Select Committee on European Union Minutes of Evidence

Examination of Witnesses (Quesitons 80-99)

Mrs Kathryn Tyson, Ms Susannah Rix and Mr Jim Fowles

19 OCTOBER 2006

  Q80  Lord Trefgarne: There will be national representatives on it. I was going to ask you about the EU platform. Do you see that as an improvement on the Open Method of Co-ordination and, as I guess from what you have just been saying, there will be user representatives on that platform?

  Mr Fowles: Yes. The first thing I have to say is that my understanding of the Open Method of Co-ordination is very limited but, based on what I do know, we are not sure that it is directly applicable, or should be, to the sort of strategy that we are expecting. The objectives that Member States will be working towards will be what they are now, which are those of the Helsinki Declaration and, as Kathryn was saying, we do not expect an EU strategy to change that, and the World Health Organisation themselves are currently considering how they can best gather in information from Member States to enable them to judge what is happening and what progress is being made, so I think there is a risk of setting up the sorts of duplicate systems that we were trying to avoid in our response to the Green Paper. The platform on the other hand does bring together non-governmental representatives, I think, who are stakeholders in terms of people from independent sector organisations and service users and professionals. That gives the opportunity for a different sort of scrutiny or monitoring of progress, the holding to account of the sort that you were suggesting is needed in keeping this centred on the needs of real people rather than turning it into a totally academic discussion between bureaucrats or clinicians.

  Q81  Lord Trefgarne: I am right in thinking, am I not, that the provision of mental health care throughout the EU at present is very variable and in some cases no doubt pretty poor?

  Mr Fowles: Yes.

  Q82  Lord Trefgarne: Will the end result be a raising of the standard all round or is that too much to hope for?

  Mr Fowles: It is not too much to hope for. I doubt if the strategy itself will set new standards to be worked towards that Member States do not already have through the Helsinki Declaration or through human rights legislation or disability legislation, but we hope that just the very fact that there is an EU strategy will help to raise the profile of the subject and bring it out from the darkness into the light in those places where it does still remain in the darkness, if you see what I mean.

  Q83  Baroness Gale: When the Government talks about real people and that the platform will be used to bring in these real people, I am aware, and I am sure everybody else is, that Scotland and Wales will have their own mental health strategy, but how is that going to work as far as the UK is concerned because as I understand it what we are looking at is what is going on in England rather than in Wales and Scotland? How will all of those people be brought in to reflect what has gone on in Wales and Scotland as well as in England?

  Mr Fowles: It is true that we all represent the English Department of Health but the response that we gave to the Commission on their Green Paper was a joint agreed UK response and colleagues from Scotland and Wales have been involved in the build-up to the publication of the Green Paper and in the consultation exercise since. I do not know but I suspect that there are representatives from Scotland and Wales on the platform now and if there are not that is something that we can certainly pursue and make sure the Commission realises that that is a gap they need to fill.

  Mrs Tyson: If I may add to that, we do not expect that England, Wales or Scotland will stop doing their own consulting and involving of real people, service users and carers and families as they seek to develop and implement their own policies but we do see that the platform may add an extra dimension and an extra encouragement to that, so we fully see the importance of continuing that involvement through our own countries' implementation of service development.

  Q84  Lord Moser: My question also in a sense relates to Open Method of Co-ordination. My particular interest is in the statistical information base. Obviously, it is one of the roles of the Commission to improve that. I hope that in the course of our inquiry we will get some understanding of how adequate the statistics are in the different countries but that is not for now. Presumably the Statistical Office in Luxembourg will be responsible together with WHO and I hope not too much duplication will result. The basic issue is the Government's view and Mr Scheftlein told us that he had no doubt that the Open Method of Co-ordination was important and that individual Member States would be required to support it and go with it. He also indicated that a less formal process might be just as helpful, so I would be interested to know what you feel about that. In other words, have you any comments on the information base in general and the Government's particular approach to improving it?

  Mrs Tyson: Building on Jim's remarks earlier, that we do not have a very great understanding of the Open Method of Co-ordination but we can find out some more, you asked about the state of the information base in general. I expect that, just as the state of mental health care varies across Member States, so the state of their information about both the performance of those services and the general state of mental health of their populations will vary considerably. We have something called the mental health minimum data set which you may know about. That is a very comprehensive tool. It is not quite as widely implemented and used as we might hope and there is continuing work to do to roll it out better. Where it is fully implemented it has provided a very rich set of data about what services are doing, how they are helping people, how many people and so on. Public health observatories, particularly, I think, the one in Yorkshire, the northern one, have a lead on mental health public health data, and again provide a very rich variety of things for us. Just as there is work continuing for us to do, so there will be for the other Member States and we do think that even Mr Scheftlein's less formal means of swapping and comparing data will be helpful for Member States to compare where they are at to learn from each other's models of collection of statistics and so forth. I am sorry if that is a bit of a waffly answer. I am very happy to write if there is some more detail that you would like.

  Q85  Lord Moser: No, just two quick supplementaries. So far Brussels, or rather Luxembourg for statistics, seems happy with our statistics.

  Mr Fowles: Yes.

  Q86  Lord Moser: I know from my days that they are pretty comprehensive, are they not?

  Mr Fowles: Yes, they are.

  Q87  Lord Moser: Here are you looking mainly to ONS or to the Department of Health for mental health data? That is not very relevant but it is interesting to me.

  Mrs Tyson: There are periodic surveys for the prevalence of mental illness and those are, as I understand it, run for us by the ONS, but mostly the statistical base that we use is the Department of Health's and the NHS's own.

  Mr Fowles: That, for example, gives us plenty of information to tell us whether we are meeting the World Health Organisation's Helsinki Declaration. Whatever questions they choose to ask us about that we will certainly have the information to be able to answer them.

  Q88  Earl of Dundee: Turning to promotion and prevention, might these really be best done by Member States themselves at national, local and sectoral level rather than by the Commission?

  Mrs Tyson: We do clearly believe that we should be carrying out our own mental health promotion and prevention activities to tackle the particular range of problems and causes in the particular context of this country, and clearly other Member States will feel the same, that they know their local situation best and can best carry it forward. Having said that, they are not straightforward activities and their effectiveness is difficult to track, by which I mean that it is difficult to know if you have prevented something, if you are being successful in your promotion activities. We are therefore very alive to the possibility that input from an EU strategy might help with our own national promotion and prevention agenda. This might be through further raising of the profile of mental health issues and the actions that people can take in their everyday lives to preserve and promote their own mental health. It might be through the sharing of good practice and we have got an example. There is a very helpful publication that accompanied the Green Paper called Country Stories and that had a collection of, as it says on the tin, stories about successful activities around promoting mental health from different Member States. That sort of thing is helpful. It can be a bit of a long and lonely hard slog in the world of mental health promotion and prevention precisely because it is difficult to point to something and say, "Look what we have achieved". A lack of something is difficult to evidence, and so evidence that you are not alone, that there are other people doing this and finding evidence that certain things succeed better than others in certain contexts that may be similar across different states, is always useful.

  Q89  Earl of Dundee: So you would like to see a joint effort, would you, between the Commission and Member States?

  Mrs Tyson: I would like to see whatever the strategy says supporting the idea that there is a Member State-specific lead to these activities because the context and the particular state of affairs with the Member States' populations are unique but I would like to see more of the sharing of things that have worked between Member States and more sharing of evidence about prevalence and what we know about the causes and the possible prevention of those things.

  Q90  Earl of Dundee: These differentials are really rather obvious. One would not expect the Member States to be party to something where the Commission rode roughshod over that. Would you agree?

  Mrs Tyson: Indeed, yes.

  Q91  Earl of Dundee: So it will fall into place on its own and that will be satisfactory?

  Mrs Tyson: If that was the case I think we would not need to be paying the attention that we are, but we are. We do not perceive it as an imminent large threat but we will be looking in our support for ministers and how they react to this to see that that is precisely how this fits in.

  Q92  Baroness Greengross: It is extremely interesting to hear about the platform and the close working relationships at different levels but, perhaps particularly in the area that Mr Fowles covers, legal instruments legislation can do an enormous amount and if we are to have a lasting effect in these very difficult areas is there a need for some legal instruments or at least regulations and, if so, what sort of thing do you envisage?

  Mrs Tyson: We have a bit of difficulty with this question. We do not think that the strategy, when it comes, will be the sort of thing that ends up being enacted through legal instruments at all. We just do not think it is that kind of thing. I believe there is something called a Council recommendation which is a sort of one-star "It would be a jolly good idea if you did this, chaps", and we think that there might be some areas where that sort of thing is developed.

  Mr Fowles: The Green Paper itself says that it is difficult to come up with a one-size-fits-all solution and, as I understand it, legislation would be an attempt at the one-size-fits-all solution that we do not think would work.

  Q93  Baroness Greengross: But you will use the Human Rights Convention and so on and the legislation there to implement whatever is recommended, will you?

  Mrs Tyson: Indeed, and a country's own mental health legislation where it exists.

  Q94  Lord Colwyn: I want to move on to attitudes to mental health. I am sure that you would agree that many people with mental health problems also have a range of other health conditions and care needs, and the media are widely to blame, I think, for implying a link between violence and mental health conditions which I imagine probably does lead to some form of discrimination. We are aware of the Department's five-year shift programme to tackle stigma and discrimination. Can you say whether this EU Mental Health Strategy is going to be utilised and will do any more to overcome a change in attitudes to mental health, and also could it cover the problems faced by the learning disabled?

  Mrs Tyson: My answer to this is going to be very similar to my answer to the question about mental health promotion and prevention in terms of describing what we think the contribution of any new strategy will be. It is about further raising the profile and the more that can be done to give a high public profile to the ways in which people who have suffered or are suffering some form of mental health problem, the difficulties that they have even when they are recovered, picking up the pieces of their lives and regaining employment, fitting back into their communities and where this is ascribed to discriminatory attitudes through the media, by employers and in people's own communities then I think the more fuel that can be added to that fire the better and so I would welcome what an EU strategy had to say about this as a significant barrier to people regaining the running of their normal lives. I would say again that tackling stigma and discrimination, like prevention and promotion, is a very difficult thing to do, so again all the help and all the learning that we can get (and I am aware that there are other countries that have tried different approaches and have had differing degrees of success), any information sharing, good practice sharing, platform and facilitation that we can have through the EU Strategy and in other places will be extremely welcome. There is a small and growing body of expertise on what works, but it does need nurturing and helping by contacts. It is also clear that this is not something that the health sector can do on its own. You will know that there is a Government strategy called Health, Work and Wellbeing which brings together the Department for Work and Pensions for the benefits end of things, the Health and Safety Executive for support to employees in the workplace, and the Department of Health. Ministers also launched the Action on Stigma campaign on World Mental Health Day last week, which again seeks to engage major employers, starting with NHS employers, in helping to tackle this together.

  Q95  Chairman: That was what we thought, did we not?

  Mrs Tyson: We should get our own house in order first!

  Q96  Chairman: Several minds are thinking alike on that one!

  Mrs Tyson: Looking wider, we have a national social inclusion programme as part of the mental health programme and that is based on the work of the Social Exclusion Unit in 2003. It involves folk from a lot of government departments and delivery agencies, local government, housing, DWP again, the Home Office around homeless people, offenders, asylum seekers and so forth. The EU does work in this way and we talked earlier about it being a cross-sectoral organisation, and so it can, for instance, very powerfully bring their employment spokesperson to things that look at first sight to be a health event and, both through encouraging by example and through simply the knock-on effect of, "Oh, the employment spokesperson is there; the employment people had better come and join the discussion", can be quite powerful in helping that sort of cross-sectoral effort. I have not talked about your learning disability point. When we think about the practical things, the strategies that might be employed to tackle stigma and discrimination, those might well look very similar for whatever group of people it is that is being stigmatised and discriminated against, but I do think it probably is not fair to lump together with a learning disability or other sorts of disability a group of people with mental health problems because I think their particular concerns and some of the specific ways in which they experience difficulties in integrating into communities and taking up employment again are sufficiently different and individual that they need a separate approach. There is practical use in making sure that lots of work does not go into reinventing the same sorts of strategies that are at a process level but we must be alive to the different concerns of different groups of people.

  Q97  Lord Colwyn: I must say I am attracted by the view of professionals being available in places like churches or council leisure centres, libraries, et cetera, and I am sure you probably agree with that. Anyhow, the two of you agree that the strategy will work, are you?

  Mrs Tyson: Absolutely, yes.

  Q98  Chairman: One of the things which always concerns me is that employers do not seem to see the value of early approaches to people who are obviously having health problems of any kind. If you have trained somebody to do whatever job it is you would have thought that you would want to notice straightaway if there was something wrong so that you could deal with it with the minimum amount of disruption in the workplace, leaving out anything charitable, nothing to do with that, but the sheer practical reason for doing that. Do you think that kind of topic is going to get spoken about in the context of this exchange of information and better practice and so forth? I am going to leave the next question as it comes into what Lord Harrison wants to say, but I just wondered whether you felt that that was something you could get at through this process we are just starting now.

  Mrs Tyson: Through the process with the EU strategy?

  Q99  Chairman: Yes.

  Mrs Tyson: I think it will, and it will be part of what we in the UK, in England, will want to bring to the discourse. You will know about the work led by Lord Layard around identifying relatively cheap and simple interventions that can help people not only get back to work but also stay there and work through a wobbly patch in the first place. On the back of that we are pursuing some demonstration work to show how that can be done in the context of local services and with real people rather than on the basis of an economic model, and that is indeed showing that part of the enormous benefit of this is that it can be used to stop people from having to leave work in the first place, that you can pick up these early signs, you can offer help in a non-stigmatising way and people can be supported and continue working. The Health, Work and Wellbeing Strategy also, through engagement of the Health and Safety Executive, does aim to do more for helping people to handle workplace stress, so we will certainly be bringing those pieces of evidence to the discourse and we would expect a number of other Member States to be doing the same sorts of things.

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