Citizenship, Recovery, and Inclusive Society Partnership (CRISP)

Funded by Marie Sklodowska-Curie Actions, Research and Innovation Staff Exchange (RISE), our international network unites leaders from academia, policy, practice, business and community organisations from the EU and the US.

The CRISP network includes University of Strathclyde, New York University, Mental Health Foundation, MIELI Mental Health FinlandUlm University, Yale University and Illinois Institute of Technology and has an impressive track record of leading evidence-based policy and programme development at national and international level, and has successfully pioneered participation of people with lived experience of mental health problems in research initiatives.

People with mental health problems experience significant inequalities including high levels of early mortality, morbidity, unemployment, poverty, isolation and social exclusion presenting major health, social and economic challenges to wider society.

The main objectives of the CRISP network include sharing and disseminating learning in terms of ‘what works’ in different social contexts.  Particular attention will be given to issues of intersectionality and how to promote social inclusion, citizenship, and human rights of people with lived experience of mental health problems.

The international network will build upon state of the art knowledge in four key areas of mental health namely citizenship, recovery, stigma, and public policy.  International collaboration in these areas enables new perspectives enhancing skills and career opportunities for researchers and practitioners alike. These new opportunities and perspectives allow for innovative initiatives ‘back home’, contributing towards the sustained inclusion of people with experience of mental health problems. The CRISP partnership is divided into 4 themes.

Citizenship and Participatory Research

Citizenship has an established significance in social and political life, although is often overlooked in terms of health, especially mental health.  Implications of being excluded from citizenship are high, with those not able to claim or exhibit their citizenship being construed as being in deficit to society, having fewer rights and consequently not considered full citizens. Citizenship is a useful way of understanding how people with characteristics that set them apart from mainstream society (for example in conjunction with mental health problems or disabilities) are excluded from society.

The focus of this work package is to investigate what influences the transition from isolation to inclusion, and what is important for people with lived experience of mental health problems on their journey to reclaim their citizenship. Exploring citizenship based on Rowe et al.’s framework of Rights, Responsibilities, Roles, Resources and Relationships , there is an opportunity to measure the extent to which individuals assess they are fully able to participate in their communities and exercise their rights and responsibilities as citizens. This process has enabled the application of the theoretical construction of citizenship to lived experience.

Led by Micheal Rowe at Yale University, this work package is underpinned by principles of Community Based Participatory Research (CBPR),  a partnership approach to research that equitably involves community members, agency representatives and researchers in all aspects of the research process, and in which all partners contribute expertise and share decision making and ownership. CBPR approaches generate human and social capital that is difficult to acquire through other approaches in the domain of mental health and of the socioeconomic marginalization associated with it. CBPR increasingly guides health policy reform, and by connecting academics, practitioners and citizens in the research and action process we can produce research that is more valid, action orientated, and likely to achieve change.

Promoting Recovery and Person-Centred Care

With roots in the civil rights movements of the 1960s and 70s the recovery movement in mental health is currently spreading across the globe, supported by the principles outlined in the UN Convention of Rights for People with Disabilities. The recovery movement has profoundly challenged the way we understand mental illness, shifting the lens from a medical model that focuses on deficits and symptom reduction, to an empowerment model that understands wellness holistically in terms of what it means to pursue a meaningful life. Although we are far from finding a cure for mental illness, people do recover from it, both in traditional terms of symptom remission but also in the broader sense of being able to lead a meaningful life.

Different innovations in terms of how people with lived experience can be supported and empowered in the community have been made both in the USA and Europe.  This work package brings together people from multiple sectors across different countries creating opportunities to share such innovations.

The objectives of this work package led by Victoria Stanhope at New York Unviersity, will build on innovations, implementation strategies and evaluations of recovery-orientated policies.  Detailed comparison of existing research programmes on person-centred and outcome-focused approaches (and their relative impact on social inclusion) will be made, including clearer conceptualisation of how to reconcile measurement and meaning in mental health services from a transatlantic perspective.

Health care systems both in Europe and USA are subject to increased regulation and accountability mechanisms in order to closely document the spending of public funds increasing the risk of less individualized approaches and the need for more uniform outcomes.

Addressing Stigma and Discrimination

Stigma and discrimination undermine the life chances of people with mental health problems, potentially leading to reduced self-esteem, social isolation, chronic stress and delayed help seeking as well as recovery pessimism, fear, social distance, and blame. A fundamental barrier to full societal inclusion for people with lived experience of mental health problems has been civil rights abuses and discrimination driven by stigma. The sources of stigma are both structural and interpersonal.  

There are new trends on how to understand and tackle stigma. Previous research has centred around defining and measuring reported stigma and developing anti-stigma campaigns. However, despite international anti-stigma initiatives and policy developments stigma and its consequences persist. Moreover, multiple vulnerabilities related to ethnicity, migration, poverty etc. can exacerbate mental health problems and result in even greater levels of stigma and discrimination.

Within the framework of the overall CRISP project, led by Neil Quinn and Lee Knifton from University of Strathclyde, this work package 3 on stigma and discrimination, led by Nicolas Rüsch, Ulm University, and Patrick W. Corrigan, IIT Chicago, has the following main objectives:

  • to facilitate knowledge exchanges on innovations to reduce public stigma through social contact as well as digital and arts approaches
  • to study programmes currently being developed and evaluated in Canada, the US and Europe that have the aim to reduce workplace stigma and exclusion of employees with mental health problems
  • to evaluate, adapt and implement the peer-led group programme Coming Out Proud / Honest Open Proud that supports people with mental illness in their disclosure decisions and has shown positive effects on self-stigma and stigma stress
  • to study the effects of arts participation on self-stigma.

The collective community of learning will include contributions from people with lived experiences of mental health problems  at all stages, as well as multi-disciplinary engagement from medicine, psychology, public health, social policy, social work and economics, as well as involving policy makers, civil society organisations, lived experience groups, activists and businesses.

Public Policy

The fourth work package focuses on public policy, with the aim of analyzing impact of policy and the participation of people with lived experience of mental health problems in policy formulation. Policies can enable or inhibit social inclusion, empowerment and citizenship of people with mental health problems.

The mental health of a population is affected by a range of public policies, such as labour policies, social protection policies and education policies. An important debate for many countries is how mental health can be improved through policy actions.

The aims of this work package, led by Kristian Wahlbeck at MIELI Mental Health Finland is to engender a cross-sector discussion between researchers, experts by experience, policy makers advocates and practitioners around how public policy must change in order to address social and economic determinants of health and equity. Additionally, it will to explore ways to empower people with lived experience in broader social, political and economic domains through involvement in policy development processes. 

The focus is on comparative public policy and on identifying which approaches are most effective in promoting the rights, citizenship, social inclusion and empowerment of people with mental health problems.

Strengthening the interface between public policy and population mental health has been prioritized at EU level through the Member States and Commissions Joint Action for Mental Health including a work package on Mental Health and Wellbeing in all Policies. Different public policies from different sectors can impact mental health equity and due to this necessary breadth of frameworks, policy makers need to be able to rely on guidance and direction from reliable resources.

Engaging and nurturing relationships with stakeholders is an important step in the process. Successful policy actions build on policy development by exchange of data, evidence and expertise, implementation of mental health impact assessment and by monitoring of mental health and mental health equity outcomes.

The CRISP exchange network allows partners the opportunity for in-depth examination of relevant topics such as good practice, training for policy involvement, mental health impact assessment tools, effective means of dealing with conflict of interests,  the role of deliberative democracy, audits and public hearings, legislative and infrastructural support for involvement, policy evaluation and the role of NGO’s in policy processes.

For more information please contact the CRISP Partnership Principal Investigators:

Lee Knifton

Neil Quinn  

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 690954.

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