Mental health policy and practice across Europe: an overview

chapter
fourteen
The user and survivor
movement in Europe
Diana Rose and Jo Lucas
Introduction
This chapter explores the role of user involvement in mental health policy and
practice both at a European level and across selected countries. The issues we
seek to elucidate are: the history of the user movement; its activities (i.e. what
groups do); and whether or not these groups are user-controlled. We then briefly
comment on the role users can play in research and what influence they have, if
any, on policy.
User involvement in mental health is one of the most exciting and innovative
developments in the field of psychiatry. It empowers individual service users
and enables them to organize collectively. Historically, users of mental health
services did not have such a voice but this has been changing with involvement
growing in a number of countries in recent years (Wallcraft et al. 2003; Rush
2004; Campbell 2005; Chamberlin 2005).
Clearly, moving towards greater user involvement is not without tensions
with other stakeholders. When a disempowered group finds its voice and formulates
a position from which to develop change, there will always be obstacles.
While never underestimating the newly-found power of users, this chapter will
also describe some of the hurdles that are still to be overcome.
In addition to the strong ethical and democratic imperatives for user involvement
in the planning and delivery of activities, there is also an increasing, albeit
still limited, body of evidence supporting the vital contribution that service
users can make to mental health research. Indeed, service users may be better
placed than professionals to assess how services address their needs (Thornicroft
and Tansella 2005). It also has been shown, for example, that users report less
satisfaction with services when interviewed by other service users (Simpson and
House 2002). User involvement in research can also have benefits for the individuals
involved, including the acquisition of new skills and knowledge, a sense