Memorandum by Rethink
1. Rethink is the leading national mental
health membership charity in the United Kingdom; supporting around
7,500 people every day of the year and working together to help
everyone affected by severe mental illness recover a better quality
of life. Our aim is to make a practical and positive difference
by providing hope and empowerment through effective services and
support to all those who need us. We believe that people who experience
severe mental illness are entitled to be treated with respect
and as equal citizens. We actively campaign for change through
greater awareness and understanding and we are dedicated to creating
a world where prejudice and stigma are eliminated.
2. Rethink believes mental health is a prerequisite
to achieving the strategic policy objectives of the European Union
because long term prosperity within the European Union rests on
the health and wellbeing of its citizens. Mental health is an
integral part of the overall wellbeing of individuals and communities.
As such Rethink, together with EUFAMI (European Union Federation
of Associations of Families of People with Mental Illness) wanted
to contribute to the European Union consultation process by gathering
the views of people who have experienced mental ill health, their
families and carers. We did this by creating an online survey.
The results of which have informed our response.
3. The concern for the European Union is
that mental ill health is becoming increasingly prevalent and
the consequences of developing a mental illness are far-reaching.
"Mental health problems are increasing significantly. Some
countries register up to 6 per cent of the population as having
serious mental disorders. Mental ill health accounts for up to
30 per cent of consultations with general practitioners in Europe."[1]
The increased prevalence of mental illness within the European
Union will have significant consequences for the Lisbon agenda
of improving the competitiveness of Europe within the world economy.
"Mental ill health costs the UK £77 billion a year through
the costs of care, economic losses and premature death."[2]
4. Any EU mental health strategy would sit
within the overall EU strategic objectives of prosperity, security
and solidarity. Thus, mental health should be integrated within
other work programmes. Embedding mental health issues within the
work of other departments is essential to ending the social exclusion
currently experienced by people with mental illness. This would
contribute to the work of the British governments' Social Exclusion
Unit and the Strategy Unit's aim of improving the life chances
of people with mental illness. This is particularly important
in the context of employment for people with mental illness. The
Department for Work and Pensions has outlined an ambitious programme
of work aimed at reducing the number of people receiving incapacity
benefit by 1million. Given that 40 per cent of Incapacity Benefits
claimants have a primary diagnosis of mental illness; it is essential
that employers' understanding of mental illness improves in order
to achieve this goal. An EU strategy could help to ensure that
mental illness becomes part of cross-European initiatives on employment.
5. An EU strategy would particularly contribute
towards the goals of mental health promotion and stigma reduction
expressed in Standard One of the National Service Framework for
Mental Health and the Shift anti-discrimination programme. Both
these goals require extensive cross-departmental working and an
EU strategy would help ensure that a coherent approach is taken
across all UK Government departments, especially the Department
for Education and Skills, the Department for Work and Pensions
and the Department for Trade and Industry as well as local government.
In bringing together people who access services and civil society
organisations, an EU strategy would help to embed mental health
within the culture of these organisations.
6. Finally, Rethink believes that the creation
of an EU strategy on mental health would help to ensure that research
priorities among the member states are better coordinated, that
good practice is shared more effectively and a wider evidence-base
for mental health interventions is built up. This will help to
ensure that assessment of mental illness, under Standard 2 of
the National Service Framework, is more effective and accurate.
It will also help to facilitate the provision of "care which
optimises engagement, anticipates or prevents a crisis, and reduces
risk" under standard three of the National Service Framework.
7. A European strategy for mental health
should address the following issues Unemployment, Poverty, Poor
physical health, Poor quality of life and Social exclusion to
build mental health into it's population.
8. Unemployment—Economic prosperity
within the European Union significantly relies on the health and
happiness of its workforce. The burden of mental ill heath has
a significant impact on the productivity of a country's workforce.
"People with long term mental health problems are less likely
to be in employment than people with other disabilities (21 per
cent compared to 49 per cent of all people with disabilities)."[3]
9. Though for some mental illness is a barrier
preventing them returning to, or gaining employment, the majority
of people with mental ill health wish to return to work. It is
necessary that the European Union ensures employers consider the
needs of people with mental ill health; principally the need for
ongoing support during occasional periods of illness or difficulty.
The European Union should actively encourage the employment of
people with mental ill health, should they wish to pursue employment,
particularly through initiatives such as flexible working hours,
part time work, job sharing, and voluntary work. The stigma and
discrimination of employers is a barrier to bring about social
inclusion of those with mental ill health.
10. Poverty and Social exclusion—Social
cohesion relies on the fulfillment of an individual's human rights
and the social inclusion of an individual as a citizen of the
European Community as well as community acceptance of individual
difference. People with mental ill health often express feelings
of isolation and exclusion from things such as employment, quality
housing, social networks and education. Some groups are more vulnerable
than others; particularly women who are single parents or experience
domestic violence, BAME (Black Asian and Ethnic Minority) groups,
the homeless and unemployed. Withdrawal from society, particularly
through unemployment has been closely linked to mental ill health.
"Social isolation is an important risk factor for deteriorating
mental health and suicide. Two thirds of men under the age of
35 with mental health problems who die (in the UK) by suicide
are unemployed."[4]
11. The stigma surrounding mental illness
often prevents people with mental ill health forming close personal
relationships, compounding their isolation. Social exclusion and
mental ill heath are a vicious cycle—each perpetuating the
other.
12. Poor physical health—Mental
health is fundamentally linked to physical health. "People
with severe mental illness die 10 years younger than the rest
of the population, not because of suicide or self-harm, but because
of physical health problems".[5]
Regular physical health checks can help tackle many of the physical
aliments that affect people with mental ill health. Many of these
physical ailments are the result of their medication.
13. Service users with severe mental illness
often cite improving the side effects of their medication as something
they would like to change. Continued investment in drug research
is necessary as part of a holistic approach to tackling the burden
of mental ill health on the Community.
14. It is necessary to ensure that primary
care workers are trained and have adequate resources to address
the physical needs of those with mental illness.
15. Poor quality of life—Poor
quality of life is a significant problem for people who have mental
health problems. Access to education, housing, transport, employment,
leisure facilities and social networks can vastly improve the
quality of life of service users.
16. Tackling the discrimination surrounding
mental ill health requires a concerted effort to uphold people's
human rights—particularly with reference to Article 14 of
the European Convention of Human Rights—the prohibition
of discrimination. Education can further awareness of mental health
and build mental health into society, thus easing the burden of
mental ill health on society.
17. And| Mental ill health not only affects
those who experience it but those who provide informal care for
them; their friends and families. "There are 1.5 million
carers in UK".[6]
Comparable data for other European Union Member States was not
available. Supporting these informal social networks is extremely
important, not only to create an atmosphere of social inclusion
for individuals experiencing mental ill health, but to ensure
that these informal networks are encouraged and maintained.
18. Support and acknowledgement is something
that carers often feel they lack. "1 in 6 carers have no
carers services in their area despite government commitments."[7]
Examining the needs of carers is as important as fulfilling the
needs of those with mental ill health. It must be recognised that
providing round the clock care and support has many impacts on
an individual's health and wellbeing. "Involved and supported
carers have a better experience and are more effective carers
than those who are uninvolved and without access to support and
information".[8]
Informal carers require better information, communication and
support. They must not feel excluded from the formal care system.
Informal carers need to be recompensed financially for their time.
Respite care for both informal carers and those with mental ill
health is a necessity. The European Union's strategy should include
recommendations for supporting carers
19. Rethink believes the European Green
Paper sets out a positive approach to tackling mental ill health
in Europe and that these solutions will have a great impact on
mental ill health across European Union Member States provided
they are accompanied by adequate funding and the mechanism to
distribute it. With regard to specific points Rethink would like
to highlight the following aspects which it feels should be prioritised.
20. Promoting the mental health of the
population—European Union wide public health campaigns
should be in line with other European Union health competencies.
Health promotion campaigns should not only focus on mental health
specifically but health and wellbeing in general. Health promotion
campaigns need to be locally and nationally based.
21. Addressing mental ill health through
preventative action—Preventative action and the dissemination
of good practice should be coordinated within the European Union
network. Of particular concern to us is developing and facilitating
good practice on issues such as cannabis and suicide interventions.
Though the paper expresses that "mental ill health"
will be addressed through preventative action the importance of
both proactive and reactive approaches to mental ill health must
be recognised.
22. Promoting the social inclusion of
mentally ill or disabled people and protecting their fundamental
rights and dignity—The promotion of mental health and
building mental health, through public education, into the European
Community is an important aspect of tackling both mental ill health
and the stigma associated with it. It is necessary to stress every
individual's right to good health.
23. The European Union should undertake
a broad piece of work on social inclusion, to promote the awareness
of rights under European Convention of Human Rights for all people
including those experiencing mental ill health.
24. Mental health service users do not only
require the protection of civil society. More importantly those
with mental ill health require empowerment. By enabling involvement
within society through correct medication, adequate support in
accessing services, and reducing barriers to accessing services,
not only in mental health services but all services, particularly
housing, education, those with mental ill health can be enabled
to participate within wider society. It is extremely important
to enable service users and carers' voices to be heard by involving
stakeholders who vocalise the needs of those involved. Bringing
together patient and civil society organisations will perpetuate
the building of long term solutions. Enabling participation, and
maintaining involvement, in society helps people with mental ill
health to remain active citizens.
25. Improving information and knowledge
on mental health in the EU—The European Union's desire
to confront mental health creates a considerable opportunity to
create a knowledge base that can communicate and implement `best
practice' within mental health. The European Union should give
priority to mental health research. Funding needs to be proportionate
to spending on other areas of public health.
26. Rethink considers a comprehensive European
Union strategy would add value to the existing and envisaged actions
and strategies of other Member States and international bodies
such as the WHO.
27. A framework to facilitate exchange and
cooperation between member states would aid the development of
research and investment in mental ill health; thus enabling the
European Community to tackle those issues most important to service
users and carers. This framework would be particularly of use
if it was accessible to both to mental health professionals, researchers
and mental health service users and carers. Accessible information
for service users and carers aids the empowerment of both groups.
28. Facilitating the increase in the coherence
of actions in different policy sectors is extremely important
namely because people experiencing mental ill health have a multiplicity
of needs—not only in terms of accessing the correct treatments
but also accessing the services they require to function as a
citizen within society including adequate housing and employment
services and education. Synergies need to be created both between
departments within member states governments, and between members
states themselves.
29. The paper does not explicitly expand
upon "mental ill health". Mental ill health has a variety
of forms and levels of severity. Mental ill health is also extremely
complex in its causes and outcomes. For example co-morbidity,
or dual diagnosis seriously impact upon mental ill health, either
by causing, or aggravating, mental health disorders. "Suicide
is the second most common cause of death after road traffic accidents
for Europeans aged between 15 and 35. Alcohol use and co-morbidity
heighten the risk of suicide".[9]
Rethink believes that the definition of mental illness should
clearly state the inclusion of personality disorders.
30. Though the paper mentions the link between
physical health and mental health, the connection should be expanded
upon, as physical health has an important part to play. Mental
ill health can be expressed through physical manifestations, particularly
stress. Improving the physical health of the population can impact
upon mental health and vice versa. It is important that co-morbidity
between physical health and mental health is recognized. "The
side effects of medication can have serious detrimental effects
on a person's physical health. Promoting healthy eating, regular
exercise and the use of complimentary therapies will impact significantly
on people's mental wellbeing and physical fitness."[10]
1 World Health Organisation. (2002). "European
Health Report." http://www.euro.who.int/document/e76907.pdf Back
2
The Sainsbury Centre for Mental Health, Policy Paper 3: The Economic
and Social Costs of Mental Illness. (2003) London, The Sainsbury
Centre for Mental Health. Back
3
Department for Work and Pensions 2001. Back
4
Office of the Deputy Prime Minister. (2004). "Mental Health
and Social Exclusion". Social Exclusion Unit Report Summary.
Page 3. ODPM Publications. Back
5
Harris, J (2006). "A win-win situation. Making life easier
for GP practices and people with mental illness." Page 1.
Rethink. Back
6
V Pinfold and P Corry. June 2003. "Who Cares? The Experiences
of Mental Health Carers Accessing Services and Information".
Page 2. Rethink. Back
7
V Pinfold and P Corry. June 2003. "Who Cares? The Experiences
of Mental Health Carers Accessing Services and Information".
Page 2. Rethink. Back
8
V Pinfold & P Corry. 2003. "Under Pressure". Rethink. Back
9
Jane-Llopis, E & Anderson, P. 2005. Mental Health Promotion
and Mental Disorder Prevention. A Policy for Europe. Nijmegen:Radboud
University Nijmegen. Back
10
Harris, J & Corry, P. 2005. Make a Fresh Start: An Action
Pack for the Forgotten Generation. Page 20. Rethink. Back
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