Mental health policy and practice across Europe: an overview

The user and survivor movement 345
institutions, may be vulnerable to having their rights curtailed, and may not
always be able to express their preferences and needs. Advocacy can play an
important role in filling this gap. The United Kingdom has a national group, the
UK Advocacy Network (UKAN), a federation of organizations that are mainly
advocacy-focused groups or Patients’ Councils. Certainly, advocacy is a common
activity for Patients’ Councils in the Netherlands, although it should be
stressed that in both countries these councils engage in other activities such as
pressing for the improvement of conditions in hospitals.
There has been a major advance in the provision of advocacy services in
England recently, through proposed, highly controversial changes in mental
health legislation. While there has been almost unanimous opposition to much
of this legislation, most users take it as an achievement that the legislation
proposes that all detained and compulsorily-treated patients will now have an
advocate by law.
Advocacy can also take new forms. In one part of Sweden there is a new
project whereby users are allocated a ‘personligt ombud’. This roughly translates
as ‘personal ombudsman’ and is a mixture of an advocate and the best forms of
keyworking. Personal ombudsmen are professional workers, while in many
forms of advocacy the advocates are service users themselves. Elsewhere, the
Estonian Patient Advocacy Association began as a purely mental health organization
but now works across the whole health field and is funded by central
government. It tends to take a systemic approach to advocacy, focusing on
campaigning for change nationally. An advocacy project in Georgia focuses
more on individual problems, many of which have a legal basis, like access to
housing and passports. This project employs both ex-users and professionals as
advocates.
Anti-stigma work
In addition to advocacy, anti-stigma work is also very common and a key activity
of many user groups in Europe. For instance, there may be concerns about
social inclusion; thus, activities may take the form of training for work or setting
up small businesses, often based on the model of a social firm, especially among
better-funded groups. However, some users have criticized training schemes as,
in effect, the equivalent of ‘sheltered workshops’, arguing that they do not promote
social inclusion (see Chapter 12).
For many user groups, stigma and discrimination lead to, or compound, mental
distress – and this is the message they wish to convey to the media and the
public. Anti-stigma and public education campaigns thus can cause division
between user groups and other stakeholders. For instance, while organizations
such as the WHO engage in anti-stigma work, their campaigns tend to be based
on a medical model, with mental illness seen as an illness like any other. For
them, mental illness is a disease of the brain; many user groups see this as a
counterproductive stance, as diseases of the brain also do not have a socially
acceptable image.