Nessa Childers MEP, co-founder of the Interest Group on Mental Health, Wellbeing and Brain Disorders, discusses the need for more ambitious EU-level action on mental health.
Mental health has always been one of my priority interests. This is clearly demonstrated by my choice of profession – I am a psychotherapist by training – as well as through my concrete actions as a politician – not least as one of the co-founders of the European Parliament Interest Group on Mental Health, Wellbeing and Brain Disorders. There are many reasons why mental health should be a health and social policy priority across the board. Mental disorders cause immense suffering for individuals, families and communities; they put pressure on health, educational, economic, labour market and social welfare systems across the EU; and these disorders are highly prevalent and increasing in the EU with 50 million citizens – about 11% of the population – estimated to experience mental health disorders.
Depression is the most prevalent health problem in many EU member states, with suicide remaining a major cause of death: in the EU, there are about 58,000 suicides per year (75% are committed by men). Nine of the ten countries with the highest rates of suicide in the world are in the European Region.
Only 50% of those affected by depression receive treatment. In European countries, at least 30% of people with severe mental disorders do not have access to mental healthcare, and the majority do not benefit from the interventions that have proved to be effective in prevention and promotion. There is a link between mental health problems and losses of productive human capital: research has shown that there are substantial costs associated with mental disorders, such as higher presenteeism and absenteeism or significantly reduced earnings. Stigma, prejudice and discrimination are unfortunately widespread and have a huge impact on those affected seeking or receiving help and support.
On a more positive note, there is increasing data proving that positive mental health and wellbeing is a key factor for social cohesion, economic progress and sustainable development in the EU – so the need to prevent mental illness and promote mental health is increasingly recognised by policymakers. In many or most cases mental ill health can be prevented, cured, treated and managed. A more widespread understanding of this fact might help to combat stigma.
EU action to date
Over recent years the European Commission has taken various steps to ensure a place for mental health on the EU political agenda. The Commission Green Paper ‘Improving the mental health of the population: Towards a strategy on mental health for the European Union’ (2004) proposed an EU-strategy to focus on promoting the mental health of all. However – and disappointingly – the idea of a concrete strategy did not meet with sufficient support from the member states so, instead, the commission came forward with the European Pact for Mental Health and Wellbeing (2008), which concentrated on five themes: prevention of depression and suicide; mental health in older people; mental health in youth and education; mental health in workplace settings; and stigma and social inclusion. Numerous high-level conferences took place, leading to a set of Council Conclusions (2011) that recognised mental wellbeing as an essential constituent of health and quality of life, and a prerequisite for the ability to learn, work and contribute to social life.
More importantly, the report invited member states to make mental health and wellbeing a priority of their health policies, and to develop strategies and/or action plans on mental health including depression and suicide prevention.
The Council Conclusions also invited member states and the commission to put in place a Joint Action on Mental Health and Wellbeing (2013), building on the findings of the pact, and aiming to build a framework for action in mental health policy at EU level.
When this Joint Action came to an end, the EU Compass for Action on Mental Health and Wellbeing (a mechanism to collect, exchange and analyse information on policy and stakeholder activities in mental health) took over. This compass aims to disseminate the ‘European Framework for Action on Mental Health and Wellbeing’ as developed by the Joint Action and it monitors mental health and wellbeing policies and activities by member states and non-governmental stakeholders. The compass will come to an end in 2018.
No specific action on mental health is foreseen when the work of the compass comes to an end. Instead, the commission intends to address mental health as part of its more general chronic disease agenda.
So, what next?
All in all it is fair to say that, while relevant, EU-level action on mental health has been disappointing – and the current move to address mental health as part of the general chronic disease agenda will decrease the visibility and potential of mental health issues even more. So clearly, action needs to be taken to ensure a robust place for mental health on the EU policy agenda.
The Interest Group on Mental Health, Wellbeing and Brain Disorders, co-ordinated by GAMIAN-Europe, aims to do just that. It was launched in 2009 and works to ‘advocate the development of sound EU policies which contribute to prevention of mental health problems and ensure good services, care and empowerment for those affected by mental health problems’.
The group meets three times a year and aims to address current EU policy files and topics; its co-chairs regularly table written questions as well as amendments to commission reports to ensure a strong mental health dimension in all policies that have a bearing on health and wellbeing. Since its inception, the group has brought about stronger collaboration between the various EU-level mental health stakeholders and brought forward patients’ opinions in policy development.
One of its main activities over the last two years has been the development of a rationale and draft framework for a future EU-level Action Programme on Mental Health and Wellbeing. This outlines the specific reasons why there is a need for such a plan and makes the case for the added value of a much more ambitious EU-level initiative in this area, building on the work that has already been done.
All member states are facing the same issues in relation to tackling mental ill health, both with respect to prevention and mental health promotion as well as the development and implementation of effective and sustainable care provision models. For instance, the current trend towards community healthcare requires clear strategies and policies to ensure quality of and access to appropriate care.
Many countries are struggling with this development, and member states can (continue to) benefit from co-operation, mutual learning and the exchange of good (and bad) practices. GAMIAN-Europe and the interest group believe that, through the various EU-level actions that have already been taken, the foundations have been laid for more ambitious and structured actions, which will engage the relevant policymakers as well as other stakeholders (e.g. patients). There are EU-level precedents for more ambitious actions in specific health areas in, for instance, the cancer and rare diseases fields.
A more ambitious approach would also be in line with the expected outcomes of the Joint Action, which aimed to ‘build capacity of national mental health leaders and other stakeholders in mental health policy development and the creation of mechanisms supporting a structured collaboration between key actors in the implementation of mental health policies in Europe.
The action plan would consist of six strands:
1) Inclusion of mental health as a priority in health and social policy development – mainstreaming: a need, recognised by the Joint Action to explicitly include mental health in all areas which have a direct or indirect bearing on mental health, such as the Health Programme, the European Social Fund, the disability strategy, the social open method of co-ordination (addressing accessible, high quality and sustainable health and long term care systems), Horizon 2020 (research), the European Semester Process, actions on Corporate Social Responsibility, health and safety in the workplace and the Employment Strategy.
2) Awareness-raising and good practice exchange – mutual learning and exchange: The EU Action programme should ensure and co-ordinate an effective exchange of information, experience and good practice between relevant stakeholders and member states. Another option to raise awareness would be to consider designating one of the coming years as the European Year of Mental Health and Wellbeing.
3) Stimulate the development of national action plans on mental health and wellbeing: As already referred to in the 2011 Council Conclusions, national action plans on mental health could be put in place, using the existing national actions plans on cancer and rare diseases as models: these plans should be established to explore appropriate measures for mental health in order to ensure that patients with mental health problems have access to high-quality care, including diagnostics, treatments and rehabilitation. National plans can also be useful for mutual learning and exchange, with the Group of Governmental Experts on Mental Health acting as a co-ordinating mechanism for a structured and effective exchange and mutual learning.
4) Financial support: Several of the above initiatives hold the potential for funding (e.g. the health programme, the Structural Funds, Horizon2020). This funding could contribute to capacity building of mental health organisations in relation to the provision of support (e.g. emotional support, exchanges, information) and advocacy (e.g. policy development, practical solutions). It could also support the exchange of information, research and networking.
5) Data collection and monitoring: The Horizon2020 programme should continue to issue specific calls for research projects addressing mental health in future calls for proposals under the action ‘Tackling Societal Changes’, section ‘Health, demographic change and wellbeing’. The EU-funded ROAMER project has developed a sensible and inclusive roadmap for research in this area, which could provide guidance on priority setting and the most pressing issues.
6) Inclusion of people affected by mental health problems in relevant EU consultations, fora and advisory boards: Any strategy or policy addressing mental health should be developed as a joint effort by all key stakeholders from societal and policy sectors concerned, including representative organisations active in the field of mental health should explicitly be included in social and health consultations as well as in relevant fora and advisory boards.
As already mentioned, there are EU-level precedents for this type of Action Plan, and given the impact and relevance of mental ill health on individuals, their families, their communities and society as a whole, it is imperative that action should be taken. It has already been recognised at the EU-level that ‘complementary action and a combined effort at EU-level can help member states tackle these challenges by promoting good mental health and wellbeing in the population, strengthening preventive action and self-help, and providing support to people who experienced mental health problems and their families’.
Initiatives like the Joint Action have laid the foundations for a more sustained and structured effort at EU and national levels. The momentum of the Joint Action should now be put to use as a starting point for a more ambitious effort to ensure sound policy development, with the ultimate aim of improving the quality of life of those affected by mental health problems. I will continue to work with the Interest Group to accomplish this.
Nessa Childers MEP
European Parliament Interest Group on Mental Health, Wellbeing and Brain Disorders
This article will appear in Pan European Networks: Government issue 24, which will be published in January, 2017.