Examples of good practice
219. Examples and case studies provided to us
cover a variety of activities and initiatives. Dr Muijen
referred to posters on buses in France that said "Your neighbour
may suffer from mental illness", but he was not sure whether
this was helpful or not. He was positive about activities in Greece
where famous singers and other "champions" of mental
well-being were involved. He referred also to initiatives in Finland,
the Netherlands and Scotland, but effective evaluation had not
taken place (Q 210).
220. Mr Scheftlein, Mr Bowis and Ms
Parker, among others, emphasised that efforts to counter stigma
would help to encourage people to refer themselves or their relative
for treatment at the early signs of a mental health problem, rather
than allowing the problem to develop into something more serious
that was not only much more distressing but might also require
more drastic (and more costly) service responses. Similarly, improving
"mental health literacy" among the general public ought
to improve early recognition of symptoms, and so should have preventive
benefits (QQ 13, 112, 182).
221. The Mental Health Foundation argued that
investment in early detection and early intervention services
appeared (from UK evidence in one or two areas) to pay dividends
in terms of health, quality of life and cost-effectiveness. They
also referred to whole-school approaches to mental health promotion,
aiming to reduce bullying in schools, providing universal support
to parents and mechanisms to monitor progress on promoting children's
mental health. The Foundation advocated less reliance on medication
and more attention to be paid to identifying effective ways of
building resilience (pp 140-144).
222. Mind told us that in Estonia, an attempt
was made to encourage local communities to be more welcoming of
people with mental health problems by screening the film A
Beautiful Mind (Q 161). The International Longevity Centre
UK sent us information that in Denmark, the Danish Mental Health
Fund had experimented with a "Happy Bus", providing
full educational facilities, including internet access. A mobile
unit went around the community and targeted children and young
adults. They described "Mindfull", a project promoted
by STAKES, the Finnish National research and development centre
for welfare and health, which demonstrated the power of good information
in raising awareness and understanding of severe mental health
problems and their treatment (pp 120-123).
223. A number of witnesses described how programmes
such as Mind out for Mental Health, Shift (in England)
and See Me (in Scotland) provide examples that are making
a positive impact. The Minister, Ms Rosie Winterton MP, pointed
to some of the real successes in the five-year Shift programme.
She thought a lot of the work with the media had been quite successful
and some of the BBC campaigns targeted at young people had been
effective (Q 237).
224. Action is also needed outside the mental
health system. Among the areas mentioned were: urban improvements;
housing; employment opportunities; skill development; physical
activity; investment in social capital; and healthy workplaces.
The European Public Health Alliance pointed out the link between
good nutrition, physical activity and mental health (pp 115-117).
Mind informed us that there was growing empirical evidence that
participation in physical activities, such as walking and conservation
work, could have substantial mental health benefits (pp 54-60).
225. The encouraging work undertaken by big employers
like Royal Mail and BT to give advice to managers to be more open
about mental health issues was also mentioned by the Minister.
Such initiatives could help to reduce the embarrassment and counter
the stigma associated with mental health problems. These companies
had sought to create environments that positively influenced the
mental health of their employees. The Minister questioned whether
major national campaigns were as effective as smaller efforts
to tackle what was happening to people in their everyday lives,
particularly in the workplace. She drew attention also to workplace
mental health promotion efforts in Spain and France (Q 237).
226. Mr Jurgen Scheftlein (Q 19) referred
to "corporate social responsibility", which he saw as
an avenue for spreading information about good practice and involving
companies in mental health promotion. Mr Muijen explained
that there was technical evidence that certain ways of working
and the workplace atmosphere can be directly inimical to mental
well-being (Q 207). Mr McDaid told us that the Boeing
Company's long-standing programme on promoting mental as well
as physical health has apparently shown some good outcomes (Q 66).
227. Mr Jurgen Scheftlein described how
the European Alliance against Depression (EAAD) had sponsored
the establishment of regional networks of information-sharing
among different sections of the communitymedia, teachers,
priests, police and doctors. This had apparently resulted in some
pilot projects reporting a 25% reduction in suicides and suicide
attempts. Effective promotion and prevention campaigns did make
people understand and helped them to seek medical care (Q 13).
228. The Citizens Advice Bureaux report published
in April 2004, Out of the Picture, highlighted problems
resulting from an interaction between debt and mental illness.
This motivated the International Longevity Centre to produce a
film and training materials entitled Money Worries to improve
the advice and support offered by finance providers to those with
mental health difficulties and debt problems (pp 120-123).
229. Evidence from Mr McDaid and colleagues
from the London School of Economics noted the use of parent training
programmes and interventions for the early identification of mental
health problems in schools, as well as bereavement counselling
and social activities to reduce isolation and the risk of depression
in older age (pp 10-12).
230. Rethink told us that informal carers often
needed better information, communication and support and that
it had been reported that informed, involved and supported carers
had a better experience and were more effective carers than those
who were uninvolved and without access to support and information.
Targeting informed carers in such a manner significantly reduced
the risk of developing depression and suicidal tendencies (pp 60-63).
The International Longevity Centre described an example of this
approach in Poland, where priests working with carers in innovative
partnerships had been able to reduce the number of suicides. The
ILC gave details of a number of training programmes for carers
across Europe (pp 120-123).
231. Promoting public understanding of mental
health problems would help to change the way the public perceive
those affected by such problems, particularly if the policy aim
is to integrate people in the community. For example, Mr John
Bowis MEP described the case of a woman who was concerned about
her mentally ill neighbour living alone, but then felt reassured
because of information campaigns and knowledge that she could
approach relevant agencies to seek out help for her neighbour
in times of need (Q 127).
232. We have been impressed by the many examples
of good practice in mental health promotion and prevention, both
in the community and in the workplace, that have been drawn to
our attention in this inquiry. We support the Commission's proposals
to encourage Member States and employers to learn from such examples
and to recognise the benefits of adopting such an approach.
Sharing good practice
233. It was not possible for us to judge whether
initiatives based on the examples of good practice described to
us would indeed prevent mental health problems from emerging,
delay onset of symptoms or improve quality of life for individuals,
families and communities. It would be important, however, for
the Commission and national governments to encourage the sharing
of experience that was, as far as this can be ascertained, of
proven benefit. As Mr Scheftlein remarked, the European Commission
was funding the Mental Health Economics European Network which
was currently gathering evidence on mental health promotion and
prevention from 32 countries, looking especially at early childhood
interventions and the workplace (Q 19).
234. Department of Health officials noted that
there was a very helpful publication that accompanied the Green
Paper, Country Stories, that collected stories about successful
activities around promoting mental health from different Member
States. Mrs Tyson, one of the DH officials, argued that the
UK should be carrying out its own mental health promotion and
prevention activities to tackle the particular problems that arose
in the particular context of this country. She expected other
Member States to have the same view. In the same way as other
witnesses, she referred to the difficulty of identifying whether
a mental health promotion initiative had indeed been effective
235. Consequently, Mrs Tyson noted that
the Department of Health was alive to the possibility that input
from an EU strategy might help with the UK's own national promotion
and prevention agenda. This might be by raising the profile of
mental health issues and the actions that people could take in
their everyday lives to preserve and promote their own mental
health. It might be through the sharing of good practice (Q 88).
236. We support the Commission's proposal
for sharing good practice across the EU, and indeed more broadly,
and we believe it would be helpful for the Commission and/or the
WHO to take responsibility for the collation of these examples,
with the help of national governments. Those examples should be
of proven effectiveness.
53 A policy framework for the promotion of mental health
and the prevention of mental disorders, in Knapp M, McDaid D,
Mossialos E, Thornicroft G (eds) Mental Health Policy and Practice
across Europe, (2007) Open University Press, pp. 188-214). Back
Mental Health and social exclusion. Social Exclusion Unit
Report, June 2004 Back
op. cit. p.8 Back