Minimum standards or guiding
289. Our witnesses suggested two principal means
of addressing these inter-country differences; in particular to
help eradicate unacceptable policies and practices:
(a) a set of minimum standards that each Member
State would be required to achieve; and
(b) a set of guiding principles which each Member
State would be asked to agree.
Under a), the Commission's role would be to regulate;
under b), the role would be to advise, guide and occasionally
290. Mr Jurgen Scheftlein of the Commission
explained the thinking behind the drafting of the Green Paper.
One idea was to use a vehicle such as the Fundamental Rights Agency
as a means to collect information about conditions in institutions
for people with mental health problems in all Member States (and
not just new Member States) on the premise that there could be
a need for action across the whole of Europe. He was unsure whether
Member States would be ready to accept such an approach. He was
equally unsure about whether it made sense to set minimum standards
on human rights in mental health care. His preference was to encourage
the emergence of harmonised but not legally binding standards
291. Officials from the Department of Health
indicated to us their broad support for the principles set out
in the Green Paper, which were of course very similar to those
in the WHO Helsinki Declaration, and not antagonistic to the standards
set out in the 1999 National Service Framework for Mental Health
in England. The feeling was that Member States might feel that
they know their local situation best, but that they would and
should be willing to learn from good practice examples from elsewhere.
Mr Fowles, one of the DH officials, commented that it was
difficult to come up with a one-size-fits-all solution (QQ 75,
292. Mr John Bowis MEP told us that he could
see some arguments for favouring an approach based on minimum
standards in some areas, and certainly, as he said, in the areas
of employment law and human rights. He suggested that there were
plenty of examples of good practice across Europe, and the challenge
was to find them and share them. Overall, Mr Bowis favoured
describing, rather than prescribing, good practice in order to
put pressure to raise standards on Member States via their citizens,
their media and their professionals who have come to learn what
was possible and what had been achieved in other Member States
293. Mind and Rethink gave some support for minimum
standards. Dr Marcus Roberts of Mind suggested that the EU
could play a role in ensuring that certain minimum standards were
upheld, against the background of Europe's long-term commitment
to human rights. He also argued that the Commission could ensure
that mental health policy was based on evidence and that it could
be a bastion and informer of evidence-based practice. He illustrated
the point by questioning the principles underlying the proposals
in the Mental Health Bill
294. Ms Camilla Parker (a legal and policy consultant
working in the field of mental health disability and human rights)
saw the attractions of minimum standards, but warned of the danger
that countries that had already achieved higher standards might
feel that they did not need to try quite so hard to progress (QQ 173-174).
In Table 2, reproduced following chapter 5, Ms Parker set out
some of the human rights principles that she suggested might be
adopted as guiding principles to provide an alternative approach
to setting minimum standards.
295. Dr Matt Muijen (Regional Adviser for
the European Region of the WHO) also expressed reservations about
minimum standards. He was unsure how these could be phrased in
such a way as to have meaning, and how they could be monitored
or enforced. His preference would be for a system based on both
minimum standards and guiding principles (QQ 200-201). Dr Muijen
discussed the National Service Framework for mental health services
in England, one of the strengths of which was that it was based
on principles reinforced by standards, but not minimum standards.
He recommended that well-meaning principles needed to be followed
by quite hard-hitting policies and legislation supported by funding.
Neither the EU nor the WHO has a mandate to set binding principles
or standards, so that any initiative would at best be advisory.
He was worried that principles could refer to attractive ideas
about human rights and other aspects of care, but must not be
seen as a substitute for the real thing. A second worry was that
principles could have different interpretations in different countries,
so that they should perhaps be translated into quite specific
statements of what was required. He did not oppose principles,
but on their own he felt they could be worthy but meaningless
296. The Minister, Ms Rosie Winterton MP,
did not feel that setting minimum standards would be particularly
helpful. She supported the general approach to health service
matters within the EU, which was to try to keep responsibility
with individual Member States, not least because of the substantial
differences between them. She argued that mental health provision
in the UK was already at quite a high standard, and she was not
sure that European legislation would necessarily alter the standard
of provision already available in the UK (QQ 247-248).
297. We find it helpful to recall that the mental
health spectrum is wide, and there is a need to make some distinctions.
For people with severe, enduring and highly distressing symptoms,
institutional care remains the mainstay of provision in some countries.
Some arguments were made to us that to set minimum standards might
be a helpful way to convey the strength of feeling about the inappropriateness
of such provision, particularly during negotiations with candidate
Member States. However, the diversity of circumstances and provision
across countries to which we have just referred, especially with
regard to the identification and treatment of less severe mental
health problems, was seen by many witnesses as probably ruling
out the use of minimum standards.
Sharing good practice
298. The processes through which changes might
be achieved in Europe's mental health systems were discussed by
witnesses at various points during the inquiry. Framework directives,
minimum standards, principles and other mechanisms were discussed.
There was universal agreement that the sharing of experiences,
both good and bad, would provide very valuable material to inform
efforts to improve the identification and treatment of mental
299. This approach was advocated by the Commission
itself in the Green Paper.
They recognise that there are significant inequalities between
(and also within) Member States' so that, given the diversity
between Member States, it is not possible to draw simple conclusions
or to propose uniform solutions. They take the view, however,
that there is scope for exchange and cooperation between Member
States and for opportunities for them to learn from each other.
300. We recognise the diversity of circumstances
and provision across Member States, especially with regard to
the identification and treatment of less severe mental health
problems and we do not, therefore, support the imposition of minimum
standards for mental health provision across the European Union.
301. We do, however, support the development
of a set of principles to guide mental health policy and practice
in Member States. These principles could cover the locus of care
(and particularly the use of institutional services), compulsory
treatment, access to evidence-based treatments, protection of
human rights, efforts to combat negative attitudes, stigma and
discrimination, and structures to empower individuals.
302. We recommend that the European Commission
and the World Health Organization draw up, in consultation with
national governments, a set of such principles. We also recommend
that the Commission and the WHO introduce mechanisms designed
to facilitate the effective operation of these principles.
61 A Bill to "Amend the Mental Health Act 1983
and the Mental Capacity Act 2005 in relation to mentally disordered
persons; and for connected purposes". Back
op. cit. p. 6 Back
op. cit. p. 7 Back