Mental health policy and practice across Europe: an overview

The evidence base 117
Europe, and increasingly, in some countries of eastern Europe. By involving
users and local stakeholders in social change, mental health policy and practice
can have greater ownership and investment from all sectors of society, especially
those who have been excluded (Barham 1992). Local expertise and real-world
knowledge can be harnessed.
While civil society structures are relatively well established in western Europe,
their recent development in central and eastern Europe, coupled with greater
local democracy and local institutional frameworks for expressing the plurality
of views in mental health, provided a new impetus for more transparency
in the creation and evaluation of policy options. There has been an opportunity
for the promotion of mental health issues to be seen as fundamental to
citizenship and human rights; it is no longer seen as a separate issue but an
integral part of the wider human-development agenda (Cutler and Hayward
2005, 2006).
The Pathways to Policy project established in partnership with local mental
health NGOs in five countries (Estonia, Bosnia and Herzegovina, Romania,
Armenia and Kyrgyzstan), focused on the development of new skills and
knowledge to build capacity to participate in local service situation appraisal,
advocacy, dialogue with professionals on assessments and treatment plans, and
the development of strategic multi-sectoral relationships in order to achieve
change. The overall aims were to increase active participation in the local policy
process and raise public awareness about mental health.
The project evolved as a result of the changing interests and vision of local
groups in central and eastern Europe demanding to have a voice at a wider
community level (Barham and Hayward 1995). Strategic changes in the region
and the development of civil society provided a backdrop to this precedent. A
theme emerged of increased confidence and awareness among local grass-roots
stakeholders that they had both the right and ability to engage in mental health
policy. There was also a recognition that users, families and other local community
actors had been excluded from existing policy processes (Cutler and
Hayward 2003). The project demonstrated the benefits that can be acquired by
local stakeholders as part of the process of participating in the policy-making
process. This ‘policy-as-process model’ highlighted the importance of how policy
was made, and focused on the success of the project in building local policy
capacity and mechanisms for dialogue rather than on the outcomes of any
particular policy. Four fundamental measures of progress in capacity-building
were observed. 2
The first was the development of new skills and knowledge to build local
policy capacities. Users of mental health services, their families and carers, their
NGOs and other local mental health stakeholders in each of the five Pathways to
Policy countries were able to develop new skills and knowledge about advocacy
and policy. These skills were used to undertake local action to improve the
quality of life of individuals and groups of people with mental health problems.
Links with policy-makers meant that this learning experience worked both
ways; for example, at a Tallinn policy workshop a member of the mental health
section of the Estonian Ministry of Social Affairs was asked to work in a small
group with several users. She later commented that she learned more about the
reality of local mental health housing projects from that discussion than from