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:
- creating a framework for information
exchange;
- increasing coherence of action across different
policy sectors; and
- opening a platform for involving stakeholders,
including patient and civil society organisations.
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
