Select Committee on European Union Fourteenth Report


CHAPTER 4: The added value of an EU mental health strategy

What an EU strategy would set out to achieve

71.  The Green Paper proposes[31] that the priorities of an EU strategy could be:

(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.

72.  In pursuit of these priorities the Green Paper identifies[32] a number of initiatives for action:

(a)  Promoting mental health and addressing mental ill health through preventive action;

(b)  Promoting the social inclusion of mentally ill or disabled people and protecting their fundamental rights and dignity;

(c)  Improving information and knowledge on mental health in the EU;

(d)  Launching an EU-Platform on Mental Health;

(e)  Developing an interface between policy and research on mental health.

73.  The Commission Green Paper states[33] that the legal basis for EU action on mental health is provided by the EU's Public Health Programme 2003-2008. This is based on Article 152 of the Treaty establishing the European Community which states that "Community action in the field of public health shall fully respect the responsibilities of the Member States for the organisation and delivery of health services and medical care." The Community has an awareness-raising and co-ordination role in addition to the obligation to ensure a high level of human health protection in the definition and implementation of all Community policies and activities.

74.  In relation to the aims set out in the Green Paper on the issue of EU competence in this area, Ms Rosie Winterton MP, Minister of State for Health Services, stated that "… legislation is not generally considered to be something that we would want to be particularly tied to at a European level because we do want to make sure that we have the ability to decide our health systems, particularly because of the uniqueness of the National Health Service." On the other hand, she added, "The platform for exchange of ideas will act … as a kind of stimulus for people to be able to go back and say, 'This is what is available, how can we look to copy these?'" (Q 248).

75.  In responding to the Commission Green Paper, the Government took the view that the priorities identified were sufficiently broadly defined in order to allow for local variations in emphasis; and that the actions identified arose naturally from those priorities (pp 30-34).

76.  Mr Jurgen Scheftlein (EU Directorate General for Health and Consumer Protection) reassured us that the Commission's work in developing a strategy was within the scope of areas in which it had competence to act, in particular (Q 2):

  • promotion and prevention;
  • supporting vulnerable groups;
  • information and research; and
  • addressing discrimination and stigma.

77.  Mr Scheftlein also emphasised that the issues relating to mental health cover many different areas within the Commission's competence including: health; employment; social affairs; equal opportunities; and research and information. The Green Paper was intended to stimulate a consensus among EU Member States about how the Commission's actions in these areas could best contribute to the WHO Declaration's objectives (Q 2).

78.  Mr Scheftlein anticipated further that the Commission's involvement in a mental health strategy would have the role of helping to develop agreement about the importance of positive mental health programmes among stakeholders in the fields of education, employment and the general community (Q 18). He expected it would include mechanisms for collecting and making available information, for stimulating understanding of the issues, for sharing information and for encouraging the development of a consensus about best practice (Q 34). A similar view was expressed by the Royal College of Psychiatrists who supported the plan for a single integrated and coordinated strategy as set out in the Green Paper, stating that this should avoid the risk of separate, independently generated projects giving incoherent coverage of the issues (pp 161-164).

79.  Mr Scheftlein explained that the EU's role in taking forward the strategy would be to bring together people from a number of relevant backgrounds in order to share information and best practice. Participants would be invited from: the economic world; the health profession; the social field; and from civil society. Representatives of the WHO would certainly be involved, in partnership, but the Commission would be the "owner" of this platform or forum process. The Commission wished to a launch this approach, in 2007, to replace the former working party on mental health. He saw this as the principal Commission structure for the implementation of an EU strategy on mental health (Q 26).

80.  Dr Matt Muijen (Regional Adviser for Mental Health at the European Region of the World Health Organization) confirmed that the Commission had made great efforts to involve the WHO in the development of the ideas set out in the Green Paper (Q 198).

81.  Mr Scheftlein explained that most of the areas of activity in the strategy proposed were outside the mandate for legislative action of the Commission. It might focus on such activities as producing recommendations (in the sense of encouragement), promoting the exchange of good practice and helping to develop better technical and statistical bases of information. He suggested that a platform would have value as a means of improving understanding and of developing a consensus around these issues (QQ 28-31).

82.  Mr Scheftlein's view was that the Open Method of Consultation (OMC) was not an instrument that would be used either as part of the mental health strategy to gather information and exchange best practice, or in the policy context generally. His view was that, while OMC was an effective tool, it required a lot of resource investment, so that the "looser" approach of the platform would be preferable (Q 24). He explained that the platform approach would allow for the involvement of other relevant areas of the Commission than health, for example DG Employment. He envisaged that meetings could take place once or twice a year and could be used to monitor progress in implementing elements of the WHO Helsinki Declaration (Q 27).

83.  A number of witnesses lent their support to the view that the Commission's platform process should, and probably would, encourage cross-Directorate discussion and collaboration within the European Commission, just as cross-ministry collaboration was essential to the successful prosecution of good mental health policy and practice within Member States. Officials from the Department of Health commented that, by bringing in non-governmental representatives, the platform would help to ensure a focus on the needs of real people (Q 79). Mr John Bowis MEP took a similar view of the advantages of involving non-governmental organisations in discussions, but added that it was insufficient just to share good practice. His view was that the platform discussions needed to generate plans for further action (Q 115).

84.  Mr McDaid (London School of Economics) commented that the value of an EU Platform on Mental Health would depend a lot on whether or not there were good links between those working on the platform and those people who actually influence policy in Member States. He thought it important that all stakeholders should take part and that, where necessary, practical difficulties relating to the funding of attendance expenses should be addressed in order to facilitate good attendance (Q 71).

85.  Asked about the suggestions in paragraph 6.2 of the Green Paper[34] that possible initiatives within the EU strategy might relate to social inclusion and also the Fundamental Rights Agency,[35] Mr Scheftlein replied that, on social inclusion, the Commission would not wish to take action separately from that already being taken forward by DG Employment. The contribution of the strategy could be to stimulate work with DG Employment to add a greater dimension to the Commission's existing social inclusion work relating to mental health issues (Q 33).

86.  Mr Scheftlein explained that the idea put forward in the Green Paper was that the Fundamental Rights Agency might be a place for the collection of information about conditions in psychiatric institutions across the EU. He did not envisage the development of legally binding, or even harmonised, minimum standards on human rights in health care. He did, however, envisage that good guidelines might be developed for health promotion and quality management in mental health institutions (Q 33). We return to the question of minimum standards or guidelines in chapter 9.

87.  Mr Scheftlein agreed: in summary, he envisaged action at the Community level taking place in the fields of:

  • stimulating understanding which would result in action among practitioners;
  • providing and collecting data;
  • raising awareness on the basis of new data; and
  • exchanging best practice.

He hoped that the functions of consensus building and monitoring actions could also form part of the implementation of the strategy (Q 34).

88.  The Commission's summary of responses to its Green Paper was published on 19 December 2006.[36] Some 237 responses were received, of which the majority supported the development of a comprehensive mental health strategy. Respondents advised that the emphasis be put on mental health promotion and prevention, as well as on enhancing the situation of those with mental health problems through reducing stigma and discrimination.

89.  Differing views were expressed by witnesses about whether the proposed platform approach would give sufficient opportunity for mental health service users and carers to participate in discussion about the development of policy and practice. Broadly speaking, however, there was support for the view that the proposed mode of working should provide an opportunity for service users and carers to be involved. Mrs Alexandra Burner from Rethink commented to us that she felt that the EU platform that was proposed would be a useful mechanism for giving service users and carers a voice within Europe (Q 159). She took the view that it would provide an important single point of access to information about service users and carers, and to information from service users and carers as well (Q 167).

90.  Dr Marcus Roberts, from Mind, also supported the proposed platform approach and added that, although there was a lot more to learn in the UK and there was a long way still to go on user involvement, the UK could play a part in sharing good practice across the EU relating to the involvement of service users and carers in mental health issues, largely because the work of organisations like Mind and Rethink was quite well developed in this area (Q 167).

91.  We recognise that the question of EU competence regarding mental health matters is complex, given that mental health impacts upon a range of policy areas. We recommend that careful consideration be given to this matter before the adoption of any measures at EU level.

92.  Our view is, however, that the platform or forum approach set out by the Commission should be supported because of its inclusiveness, transparency, engagement with service users and other relevant stakeholders. This could add value by co-ordinating Member States' actions and by assisting in the exchange of best practice across the EU. We emphasise that the wide-ranging impacts of many mental health problems make it imperative that there is collaboration between different parts of the Commission, just as there needs to be cross-ministry collaboration within Member States.

How the EU's role differs from that of the WHO

93.  In relation to the interaction between the roles of the WHO and of the Commission in the field of mental health, Mr Scheftlein explained that, following the Helsinki Conference, the WHO, the Council of Europe and the Commission were meeting regularly to coordinate their work and to work in partnership (Q 6). In broad terms, the WHO had the role of advising Member States on issues of health care and treatment, the Council of Europe worked on human rights aspects and the Commission's role focused on information collection and provision, and the development of a consensus on policies for the promotion of understanding about mental health and for the prevention of mental ill-health (Q 9).

94.  The Government's view (pp 30-34) was that an EU mental health strategy would have potential for added value in the areas of:

The EU strategy should have the aim of providing practical support to Member States for implementing the WHO Helsinki Mental Health Action Plan.

95.  Professor Thornicroft (Consultant psychiatrist at the South London and Maudsley NHS Trust) supported the need for European Commission involvement in the field of mental health, which he thought would complement rather than duplicate the role of the WHO. He put forward two main reasons. First, that the WHO European Region had a much wider coverage of countries than the EU—53 as against 27—and that its focus was necessarily on the most deprived and underdeveloped countries, many of them in central Asia. Second, that the WHO's resources were limited so that the number of staff in its mental health office was small and it did not have the capacity needed (Q 40). Dr Matt Muijen, who welcomed the Commission's role in formulating a strategy for mental health in Europe, identified a third reason why the Commission's and the WHO's roles in this area were complementary rather than overlapping. The WHO had a broader health mandate than the EU, and could provide technical support to countries as they sought to develop their health systems and services (Q 198, pp 86-87).

96.  Mr McDaid (Mental health policy analyst at the London School of Economics) agreed: the proposed Commission role was complementary to that of the WHO. In addition to the points made by Professor Thornicroft, he noted that the remit of the Commission across a number of policy areas added a dimension not provided by the WHO. Examples where the WHO could not have a locus but the Commission could were (Q 41):

  • ways and means of integrating individuals back into the community (following mental health problems);
  • the promotion of good health in the workplace;
  • the protection of the health of vulnerable people returning to the workplace;
  • access to housing, discrimination, education; and
  • support for carers.

The Minister also saw the benefits of complementary WHO and Commission roles in this area (Q 226).

97.  We conclude that, given the wide impact of mental health problems on many aspects of an individual's life and on many different service-providing and other sectors, the Commission's areas of competence and interest in relation to a mental health strategy would complement the specific expertise of the WHO. Moreover, we recognise that because mental health is not just a medical issue, but also a social issue and economic issue, it is important that the strategic agenda is not seen as solely the preserve of health ministries, nor that the international agenda is solely the preserve of the WHO.

98.  Our view is that, for promoting better mental health and delivering better services, there is an important role for the EU, with its breadth of competence and interests, alongside the more specialised roles of the WHO and the legislative and policy-making responsibilities of national governments.


31  
op. cit. p. 80 Back

32   op. cit. ps. 8-13 Back

33   op. cit. p. 6 Back

34   op. cit. ps. 11-12 Back

35   Established by Council Regulation (EC) No. 168/2007 of 15 February 2007 establishing a European Union Agency for Fundamental Rights [2007] OJ L53/1. Back

36   See Responses to the Commission Green paper-http://ec.europa.eu/health/ph_determinants/life_style/mental/green_paper/mentalgp_report.pdf Back


 
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