Talking mental health recovery in Switzerland

Mental health specialist Eliane Bovitutti had to rethink her approach to the patient-caregiver relationship when she began working with addiction patients. Originally trained as a community health nurse, she is candid about having to learn new methods to best suit the needs of the diverse community she oversees.

Bovitutti is executive director of the mental health cluster at Fondation de l’Orme in Lausanne, an institution specialising in supporting mental health recovery. At Taking Care Together, an innovative health festival held in Geneva from 30 April to 8 May, she shared personal insight from working in the health sphere and began a dialogue on addiction and recovery.

What is your role at Fondation de l’Orme?

My role includes managing a mobile community support team, which cares for about 40 people in the “Housing First” programme, which we created in 2012. There is also a psycho-social boarding house with 38 places that welcomes people in situations of social precariousness or psychological vulnerability. We also have a psycho-social medical establishment, which provides care for 21 people. It welcomes those who live with mental health disorders, which are frequently associated with legal problems, or homelessness, in order to limit the ‘breaking of the care course’ [when a person interrupts his or her hospitalisation or a consultation out of frustration, or that the hospital terminates the stay because of incivilities or failure to respect the rules], and to support their recovery. Our mission is harm reduction and engagement in the recovery process. In my role, I listen to the needs that are expressed by my teams and those that come to Fondation de l’Orme, and find pragmatic, original and supportive solutions.

Can you explain the idea of recovery according to your organisation?

We are lucky to have opened the last [most recent] institution in our canton. As a result, when we opened our doors, we welcomed a new population with new needs. It’s an extremely marginalised population that came from prison, from the streets – people who were excluded from other areas of society because of their disorders… In hindsight, it all began when I decided to meet all the residents. I asked [the residents] to tell me, ‘Is there something I don't understand between why you wanted to come here, and how you behave?’ And that I think was fundamental in the paradigm shift of the relationship between us, because somewhere along the line, it was the first time they were asked for their opinion. They explained to me that the community housing structure did not suit them at all because they were stigmatised, and that all the rules related to community life did not necessarily make sense to them. And that’s when I started to formulate the hypothesis of saying to myself, ‘Well, do we blame the addiction to psychoactive substances on this? Is there a way to survive in these institutions and to meet their needs?’ This is the first hypothesis that I formulated at that time. [The residents] said to me, ‘We want to have a job, to have a relationship, and to have housing.’ And there, I felt very strongly the stigmas surrounding people with these types of disorders, and I said to myself, ‘If we succeeded in helping one person, that is already incredible.’

To what extent are psychological illnesses currently affecting people in Switzerland?

In recent years, we have seen an increase in poverty among people here [722,000 people live in poverty in Switzerland-ed]. A certain part of the population is struggling to find its place in society. And I observe that these people are not being focused on. They are generally excluded. That is to say, with the neoliberal policies in particular, today, we always have things to lose... social assets, our houses, our jobs. Today, we live in a society that is a little neurotic. Sometimes, we are even losing each other. When we meet, we don't say hello, because we don't know what the other person will ask. People, by way of losing losing losing, have reappropriated power by putting themselves on the other side. For example, someone will exclude himself or herself because it is a way to reappropriate a form of power. But this can cause that person to, in the end, be deprived of care. And all of our work consists around that. It is to have faith in that person, because I think that what we mostly draw attention to is the healthy part of the person. Very often, when we reconnect with the persons, we try to connect them to their dreams... to create hope.

What are some of your organisation's successes?

We had someone who dreamt of being a pilot. And I was sure that this person would never become a pilot. But for a moment, it was important to believe in that. Today she is a photographer who takes photos of airports and aeroplanes. Recovery is really about seeing the human side, about giving dignity to a person. We always say that the person suffers from an illness, we don't say that they are ill.

Why is it important to destigmatise psychological disorders?

I think that looking at the evolution of society in general, we keep wanting to do everything to the extreme. I mean, if we look at school, people want to intellectualise to the extreme. And we do the same with psychiatry. We don't know how to integrate this ‘sick part’ anymore. And of course this ‘sick part’ conditions the person in their state of dependence. After all, it's a question of how we see things. What we try is to avoid telling the person what to do to be ‘normal,’ because there is no such thing. We just try to find the best balance.

What was your organisation's role in the Taking Care Together festival?

I'm really a facilitator… I love facilitating new relationships around a project. I brought people together, and it was a wonderful day with about seven experts. This day allowed us to bring together peer helpers, mental health peer practitioners, and health and social professionals from across the mental health landscape.

We spent one day together to discuss important issues such as harm reduction – everyone has a mental health, which sometimes plays tricks on us. We demonstrated how recovery makes it possible to live a happy and fulfilled life with a mental disorder. It helped highlight that recovery is not about getting better, but about living with a mental health disorder. Recovery is also the work of a lifetime: (re)getting to know one's disorder, understanding it, taming it, finding support, regaining hope and decision-making power...

Society is warming up to the idea that mental health is just as essential as physical health. Although Switzerland tends to poll on the higher end of happiness scales, many still face mental health obstacles. According to Switzerland’s Federal Statistics Office, 15 per cent of the population displays medium or high psychological distress, and almost one person out of ten use at least one psychotropic drug, such as an antidepressant, sleeping pill or sedative. The most common mental health issue is depression, which impacts eight per cent of men and 10 per cent of women, with people aged 15 to 24 being the most affected.

Bringing together, in two months, over 50 professionals interested and concerned by peer support shows the meaning and the obvious added value it represents for mental health. Everyone was actively contributing to create emotional intelligence. Here, academic knowledge and field experience were valued in equal measure. This form of bottom-up collaboration is essential: it enables practices to emerge from the group, providing meaning and emancipation to each person. This event was the kick-off to legitimise peer support, and we already planned various gatherings and activities to build on this. Personally, I felt like a fish in water.

This Q&A was produced for the Breathing Games Association, which organised the Taking Care Together festival, and Open Geneva, a patron of the festival, which took place from 30 April to 8 May 2022.