Mental health policy and practice across Europe: an overview

386 Mental health policy and practice
Do countries consult with carers and family members when
they review/develop mental health legislation or policy?
Seven of ten EUFAMI country members responding to this question (Belgium,
England, Ireland, Italy, the Netherlands, Norway and Scotland) stated that they
had been, or were going to be involved in the formulation of new legislation.
Two of these country members, including Italy, expressly said it had been a
positive experience, while the only other association to express a view was a
family association in England who felt that consultation was only tokenistic
and not properly valued. The countries where family members had not been
involved in consultation were Cyprus, Greece and Slovenia, although in Greece
there had been consultation within a committee examining the rights of people
with mental health problems, and while this process was not intended to
develop legislation it does show an acknowledgement by legislators of the
benefits of consultation.
How are family members affected by legislation that allows
people with mental illness to be detained and treated?
Again, the involvement of families in treatment decisions is complex and sensitive.
Families in some situations may feel that it is essential that they make the
decision on whether a loved one should or should not receive professional
treatment and/or services. This may go against the wishes of the individual with
a mental health disorder, and hence in other situations families may wish not to
be involved in such decisions, fearing that they later may be blamed by their
relative for committing them (World Health Organization 2005c). Family members
can also have an important right to appeal against involuntary detention
or treatment decisions on behalf of their relative, if this individual is unable to
do so.
In the survey (Berzins 2003), information was obtained from 12 countries on
the involvement of families on these issues. Half of these, including Cyprus,
England, Greece and Ireland, have legal involvement in authorizing a family
member to be subject to compulsory admission. Countries that did not legally
involve family members in this decision included Belgium, Portugal, Sweden
and the Netherlands. In a review of Scotland’s mental health legislation the
involvement of family members in compulsory admittance was seen as having
the potential to cause conflict between the person with mental health problems
and the relative, and as such this role was subsequently removed in legislation
passed by the Scottish Parliament in March 2003. Legislation in Norway has
adopted a different approach, making this an optional responsibility for families.
Are there any legal family responsibilities to the individual
with mental illness?
Eleven country associations responded to this third question and all but two
stated that they had no legal obligations unless the relative was a legal minor or