Pathways To Policy ‐ Developing Inclusive Mental Health Policy In Eastern Europe

Abstract

These are the words of Orieta Kallushi, a service user speaking at the launch of Hamlet Trust’s Pathways to Policy programme in Tirana, Albania, a project that is enabling those who are most affected by mental health policy – service users – to have a powerful voice in how services are developed. People with mental health problems have long been discriminated against, marginalised and excluded from the process of developing policies that actually respond to their needs. It was with the aim of developing inclusive, alternative mental health initiatives that the Hamlet Trust, a UK-based charity, was established in the early days of care in the community in the 1980s. Since the early 1990s, the main focus of Hamlet’s work has been in its development of a network of grassroots, user-led partner organisations in central and eastern Europe and central Asia – communities still coping with the social and economic upheavals that followed the collapse of communism. During Hamlet Trust’s Developing Network Partners project, 2000-2002, service users repeatedly stated that, though their organisations were becoming stronger and more effective, they still felt excluded from the decision-making processes. Too many decisions about their lives were being made by municipalities, governments, professionals and business people with their own agendas and without consulting service users. This led to the Hamlet Trust’s Pathways to Policy programme which, since its launch in 2002, has demonstrated that it is possible to improve mental health policies and outcomes for service users by inclusive, open means. As a result, service users are beginning to perceive the influence they can wield in the policy environment. To date local policy forums have been established in eight countries. These forums are independent bodies featuring a broad range of stakeholders (including – vitally – a minimum of 33% service users) who come together on equal terms to influence and contribute to local mental health policy. Forums were developed in the first year in Estonia and Poland, followed in the second by Bosnia, Romania, Armenia and Kyrgyzstan, while in 2004 and 2005 new forums were launched in India and Albania. A major international policy conference was held in 2004 in Slovenia where stakeholders, including many service users, shared experience and good practice with representatives from international policymaking bodies and national and international NGOs. Funding for the programme initially came from the Big Lottery Fund (formerly the Community Fund), with more recent support coming from the Open Society Mental Health Initiative, and lately from local authorities and other local funders in the countries themselves. The Pathways to Policy project was evaluated using a combination of quantitative and qualitative methods including semi-structured interviews, focus groups and questionnaires, along with reflective diaries. Quotes used in this article are taken from that evaluation. The programme has