Mental health policy and practice across Europe: an overview

The user and survivor movement 337
of empowerment and being valued, and a better understanding and relationship
with other researchers (Allam et al. 2004).
User involvement can take place at the European level as well as in individual
countries. The mandate that the European Union (EU) has to intervene to promote
social inclusion, eliminate discrimination, protect human rights and
promote good health and well-being (see Chapter 13) provides opportunities for
active user involvement at a pan-European level. Unfortunately, user involvement
at this level today exists mostly in the virtual realm due to a lack of
funding, and more generally, user involvement across Europe is very unevenly
developed. This is partly due to differing social, economic and political conditions
in the various regions, and differs from the disability movement which
seems to be more well accepted and active at an EU level (e.g. the European
Disability Forum).
Another factor influencing the level and nature of user involvement is the
way in which mental health services are provided. On the one hand, the transition
to community care appears to facilitate the rise of user groups. On the
other, harsh involuntary treatment legislation and practice appears to give rise
to sympathetic professionals, including lawyers, forming non-user initiated
groups to change these practices. One exception to this pattern is the Netherlands
where there is a strong (albeit divided) user movement, even though mental
health provision remains largely hospital-based.
These structural differences in the way groups are formed present challenges
when seeking to map user groups across Europe. Those familiar with the situation
in the United Kingdom will know that a ‘user group’ is usually defined as a
group whose members are users only and/or where the major decisions are
taken by service users. This is not necessarily the case in all European countries.
Groups may involve families (indeed they may be primarily groups of family
members), sympathetic professionals and interested members of the general
public. In the email survey for this chapter (see below) we included a question
on whether or not groups were user-controlled, where this was defined as users
controlling decision-making in an organization. Few groups outside the United
Kingdom answered this question, which may indicate that this concept is not
known to them.
Another challenge is that in most western European countries (but not all),
groups are organized at both the national, regional and local levels. Such structures
are well developed, for instance in Sweden, Denmark, France and Austria
among others, where local and regional groups are often affiliated to national
organizations. The links in other countries are less clear. In many countries
there also may be diagnosis-specific groups which again may be linked to
national umbrella organizations. In France, for example, some diagnosis-specific
groups are linked to the national French network of user organizations – FNAP
PSY (Fédération Nationale des Associations de Patients et [ex] Patients ‘PSY’).
In the countries of eastern and central Europe there are no user groups with a
national brief currently, although there are developments in both Lithuania
and Georgia.
A final challenge in mapping the European scene is the sustainability and
turnover of user groups. It is well known that user groups emerge and close
down with some rapidity (Wallcraft et al. 2003). Even quite large organizations,