Select Committee on European Union Fourteenth Report

CHAPTER 11: Conclusions and recommendations

Chapter 1—Setting the scene

THE WHO HELSINKI DECLARATION AND ACTION PLAN

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

THE CONDUCT OF OUR INQUIRY

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

Chapter 2—Defining mental well-being and mental health problems

THE EXTENT OF MENTAL HEALTH PROBLEMS

339.  We welcome the recognition by the Commission of the considerable extent of mental health problems; and we recommend that action is taken to ensure that people with diagnosable and treatable problems get access to appropriate, evidence-based care.

LEARNING OR INTELLECTUAL DISABILITY

340.  We consider that it is wrong to group together learning disability and mental health problems for the purposes of the programme of action for mental health envisaged in the Green Paper. The two conditions are clearly separate and, indeed, a person with a learning disability, just as any other person, may or may not suffer from a mental health problem. We recommend, however, that the Commission give serious consideration to launching an action programme to address concerns about people with learning disabilities in Europe, how they are supported and the lives they are able to lead.

Chapter 3—The social and economic impact of mental health problems

SUMMARY OF IMPACTS

341.  We urge a wider public recognition of the considerable body of evidence which indicates the substantial social and economic impact of mental health problems. Our view is that the heavy responsibilities carried by the families and other carers of people with mental health problems are too often overlooked, and that better recognition and support of carers is essential. We recommend that the Commission encourages EU Member States to take steps to address these issues, coordinating action as necessary across many different parts of government and society.

Chapter 4—The added value of an EU mental health strategy

WHAT AN EU STRATEGY WOULD SET OUT TO ACHIEVE

342.  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.

343.  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

344.  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.

345.  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.

Chapter 5—Human rights issues

DEINSTITUTIONALISATION

346.  We support the Commission's view set out in the Green Paper that there is a need to move "away from the provision of mental health services through large psychiatric institutions … towards community-based services", but warn against the dangers of inadequately planned and insufficiently resourced community-based alternatives.

347.  We also take the view that there is a need to recognise better that smaller care settings can be highly institutional in the way they treat individuals with mental health problems. Member States and accession countries should move away from institutionally organised services that deny residents their basic human rights and subject them to poor and often appalling conditions of care.

COMPULSORY TREATMENT

348.  Again, we support the view set out in the Green Paper that the compulsory placement of individuals in institutions should be proportionate, appropriate, and for the purposes of treatment rather than mere incarceration. Compulsory treatment should only be applied as a last resort, where other alternatives have failed.

COMMUNITY CARE

349.  Good community care requires coordinated responses from a range of public and other bodies, the challenges of which should never be under-estimated.

350.  We recognise that the consensus among organisations in the UK, representing both service providers and service users, is that front-line services for the treatment of mental health problems should primarily be based in the community, but that hospitals still need to play an important role as specialist providers. Our view is that Member States should pursue a balanced care approach, using specialist hospital services within a system of care and treatment that is primarily community-based, and that promotes integration, inclusion and choice for the individual and appropriate protection for the community.

Chapter 6—Social exclusion, stigma and discrimination

SOCIAL EXCLUSION—NEED FOR ACTION

351.  We conclude that social exclusion is itself a risk factor for poor health, including mental health problems. We think therefore that action to address the mental health needs of the population should recognise the social causes and contexts of mental distress. We strongly support the Commission's proposals to address this social exclusion.

352.  We recognise that the Government has arguably done more than most Member States to recognise the problem of social exclusion of people with mental health problems, and has taken a number of initiatives to address the problem. Nevertheless, there is still a long way to go, and we recommend that the Commission should support concerted efforts by Member States and others to counter the social exclusion of people with mental health problems, who experience disadvantage in many areas, including housing, employment, access to services, income and participation.

353.  We accept that a particularly difficult challenge is the number of people with mental health problems who are in prison, where their mental health needs may not get recognised or appropriately treated. We recommend that the Commission should encourage Member States urgently to examine the services available to recognise and to treat those with mental health problems in prisons.

ACTION TO TACKLE NEGATIVE ATTITUDES AND DISCRIMINATION

354.  We are persuaded that to improve public understanding of mental health problems would help to counter the negative attitudes that are often expressed. To achieve this, we recommend that efforts should be continued and reinforced to raise public awareness as to the extent, causes, characteristics and impact of mental health problems (sometimes called improvements to "mental health literacy").

355.  While we recognise that different approaches might work best in different countries, we believe that Member States should be encouraged to make a commitment to tackling stigma and discrimination and to promoting the social integration of people with mental health problems. Member States should also be encouraged to work towards a code of good practice and to share examples of successful initiatives.

356.  Our view is that mental health problems should be recognised as coming within the scope of anti-discrimination legislation relating to disability and that, to the extent that such legislation exists already, it should be enforced and its impact should be monitored. Member States that do not have such legislation should be encouraged to introduce it.

ACTION TO ADDRESS EMPLOYMENT PROBLEMS

357.  We recognise that a key area of exclusion and stigma is employment, and that disadvantage in employment has major economic and social consequences. We recommend that the Commission should encourage Member States to work with employers to help them to recognise the economic benefits of mental health promotion/prevention, and to agree a code of practice.

358.  We understand why small businesses might find it economically difficult to put in place the flexible working arrangements that can help people with mental health problems. We urge Member States to seek practical means of helping small businesses to comply both with the legislation and with any voluntary codes of practice.

359.  We recommend also that the European Commission should consider introducing a "reporting obligation" for Member States to monitor how employers are performing in relation to the employment of people with mental health problems.

Chapter 7—Promotion and prevention

MENTAL HEALTH PROMOTION AND PREVENTION

360.  We believe that a "public health" approach for addressing the promotion and prevention of mental health issues is to be encouraged, recognising the multiple influences on the mental health of populations, from outside as well as from within the mental health system as conventionally defined.

361.  We recommend that the Commission encourage national governments to investigate ways to provide early identification and early intervention services. At the European level, we support the Commission's proposal for a platform approach that would help to bring together different Commission Directorates and encourage parallel efforts in Member States.

EXAMPLES OF GOOD PRACTICE

362.  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

363.  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.

Chapter 8—Mental health issues for population subgroups

CHILDREN AND ADOLESCENTS

364.  We recognise that to address the mental health needs of children and adolescents requires specialist attention, separate from the action needed in the case of adults. We note also that, for this action to be effective, especially good collaborative working by education, health, social services and other agencies is essential. We recommend, therefore, that the Commission encourage Member States to put in place, for children and adolescents with emotional and behavioural problems, proven preventive and treatment strategies with effective structures and incentives.

OLDER PEOPLE

365.  We recognise that there is a growing number of older people in the EU, and that to address their mental health needs requires especially good collaborative working by health, social services and other agencies. We recommend, therefore, that the Commission encourage national governments to pay more attention to the identification, prevention and treatment of mental health problems experienced by older people, including those who may already be using social or other health care services. Among other things, this should include encouraging staff training so as to improve the recognition of mental health problems experienced by older people

ETHNICITY

366.  We anticipate that, as migration patterns change, so will the ethnic diversity of Europe's populations. Our view is that more attention needs to be paid to the mental health needs of people from minority ethnic groups, both established populations and migrants, and including refugees and asylum seekers.

367.  We draw attention also to the pressing need to develop culturally appropriate mental health services.

WOMEN

368.  We recommend that differences in the prevalence and impact of mental health problems between men and women should be recognised in the European Commission's mental health strategy, and in the design of mental health systems in Member States.

Chapter 9—Setting minimum standards or promoting principles

SHARING GOOD PRACTICE

369.  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.

370.  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.

371.  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.

Chapter 10—Information needs

STATISTICS ON MENTAL HEALTH SYSTEMS

372.  We recognise the inherent difficulties of obtaining consistently defined, reliable and meaningful indicators for some key dimensions of a mental health system, such as the outcomes of treatment and care for individuals and families. Nevertheless, if the ultimate performance of a mental health system is to be assessed and monitored, such indicators will be needed. We welcome the Commission's quest to develop better statistical indicators of how national mental health systems are funded, how they function and how they perform.

373.  We recommend that the Commission encourage Member States to invest in better statistical reporting on mental health problems and the systems of services set up to respond to them. These indicators should relate not only to health care, but also range over relevant aspects of social care, housing, education, criminal justice, social security and other fields.

INFORMATION ON POLICY AND PRACTICE

374.  We recognise that some highly relevant aspects of mental health systems cannot easily be described with statistical indicators. Nevertheless, we recommend that the Commission should seek to collect comparable information on aspects of policy, practice and experience to underpin national and European strategies to improve the mental health of the population.

RESEARCH

375.  We draw attention to the need for more and better research to establish which circumstances, factors and actions lead to improved performance in mental health systems. This includes research on patterns of care, the utilisation of compulsory powers, quality of care, social inclusion and participation, discrimination, service user choice and empowerment, protection of human rights and effective forms of mental health promotion and prevention.

SHARING GOOD PRACTICE

376.  We see considerable advantage in the sharing of information and experience across Europe about the operation and performance of mental health systems across countries. This action could highlight evidence-based processes and practices that have demonstrated success in preventing the emergence of mental health problems, and in promoting better opportunity and quality of life for people with those problems.

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