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

What makes psychiatry so attractive, but also challenging, is the many uncertainties, even contradictions. Practitioners talk about evidence-based treatment, but sometimes what is offered resembles a hotchpotch of ideas. In reality, we heavily rely on an interaction of the infinitely varied experiences of the people who ask for help and the beliefs and knowledge of the therapist. We apply many treatments, and some work, and we do not always know which one and why.

Lia’s story shows a surprising tolerance for conditions against which many people would revolt. Eight in a room and needing to be numbed by tranquillizers to sleep after an involuntary admission are strong stuff. But the treatment worked, and the time to reflect and especially the psychotherapy seemed to have been of great value: in Lia’s case, more so than the dog-contact treatment, anyway. What was effective for Lia is difficult to say, but key factors in her recovery were a treatment that was always human, kind and understanding, not being tormented by a schizophrenia diagnosis, the 14-month moratorium, the freedom of not feeling like a prisoner, the closeness of her family, and the warm, available presence of a psychiatrist and psychotherapist.

Lia’s full recovery is genuinely uplifting. She came through these experiences stronger, but with some sad discoveries about other people’s attitudes. The most important message for me is the role of the family, and possibly culture, in combining and sometimes confusing the origins of the problem with the solution. Lia and her family seem to have adapted to the situation. The last sentence of her story is striking. People often mention love as a powerful factor in recovery, but I do not know of any evidence-based guidelines using the word. When we are reflecting so much on happiness and well-being, this is a surprising omission.

Dr Matt Muijen, Regional Adviser, WHO/Europe