Select Committee on European Union Minutes of Evidence

Examination of Witnesses (Quesitons 100-110)

Mrs Kathryn Tyson, Ms Susannah Rix and Mr Jim Fowles

19 OCTOBER 2006

  Q100  Lord Harrison: Good morning to you all. I think you have been very frank in saying that you do not demonstrate any great knowledge of finding your way around the warren of EU business and the way things are transacted there, but, of course, the Committee is looking at this issue in terms of what added value an EU dimension can bring to this very difficult area. Doubtless when you first saw the Lisbon Strategy you wondered what that had to do with mental health but what I am sure you will deeply understand is the affliction that mental health has brought on people who are trying to lead industrious and proper, fulfilling lives, especially in the workplace. It is that area that I want to go into because I wonder whether you share with me the feeling that this area of the economic consequences of having good practice throughout the European Union, of vibrant and innovative mental health strategies, can bring in terms of the practical results of people being in their jobs and doing those very things that we want. What is the state of play at the moment in the discussions that you have, say, with business organisations, trade unions and so on to gauge what they feel about the importance or otherwise of having good policies for mental health? Do you see that there can be added value by having that European dimension so that we help to mobilise those who might otherwise be left on the sidelines because strategies which may have been successful elsewhere, which you talked about earlier, are not necessarily practised in this country or indeed in one of the other 24 countries of the European Union?

  Ms Rix: The first thing to say is that the link between economic prosperity and good mental health has been well made in the report on mental health from our Social Exclusion Unit. The European Union Commission asked a number of Member States to make contributions to the consultation meetings by offering a presentation on a particular innovation or the progress that was being made in an individual Member State. The United Kingdom was asked in particular to contribute to the programme for the second of the consultation meetings which was in Vienna in March and that was on the theme of social inclusion. At that meeting myself and another representative from the National Institute for Mental Health in England provided a presentation on that Social Exclusion Unit report on mental health. Our experience there was and has been at other times that that particular specific development in mental health policy in this country has been of interest to other Member States. Building on that, the Department of Health has agreed to develop a special document which will summarise our experience in England on social inclusion and the work so far to implement that report that can be disseminated through WHO Europe to other Member States as part of the work around the Helsinki Declaration. Looking at the responses that the European Commission appears to have received so far in response to this consultation on the Green Paper, it is interesting that the Commission does not appear to have received any direct responses from business or industry colleagues in response to the Green Paper other than perhaps the pharmaceutical industry, but perhaps the comment to make about that is whether or not those were sought.

  Q101  Lord Harrison: The pharmaceutical industry but not the actual employers which might benefit in the end—how interesting.

  Ms Rix: Yes. We have noticed that. Perhaps I can hand over to Jim to talk about our own experience.

  Mr Fowles: Perhaps our own experience here could be helpful to the strategy in terms of demonstrating that this sort of participation can happen and can work. The anti-stigma programme that we talked about earlier involves representatives from business as does work being taken forward to implement the Social Exclusion Unit's report on mental health. There is also a piece of work just beginning that Kathryn might have referred to earlier between ourselves, the Treasury and the Department for Work and Pensions on improving employment outcomes for people with mental illness, keeping them in work and getting them back to work more quickly than can happen now, and organisations like the CBI are deeply involved in formulating that policy. We can demonstrate precedents here domestically that might be of interest to a wider European strategy.

  Q102  Lord Harrison: So, to put words into your mouth, you can see how this would be an addition that could add value to the work that you do here in our country by having this EU dimension and that this is a question that we need to satisfy ourselves about here?

  Mr Fowles: Yes. The Green Paper recognises that, and in our conversations with the Commission this is another gap that they recognise needs to be filled. We all accept now that we cannot tackle all these problems from within the health sector alone. It is much bigger than that.

  Ms Rix: I attended a meeting with some presentations on tackling social inclusion around Europe and at that there were some interesting contributions on projects from Germany. I think there was one from a large car manufacturing company—it might have been VW, it might have been BMW, I cannot remember, but it was talking about a corporate response on mental health. Obviously, that could have wider benefits if that company has a base in the UK as well.

  Q103  Baroness Neuberger: I wish to declare an interest. I am an adviser to the trustees of the Sainsbury Centre for Mental Health, so I have been fairly involved in some of these issues over the years. I have to say I was slightly disappointed by your response to Baroness Greengross's question on legal instruments, particularly when you said that it is almost like a one-star piece of advice that might come out as opposed to using the directives or other instruments that are there. Our evidence suggests that the Green Paper is itself raising expectations of what could be done by setting some EU minimum standards and using obligations under human rights legislation and disability legislation, if you like. There are pretty good examples in this country under the disability discrimination legislation. I suppose the first question I would like to put to you is whether, given what you said before, the Government sees this kind of use of the human rights legislation, the fundamental rights perspective, possibly a European fundamental rights agency, as a desirable and feasible outcome of the strategy because so far you have not suggested that it does?

  Mr Fowles: First of all, I do not think there is anything wrong with raising expectations.

  Q104  Baroness Neuberger: I presume not!

  Mr Fowles: It is a necessary precedent to raising the quality of service and care, but I have to echo what Kathryn was saying earlier, which is that we do not expect this strategy document, when it appears, to add to the standards that you can argue already exist through mental health instruments like the Helsinki Declaration or human rights legislation or disability legislation. That is not to say that the strategy will not have a beneficial effect, as I say, by raising expectations and by giving more attention to the subject, and I think there are some precedents for Europe using structural funds to help improve mental health services but in the context of human rights rather than mental health or whatever. Recent funds have been used in Greece that have had the effect of improving mental health services but taken from the approach of human rights rather than a health service approach.

  Q105  Baroness Neuberger: One of the things that has been put to us is that in a sense raising expectations and using human rights legislation and fundamental rights thinking from that perspective could also have an effect on candidate Member States. Is that something as far as you know that the Government is keen on and would want to promote?

  Mrs Tyson: I do not feel informed enough to comment on that.

  Baroness Neuberger: That is fine. Thank you.

  Q106  Chairman: The scope of the strategy is something which people who have responded to us have spoken about at some length and people have suggested that there should be more emphasis on suicide reduction or young people or elderly persons or alcohol and drugs and other things. Spiritual needs, for example, comes in several times. Several respondents have urged more involvement of service users, so how might the strategy reconcile these claims and set sensible priorities, or is that suggestion slightly beside the point of the strategy as it is developing?

  Mr Fowles: The Green Paper sets four broad priorities which we express support for in our response and those are to promote good mental health, to prevent mental ill health, to promote social inclusion and to develop a better information system, and we feel that that is as detailed as a strategy needs to be, the priorities you were just talking about, and we can point to activity in every one of those within the UK and they are all entirely consistent with the Helsinki Declaration. Our approach is that Member States will have their own differing priorities depending on their starting position and it is the job of a strategy to support Member States in delivering those priorities insofar as they are consistent with Helsinki and other existing practice. We do not think it would be helpful for a strategy to try and set that level of detail of objective for Member States.

  Q107  Chairman: I think probably we are rather glad that that was the answer you gave because when we first tackled this paper we were deeply concerned that we might get ourselves bogged down in different professional views as to what the best treatment was for A or B aspect of mental health. We simply feel ourselves competent to—well, some of us are competent, as you have seen, but most of us are not competent to deal with that sort of subject. Some of us are greatly above our pay grade, not just slightly. The sorts of things you have been talking about are much more accessible and indeed important in terms of the development of the European Union and our scrutiny of what goes on during that kind of process.

  Mrs Tyson: If I could just add to the answer, I do think it might well be helpful if the strategy could make it clear that it was concerned about mental health as it manifests itself in all of these sorts of areas, really reminding Member States that there are mental health issues pervading a lot of other aspects of the care of their population.

  Q108  Chairman: I think that is absolutely right. It is when we got down to detailed consideration of the correct treatment for A or B that we felt we might be getting rather lost in that whole area. Mr Scheftlein told us that he was expecting to publish an analysis of the responses to the Green Paper in the autumn and proposals in the spring. What is the Government's latest information about the Commission's plans and when do you expect the Commission's proposals to be published, and how soon after that do you foresee the need for the Council to take a decision because in the end there will be a Council of Ministers decision? I wondered if you had an idea of how that programme was likely to develop.

  Ms Rix: Our latest information from the European Commission—I think you heard this from Jürgen Scheftlein—is that they received a lot more responses than they originally anticipated in response to the consultation, so it has taken a little longer to work through them than they originally planned. At the moment they are working through those and they are expecting to produce quite a high-level analysis of the main themes of emerging consultation and they think that might be available in November. Apparently that is currently in production and they have had some assistance from Finland, I think, in producing that. The European Commission have also told us that they will be conducting something called "an impact assessment exercise" on the Green Paper and we are told that this is a standard procedure which has two aims: first, to consider the effects of policy proposals in their economic, social and environmental dimensions and, secondly, to try to simplify and improve the regulatory environment. This assessment will consider the impact of the policy at both EU and Member State level and its aims are to try to consider whether there is a need for strategy at EU level at all. Following that impact assessment exercise the Commission say that they still expect to publish their proposals in spring 2007 and you would expect that then to be considered by the Council shortly following that.

  Q109  Chairman: Thank you, that was very helpful. Is there anything that you have not said which you came here wanting to say? I always think I do not want to miss the thing when someone said, "You must tell them this", or, "You must express a view on that".

  Ms Rix: Maybe one. One of the points that we took pains to make at the consultation meetings was to urge the involvement of service users and carers in the meetings. At the consultation meetings I think the most moving part for me was hearing the experience of an Austrian service user who really was able to make people laugh and cry in the space of 10 minutes and that was a very consistent theme that might not be explicit in this document but certainly was a very live issue at the meetings that I attended.

  Chairman: Thank you very much for that, and thank you for being with us. I think you did say you would send some additional information?

  Q110  Lord Harrison: Could I just say on that last point that was made and also the earlier point about the German car manufacturer that it would be very interesting to have some of those examples if you have got them ready to hand just to give us an idea of what might be done in a practical way.

  Ms Rix: Okay.

  Chairman: I think that you felt you might have some additional information for Lord Moser on the information collection issue, so we look forward to seeing that. As I say, thank you very much for being with us, all three of you, and assisting us in our inquiry.

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