Letter from PRF Chair, Lisa Razzano

Greetings PRA members! As we move into these final months of 2014, we have an opportunity to look back at the past year and forward to what lies ahead in 2015. This year has been demanding for health and wellness, with new challenges facing all of us who work to promote recovery. Most recently, we have all become more aware of global health concerns with cases of the Ebola virus in Western Africa, but also individuals infected here in the United States. Infectious diseases like Ebola, HIV/AIDS, Hepatitis C, and Tuberculosis that force us to confront public health on nearly every level; the illnesses also are bound by a common thread – poverty. As noted by former Secretary General of the United Nations, Kofi Annan, "The biggest enemy of health in the developing world is poverty." According to the World Health Organization (WHO), more than 1 billion people in the world live in extreme poverty, subsisting on less than $1 a day. The vast majority of individuals who comprise those living in poverty worldwide are women and their children. As a result, poverty itself is a health risk; forcing individuals into environments without decent shelter, clean water, consistent access to food, or adequate sanitation.

The WHO also notes that globally, the overwhelming majority of individuals in recovery live in poverty, experience institutionalized stigma and discrimination, and high rates of physical and sexual victimization. Individuals in recovery experience barriers to access for critical health care and social supports, including limited participation in attending school and employment, two fundamental areas that can move individuals out of poverty. More locally, the U.S. Department of Health and Human Services’ (US-DHHS) “Healthy People 2020” identifies poverty of one of the most influential social determinants of physical and mental health disparities, including it as a major factor affecting wellness among individuals in recovery of mental health conditions.

Collectively, recommendations from the WHO and the US-DHHS concur with principles and actions regarding health and mental needs worldwide offered by the Convention of the Rights of People with Disabilities. These recommendations not only address the needs of adult individuals, but also ways to promote health and wellness among children, families, and communities. Among others, several key recommendations include:

• Mental health services should be integrated systematically into all health services including primary level care;
• Mental health issues should be integrated into broader health policies, programs, and partnerships;
• Mental health issues should be mainstreamed into education, and children with mental and serious emotional issues should be supported with greater access education;
• Employment and income generating opportunities must be created for people in recovery; and
• Programs must create mechanisms to ensure the involvement of individuals in recovery in all decision-making processes.

In reading these suggestions, I was struck by the overlap between recent recommendations from global and national health authorities and the long-standing principles of psychiatric rehabilitation. The work of PRA and PRF and our standards for promoting and sustaining recovery not only define our workforce and service providers, but fundamentally fit into the evolution of global physical and mental health initiatives. There is no better time than now for us to focus on the ways in which psychiatric rehabilitation services and the skills of our workforce can be part of the globalization of wellness. I invite all of you to learn more about the effects of poverty on health and mental health, and to consider the ways in which advancing our world economically also advances our health and quality of life.

For additional information about poverty, health, and mental health, as well as the full list of recommendations, please visit http://www.who.int/mental_health/policy/development/en/.