We looked at key information from a selection of questions representing thousands of people, to get a better idea of what they are actually about.

What we found tells us a lot about **mental healthcare**.

People don’t always write to us about psychosis, anxiety or depression. Many of their questions are about mental healthcare itself — or rather, the lack of it, and the long wait to receive it.

Almost half of the questions touch on people’s personal experiences with the mental healthcare sector. Waiting for treatment and a lack of communication are especially common themes. It is almost the biggest theme in the entire online consultation, alongside psychological suffering itself.

People write to us because they have become stuck somewhere along the way: they have been on a waiting list for too long, communication has stopped, their treatment has been discontinued, they are in conflict with their healthcare provider about medication, they feel they are not being heard, or they want a second opinion.

And the most popular topic? **Reducing medication.**

Almost three out of ten questions are about this. The question is often phrased as: ‘Am I allowed to reduce my medication?’

People are looking for permission, or for confirmation of something they have already discussed with their healthcare provider — sometimes after being told no.

And that tells us something. A conversation that belongs in the treatment room has apparently been ended somewhere along the way.

Mental Healthcare:Who asks the questions?

More than six in ten men write about themselves. Almost a quarter write on behalf of someone else: a parent asking about their child, or a partner asking about their partner.

These family questions are often about psychosis, involuntary admission and what medication might be suitable for a loved one. It is often the people closest to someone who are left with the biggest questions.

There are also parents who write because they are frightened that their child might want euthanasia, or because they are worried about professionals supporting such a decision.

The fear of coercion in mental healthcare

Of all the experiences described by people who are already in contact with the mental healthcare sector, or have been in the past, one stands out: involuntary admission.

People write about tension, uncertainty and fear around coercion.

At first glance, waiting lists may not be mentioned as often. But indirectly, they are very much present. Many people describe being unable to access the help they need in the first place.

How do we respond?

So what do we do with all these questions?

The replies are long and personal — around 3,000 words on average — and almost all of them start in the same way: with understanding.

Almost six in ten answers begin with a personal introduction. First the human being, then the content.

It is also worth looking at who we refer people to in our online consultations. Not always a mental health service or a GP, but sometimes an experience expert, fellow sufferers, or reliable information online.

Why?

Because a formal referral is not always what is needed.

Most people who write to us already know about the mental healthcare sector. What they are often looking for is something else: to be heard, to be allowed to take part in the thinking process, and to get to know their vulnerabilities and talents rather than having only their symptoms treated.

There is a pattern here.

People who feel they are not being listened to can start to lose themselves. You adjust. You keep your mouth shut. You do what your healthcare professional tells you, even when it does not feel right.

It can become a survival strategy in a system that leaves little room to move.

Recovery can start when someone holds space for you: an experience expert who has been through something similar, a fellow sufferer, someone you care about, or a healthcare professional who takes the time to listen.

Let people embrace each other. That is where it starts.

What does this tell us about mental healthcare?

We can learn something from another discipline.

Cardiology has made significant progress not only through better surgery and medication, but also by paying attention to lifestyle: exercise, quitting smoking and healthy eating.

The mental healthcare sector has never really taken the same step.

We mainly keep fixing what looks broken to us, instead of helping people learn how to live with who they are.

The fact that questions about psychosis keep reappearing is telling. For some groups, regular mental healthcare is not enough. There is too little time, too little knowledge, too little willingness to consider reducing medication, and too little shared decision-making.

People want to be involved in decisions about their own bodies and their own lives. There is nothing unreasonable about that.

The online consultation should not be the place where someone gets to think about their own medication for the first time.

That conversation belongs in an actual consultation room.

So perhaps the real question is not what an online consultation can do.

It is this:

**What can the regular mental healthcare sector learn from the thousands of people who took the trouble to ask a question?**

That is what we need to focus on.