Integrating people who are stigmatized: the tetralogue model.

Although present everywhere, segregation of people with mental illness and their relatives and violation of their human rights cannot be justified any longer. What can change the status quo? Breaking the silence of a society that does not recognize or acknowledge its mental health problems. Communicating about them opens the doors for the integration of mental health into general health and people with mental illness into society. In Michalovce, Slovakia, the tetralogue model (a dialogue of four sides) supports this necessary communication to overcome stigma by integrating people with mental illness into society, bringing benefit to all parties involved: people with mental illness, their relatives, professionals and the public. First and foremost, we recognized that people with mental illness and their relatives are the best experts on issues of stigma and discrimination. The motivation to improve their own situation needs to be supported. Having formed associations in 1997, users and relatives are able to act as equal partners with the professionals, moving from dialogue to trialogue. The first result of regular monthly meetings of the trialogue was a patients' advocacy programme, changing the way that patients and professionals relate to each other. Each week, individuals from the local users' organization visit the hospital, hearing the concerns of patients and finding solutions by working as partners with the professional staff. At first, the nurses expressed resistance to this programme, fearing criticism and rebellion. In a short time, they found that addressing problems openly helped solve them more quickly, with less stress and conflict. In addition, patients have started to contribute to their own treatment plans. The professionals are finding their work easier as they share the responsibility for treatment with the patients, rather than taking the traditional, patriarchal, non-participatory approach. Real integration is not possible without winning over the public. People with mental illness must be the main actors who, together with their relatives and professionals, help the public overcome fear and anger. Our Club of People with Schizophrenia is talking to school groups and meeting with public administrators. The response from the participants - the presenters and the audiences, especially the students - has been overwhelmingly positive. We have seen these interactions benefit society by encouraging individuals to become more interested in their own mental health. Our participation in the WPA Program against Stigma and Discrimination has enabled us to involve more people across Slovakia in our work. This not only strengthens the Slovak users' and relatives' movement, but also motivates professionals to participate in this partnership. The result is a stronger tetralogue at the national level. As more people at all levels become interested in mental health, the walls around society can slowly come down, replaced with bridges to mental health and open doors to integration.