A lived experience perspective on the new World Mental Health Report

The new World Mental Health Report by the World Health Organization (WHO) ¹ is a landmark document that follows up on the 2001 World Health Report ² . One could argue that not so much has changed since then but, from our perspective, a very significant change has been actually occurring: the collectively amplified voices of people with lived experience of mental health conditions from all corners of the world. We (people with lived experience) have been speaking publicly about our experiences, our struggles, how we have survived and how we can thrive. Indeed, our realities enable us to be uniquely positioned to provide advice and guidance on policy and service transformation, and to accelerate progress in restructuring mental health care so that it takes on a person‐centered and recovery focused approach, as recommended in the report.

The report places a particular focus on the shift towards community‐based mental health care and recognizes that mental health is not isolated within the health sector but rather represents an essential element across all areas of life and all life courses. A noticeable improvement in quality of life can be seen when unmet needs of persons with mental health conditions are met within the social domain ³ . The WHO defines mental health as “a state of mental well‐being that enables people to cope with the stresses of life, to realize their abilities, to learn well and work well, and to contribute to their communities; it is an integral component of health and well‐being and is more than the absence of mental disorder”. This definition reiterates that a prerequisite for overall well‐being and quality of life is entrenched in mental health, applicable in the presence or absence of a mental health condition. Therefore, a community‐based approach is sensible and can make a significant impact at multiple levels (the individual, the community, the country and the world).

Providing services and support in communities, through mainstreaming mental health across sectors, has the potential to enhance personal, community and economic development. The benefits range from long‐term economic gains to greater access to care and improved identification of when, where and how someone needs mental health services and support, while appreciating equal human rights and creating stigma‐ and discrimination‐free societies. This, in particular, is what we – as users of mental health care services – have been advocating for over the past decades, with the support of international human rights instruments.

The United Nations (UN) Special Rapporteur on the Right of Ev­eryone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health has acknowledged that some advancements have been made in mental health care. However, human rights violations within mental health systems have been poorly addressed. He further noted that this failure reinforces a vicious cycle of discrimination, disempowerment, coercion, social exclusion and injustice; and recommended that mental health be seen beyond a biomedical concept ⁴ .

Ethics‐based and evidence‐based practices can generate positive outcomes when people with mental health conditions are involved in service development and service delivery ³ . Although there have been advances in involving people with lived experience of mental health conditions in strengthening health systems, progress in this regard has been very limited especially in low‐ and middle‐income countries, where continued stigma and poverty remain the main barriers to inclusion ⁵ .

The undeniable importance of including people with lived experience in decision‐making processes and integrating peer‐led services within mental health care is well emphasized in the World Mental Health report. More common in high‐income countries, peer‐led services such as formal peer support work and other related recovery occupations, have become part of mental health service delivery. Peer‐led service providers have an advantage in comparison with other professional services, through having lived experience and practical knowledge of navigating mental health related services and processes, and therefore being in a better position to understand the vulnerabilities and associated needs of peers ⁶ . Hopefully, the new report's explicit reference to the value of including peer‐led services will encourage governments to invest in the inclusion of lived experience service providers into the mental health workforce.

Alongside the evidence‐based content and showcasing of best practices, the lived experience narratives from diverse geographical contexts make the report powerful and give a clear message to policy makers that we (people with lived experience) are not silent voices anymore, that we claim our right to speak and share our realities and can contribute practical solutions towards improved mental health care and services for everyone. We are ready to partner and to create change together.

We hope that the lived experience contributions in the report will generate encouragement among governments to authentically and meaningfully involve people with lived experience from the planning to the implementation phase of all new developments in the mental health field. Equally important is for people with lived experience to be integrated within the monitoring and evaluation mechanisms of interventions and service delivery, as well as assessing compliance with local and international human rights instruments.

Going forward, for governments to truly commit to the inclusion of persons with lived experience and their representative organizations, it should be well noted that authentic and meaningful inclusion can only happen when these persons are involved from the very start and not as an afterthought. At the same time, it is critical to consider diversity (gender, race, age groups; lesbian, gay, bisexual, transgender and queer or questioning) when engaging and working with people with lived experience, to ensure that all population groups are able to voice their specific concerns, needs and recommendations.

In conclusion, the launch of the new World Mental Health Report is an exciting moment and represents a welcome step towards pushing mental health to become a truly global priority, making mental health everyone's business. At the very same time, we need to forge a link between mental health, social justice and human rights as an intertwined approach towards successfully implementing the recommendations of the report.