20515545, 2022, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/wps.21031 by Cochrane Mexico, Wiley Online Library on [20/12/2022].

See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
that were not limited to controlled trials8. while throughout the course of treatment, recovery, and psycho-
Even among patients who are facing long-term mental health logical health maintenance. Particularly so in an era of significant
challenges, maintaining treatment adherence seems to assist psychological stress, when so many feel haunted by inner empti-
in helping build a sense of meaning in life. In a study of 60 in- ness.
dividuals with schizophrenia diagnoses and psychiatric histories
Michael F. Steger
at least 5 years in duration, meaning in life was positively related Center for Meaning and Purpose, Colorado State University, Fort Collins, CO, USA;
to treatment adherence, in addition to being inversely related to Optentia Research Unit, North-West University, Vanderbijlpark, South Africa
depression symptoms and positively to quality of life9.
1. Frankl VE. Man’s search for meaning: an introduction to logotherapy. New
Meaning in life is a construct that is relevant and predictive
York: Washington Square Press, 1963.
across the continuum of psychological functioning, from individu- 2. Martela F, Steger MF. J Positive Psychol 2016;11:531-45.
als receiving inpatient psychiatric care to those experiencing high 3. Steger MF, Frazier P, Oishi S et al. J Couns Psychol 2006;53:80-93.
4. Volkert J, Schulz H, Brütt AL et al. J Clin Psychol 2014;70:528-35.
levels of well-being. Further, measures with high utility and robust
5. Costanza A, Baertschi M, Richard-Lepouriel H et al. Front Psychiatry 2020;
psychometric properties are readily available and are collectively 11:327.
shown to reflect positive treatment progress and outcomes. Incor- 6. Lin L. Br J Health Psychol 2021;26:525-34.
7. Manco N, Hamby S. Am J Health Promotion 2021;35:866-73.
porating explicitly meaning-focused elements into treatment also
8. Vos J, Vitali D. Palliat Support Care 2018;16:608-32.
benefits patient progress and outcomes. 9. Tali S, Rachel LW, Adiel D et al. J Nerv Ment Dis 2009;197:133-5.
Paying attention to the meaning of patients’ lives would be worth-
DOI:10.1002/wps.20916

A lived experience perspective on the new World Mental Health

Report
The new World Mental Health Report by the World Health streaming mental health across sectors, has the potential to enhance
Organization (WHO)1 is a landmark document that follows up personal, community and economic development. The benefits
on the 2001 World Health Report2. One could argue that not so range from long-term economic gains to greater access to care and
much has changed since then but, from our perspective, a very improved identification of when, where and how someone needs
significant change has been actually occurring: the collectively mental health services and support, while appreciating equal hu-
amplified voices of people with lived experience of mental health man rights and creating stigma- and discrimination-free societies.
conditions from all corners of the world. We (people with lived This, in particular, is what we – as users of mental health care services
experience) have been speaking publicly about our experiences, – have been advocating for over the past decades, with the support of
our struggles, how we have survived and how we can thrive. In- international human rights instruments.
deed, our realities enable us to be uniquely positioned to provide The United Nations (UN) Special Rapporteur on the Right of Ev­
advice and guidance on policy and service transformation, and eryone to the Enjoyment of the Highest Attainable Standard of
to accelerate progress in restructuring mental health care so that Physical and Mental Health has acknowledged that some advance-
it takes on a person-centered and recovery focused approach, as ments have been made in mental health care. However, human
recommended in the report. rights violations within mental health systems have been poorly
The report places a particular focus on the shift towards com- addressed. He further noted that this failure reinforces a vicious
munity-based mental health care and recognizes that mental cycle of discrimination, disempowerment, coercion, social exclu-
health is not isolated within the health sector but rather rep- sion and injustice; and recommended that mental health be seen
resents an essential element across all areas of life and all life beyond a biomedical concept4.
courses. A noticeable improvement in quality of life can be seen Ethics-based and evidence-based practices can generate pos-
when unmet needs of persons with mental health conditions are itive outcomes when people with mental health conditions are
met within the social domain3. The WHO defines mental health involved in service development and service delivery3. Although
as “a state of mental well-being that enables people to cope with there have been advances in involving people with lived experi-
the stresses of life, to realize their abilities, to learn well and work ence of mental health conditions in strengthening health systems,
well, and to contribute to their communities; it is an integral com- progress in this regard has been very limited especially in low-
ponent of health and well-being and is more than the absence and middle-income countries, where continued stigma and pov-
of mental disorder”. This definition reiterates that a prerequisite erty remain the main barriers to inclusion5.
for overall well-being and quality of life is entrenched in mental The undeniable importance of including people with lived ex-
health, applicable in the presence or absence of a mental health perience in decision-making processes and integrating peer-led
condition. Therefore, a community-based approach is sensible services within mental health care is well emphasized in the World
and can make a significant impact at multiple levels (the individ- Mental Health report. More common in high-income countries,
ual, the community, the country and the world). peer-led services such as formal peer support work and other re-
Providing services and support in communities, through main- lated recovery occupations, have become part of mental health

390 World Psychiatry 21:3 - October 2022

 20515545, 2022, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/wps.21031 by Cochrane Mexico, Wiley Online Library on [20/12/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
service delivery. Peer-led service providers have an advantage in ganizations, it should be well noted that authentic and meaningful
comparison with other professional services, through having lived inclusion can only happen when these persons are involved from
experience and practical knowledge of navigating mental health the very start and not as an afterthought. At the same time, it is
related services and processes, and therefore being in a better po- critical to consider diversity (gender, race, age groups; lesbian,
sition to understand the vulnerabilities and associated needs of gay, bisexual, transgender and queer or questioning) when en-
peers6. Hopefully, the new report’s explicit reference to the value gaging and working with people with lived experience, to ensure
of including peer-led services will encourage governments to in- that all population groups are able to voice their specific concerns,
vest in the inclusion of lived experience service providers into the needs and recommendations.
mental health workforce. In conclusion, the launch of the new World Mental Health Re-
Alongside the evidence-based content and showcasing of best port is an exciting moment and represents a welcome step towards
practices, the lived experience narratives from diverse geograph- pushing mental health to become a truly global priority, making
ical contexts make the report powerful and give a clear message mental health everyone’s business. At the very same time, we need
to policy makers that we (people with lived experience) are not to forge a link between mental health, social justice and human
silent voices anymore, that we claim our right to speak and share rights as an intertwined approach towards successfully imple-
our realities and can contribute practical solutions towards im- menting the recommendations of the report.
proved mental health care and services for everyone. We are ready
to partner and to create change together. Charlene Sunkel
Chief Executive Officer, Global Mental Health Network
We hope that the lived experience contributions in the report
will generate encouragement among governments to authenti- 1. World Health Organization. World mental health report. Transforming men­
cally and meaningfully involve people with lived experience from tal health for all. Geneva: World Health Organization, 2022.
2. World Health Organization. The world health report 2001. Mental health:
the planning to the implementation phase of all new develop- new understanding, new hope. Geneva: World Health Organization, 2001.
ments in the mental health field. Equally important is for people 3. Thornicroft G, Tansella M. Epidemiol Psichiatr Soc 2005:14:1-3.
with lived experience to be integrated within the monitoring and 4. UN Special Rapporteur on the Right of Everyone to the Enjoyment of the High-
est Attainable Standard of Physical and Mental Health. http://digitallibrary.
evaluation mechanisms of interventions and service delivery, as un.org/record/3862194.
well as assessing compliance with local and international human 5. Lempp H, Abayneh S, Gurung D et al. Epidemiol Psychiatr Sci 2018;27:29-39.
rights instruments. 6. Sunkel C, Sartor C. BJPsych Bull 2022;46:160-4.
Going forward, for governments to truly commit to the inclu- DOI:10.1002/wps.21031
sion of persons with lived experience and their representative or-

The World Mental Health Report: transforming mental health for all
It has become clichéd to say that mental health is undervalued, communities. Mental health is an integral component of health
that little is done to promote mental health or prevent mental and well-being and is more than the absence of mental disorder”.
health conditions from occurring, that mental health services fail Other than when reporting on epidemiological data, the report
to meet need in almost all countries, and that human rights are of- focusses on mental health conditions/disorder and not on sub-
ten abused. However, each of these is not only true, but of such se- stance use, neurological disorders or intellectual disability. While
rious concern that failing to change them will have serious future this is possibly a limitation in that all these areas are important,
consequences for individuals, families, communities, economies, it is a strength in that the report includes detail and analysis that
and the cohesion and prosperity of societies as a whole. Decades would not have been possible had all areas been included. More-
of research and data collection, advocacy, as well as recommen- over, other global reports are available that focus on many of these
dations and assistance programmes to countries have had some issues, and there will likely be more such reports in the future2-4.
positive global impact, but mental health around the world re- No single advocacy enterprise, action plan, journal article or
mains poor, and services insufficient and inadequate, and for report is likely to suddenly overcome the years of inattention to
some abusive. The new World Health Organization (WHO)’s and disregard for mental health. Notwithstanding, there are de-
World Mental Health Report1 focuses attention on these matters cisive moments in public health, and strategic documents that
and creates a compelling and fresh picture of why change is ur- are turning points. This report has been launched at a potentially
gently needed. Moreover, without being prescriptive, and recog- critical historical juncture where mental health is beginning to
nizing country and cultural differences, it provides clear pointers receive far more worldwide attention, and it contains sufficiently
to the transformation needed, and outlines in broad terms how well-researched information (with over 550 references), epidemi-
this can be achieved. ological data, persuasive arguments, innovative approaches and
Mental health is defined in this report (slightly modified from practices, and experiences of users to seriously activate greater
previous WHO definitions) as “A state of mental well-being that mental health revitalization and change.
enables people to cope with the stresses of life, to realize their The WHO report Mental Health: New Understanding, New
abilities, to learn well and work well, and to contribute to their Hope5 was a landmark in mental health. Launched in 2001, at a

World Psychiatry 21:3 - October 2022 391