Mental health policy and practice across Europe: an overview

338 Mental health policy and practice
such as FAPI (Forum Anti-Psychiatrischer Initiativen) operating in Germanspeaking
countries, may not last forever. The main reason for closure would
appear to be the struggle with long-term financial sustainability as groups are
usually heavily reliant on public grants and support. However, it should be
noted that some groups exist with no funding, relying solely on the goodwill,
time and resources of volunteers.
It is important to end this introduction by briefly discussing terminology for
those readers who are unfamiliar with the user movement. Terms used by
groups and individuals reflect their philosophical stance towards psychiatry.
‘User’ tends to denote people who are still in receipt of services. ‘Survivor’ is
used by those who feel that the psychiatric system is something to survive; one
copes despite it, not because of it. Indeed, some people who are still ‘users’
nevertheless refer to themselves as survivors. When user groups are actually in a
position to run and provide services they generally refer to people in receipt of
these services as ‘clients’ or perhaps ‘consumers’ as these user-run services do
offer a choice. In practice, words like ‘client’ or ‘consumer’ are rarely used. Many
people still feel that psychiatric services within their own countries deny users
choice. Poverty also can deny them the option of choosing private alternatives.
‘Patient’ is the least-used term, again as it is not associated with choice and also
implies the use of the ‘medical model’ approach. In this chapter, these different
terms will be used as the groups themselves use them.
Methods
The principal method used for gathering information for this chapter was
largely through a search of internet resources, augmented by studies reported in
the literature. The authors also relied on their personal knowledge. Diana Rose
has been a member of the user/survivor movement in the United Kingdom
since the mid-1980s. Jo Lucas is an independent consultant and former director
of the Hamlet Trust. Mary Nettle, a British user board member of ENUSP
(European Network of (ex) Users and Survivors of Psychiatry), was also interviewed
and provided some documentation.
The key web resource used was that of ENUSP (www.enusp.org) and its two
email lists. The website is mostly written in German but sections of it are accessible
in English, Dutch, Finnish, French, Romanian and Spanish, with welcome
screens in most other languages – although it is still advertising for users to
translate parts of the site into other languages.
This diversity of languages is significant and has posed a difficulty in writing
this chapter. While most professionals may accept that English is the international
language of scientific and professional communication, this is not the
case for users of mental health systems. Access to English language teaching or
to opportunities to practise English learnt at school on an everyday basis is not
common for many service users. In addition to this, native English speakers are
well known to be lazy about learning other languages, making it difficult for us
to understand information on websites such as that of ENUSP!
A further caveat lies in our emphasis on the internet. Access is likely to be
denied to users in institutions or to those who live in poverty. User involvement