The voluntary sector plays an important role in the mental health field across the world. Originally set up and run by volunteers, the prime motivation and purpose for this sector is improving the lives of people affected by mental health problems by doing things differently, tirelessly pushing for change, never giving up hope and working alongside service users (also known as patients and consumers) and their families every step of the way. In some countries it has been labelled the ‘third sector’ to distinguish it from other organizational sectors namely industry (private sector) and government (public or statutory sector).

The voluntary sector is not, however, a cohesive group of organizations and across the mental health community each one operates with its own specific remit. Some of these organizations have become large businesses providing a wide range of services under contract with statutory agencies. Others choose to avoid employing staff and are still run entirely by committed volunteers. Many rely on voluntary donations in order to remain fiercely independent of government. Each has its own aims and mission, core stakeholder group, trustee and membership structures, management systems, governance procedures, and a unique portfolio of activities.

Some mental health organizations focus activities on mental health or emotional well-being specifically (e.g. Finnish Association for Mental Health). Others target a social problem and support all those affected such as charities working with the homeless, refugees, victims of domestic violence, or young offenders, including people with mental health problems. There are organizations that primarily campaign, educate, advocate, lobby, and promote self-help resources such as EUFAMI—an association for families across Europe and SANE Australia. In parts of the world, including Eastern Europe, there are particular challenges in mental health resulting from poverty, dislocation of the population, and insufficient resources for health. Some states, like Armenia, have no mental health services. Here, the Catholic Agency for Overseas Development (CAFOD) is working with Armenia’s Association of Child Psychiatrists and Psychologists to provide therapy and mental health care and to increase awareness and understanding in order to overcome prejudice.

Wherever they work, key characteristics of voluntary sector organizations include an independent position, a strong values base, empowerment principles, non-profit distributing of resources, passionate commitment to the work focus, rooted to service user, and carer experiences and they are always striving for changes to provide people with mental health problems better provision and opportunities. Most started as local support groups but some have grown into large national organizations with considerable political leverage. The National Schizophrenia Fellowship (known today as Rethink) was founded in 1972 by a group of families concerned that relatives of people with schizophrenia had no support for themselves. In this chapter we draw on the Rethink experience to illustrate how the voluntary sector contributes to, and shapes, modern psychiatry. Although the English experience does not directly map onto those in other countries across the world, there are similarities and we seek to highlight these through the use of international examples where possible.

Rethink is a membership charity with 7500 members (service users, carers, mental health professionals, the general public) whose mission is ‘to support everyone affected by severe mental illness recover a better quality of life’. It adopts a recovery-orientated approach to supporting the individual and their family through periods of ill health and their journey of recovery. This perspective is significantly different from that of clinicians and statutory providers, who have not been through the experiences common to people who suddenly have to cope with severe mental illness. Rethink staff descriptions of their role include:

Initially providing mutual support, the organization later offered information resources which address the problems commonly encountered by service users and carers, like difficulty in gaining access to services or funding for appropriate care. The emphasis is on finding successful strategies which achieve solutions. Advocacy is provided for individuals and families whose needs are not being met. The experiences of service users struggling to cope provide detailed evidence which is used to develop Rethink’s policy on the mental health issues which reach the political arena and also as the basis of campaigns on stigma and discrimination. Research and
surveys of service user and carer views form the basis of reports on vital issues, like how information can be provided to carers with due respect for the service user’s privacy and autonomy. Guidance on good practice may be developed and sometimes training for professionals. Media activity has publicized Rethink’s campaigns and using the internet has made dissemination of information cheaper and easier than it used to be.