Examination of Witnesses (Quesitons 37-39)
Professor Graham Thornicroft and Mr David McDaid
20 JULY 2006
Q37Chairman: Good morning, gentlemen. A very
warm welcome to Professor Graham Thornicroft and Mr David McDaid.
We are grateful to you for coming in. We are sorry about your
colleague, Professor Knapp, being unavailable, but at such short
notice and at the end of term, as it were, it is so helpful to
have you here. This is, of course, an open meeting of the Committee
so there may be hordes of the general public who will come sweeping
in through those doors, but I am sure they will sit down very
quietly. A verbatim transcript will be made. As ever, when you
leave the room if you think there are other things you wanted
to say or wanted to correct, or whatever, please let us know.
We will send you a copy of the transcript. Please do feel free
if you feel you have made a material error or whatever to correct
it and change what might have been misunderstood. Equally, you
may feel there were items that you had wanted to say which you
had not said and we would be most grateful if you jotted us a
note and told us more. Our purpose today is to get as much out
of you to help us in this particular Inquiry. You have had a note
of the members' interests but I think some colleagues will feel
happier to say so on the record. You may know about the acoustics
of this room. These rooms were designed for politicians who declaimed
and threw their voices over large crowds, so if you could speak
up it would be extremely helpful. I now turn to the main purpose
of this morning's hour, which is that we have embarked upon this
Inquiry and we recognise it is at an early stage. It is a Green
Paper, but we think it important to bring in colleagues like yourselves
to give us a feel for the area that we are talking about and to
test that difficult question about where the European Union can
bring, as it were, added value so that what we do is worthwhile,
and particularly worthwhile to you, your colleagues, your patients
and those who you serve. That would be very helpful, especially
right at the end of term when we can think about what we hear
from you over the Summer. I would like to ask you this. It could
be argued that, with some 52 countries signed up to the World
Health Organisation Action Plan for Europe, a separate strategy
for the European Union is not really needed. Could you summarise
what you think about that and, in inviting you to summarise, for
the purposes of the transcript could you please say who you are
and where you are from right at the beginning. Professor Thornicroft,
do you want to start first? If either of you want to make a brief
opening statement, please do, but otherwise if you would like
to take that first question.
Professor Thornicroft: My Lord Chairman, thank
you very much for inviting me this morning. First I will introduce
myself to the Committee. I come from both a clinical and research
background. I am a consultant psychiatrist at South London and
Maudsley NHS Trust. I have worked in psychiatry for the last 20
years, most of that time in community mental health teams. Secondly,
at the same trust I am Director of Research and Development so
I have an overall responsibility for managing our research and
seeing that it gets through to be implemented for the public good.
Thirdly, I am Head of the Health Service Research Department at
the Institute of Psychiatry at King's College, London, so I am
the head of a large research team investigating which treatments
and services are effective and cost-effective. To turn to your
question, my starting point would be the bigger picture about
mental health in Europe. We know that the large majority of people
with mental illnesses receive no treatment at all. I think our
starting point is that it is not at all the case that even in
the best organised and funded countries in Europe that we are
doing even a half-way decent service. I have brought some background
material that I can pass on to the Committee to reference some
evidence points that I shall make. In terms of the simple occurrence
of mental illness, we know that in the best-financed system in
the world, namely the United States, better provided even than
the European countries, the most recent surveys show that the
occurrence of mental illness in a year is about 29-30 per cent.
It depends how you measure it. We know that of all those people
in any one year only about 30 per cent will actually receive any
treatment at all for their mental illnesses. To turn this round
the other way, we know that over two-thirds of all people, where
we have studied this, with mental illness receive no treatment
at all. The starting point is quite shocking levels of neglect
and failure to treat people with treatable mental illnesses. Shall
I pass the materials to you later or as we go along?
Chairman: You could pass them to our
assistant.
Q38 Lord Colwyn: Do those people who
have a mental illness know they have a mental illness or are these
people who do not know?
Professor Thornicroft: This will vary a lot.
In terms of the public understanding about mental health problems,
I would say it is a mixture of lack of information and gross misinformation.
This brings us on to the stigma area to some extent. Most people
receive no formal teaching at any stage of their lives about any
types of mental illness, so there is very widespread misunderstanding
about, for example, features that would indicate that someone
may have depression. So if a man who has become unemployed is
irritable and drinking more, most people would not think "perhaps
this is depression", including that person, "maybe I
should seek an assessment and treatment". There are very
widespread levels of misunderstanding and ways in which misinformation
is put out into the public domain, mostly through the press, broadcast
and cinematographic media.
Q39 Chairman: We will come on to stigma,
Baroness Howarth in particular will take that up later.
Professor Thornicroft: My first general point
is I think the large majority of people in all of our European
countries simply go wholly untreated. My second point is that
for many of those people who are treated within mental health
care systems in Europe, the standards of care are poor or very
poor indeed. In the first case we may look at some countries in
Eastern Europe, including some accession and, indeed, pre-accession
countries, to see the worst excesses. There have been recent reports
by Amnesty International on some of these countries and also by
the Mental Disability Rights International Group showing, for
example, that in some of these countries people receive electroconvulsive
treatment without anaesthetic modification. In some of these countries
it is clear that there is good evidence that people die within
psychiatric hospitals at a higher rate than you would expect largely
because of malnutrition and hypothermia in Winter for a series
of institutional reasons. The standards of care at present in
some, I would say in many, Eastern European countries especially,
are not up to what I would say is a reasonably basic acceptable
standard. To come back to your main point, I think that one reason
to say that we do need a pan-European strategy is because the
current situation left to members alone is not at an acceptable
level.
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