Opinion | Africa
World Mental Health Day’s call to hear lived experience should change who makes decisions, how services spend money and what patients can challenge.
A person can be invited to describe the hardest period of their life and still leave the room without any influence over what happens next. That is the difference between being heard and having power. African mental-health services should take that difference seriously.
For World Mental Health Day on 10 October, the World Health Organization called for people with lived experience to help shape policies, services and decisions. Its campaign identifies participation in service design, peer support and accountability as practical priorities. This is a global campaign, not evidence that every African country has adopted those arrangements.
The argument matters because a consultation can look inclusive while leaving every consequential decision untouched. An institution might collect moving testimony, publish photographs and thank participants. But if patients cannot influence opening hours, complaint procedures or the support available after discharge, the exercise has delivered visibility without authority.
Our position is that public services should show what changed because people participated. A meeting should produce an accessible record: which recommendations were accepted, which were rejected, who made those decisions and why. Patients should not have to search through a technical report to discover whether their contribution mattered.
Participation also needs resources. We propose reimbursing transport, offering interpretation and allowing confidential contributions. A person should not have to disclose a diagnosis publicly to improve a service. Nor should one articulate participant be expected to represent everyone who has used it.
Family members and caregivers can contribute valuable knowledge, but their preferences should not automatically replace those of the person receiving care. Good participation should allow disagreement. It should include people whose experiences challenge the institution’s preferred account of its work.
WHO also describes a planned transition from long-stay psychiatric institutions towards community-based care. It stresses that this requires funding, services and practical support. Closing a ward alone is not such a transition.
For African policymakers considering reform, the useful questions are concrete. Where will someone receive follow-up care? What support exists for housing, transport and daily life? Who answers when a referral fails? These are proposed tests for reform, not findings that any particular country has failed them.
A budget should make those answers visible. We would favour publishing spending commitments alongside service responsibilities, rather than announcing community care without identifying who will deliver it. Participation should extend to evaluating whether those promises were kept.
There should also be a route to challenge decisions without risking retaliation or losing access to treatment. Independent complaints, clear explanations and consent procedures deserve as much attention as awareness campaigns.
Professional expertise remains essential. Meaningful participation does not require clinicians to abandon evidence or make every clinical decision by committee. It requires recognising that someone who uses a service can identify obstacles that an administrative dashboard misses.
The next stage of mental-health reform should therefore be judged by changed relationships. Can a patient ask a question and receive an answer? Can they refuse a publicity request? Can their experience alter a service?
A voice becomes powerful when an institution must respond to it. That is the standard we should carry beyond one commemorative day.
Discussion: What would meaningful patient influence look like at your local health service: budget participation, independent complaints, service design or something else?
Reporting limit: Source checked 11 October 2026. This is an editorial proposal, not an assessment of individual countries’ implementation.
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