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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