Select Committee on European Union Fourteenth Report

CHAPTER 1: Setting the Scene

"Improving the mental health of the population": can the European Union help?

The purpose of our Inquiry

1.  It is time to bring mental illness out of the dark corners where it has for too long been consigned by fear, prejudice and ignorance. People with mental health problems should be helped to participate in society as fully as they are able, including in employment. This is, however, a major long-term task requiring sustained political determination and a clear sense of priorities.

2.  We welcome the attention to mental health across the European Union (EU) generated by the European Commission's Green Paper—"Improving the mental health of the population: Towards a strategy on mental health for the European Union". Our Report, which brings together a wide range of evidence on the Green Paper, is intended as a contribution to raising the public's awareness and knowledge of some of the issues involved.

The human and economic costs of mental ill health

3.  The Commission report recent estimates that one in four adult Europeans experience a mental health problem in any one year, often as a result of an anxiety disorder or depression. Emotional and behavioural problems are also highly prevalent among children. For many, the impact on their quality of life will be enormous, affecting their ability to function, their personal relationships and social roles, their work and incomes, and their very sense of self. An extreme consequence is that, across the European Union, some 58,000 citizens each year commit suicide, a number that is greater than the annual death toll from road accidents. Many other people deliberately harm themselves. In addition, because mental health problems may last for long periods, they can take a tremendous toll on the emotional capabilities and economic circumstances of relatives who care for those affected.[1]

4.  The impact on the EU economy of mental ill health is estimated to be equivalent to a reduction of 3% to 4% of total GDP.[2] In the United Kingdom alone, mental health problems are estimated to cost over £77 billion every year through the costs of medical or social care, production output losses, and a monetary valuation of the intangible human cost of disability, suffering and distress.[3] A mental health problem is now the most common reason for someone claiming Incapacity Benefit in the UK: the number making claims for benefit because of stress has trebled in ten years.

5.  Among the most challenging consequences of mental health problems are the ways in which society reacts and responds. While a person with a problem of physical ill health is usually regarded with sympathy, someone with a mental health problem may experience ridicule, prejudice and discrimination. The stigmatisation of mental illness can lead to social exclusion, and may sometimes prevent people with a mental health problem from seeking help for fear of being labelled. In many countries, basic human rights are denied people with mental health problems, not least the right to live in community settings. Compulsory treatment remains a highly controversial issue. In many European countries, both within the European Union and outside it, there are large numbers of people hidden away—often locked away—in remote, run-down, under-staffed asylums.

6.  Another major challenge across the EU is the widespread under-recognition of mental health problems, and consequently their under-treatment. Stigma may discourage individuals from seeking treatment, and family shame may hinder referral of a loved one. Primary health care staff may not recognise the psychological problems that often underpin or accompany poor physical health. Even if they do, they may not have access to the kinds of treatment that are needed: under-resourcing of mental health care systems is a Europe-wide issue.

7.  The scale of these challenges varies markedly across the EU and in the wider Europe. Some Member States have made great strides to protect the rights of individuals with mental health problems, while others continue to discriminate in numerous and damaging ways. Countries such as Italy and the UK have closed almost all of their "asylums", moving the locus of care into community settings where individuals have a better chance to access integrated services and using inpatient beds in general hospitals for short-term treatment. But many other countries continue to incarcerate people for long periods with little hope of a return to an "ordinary" life; asylums accommodate large numbers of people in some Eastern European countries, but also in Belgium and the Netherlands.[4] In some countries, people with even quite severe mental health problems are supported in paid employment; while in most countries economic inactivity unfortunately remains the norm, with its attendant consequences for economic and social marginalisation. Some, but only a few, countries have recognised the value of mental health promotion and prevention, experimenting with a range of initiatives designed to stop the emergence of mental health problems in the first place or offering early intervention services at the first sign of need.

8.  Variations of this kind across—and indeed within—existing and potential future EU Member States have often prompted calls for action to eradicate undesirable patterns of treatment and experience for people with mental health problems. At the same time, such variations provide a building block for improvement, for across the EU there are copious examples of good practice from which others can and should learn.

9.  One further challenge warrants emphasis. Mental health problems, because of their chronic nature and breadth of impact, can have a substantial impact on many domains of an individual's life. They lead to multiple needs, and could in principle therefore elicit service responses from a number of agencies. The need for coordinated action is another pervasive feature across Europe. Most mental health systems have yet to respond adequately.

The WHO Helsinki Declaration and Action Plan

10.  In January 2005, the Office of the European Region of the World Health Organization (WHO) convened a Conference of European Health Ministers in Helsinki to discuss the issue of mental health problems across Europe (including Member States of the European Union as well as other countries covered by the WHO Europe Region). The outcome of the Conference was the endorsement by all the Ministers attending of a Declaration[5] recognising that mental health and mental well-being are fundamental to the quality of life and productivity of individuals, families, communities and nations, enabling people to experience life as meaningful and to be creative and active citizens. Ministers attending the Helsinki Conference also drew up a Plan for Action,[6] which is reproduced in Appendix 4 of this Report. They perceived that the task of coordinating EU-wide action in the areas identified would require the resources of the European Commission in addition to the much more limited resources available to the WHO Europe Region Office. They therefore included a request for support from the European Commission in the WHO Conference Declaration.

11.  We support the Mental Health Action Plan agreed by European Health Ministers at the 2005 WHO Helsinki Conference.

The European Commission Green Paper

12.  The publication of the EU Commission Green Paper in October 2005 was the first step in the Commission's response to the invitation from the Health Ministers of Member States to support the WHO Action Plan. The aim of the Green Paper was to launch a debate with the European institutions, Governments, health professionals, stakeholders in other sectors, civil society including patient organisations, and the research community about the relevance of good mental health for the EU, the need for a strategy at EU-level and its possible priorities.[7] In so doing, the EU set out to build on the political impetus created by the WHO's Helsinki Declaration to take much needed action in the mental health field. The case was put forward that the creation of a European Strategy for Mental Health could have positive benefits for the EU's strategic objectives of long-term economic prosperity and a better quality of life.

13.  In particular, the Commission proposed that the Strategy could focus on four aspects.[8]

(a)  Promote the mental health of all;

(b)  Address mental ill health through preventive action;

(c)  Improve the quality of life of people with mental ill health or disability through social inclusion and the protection of their rights and dignity; and

(d)  Develop a mental health information, research and knowledge system for the EU.

14.  The Commission argue that the establishment of a strategy at EU level could add value in a number of areas to the actions of Member States acting alone. There is, they argue, "widespread agreement that the human, social and economic dimension of mental health need wider recognition by policy makers and greater public awareness. Important initiatives are being taken at the level of Member States, the EU and the WHO".[9] The concept of an EU "Platform" approach is advanced for creating a framework for the exchange of information and development of best practice. It is envisaged that a wide range of stakeholders would be involved including: policy makers, professional experts from the health and non-health sectors, and patient and civil society organisations.

The conduct of our Inquiry

15.  The Members of our Social Policy and Consumer Affairs Sub-Committee (Sub-Committee G) who conducted the Inquiry, showing their declared interests, are listed in Appendix 1.

16.  Our Call for Evidence is in Appendix 2. We are most grateful for the evidence that we received in response to this; and we thank, in particular, those witnesses who gave us evidence in person. Those who gave us evidence are listed in Appendix 3, and the evidence we received is printed in Volume 2 of this Report.[10]

17.  We acknowledge with considerable thanks the expertise and hard work of our Specialist Adviser for the Inquiry—Professor Martin Knapp—who played a key role in helping us to prepare this Report.

18.  We make this Report to the House for debate.

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1   Commission Green Paper Improving the mental health of the population: Towards a strategy on mental health for the European Union: section 3 and Annex 2. Back

2   Mental health in the workplace: Introduction. Prepared by Ms. Phyllis Gabriel and Ms. Marjo-Riitta Liimatainen. International Labour Office, Geneva, October 2000. ISBN 92-2-112223-9 Back

3   Sainsbury Centre for Mental Health-The economic and social costs of mental illness in England, June 2003 Back

4   Knapp et al, editors, Mental Health Policy and Practice across Europe, Open University Press, 2007 Back

5   Mental Health Declaration for Europe: Facing the challenges, building solutions, WHO 2005 Back

6   Mental Health Action Plan for Europe: Facing the challenges, building solutions, WHO 2005 Back

7   op. cit. p.3 Back

8   op. cit. p.8 Back

9   op. cit. p.13 Back

10   In addition, a number of references are made in the report to documents which are not printed; these are available for inspection in the Parliamentary Archives (Tel. [phone]). Back