european psychiatric association

Developing Trust and Effective Care Project

Patients and psychiatrists working in partnership

There has been little systematic exploration of the mutual experiences of patients and clinicians/psychiatrists and how these interact throughout the care process. In order to address these challenges, GAMIAN-Europe and the EPA launched a project to assess and better understand hopes and objectives, decision making processes, successes and frustrations from both the patient and the mental health worker’s perspective of the care process.

Prevention of negative experiences and overcoming current challenges can only be effective if patients and mental health workers can develop trust, reduce fear and enable the establishment of a therapeutic relationship. This will require an understanding of each others’ expectations, powers and limitations.

Without such positive care experience that relies on trust and mutual understanding, mental health interventions cannot be effective for a number of reasons including engagement, concordance and the therapeutic effect of positive relationships. Conversely, negative patient experience is a key marker of service failure and needs to be picked up by healthcare systems.


The aim of the project is to identify the care experience of patients, complemented by the narrative of the mental health service. The two experiences are brought together in a dialogue, leading to conclusions about desirable actions that can improve the care experience. The participants to the project are open in how much they can tell about their experience in an interview or written questions.

The questions raised in this process include:

  • What have been good and what have been negative experiences?
  • Is the interaction between patients and mental health workers lacking a foundation of trust, leading to a cycle of disrespect, fear and coercion?
  • What interventions might have facilitated a positive process?
  • What interventions would support patients to gain optimal benefit from treatment and care?
  • Does psychiatric care have the tools and resources to offer adequate care for many of its patients, or does their absence result in a demoralised workforce giving up hope?
  • Is there sufficient system support for the psychiatric workforce from sectors such as social care, housing and employment, limiting scope of interventions to medical care, enabling holistic care?
  • Has training and education prepared the mental health workforce adequately?


With the analysis of the data collected, GAMIAN-Europe and the EPA identify key factors to facilitate and improve the therapeutic relationship and policy recommendations to support patients and psychiatrists in this process.

The “TRUST” Project started in 2018, focusing on the experience of patients with Major Depressive Disorder.  In September 2020, the Report “Developing trust and effective care for people with depression: Patients and Psychiatrists working in partnership” was released. Download the Report here.

The same approach was used to develop another “Trust” Report centred around the experience of patients with Schizophrenia. The Report of this latter phase was released in 2023 , download it here.


For more information on the project, please contact the EPA Brussels Office here.