Mental Health & Values

Skip anything

Every question is optional. No one has to retell painful events, name a diagnosis, or choose a religion or identity to begin.

Pause or stop

Stop at any point. Nothing is sent anywhere, and nothing is shared unless the person chooses it in the sharing review.

Whose words

Record who said each thing: the person, a caregiver or surrogate, or a professional. A caregiver's needs get their own field.

Support to take part

Extra time, a quieter place, pictures, an interpreter or a trusted person can help someone say what matters. Ask what helps.

Barriers are not preferences

Cost, travel, work, housing, caring for others and digital access are written down as barriers, not as what the person wants.

Meaning, religious or not

Hope, purpose, faith, relationships and identity can be part of the conversation if the person wants. None is assumed.

• Physician, psychiatrist or nurse: Treatment options, side effects and follow-up.
• Psychologist or other mental-health professional: Therapy options and coping strategies.
• Peer support worker: Lived experience of recovery, where such roles exist.
• Social worker: Housing, income, work and practical barriers.
• Chaplain or spiritual-care provider: Meaning, distress, hope and relationships, for people of any faith or none.
• Interpreter or communication specialist: Language and communication support so the person's own words come through.
• People the person chooses: Family, friends, or a community or faith contact, only if the person wants them. Never assumed safe, available or wanted.

Roles, titles and training differ by country and service. Not every role exists everywhere.

A small set of places chosen for contrast, not a ranking or a representative survey: Global, Mexico, Brazil, Zimbabwe, Kenya, India, Myanmar, Sweden, Lebanon, Norway. Each example states what its source establishes and what it does not. Policy on paper is not proof that a service is available.

Guidance, not outcomes:

Shows what is written or recommended. It does not show that it is followed or what results.

Policy, not outcomes:

Shows what is written or recommended. It does not show that it is followed or what results.

Service as described:

Describes a service when the source was written. Whether it still runs is not verified.

Abstract only:

Read from the abstract. The full paper may add or qualify this.

• Global · Guidance · 2023

  WHO/OHCHR guidance frames mental health advance planning as supported decision-making and suggests laws make advance directives binding, revocable at any time, and set aside only for undue influence or impracticability.

  Limits: Guidance, not outcomes

  What others could learn: Advance directives can carry a person's stated treatment, support and supporter preferences into a later crisis if law makes them binding, easy to change, and accessible to providers.

  Conditions, limits and source

  Conditions that matter:

  Requires legal-capacity law aligned with CRPD Article 12; a duty on services to inform people and support drafting; a registry or other provider access; clinician indemnity when following directives; formats beyond writing (video, audio).

  Cannot be inferred:

  Does not show that binding directives reduce coercion or improve outcomes; does not describe any one country's current law; Germany is cited only as an example of binding living wills.

  Limits:

  Normative guidance, not an evaluation. It notes most jurisdictions activate directives only on a finding of incapacity and that 'Ulysses' self-binding clauses remain contested and under-researched. Model provisions are illustrative, not enacted law.

  Source: World Health Organization; United Nations Office of the High Commissioner for Human Rights, Mental health, human rights and legislation: guidance and practice (Section 2.3.2 'Advance planning', printed p. 60 (PDF p. 82); model provisions at printed pp. 62-63 (PDF pp. 84-85)). Where: Global. Population: People using mental health services, including people with psychosocial disabilities. Published 2023-10-03; retrieved 2026-10-11.

• Mexico · Policy · 2023

  WHO/OHCHR guidance reports that Mexico's General Health Law, amended in 2022, makes all mental health treatment and hospitalization voluntary and prohibits seclusion and restraints, with one general medical-emergency rule.

  Limits: Policy, not outcomes

  What others could learn: A national law can make voluntariness the rule for all mental health care and ban seclusion and restraint, but must be paired with community crisis services.

  Conditions, limits and source

  Conditions that matter:

  Legal: statutory consent rules covering family and clinician disagreement; an emergency exception tied to absent advance directives. Practical: community-based crisis alternatives, staff training, and funding (as the source stresses).

  Cannot be inferred:

  Whether involuntary admissions, seclusion or restraint actually ended in Mexican services; any patient outcomes; how courts or states have implemented the reform.

  Limits:

  Secondary summary; the primary decree (Diario Oficial de la Federación, May 2022) was not retrieved because dof.gob.mx was unreachable. The law keeps a medical-emergency exception. WHO/OHCHR note that law reform alone needs resources and services to change practice.

  Source: World Health Organization; United Nations Office of the High Commissioner for Human Rights, Mental health, human rights and legislation: guidance and practice (Section 2.3.4 'Prohibition of involuntary hospitalization and treatment', printed p. 66 (PDF p. 88); reference 164). Where: Mexico. Population: People using mental health services. Published 2023-10-03; retrieved 2026-10-11.

• Brazil · Service described in 2021

  WHO's 2021 profile of CAPS III Brasilândia (São Paulo) says each registered user develops an individual care plan (PTS) with a reference practitioner, mapping needs, support network, strengths and life goals.

  Limits: Service as described

  What others could learn: A written plan co-produced with a named practitioner, covering goals and support networks as well as diagnosis, gives a routine place to record what matters to the person.

  Conditions, limits and source

  Conditions that matter:

  Free at point of use under SUS; federal government covers 50-70% of operating cost, the municipality the rest; 58 staff; integration with Family Health Teams; up to 14-day respite beds (all per the same WHO profile).

  Cannot be inferred:

  That the PTS process alone improves outcomes; that all CAPS across Brazil operate this way; cost-effectiveness (the source compares per-user monthly cost with hospital per-day cost, which is not a like-for-like comparison).

  Limits:

  Good-practice profile compiled for WHO, not an independent outcome study. Evidence cited is a 2009 satisfaction study and a 2020 QualityRights assessment. Restraint was used three times in Feb 2019-Feb 2020 despite the non-coercion principle.

  Source: World Health Organization, Guidance on community mental health services: promoting person-centred and rights-based approaches (Section 2.3.2 'Centros de Atenção Psicossocial (CAPS) III - Brasilândia', printed p. 62 (PDF p. 92)). Where: Brazil (São Paulo, Brasilândia). Population: Adults, children and adolescents with severe or persistent mental health conditions and psychosocial disabilities in an area of about 430,000 people. Published 2021-06-07; retrieved 2026-10-11.

• Zimbabwe · Measured outcome · 2016

  In a Harare cluster RCT (24 clinics, 573 adults), lay health worker-delivered Friendship Bench problem-solving therapy improved common mental disorder symptoms at 6 months versus standard care plus education and support.

  Limits: Abstract only

  What others could learn: Trained, supervised lay health workers in primary care can deliver structured problem-solving therapy with measurable short-term symptom benefit where specialists are scarce.

  Conditions, limits and source

  Conditions that matter:

  Per WHO 2021 (who-cmh-2021.txt, printed pp. 93-95): delivered in Shona using local idioms by older women employed by local health authorities; 8 days of training; optional peer groups; free to users; first session estimated at US$5 (2019).

  Cannot be inferred:

  Effects in other languages or cultures, at national scale, or beyond 6 months; whether the current nationwide service matches the 2014-2015 trial protocol; effects on people with severe mental health conditions.

  Limits:

  Abstract only (full text on jamanetwork.com unreachable). Outcomes are self-reported symptom ratings at 6 months; longer-term effects not reported in the abstract. Single city; most participants were women. Authors include the intervention's developers.

  Source: JAMA (Chibanda D, Weiss HA, Verhey R, et al.); abstract via PubMed, Effect of a Primary Care-Based Psychological Intervention on Symptoms of Common Mental Disorders in Zimbabwe: A Randomized Clinical Trial (Abstract, Conclusions and Relevance). Where: Zimbabwe (Harare). Population: Primary care attenders aged 18+ screening positive for common mental disorders; 86.4% women; 41.7% HIV-positive. Published 2016-12-27; retrieved 2026-10-11.

• Kenya · Service described in 2021

  WHO reports that a Nairobi peer support group affiliated with Users and Survivors of Psychiatry in Kenya sometimes helps members draft informal advance directives, which Kenyan law does not recognize.

  Limits: Service as described

  What others could learn: Peer groups can help people record crisis preferences and practise having choices respected even where formal advance directives lack legal force.

  Conditions, limits and source

  Conditions that matter:

  Per the same profile: family engagement with the member's consent, otherwise the group may consult local community structures (printed p. 78); groups registered with the Ministry of Labour and Social Protection and the National Council for Persons with Disabilities; about US$4000 a year per group; seed funding from the umbrella organization.

  Cannot be inferred:

  That informal directives are honoured by clinicians or families; quantitative outcomes; that the model works without a national rights-focused umbrella organization.

  Limits:

  One group selected as a model because evaluation data existed. Evidence is a single qualitative study. Legal status of advance directives is as described in 2021. Funding is largely donor and grant based.

  Source: World Health Organization, Guidance on community mental health services: promoting person-centred and rights-based approaches (Section 2.4.2 'Nairobi Mind Empowerment Peer Support Group - USP Kenya', printed p. 78 (PDF p. 108)). Where: Kenya (Nairobi). Population: People with lived experience of mental health conditions and psychosocial disabilities (at least 70% of members); caregivers may join. Published 2021-06-07; retrieved 2026-10-11.

• India · Measured outcome · 2023

  In a stepped-wedge cluster RCT across 645 villages in Mehsana, Gujarat (1191 participants), the volunteer-led Atmiyata intervention improved recovery from depression or anxiety symptoms at 3 and 8 months.

  Limits: Abstract only

  What others could learn: Respected village volunteers, trained in brief counseling and linked to public services and social benefits, can deliver measurable gains in low-resource rural areas.

  Conditions, limits and source

  Conditions that matter:

  Per WHO 2021 (who-cmh-2021.txt, printed pp. 88-90): two volunteer tiers plus social-worker facilitators; Gujarati-dubbed awareness films; help accessing social benefits; donor and NGO funding; about US$120,000 a year for 500 villages (2019).

  Cannot be inferred:

  Effects for severe mental health conditions; sustainability after donor funding; transfer to urban or non-Gujarati settings; which component drove the effect.

  Limits:

  Abstract only. 85% completed 3-month follow-up. Self-reported symptom scales. Trial authors are from the organization that runs the program. WHO 2021 describes the evaluation as 'eight months' in 2017, while the abstract gives April 2017-August 2019 (difference noted, not resolved).

  Source: PLoS One (Pathare S, Joag K, Kalha J, et al.); abstract via PubMed, Atmiyata, a community champion led psychosocial intervention for common mental disorders: A stepped wedge cluster randomized controlled trial in rural Gujarat, India (Abstract, Results). Where: India (Gujarat, Mehsana district). Population: Rural adults with common mental disorder symptoms. Published 2023-06-08; retrieved 2026-10-11.

• Myanmar · Service described in 2021

  WHO's 2021 profile says Yangon's Aung Clinic documents the will and preferences people express in peer support groups so treatment and support stay consistent with their wishes.

  Limits: Service as described

  What others could learn: Peer groups can be one place where stated preferences are documented to inform treatment. The profile does not show that documented preferences were followed.

  Conditions, limits and source

  Conditions that matter:

  Per the same profile: family and friends involved with the person's consent (printed p. 57); five paid peer support workers; free to users; Open Society Foundations funding; state services in Myanmar described as limited and hospital-focused.

  Cannot be inferred:

  That documented preferences were followed in practice; outcomes; scalability within Myanmar's public system.

  Limits:

  Self-described good-practice profile. Only evaluation cited is an unpublished 2020 qualitative study of 20 participants. Described as the only service of its kind in the country. Donor-dependent. Current operating status not verified.

  Source: World Health Organization, Guidance on community mental health services: promoting person-centred and rights-based approaches (Section 2.3.1 'Aung Clinic - Yangon, Myanmar', printed p. 57 (PDF p. 87)). Where: Myanmar (Yangon). Population: People with mental health conditions and psychosocial disabilities, and their families (over 200 people a year). Published 2021-06-07; retrieved 2026-10-11.

• Sweden · Service described in 2021

  WHO reports that Sweden's Personal Ombudsman service, in 87% of municipalities by 2018, is voluntary: only the individual can request an ombudsman and can end the relationship at any time.

  Limits: Service as described

  What others could learn: A publicly funded navigator role that only the client can request or end, and that family, authorities or courts cannot impose, is one design for client-directed coordination of housing, benefits and health supports.

  Conditions, limits and source

  Conditions that matter:

  Built on a 2000 national reform shifting 15% of the mental health budget to municipalities; permanent funding regulation since 2013, paid to municipalities as a state grant per ombudsman; 13-20 clients per ombudsman; management bodies include user and family organizations; free to users.

  Cannot be inferred:

  That the model would work under different welfare, insurance or guardianship systems such as those in the U.S.; causal effects or cost savings; outcomes for people who decline the service.

  Limits:

  Good-practice profile. Cited outcomes and the '17 times the costs' savings figure come from Swedish evaluations not retrieved here. An ombudsman may notify authorities if they judge serious risk. PDF text extraction renders small caps as lower case.

  Source: World Health Organization, Guidance on community mental health services: promoting person-centred and rights-based approaches (Section 2.5.5 'Personal Ombudsman - Sweden', printed p. 109 (PDF p. 139)). Where: Sweden. Population: Adults with severe or long-term psychosocial disabilities and significant support needs. Published 2021-06-07; retrieved 2026-10-11.

• Lebanon · Service described in 2018

  Lebanon's National Mental Health Programme used community cognitive interviews (11 key informants; 8 focus groups) to adapt WHO's digital Step-by-Step, shortening it about 30% and revising story, contact methods and activities.

  Limits: Abstract only

  What others could learn: Asking intended users and front-line workers to react to an intervention's story, delivery and contact methods can surface needed changes, such as gender norms, before rollout.

  Conditions, limits and source

  Conditions that matter:

  E-mental health was already in Lebanon's national strategy; delivery depends on digital access and nonspecialist helpers (per trial abstracts); a ministry programme led the adaptation.

  Cannot be inferred:

  That the adaptations caused the later trial effects; acceptability for groups not interviewed; transfer of the specific edits to other countries.

  Limits:

  Describes the adaptation process, not effects. Effectiveness was tested later in separate RCTs (PMIDs 35737665, 35577536, saved alongside) that report high attrition. Abstract only.

  Source: Global Mental Health (Abi Ramia J, Harper Shehadeh M, et al.); abstract via PubMed, Community cognitive interviewing to inform local adaptations of an e-mental health intervention in Lebanon (Abstract, Results). Where: Lebanon. Population: Lebanese, Syrian and Palestinian community members; primary care front-line workers; mental health professionals. Published 2018-11-27; retrieved 2026-10-11.

• Norway · Service described in 2021

  WHO reports that Norway's six-bed, open-door BET Unit at Blakstad Hospital, serving people with prior lengthy admissions, used no coercive measures in the two years before reporting.

  Limits: Service as described

  What others could learn: Hospital units can plan care around the person's goals and work toward no coercion, even for people with long histories of coercive care.

  Conditions, limits and source

  Conditions that matter:

  Public funding; 19.5 staff for 6 beds; structured consent meetings and service users involved in drafting their own medication withdrawal plans; family or network involvement encouraged; reported cost about NOK 8800 per day, 30-40% below other units in the trust.

  Cannot be inferred:

  Long-term outcomes; generalization to larger or acute admission units; that results would hold where law or liability rules push toward coercion.

  Limits:

  Service-reported figure; the two-year window is undated and the profile does not define 'coercive measures'. Over-regulation (intensified staff care, reduced stimuli) and presumed-consent medical treatment after self-harm are described separately. Very small unit (6 beds, 6-10 people a month). The profile's claim that coercion 'can be reduced by as much as 97%' is uncited in that sentence.

  Source: World Health Organization, Guidance on community mental health services: promoting person-centred and rights-based approaches (Section 2.2.1 'BET Unit, Blakstad Hospital, Vestre Viken Hospital Trust - Viken, Norway', printed p. 41 (PDF p. 71)). Where: Norway (Viken, Asker). Population: Adults with complex mental health conditions and repeated or lengthy prior admissions, often with past coercion. Published 2021-06-07; retrieved 2026-10-11.

• The sourced examples include guidance, policy, service description, measured outcome. Each quote was matched to the source text; that is not independent expert review.
• The prompts and fictional case are original. They have not been tested with patients, caregivers or clinicians.
• Whether this workflow helps anyone is an open research question.
• Content is in English. Interface translations are not reviewed for this topic.