Examination of Witnesses (Questions 20-36)
Mr Jurgen Scheftlein
6 JULY 2006
Q20 Baroness Greengross: May I follow
up on that? I Chair the all-party group here on CSR (Corporate
Social Responsibility) and I know that there is somebody in the
Commission who has responsibility for that. If that unit was involved
with you in getting out these hard messages, would that not be
very helpful?
Mr Scheftlein: Of course.
Baroness Greengross: I think it might
be. I would be very happy to take that further from this end.
What I am saying is it is so vague and we need hard, convincing
data, economic data, which would be very, very welcome, I think,
from the business community. Thank you.
Q21 Lord Moser: It really continues the
same theme raised by my colleagues either side of me: we are at
a loss where to focus our energies in this Committee. That is
our problem, in a sense. However, the Green Paper, which I have
studied quite carefully, is very interesting, and it covers almost
everything one can think of, but I want to focus on this issue
of awareness, which takes us back to facts and knowledge. Obviously,
in the Green Paper it is clear you are very interested in the
issue of public awareness of mental health problems—however
they are defined. If you take Alzheimer's, I speak as somebody
slightly involved with the Alzheimer's Society in this country.
Everybody knows it is a terrible affliction.
Mr Scheftlein: Yes.
Q22 Lord Moser: At a low level everybody
is aware, but that does not get one anywhere because people do
not know the facts at any level. For example, in the case of Alzheimer's
or dementia, we believe that in this country there are 150,000
new cases every year. That is one every three minutes. That kind
of dramatic fact gets the headlines but, again, it is not very
solid. Question one: as an input to raising awareness, how good
is Europe now, in your view, on hard facts on the incidence, first
of all, of various kinds of mental illness? Question two: how
well-informed is Europe (the different countries and Brussels)
on the state of medical knowledge, which is something quite different—not
the incidence but the state of the medical knowledge? Most people
think that Alzheimer's is totally incurable. Somebody said to
me at lunch yesterday: "You do know there is a new pill?"
I did not know there was a new pill and it may not be true anyway.
So there are hard facts on the medical side and then there are
hard facts on cures and care, etc, etc. I am interested—and,
I think, we are interested—in what Brussels can contribute
and what we can contribute and work on in helping to improve the
state of awareness via these various levels of knowledge. Hard
facts on the incidence, hard facts of medical knowledge, hard
facts on care and cures, etc, etc. Do you get my drift?
Mr Scheftlein: First, I would like to say that
through the meetings that we organise and through the reactions
that we receive I also understand that raising awareness is very
important, and that it might get in a possible strategy even a
higher priority than it has in the Green Paper. We would have
to find adequate ways for ensuring that. The Green Paper itself
is certainly already an initiative to raise awareness. Regarding
your questions about Alzheimer's, that is not my field of expertise
but I have a colleague who is working on this and I know that
we are doing projects on Alzheimer's. So it is not something that
would be included in the routine data collection system of the
EU, through Eurostat, but it is something that we address in our
annual calls for projects under the public health programme explicitly
and we have good contacts to Alzheimer's Europe and to the European
Brain Council. So we will certainly be at the state of play of
research.
Q23 Lord Moser: I used Alzheimer's as
an example.
Mr Scheftlein: Mental health data is a bit difficult
area, I must say. We have invested quite a lot of funding into
information projects but we do not yet have the complete picture.
That is also why I quote WHO figures and studies of the European
Brain Council. We are telling Europe that we are developing systems
of indicators on which data should be collected, and we have some
data available. There are some mental health indicators in our
main list that we have developed—the list of European Community
Health Indicators (ECHI)—but for many we have problems in
getting the data. That has to grow. That is also something that
needs the visibility of the issue and awareness in Eurostat, for
instance, and more psychological indicators will be part of an
European household survey in the future. Also, under the EU's
Labour Force Survey there will be more mental health indicators.
So this is clearly growing. The information will become better,
but we are clearly not where we would like to be at the moment
because it is difficult to cope with it. As regards the state
of medical knowledge, we rely on support from the WHO. Our field
of work is mainly the promotion and prevention side—so what
is happening around the medical intervention but not the treatment
issues as such, and also not in detail what is behind the illness
in medical terms.
Q24 Earl of Dundee: We presume that gathering
more information and exchanging best practice will be handled
through the Open Method of Co-ordination. How might this activity
in fact be co-ordinated and the results disseminated?
Mr Scheftlein: I would say that we need to define
our strategy and, in fact, the principal decision about whether
our strategy would be developed has not yet been made. The Open
Method of Co-ordination is, at this stage, not an instrument which
would be used in the health policy context. So I do not think
that we would do it here. The Open Method of Co-ordination would
also require that Member States agree to this. It is an effective
tool, certainly. On the other hand, it is one that requires a
lot of resource investment. I think we would try to find a looser
way of co-operation in the form of a Platform on Mental Health.
Q25 Earl of Dundee: Even if that policy
were deployed, up until now other OMC exercises perhaps provide
a useful guide?
Mr Scheftlein: Maybe. The Open Method of Co-ordination
as a tool where guidelines and targets are defined and then Member
States report on their actions and achievements is a very valid
one, and we should certainly learn from it. We also have one on
long-term health care which is, however, operated under the responsibility
of the colleagues in DG Employment, and we contribute to it. Perhaps
it could also look into some aspects of mental health, it is possible,
yes, but for ourselves it is not really an option in our reflections
to launch an Open Method of Co-ordination. However, there might
be some elements of that approach in our work. So, of course,
we need to agree on some principles and on some objectives when
we work together, but certainly the implementation of a mental
health strategy will not be as fixed as other Open Methods of
Co-ordination are.
Q26 Baroness Neuberger: I think we have
all read what there is in the Green Paper about the EU Platform
on Mental Health, and I can see it is co-ordinating policy makers
and experts and it is drawing together, if you like, health people
and people interested in civil society. I have two bits to this
question: first, I am not clear what the Commission brings that
is additional to what the World Health Organisation can already
do and, indeed, to some extent, does already do. Secondly, if
you are going to go down this path and, presumably, therefore,
do more than the World Health Organisation does, what would it
mean in practice? What would it look like?
Mr Scheftlein: One has to see that the structures
explained in the Green Paper mainly relate to the consultation
itself. This is over now; so it has been an experimental phase.
However, what we want to do is we want to launch a platform on
mental health next year, and that will replace the former working
party on mental health that we had. That will probably be the
main structure for the implementation of a strategy on mental
health. At least, as far as the health policy context is concerned.
Q27 Baroness Neuberger: With the World
Health Organisation in partnership?
Mr Scheftlein: The WHO will be involved in it,
yes, in partnership, but the Commission will be the owner of the
platform, so to say. We will invite the WHO. The idea will be
there to bring people together like we did in the consultation
process from Member States: on the one hand, from the economic
world, from the health context, from the social field and from
civil society. So a mixture of key actors in that field. In the
past we had only researchers there, plus some NGOs, but that does
not lead to action; it leads to research, yes, knowledge but not
to implementation. There I see the contribution, the value, that
the Commission can add in partnership with WHO. WHO is a sectoral
organisation, so to say, it is a health organisation, whereas
we, as the Commission, have our colleagues in the other departments
who we can invite, and they came to our consultation meetings
from DG Research, from Employment and from others. So we can involve
them, and that means we also have access to other sectors, which
is key in this public health approach that we are pursuing. Secondly,
we have more of a sustainability dimension. Platform meetings
could take place once or twice every year, whereas for WHO it
is not possible to involve delegates from Member States every
year. So that means we can add a continuity to the work on mental
health. This we can use to monitor the progress in implementing
the commitment at the Helsinki conference. So that is our starting
point. Our own strategy would remain within the ranges of that
strategy, but it would be tailored towards the needs of the EU,
what Member States identified together with us, and then we can
establish a monitoring process. WHO cannot do that alone. At least,
they can do it much better if they do it together with us.
Q28 Baroness Neuberger: And the result
of that monitoring and the result of that platform is that you
might make recommendations for legislation?
Mr Scheftlein: Legislation, or recommendations
in the sense of encouragement. Most of these areas are out of
the mandate for legislative action at Community level.
Q29 Chairman: So it is exchange of good
practice?
Mr Scheftlein: Yes.
Q30 Chairman: Perhaps a better technical
base, a better statistical base—that kind of thing?
Mr Scheftlein: Yes. As a brief idea of how this
could work we could use our projects and our research networks
that have been growing to put together a state-of-the-art on a
theme like suicide prevention. We could have a discussion paper,
we could agree with Member States and the other actors involved
in the Platform on Mental Health that this is an issue of common
interest, where we believe we can learn from each other, and that
action at a Community level makes sense. There could be a paper
prepared putting together the existing knowledge and proposals
for action. It could be presented for discussion. A consensus
could be built on the key measures to be taken at community level
and in Member States. That could then be the material for a Council
recommendation. Then there could be some reporting about how this
has been implemented in Community policies in Member States. So
everything would be there; you could even think of legislation
on the size of packages of sleeping drugs, but the key of the
approach is to promote more informed action.
Q31 Chairman: Understanding, informing
and exchanging?
Mr Scheftlein: Yes.
Chairman: We are getting to the end of
our time and, also, your time.
Q32 Lord Harrison: Good morning, Mr Scheftlein.
Thank you very much for answering our questions. I wonder if I
could just ask you about paragraph 6.2, where you raise the question
of some initiatives that might be done at a Community level, including
the question of social inclusion, but also the Fundamental Rights
Agency. What kind of initiative might arise there? My final question
is: in answer to Baroness Neuberger about possible legislation,
you gave a reply, but would the Commission perhaps go as far—other
than being a swap-shop for good ideas and best practice—as
to try and think about minimum good standards which should operate
throughout the European Union in the field of mental health? Or
would you stand back from that?
Mr Scheftlein: This is a very tricky issue.
Q33 Chairman: That is why we are asking
it!
Mr Scheftlein: Regarding social inclusion that
may not be so tricky, to begin with this. We would have to work
together with colleagues in the Directorate-General for Employment
and we would certainly not wish to reinvent the wheel. We would
work together with them and would see how we could give more priority,
more attention to mental health and mental disability or disability
resulting from mental health within the processes that already
exist on social inclusion. That would be there and then we could
see about further additional actions. Regarding the Fundamental
Rights Agency, that is a matter of discussion with Member States,
and a mandate will arrive from that. Whether there will then,
in the end, be a mandate to look into issues relating to human
rights in mental health, I do not know. The idea we put into the
Green Paper was that it could be a place for collection of information
about conditions in institutions in all Member States, not only
the new Member States, because we believe there could be deficits
in all of them. Whether Member States are ready to accept that,
I do not know. Regarding minimum standards on human rights in
health care. I would certainly not see the emergence of harmonised
and not legally binding ones. But one could think about developing
good practice and guidelines for health promotion in such institutions,
and you could also link it to quality management. In one of the
consultation meetings we had a colleague from the Council of Europe,
so we worked together with them, similarly to how we work with
WHO. We can also help in monitoring what is happening on the basis
of the Council of Europe's recommendations, but I don't expect
binding instruments. The whole project of a mental health strategy
is certainly a long-term endeavour. We could now enter into a
kind of test phase now. We would see how it develops and then
it could grow into something more settled, but it is now important
to start up with this action.
Q34 Chairman: I am aware that we
are beginning to lose some Members and I am watching our quorum.
May I butt in at this point. Am I right when I think that the
actions which would be taken at Community level would lie in the
field of stimulating understanding which results in action amongst
practitioners, as it were, providing and collecting data, the
exchange of best practice and perhaps awareness-raising as a result
of the improved data, the exchange of best practice and so on,
those are the sorts of activities from the Commission's point
of view that you are thinking about?
Mr Scheftlein: Mainly, yes, but at this stage
I would also think of consensus building and then offering media
to monitor actions, so not only saying, "This is important",
but also agreeing on what should be done and then asking what
has been done. I hope that will also be an element of the strategy.
Chairman: Thank you. That was a very
helpful answer.
Q35 Baroness Morgan of Huyton: This
is just on funding and, in a sense, it partly relates to that.
Is this about better use of existing funding in the community
of research and structural funds? Is it taking the same money
that is there now and using it differently, or is it also going
to change the priority which is given to other cross-cutting issues,
like drugs or alcohol abuse?
Mr Scheftlein: It is about encouraging that
an adequate part of funding from existing community instruments
is used for mental health. If you look into structural funds,
that is an area where the Commission can only highlight its priorities.
It is up to Member States to ask for funding for mental health.
We cannot impose this. It is also about integrating mental health
as a context into the research framework programme. I think that
works well and there is interest in this.
Q36 Chairman: Thank you very much.
You have already explained to us that your deadline for the receipt
of consultation responses has now finished. Can you give us any
indication about what the future timetable of this paper might
be?
Mr Scheftlein: The deadline for contributions
in principle ended on 31 May. We have received about 250/260 reactions
and a few further ones are still expected. Over the Summer, into
the Autumn, we will perform an analysis of these contributions,
and then during the Autumn we should publish a work document providing
a summary of the outcomes. Also, hopefully during the next few
days, if not during the next few weeks, all the contributions
will be published on our website to make them transparent. Then
in the Autumn we will publish our own analysis and then we will
make the decisions about the follow-up steps, including the strategy,
and we hope it will be ready for the spring of 2007. Because of
the good feedback to the Green Paper, and also the delays in the
replies from some of the main actors, for example the European
Parliament will only send in its report in September, we have
decided that we will give it more time and have a new deadline
in the spring of 2007.
Chairman: Thank you very much for coming.
You will understand that our interlocutor is our own government,
so our report will be made to them. You have been extremely helpful
in clarifying particularly what the potential activities and actions
of the Commission might be. We were getting ourselves a little
bit worried that in such a wide field there might be something
rather peculiar going on, but I think we are much clearer now
as to what your paper is moving towards and what your aims and
objectives so far are. Obviously they may change as you respond
to the consultation. Thank you very much for coming and helping
us to clarify our own minds, and I hope you have had an interesting
session as well. I can see that sometimes our questions took you
into territory that you were not always happy about, but never
mind, you coped with all our questions, and we are very grateful
for all your help.
Mr Scheftlein: Thank you very much for offering
me this opportunity. If it helped to clarify our objectives, it
was a good investment from my side.
Chairman: Thank you.
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