How can Anna‘s story influence policy-making for mental health?

This is a strong story of suffering turning into hope. One cannot read it without feeling hurt and angry about the way Anna was treated by other people, or without admiring her resilience and will to succeed. Her ability to describe her experiences of mental health services so objectively and constructively means that we should take her advice very seriously.

Her experience in hospital is very familiar, and reminds me of the term “non-therapeutic hospital stays“. In some countries, the environment could better be described as anti-therapeutic. The therapist’s misguided comment – that talking therapy cannot help people with schizophrenia – emphasizes The degree to which hospital care complacently relies exclusively on medication in the absence of any therapeutic interventions. Considerable evidence now demonstrates the effectiveness of psychotherapy for many people, including those with schizophrenia.

Equally disturbing is that Anna has to pay for her therapy, which she can ill afford. This is hardly equitable, but surprisingly she considers herself lucky. Maybe she compares her situation to that of people who do not receive any form of care. Accessibility and affordability should be high on the reform agenda.

Her story describes the beneficial role of user groups, and how they can support integrated care. The suggestion of a buddy, whether a service user or a social worker, is also worth considering, and some countries show good examples of such practices.

Although stories such as Anna’s may seem far away from WHO’s work with policies, they are the very essence of our work. The WHO Mental Health Action Plan for Europe is not a dry document to discuss with Member States; it results from research and people’s experiences. By talking about the importance of support from her husband, getting an education, playing a role in the community by working in a user organization and coping with problems of access to proper treatment, Anna gives a human face to policy.

This story left me pondering the role of prevention and community, and how mental health services can do better. How much pain and suffering could Anna have avoided if someone had intervened earlier: not only when Anna knew she needed hospital admission to prevent further deterioration, but earlier in her life, when some people must have noticed signs of suffering in a young girl?

Dr Matt Muijen, Regional Adviser, Mental Health, WHO/Europe