophrenia and Allied Disorders (WFSAD) (since 2001), and is a participant of the Global Alliance of Mental Illness Advocacy Networks-- Europe (GAMIAN-Europe). NC regularly participates in the conferences of the American National Alliance on Mental Illness (NAMI) and WHO.

Funding Sources for Projects

Interregional conventions and some international exchange initiatives of the NC receive sponsorship support from the leading pharmaceutical companies AstraZeneca, Eli Lilly, and Janssen-Cilag. The development of the printing workshop, computer classes, organizing consumer conventions, and music classes are partially funded through Moscow municipal grants, but more often they are sponsored by international organizations and pharmaceutical companies (Table 2). NC members volunteer as project facilitators and represent both leaders and participants of these projects. A number of club groups are facilitated by paid employees.

Table 2:
Financial Support to the Organization's Activities

NC is a common type of self help organization whose activities relate to a broad range of mental health issues. This is the same type of organization that also includes GROW, Recovery, Inc., Schizophrenics Anonymous, and Double Trouble groups for persons with a dual diagnosis. The activities of NC are run by the society members, including planning, implementation, management, and evaluation of the activities. Through offering member education and training, informal support, and encouragement, the society is practicing an innovative approach to caring for persons with severe mental illness. Within the framework of comprehensive integrated services, there is a tendency towards productive collaboration between public organizations, psychiatric services, and social service sector.

Conclusion

Trained and organized NC members are becoming an important resource of the mental health service in its transition towards the bio-psychosocial model; they can partially meet the needs and hopes of patients and their families who cannot receive sufficient help from the specialized services. NC members contribute to the improvement of planning, accessibility, and quality of mental health services. The society promotes the responsiveness of mental health service activities to the diverse needs of patients and their families, and advocates for pursuing their increased satisfaction with the services. NC activities increase the motivation of people with mental illness towards being responsible for their treatment outcomes and becoming equal partners of the psychiatrists in their treatment process.

Similarly to their peers in other countries, people with mental illness and their families in Russia are increasingly gaining power to influence the style of their relationships with the services, as well as the organization of the services (Frese, 1998). The responsibility for achieving recovery is now set beyond the traditional framework of governmental psychiatric services. Recovery is expected to be enhanced through the patients' informal supports and networks. It is essential that the standard treatment plans now include referring patients and their families to local self help organizations. NC can impact the recovery process through attending to the real needs of people with chronic mental illness and their family members, and it is necessary that this impact be supported by the establishment of community services such as rehabilitation, assertive community treatment teams, supported housing, and other community alternatives to hospital treatment.

NC advocates for the increased responsiveness of mental health services to the needs and hopes of patients and their families, which can made possible through the establishment of outpatient community service models. Survey results have demonstrated that consumers prefer community services to inpatient treatment, and these results correspond with similar data reported in other countries (Olfsen, 1990). NC members work towards engaging local medical and social service resources in providing support and assistance to people with mental illness. It is essential that the opinion of NC members be considered in conducting service audits and planning and evaluation of new programs, because consumer satisfaction has become an important aspect of mental health service outcome evaluation (Chue, 2006; Diamond et al., 2004).

NC can and must play an important role in supporting research, community antistigma campaigns, advocacy, and organizing crisis intervention services.

NC is rapidly growing, and its members are becoming increasingly confident in the society's mission and strengths. For mental health service consumers, the society has become an effective school of engaging into the processes of service reform and taking control over their own lives. Among other partners, NC gives credit to the Canada-Russia Disability Program (CRDP) for its important contribution into the organisation's growth, especially during the first stages of its development.

Through its supportive activities, NC manages to partially replace the missing links between the areas of responsibility covered by psychiatric and social services, and works towards filling the gaps left by the governmental structures in meeting the patients' needs. The NC's participation is becoming an essential element of mental health services that emphasise recovery and aim at alleviating the burden of mental illness through awareness, education and training, support, and advocacy.

References

American Psychiatric Association. (2004). Practice guideline for the treatment of patients with schizophrenia, 2nd ed. Am. J. Psychiatry, 161, 1-114.

Chinman M.J., Weingarten R., Stayner D. et al. (2001). Chronicity reconsidered: improving person-environment fit through a consumer-run serv-ice. Com. Ment. Health J., 37, 215-229.

Chue P. (2006). The relationship between patient satisfaction and treatment outcomes in schizophrenia. J. Psychopharmacol. 20, 38-56.

Davidson L., Chinman M., Kloos B. et al. (1999). Peer support among individuals with severe mental illness: a review of the evidence. Clin. Psychol. Sci. Pract. , 6, 165-187.

Dixon L. (1999). Providing services to families of persons with schizophrenia: present and future. J. Ment. Health Policy Econ. , 2, 3-8.

Edmunson E., Bedell J., Archer R. et al. (1982). Integrating skill building and peer support in mental health treatment: the early intervention and community network development projects. In M.Jeger, R.Slotnick (Eds.), Community mental health and behavioral ecology. New York: Plenum, 127-139.

Frese F. J. (1998). Advocacy, recovery, and the challenges of consumerism for schizophrenia. Psychiatr. Clin. North Am. 21, 233-249.

Gartner A. J., Riessman F. (1982). Self-help and mental health. Hosp. Com. Psychiatry, 33, 631-635.

Gurovich, I. Y. (2007). The Current Status of Psychiatric Services in Russia: Moving Towards Community Based Psychiatry. International J. of Disability, Community & Rehabilitation, 6 (2) [see URL: www.ijdcr.ca].

Gurovich I. Ya., Shmukler A. B., Storozhakova Ya. A. (2004). Psychoso-cial treatment and psychosocial rehabilitation in psychiatry. Moscow: Medpractika-M.

Klein A., Cnaan R.A., Whitecraft J. (1998). Significance of peer social support for dually diagnosed clients: findings from pilot study. Res. Soc. Work Pract, 8, 529-551.

Nikkel R. E., Smith G., Edwards D. (1992). A consumer-operated case man-agement project. Hosp. Com. Psychiatry 43, 577-579.

Olfsen M. (1990). Assertive community treatment: An evaluation of the ex-perimental evidence. Hosp. Com. Psychiatry, 41, 634-641.

Stanley S., Shweta Rammohan A., Rao K., Subbakrishna D.K. (2002). Relig-ious coping and psychological wellbeing in carers of relatives with schizophrenia. Acta Psychiatr. Scand. 105, 356-362.

Reynolds S. (2004). Psychosis: a support group for carers. Meriden Newslet-ter, 2, 2-3.

Rosenheck R., Lam J.A. (1997). Homeless mentally ill clients' and providers' perceptions of service needs and clients' use of services. Psychiatr. Serv., 48, 381-386.

Sin J., Moone N., Wellman N. (2003). Practice development: Incorporating psycho-educational family and carers work into routine clinical prac-tice. J. Psychiatr. Ment. Health Nurs. , 10, 730-734.

Smith G., Velleman R. (2002). Maintaining a family work for psychosis service by recognising and addressing the barriers to implementation. J. Ment. Health, 11, 471-479.

Stanley S., Shweta S. (2006). Integrated psychosocial intervention in schizo-phrenia: implications for patients and caregivers. Int. J. Psychoso-cial Rehabilitation, 10 (2), 113-128.

Wynne L.C. (1994). The rationale for consultation with the families of schizo-phrenic patients. Acta Psychiatr. Scand., 90, 125-32.

Submitted by:

Nellie Levina
Chair, The All-Russia Public Organization of People with Psychiatric Disabilities and their Families "New Choices."
E-mail: levinan36@gmail.com
URL: www.nvm.org.ru

Dr. Yevgeny Lubov
Senior Researcher, Outpatient Psychiatry and Mental Health Services Organization, Moscow Research Institute of Psychiatry
Moscow, Russia
Address: Poteshnaya Street 3, building 11, Moscow, 107076 Russia Tel: (495) 963-1435
Mobile: (916) 089-2067
Fax: (495) 162-1003

Translation:

Translated from Russian by

Svetlana Shklarov, MD, PhD Candidate
Interdisciplinary Graduate Program
Community Rehabilitation and Disability Studies Program
University of Calgary
Canada

Email: shklarov@ucalgary.ca

International Journal of Disability, Community & Rehabilitation
Volume 6, No. 2
www.ijdcr.ca
ISSN 1703-3381