Mental health policy and practice across Europe: an overview

The user and survivor movement 351
services’, and supports the creation of service user organizations (WHO 2005a).
The detailed Action Plan invites member states to consider setting standards on
the representation of users on committees and groups responsible for planning,
delivery, review and inspection of mental health activities, empowering service
users to take responsibility for their care and increase the level of social inclusion
(WHO 2005b). Only time will tell if these words are translated into effective
action.
Turning to policy at the national level, and starting this time with the countries
of the ex-Soviet bloc, there is still little evidence of users having any influence
whatsoever on state policy. Indeed, this lack of link with policy-making led
the Hamlet Trust to develop an initiative called Pathways to Policy in five countries,
establishing local policy forums and arranging a number of stakeholder
meetings (Hamlet Trust 2003, 2004). The forums can help to establish communication
channels between groups and are beginning to have some kind of
impact in making people think in new ways about the importance of listening
to the experience of users. In Estonia, where some of this thinking had already
begun, the Policy Forum is taking off with active support from the Ministry of
Social Welfare. There is, however, little interest from the Ministry of Health or
mainstream psychiatry.
It is also worth noting that there is little well-developed mental health policy
in this region. This could be seen as a positive thing in that by the time governments
become willing to develop and implement good policy, the user movement
might be well developed enough to take a natural part in that process. In
fact, this appears to be happening in Hungary already, with the national user
organization involved in many activities and campaigns.
In western Europe, large groups with national, regional and local structures
and networks usually have a direct influence on government policy on mental
health. This is true, for example, in France, Sweden, Denmark and the Netherlands.
Southern European countries whose health and social welfare systems are
decentralized have few national organizations and the limited influence on
policy-making must take place at a regional level. In Catalonia, for instance, a
region-wide group can directly lobby the Catalan government.
In the United Kingdom, policy-making related to mental health is an issue for
the devolved administrations in Wales, Scotland and Northern Ireland (when
devolution is restored). Thus, there is no over-arching user empowerment group
and most organization is at the local level. Since most funding is at local level,
most influence is inevitably confined to that level. There are several national
groups but they tend to be specific to issues (Hearing Voices Network) or part of
other organizations (MINDlink). However, very recently there have been
attempts to establish a ‘network of networks’ in an effort to develop a national
user/survivor organization.
In England there is currently a strong emphasis on consumer involvement in
all aspects of health policy, and certainly groups of individual users were
involved in the process of developing the National Service Framework (NSF) for
mental health. However, these users were not elected by national groups and
most found it a very unhappy experience (Wallcraft et al. 2003). Moreover,
although the final version of the NSF states that there should be arrangements
in place for user involvement, there are few additional references to users in the