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This year we celebrate World Mental Health Day on Monday 10 October.
The World Federation for Mental Health is the driver behind this important awareness day.
“World Mental Health Day aims to raise awareness in the global community about the critical mental health agendas – with a unifying voice through collaboration with various partners – to take action and to create lasting change through the messages we promote.”
The theme this year is “Make mental health & well-being for all a global priority”.
"The COVID-19 pandemic has created a global crisis for mental health, fuelling short- and long-term stresses and undermining the mental health of millions. Estimates put the rise in both anxiety and depressive disorders at more than 25% during the first year of the pandemic. At the same time, mental health services have been severely disrupted and the treatment gap for mental health conditions has widened."
What can we learn from the rest of the world about good mental health services?
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Open Dialogue in Finland
The name Open Dialogue was first used in 1995 to describe two key features of the approach: the use of open family / network meetings and a set of principles for organising the whole psychiatric system that made dialogue possible.
The Open Dialogue approach was originally developed in Western Lapland in Finland by Jaakko Seikkula and colleagues. They wanted to create a crisis service in which families and mental health services worked closely with the person experiencing the crisis and generate better outcomes for patients experiencing psychosis than those resulting from use of antipsychotic medication.
According to the Open Dialogue UK website: “If the family / team can bear the extreme emotion in a crisis situation, and tolerate the uncertainty, in time shared meaning usually emerges and healing / recovery is possible.”
The results of this approach are clear from the statistics – about 75% of those who experienced psychosis return to work or study within 2 years and only about 20% are still taking antipsychotic medication at 2 year follow-up.
As American journalist Robert Whitaker concluded in his book Anatomy of an Epidemic: “Western Lapland in Finland has adopted a form of care for its psychotic patients that has produced astonishingly good long-term outcomes.”
Read more here.
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The Italian Trieste mental health model inspired by Franco Basaglia
The mental healthcare model in the port of Trieste, in north east Italy, is based on the theories of the reforming psychiatrist Franco Basaglia. Franco believed that psychiatry in large institutions unfairly ostracised people with mental problems and the area has seen a radical switch to community based care over the years. It is often called a “whole system – whole community” approach.
Basaglia died prematurely in 1980, but his team continued to develop and support his innovative approach to mental health care over the next three decades. The approach includes looking at the whole person and also their social background when considering what support someone needs.
“Historically, Trieste pioneered the shift from relationships based on domination / control to the therapeutic relationship seen as reciprocal, based on rediscovering the whole person.” Roberto Mezzino, MD
“While it is not without controversy, supporters of the Trieste system in Italy and around the world say that it is more humane, more effective, and even economically more viable.”
Political upheavals in recent years have reportedly put the approach at risk and people have organised petitions as recently as 2021 to try and protect the Trieste model.
Read more here.
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Norway medication free mental health services
In 2016 regional health authorities in Norway were instructed by health minister Bent Hoie to provide medication-free treatment wards as an option for mental health patients. This followed years of forced treatment and forced isolation in mental health facilities. For some time, there had been considerable debate in Norway about the effectiveness and adverse effects of using antipsychotic medication, and individuals had long campaigned for change. While medication-free treatment is available in some other countries, Norway became the first country in the world to embed it as an option in the state-run mental healthcare system.
Dr Magnus Hald took on the job of running the new drug-free hospital in Tronsko in North Norway. "The idea of evidence-based medicine is difficult within mental health as a whole, although it's of course an aim that we should have. At the same time, we know that diagnoses in psychiatry are just a classification system. Even though you give a person a diagnosis of schizophrenia, you do not see any malfunction in the brain besides what you experience by engaging in a conversation with the person. You cannot see anything on the CT or the MRI images."
Whilst the debate continues in Norway about the pros and cons of medication free treatment, there is more patient choice now and according to research greatly improved trust between people seeking support and their therapists which can result in better outcomes.
Read more here.
Making mental health a priority in Wales – what’s happening now
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Mental health and wellbeing will be one of the main focuses of the Welsh Youth Parliament over the next two years as the parliament stands up for the issues that matter most to young people in Wales.
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Together for Mental Health is a cross-government strategy setting out Welsh Government’s goals for improving mental health and mental health services in Wales. It is the first Mental Health Strategy that covers all ages; children and young people, adults of working age and older people.
This strategy is currently being evaluated nationally, and a new updated strategy will then be produced.
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Until such time as the new Together for Mental Health National Strategy is produced, Powys will continue to drive on its stated priorities. These priorities are identified in this document – T4MH Priorities.
Mental Health is also one of the Big Four health issues facing the county as identified in the Powys Health & Care Strategy. Powys Teaching Health Board says: “We will develop effective services to treat and support people suffering from the four main causes of ill health and premature mortality in Powys (which includes mental health problems).”
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