Statements - Recommendations - Summary 9th Seminar: Berlin 6-8 October 2005
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IN  PLENUM	The majority of the participants – expressed in plenum and in work-shops at the SMES-conference in Berlin 6. – 8. October 2005 agreed to recommend the following viewpoints, on the basis of the presentations and from 5 double workshops
At Berlin Conference was present more than 160 participants, from the 11 partners countries (BG-CZ-LV-PL-RO and B-D-DK-E-F-I), as well as other participants from other European countries. NAPincl is a useful instrument  :   In the two projects NAPincl has been helpful in understanding and working in exchanges and discussions and in developing new and better strategies for social work with severely excluded people in Europe. More focus must be put on prevention : Absolute priority has to be given to prevention of all kinds of chronicity in exclusion and rough sleeping. Treatment and re-socialization is important but not the only need : The general political situation, the culture, tradition and levels of equality and humanity in the community play an important role in determining who and how many are excluded.  The way  mainstream politics is handled is just as important as the policies aimed directly at minimizing exclusion. The professionals and users in eastern European countries  need to participate in a mutual exchange of knowledge, discussions and learning with colleagues from all over Europe. Vocational and skill training of social workers must be strengthened : Multidisciplinary and trans-national studies are important instruments in social work, at the local as well as the national level. Further development must focus on all forms of cooperation between different services and the network, street teams and mental health teams. Social work training should pay particular attention to skills in listening to all citizens, no matter who they are and what kind of “language” they talk. There must be a real focus on how to invite excluded groups to participate in the debate and on the need to accept the fact that these people are experts on their own lives. This does not just happen but must be encouraged. We have to realise that no support to excluded groups is simple and uses just one approach. To be excluded is the result of multiple factors and is a complex matter. Therefore services as well as evaluation must be based on a multi- dimensional approach. More outreach work less institutionalization is needed : We have to realise that care facilities are increasingly inaccessible and impermeable for marginalised people because of their costs and the increasing number of barriers in place to exclude difficult costumers. For this reason it is important that some social workers  work as “bridge-builders.” Throughout Europe it has repeatedly been expressed that co-working between health and social services does not work well. Ideology and “language” are different. The two systems don’t understand each other and each has a tradition, a set of strategies and aims that are basically different. Evaluations and joint conferences are needed. Street-work is an increasingly common part of social work all over Europe and new methods for this kind of work are being developed. As a new way of operating it is important that a lot of energy is put into developing methods but it is also important  that this energy is not used by all involved to develop the same services. Training, evaluation, research and development could and should be done by co-working between European countries. Proximity in outreach work is an example of a common method of working. It offers useful ways of entering into pragmatic relationships: shelter, food, personal care, syringes. Beginning from these forms of help, the links which are established allow, when needs are expressed, further intervention in the field of rights, shelter and care. Mobile teams and street work are the most effective ways of making progress, allowing the re-establishement of links and dealings with the person. In order to continue, this kind of work relies on progress in community awareness. The role of the public system and the NGO’s must be further discussed : It appears that public services and  NGO’s are focusing on the same problems, but  in practice they are experiencing difficulties in their daily co-working. What is needed on both sides is knowledge of and respect for the differences while on the other hand a method of  using the different approaches for a more comprehensive assistance. Users must be more involved on all levels: It  is important to develop models to involve users on all levels. There is  general agreement about this by professionals from both NGO’s and the public system. Participation and empowerment are the driving forces in the development of new skills and abilities. Users are naturally particularly sensitive to everything involving discrimination and stigmatisation which prevents them from really finding a place in society and which reduces attempts at participation in specialised services to a derisory level. The two ought to go hand in hand and lead to the question of citizenship. Self-help experiences (development of resources which increase the capacity of people to manage their difficulties by themselves) are another consideration On all levels it is important that professionals learn to co-work with users. This is important also in research and evaluation. Ethical issues must be part of the quality discussion : For professionals, voluntary workers and others working with excluded people, the main points are respect, listening quality and targeted intervention.  The way to establish rights and to make sure they are respected passes through the development of more open and tolerant attitudes on the part of society. Difficulties encountered in making progress in this direction means that some mentally ill people have begun to organise independently, to create their own services and pressure groups with a view to claiming their rights and improving their situation.
In workshops	The majority of the participants – expressed in work-shops at the SMES  conference in Berlin agreed to recommend the following viewpoints, on the basis of the presentations and from 5 double workshops
EMPOWERMENT : regaining of dignity – rights – place in society
Statements  Processes of exclusion and  integration  in society must be understood in a historical, political and community context. It is not only a question of treatment and services: the sense of community responsibility must be strengthened. Empowerment and the right to be a citizen must be based on a fight against inequality It is important to realise and overcome the history of political oppression in Eastern Europe. Users must be invited to active participation Excluded people must be regarded as individuals not as cases Users must be seen as human beings, with respect for their needs. There needs to be a change in the way  health services work with users. Bridge the gap between psychiatry and social work! The need for new ideas and diffusion of information about alternatives to the official and traditional institutions Importance of  active co-working between the public system and NGO's We suggest development of  networking and common educational programmes for street-workers around Europe. Street-workers must  network Recommendation The statements in the workshops concerning “regaining of dignity, rights and a place in society” seem to focus on five main themes: The general political situation, the culture, tradition and levels of equality and humanity in the community play an important role in determining who and how many are excluded.  The way mainstream politics is handled is just as important as the policies aimed directly at minimizing exclusion.  The professionals and users in  eastern European countries  need to participate in a mutual exchange of knowledge, discussions and learning with colleagues from all over Europe . It is important to develop models to involve users on all levels. There is general agreement about this by professionals from both NGO's and the public system. Throughout Europe it has repeatedly been expressed that co-working between health and social services does not work well. Ideology and “language” are different. The two systems don’t understand each other and each has a tradition, a set of strategies and aims that are basically different. Evaluations and common conferences are needed. It appears that public services and NGO's are focusing on the same problems, but in practice they are experiencing difficulties in their daily co-working. What is needed on both sides is knowledge of and respect for the differences while on the other hand a method of using the different approaches for a more comprehensive assistance. Street-work is an increasingly common part of social work all over Europe and new methods for this kind of work are being developed. As a new way of operating it is important that a lot of energy is put into developing methods but it is also important that this energy is not used by all involved to develop the same services. Training, evaluation, research and development could and should be done by co-working between European countries.
DEINSTITUTIONALISATION  :  alternatives to total institutions at social & health level
Statements:   Care facilities are increasingly inaccessible and impermeable for marginalised people.  Total institutions, those which claim to answer all the needs of the individual,  produce only exclusion.  The family-network and neighbourhood-network in which the mentally ill live, are not sufficient involved.  Recommendation The statements in the workshops concerning “Deinstitutionalization†alternatives to total institutions at social & health level” seem to focus on three main themes: 1        Institutions working with the most excluded people must begin to involve all civil society 2        Put the person back at the centre in dealing with hospitals, places of specialised treatments 3        Promote community health with particular attention to those who are lacking in all social protection.
PARTICIPATION : evaluation, control, involvement
Statements  Excluded people must be invited to participate in decision-making on political (state), administrative (state and local) and personal (local) levels  Participation has to do with the right to democracy and promotion of involvement, empowerment and even citizenship To be heard and to be part of a dialogue should be the right of all citizens Peer research by people with experience of homelessness Professionals as well as users need to be trained in involvement Evaluation of services is needed We need structured  threshold and crisis services Recommendation The statements in the workshops concerning “Participation, evaluation, control, involvement” have three main themes: Particular attention should be paid to honest listening to all citizens, no matter who they are and what kind of “language” they talk. There must be a real focus on how to invite excluded groups to participate in the debate and on  the need to accept the fact that these people are experts on their own lives. This does not just happen but must be encouraged. On all levels it is important that professionals learn to co-work with users. The same with research and evaluation. We have to realise that no support to excluded groups is simple and and uses just one approach. To be excluded is the result of multiple factors and is a complex matter. Therefore services as well as evaluation must be based on a multi -dimensional approach.
CHRONICITY and OUTREACH : on the street, in the institutions, at home
Statements Proximity and presence are the aptitudes characterising outreach Being able to have a say and being listened to are the most important aims of this work on the street. The contradiction between identity, respect for diversity and freedom of intervention in emergency situations can be overcome by caring for the person as a whole. Recommedations  Develop research, both regarding real individual needs and the effective answers offered by the institutions.  Training – a specific training both for social workers and administrators Prevention – absolute priority to be given to prevention of every kind of chronicity on the street Multi-disciplinary and trans-national : develop all forms of co-operation between  different services and the network, the street teams and mental health teams. The basic aim is not to clear everyone off the streets, but to be present and care for these people.
DENIED IDENTITY - ILLEGAL MIGRANTS : dignity & health without borders
Statements Migration in itself is a cause and/or symptom of suffering, of deprivation Theoretical or practical rights – sometimes even the existence of migrants is denied This context of total deprivation of human rights and access to basic civil rights leads to vulnerability and exclusion.  Recommendations The past history and present life of  each excluded person must  be studied, documented and made “public” To define a real, official, secure, dignified place for migrants in our society. It is important to investigate, discuss and bring changes to bear on ‘migration factors’…
Summary	In the 2nd project Dignity and Health the 5 west European capitals were visited in a similar way and with the same purpose as in the 1st "D&H/I-5Projects"first project.  Again there was a concluding conference.
Background for the 2 projects:  Earlier SMES projects have documented how homeless people all over Europe are struggling to survive in the same way. Mental illness and physical illness are the same everywhere. Humiliation and exclusion are also the same. Social and health workers are facing the same methodological problems. But comparisons also highlight  differences and requests for inspiration and new knowledge.       The aim of the 2 projects: To bring social workers from 10 European countries together by visiting each other in the capitals of the 10 countries. The participants include professionals and non-professionals working directly with homeless and socially excluded people. This includes social workers, psychologists, G.P.s, doctors, nurses, and NGO staff The capitals were: Riga, Warsaw, Prague, Bucharest, Sofia, Rome, Madrid, Paris, Brussels and Copenhagen. The strategy for the visits: In every capital visits were planned to at least 4 – 5 different institutions in some way  serving homeless and excluded people. Every visit was completed by a small local seminar for presentations and discussions. The first project included five visits to the capitals of the 5 eastern countries of Europe and was concluded by a European conference in Prague attended by all the 5 countries and representatives from the EU At Berlin Conference was present more than 160 participants, from the 11 partners countries (BG-CZ-LV-PL-RO and B-D-DK-E-F-I), as well as other participants from other European countries. It appears that the point about deinstitutionalisation was not dealt with in the same way by different contributors. Nevertheless, many made references to institutions and an institutionalized way of thinking. This was the case for those working in them, those working in related sectors (on the fringes or complementary services) and those totally outside institutions. For professionals, voluntary workers and others working with excluded people, the main points are respect, listening quality and targeted intervention.  The way to establish rights and to make sure they are respected passes through the development of more open and tolerant attitudes on the part of society. Difficulties encountered in making progress in this direction means that some mentally ill people have begun to organise independently, to create their own services and pressure groups with a view to claiming their rights and improving their situation. Participation and empowerment are the driving forces in the development of new skills and abilities. Users are particularly sensitive to everything involving discrimination and stigmatisation which prevents them from really finding a place in society and which reduces attempts at participation in specialised services to a derisory level. The two ought to go hand in hand and lead to the question of citizenship. Self-help experiences (development of resources which increase the capacity of people to manage their difficulties by themselves) are another consideration The reduction of risks brings at the same time changes in the opportunities given to people to make progress without the impression of being judged, or of institutional violence. Lastly, everything which plays a role in one's activity and work is equally important: the possibility of recognition, of developing better self-esteem, of accessing resources less identified with assistance, all assure the rebuilding of independence by allowing the person to become an actor in his or her own life, to have a voice in what matters. Proximity is the standard way of operating for many of those working with people in difficulty as it offers a better way of intervening and also reduces the distance between the user and services or institutions.   __ here are two images of the exchanges ---
for reminder Conference in Prague (2004):   At that conference each of the 5 eastern countries presented the daily practices and local dispositions that either interfere with or encourage access to social and healthcare services for homeless and vulnerable people.  Discussed:  How the national action plans (NAPincl) might be effective in increasing access to health and social services  How to increase local workers' knowledge of EU objectives included in the NAP, as they can be applied to problems arising in their daily work  How to increase awareness of EU action and initiatives with national and regional policy makers.  How to produce local reports and materials which can both assist local practice and inform local policy and planning  The hypotheses were:  Low public awareness of legal entitlements and  rights of the individual citizen.  Poor access to health and social care for homeless and socially marginalised people  Poor integration of social and health services in public, private and NGO sectors.  Lack of knowledge of  European models of social work practice.  For Recommendations from Prague, please cf. : 8th SEM Prague 2004