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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