Select Committee on European Union Minutes of Evidence

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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